A Michael Borkon

Saint Luke's Health System (KS, USA), Kansas City, Kansas, United States

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Publications (37)226.63 Total impact

  • Journal of Vascular Surgery 06/2015; 61(6):131S-132S. DOI:10.1016/j.jvs.2015.04.458 · 2.98 Impact Factor
  • The Journal of Heart and Lung Transplantation 04/2015; 34(4):S85-S86. DOI:10.1016/j.healun.2015.01.227 · 5.61 Impact Factor
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    ABSTRACT: Radial artery pseudoaneurysms occur infrequently and are most commonly associated with medical interventions such as arterial lines or cardiac catheterization procedures.1 Animal bites, particularly cate bites, as a cause for radial artery pseudoaneurysms are extremely rare with only one previously reported case in the literature. 2 A unique case of digital micro emboli from a radial artery pseudoaneurysm caused by a cat bite to the wrist is presented.
    Annals of Vascular Surgery 11/2014; 29(2). DOI:10.1016/j.avsg.2014.09.016 · 1.03 Impact Factor
  • Journal of the American College of Cardiology 04/2014; 63(12):A1819. DOI:10.1016/S0735-1097(14)61822-2 · 15.34 Impact Factor
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    ABSTRACT: The management paradigm for traumatic aortic disruptions has evolved from open to endovascular repair. Thoracic stent grafts designed to treat aneurysmal disease, however, have disadvantages, including size mismatch in younger trauma patients and current standard lengths, which may needlessly necessitate coverage of at least 10 cm of thoracic aorta, increasing the risk of spinal cord ischemia. The "off-label" use of abdominal aortic extension cuffs to treat traumatic aortic disruptions may provide an advantage in this regard by better size matching for the younger trauma patient, reduced thoracic aortic coverage, and less cost to the institution. From 2008 to 2011, a total of 16 traumatic aortic disruptions were evaluated and managed with endovascular techniques. The last six were treated with abdominal aortic extensions cuffs (Excluder Extension Cuffs; W.L. Gore & Associates, Flagstaff, AZ) rather than traditional thoracic stent grafts. In addition to demographics and trauma-related data, additional endpoints evaluated in this retrospective review included operative time, number of cuffs used, stent cost data, procedural complications, and follow-up. All six patients (five men/one woman) with traumatic aortic disruption were successfully treated with complete exclusion of the disruption using abdominal aortic cuffs. There were no complications including death or spinal cord ischemia. The average age was 27 years (range, 18-44 years). The average number of cuffs used to cover the traumatic tear was 2.6 per patient (range, 2-3 cuffs per patient), covering an average of 5.3 cm of thoracic aorta (range, 4-6 cm). Mean procedure time was 70 minutes. Hospital cost for each cuff was $2200 (average total stent cost per patient, $5720). For comparison, a single 10-cm conformable thoracic aortic graft (CTAG) (Gore) costs $14,500. Average follow-up of all six patients for up to 3 years demonstrates no complications or migration of the stent grafts. Traumatic aortic disruptions can be safely and selectively managed with "stacked" abdominal aortic extension cuffs. This tailored therapy may provide advantages over traditional thoracic stents, including improved size match in a younger trauma patient, less aortic coverage, and reduced cost.
    Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery 09/2012; 7(5):346-9. DOI:10.1097/IMI.0b013e31827e7969
  • The Journal of Heart and Lung Transplantation 04/2012; 31(4):S166-S167. DOI:10.1016/j.healun.2012.01.485 · 5.61 Impact Factor
  • The Journal of Heart and Lung Transplantation 04/2011; 30(4). DOI:10.1016/j.healun.2011.01.134 · 5.61 Impact Factor
  • The Journal of Heart and Lung Transplantation 02/2010; 29(2). DOI:10.1016/j.healun.2009.11.483 · 5.61 Impact Factor
  • The Journal of Heart and Lung Transplantation 02/2010; 29(2). DOI:10.1016/j.healun.2009.11.188 · 5.61 Impact Factor
