John Entwistle | Thomas Jefferson University (original) (raw)

Papers by John Entwistle

Research paper thumbnail of Management and Outcomes of Coronary Artery Aneurysms: A Patient-Level Systematic Review

Journal of the American College of Cardiology

Research paper thumbnail of Family Presence for Acutely Dying Patients

The Annals of Thoracic Surgery, 2021

Research paper thumbnail of Left Subclavian Transcatheter Aortic Valve Replacement Under Combined Interscalene and Pectoralis Nerve Blocks: A Case Series

A&A Practice, 2018

The treatment for aortic stenosis is evolving rapidly with new developments in transcatheter aort... more The treatment for aortic stenosis is evolving rapidly with new developments in transcatheter aortic valve replacement (TAVR). While the procedure was initially performed under general anesthesia with invasive monitoring and transesophageal echocardiography, recent trends have shifted toward less invasive strategies. Transfemoral TAVRs are frequently performed under sedation; however, TAVRs using alternative access sites, such as the subclavian artery, are typically performed under general anesthesia. This case series describes 3 patients who underwent subclavian TAVR under combined pectoralis and interscalene blocks. All patients tolerated the procedure without complication, requiring no airway manipulation and minimal postoperative analgesia.

Research paper thumbnail of Impact of Concomitant Mitral Valve Surgery With LVAD Placement: Systematic Review and Meta-Analysis

Artificial organs, Jan 12, 2018

The aim of this systematic review and meta-analysis was to evaluate the outcomes of concomitant m... more The aim of this systematic review and meta-analysis was to evaluate the outcomes of concomitant mitral valve surgery for significant preexisting mitral regurgitation (MR) in patients undergoing continuous-flow left ventricular assist device (CF-LVAD) implantation. Electronic search was performed to identify all studies in the English literature examining concurrent mitral valve surgery in patients with CF-LVAD implantation. Identified articles were systematically assessed for inclusion and exclusion criteria. Of 2319 studies identified, 8 studies were included. Among 445 patients with moderate to severe or severe MR, 113 (25.4%) patients received concurrent mitral valvular intervention during CF-LVAD implantation. There were no significant differences in cardiopulmonary bypass time (MR Surgery 154 min vs. no MR Surgery 119 min, P = 0.64) or hospital length of stay (MR Surgery 21 days vs. no MR Surgery 18 days, P = 0.93). On follow-up, there were no significant differences in freedom...

Research paper thumbnail of Should Family Presence Be Allowed During Cardiopulmonary Resuscitation?

The Annals of Thoracic Surgery, 2016

Research paper thumbnail of Arteriovenous Malformations, Gastrointestinal Bleeding, Left Ventricular Assist Devices and Use of Thalidomide

Journal of the American College of Cardiology, 2016

Gastrointestinal bleeding (GIB) in the patients on continuous flow left ventricular assist device... more Gastrointestinal bleeding (GIB) in the patients on continuous flow left ventricular assist device (cfLVAD) has been reported with an incidence varying from 5 %-30 %.Pathogenesis of GIB in patients with cFLVAD is multifactorial. Commonly implicated factors include development of acquired von

Research paper thumbnail of Massive Thrombosis of the Transplanted Heart in the Early Postoperative Period

Journal of cardiac surgery, 2016

We experienced a case with the left atrium almost completely filled with a thrombus after orthoto... more We experienced a case with the left atrium almost completely filled with a thrombus after orthotopic heart transplantation while the patient was supported on extracorporeal membrane oxygenation for primary graft failure. The patient had recurrent thrombosis even after successful surgical thrombectomy and appropriate anticoagulation. The cardiac thrombosis resolved only after starting plasmapheresis. doi: 10.1111/jocs.12674 (J Card Surg 2016;31:117-119).

Research paper thumbnail of Functional Improvement Following Inpatient Rehabilitation in Patients with Left Ventricular Assist Devices

Journal of Cardiac Failure, 2014

Research paper thumbnail of failure with irreversible pulmonary hypertension Use of the AbioCor replacement heart as destination therapy for end-stage heart

Research paper thumbnail of Superior Vena Cava Rupture during Balloon Angioplasty and Stent Placement to Relieve Superior Vena Cava Syndrome: A Case Report

The Heart Surgery Forum, 2007

Percutaneous stenting of the superior vena cava (SVC) has been an accepted therapy for SVC syndro... more Percutaneous stenting of the superior vena cava (SVC) has been an accepted therapy for SVC syndrome for more than a decade. Complications are uncommon and usually of minor consequence. Three previous reports have described ruptures of the SVC during venoplasty with death on one occasion. We report a fourth case of SVC rupture during angioplasty and stenting that required immediate pericardiocentesis followed by open surgical repair via sternotomy for direct control and repair. An algorithm for rapid recognition and prompt intervention is described.

