Michael F Swartz

University Center Rochester, Rochester, Minnesota, United States

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Publications (31)95.88 Total impact

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    ABSTRACT: Left ventricular hypertrophy (LVH) frequently accompanies the progression of aortic valve disease in children. The extent of LVH regression following surgical relief of aortic valve disease in children has not been clearly elucidated. We hypothesized that significant regression of LVH will occur in children following the Ross procedure. We examined LVH over time in children <18 years of age who underwent the Ross procedure. Left ventricular mass index (LVMI) and corresponding z scores were calculated based on height, age and gender. Left ventricular hypertrophy was defined as an LVMI of > 39 g/m(2.7) and a z score of >1.6. Twenty-five children underwent the Ross procedure. The left ventricular mass increased proportionally with the growth of the child from baseline to the latest follow-up at 7.3 ± 2.9 years (121.1 ± 81.5 vs 133.1 ± 79.8 g, P = 0.4). However, 96% (24/25) of children demonstrated LVMI regression from baseline. Mean LVMI decreased from 70.8 ± 31.2 to 41.8 ± 16.6 g/m(2.7) (P < 0.001). Similarly, LVMI z scores decreased from 2.2 ± 1.2 to 0.2 ± 1.9 (P < 0.001). Freedom from LVH was 83% at 10 years. Examination of LVMI and z scores over time demonstrated that the largest decrease occurred after the first year, with continued gradual decline over 10 years of follow-up. The Ross procedure is effective in reversing LVH in children with aortic valve disease.
    Interactive Cardiovascular and Thoracic Surgery 05/2014; 18(5):607-10. · 1.11 Impact Factor
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    ABSTRACT: Little is known about the mechanisms underlying the transition from paroxysmal to persistent atrial fibrillation (AF). In an ovine model of long-standing persistent AF (LS-PAF) we tested the hypothesis that the rate of electrical and/or structural remodeling, assessed by dominant frequency (DF) changes, determines the time at which AF becomes persistent. Self-sustained AF was induced by atrial tachypacing. Seven sheep were sacrificed 11.5±2.3 days after the transition to persistent AF and without reversal to sinus rhythm (SR); 7 sheep were sacrificed after 341.3±16.7 days of LS-PAF. Seven sham-operated animals were in SR for 1 year. DF was monitored continuously in each group. RT-PCR, western blotting, patch-clamping and histological analyses were used to determine changes in functional ion channel expression and structural remodeling. Atrial dilatation, mitral valve regurgitation, myocyte hypertrophy, and atrial fibrosis occurred progressively and became statistically significant after the transition to persistent AF, with no evidence for left ventricular dysfunction. DF increased progressively during the paroxysmal-to-persistent AF transition and stabilized when AF became persistent. Importantly, the rate of DF increase (dDF/dt) correlated strongly with the time to persistent AF. Significant action potential duration (APD) abbreviation, secondary to functional ion channel protein expression changes (CaV1.2, NaV1.5 and KV4.2 decrease; Kir2.3 increase), was already present at the transition and persisted for one-year follow up. In the sheep model of LS-PAF, the rate of DF increase predicts the time at which AF stabilizes and becomes persistent, reflecting changes in APD and densities of sodium, L-type calcium and inward rectifier currents.
    Circulation 01/2014; · 15.20 Impact Factor
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    ABSTRACT: During the surgical repair of infants with congenital cardiac defects, there can be periods of decreased cerebral blood flow, particularly during deep hypothermic circulatory arrest. As a result, these infants are at increased risk for seizures and long-term neurodevelopmental difficulties. Thirty-two infants with congenital heart disease had continuous video-electroencephalographic (EEG) monitoring pre-, intra-, and postoperatively for 48 hours after surgery. For patients requiring deep hypothermic circulatory arrest (n = 17) the EEG pattern for all patients became suppressed and eventually isoelectric below 25°C. Two of the 32 infants had electrical seizures within the 48-hour monitoring period. Both required deep hypothermic circulatory arrest, and the burst pattern during recovery had rhythmic, sharp components that were high amplitude and often asynchronous between the hemispheres. The interval between the onset of seizure activity and initiation of the sharp burst pattern during surgery was 29 and 40 hours. This pattern was not observed during isoelectric recovery from infants who did not develop postoperative seizures. The EEG in infants during deep hypothermic circulatory arrest displayed predictable changes. We identified an electroencephalographic pattern following the isoelectric period that may predict seizure development in the subsequent 48 hours.
