Juan A Crestanello

The Ohio State University, Columbus, Ohio, United States

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Publications (70)295.44 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Cardiac myxomas account for 50% of all benign primary cardiac tumors. Rarely, these tumors occur in the right atrium (RA; 10% to 20%), with a stalk frequently attached to the interatrial septum. Right atrial myxomas can lead to RA enlargement, arrhythmias, functional tricuspid stenosis, right heart failure, and catastophic pulmonary embolization resulting in sudden cardiac death. Anesthetic management of patients with RA myxomas can be complicated by the mass effect of the myxoma, preload limitations, and the potential for cardiovascular collapse. Multimodal cardiac imaging inclusive of echocardiography, computed tomography, and magnetic resonance imaging helps with the diagnosis, preoperative optimization, and formulation of anesthetic and surgical plans. We present a case report highlighting the importance of multimodal imaging, adequate preoperative patient optimization, and the anesthetic considerations in the successful management of a patient with a giant 8.3 × 4.7 cm RA myxoma. © The Author(s) 2015.
    Seminars in Cardiothoracic and Vascular Anesthesia 04/2015; DOI:10.1177/1089253215584194
  • Journal of Thoracic and Cardiovascular Surgery 12/2014; 149(4). DOI:10.1016/j.jtcvs.2014.12.054 · 3.99 Impact Factor
  • Source
    12/2014; 1. DOI:10.3389/fcvm.2014.00014
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    ABSTRACT: Endothelial cell dysfunction is the hallmark of every cardiovascular disease/condition, including atherosclerosis and ischemia/reperfusion injury. Fluid shear stress acting on the vascular endothelium is known to regulate cell homeostasis. Altered hemodynamics is thought to play a causative role in endothelial dysfunction. The dysfunction is associated with/preceded by mitochondrial oxidative stress. Studies by our group and others have shown that the form and/or function of the mitochondrial network are affected when endothelial cells are exposed to shear stress in the absence or presence of additional physico-chemical stimuli. The present review will summarize the current knowledge on the interconnections among intracellular Ca2+–nitric oxide–mitochondrial reactive oxygen species, mitochondrial fusion/fission, autophagy/mitophagy, and cell apoptosis vs. survival. More specifically, it will list the evidence on potential regulation of the above intracellular species and processes by the fluid shear stress acting on the endothelium under either physiological flow conditions or during reperfusion (following a period of ischemia). Understanding how the local hemodynamics affects mitochondrial physiology and the cell redox state may lead to development of novel therapeutic strategies for prevention or treatment of the endothelial dysfunction and, hence, of cardiovascular disease.
    Cellular and Molecular Bioengineering 12/2014; 7(4). DOI:10.1007/s12195-014-0357-4 · 1.23 Impact Factor
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    ABSTRACT: We studied the association between components of chronic lung disease (CLD) assessment and operative outcomes in patients undergoing aortic valve replacement (AVR) for aortic stenosis. From 2011 to 2012, 9,177 patients included in The Society of Thoracic Surgeons (STS) Cardiac Surgery Database underwent AVR for aortic stenosis with complete pulmonary function tests (PFT) and CLD data (31% of AVRs). We evaluated markers of CLD and their association with operative mortality, pulmonary morbidity, and length of hospital stay using multivariable logistic regression analysis. In a selected population of AVR patients with PFTs, CLD was prevalent in 50% (mild, 25.6%; moderate, 13.2%; severe, 11.2%). Predicted forced expiratory volume in 1 second (FEV1) was obtained in all patients and diffusion capacity of the lung for carbon monoxide (DLCO), arterial oxygen tension (PaO2), and arterial carbon dioxide tension (PaCO2) in 31%. The STS predicted risk of operative mortality, mortality, pulmonary morbidity, and hospital stay increased with severity of CLD and with low FEV1, DLCO, and PaO2. Moderate and severe CLD were independently associated with operative mortality (odds ratio [OR] 2.88, 95% confidence interval [CI]: 2.0-4.5), pulmonary morbidity (OR 2.33, 95% CI: 1.93-2.8), and prolonged hospital stay (OR 2.73, 95% CI: 2.17-3.45). Low FEV1 was independently associated with pulmonary morbidity and prolonged hospital stay. Low PaO2 and DLCO were independently associated with a combined mortality and pulmonary morbidity endpoint. CLD is associated with adverse operative outcomes in selected patients with aortic stenosis undergoing AVR. FEV1, DLCO, and PaO2 may add important information to current risk adjustment models beyond the broad CLD classification. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