Research paper thumbnail of Stroke from A Large Left Atrial Myxoma

The Open Cardiovascular Medicine Journal, 2008

A 36-year-old male involved in a car accident was found to have an embolic stroke due to a left a... more A 36-year-old male involved in a car accident was found to have an embolic stroke due to a left atrial myxoma. Open heart surgery was delayed 4 weeks to decrease the risk of neurologic complications from the anticoagulation required for cardiopulmonary bypass. After resection of the myxoma, intraoperative transesophageal echocardiography found severe mitral regurgitation, which was repaired.

Research paper thumbnail of Comparison of eight prosthetic aortic valves in a cadaver model

The Journal of Thoracic and Cardiovascular Surgery, 2007

Proper valve selection is critical to ensure appropriate valve replacement for patients, because ... more Proper valve selection is critical to ensure appropriate valve replacement for patients, because implantation of a small valve might place the patient at risk for persistent gradients. Labeled valve size is not the same as millimeter measure of prosthetic valve diameters or the annulus into which it will fit. Studies that use the labeled valve size in lieu of actual measured diameter in millimeters to compare different valves might be misleading. Using human cadaver hearts, we sized the aortic annulus with 8 commonly used prosthetic aortic valve sizers and compared the valves using geometric orifice area. This novel method for comparing prosthetic valves allowed us to evaluate multiple valves for implantation into the same annulus. Methods: Aortic annular area was determined in 66 cadavers. Valve sizers for 8 prosthetic valves were used to determine the appropriate valve for aortic valve replacement. Regression analyses were performed to compare the relationship between geometric orifice area and aortic annular area. Results: Tissue valves had a larger orifice area for any annular size but were not different at small sizes. Supra-annular valves were larger than intra-annular valves for the small annulus, but this relationship was not uniform with increasing annular size. Conclusions: Labeled valve size relates unpredictably to annular size and orifice area. No advantage in geometric orifice area could be demonstrated between these tissue valves at small annular sizes. Valves with the steepest slope on regression analysis might provide a larger benefit with upsizing with respect to geometric orifice area.

Research paper thumbnail of Use of the AbioCor replacement heart as destination therapy for end-stage heart failure with irreversible pulmonary hypertension

The Journal of Thoracic and Cardiovascular Surgery, 2004

Research paper thumbnail of Two-Vessel Off-Pump Coronary Artery Bypass Grafting by Left Thoracotomy in a Complex Redo Case

CHEST Journal, 2013

Part of the Surgery Commons This Article is brought to you for free and open access by the Jeffer... more Part of the Surgery Commons This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in Department of Surgery Faculty Papers by an authorized administrator of the Jefferson Digital Commons.

Research paper thumbnail of Initial Experience with the AbioCor Implantable Replacement Heart at the University of Louisville

ASAIO Journal, 2000

Potential benefits of heart transplantation are limited by the severe donor organ shortage. The A... more Potential benefits of heart transplantation are limited by the severe donor organ shortage. The AbioCor implantable replacement heart has been developed as a potential alternative to heart transplantation. We report our initial experience with the AbioCor in a bovine model. A right thoracotomy was performed for access to the heart and great vessels. After initiation of cardiopulmonary bypass, excision of the native ventricles was followed by orthotopic placement of the IRH and complete implantation of the transcutaneous energy transfer coil, controller, and battery pack. Invasive monitoring of IVC, SVC, carotid artery, pulmonary artery, and left atrial (LA) pressures was performed in all animals. Twelve calves have undergone implantation of the AbioCor. There were three early deaths, one from bleeding, one from respiratory failure, and one from neurodysfunction from low flow during CPB. Nine animals have had a normal recovery and survived a mean of 24.5 days (range, 4-48 days). All the animals have demonstrated excellent hemodynamics with the maintenance of normal pressures in the LA, SVC, IVC, pulmonary artery, and aorta. Adjustment of the right-sided internal hydraulic fluid shunt has allowed for control of rightleft balance and, thereby, manipulation of left and right side filling pressures. Late morbidity has consisted of neck wound infection and sepsis, pneumonia, and bleeding. Successful orthotopic implantation of all components of the AbioCor has been achieved in a bovine model. This device has demonstrated restoration of normal hemodynamics and excellent function of the atrial hydraulic shunt to achieve right-left balance.

