Harold L Lazar

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

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Publications (135)538.86 Total impact

  • [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; · 1.35 Impact Factor
  • Seminars in Thoracic and Cardiovascular Surgery. 01/2014;
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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.
    The Journal of Thoracic and Cardiovascular Surgery. 01/2014;
  • Harold L Lazar
    Circulation 07/2013; 128(4):406-13. · 15.20 Impact Factor
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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. · 1.35 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; · 3.41 Impact Factor
  • Harold L Lazar
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    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. · 1.35 Impact Factor
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    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. · 1.35 Impact Factor
  • Harold L Lazar
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    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. · 1.35 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 01/2012; 46:219-35.
  • Source
    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.
    ISRN cardiology. 01/2012; 2012:292490.
  • Journal of cardiothoracic and vascular anesthesia 09/2011; 26(2):327-32. · 1.06 Impact Factor
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    ABSTRACT: This study sought to determine whether aggressive glycemic control (90-120 mg/dL) would result in more optimal clinical outcomes and less morbidity than moderate glycemic control (120-180 mg/dL) in diabetic patients undergoing coronary artery bypass graft (CABG) surgery. Maintaining serum glucose levels between 120 and 180 mg/dL with continuous insulin infusions decreases morbidity in diabetic patients undergoing CABG surgery. Studies in surgical patients requiring prolonged ventilation suggest that aggressive glycemic control (<120 mg/dL) may improve survival; however, its effect in diabetic CABG patients is unknown. Eighty-two diabetic patients undergoing CABG were prospectively randomized to aggressive glycemic control (90-120 mg/dL) or moderate glycemic control (120-180 mg/dL) using continuous intravenous insulin solutions (100 units regular insulin in 100 mL: normal saline) beginning at the induction of anesthesia and continuing for 18 hours after CABG. Primary end points were the incidence of major adverse events (major adverse events = 30-day mortality, myocardial infarction, neurologic events, deep sternal infections, and atrial fibrillation), the level of serum glucose, and the incidence of hypoglycemic events. There were no differences in the incidence of major adverse events between the groups (17 moderate vs 15 aggressive; P = 0.91). Patients with aggressive control had a lower mean glucose at the end of 18 hours of insulin infusion (135 ± 12 mg/dL moderate vs 103 ± 17 mg/dL aggressive; P < 0.0001). Patients with aggressive control had a higher incidence of hypoglycemic events (4 vs 30; P < 0.0001). In diabetic patients undergoing CABG surgery, aggressive glycemic control increases the incidence of hypoglycemic events and does not result in any significant improvement in clinical outcomes that can be achieved with moderate control. Clinical Trials.gov (ID #NCT00460499).
    Annals of surgery 09/2011; 254(3):458-63; discussion 463-4. · 7.90 Impact Factor
  • Harold L Lazar, Tamar Barlam, Howard Cabral
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    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. · 1.35 Impact Factor
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    ABSTRACT: Drug interaction between Warfarin and psychiatric agents may have important therapeutic effects for patients undergoing cardiac surgery. We present a case of a patient in whom concurrent treatment with Warfarin and valproic acid resulted in supratherapeutic international normalized ratio values. A discussion of the possible mechanisms for this interaction as well as a review of interactions between Warfarin and other psychiatric medications is the subject of this case report.
    Journal of Cardiac Surgery 08/2011; 26(5):492-4. · 1.35 Impact Factor
  • Harold L Lazar
    Journal of Cardiac Surgery 07/2011; 26(4):343. · 1.35 Impact Factor
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    ABSTRACT: This prospective randomized study was undertaken to compare the use of the 3M™ Steri-Strip™ S Surgical Skin closure system with a running absorbable subcuticular suture technique for skin closure following a mediansternotomy for cardiac surgical procedures. Thirty-six patients undergoing a mediansternotomy for a cardiac surgical procedure were prospectively randomized to either Steri-Strip S or subcuticular suture for wound closure. The wounds were evaluated on postoperative days 7 and 21 for erythema, edema, pain, cosmesis, and the time taken to close the incision. Skin closure with Steri-Strip S was faster (5.33 ± 1.32 minutes steri-strips vs. 6.07 ± 0.91 sutures; p = 0.06) and resulted in significantly less erythema and edema, but no difference in pain or cosmesis after seven days. Following 21 days, there was no difference in pain, edema, or cosmesis between the groups. However, patients receiving steri-strips continue to have less erythema. Both Steri-Strip S and absorbable sutures are effective techniques for skin closure following a mediansternotomy incision for cardiac surgical procedures. Steri-Strip S can decrease the amount of erythema, but results in no significant difference in pain, cosmesis, or edema compared to the traditional subcuticular wound closure technique. 
    Journal of Cardiac Surgery 05/2011; 26(4):344-7. · 1.35 Impact Factor
  • Harold Lazar
    The Annals of thoracic surgery 12/2010; 90(6):1823-4. · 3.45 Impact Factor
  • Harold L Lazar, Harrison W Farber
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    ABSTRACT: To the Editor: In their review article, Agnelli and Becattini (July 15 issue)(1) discuss many important topics in acute pulmonary embolism. We would like to highlight the importance of the use of pulmonary magnetic resonance imaging (MRI) in the diagnosis of this condition, since substantial technical developments have been introduced in recent years.(2),(3) Continued improvements include the use of parallel imaging, angiography technique, and pulmonary perfusion,(2)-(4) with the latter showing the most promise for the diagnosis of pulmonary embolism.(3) However, even in protocols without pulmonary perfusion, large studies have shown good results with the use of MRI.(5) Overall, . . .
    New England Journal of Medicine 11/2010; 363(20):1974; author reply 1974-5. · 51.66 Impact Factor
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    Harold L Lazar
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    ABSTRACT: Aortic-valve replacement is the most effective treatment to alleviate symptoms and improve survival in patients with critical aortic stenosis. The incidence of aortic stenosis multiplies with age, and as the life span of our population increases, a larger number of elderly patients will require aortic-valve replacement. However, a substantial number of these patients will have coexisting conditions that preclude surgery. Since outcomes with medical management are uniformly poor, a less invasive and safer alternative to surgical aortic-valve replacement is needed for this expanding group of patients. Transcatheter aortic-valve implantation (TAVI) has emerged as an alternative treatment for aortic stenosis in . . .
    New England Journal of Medicine 10/2010; 363(17):1667-8. · 51.66 Impact Factor

Publication Stats

2k Citations
538.86 Total Impact Points

Institutions

  • 2011–2014
    • Beverly Hospital, Boston MA
      Beverly, Massachusetts, United States
  • 1986–2013
    • Boston Medical Center
      Boston, Massachusetts, United States
  • 2006–2012
    • Boston University
      • Department of Medicine
      Boston, MA, United States
    • Robert Wood Johnson University Hospital
      New Brunswick, New Jersey, United States
  • 1987–2011
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
  • 2004
    • Cape Cod Hospital
      Hyannis, Massachusetts, United States
  • 1997
    • Karl Jaspers Society of North America
      United States
  • 1996
    • Beth Israel Deaconess Medical Center
      Boston, Massachusetts, United States