    Pediatric Neurology 12/2013; · 1.42 Impact Factor
  • Allen Cheng, Michael F Swartz, H Todd Massey
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    ABSTRACT: With HeartMate II (HMII) implants increasing so has the frequency of device exchange. However, identifying inflow cannula obstruction, pump thrombosis, or outflow obstruction as the mechanism of pump dysfunction can be difficult. Echocardiography, CT angiogram, and cardiac catheterization are not definitive in determining the location of pump failure. Therefore, intraoperative examination is often necessary to confirm a diagnosis, requiring extensive dissection to visualize the entire system. We hypothesized a novel intraoperative technique, VADoscopy, can evaluate the inflow cannula for thrombus or pannus formation, and can help guide decision on which portion(s) of the HMII require replacement. Visualization of the inflow cannula can determine if either the pump itself or the pump along with the inflow cannula requires replacement, potentially limiting unnecessary dissection around the left ventricular apex and inflow cannula. A subxiphoid or subcostal incision exposes the pump. Patients are placed on cardiopulmonary bypass using the femoral vein and artery, after the outflow cannula is clamped. Once the pump is removed from the pocket, a 22 French 80 cm(Edwards Life Science, Irvine, CA) Fogarty balloon is advanced through the inflow cannula into the left ventricle and inflated to limit blood flow from the heart. A 5 French 30 cm flexible endoscope (Karl Starz Flex-X, Germany) is then placed into the inflow cannula and left ventricle to evaluate for the presence of thrombus, pannus, or debris. Six patients had HMII exchange with VADoscopy. In all patients, VADoscopy demonstrated no inflow cannula pannus or thrombus as the cause of pump dysfunction. Postoperatively there were no embolic events or evidence of reoccurring pump dysfunction suggesting an inflow cannula obstruction was not missed. VADoscopy is a novel and effective operative diagnostic modality to evaluate the inflow cannula within the HMII left ventricular assist device, limiting the amount of dissection, and potentially reducing the morbidity associated with HMII pump exchange.
    ASAIO journal (American Society for Artificial Internal Organs: 1992) 10/2013; · 1.39 Impact Factor
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    ABSTRACT: Right ventricular (RV) failure after the insertion of a left ventricular assist device (LVAD) historically results in poor outcomes. Patients requiring temporary RV support after LVAD insertion are a heterogeneous group of patients consisting of those in cardiogenic shock after myocardial infarction, to those with chronic decompensated heart failure. For patients requiring biventricular support, we have used a hybrid system consisting of a HeartMate II LVAD and CentriMag right ventricular assist device (RVAD). The purpose of this study was to determine the 1-year survival in patients requiring isolated LVAD and patients requiring biventricular support. All patients who underwent HeartMate II LVAD alone or in conjunction with a temporary CentriMag RVAD were examined from 2006 to 2011. Preoperative demographics, operative outcomes, and survival were analyzed. A total of 139 patients required HeartMate II insertion; 34 (24%) required biventricular support at the time of HeartMate II implantation. The mean duration of biventricular support was 17 ± 11.9 days (range, 6 to 56 days) with 91.8% (n = 31) of RVADs successfully explanted. Survival to hospital discharge was not different between groups (95.2 versus 88.2%; p = 0.2). However, 1-year survival was significantly greater in patients who required isolated HeartMate II LVAD (87% versus 77%; p = 0.03). Biventricular support using a HeartMate II LVAD and CentriMag RVAD resulted in limited mortality at hospital discharge. However biventricular dysfunction does not have a favorable outcome at 1 year when compared with patients requiring isolated HeartMate II.
    The Annals of thoracic surgery 09/2013; · 3.45 Impact Factor
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    ABSTRACT: BACKGROUND: Providing unobstructed systemic blood flow is one goal of stage I palliation for hypoplastic left heart syndrome. Although clinically significant obstruction is defined when the arch gradient exceeds 15 mm Hg, any positive gradient constitutes obstruction, which may impair ventricular function. We sought to identify risk factors before stage I palliation that result in a positive neoaortic arch gradient before bidirectional Glenn. METHODS: Reviewed were 51 neonates who underwent stage I palliation and subsequent bidirectional cavopulmonary anastomosis procedures for hypoplastic left heart syndrome. Echocardiograms before stage I palliation were reviewed for aortic dimensions. Cardiac catheterization before bidirectional cavopulmonary anastomosis determined the aortic arch gradient and degree of right ventricular dysfunction. RESULTS: Of the 51 patients, 24 (47%) had a negative or absent arch gradient. Patients with a positive gradient had a median gradient of 5 mm Hg (range, 1 to 60 mm Hg). The diameter of the ascending aorta and proximal transverse arch indexed to the descending thoracic aorta (0.5 ± 0.2 vs 0.7 ± 0.4 and 0.4 ± 0.2 vs 0.6 ± 0.2 mm, p = 0.02 and p = 0.01) and lower birth weight (3.1 ± 0.5 vs 3.4 ± 0.4 kg, p = 0.03) were risk factors of a positive neoaortic arch gradient. Further, the degree of arch obstruction was inversely related to the degree of right ventricular function (odds ratio, 1.08; p < 0.01). CONCLUSIONS: Lower birth weight and a smaller aortic diameter confer a higher risk of developing a positive neoaortic arch gradient, resulting in reduced right ventricular function.