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    ABSTRACT: The collection of gene expression data from human heart biopsies is important for understanding the cellular mechanisms of arrhythmias and diseases such as cardiac hypertrophy and heart failure. Many clinical and basic research laboratories conduct gene expression analysis using RNA from whole cardiac biopsies. This allows for the analysis of global changes in gene expression in areas of the heart, while eliminating the need for more complex and technically difficult single-cell isolation procedures (such as flow cytometry, laser capture microdissection, etc.) that require expensive equipment and specialized training. The abundance of fibroblasts and other cell types in whole biopsies, however, can complicate gene expression analysis and the interpretation of results. Therefore, we have designed a technique to quickly and easily purify cardiac myocytes from whole cardiac biopsies for RNA extraction. Human heart tissue samples were collected, and our purification method was compared with the standard nonpurification method. Cell imaging using acridine orange staining of the purified sample demonstrated that >98% of total RNA was contained within identifiable cardiac myocytes. Real-time RT-PCR was performed comparing nonpurified and purified samples for the expression of troponin T (myocyte marker), vimentin (fibroblast marker), and alpha-smooth muscle actin (smooth muscle marker). Troponin T expression was significantly increased, and vimentin and alpha-smooth muscle actin were significantly decreased in the purified sample (n = 8; P < 0.05). Extracted RNA was analyzed during each step of the purification, and no significant degradation occurred. These results demonstrate that this isolation method yields a more purified cardiac myocyte RNA sample suitable for downstream applications, such as real-time RT-PCR, and allows for more accurate gene expression changes in cardiac myocytes from heart biopsies.
    AJP Heart and Circulatory Physiology 08/2009; 297(3):H1163-9. DOI:10.1152/ajpheart.00118.2009 · 4.01 Impact Factor
  • The Journal of Heart and Lung Transplantation 02/2009; 28(2). DOI:10.1016/j.healun.2008.11.369 · 5.61 Impact Factor
  • The Journal of Heart and Lung Transplantation 02/2009; 28(2). DOI:10.1016/j.healun.2008.11.368 · 5.61 Impact Factor
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    ABSTRACT: Cardiac surgeons are increasingly faced with a more complex patient who has developed a pattern of diffuse coronary artery disease that cannot be completely revascularized by CAGB alone. Considering the increased operative and long-term cardiac risks predicted by incomplete revascularization, and the documented operative and long-term benefits associated with sole therapy and adjunctive TMR in randomized patients with diffuse coronary artery disease, increased use of sole therapy and adjunctive TMR therapy is warranted.
    Anesthesiology Clinics 10/2008; 26(3):501-19. DOI:10.1016/j.anclin.2008.04.001
  • The Journal of Heart and Lung Transplantation 02/2008; 27(2). DOI:10.1016/j.healun.2007.11.260 · 5.61 Impact Factor
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    ABSTRACT: Omega-3 fatty acid (n-3 FA) consumption has been linked to reductions in the risk of death from coronary heart disease and, recently, to lower heart rates (HRs). The investigators previously observed a reduction of 5 beats/min in HR in patients with coronary heart disease given n-3 FAs (eicosapentaenoic acid and docosahexaenoic acid) for 4 months. Reductions in HR may be explained by enhanced vagal tone, influences on cardiac voltage-gated ion channels, or both. The hypothesis that n-3 FAs would affect HR independent of vagal input was investigated by studying the effects of n-3 FA supplementation on HR in patients with denervated hearts after orthotopic heart transplantation. Electrocardiographic data obtained in 2 prospective trials in which 18 heart transplant recipients received n-3 FA supplementation (1 to 3.4 g/day) for 4 to 6 months were collected. Patients were studied 4.4 +/- 2.6 years after transplantation. HR, QRS complex, and QTc duration were determined before and after treatment. Pretreatment HR was reduced from 88 +/- 14 to 83 +/- 13 beats/min after n-3 FA treatment (p = 0.016). QRS duration increased from 107 +/- 24 to 117 +/- 25 ms (p = 0.001). QTc duration remained unchanged from baseline (427 +/- 34 ms) to study end (424 +/- 39 ms). In conclusion, n-3 FA supplementation reduced HR and prolonged QRS duration in heart transplant recipients who were presumably devoid of vagal innervation. These findings suggest that n-3 FAs may modify electrophysiologic properties of the myocardium itself.