    The Annals of Thoracic Surgery 12/2014; 98(6):2068-77. DOI:10.1016/j.athoracsur.2014.06.087 · 3.63 Impact Factor
  • Circulation 11/2014; 2014(130):A15954. · 14.95 Impact Factor
  • Lee P, Kilic A, Whitson B, Crestanello J, Higgins R
    Circulation 11/2014; 2014(130):A15269. · 14.95 Impact Factor
  • ASA, New Orleans; 10/2014
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    ABSTRACT: Background: Cardiac ischemia-reperfusion (IR) leads to myocardial dysfunction by increasing production of reactive oxygen species (ROS). Mitochondrial H(+) leak decreases ROS formation; it has been postulated that increasing H(+) leak may be a mechanism of decreasing ROS production after IR. Ischemic preconditioning (IPC) decreases ROS formation after IR, but the mechanism is unknown. We hypothesize that pharmacologically increasing mitochondrial H(+) leak would decrease ROS production after IR. We further hypothesize that IPC would be associated with an increase in the rate of H+ leak. Methods: Isolated male Sprague-Dawley rat hearts were subjected to either Control or IPC. Mitochondria were isolated at end equilibration, end ischemia, and end reperfusion. Mitochondrial membrane potential (mΔΨ) was measured using a tetraphenylphosphonium electrode. Mitochondrial uncoupling was achieved by adding increasing concentrations of FCCP. Mitochondrial ROS production was measured by fluorometry using Amplex-Red. Pyridine dinucleotide levels were measured using HPLC. Results: Prior to IR, increasing H+ leak decreased mitochondrial ROS production. After IR, ROS production was not affected by increasing H+ leak. H(+) leak increased at end ischemia in Control mitochondria. IPC mitochondria showed no change in the rate of H(+) leak throughout IR. NADPH levels decreased after IR in both IPC and Control mitochondria while NADH increased. Conclusion: Pharmacologically increasing H(+) leak is not a method of decreasing ROS production after IR. Replenishing the NADPH pool may be a means of scavenging the excess ROS thereby attenuating oxidative damage after IR.
    AJP Heart and Circulatory Physiology 08/2014; 307(7). DOI:10.1152/ajpheart.00189.2014 · 4.01 Impact Factor
  • The Journal of Heart and Lung Transplantation 04/2014; 33(4):S266-S267. DOI:10.1016/j.healun.2014.01.704 · 5.61 Impact Factor
  • D. Lee, W. Ye, K. Park, J. Ma, J. Ralston, J. Zweier, J. Crestanello
    Journal of Surgical Research 02/2014; 186(2):494. DOI:10.1016/j.jss.2013.11.029 · 2.12 Impact Factor
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    ABSTRACT: Right-sided aortic arch with retroesophageal left subclavian artery and left ligamentum arteriosum is the second most common vascular ring. Aneurysms of the arch in its retroesophageal portion are rare. The surgical repair of a retroesophageal arch aneurysm poses a significant challenge because no single approach provides access to the whole arch and all of its branches. We describe a 39-year-old patient with aneurysmal dilatation of the retroesophageal arch who presented with airway obstruction. The arch aneurysm was repaired with a staged approach. A right-sided carotid-subclavian artery bypass was performed, followed by distal ascending aorta and aortic arch replacement under hypothermic circulatory arrest through a left thoracotomy.
    The Annals of thoracic surgery 01/2014; 97(1):317-9. DOI:10.1016/j.athoracsur.2013.04.117 · 3.65 Impact Factor
  • 43rd Annual Critical Care Congress; 12/2013
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    ABSTRACT: We report a patient with congenital absence of the left pericardium with development of progressive annuloaortic ectasia and aortic insufficiency during a 12-year period. The patient was treated with a Bentall procedure. Pathologic examination of the aorta revealed cystic medial necrosis. The surgical management and a possible association between congenital absence of pericardium and Marfan syndrome are discussed.