    The Annals of thoracic surgery 06/2013; · 3.45 Impact Factor
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    ABSTRACT: BACKGROUND: Despite repair, a significant proportion of patients with coarctation of the aorta (CoA) present with late hypertension. Increased gene expression of aortic wall collagen and vascular smooth muscle cell markers occurs in the presence of hypertension. Before repair, a patent ductus arteriosus (PDA) limits hypertension proximal to the coarctation. We hypothesize that preoperative collagen and vascular smooth muscle expression from the aortic arch in children is variable, depending on the presence or absence of a PDA. METHODS: We analyzed the expression patterns of collagen and vascular smooth muscle cell markers in 25 children with CoA using a quantitative polymerase chain reaction. Aortic arch tissue proximal to the CoA was normalized to descending aortic tissue distal to the coarctation. Collagen-I, transforming growth factor-β, elastin, and calponin were analyzed. RESULTS: At repair, 19 patients were aged younger than 3 months (14 with a PDA, 5 with a ligamentum arteriosum), and the remaining 6 were older than 1 year. There was no difference in age or weight between infants with or without a PDA. Infants without a PDA had the greatest difference in collagen-I expression compared with infants with a PDA (7.0 ± 1.6-fold vs 0.8 ± 1.1-fold, p = 0.01). Expression of transforming growth factor-β (4.3 ± 1.4 vs 2.6 ± 2.3, p = 0.01) and calponin (3.7 ± 0.7 vs 0.6 ± 1.1, p = 0.05) was lower from infants with vs without a PDA. CONCLUSIONS: Our findings provide evidence of preoperative changes in the aortic arch before repair, particularly in the absence of a PDA.
    The Annals of thoracic surgery 05/2013; · 3.45 Impact Factor
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    ABSTRACT: OBJECTIVE:: To evaluate whether transfusion of cell saver salvaged, stored at the bedside for up to 24 hrs, would decrease the number of postoperative allogeneic RBC transfusions and donor exposures, and possibly improve clinical outcomes. DESIGN:: Prospective, randomized, controlled, clinical trial. SETTING:: Pediatric cardiac intensive care unit. PATIENTS:: Infants weighing less than 20 kg (n = 106) presenting for cardiac surgery with cardiopulmonary bypass. INTERVENTIONS:: Subjects were randomized to a cell saver transfusion group where cell saver blood was available for transfusion up to 24 hrs after collection, or to a control group. Cell saver subjects received cell saver blood for volume replacement and/or RBC transfusions. Control subjects received crystalloid or albumin for volume replacement and RBCs for anemia. Blood product transfusions, donor exposures, and clinical outcomes were compared between groups. MEASUREMENTS AND MAIN RESULTS:: Children randomized to the cell saver group had significantly fewer RBC transfusions (cell saver: 0.19 ± 0.44 vs. control: 0.75 ± 1.2; p = 0.003) and coagulant product transfusions in the first 48 hrs post-op (cell saver: 0.09 ± 0.45 vs. control: 0.62 ± 1.4; p = 0.013), and significantly fewer donor exposures (cell saver: 0.60 ± 1.4 vs. control: 2.3 ± 4.8; p = 0.019). This difference persisted over the first week post-op, but did not reach statistical significance (cell saver: 0.64 ± 1.24 vs. control: 1.1 ± 1.4; p = 0.07). There were no significant clinical outcome differences. CONCLUSION:: Cell saver blood can be safely stored at the bedside for immediate transfusion for 24 hrs after collection. Administration of cell saver blood significantly reduces the number of RBC and coagulant product transfusions and donor exposures in the immediate postoperative period. Reduction of blood product transfusions has the potential to reduce transfusion-associated complications and decrease postoperative morbidity. Larger studies are needed to determine whether this transfusion strategy will improve clinical outcomes.
