Patrick M McCarthy

Northwestern Memorial Hospital, Chicago, Illinois, United States

Are you Patrick M McCarthy?

Claim your profile

Publications (492)2064.03 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Severe symptomatic aortic stenosis (AS) is associated with high mortality without intervention. The impact of waiting time for aortic valve replacement (AVR), either surgically or transcatheter, has not been reported.
    The Annals of thoracic surgery. 09/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Ventricular septal myectomy in patients with obstructive hypertrophic cardiomyopathy (HC) has been shown to reduce left ventricular (LV) outflow tract (LVOT) gradient and improve symptoms, although little data exist regarding changes in left atrial (LA) volume and LV diastolic function after myectomy. We investigated changes in LA size and LV diastolic function in patients with HC after septal myectomy from 2004 to 2011. We studied 25 patients (age 49.2 ± 13.1 years, 48% women) followed for a mean of 527 days after surgery who had serial echocardiography at baseline and at most recent follow-up, at least 6 months after myectomy. In addition to myectomy, 3 patients (12%) underwent Maze surgery and 13 (52%) underwent mitral valve surgery, of whom 5 had a mitral valve replacement or mitral annuloplasty. Patients with mitral valve replacement or mitral annuloplasty were excluded from LV diastolic function analysis. LA volume index decreased (from 47.2 ± 17.6 to 35.9 ± 17.0 ml/m(2), p = 0.001) and LV diastolic function improved with an increase in lateral e' velocity (from 7.3 ± 2.9 to 9.8 ± 3.1 cm/sec, p = 0.01) and a decrease in E/e' (from 14.8 ± 6.3 to 11.7 ± 5.5, p = 0.051). Ventricular septal thickness and LVOT gradient decreased, and symptoms of dyspnea and heart failure improved, with reduction in the New York Heart Association functional class III/IV symptoms from 21 (84%) to 1 (4%). In conclusion, relief of LVOT obstruction in HC by septal myectomy results in improved LV diastolic function and reduction in LA volume with improved symptoms.
    The American journal of cardiology. 08/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: There exists considerable controversy surrounding the timing and extent of aortic resection for patients with BAV disease. Since abnormal wall shear stress (WSS) is potentially associated with tissue remodeling in BAV-related aortopathy, we propose a methodology that creates patient-specific 'heat maps' of abnormal WSS, based on 4D flow MRI. The heat maps were created by detecting outlier measurements from a volumetric 3D map of ensemble-averaged WSS in healthy controls. 4D flow MRI was performed in 13 BAV patients, referred for aortic resection and 10 age-matched controls. Systolic WSS was calculated from this data, and an ensemble-average and standard deviation (SD) WSS map of the controls was created. Regions of the individual WSS maps of the BAV patients that showed a higher WSS than the mean + 1.96SD of the ensemble-average control WSS map were highlighted. Elevated WSS was found on the greater ascending aorta (35% ± 15 of the surface area), which correlated significantly with peak systolic velocity (R (2) = 0.5, p = 0.01) and showed good agreement with the resected aortic regions. This novel approach to characterize regional aortic WSS may allow clinicians to gain unique insights regarding the heterogeneous expression of aortopathy and may be leveraged to guide patient-specific resection strategies for aorta repair.
    Annals of biomedical engineering. 08/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Multiple techniques have been used to repair degenerative mitral valve prolapse with leaflet elongation, without creating systolic anterior motion. We describe a simple, reproducible, measured technique to guide repair.
