Harold L Lazar

Boston University, Boston, Massachusetts, United States

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Publications (159)712.82 Total impact

  • Harold L Lazar ·
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    ABSTRACT: Historically, the standard approach for all mitral valve surgery has been the mediasternotomy. Although initially developed for cosmesis, minimally invasive techniques for mitral valve surgery use a limited right anterior thoracotomy with and without endoscopic techniques, which have resulted in outcomes comparable to the traditional mediasternotomy incision(1,2). Advances in robotic technology, including three dimensional visualization and improved dexterity have facilitated the introduction of robotic surgery for mitral valve repairs. In an FDA safety and efficacy trial in 2000 involving 20 patients, Nifong and co-workers used robotic technology to perform a wide spectrum of mitral valve repair procedures(3). Although crossclamp and operative times were longer when compared to the conventional mediasternotomy approach, the morbidity and mortality was similar and the mean hospital length of stay (LOS) was only 4 days. A follow-up study involving 112 patients showed a 30-day mortality of 0.7% and no conversions to a mediasternotomy(4). The mean hospital LOS was 5 days and the 5-year freedom from reoperation was 90%. More recent series using robotic techniques for mitral valve repairs have duplicated these excellent outcomes(5,6). Although crossclamp, cardiopulmonary bypass, and total operative times are significantly longer, there are no differences in morbidity or mortality between robotic and non-robotic repairs. In general, robotic patients spend one less day in the hospital. Follow-up from 1-3 years show that > 90% of patients are free of moderate-to-severe mitral regurgitation (MR) and the need for another mitral valve procedure. However, despite the apparent cost savings of spending one less day in the hospital, Kam and co-workers could not demonstrate any differences in hospital expenses for patients undergoing robotic mitral repairs(7). The decreased LOS appears to be offset by increased operation time. Furthermore, the cost of purchasing the robotic equipment, its maintenance and need for upgrades and supplies are usually not factored into most cost analyses.
    Circulation 10/2015; DOI:10.1161/CIRCULATIONAHA.115.019843 · 14.43 Impact Factor
  • Harold L Lazar ·

    The Canadian journal of cardiology 09/2015; DOI:10.1016/j.cjca.2015.08.003 · 3.94 Impact Factor
  • Harold L Lazar ·
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    ABSTRACT: Purpose of review: This review will examine the current role of off-pump coronary artery bypass (OPCAB) surgery compared with on-pump coronary artery bypass (ONCAB) surgery for the revascularization of ischemic myocardium. Recent findings: Recent studies have confirmed earlier findings that OPCAB is associated with less grafts per patient and less complete revascularization, and increased incidence of recurrent angina and need for repeat revascularization procedures, and more frequent rehospitalization for cardiac-related issues. OPCAB does not prevent postoperative renal dysfunction and is associated with worse long-term outcomes. Hospital costs are not reduced and are increased in those OPCAB patients who require intraoperative conversion to ONCAB procedures; however, when multiple arterial grafts are used and a complete revascularization is performed, OPCAB outcomes are equivalent to those of ONCAB procedures. Summary: OPCAB should only be performed by surgeons experienced in this technique in patients in whom a complete revascularization can be achieved; preferably with multiple arterial grafts.
    Current opinion in cardiology 09/2015; 30(6). DOI:10.1097/HCO.0000000000000221 · 2.70 Impact Factor
  • Harold L. Lazar ·

    The Journal of thoracic and cardiovascular surgery 06/2015; 150(3). DOI:10.1016/j.jtcvs.2015.06.004 · 4.17 Impact Factor
  • Harold L. Lazar ·

    Journal of Thoracic and Cardiovascular Surgery 02/2015; 149(6). DOI:10.1016/j.jtcvs.2015.01.072 · 4.17 Impact Factor
  • Harold L. Lazar ·

    Journal of Thoracic and Cardiovascular Surgery 12/2014; 148(5). DOI:10.1016/j.jtcvs.2014.10.006 · 4.17 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 · 4.17 Impact Factor
  • Harold Lazar · Hillary Bixby ·

    Journal of Cardiac Surgery 11/2014; 29(6):765-765. DOI:10.1111/jocs.12473 · 0.89 Impact Factor
  • Harold L Lazar ·

    Journal of Thoracic and Cardiovascular Surgery 10/2014; 149(2). DOI:10.1016/j.jtcvs.2014.10.061 · 4.17 Impact Factor
  • Harold L. Lazar · Ara Ketchedjian · Miguel Haime · Karl Karlson · Howard Cabral ·
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    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; 148(3). DOI:10.1016/j.jtcvs.2014.06.045 · 4.17 Impact Factor
  • Mohammad H. Eslami · Alan Sherburne · Avneesh Gupta · Harold L. Lazar ·
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    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

  • Seminars in Thoracic and Cardiovascular Surgery 06/2014; 26(1):76-94. DOI:10.1053/j.semtcvs.2014.03.002
  • Harold L Lazar ·

    Circulation 03/2014; 129(10):e389. DOI:10.1161/CIRCULATIONAHA.113.008030 · 14.43 Impact Factor

  • Harold L Lazar ·
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    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 · 14.43 Impact Factor
  • Harold L Lazar ·

    Circulation 07/2013; 128(4):406-13. DOI:10.1161/CIRCULATIONAHA.113.003388 · 14.43 Impact Factor
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    Harold L Lazar ·
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    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
  • Julia H Perry · Harold L Lazar · Karen Quillen · J Mark Sloan ·
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    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
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    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; 145(2). DOI:10.1016/j.jtcvs.2012.09.031 · 4.17 Impact Factor
  • Harold L Lazar ·
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    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(1):219-35. DOI:10.1016/j.yasu.2012.03.007

Publication Stats

3k Citations
712.82 Total Impact Points


  • 1987-2015
    • Boston University
      • Department of Medicine
      Boston, Massachusetts, United States
    • Columbia University
      • Department of Surgery
      New York City, NY, United States
  • 2014
    • Beverly Hospital, Boston MA
      Beverly, Massachusetts, United States
  • 1987-2014
    • Boston Medical Center
      Boston, Massachusetts, United States
  • 1999-2011
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
  • 1998-2006
    • University of Massachusetts Medical School
      Worcester, 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
  • 1984-1985
    • CUNY Graduate Center
      New York, New York, United States