    The Annals of thoracic surgery 12/2013; 96(6):2243-5. DOI:10.1016/j.athoracsur.2013.04.106 · 3.65 Impact Factor
  • Journal of cardiothoracic and vascular anesthesia 06/2013; 27(3):e26-e28. DOI:10.1053/j.jvca.2012.11.018 · 1.48 Impact Factor
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    ABSTRACT: BACKGROUND: The association between postoperative hyponatremia (Na < 135 mEq/L) and outcomes after cardiac surgery has not been established. We studied the prevalence of postoperative hyponatremia and its effects on outcomes after cardiac surgery. STUDY DESIGN: We studied 4,850 patients who underwent cardiac surgery from 2002 to 2008. We used multivariable logistic and Cox regression analysis to study the association between postoperative hyponatremia and mortality, length of hospital stay (LOS), and complications. RESULTS: Postoperative hyponatremia was present in 59%. Hyponatremic patients were older (mean ± SD, 62 ± 13 vs 61 ± 14 years, p = 0.001), had lower left ventricle ejection fraction (mean ± SD, 44% ± 16% vs 48% ± 13%, p < 0.001), higher mean pulmonary artery pressures (mean ± SD, 30 ± 11 vs 27 ± 9 mmHg, p < 0.001), lower glomerular filtration rate (mean ± SD, 72 ± 29 vs 74 ± 27 mg/min/1.73 m(2), p = 0.01), higher EuroSCORE (median, 15% vs 6%, p < 0.001), higher New York Heart Association class IV (31% vs 26%, p = 0.002), prevalence of COPD (23% vs 14%, p < 0.001), and peripheral vascular disease (16% vs 12%, p < 0.001). Hyponatremia increased overall (24% vs 18.2%, p < 0.001) and late mortality (18.6% vs 13.9%, p < 0.001) and length of stay (LOS; 11 vs 7 days, p < 0.001). Mortality increased with the severity of the hyponatremia. After adjusting for baseline and procedure variables, postoperative hyponatremia was associated with increase in mortality (hazard ratio 1.22, 95% CI 1.06-1.4, p = 0.004), LOS (multiplier 1.34, 95% CI 1.22-1.49, p < 0.001), infectious (odds ratio [OR] 2.32, 95% CI 1.48-3.62, p < 0.001), pulmonary (OR 1.82, 95% CI 1.49-2.21, p < 0.001), and renal failure complications (OR 2.46, 95% CI 1.58-3.81, p < 0.001) and need for dialysis (OR 3.66, 95% CI 1.72-7.79, p = 0.001). CONCLUSIONS: Hyponatremia is common after cardiac surgery and is an independent predictor of increased mortality, length of hospital stay, and postoperative complications.
    Journal of the American College of Surgeons 04/2013; 216(6). DOI:10.1016/j.jamcollsurg.2013.02.010 · 4.45 Impact Factor
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    ABSTRACT: OBJECTIVE: Left ventricular dysfunction and preoperative hyponatremia are associated with adverse outcomes after cardiac surgery. However, the interactions between them are unknown. Thus, we evaluated the interaction of low left ventricular ejection fraction (<40%) and preoperative hyponatremia (Na <135 mEq/L) with morbidity and mortality after cardiac surgery. METHODS: The interaction of hyponatremia and ejection fraction with hospital complications, length of stay, and mortality was analyzed using logistic and Cox regression analysis in 2247 patients who underwent cardiac surgery between 2005 and 2008 at The Ohio State University Wexner Medical Center. RESULTS: Of the patients, 68.5% had normal ejection fraction. Hyponatremia was present in 18% of patients with normal ejection fraction and 35% of patients with low ejection fraction. Hyponatremic patients had higher rates of New York Heart Association class III and IV, more comorbidities, and higher Society of Thoracic Surgeons score and European System for Cardiac Operative Risk Evaluation irrespectively of their ejection fraction. The correlation between preoperative sodium and ejection fraction was weak (r(2) = 0.04). Hyponatremia increased the rate of postoperative complications and hospital stay, and decreased 1- and 3-year survivals in patients with both normal and low ejection fraction. Hyponatremia was independently associated with longer hospital stay for normal ejection fraction (multiplier, 1.18; confidence interval, 1.09-1.27; P < .001) and low ejection fraction (multiplier, 1.10; confidence interval, 1.0-1.21; P = .05), increased need for dialysis for normal ejection fraction (odds ratio, 2.16; confidence interval, 1.08-4.32; P = .03), and increased risk of mortality for normal ejection fraction (hazard ratio, 1.56; confidence interval, 1.20-2.05; P = .001), but not for patients with low ejection fraction (hazard ratio, 1.21; confidence interval, 0.89-1.65; P = .21). CONCLUSIONS: Hyponatremia is more common in patients with low ejection fraction. Although preoperative hyponatremia is independently associated with adverse outcomes in patients with normal ejection fraction, an association with adverse outcomes in patients with low ejection fraction was not demonstrated.