    The Journal of thoracic and cardiovascular surgery. 07/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background The EVEREST II (Endovascular Valve Edge-to-Edge REpair STudy) High-Risk registry and REALISM Continued Access Study High-Risk Arm are prospective registries of patients who received the MitraClip device (Abbott Vascular, Santa Clara, California) for mitral regurgitation (MR) in the United States. Objectives The purpose of this study was to report 12-month outcomes in high-risk patients treated with the percutaneous mitral valve edge-to-edge repair. Methods Patients with grades 3 to 4+ MR and a surgical mortality risk of ≥12%, based on the Society of Thoracic Surgeons risk calculator or the estimate of a surgeon coinvestigator following pre-specified protocol criteria, were enrolled. Results In the studies, 327 of 351 patients completed 12 months of follow-up. Patients were elderly (76 ± 11 years of age), with 70% having functional MR and 60% having prior cardiac surgery. The mitral valve device reduced MR to ≤2+ in 86% of patients at discharge (n = 325; p < 0.0001). Major adverse events at 30 days included death in 4.8%, myocardial infarction in 1.1%, and stroke in 2.6%. At 12 months, MR was ≤2+ in 84% of patients (n = 225; p < 0.0001). From baseline to 12 months, left ventricular (LV) end-diastolic volume improved from 161 ± 56 ml to 143 ± 53 ml (n = 203; p < 0.0001) and LV end-systolic volume improved from 87 ± 47 ml to 79 ± 44 ml (n = 202; p < 0.0001). New York Heart Association functional class improved from 82% in class III/IV at baseline to 83% in class I/II at 12 months (n = 234; p < 0.0001). The 36-item Short Form Health Survey physical and mental quality-of-life scores improved from baseline to 12 months (n = 191; p < 0.0001). Annual hospitalization rate for heart failure fell from 0.79% pre-procedure to 0.41% post-procedure (n = 338; p < 0.0001). Kaplan-Meier survival estimate at 12 months was 77.2%. Conclusions The percutaneous mitral valve device significantly reduced MR, improved clinical symptoms, and decreased LV dimensions at 12 months in this high-surgical-risk cohort. (Endovascular Valve Edge-to-Edge REpair STudy [EVERESTIIRCT]; NCT00209274)
    Journal of the American College of Cardiology 07/2014; 64(2):172–181. · 14.09 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The recently implemented integrated 6-year (I-6) format represents a significant change in cardiothoracic surgical residency training. We report the results of the first nationwide survey assessing I-6 program directors' impressions of this new format. A 28-question web-based survey was distributed to program directors of all 24 Accreditation Council for Graduate Medical Education-accredited I-6 training programs in November 2013. The response rate was a robust 67%. Compared with graduates of traditional residencies, most I-6 program directors with enrolled residents believed that their graduates will be better trained (67%), be better prepared for new technological advances (67%), and have superior comprehension of cardiothoracic disease processes (83%). Just as with traditional program graduates, most respondents believed their I-6 graduates would be able to independently perform routine adult cardiac and general thoracic operations (75%) and were equivocal on whether additional specialty training (eg, minimally invasive, heart failure, aortic) was necessary. Most respondents did not believe that less general surgical training disadvantaged I-6 residents in terms of their career (83%); 67% of respondents would have chosen the I-6 format for themselves if given the choice. The greater challenges in training less mature and experienced trainees and vulnerability to attrition were noted as disadvantages of the I-6 format. Most respondents believed that I-6 programs represent a natural evolution toward improved residency training rather than a response to declining interest among medical school graduates. High satisfaction rates with the I-6 format were prevalent among I-6 program directors. However, concerns with respect to training relatively less experienced, mature trainees were evident.
