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Staying abreast of new technology and diagnostic as well as treatment options for our patients is a high priority at Baylor Jack and Jane Hamilton Heart and Vascular Hospital. Our goal is to develop and be involved in advanced research of the highest integrity that will allow our patients to participate in and benefit from innovative heart and vascular discoveries. Research is the backbone and first step in defining patient care. The 75-plus trials we are currently running are investigating many areas, including an anticoagulant that does not require INR bloodwork, genes and angina, atrial fibrillation, and stenting of the left main coronary artery.

The physicians on our medical staff and clinical staff members have been published in numerous journals and books, on topics ranging from atrial septal defects to congestive heart failure to angiography. Recent articles are included below:

2017 Cardiac Surgery Publications

Report From the American Society of Transplantation Conference on Donor Heart Selection in Adult Cardiac Transplantation in the United States.

Kobashigawa J, Khush K, Colvin M, Acker M, Van Bakel A, Eisen H, Naka Y, Patel J, Baran DA, Daun T, Luu M, Olymbios M, Rogers J, Jeevanandam V, Esmailian F, Pagani FD, Lima B, Stehlik J.
Cardiac transplantation remains the only definitive treatment for end-stage heart failure. Transplantation rates are limited by a shortage of donor hearts. This shortage is magnified because many hearts are discarded because of strict selection criteria and concern for regulatory reprimand for less-than-optimal posttransplant outcomes. There is no standardized approach to donor selection despite proposals to liberalize acceptance criteria. A donor heart selection conference was organized to facilitate discussion and generate ideas for future research. Participants debated misconceptions and established agreement on donor and recipient risk factors for donor selection and identified the components necessary for a future donor risk score. With agreement on the most important donor and recipient risk factors, it is anticipated that a consistent approach to donor selection will improve rates of heart transplantation.

Comparison of Outcomes of Operative Therapy for Acute Type A Aortic Dissections Provided at High-Volume Versus Low-Volume Medical Centers in North Texas.

Arsalan M, Squiers JJ, Herbert MA, MacHannaford JC, Chamogeorgakis T, Prince SL, Hamman BL, Knoff C, Moore DO, Harrington KB, DiMaio JM, Mack MJ, Brinkman WT.
Immediate surgery is standard therapy for acute type A aortic dissections (TAAD). Because of its low incidence, many smaller cardiac surgery programs do not routinely perform this procedure because it may negatively affect outcomes. Many high-risk, low-volume (LV) surgical procedures are now preferentially performed in reference centers. We compared the outcomes of surgery for TAAD in high-volume (HV) and LV centers in a single metropolitan area to determine the optimal setting for treatment.

Right atrial thrombus and its causes, complications, and therapy.

Benjamin MM, Afzal A, Chamogeorgakis T, Feghali GA.
A 70-year-old man who presented with dyspnea and intermittent chest pain was found to have a large free-floating right atrial thrombus on two-dimensional echocardiogram. Atriotomy was performed, and an 18-cm-long thrombus was removed from the right atrium and inferior vena cava. Postoperatively, the patient developed cardiogenic shock treated by intravenous vasopressor agents and extracorporeal membrane oxygenation. The postoperative course was also complicated by bilateral pulmonary emboli requiring pulmonary artery thrombectomy. Right atrial thrombus is an underdiagnosed condition with a high mortality rate. The best management modality has not yet been established.

Ambulatory extracorporeal membrane oxygenation with subclavian venoarterial cannulation to increase mobility and recovery in a patient awaiting cardiac transplantation.

Jacob S, MacHannaford JC, Chamogeorgakis T, Gonzalez-Stawinski GV, Felius J, Rafael AE, Malyala RS, Lima B.
Venoarterial extracorporeal membrane oxygenation (ECMO) can provide temporary cardiopulmonary support for patients in hemodynamic extremis or refractory heart failure until more durable therapies-such as cardiac transplantation or a left ventricular assist device-can be safely implemented. Conventional ECMO cannulation strategies commonly employ the femoral artery and vein, constraining the patients to the supine position for the duration of ECMO support. We have recently adopted a modified cannulation approach to promote patient mobility, rehabilitation, and faster recovery and to mitigate complications associated with femoral arterial cannulation, such as limb ischemia and compartment syndrome. This technique involves cannulation of the subclavian artery and vein. The current case report details our recent experience with this approach in a critically ill patient awaiting cardiac transplantation.

One-Year Outcomes of Transcatheter Aortic Valve Replacement in Patients With End-Stage Renal Disease.

