Harold L Lazar

Beverly Hospital, Boston MA, Beverly, Massachusetts, United States

Are you Harold L Lazar?

Claim your profile

Publications (154)666.32 Total impact

  • Harold L. Lazar
  • Harold L. Lazar
    Journal of Thoracic and Cardiovascular Surgery 02/2015; 149(6). DOI:10.1016/j.jtcvs.2015.01.072 · 3.99 Impact Factor
  • Harold L. Lazar
    Journal of Thoracic and Cardiovascular Surgery 12/2014; 148(5). DOI:10.1016/j.jtcvs.2014.10.006 · 3.99 Impact Factor
  • Harold L Lazar
    Journal of Thoracic and Cardiovascular Surgery 11/2014; 148(5):1884-6. DOI:10.1016/j.jtcvs.2014.09.055 · 3.99 Impact Factor
  • Harold L Lazar
    Journal of Thoracic and Cardiovascular Surgery 10/2014; 149(2). DOI:10.1016/j.jtcvs.2014.10.061 · 3.99 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective This study was undertaken to determine whether topical vancomycin would further reduce the incidence of sternal infections in the presence of perioperative antibiotics and tight glycemic control. Methods 1075 consecutive patients undergoing cardiac surgery from 12/2007 to 8/2013 receiving topical vancomycin (2.5gm in 2ml Normal Saline) applied as a slurry to the cut edges of the sternum were compared to 2190 patients from 12/2003 to 11/2007 in whom topical vancomycin was not employed. All patients received perioperative antibiotics (Ancef 2gm IV g8h and Vancomycin 1gm IVg12h) upon anesthetic induction and continuing for 48 hours; and IV insulin infusions to maintain serum blood glucose between 120-180mg/dl. Results Patients receiving topical vancomycin had less superficial sternal infections (0% vs 1.6%; p=<.0001), deep sternal infections (0% vs 0.7%; p=0.005), any type of sternal infections (0% vs 2.2%; p<0.0001) and significantly less type of any sternal infection in patients with diabetes mellitus (0% vs 3.3%; p=0.0004). Conclusions Topical vancomycin applied to the sternal edges, in conjunction with perioperative antibiotics and tight glycemic control, helps to eliminate wound infections in cardiac surgical patients.
    Journal of Thoracic and Cardiovascular Surgery 09/2014; DOI:10.1016/j.jtcvs.2014.06.045 · 3.99 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We describe an endovascular technique using in situ stent graft fenestration and pump assist to repair a pseudoaneurysm of the transverse arch following previous ascending aortic and transverse arch replacements.
    Journal of Cardiac Surgery 07/2014; 29(6). DOI:10.1111/jocs.12395 · 0.89 Impact Factor
  • Harold L Lazar
    Circulation 03/2014; 129(10):e389. DOI:10.1161/CIRCULATIONAHA.113.008030 · 14.95 Impact Factor
  • Harold L Lazar
    [Show abstract] [Hide abstract]
    ABSTRACT: The traditional basis for all forms of coronary artery revascularization has been the percent stenosis due to an atherosclerotic plaque or thrombotic occlusion based on coronary angiography. With the introduction of Fractional Flow Reserve (FFR) technology, a new gold standard has been developed to assess the severity of a coronary artery stenosis which takes into account the physiology of that stenosis. FFR is defined as the ratio of maximal blood flow across a stenotic lesion compared to normal maximal flow. It is measured using a coronary pressure guidewire and is compared to the aortic pressure measured simultaneously with the guide catheter during maximum hyperemia. An FFR value of < 0.80 is predictive of a coronary stenosis responsible for ischemia with an accuracy > 90%(1). The FFR technique requires some extra manipulation during the cath and a central line may be necessary if IV adenosine is used to elicit the maximal hyperemic response. Although there is potential for trauma to the coronary vessel, this complication is rarely reported.
    Circulation 08/2013; 128(13). DOI:10.1161/CIRCULATIONAHA.113.005397 · 14.95 Impact Factor
  • Harold L Lazar
    Circulation 07/2013; 128(4):406-13. DOI:10.1161/CIRCULATIONAHA.113.003388 · 14.95 Impact Factor
  • Source
    Harold L Lazar
    [Show abstract] [Hide abstract]