    Pediatric Critical Care Medicine 01/2013; · 2.35 Impact Factor
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    ABSTRACT: Ventricular assist devices emerged as a widely used modality for treatment of end-stage heart failure; however, despite significant advances, external energy supply remains a problem contributing to significant patient morbidity and potential mortality. One potential solution is using the nuclear radioisotope Plutonium-238 as a power source. Given its very high energy density and long half-life, Plutonium-238 could eventually allow a totally intracorporeal ventricular assist system that lasts for the patient's lifetime. Risks, such as leakage and theft identified decades ago, still remain. However, it is possible that newer technologies could be used to overcome the system complexity and unreliability of the previous generations of nuclear-powered mechanical assist systems. Were it not for the remaining safety risks, Plutonium-238 would be an ideal energy source for this purpose.
    ASAIO journal (American Society for Artificial Internal Organs: 1992) 10/2012; · 1.39 Impact Factor
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    ABSTRACT: This study sought to determine if serum markers for collagen I and III synthesis, the carboxyl terminal peptide from pro-collagen I (PICP) and the amino terminal peptide from pro-collagen III (PIIINP), correlate with left atrial (LA) fibrosis and post-operative atrial fibrillation (AF). AF after cardiac surgery is associated with adverse outcomes. We recently demonstrated that LA fibrosis is associated with post-operative AF in patients with no previous history of AF. Fifty-four patients having cardiac surgery without a history of AF consented to left and right atrial biopsies and a pre-operative peripheral blood draw. Picrosirius red staining quantified the percentage of fibrosis, and reverse transcriptase polymerase chain reaction assessed atrial tissue messenger ribonucleic acid transcripts involved in the fibrosis pathway. PICP and PIIINP levels were measured using an enzyme immunosorbent assay. Eighteen patients developed AF, whereas 36 remained in normal sinus rhythm. LA fibrosis was higher in patients who developed AF versus normal sinus rhythm (6.13 ± 2.9% vs. 2.03 ± 1.9%, p = 0.03). LA messenger ribonucleic acid transcripts for collagen I, III, transforming growth factor, and angiotensin were 1.5- to 2.0-fold higher in AF patients. Serum PICP and PIIINP levels were highest in AF versus normal sinus rhythm (PICP: 451.7 ± 200 ng/ml vs. 293.3 ± 114 ng/ml, p = 0.006; PIIINP: 379 ± 286 pg/ml vs. 191.6 ± 162 pg/ml, p = 0.01). Furthermore, there was a linear correlation between LA fibrosis and serum PICP levels (R(2) = 0.2; p = 0.01), and of the markers, only PICP was independently associated with AF. This demonstrates that serum PICP and PIIINP levels correlate with the presence of LA fibrosis and may act as predictors for post-operative AF even in the absence of previous history of AF.
    Journal of the American College of Cardiology 09/2012; 60(18):1799-806. · 14.09 Impact Factor
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    ABSTRACT: Supravalvar pulmonary stenosis (SVPS) is frequently observed after arterial switch. Traditionally the coronary arteries are removed from the neopulmonic root by excising the entire sinus of Valsalva. As a result, reconstruction of the neopulmonic root requires a pericardial patch encompassing two-thirds of the anastomosis between the neopulmonic root and pulmonary artery. We present a technique where the coronary arteries are removed as limited buttons of sinus tissue, leaving the transected edge of the neopulmonic root intact. We hypothesize that maintaining native arterial tissue in the anastomosis between the neopulmonic root and the pulmonary artery bifurcation reduces postoperative SVPS. We performed a retrospective review of neonates with D-transposition of the great arteries undergoing arterial switch procedure from 1996 to 2009. Charts were reviewed, and clinical outcomes recorded for each patient. Most recent echocardiograms were evaluated for right ventricular outflow tract obstruction. A total of 120 patients received arterial switch using this technique. There was 99% survival and no injuries to the coronary arteries regardless of anatomy. Total follow-up was 564 patient-years. Mean follow-up at last clinical visit was 66±46 months. Evaluation of the most recent outpatient echocardiogram revealed an average peak instantaneous gradient across the neopulmonic root of 22.5±5 mm Hg. Only 7 (5%) patients required reintervention (balloon dilation, n=5; surgery, n=2). Our technique of removing the coronary arteries as limited buttons, and anastomosis of the pulmonary artery using only native arterial tissue provides excellent midterm results with minimal SVPS.