    The American Journal of Cardiology 12/2006; 98(10):1393-5. DOI:10.1016/j.amjcard.2006.06.033 · 3.43 Impact Factor
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    ABSTRACT: An objective of the United States' Healthy People 2010 Initiative is to eliminate disparities based on socioeconomic status. We assessed the effect of difficulty affording health care on the health status (symptoms, function, and quality of life) of patients treated with percutaneous coronary intervention or CABG. A consecutive, single-center cohort of 480 patients undergoing coronary revascularization received the Seattle Angina Questionnaire at the time of their procedure and at subsequent monthly intervals for 6 months. At baseline, patients who reported somewhat of a burden to a severe burden in affording health care had significantly lower scores on the Seattle Angina Questionnaire (mean+/-SD) with respect to angina (55+/-29 versus 68+/-25, P<0.0001), physical limitation (55+/-26 versus 72+/-24, P<0.0001), and quality of life (46+/-22 versus 56+/-22, P<0.0001) than those who did not perceive healthcare costs to be burdensome. Although both groups of patients improved after revascularization, poorer health status persisted among those with difficulty affording health care after percutaneous coronary intervention (6-month mean+/-SE: angina 79+/-2.5 versus 88+/-1.9, P=0.002; physical function 61+/-2.7 versus 80+/-2.0, P<0.0001; quality of life 67+/-2.4 versus 82+/-1.8, P<0.0001) but not after CABG (angina 91+/-2.5 versus 93+/-1.6, P=0.47; physical function 75+/-3.4 versus 81+/-2.2, P=0.13; quality of life 84+/-3.1 versus 84+/-2.0, P=0.81). Similar differences remained after adjustment for demographic and clinical characteristics. Patients reporting difficulty affording health care have worse health status at the time of coronary revascularization. A persistent disparity exists after percutaneous but not surgical revascularization. Additional inquiry into the mechanism of this disparity is needed so that the goals of equitable health care, irrespective of treatment strategy, can be achieved.
    Circulation 06/2005; 111(20):2572-8. DOI:10.1161/CIRCULATIONAHA.104.474775 · 14.95 Impact Factor
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    ABSTRACT: Previous comparisons of percutaneous coronary interventions (PCIs) and coronary artery bypass graft (CABG) surgery have demonstrated similar survival but have also generally found better health status outcomes (symptoms, function, and quality of life) with CABG. The principal limitation of PCI has been the occurrence of restenosis. No previous studies comparing the health status outcomes of PCI and CABG have examined differences in these outcomes as a function of patients' preprocedural risk for restenosis. We examined the health status outcomes, using the Seattle Angina Questionnaire (SAQ), among 1459 consecutive patients (1027 treated with PCI and 432, with CABG), stratified by their risk for restenosis. In multivariable-adjusted, linear regression analyses, no differences in 1-year angina or quality of life were observed among the 37.4% of patients at low risk for restenosis. However, among the 46.7% at intermediate risk for restenosis, 1-year health status scores were moderately better after CABG surgery compared with PCI (difference in SAQ angina frequency scores favoring CABG=6.1+/-1.7 points, P=0.0003; difference in SAQ quality of life=5.8+/-1.6 points, P=0.0004). Even larger differences in 1-year outcomes favoring CABG surgery were observed in patients at high risk for restenosis (SAQ angina frequency difference=10.8+/-4.2, P=0.01; SAQ quality of life difference=10.8+/-3.9, P=0.006). The relative health status benefits of CABG surgery compared with PCI increase as the risk of restenosis increases. Although selecting CABG or PCI is complex, preprocedural restenosis risk should be considered. It should also be tested as a means for considering drug-eluting as opposed to bare metal stents in PCI.
    Circulation 03/2005; 111(6):768-73. DOI:10.1161/01.CIR.0000155242.70417.60 · 14.95 Impact Factor