    The Journal of thoracic and cardiovascular surgery 04/2013; 145(6). DOI:10.1016/j.jtcvs.2012.12.093 · 3.99 Impact Factor
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    ABSTRACT: OBJECTIVES We reviewed our single-centre experience with emergent operative repair of Stanford Type A aortic dissections, with particular attention to outcomes in the elderly.METHODS Consecutive adult patients undergoing emergent operative repair of acute Type A aortic dissections between February 2004 and December 2011 at a single institution were identified. Patients were stratified into elderly (≥70 years) and control cohorts (<70 years). Kaplan-Meier analysis was used to evaluate survival.RESULTSA total of 117 patients undergoing emergent repair of Type A aortic dissection were identified during the study period, including 31 (26.5%) elderly and 86 (73.5%) control patients. The mean age in the elderly cohort was 78.0 ± 4.7 years, with 41.9% (13 of 31) being 80 years or older. The elderly and control groups were well matched with regard to preoperative comorbidities (each P > 0.05) and the presence of malperfusion at presentation (elderly: 19.4 vs controls: 27.9%, P = 0.35). The most common site of tear involved the proximal ascending aorta (elderly: 83.9 vs controls: 84.9%), with fewer cases affecting the aortic arch (12.9 vs 14.0%; P = 0.75). Operative data, including cardiopulmonary bypass and aortic cross-clamp time, concomitant aortic valve procedures and arch replacement were also similar between cohorts. Fewer elderly patients underwent hypothermic circulatory arrest (67.7 vs 90.7%, P = 0.002). Overall survival to discharge was 87.2% (n = 102), with no difference in the elderly (83.9%; n = 26) vs controls (88.4%; n = 76; P = 0.52). The 30-day (elderly: 82.8 vs controls: 86.2%), 90-day (elderly: 79.0 vs controls: 84.8%) and 1-year (elderly: 75.4 vs controls: 84.8%) survivals were also comparable.CONCLUSIONS Excellent operative outcomes can be achieved in elderly patients undergoing emergent repair of Type A aortic dissections. Advanced patient age should therefore not serve as an absolute contraindication to operative repair in this high-risk cohort.
    Interactive Cardiovascular and Thoracic Surgery 04/2013; 17(1). DOI:10.1093/icvts/ivt155 · 1.11 Impact Factor
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    ABSTRACT: Purpose Obesity in heart failure may be associated with improved outcomes. We sought to assess the impact of pre-transplant body mass index (BMI) on post-heart transplant survival. Methods and Materials We analyzed The United Network for Organ Sharing data registry for adult orthotopic heart transplant recipients from 1987 to 2012. Recipients with right or bi-ventricular support or total artificial hearts were excluded. Patients were stratified based on body mass index (BMI in kg/m²) at time of transplant based on conventional thresholds for transplantation into BMI 15-18.4 (UNDERWEIGHT), 18.5- 29.9 (NORMAL), 30-34.9 (OVERWEIGHT) and 35-40 (OBESE). Kaplan-Meier estimates were used to evaluate survival. Results 52,903 heart transplant recipients were identified and 45,261 were included. Of the overall cohort, 78.4% - NORMAL, 15.2% - OVERWEIGHT, 3.3% - UNDERWEIGHT and 3.1% - OBESE. Pre-transplant BMI affected survival significantly at 30 days, 1, 5, and 10 years post-transplant (p<0.0001). [figure 1] In the proportional hazards model, OVERWEIGHT and UNDERWEIGHT patients had decreased survival. Factors negatively affecting survival include female donor to male recipients, African-American recipients, pulmonary hypertension, LVAD, increasing age and ischemic times. Conclusions In a population based analysis, BMI influences survival in the short and long term. Underweight recipients may not have physiologic reserves for optimum results. View Within Article
    The Journal of Heart and Lung Transplantation 04/2013; 32(4):S39. DOI:10.1016/j.healun.2013.01.901 · 5.61 Impact Factor

Publication Stats

155 Citations
295.44 Total Impact Points

Institutions

  • 2006–2015
    • The Ohio State University
      • • Department of Surgery
      • • Division of Cardiothoracic Surgery
      • • Division of Cardiovascular Medicine
      Columbus, Ohio, United States
  • 2013
    • Arkansas Heart Hospital
      Little Rock, Arkansas, United States