A M Borkon

St. Luke's Hospital (MO, USA), Saint Louis, Michigan, United States

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Publications (33)139.27 Total impact

  • [Show abstract] [Hide abstract]
    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; · 0.99 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.
  • Journal of Heart and Lung Transplantation - J HEART LUNG TRANSPLANT. 01/2011; 30(4).
  • The Journal of Heart and Lung Transplantation 02/2010; 29(2). · 5.11 Impact Factor
  • Journal of Heart and Lung Transplantation - J HEART LUNG TRANSPLANT. 01/2010; 29(2).
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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. · 4.01 Impact Factor
  • The Journal of Heart and Lung Transplantation 02/2009; 28(2). · 5.11 Impact Factor
  • Journal of Heart and Lung Transplantation - J HEART LUNG TRANSPLANT. 01/2009; 28(2).
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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.
  • Journal of Heart and Lung Transplantation - J HEART LUNG TRANSPLANT. 01/2008; 27(2).
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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. · 15.20 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. · 15.20 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. · 5.11 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. · 3.21 Impact Factor
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    ABSTRACT: The purpose of this study was to describe the health status (symptoms, function, and quality of life) changes of elderly patients undergoing coronary artery bypass grafting (CABG) and compare these to younger patients. Despite increasing use of CABG in the elderly, few data exist about elderly patients' health status benefits from CABG. A total of 690 consecutive patients (n = 156, >75 years of age; n = 534, <or=75 years of age) from a single center were administered the Seattle Angina Questionnaire (SAQ) at baseline and at one year. The first 224 patients were also given monthly questionnaires for six months after CABG. Although peri-operative mortality was similar (2.6% vs. 2.2%, p = NS), one-year mortality was greater in older patients (11.5% vs. 5.4%, p = 0.008). Among survivors, similar health status benefits were observed one year after surgery (SAQ change scores for Physical Function 21.5 +/- 27.0 vs. 19.7 +/- 27.0, p = 0.67; Angina Frequency 30.1 +/- 25.7 vs. 24.6 +/- 25.6, p = 0.07; and Quality of Life 37.7 +/- 21.8 vs. 33.6 +/- 25.2, p = 0.16). In 224 patients assessed monthly, elderly patients' physical function scores were significantly lower than the younger group until one year. The age-time interaction term was significant (p = 0.003), confirming a slower recovery of physical function. In contrast, angina relief and quality of life improvement did not differ by age. Despite a slower rate of physical recovery, older patients derived similar health status benefits from CABG compared with younger patients. These data should assist physicians in counseling elderly patients and suggest that age alone should not be a deterrent for recommending bypass surgery.
    Journal of the American College of Cardiology 10/2003; 42(8):1421-6. · 14.09 Impact Factor
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    ABSTRACT: We sought to evaluate the risk of long-term mortality with respect to post-operative elevation of the isoenzyme CK-MB following first-time isolated coronary artery bypass grafting (CABG) surgery. Patients undergoing first-time isolated CABG between September 1992 and December 2001, at the Mid America Heart Institute, were included in this registry analysis. A sole CK-MB measurement was obtained at an average of 15.2h following CABG. The main endpoint was long-term mortality. There were 3667 patients included in this registry. The mean follow up was 5.1 years. The event-free survival rate was 80%, 78% and 73%, for the normal, 1-3 and >3 times by ULN groups respectively; log-rank p=0.0058. The event-free survival for the four CK-MB groups was 80%, 78%, 75% and 72% for the normal, 1-3 times, >3-5, and >5 times ULN groups respectively, log-rank p=0.0078. The CK-MB elevation following CABG remained a significant predictor following multivariate adjustment. With a point estimate of 1.04, 95% confidence limits 1.009-1.062, p=0.007. Elevation of the isoenzyme CK-MB is an important predictor of longterm mortality following coronary bypass grafting. These data support routine use of creatinine kinase measurement following bypass surgery to further delineate long-term risk.
    European Heart Journal 07/2003; 24(14):1323-8. · 14.72 Impact Factor
  • Journal of The American College of Cardiology - J AMER COLL CARDIOL. 01/2003; 41(6):522-522.
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    ABSTRACT: Selection of the optimum mode of coronary revascularization should not only be directed by technical outcomes, but should also consider patients' postprocedural health status, including symptoms, functionality, and quality of life. Health status was analyzed and compared after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) using the Seattle Angina Questionnaire (SAQ). The SAQ was administered to 475 patients (252 PCI and 223 CABG) preprocedure and then monthly for 6 months and again at 1 year. Differences in baseline characteristics were controlled by multivariable risk adjustment, and outcomes over time were compared using repeated-measures analysis of variance. In-hospital, 6-and 12-month clinical outcomes were not different; however, 25% of PCI patients required at least one reintervention during the study period, compared with only 1% of CABG patients (p < 0.001). Although physical function decreased for CABG patients at 1 month (p < 0.001), it improved and was better than the PCI group by 12 months (p = 0.008). Relief of angina was greater for CABG than PCI when analyzed over time (p < 0.001), principally due to the adverse effects of restenosis in the PCI group. Multivariable analysis confirmed that CABG independently conferred greater angina relief compared with PCI (p < 0.001). At 12 months postprocedure, quality of life had improved to a greater extent for CABG than PCI (p = 0.004). Over 12 months of follow-up, health status was improved to a greater extent for CABG patients than for PCI patients, primarily due to the adverse influence of restenosis after PCI.
    The Annals of Thoracic Surgery 11/2002; 74(5):1526-30; discussion 1530. · 3.45 Impact Factor
  • The Journal of Heart and Lung Transplantation 01/2002; 21(1). · 5.11 Impact Factor
  • N D Long, A M Borkon
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    ABSTRACT: The number of patients being listed for heart transplantation continues to escalate. Despite a variety of attempts to increase organ donation, the number of available donor hearts remains unchanged. This imbalance of supply and demand creates medical rationing of donor organs. When the success of heart transplantation became apparent, selection criteria was relaxed, further increasing the disparity between the numbers of donor hearts and potential recipients. Decreasing the demand by tightening the selection criteria is the most reasonable solution at this time.
    Journal of transplant coordination: official publication of the North American Transplant Coordinators Organization (NATCO) 01/2000; 9(4):277-80.

Publication Stats

270 Citations
139.27 Total Impact Points

Institutions

  • 2005
    • St. Luke's Hospital (MO, USA)
      Saint Louis, Michigan, United States
  • 1991–2004
    • University of Missouri - Kansas City
      • • "Saint Luke's" Mid America Heart Institute
      • • Department of Surgery
      Kansas City, Missouri, United States
  • 2003
    • Saint Luke's Health System (KS, USA)
      Kansas City, Kansas, United States
  • 1992–2000
    • St. Luke's Hospital
      Cedar Rapids, Iowa, United States
  • 1999
    • St. Luke School of Medicine
      Kansas City, Missouri, United States