Joan Tryzelaar | Tufts University (original) (raw)

Papers by Joan Tryzelaar

Early coronary artery bypass graft (CABG) failure is a troubling complication that may result in ... more Early coronary artery bypass graft (CABG) failure is a troubling complication that may result in a wide range of problems, including refractory angina, myocardial infarction, low cardiac output, arrhythmia, and fatal heart failure. Early graft failures are related to poor quality and size of the distal native vascular bed, coagulation abnormalities, or technical problems involving the graft conduits and anastomoses. Unfortunately, graft failure is difficult to detect during surgery by visual assessment, palpation, or conventional monitoring. We evaluated the accuracy and utility of a transit-time, ultrasonic flow measurement system for measurement of CABGs. There were no differences between transit-time measurements and volumetric-time collected samples in an in vitro circuit over a range of flows from 10 to 100 ml/min (Bland and Altman Plot, 1.96 SD). Two hundred and ninety-eight CABGs were examined in 125 patients. Graft flow rate was proportional to the target vessel diameter. Ni...

The Annals of otology, rhinology, and laryngology

The unusual complex of physiological problems associated with rupture of the tracheobronchial tre... more The unusual complex of physiological problems associated with rupture of the tracheobronchial tree complicating blunt chest trauma is discussed. The mechanics of injury leading to rupture are abrupt compression of the chest with consequent fixation of the cervical trachea where it enters the mediastinum, separation of the lungs, and fracture of the bronchus over the vertebral bodies. Treatment by aspiration thoracentesis, tracheotomy, and thoracotomy with primary repair as well as expectant therapy are discussed. Two cases, one treated expectantly and one treated by thoracotomy, both with complete recovery, are presented.

JAMA: The Journal of …, 1996

To determine whether an organized intervention including data feedback, training in continuous qu... more To determine whether an organized intervention including data feedback, training in continuous quality improvement techniques, and site visits to other medical centers could improve the hospital mortality rates associated with coronary artery bypass graft (CABG) surgery. Regional intervention study. Patient demographic and historical data, body surface area, cardiac catheterization results, priority of surgery, comorbidity, and status at hospital discharge were collected on CABG patients in Northern New England between July 1, 1987, and July 31, 1993. This study included all 23 cardiothoracic surgeons practicing in Maine, New Hampshire, and Vermont during the study period. Data were collected on 15,095 consecutive patients undergoing isolated CABG procedures in Maine, New Hampshire and Vermont during the study period. A three-component intervention aimed at reducing CABG mortality was fielded in 1990 and 1991. The interventions included feedback of outcome data, training in continuous quality improvement techniques, and site visits to other medical centers. A comparison of the observed and expected hospital mortality rates during the postintervention period. During the postintervention period, we observed the outcomes for 6488 consecutive cases of CABG surgery. There were 74 fewer deaths than would have been expected. This 24% reduction in the hospital mortality rate was statistically significant (P = .001). This reduction in mortality rate was relatively consistent across patient subgroups and was temporally associated with the interventions. We conclude that a multi-institutional, regional model for the continuous improvement of surgical care is feasible and effective. This model may have applications in other settings.

Perfusion, 2001

JAMA: The Journal of …, 1991

Objective.\p=m-\Aprospective regional study was conducted to determine if the observed difference... more Objective.\p=m-\Aprospective regional study was conducted to determine if the observed differences in in-hospital mortality rates associated with coronary artery bypass grafting (CABG) are solely the result of differences in patient case mix. Design.\p=m-\Regionalprospective cohort ...

JAMA: The Journal of …, 1991

A shift in surgical procedures towards minimally invasive techniques has greatly complicated surg... more A shift in surgical procedures towards minimally invasive techniques has greatly complicated surgical education with a major potential impact on emergency patient care.

Journal of The American College of Cardiology, 2001

We sought to assess survival among patients with diabetes and multivessel coronary artery disease... more We sought to assess survival among patients with diabetes and multivessel coronary artery disease (MVD) after percutaneous coronary intervention (PCI) and after coronary artery bypass grafting surgery (CABG). BACKGROUND The Bypass Angioplasty Revascularization Investigation (BARI) demonstrated that diabetics with MVD survive longer after initial CABG than after initial PCI. Other randomized trials or observational databases have not conclusively reproduced this result.