    ABSTRACT: Hyperglycemia, which occurs in the perioperative period during cardiac surgery, has been shown to be associated with increased morbidity and mortality. The management of perioperative hyperglycemia during coronary artery bypass graft surgery and all cardiac surgical procedures has been the focus of intensive study in recent years. This report will paper the pathophysiology responsible for the detrimental effects of perioperative hyperglycemia during cardiac surgery, show how continuous insulin infusions in the perioperative period have improved outcomes, and discuss the results of trials designed to determine what level of a glycemic control is necessary to achieve optimal clinical outcomes.
    11/2012; 2012:292490. DOI:10.5402/2012/292490
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract  Disseminated intravascular coagulation (DIC) is a well-described complication of aortic aneurysm. In cases where surgical repair of the aneurysm is contraindicated, palliative therapy via medical management of the coagulopathy may be warranted. We present a case of aneurysm-associated DIC successfully managed with low molecular weight heparin. (J Card Surg 2012;27:730-735).
    Journal of Cardiac Surgery 11/2012; 27(6):730-5. DOI:10.1111/jocs.12010 · 0.89 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: The Surgical Care Improvement Project (SCIP) has benchmarked 6:00 am blood glucose levels of less than 200 mg/dL on postoperative day (POD) 1 and 2 as quality measures of glycemic control in cardiac surgery. This study was undertaken to (1) determine the incidence of SCIP outliers in patients receiving a continuous insulin infusion (CII) targeted to maintain perioperative serum glucose levels less than 180 mg/dL after cardiac surgery, (2) identify the profile of patients who are SCIP outliers, (3) determine whether SCIP outliers have increased morbidity and mortality, and (4) identify more relevant benchmarks for glycemic control in patients having cardiac surgery. METHODS: Between January 1, 2008, and April 30, 2011, a total of 832 patients underwent cardiac surgery and received CII to maintain serum blood glucose levels of less than 180 mg/dL. Patients were divided into 2 groups: patients compliant with SCIP and SCIP outliers. RESULTS: The incidence of SCIP outliers was 6.6% (55/832). Patients more likely to be SCIP outliers had diabetes mellitus (38, 69% vs 250, 32%; P < .0001), a higher hemoglobin A1c (8.74 ± 2.25 vs 7.59 ± 2.90; P < .0009), and a higher body mass index (31.1 ± 6.5 vs 29.2 ± 5.7; P = .03). However, SCIP outliers had no increase in morbidity, mortality, or hospital length of stay. CONCLUSIONS: Patients undergoing cardiac surgery may still be SCIP outliers despite CII targeted to maintain serum glucose levels below 180 mg/dL; however, SCIP outliers had no increase in morbidity, mortality, or length of stay.
    The Journal of thoracic and cardiovascular surgery 10/2012; DOI:10.1016/j.jtcvs.2012.09.031 · 3.99 Impact Factor
  • Harold L Lazar
    [Show abstract] [Hide abstract]
    ABSTRACT: In summary, poor perioperative glycemic control in patients undergoing CABG is associated with increased morbidity and mortality. Maintaining serum glucose less than or equal to 180 mg/dL in patients with diabetes during CABG reduces morbidity and mortality, lowers the incidence of wound infections, reduces hospital length of stay, and enhances long-term survival. In nondiabetic patients undergoing CABG surgery, maintaining serum glucose less than 180 mg/dL has also resulted in improved perioperative outcomes. More aggressive glycemic control (80-120 mg/dL) provides no added improvement in CABG patients with less than or equal to 3 days of ICU care in the absence of ventilatory support or multiorgan failure. Although the precise value for achieving glycemic control in the perioperative period is the subject of much debate, the benefits of perioperative glycemic control with continuous insulin infusions in patients undergoing CABG is no longer debatable.
    Advances in Surgery 09/2012; 46:219-35. DOI:10.1016/j.yasu.2012.03.007