    The Journal of thoracic and cardiovascular surgery 04/2014; · 3.41 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background The objectives of this study were twofold: to assess the diagnostic utility of three-dimensional (3D) multiplanar reconstruction (MPR) in identifying prolapsing mitral valve (MV) scallops, and (2) to compare two-dimensional (2D) transthoracic echocardiography (TTE) and 3DMPR to (2D) transesophageal echocardiography (TEE) approaches among patients with mitral valve prolapse (MVP).Methods Fifty-five patients with MVP who underwent MV repair or replacement were retrospectively analyzed using 3 types of echocardiographic studies (2DTEE, 2DTTE, 3DMPR). The operative (OR) findings were considered the gold standard.ResultsWhen 3DMPR was combined with 2DTTE, the agreement with the OR findings was moderately strong for the A2 scallop (P < 0.001) and strong for the A3 scallop (P = 0.001), entire anterior leaflet (P < 0.001), P2 scallop (P < 0.001) and the entire posterior leaflet (P < 0.001). In comparison to the OR findings, 2DTEE demonstrated moderately strong agreement for the A2 scallop (P = 0.010) and the entire anterior leaflet (P < 0.001), and strong agreement for the P2 scallop (P < 0.001) and entire posterior leaflet (P < 0.001).Conclusions Three-dimensional MPR should be added to the armamentarium of complementary echo techniques in the evaluation of MVP. There is increased benefit in combining 3DMPR with 2DTTE findings as part of the preoperative evaluation of patients with MVP.
    Echocardiography 04/2014; · 1.26 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Bicuspid aortic valve (BAV) disease is associated with aortic dilatation and aneurysm (AN) formation. The American College of Cardiology/American Heart Association (ACC/AHA) 2006 guidelines recommend replacement of the ascending aorta for an aortic diameter (AD) > 45 mm in patients undergoing aortic valve replacement (AVR). We evaluated the outcomes of AVR and AVR with aortic replacement (AVR/AN). We retrospectively reviewed (2004-2011) the data from 456 patients with BAV and compared the morbidity and mortality between the AVR and AVR/AN groups and 3 subgroups: AVR with an AD < 45 mm; AVR/AN with an AD of 45 to 49 mm; and AVR/AN with an AD of ≥50 mm. Propensity score matching was used to reduce bias. Of the 456 patients, 250 (55%) underwent AVR and 206 (45%) AVR/AN, with 98% compliance with the current guidelines. The overall 30-day mortality was 0.9%. The AVR AD < 45-mm group had adjusted short- and medium-term survival similar to that of the AVR/AN AD 45- to 49-mm and AVR/AN AD ≥ 50-mm groups, with a 30-day mortality of 0.8%, 0%, and 1.9%, respectively (P = .41). The propensity score-matched AVR/AN AD ≥ 50-mm group had significantly greater rates of reintubation than either the AVR AD < 45-mm (P = .012) or AVR/AN AD 45- to 49-mm (P = .04) group and greater rates of prolonged ventilation (P = .022) than the AVR AD < 45-mm group. No significant differences were found in reoperation or myocardial infarction among the subgroups. In patients with undergoing AVR, no increase was seen in morbidity or mortality when adding aortic replacement with an AD of 45 to 49 mm, in accordance with the 2006 ACC/AHA guidelines, although the AVR/AN AD ≥ 50-mm group had a greater risk of respiratory complications. Our findings indicate that compliance with the ACC/AHA guidelines is safe in select centers.
    The Journal of thoracic and cardiovascular surgery 03/2014; · 3.41 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Prospective outcome reports of mitral valve (MV)/Maze are scarce and little has been reported about the outcomes of the MV portion of the procedure [1,2]. We investigated atrial fibrillation (AF) ablation and MV repair outcomes. Methods: 1540 patients underwent MV surgery (1066 MV repair, 69%) +/- other operations; 954 had No AF history, and 586 (38%) had preoperative AF. AF was treated in 515 (88%; TrAF), and not treated in 71 (UntrAF). No AF and TrAF groups were compared using propensity score (PS) matching. Results: After PS-matching, 30-day mortality was 3% inTrAF and NoAF (p=0.63) with TrAF patients having lower perioperative morbidity (p<0.001); but a trend (p=0.08; 3% versus 6%) for permanent pacemaker implant. Annualized stroke rate was similar (1.0% TrAF versus 0.9% NoAF, p=1.0). Biatrial lesions versus left atrial lesions showed no differences in FFAF at last follow-up (79.5% versus 73.3%, p=0.33) and pre-discharge pacemakers (11% versus 6%, p=0.21). In the TrAF repair group, mean mitral regurgitation (MR) decreased from 3.4±1.0 preoperatively to 0.2±0.5 pre-discharge (p<0.001) and 0.4±0.6 at last follow-up (p<0.001). Freedom from 3+/4+ MR at last follow-up was 100%and from MV reoperation at 7 years was 97.9 % in the TrAF MV repair group. Conclusions: MV repair outcomes with AF ablation were good but there was a trend toward a need for pacemaker compared to the NoAF group. After PS-matching, the stroke rate and perioperative outcomes were similar. The LA only lesion set was as effective as more complex lesion sets.