Annals of Thoracic Surgery, 2001

Concern about the possible adverse effects of the cardiopulmonary bypass (CPB) pump and advances ... more Concern about the possible adverse effects of the cardiopulmonary bypass (CPB) pump and advances in retractors and operative techniques to access all coronary segments have resulted in increased interest in off-pump coronary artery bypass (OPCAB) procedures. Four of the Northern New England Cardiovascular Disease Study Group centers initiated OPCAB programs in 1998. We compared the preoperative risk profiles and in-hospital outcomes of patients done off-pump with those done by conventional coronary artery bypass (CCAB) with CPB. Between 1998 and 2000, 1,741 OPCAB and 6,126 CCAB procedures were performed at these four medical centers. Minimally invasive direct coronary artery bypass grafting procedures were excluded. Data were available for patient and disease risk factors, extent of coronary disease and adverse in-hospital outcomes. The OPCAB and CCAB groups were somewhat different in their preoperative patient and disease characteristics. The OPCAB patients were more likely to be female and to have peripheral vascular disease. The CCAB patients were more likely to have an ejection fraction less than 0.40 and be urgent or emergent at operation. However, overall predicted risk of in-hospital mortality, based on preoperative factors, was similar in the OPCAB and CCAB groups; the mean predicted risk was 2.6% (p = 0.567). Crude rates of mortality (2.54% OPCAB versus 2.57%, CCAB), intraoperative or postoperative stroke (1.33% versus 1.82%), mediastinitis (1.10% versus 1.37%), and return to the operating room for bleeding (3.46% versus 2.93%) did not differ significantly. The OPCAB patients did have a statistically significant reduction in the need for intraoperative or postoperative intraaortic balloon pump support (2.31% versus 3.41%; p = 0.023) and in the incidence of postoperative atrial fibrillation (21.21% versus 26.31%; p < 0.001). Adjustment for preoperative risk factors and extent of coronary disease did not substantially change the crude results. Median postoperative length of stay was significantly shorter (5 days versus 6 days, p < 0.001) for OPCAB patients than for CCAB patients. This multicenter study showed that patients having OPCAB are not exposed to a greater risk of short-term adverse outcomes. These data also provided evidence that patients having OPCAB have significantly lower need for intraoperative or postoperative intraaortic balloon pump, lower rates of postoperative atrial fibrillation, and a shorter length of stay.

Prolonged reflux esophagitis leads to replacement of the esophageal squamous epithelium by column... more Prolonged reflux esophagitis leads to replacement of the esophageal squamous epithelium by columnar epithelium in some patients. This columnar epithelium resembles gastric or intestinal mucosa and has been implicated as a precursor of esophageal adenocarcinoma. A review of 14 cases of primary esophageal adenocarcinoma disclosed that 12 (86%) arose in a columnar epithelium-lined (Barrett's) esophagus. Ten of the 12 patients had a hiatal hernia or symptoms of reflux esophagitis or both. In ten patients the columnar epithelium adjacent to and remote from the invasive adenocarcinoma showed a spectrum of abnormalities ranging from mild dysplasia to carcinoma in situ. These data support the concept that esophageal adenocarcinoma is one complication of a columnar epithelium-lined esophagus, and suggest that the invasive carcinoma evolves through a sequence of epithelial dysplasia and carcinoma in situ in most cases. Esophageal biopsy and cytology can detect this dysplasia, and should provide an effective means for monitoring patients with Barrett's esophagus for impending malignancy.

American Journal of Surgery, 1982

The Annals of otology, rhinology, and laryngology

JAMA: The Journal of …, 1996

Perfusion, 2001

JAMA: The Journal of …, 1991

Journal of The American College of Cardiology, 2001

Annals of Thoracic Surgery, 2001

American Journal of Surgery, 1982