O'Hair DP, Bajwa TK, Chetcuti SJ, Deeb GM, Stoler RC, Hebeler RF, Maini B, Mumtaz M, Kleiman NS, Reardon MJ, Li S, Adams DH, Watson DR, Yakubov SJ, Popma JJ, Petrossian G.
Early mortality in patients with ESRD is comparable to previously published data on extreme-risk patients without ESRD, but our data suggest a higher mortality rate at 1 year for ESRD patients, likely due to comorbid conditions. Stroke and major vascular injury are infrequent, and improved valve hemodynamics are maintained at 1 year.

The incidence, risk factors, and outcomes associated with late right-sided heart failure in patients supported with an axial-flow left ventricular assist device.

Rich JD, Gosev I, Patel CB, Joseph S, Katz JN, Eckman PM, Lee S, Sundareswaran K, Kilic A, Bethea B, Soleimani B, Lima B, Uriel N, Kiernan M, Evolving Mechanical Support Research Group (EMERG) Investigators.
Early right-sided heart failure (RHF) after left ventricular assist device (LVAD) implantation is associated with increased mortality, but little is known about patients who develop late RHF (LRHF). We evaluated the incidence, risk factors, and clinical impact of LRHF in patients supported by axial-flow LVADs.

Lipoma of the Mitral Valve.

Roberts WC, Grayburn PA, Hamman BL.
Described herein is a 67-year-old morbidly obese man who had a lipoma excised from his posterior mitral leaflet after it was found by echocardiogram. Findings in 6 other previously reported cases are reviewed.

A call for standardized end point definitions regarding outcomes of extracorporeal membrane oxygenation.

Squiers JJ, Lima B, DiMaio JM.

Application of the International Society for Heart and Lung Transplantation (ISHLT) criteria for primary graft dysfunction after cardiac transplantation: outcomes from a high-volume centre†.

Squiers JJ, Saracino G, Chamogeorgakis T, MacHannaford JC, Rafael AE, Gonzalez-Stawinski GV, Hall SA, Lima B.
A standardized definition for primary graft dysfunction (PGD) after cardiac transplantation was recently proposed by the International Society of Heart and Lung Transplantation (ISHLT). We sought to characterize the outcomes associated with and identify risk factors for PGD following cardiac transplantation using these criteria at a high volume centre.

2016 Cardiology Publications

Comparative Efficacy of Transradial Versus Transfemoral Approach for Coronary Angiography and Percutaneous Coronary Intervention

Jeffrey M. Schussler, MD, Anupama Vasudevan, BDS, MPH, PhD, Liana J. von Bose, BA, Jane I. Won, BS, Peter A. McCullough, MD, MPH
Transradial artery (TRA) approach is associated with fewer vascular complications and reduced mortality in patients at high risk compared with transfemoral approach (TFA). The objective of our study was to compare the characteristics and outcomes of patients who had coronary angiography by TRA and TFA over the course of hospital implementation of this approach.

Goal-Directed Heart Failure Care in Patients With Chronic Kidney Disease and End-Stage Renal Disease

Peter A McCullough, MD, MPH, Aasim Afzal, MD, MBA, Parag Kale, MD
Investigators have long recognized that renal function and cardiac performance are integrally linked through hemodynamic, neural, humoral, cell signaling, proteomic, and metabolomic pathways (1). Among risk factors for the development of heart failure (HF), chronic kidney disease (CKD) is the most powerful because it contributes to the three fundamental mechanisms of left ventricular failure: 1) pressure overload; 2) volume overload; and 3) cardiomyopathy (2). When CKD progresses to end-stage renal disease (ESRD), these three mechanisms driving HF become more difficult to control because patients undergoing dialysis have on average higher blood pressures; poor volume control only partially addressed by thrice weekly hemodialysis in most cases; and a well-described form of cardiomyopathy characterized by severe left ventricular hypertrophy, marked cardiac fibrosis, reduced capillary density, and calcific deposits on the mitral and aortic valves (3). None of the goal-directed medical or device therapies proven to reduce HF-related hospitalization and cardiovascular death in the general population with HF have been demonstrated to be effective in patients with ESRD (4).

Advanced technology in interventional cardiology: A roadmap for the future of precision coronary interventions

Chad M. Dugas, MD and Jeffrey M. Schussler, MD, FACC, FSCAI
Improving the treatment of patients with cardiovascular disease as well as the safety of the physicians who care for them can potentially be impacted by several new technologies including high-resolution CT coronary imaging with fractional flow reserve, virtual reality, vascular robotic systems, and three-dimensional printing.