    Circulation 09/2012; 126(11 Suppl 1):S118-22. · 15.20 Impact Factor
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    ABSTRACT: OBJECTIVE: Right ventricular outflow tract (RVOT) reconstruction necessitates frequent reoperation. To understand the early outcomes, we analyzed our results to provide the intra- and postoperative morbidity and mortality. We hypothesized that multiple previous sternotomies do not influence the morbidity, mortality, or survival. DESIGN: We performed a retrospective review of patients who underwent reoperative RVOT reconstruction at the University of Rochester Medical Center and SUNY Upstate Medical Center from January 1, 2000 to December 31, 2009. Patients were divided into three groups based upon the number of previous sternotomies: Group 1 with one, Group 2 with two, and Group 3 with three or more previous sternotomies. RESULTS: 220 patients had reoperative RVOT reconstruction, 103 in Group 1, 71 in Group 2, and 46 in Group 3. There was no difference in the percentage of inadvertent cardiotomy between groups (Group 1: 2%, Group 2: 1%, Group 3: 2%; P =.9) The number of previous sternotomies had no effect upon infection, arrhythmia, or the percentage of patients who received a red blood cell transfusion (Group 1: 56%, Group 2: 49% Group 3: 43%; P =.3). Perioperative mortality for the entire group was 3/220 (1.4%), with no difference between groups. At a mean follow-up of 39 months, there was a survival of 98% for Groups 1 and 3 and 97% for Group 2 (P =.7). CONCLUSION: Reoperative RVOT reconstruction can safely be performed with limited morbidity and mortality. The number of previous sternotomies does not influence the rate of cardiotomy, red blood cell transfusion, or early outcome.
    Congenital Heart Disease 06/2012; · 1.01 Impact Factor
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    ABSTRACT: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can result in left-ventricular distension and the development of pulmonary edema. We present the case of a 13-year-old girl who presented with cardiogenic shock. VA-ECMO was initiated, but after 6 days, severe left-ventricular distension resulted in decreased VA-ECMO flows. With guidance by bedside transesophageal echocardiography, a percutaneous atrial transseptal cannula was placed and connected to the venous circuit, thus decompressing the left ventricle. The patient improved, was weaned from VA-ECMO 5 days later, and was discharged from the hospital. Bedside transseptal catheter insertion is an effective method of left-ventricular decompression.
    Pediatric Cardiology 01/2012; 33(1):185-7. · 1.20 Impact Factor
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    ABSTRACT: The goal of aortic coarctation repair is laminar aortic blood flow resulting in a negative or absent arm:leg blood pressure (BP) gradient. Despite satisfactory relief of coarctation, associated arch hypoplasia can result in residual obstruction and postoperative upper body hypertension. We devised a surgical strategy to create a tension-free anastomosis with a diameter as large as both the adjacent proximal and distal aorta using a radically extended end-to-end anastomosis via sternotomy and/or thoracotomy. Sternotomy is chosen when there is significant transverse arch hypoplasia defined as a distal transverse arch ≤ diameter of the left carotid artery, presence of a common brachiocephalic trunk, or coexisting intracardiac lesion requiring repair. Thoracotomy is used in all other cases. From 2000 to 2008, 95 consecutive patients were repaired using this approach, 35 with sternotomy and 60 with thoracotomy. At a mean follow-up of 50 ± 23 months, mean systolic BP was 94 ± 10 mm Hg, and 84% of patients had no residual arm:leg BP gradient. Mean arm:leg BP gradient was not statistically different between groups (-8.5 ± 15 sternotomy and -7.0 ± 10 mm Hg thoracotomy, P= .7). With Doppler echocardiography, 96% of patients demonstrated normal early diastolic reversal of blood flow in the descending thoracic aorta. For aortic coarctation repair in infancy, a strategy designed to directly address aortic arch hypoplasia results in excellent intermediate-term results with normal BP, physiologic arm:leg BP relationship, and near normal descending aortic blood flow velocities by Doppler.