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    ABSTRACT: The incidence of tricuspid annuloplasty (TR) observed early after cardiac biatrial implantation is unpredictable and in our experience not infrequently problematic. Although the bicaval method of implant may reduce the incidence of TR, its benefit has not been conclusively documented. In an attempt to reduce the incidence of TR observed early after cardiac transplantation, 25 consecutive patients undergoing cardiac transplantation received donor heart tricuspid annuloplasty (TA) with either a DeVega or Ring technique. Early transthoracic echocardiograms were analyzed and compared with an immediately prior and consecutive cohort of 25 patients undergoing transplantation without TA. The biatrial technique of cardiac transplantation with a Cabrol modification was used for donor heart implant in both groups. Echocardiograms obtained 5 days after cardiac transplantation were reviewed in blinded fashion. TR was scored 0 = none, 1 = mild, 2 = moderate, and 3 = severe. Donor and recipient characteristics were not different between groups. No hospital deaths occurred in either group. Patients undergoing transplantation without TA had a higher TR score, 1.3 (range 0-3), than did patients with TA, 0.7 (range 0-1.5, p = 0.002). Moderate or severe TR was present in 8 of 25 patients without TA compared with 0 of 25 patients with TA (p = 0.004). No patients required permanent pacemaker. TA can significantly reduce the incidence of early postoperative TR after biatrial cardiac transplant without adding to the complexity of operation.
    The Journal of Heart and Lung Transplantation 11/2004; 23(10):1160-2. DOI:10.1016/j.healun.2004.01.001 · 5.61 Impact Factor
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    ABSTRACT: Omega-3 fatty acids (FAs) appear to reduce the risk of sudden death from myocardial infarction. This reduction is believed to occur via the incorporation of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) into the myocardium itself, altering the dynamics of sodium and calcium channel function. The extent of incorporation has not been determined in humans. We first determined the correlation between red blood cell (RBC) and cardiac omega-3 FA levels in 20 heart transplant recipients. We then examined the effects of 6 months of omega-3 FA supplementation (1 g/d) on the FA composition of human cardiac and buccal tissue, RBCs, and plasma lipids in 25 other patients. Cardiac and RBC EPA+DHA levels were highly correlated (r=0.82, P<0.001). Supplementation increased EPA+DHA levels in cardiac tissue by 110%, in RBCs by 101%, in plasma by 139%, and in cheek cells by 73% (P<0.005 versus baseline for all; responses among tissues were not significantly different). Although any of the tissues examined could serve as a surrogate for cardiac omega-3 FA content, RBC EPA+DHA was highly correlated with cardiac EPA+DHA; the RBC omega-3 response to supplementation was similar to that of the heart; RBCs are easily collected and analyzed; and they have a less variable FA composition than plasma. Therefore, RBC EPA+DHA (also called the Omega-3 Index) may be the preferred surrogate for cardiac omega-3 FA status.
    Circulation 09/2004; 110(12):1645-9. DOI:10.1161/01.CIR.0000142292.10048.B2 · 14.95 Impact Factor
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    ABSTRACT: One-year health status improvements in 62 patients with previous coronary artery bypass grafting (CABG) were compared with those of 628 patients undergoing initial CABG using the Seattle Angina Questionnaire (SAQ). Adjusted analyses revealed that repeat CABG conferred similar 1-year improvements in health status compared with patients undergoing a first CABG (changes in SAQ Physical Limitation score [SAQ-PL: repeat CABG 25 +/- 27 vs first CABG 20 +/- 27; p = 0.30], Quality of Life score [SAQ-QoL: 34 +/- 24 vs 35 +/- 5; p = 0.87], and Angina Frequency score (SAQ-AF: 35 +/- 40 vs 25 +/- 24; p = 0.03]).
    The American Journal of Cardiology 09/2004; 94(4):494-7. DOI:10.1016/j.amjcard.2004.05.008 · 3.43 Impact Factor

Publication Stats

537 Citations
226.63 Total Impact Points

Institutions

  • 2003–2010
    • Saint Luke's Health System (KS, USA)
      Kansas City, Kansas, United States
  • 1992–2008
    • St. Luke's Hospital
      Cedar Rapids, Iowa, United States
  • 2002–2006
    • University of Missouri - Kansas City
      • • Department of Surgery
      • • "Saint Luke's" Mid America Heart Institute
      • • School of Medicine
      Kansas City, Missouri, United States
    • Kansas City Art Institute
      Kansas City, Missouri, United States
  • 2005
    • University of Iowa
      Iowa City, Iowa, United States
  • 1999
    • St. Luke School of Medicine
      Kansas City, Missouri, United States