A review of spontaneous closure of ventricular septal defect

Jun Zhang, MD, MS, Jong Mi Ko, BA, Joseph M. Guileyardo, MD, and
William C. Roberts, MD
Spontaneous closure of VSD can be determined through a variety of methods — echocardiography, Doppler color flow imaging, angiography, auscultation, and cardiac catheterization — and can be proven by pathological evidence at necropsy.

Commonalities of Cardiac Rupture (Left Ventricular Free Wall or Ventricular Septum or Papillary Muscle) During Acute Myocardial Infarction Secondary to Atherosclerotic Coronary Artery Disease

William C. Roberts, MD, Kendall H. Burks, Jong Mi Ko, BA, Giovanni Filardo, PhD and Joseph M. Guileyardo, MD
Mortality rates during acute myocardial infarction (AMI) continue to drop, however, cardiac rupture (left ventricular free wall or ventricular septum or papillary muscular or combination) continues to remain relatively common. The aim of this study was to identify commonalities among patients with AMI complicated by cardiac rupture.

High-intensity cardiac rehabilitation training of a commercial pilot who, after percutaneous coronary intervention, wanted to continue participating in a rigorous strength and conditioning program.

Sanjay Shrestha, BS, Jenny Adams, PhD, Anne Lawrence, RN, and Jeffrey M. Schussler, MD
A 64-year-old commercial pilot underwent elective percutaneous coronary intervention, and was then sent to cardiac rehabilitation. He wanted to maintain his rigorous strength and conditioning training and eventually return to being a pilot. A specialized training regimen was designed specifically for his needs, and he was able to resume his life as a commercial pilot.

An alternative approach to prescribing sternal precautions after median sternotomy, "Keep Your Move in the Tube"

Jenny Adams, PhD, Ana Lotshaw, PT, PhD, CCS, Emelia Exum, PT, DPT, Mark Campbell, BSc, MSc, Cathy B. Spranger, DrPH, Jim Beveridge, RN, PCCN, Shawn Baker, PT, DPT, MS, Stephanie McCray, RN, Tim Bilbrey, MBA, Tiffany Shock, BS, Anne Lawrence, RN, Baron L. Hamman, MD, Jeffrey M. Schussler, MD
Traditional sternal precautions, given to sternotomy patients as part of their discharge education, are intended to help prevent sternal wound complications. Our research team performed a series of studies that measured the forces exerted during various common activities and their relationship to the sternum. The alternative approach that we introduce applies standard kinesiological principles and teaches patients how to perform load-bearing movements in a way that avoids excessive stress to the sternum.

Surviving Malignant Hypertrophic Cardiomyopathy with all Major Complications in a Single Patient.

Barry J. Maron, MD, Henry L. Weiner, MD, Martin S. Maron, MD, William C. Roberts, MD
This publication discusses a 38 year old patient that presented with all three major disease complications of hypertrophic cardiomyopathy and survived as a result of effective treatment modalities available for individuals with the disease.

Contemporary Review – Best practice guide for cryoballoon ablation in atrial fibrillation: The compilation experience of more than 3000 procedures.

Wilber Su, MD, FHRS, Robert Kowal, MD, FHRS, Marcin Kowalski, MD, FHRS, Andreas Metzner, MD, FHRS, J. Thomas Svinarich, MD, FHRS, Kevin Wheelan, MD, FHRS, Paul Wang, MD, FHRS
This study reviews existing best practices regarding cryoballoon ablation in atrial fibrillation to create a user's consensus guide, providing insight into safer and more effective outcomes for CB2 ablations.

The Two Extremes of Cardiac Sarcoidosis and the Effect of Prednisone Therapy

Danielle Armstrong, DO, Gonzalo V. Gonzalez-Stawinski, MD, Jong M. Ko, BA, Shelley A. Hall, MD, and William C. Roberts, MD
This article contains the clinical and morphologic findings in two patients who underwent heart transplantation because of severe heart failure as a result of cardiac sarcoidosis.

Surgical Coronary Revascularization Using an Off-Pump, No-Touch Technique

Jeffrey M. Schussler, Theodore T. Theologes, Baron L. Hamman

Screening, Diagnosis, and Management of CAD in Asymptomatic Diabetic Patients*

Peter A. McCullough, Poorya Fazel, James W. Choi.

The Incidence and Outcome of Endothermal Heat-induced Thrombosis after Endovenous Laser Ablation

Katherine Kane, Tammy Fisher, Monica Bennett, William Shutze Jr, Taylor Hicks, Brad Grimsley, Dennis Gable, Greg Pearl, Bert Smith, and William Shutze Sr, Dallas, Texas

Safety and Efficacy of Ixmyelocel-T An Expanded, Autologous Multi-Cellular Therapy, in Dilated Cardiomyopathy

Timothy D. Henry, Jay H. Traverse, Baron L. Hammon, Cara A. East, Brian Bruckner, Ann E. Remmers, David Recker, David A. Bull, Amit N. Patel.