    Society of Thoracic Surgeons, Orlando, FL; 01/2014
  • SCMR; 01/2014
  • Circulation Cardiovascular Imaging 01/2014; 7(1):210. · 5.80 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Aortic 3D blood flow was analyzed to investigate altered ascending aorta (AAo) hemodynamics in bicuspid aortic valve (BAV) patients and its association with differences in cusp fusion patterns (right-left, RL versus right-noncoronary, RN) and expression of aortopathy. 4D flow MRI measured in vivo 3D blood flow in the aorta of 75 subjects: BAV patients with aortic dilatation stratified by leaflet fusion pattern (n=15 RL-BAV, mid AAo diameter=39.9±4.4mm; n=15 RN-BAV, 39.6±7.2mm); aorta size controls with tricuspid aortic valves (n=30, 41.1±4.4mm); healthy volunteers (n=15, 24.9±3.0mm). Aortopathy type (0-3), systolic flow angle, flow displacement, and regional wall shear stress (WSS) were determined for all subjects. Eccentric outflow jet patterns in BAV patients resulted in elevated regional WSS (p<0.0125) at the right-anterior walls for RL-BAV and right-posterior walls for RN-BAV compared to aorta size controls. Dilatation of the aortic root only (type 1) or involving the entire AAo and arch (type 3) was found in the majority of RN-BAV patients (87%) but was mostly absent for RL-BAV (87% type 2). Differences in aortopathy type between RL-BAV and RN-BAV were associated with altered flow displacement in the proximal and mid AAo for type 1 (42-81% decrease versus type 2) and distal AAo for type 3 (33-39% increase versus type 2). The presence and type of BAV fusion was associated with changes in regional WSS distribution, systolic flow eccentricity, and expression of BAV aortopathy. Hemodynamic markers suggest a physiologic mechanism by which valve morphology phenotype can influence phenotypes of BAV aortopathy.
    Circulation 12/2013; · 15.20 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE To evaluate aortic hemodynamics using 4D flow MRI following aortic root replacement (AR) or aortic root and hemiarch replacement (AR+HA), comparing to patients following non-mechanical aortic valve replacement (AVR) alone. METHOD AND MATERIALS IRB approval was obtained. 31 patients were recruited following open AVR (group 1: AR, n=16, 51±13 yrs; group 2: AR+HA, n=4, 60±10 yrs; group 3: AVR alone, n=11, 69±11 yrs). Aortic blood flow was measured using ECG and respiration synchronized 4D flow MRI (3-directional venc = 150cm/s, 2.0-2.8mm3, temp res 40-44msec) at 1.5 or 3T (Aera, Avanto, or Skyra, Siemens, Erlangen, GE) post-contrast administration. Data analysis included 3D blood flow visualization (EnSight, CEI, USA) based on time-resolved 3D pathlines and systolic 3D streamlines. Helical flow was assessed in the Ascending aorta (AAo), arch, and descending aorta on a 3-point Likert scale (<180°, 180-360°, >360°). 3D pathlines qualitatively identified the existence of flow jets and the quadrant of flow impingement in the proximal, mid, and distal AAo. Flow uniformity was analyzed by quadrant dichotomizing systolic peak velocities at 1m/s. Peak systolic velocities and acceleration were quantified in 9 planes distributed throughout the thoracic aorta. Groups were compared using the student’s t-test. RESULTS 4D flow MRI revealed similar helical flow across groups (p>0.05). 72 % (8 of 11) of patients in group 3 demonstrated outflow jets impinging on the right anterior proximal aortic wall. Jet flow was seen in 52% (10 of 20) of patients in groups 1 & 2 and was preferentially directed towards the anterior wall. Flow profiles were asymmetric in 62%, 100%, and 72% of groups 1-3, respectively. There were significant differences between groups 1 and 2 compared to group 3 for peak acceleration and significant differences between groups 1 and 3 for peak velocities (p<0.05). CONCLUSION 4D flow MRI characterized flow in AVR patients. Our preliminary findings demonstrate elevated peak systolic velocities and acceleration in patients with aortic grafts compared to patients with AVR alone. Follow-up studies are warranted to investigate the influence of these findings on ventricular loading and patient outcome. CLINICAL RELEVANCE/APPLICATION 4D flow MRI demonstrates increased aortic peak velocities and acceleration status-post aortic replacement with graft material, suggesting increased ventricular loading with altered aortic compliance.