    Congenital Heart Disease 11/2011; 6(6):583-91. · 1.01 Impact Factor
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    ABSTRACT: The optimal conduit for right ventricular outflow tract (RVOT) reconstruction is uncertain, with varying degrees of longevity reported for pericardial, homograft, and xenograft valves utilized in this position. A retrospective review of children and adults with congenital heart disease who underwent RVOT reconstruction with the Carpentier Edwards™ (CE) porcine valved conduit was conducted from 2001 to 2009 at the University of Rochester and SUNY Upstate Medical Centers. Clinical data were analyzed for each subject according to conduit size, and all of the Doppler derived transconduit gradients from postoperative echocardiograms were analyzed. Two hundred and eighteen patients received a single CE conduit for RVOT reconstruction with conduit size ranging from 12 to 30 mm. Perioperative mortality was 1.8% (4/218). Follow-up data were available for 95% of subjects with duration of follow-up ranging from 1 to 9 years. The increase in transconduit gradient over time was inversely proportional to conduit size. For the entire series, freedom from reoperation was 70.3% at 8.2 years. Patients receiving 25 and 30 mm conduits demonstrated no gradient development over this period of follow-up. In this series, the CE conduit showed excellent longevity at intermediate term follow-up, with slower progression of conduit stenosis as measured by RVOT gradient change compared with previous reports.
    Journal of Cardiac Surgery 09/2011; 26(6):643-9. · 1.35 Impact Factor
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    ABSTRACT: Children undergoing cardiac surgery with cardiopulmonary bypass are susceptible to additional inflammatory and immunogenic insults from blood transfusions. We hypothesize that washing red blood cells and platelets transfused to these patients will reduce postoperative transfusion-related immune modulation and inflammation. Prospective, randomized, controlled clinical trial. University hospital pediatric cardiac intensive care unit. Children from birth to 17 yrs undergoing cardiac surgery with cardiopulmonary bypass. Children were randomized to an unwashed or washed red blood cells and platelet transfusion protocol for their surgery and postoperative care. All blood was leuko-reduced, irradiated, and ABO identical. Plasma was obtained for laboratory analysis preoperatively, immediately, and 6 and 12 hrs after cardiopulmonary bypass. Primary outcome was the 12-hr postcardiopulmonary bypass interleukin-6-to-interleukin-10 ratio. Secondary measures were interleukin levels, C-reactive protein, and clinical outcomes. One hundred sixty-two subjects were studied, 81 per group. Thirty-four subjects (17 per group) did not receive any blood transfusions. Storage duration of blood products was similar between groups. Among transfused subjects, the 12-hr interleukin ratio was significantly lower in the washed group (3.8 vs. 4.8; p = .04) secondary to lower interleukin-6 levels (after cardiopulmonary bypass: 65 vs.100 pg/mL, p = .06; 6 hrs: 89 vs.152 pg/mL, p = .02; 12 hrs: 84 vs.122 pg/mL, p = .09). Postoperative C-reactive protein was lower in subjects receiving washed blood (38 vs. 43 mg/L; p = .03). There was a numerical, but not statistically significant, decrease in total blood product transfusions (203 vs. 260) and mortality (2 vs. 6 deaths) in the washed group compared to the unwashed group. Washed blood transfusions in cardiac surgery reduced inflammatory biomarkers, number of transfusions, donor exposures, and were associated with a nonsignificant trend toward reduced mortality. A larger study powered to test for clinical outcomes is needed to determine whether these laboratory findings are clinically significant.
    Pediatric Critical Care Medicine 09/2011; 13(3):290-9. · 2.35 Impact Factor
  • Heart Rhythm. 01/2011; 8(11):1827-1827.
  • George M. Alfieris, Michael F. Swartz
    Operative Techniques in Thoracic and Cardiovascular Surgery 01/2011; 16(3):191–204.
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    Pediatric Cardiology 10/2010; 31(7):1118. · 1.20 Impact Factor
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    ABSTRACT: Neonatal surgical repair for truncus arteriosus historically involves removing the pulmonary arteries from the truncal root, closing the ventricular septal defect, and creating right ventricular to pulmonary artery continuity. Unfortunately, early reintervention is frequently required for conduit failure and proximal branch pulmonary artery stenosis. We present a technique that preserves the pulmonary artery architecture, keeping the pulmonary arteries in their native position. This technique has been applied to 16 patients and appears to decrease proximal branch pulmonary artery stenosis, thereby extending conduit longevity and increasing the freedom from early reintervention.
    The Annals of thoracic surgery 09/2010; 90(3):1038-9. · 3.45 Impact Factor

Publication Stats

91 Citations
95.88 Total Impact Points


  • 2012–2013
    • University Center Rochester
      Rochester, Minnesota, United States
    • Rochester Institute of Technology
      Rochester, New York, United States
    • University of Rochester
      • Department of Surgery
      Rochester, NY, United States
  • 2004–2009
    • State University of New York Upstate Medical University
      • • College of Medicine
      • • Division of Cardiothoracic Surgery
      Syracuse, NY, United States