Advanced technology in interventional cardiology: A roadmap for the future of precision coronary interventions

Chad M. Dugas, MD and Jeffrey M. Schussler, MD, FACC, FSCAI
Improving the treatment of patients with cardiovascular disease as well as the safety of the physicians who care for them can potentially be impacted by several new technologies including high-resolution CT coronary imaging with fractional flow reserve, virtual reality, vascular robotic systems, and three-dimensional printing.

2016 Cardiac Surgery Publications

HeartMate II Left Ventricular Assist Device Pump Exchange: A Single-Institution Experience.

Shaikh AF, Joseph SM, Lima B, Hall SA, Malyala R, Rafael AE, Gonzalez-Stawinski GV, Chamogeorgakis T.
Left ventricular assist devices (LVADs) have revolutionized the treatment of patients with end-stage heart failure. These devices are replaced when pump complications arise if heart transplant is not possible. We present our experience with HeartMate II (HMII (Thoratec, Plesanton, California, United States)) LVAD pump exchange.

Using extracorporeal membrane oxygenation support preoperatively and postoperatively as a successful bridge to recovery in a patient with a large infarct-induced ventricular septal defect.

Jacob S, Patel MJ, Lima B, Felius J, Malyala RS, Chamogeorgakis T, MacHannaford JC, Gonzalez-Stawinski GV, Rafael AE.
Rupture of the ventricular septum during acute myocardial infarction usually occurs within the first week. The event is usually followed by low cardiac output, heart failure, and multiorgan failure. Despite the many advances in the nonoperative treatment of heart failure and cardiogenic shock, including the intra-aortic balloon pump and a multitude of new inotropic agents and vasodilators, these do not supplant the need for operative intervention in these critically ill patients. This article describes the successful use of extracorporeal membrane oxygenation support as a bridge to recovery postoperatively in a patient with a large infarct-produced ventricular septal defect.

Comparison of Characteristics of Patients Undergoing Heart Transplantation at the Same Hospital in Two Different Time Periods (1997-2012 and 2013-2015).

Roberts WC, Won VS, Vasudevan A, Kapoor P, Ko JM, Meyer DM, Hall SA, Gonzalez-Stawinski GV.
Heart transplantation (HT) increases at some centers each year and decreases at others. We examined characteristics of patients having HT at the same hospital in 2 different time periods (1997-2012 and 2013-2015) by 2 different surgical groups. We compared certain clinical and morphological finding in 291 patients having HT 1997 to 2012 to finding in 228 other patients having HT from 2013 to 2015.

Impact of donor age on cardiac transplantation outcomes and on cardiac function.

Chamogeorgakis T, Joseph S, Hall S, Gonzalez-Stawinski GV, Saracino G, Rafael A, MacHannaford J, Toumpoulis I, Mendez J, Lima B.
Although the impact of older donors on heart transplant outcomes has been previously published, the survival results are conflicting. We herein analyse the impact of older donors on transplant survival and myocardial function.

Avulsion of Aortic Leaflet During Transcatheter Aortic Valve Replacement

Patankar GR, Grayburn PA, Hebeler RF Jr, Henry AC, , Stoler RC.

How to Do It: The Commando Operation for Reconstruction of the Fibrous Skeleton with Double Valve Replacement.

Lima B, Chamogeorgakis T, MacHannaford JC, Rafael A, Gonzalez-Stawinski GV, Lima Md B.
Infiltrative processes that extend into the intervalvular fibrosa, such as infection or calcification, often mandate a complex reconstructive procedure known as the Commando operation. First described less than 20 years ago, this operation is not widely implemented, with experience limited to a few select centers. This report provides a detailed summary of our approach to this intricate procedure.

Donor Hearts: Time to Look at Them in a Different Light?

Gonzalo V. Gonzalez-Stawinski, MD
In this edition of The Journal of Cardiac Heart Failure, 2 papers aim to inform readers of donor groups that could be considered at the time of cardiac donation in the hope of expanding the stagnant donor pool.

An alternative approach to prescribing sternal precautions after median sternotomy, "Keep Your Move in the Tube".

Adams J, Lotshaw A, Exum E, Campbell M, Spranger CB, Beveridge J, Baker S, McCray S, Bilbrey T, Shock T, Lawrence A, Hamman BL, Schussler JM.
An alternative approach to prescribing sternal precautions after median sternotomy, “Keep Your Move in the Tube”. Proceedings Baylor University Medical Center 2016; 29(1): 97-100.