Research paper thumbnail of Clinical Use of the Abiomed BVS 5000 as a Pulsatile Extracorporeal Membrane Oxygenation Unit

ASAIO Journal, 2004

The traditional extracorporeal membrane oxygenation circuit uses a centrifugal pump. These pumps ... more The traditional extracorporeal membrane oxygenation circuit uses a centrifugal pump. These pumps require close monitoring and are subject to complications. In addition, they do not take advantage of the potential benefits of pulsatile flow. These extracorporeal membrane oxygenation circuits use a single pump with an inline oxygenator. If cardiac failure persists after respiratory recovery has occurred, removal of the oxygenator requires an additional procedure to convert the patient to biventricular support. This report describes a circuit in which an oxygenator is connected to a pulsatile ventricular assist device. Single and dual circuit configurations are illustrated. Recommendations for pulmonary care during support are also described.

Research paper thumbnail of The AbioCor implantable replacement heart

The Annals of Thoracic Surgery, 2003

Research paper thumbnail of The Impact of Vascular Complications on Survival of Patients on Venoarterial Extracorporeal Membrane Oxygenation

The Annals of thoracic surgery, Jan 9, 2016

There are various factors that can influence the survival of patients receiving venoarterial extr... more There are various factors that can influence the survival of patients receiving venoarterial extracorporeal membrane oxygenation (VA ECMO). Vascular complications from femoral cannulation are common and are potentially serious. We analyzed the impact of vascular complications on survival of patients receiving VA ECMO. Patients supported with VA ECMO by means of femoral cannulation from October 2010 to November 2014 were enrolled in this study. Data were gathered retrospectively by reviewing our institutional database. Patients were separated into two groups depending on the presence of major vascular complications, defined as patients who required surgical intervention. We evaluated predisposing factors for vascular complications and compared survival of patients in each group. There were 84 patients enrolled in the study. The rates of overall ECMO survival and survival to hospital discharge were 60% and 43%, respectively. Major vascular complications requiring surgical intervention...

Research paper thumbnail of Management and Outcomes of Coronary Artery Aneurysms: A Patient-Level Systematic Review

Journal of the American College of Cardiology

Research paper thumbnail of Family Presence for Acutely Dying Patients

The Annals of Thoracic Surgery, 2021

Research paper thumbnail of Left Subclavian Transcatheter Aortic Valve Replacement Under Combined Interscalene and Pectoralis Nerve Blocks: A Case Series

A&A Practice, 2018

The treatment for aortic stenosis is evolving rapidly with new developments in transcatheter aort... more The treatment for aortic stenosis is evolving rapidly with new developments in transcatheter aortic valve replacement (TAVR). While the procedure was initially performed under general anesthesia with invasive monitoring and transesophageal echocardiography, recent trends have shifted toward less invasive strategies. Transfemoral TAVRs are frequently performed under sedation; however, TAVRs using alternative access sites, such as the subclavian artery, are typically performed under general anesthesia. This case series describes 3 patients who underwent subclavian TAVR under combined pectoralis and interscalene blocks. All patients tolerated the procedure without complication, requiring no airway manipulation and minimal postoperative analgesia.

Research paper thumbnail of Impact of Concomitant Mitral Valve Surgery With LVAD Placement: Systematic Review and Meta-Analysis

Artificial organs, Jan 12, 2018

The aim of this systematic review and meta-analysis was to evaluate the outcomes of concomitant m... more The aim of this systematic review and meta-analysis was to evaluate the outcomes of concomitant mitral valve surgery for significant preexisting mitral regurgitation (MR) in patients undergoing continuous-flow left ventricular assist device (CF-LVAD) implantation. Electronic search was performed to identify all studies in the English literature examining concurrent mitral valve surgery in patients with CF-LVAD implantation. Identified articles were systematically assessed for inclusion and exclusion criteria. Of 2319 studies identified, 8 studies were included. Among 445 patients with moderate to severe or severe MR, 113 (25.4%) patients received concurrent mitral valvular intervention during CF-LVAD implantation. There were no significant differences in cardiopulmonary bypass time (MR Surgery 154 min vs. no MR Surgery 119 min, P = 0.64) or hospital length of stay (MR Surgery 21 days vs. no MR Surgery 18 days, P = 0.93). On follow-up, there were no significant differences in freedom...