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: To provide a more complete characterization of aortic blood flow in patients following valve-sparing aortic root replacement (VSARR) compared with presurgical cohorts matched by tricuspid and bicuspid valve morphology, age and presurgical aorta size. Four-dimensional (4D) flow magnetic resonance imaging (MRI) was performed to analyse three-dimensional (3D) blood flow in the thoracic aorta of n = 13 patients after VSARR with reimplantation of native tricuspid aortic valve (TAV, n = 6) and bicuspid aortic valve (BAV, n = 7). Results were compared with presurgical age and aortic size-matched control cohorts with TAV (n = 10) and BAV (n = 10). Pre- and post-surgical aortic flow was evaluated using time-resolved 3D pathlines using a blinded grading system (0-2, 0 = small, 1 = moderate and 2 = prominent) analysing ascending aortic (AAo) helical flow. Systolic flow profile uniformity in the aortic root, proximal and mid-AAo was evaluated using a four-quadrant model. Further analysis in nine analysis planes distributed along the thoracic aorta quantified peak systolic velocity, retrograde fraction and peak systolic flow acceleration. Pronounced AAo helical flow in presurgical control subjects (both BAV and TAV: helix grading = 1.8 ± 0.4) was significantly reduced (0.2 ± 0.4, P < 0.001) in cohorts after VSARR independent of aortic valve morphology. Presurgical AAo flow was highly eccentric for BAV patients but more uniform for TAV. VSARR resulted in less eccentric flow profiles. Systolic peak velocities were significantly (P < 0.05) increased in post-root repair BAV patients throughout the aorta (six of nine analysis planes) and to a lesser extent in TAV patients (three of nine analysis planes). BAV reimplantation resulted in significantly increased peak velocities in the proximal AAo compared with root repair with TAV (2.3 ± 0.6 vs 1.6 ± 0.4 m/s, P = 0.017). Post-surgical patients showed a non-significant trend towards higher systolic flow acceleration as a surrogate measure of reduced aortic compliance. VSARR restored a cohesive flow pattern independent of native valve morphology but resulted in increased peak velocities throughout the aorta. 4D flow MRI methods can assess the clinical implications of altered aortic flow dynamics in patients undergoing VSARR.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 12/2013; · 2.40 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess the impact of aortic valve morphology on aortic hemodynamics between normal tricuspid and congenitally anomalous aortic valves ranging from unicuspid to quadricuspid morphology. Aortic three-dimensional (3D) blood flow was evaluated by 4D flow MRI in 14 healthy volunteers with normal trileaflet valves and 14 patients with unicuspid (n = 3), bicuspid (n = 9, 3 "true" bicuspid, 3 right-left (RL), 3 right-noncoronary (RN) leaflet fusion, and quadricuspid aortic valves (n = 2). Data analysis included the co-registered visualization of aortic valve morphology with systolic 3D blood flow. The influence of valve morphology on aortic hemodynamics was quantified by valve flow angle. All RL-bicuspid aortic valve (BAV) were associated with flow jets directed toward the right anterior aortic wall while RN-fusion and unicuspid valves resulted in flow jet patterns toward the right-posterior or posterior wall. Flow angles were clearly influenced by valve morphology (47° ± 10, 28° ± 2, 29° ± 18, 18° ± 12, 15° ± 2 for unicuspid, true BAV, RN-BAV, RL-BAV, quadricuspid valves) and increased compared with controls (7.2° ± 1.1, P = 0.001). Altered 3D aortic hemodynamics are impacted by the morphology of congenitally malformed aortic valves.J. Magn. Reson. Imaging 2013. © 2013 Wiley Periodicals, Inc.