Development of a Squamous Cell Carcinoma of the Hand and Wrist After Cardiac Transplantation.

Carey S, Jackson WT, Hitchcock MA, Lima B, Hall S. Development of a Squamous Cell Carcinoma of the Hand and Wrist After Cardiac Transplantation. American Journal of Cardiology 2016; 117(11): 1853-1854.

Excess short-term mortality in women after isolated coronary artery bypass graft surgery.

Filardo G, Hamman BL, Pollock BD, da Graca B, Sass DM, Phan TK, Edgerton J, Prince SL, Ring WS. Excess short-term mortality in women after isolated coronary artery bypass graft surgery. Open Heart 2016; 3(1): e000386.

Effectiveness and Safety of the Impella 5.0 as a Bridge to Cardiac Transplantation or Durable Left Ventricular Assist Device.

Lima B, Kale P, Gonzalez-Stawinski GV, Kuiper JJ, Carey S, Hall S. Effectiveness and Safety of the Impella 5.0 as a Bridge to Cardiac Transplantation or Durable Left Ventricular Assist Device. The American Journal of Cardiology 2016; 117(10): 1622-1628.

Invited Commentary: Using “broken hearts” for cardiac transplantation: a risky venture or fruitful endeavor?

Lima B. Invited Commentary: Using “broken hearts” for cardiac transplantation: a risky venture or fruitful endeavor? Proceedings Baylor University Medical Center 2016; 29(1): 74. 75.

The Carpentier-Edwards Perimount Magna mitral valve bioprosthesis: intermediate-term efficacy and durability.

Loor G, Schuster A, Cruz V, Rafael A, Stewart WJ, Diaz J, McCurry K. The Carpentier-Edwards Perimount Magna mitral valve bioprosthesis: intermediate-term efficacy and durability. Journal of Cardiothoracic Surgery 2016; Epub.

Frequency of Massive Cardiac Adiposity (Floating Heart) in the Native Hearts of Patients Having Heart Transplantation at a Single Texas Hospital (2013 to 2015) and Comparison of Various Clinical and Morphologic Variables in the Patients With Massive Versus Nonmassive Cardiac Adiposity.

Roberts WC, Won VS, Vasudevan A, Ko JM, Hall SA, Gonzalez-Stawinski GV. Frequency of Massive Cardiac Adiposity (Floating Heart) in the Native Hearts of Patients Having Heart Transplantation at a Single Texas Hospital (2013 to 2015) and Comparison of Various Clinical and Morphologic Variables in the Patients With Massive Versus Nonmassive Cardiac Adiposity. The American Journal of Cardiology 2016; 117(8): 1375-1380.

Massive Diffuse Calcification of the Ascending Aorta and Minimal Focal Calcification of the Abdominal Aorta in Heterozygous Familial Hypercholesterolemia.

Roberts WC, Won VS, Weissenborn MR, Khalid A, Lima B. Massive Diffuse Calcification of the Ascending Aorta and Minimal Focal Calcification of the Abdominal Aorta in Heterozygous Familial Hypercholesterolemia. American Journal of Cardiology 2016; 117(8): 1381-1385.

Atrophy of the Heart After Insertion of a Left Ventricular Assist Device and Closure of the Aortic Valve.

Roberts WC, Hall SA, Ko JM, McCullough PA, Lima B. Atrophy of the Heart After Insertion of a Left Ventricular Assist Device and Closure of the Aortic Valve. American Journal of Cardiology 2016; 117(5): 878-879.

Mitral Valve Replacement After Failed Mitral Ring Insertion With or Without Leaflet/Chordal Repair for Pure Mitral Regurgitation.

Roberts WC, Moore M, Ko JM, Hamman BL. Mitral Valve Replacement After Failed Mitral Ring Insertion With or Without Leaflet/Chordal Repair for Pure Mitral Regurgitation. The American Journal of Cardiology 2016; 117(11): 1790-1807.

Contemporary extracorporeal membrane oxygenation therapy in adults: Fundamental principles and systematic review of the evidence.

Squiers JJ, Lima B, DiMaio JM. Contemporary extracorporeal membrane oxygenation therapy in adults: Fundamental principles and systematic review of the evidence. The Journal of Thoracic and Cardiovascular Surgery 2016; Epub.

Surgery for acquired cardiac disease: An evolving paradigm with a promising future.

Whitson BA, Lima B. Surgery for acquired cardiac disease: An evolving paradigm with a promising future. The Journal of Thoracic and Cardiovascular Surgery 2016; 151(6): 1466-1469.


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