  • Harold L Lazar
    [Show abstract] [Hide abstract]
    ABSTRACT: This review highlights important advances in techniques, guidelines, outcomes and innovations in valve surgery during 2011.
    Journal of Cardiac Surgery 07/2012; 27(4):493-510. DOI:10.1111/j.1540-8191.2012.01494.x · 0.89 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Maintaining glycemic control (blood glucose <180 mg/dL) has been shown to reduce morbidity and enhance long-term survival in patients with diabetes mellitus following coronary artery bypass graft (CABG) surgery. In this review we present a management strategy to achieve perioperative glycemic control in all patients undergoing CABG surgery, with and without diabetes mellitus, designed to achieve compliance with current Surgical Care Improvement Project (SCIP) and Society of Thoracic Surgeons (STS) guidelines.
    Journal of Cardiac Surgery 05/2012; 27(4):470-7. DOI:10.1111/j.1540-8191.2012.01471.x · 0.89 Impact Factor
  • Harold L Lazar
    [Show abstract] [Hide abstract]
    ABSTRACT: Important studies highlighting the practice of coronary artery bypass surgery for 2011 are reviewed.
    Journal of Cardiac Surgery 05/2012; 27(3):347-59. DOI:10.1111/j.1540-8191.2012.01451.x · 0.89 Impact Factor
  • Journal of cardiothoracic and vascular anesthesia 09/2011; 26(2):327-32. DOI:10.1053/j.jvca.2011.07.015 · 1.48 Impact Factor
  • Harold L Lazar, Tamar Barlam, Howard Cabral
    [Show abstract] [Hide abstract]
    ABSTRACT: Topical vancomycin has been shown to reduce the incidence of sternal wound infections but concerns have been raised that persistent serum levels of vancomycin may contribute to the emergence of drug-resistant infections. This study was undertaken to determine: (1) whether serum levels of vancomycin remain elevated when applied topically to the sternum and (2) whether the use of topical vancomycin can potentiate postoperative drug-resistant infections. Serum vancomycin levels were measured on the evening of surgery and the sixth postoperative day in 36 patients in which topical vancomycin was applied to the cut edges of the sternum during their cardiac surgical procedures. Data are presented as a mean ± standard deviation and statistical significance was tested using paired t-test analyses. There was a significant decrease in serum vancomycin levels from the night of surgery to the sixth postoperative day (11.5 ± 1.9 μg/mL to 2.12 ± 0.79 μg/mL; p <0.0001). The incidence of sternal infections was 0% and no patient developed any infection or had renal toxicity during the 12-month follow-up. The use of topical vancomycin applied to the sternotomy incision does not result in persistently elevated levels of serum vancomycin following cardiac surgical procedures. Furthermore, topical vancomycin does not potentiate the emergence of drug-resistant infections or contribute to postoperative renal toxicity. 
    Journal of Cardiac Surgery 09/2011; 26(5):461-5. DOI:10.1111/j.1540-8191.2011.01300.x · 0.89 Impact Factor

Publication Stats

3k Citations
666.32 Total Impact Points

Institutions

  • 2014
    • Beverly Hospital, Boston MA
      Beverly, Massachusetts, United States
  • 1987–2014
    • Boston Medical Center
      Boston, Massachusetts, United States
    • Boston University
      • Department of Medicine
      Boston, Massachusetts, United States
    • Columbia University
      • Department of Surgery
      New York City, NY, United States
  • 1998–2012
    • University of Massachusetts Medical School
      • Department of Psychiatry
      Worcester, Massachusetts, United States
  • 1999–2011
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
  • 2004
    • Cape Cod Hospital
      Hyannis, Massachusetts, United States
  • 1996
    • Beth Israel Deaconess Medical Center
      Boston, Massachusetts, United States
  • 1993
    • University of South Carolina
      • Department of Surgery
      Columbia, South Carolina, United States
  • 1985
    • CUNY Graduate Center
      New York, New York, United States