Research paper thumbnail of Should Family Presence Be Allowed During Cardiopulmonary Resuscitation?

The Annals of Thoracic Surgery, 2016

Research paper thumbnail of Arteriovenous Malformations, Gastrointestinal Bleeding, Left Ventricular Assist Devices and Use of Thalidomide

Journal of the American College of Cardiology, 2016

Gastrointestinal bleeding (GIB) in the patients on continuous flow left ventricular assist device... more Gastrointestinal bleeding (GIB) in the patients on continuous flow left ventricular assist device (cfLVAD) has been reported with an incidence varying from 5 %-30 %.Pathogenesis of GIB in patients with cFLVAD is multifactorial. Commonly implicated factors include development of acquired von

Research paper thumbnail of Massive Thrombosis of the Transplanted Heart in the Early Postoperative Period

Journal of cardiac surgery, 2016

We experienced a case with the left atrium almost completely filled with a thrombus after orthoto... more We experienced a case with the left atrium almost completely filled with a thrombus after orthotopic heart transplantation while the patient was supported on extracorporeal membrane oxygenation for primary graft failure. The patient had recurrent thrombosis even after successful surgical thrombectomy and appropriate anticoagulation. The cardiac thrombosis resolved only after starting plasmapheresis. doi: 10.1111/jocs.12674 (J Card Surg 2016;31:117-119).

Research paper thumbnail of Functional Improvement Following Inpatient Rehabilitation in Patients with Left Ventricular Assist Devices

Journal of Cardiac Failure, 2014

Research paper thumbnail of failure with irreversible pulmonary hypertension Use of the AbioCor replacement heart as destination therapy for end-stage heart

Research paper thumbnail of Superior Vena Cava Rupture during Balloon Angioplasty and Stent Placement to Relieve Superior Vena Cava Syndrome: A Case Report

The Heart Surgery Forum, 2007

Percutaneous stenting of the superior vena cava (SVC) has been an accepted therapy for SVC syndro... more Percutaneous stenting of the superior vena cava (SVC) has been an accepted therapy for SVC syndrome for more than a decade. Complications are uncommon and usually of minor consequence. Three previous reports have described ruptures of the SVC during venoplasty with death on one occasion. We report a fourth case of SVC rupture during angioplasty and stenting that required immediate pericardiocentesis followed by open surgical repair via sternotomy for direct control and repair. An algorithm for rapid recognition and prompt intervention is described.

Research paper thumbnail of Stroke from A Large Left Atrial Myxoma

The Open Cardiovascular Medicine Journal, 2008

A 36-year-old male involved in a car accident was found to have an embolic stroke due to a left a... more A 36-year-old male involved in a car accident was found to have an embolic stroke due to a left atrial myxoma. Open heart surgery was delayed 4 weeks to decrease the risk of neurologic complications from the anticoagulation required for cardiopulmonary bypass. After resection of the myxoma, intraoperative transesophageal echocardiography found severe mitral regurgitation, which was repaired.

Research paper thumbnail of Comparison of eight prosthetic aortic valves in a cadaver model

The Journal of Thoracic and Cardiovascular Surgery, 2007

Proper valve selection is critical to ensure appropriate valve replacement for patients, because ... more Proper valve selection is critical to ensure appropriate valve replacement for patients, because implantation of a small valve might place the patient at risk for persistent gradients. Labeled valve size is not the same as millimeter measure of prosthetic valve diameters or the annulus into which it will fit. Studies that use the labeled valve size in lieu of actual measured diameter in millimeters to compare different valves might be misleading. Using human cadaver hearts, we sized the aortic annulus with 8 commonly used prosthetic aortic valve sizers and compared the valves using geometric orifice area. This novel method for comparing prosthetic valves allowed us to evaluate multiple valves for implantation into the same annulus. Methods: Aortic annular area was determined in 66 cadavers. Valve sizers for 8 prosthetic valves were used to determine the appropriate valve for aortic valve replacement. Regression analyses were performed to compare the relationship between geometric orifice area and aortic annular area. Results: Tissue valves had a larger orifice area for any annular size but were not different at small sizes. Supra-annular valves were larger than intra-annular valves for the small annulus, but this relationship was not uniform with increasing annular size. Conclusions: Labeled valve size relates unpredictably to annular size and orifice area. No advantage in geometric orifice area could be demonstrated between these tissue valves at small annular sizes. Valves with the steepest slope on regression analysis might provide a larger benefit with upsizing with respect to geometric orifice area.

Research paper thumbnail of Use of the AbioCor replacement heart as destination therapy for end-stage heart failure with irreversible pulmonary hypertension

The Journal of Thoracic and Cardiovascular Surgery, 2004

Research paper thumbnail of Two-Vessel Off-Pump Coronary Artery Bypass Grafting by Left Thoracotomy in a Complex Redo Case

CHEST Journal, 2013

Part of the Surgery Commons This Article is brought to you for free and open access by the Jeffer... more Part of the Surgery Commons This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in Department of Surgery Faculty Papers by an authorized administrator of the Jefferson Digital Commons.

Research paper thumbnail of Initial Experience with the AbioCor Implantable Replacement Heart at the University of Louisville

ASAIO Journal, 2000

Potential benefits of heart transplantation are limited by the severe donor organ shortage. The A... more Potential benefits of heart transplantation are limited by the severe donor organ shortage. The AbioCor implantable replacement heart has been developed as a potential alternative to heart transplantation. We report our initial experience with the AbioCor in a bovine model. A right thoracotomy was performed for access to the heart and great vessels. After initiation of cardiopulmonary bypass, excision of the native ventricles was followed by orthotopic placement of the IRH and complete implantation of the transcutaneous energy transfer coil, controller, and battery pack. Invasive monitoring of IVC, SVC, carotid artery, pulmonary artery, and left atrial (LA) pressures was performed in all animals. Twelve calves have undergone implantation of the AbioCor. There were three early deaths, one from bleeding, one from respiratory failure, and one from neurodysfunction from low flow during CPB. Nine animals have had a normal recovery and survived a mean of 24.5 days (range, 4-48 days). All the animals have demonstrated excellent hemodynamics with the maintenance of normal pressures in the LA, SVC, IVC, pulmonary artery, and aorta. Adjustment of the right-sided internal hydraulic fluid shunt has allowed for control of rightleft balance and, thereby, manipulation of left and right side filling pressures. Late morbidity has consisted of neck wound infection and sepsis, pneumonia, and bleeding. Successful orthotopic implantation of all components of the AbioCor has been achieved in a bovine model. This device has demonstrated restoration of normal hemodynamics and excellent function of the atrial hydraulic shunt to achieve right-left balance.

Research paper thumbnail of Clinical Use of the Abiomed BVS 5000 as a Pulsatile Extracorporeal Membrane Oxygenation Unit

ASAIO Journal, 2004

The traditional extracorporeal membrane oxygenation circuit uses a centrifugal pump. These pumps ... more The traditional extracorporeal membrane oxygenation circuit uses a centrifugal pump. These pumps require close monitoring and are subject to complications. In addition, they do not take advantage of the potential benefits of pulsatile flow. These extracorporeal membrane oxygenation circuits use a single pump with an inline oxygenator. If cardiac failure persists after respiratory recovery has occurred, removal of the oxygenator requires an additional procedure to convert the patient to biventricular support. This report describes a circuit in which an oxygenator is connected to a pulsatile ventricular assist device. Single and dual circuit configurations are illustrated. Recommendations for pulmonary care during support are also described.

Research paper thumbnail of The AbioCor implantable replacement heart

The Annals of Thoracic Surgery, 2003

Research paper thumbnail of The Impact of Vascular Complications on Survival of Patients on Venoarterial Extracorporeal Membrane Oxygenation

The Annals of thoracic surgery, Jan 9, 2016

There are various factors that can influence the survival of patients receiving venoarterial extr... more There are various factors that can influence the survival of patients receiving venoarterial extracorporeal membrane oxygenation (VA ECMO). Vascular complications from femoral cannulation are common and are potentially serious. We analyzed the impact of vascular complications on survival of patients receiving VA ECMO. Patients supported with VA ECMO by means of femoral cannulation from October 2010 to November 2014 were enrolled in this study. Data were gathered retrospectively by reviewing our institutional database. Patients were separated into two groups depending on the presence of major vascular complications, defined as patients who required surgical intervention. We evaluated predisposing factors for vascular complications and compared survival of patients in each group. There were 84 patients enrolled in the study. The rates of overall ECMO survival and survival to hospital discharge were 60% and 43%, respectively. Major vascular complications requiring surgical intervention...