    Journal of Magnetic Resonance Imaging 11/2013; · 2.57 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To present a theoretical basis for noninvasively characterizing in vivo fluid-mechanical energy losses and to apply it in a pilot study of patients known to express abnormal aortic flow patterns. Four-dimensional flow MRI was used to characterize laminar viscous energy losses in the aorta of normal controls (n = 12, age = 37 ± 10 yr), patients with aortic dilation (n = 16, age = 52 ± 8 yr), and patients with aortic valve stenosis matched for age and aortic size (n = 14, age = 46 ± 15 yr), using a relationship between the three-dimensional velocity field and viscous energy dissipation. Viscous energy loss was elevated significantly in the thoracic aorta in patients with dilated aorta (3.6 ± 1.3 mW, P = 0.024) and patients with aortic stenosis (14.3 ± 8.2 mW, P < 0.001) compared with healthy volunteers (2.3 ± 0.9 mW). The same pattern of significant differences was seen in the ascending aorta, where viscous energy losses in patients with dilated aortas (2.2 ± 1.1 mW, P = 0.021) and patients with aortic stenosis (10.9 ± 6.8 mW, P < 0.001) were elevated compared with healthy volunteers (1.2 ± 0.6 mW). This technique provides a capability to quantify the contribution of abnormal laminar blood flow to increased ventricular afterload. In this pilot study, viscous energy loss in patient cohorts was significantly elevated and indicates that cardiac afterload is increased due to abnormal flow. Magn Reson Med, 2013. © 2013 Wiley Periodicals, Inc.
    Magnetic Resonance in Medicine 10/2013; · 3.27 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: -The prevalence of prosthesis-patient mismatch (PPM) and its impact on survival after aortic valve replacement (AVR) have not been clearly defined. Historically, presence of PPM was identified from postoperative echocardiograms or pre-operative manufacturer-provided charts, resulting in wide discrepancies. The 2009 American Society of Echocardiography (ASE) guidelines proposed an algorithmic approach to calculate PPM. This study compared PPM prevalence and its impact on survival using three modalities: (i) the ASE guidelines-suggested algorithm (ASE PPM); (ii) the manufacturer-provided charts (M PPM); and (iii) the echocardiographically-measured, body surface area-indexed, effective orifice area (EOAi PPM) measurement. -614 patients underwent AVR with bovine pericardial valves from 2004 to 2009 and had normal preoperative systolic function. EOAi PPM was severe if EOAi was ≤0.60 cm(2)/m(2), moderate if EOAi was 0.60-0.85 cm(2)/m(2), and absent (none) if EOAi was ≥0.85 cm(2)/m(2). ASE PPM was severe in 22 (3.6%), moderate in 6 (1%), and absent (none) in 586 (95.4%). ASE PPM was similar to M PPM (p=1.00). ASE PPM differed significantly from EOAi PPM (p<0.001), which identified severe mismatch in 170 (29.7%), moderate in 191 (33.4%), and absent (none) in 211 patients (36.9%). Irrespective of the PPM classification method, PPM did not adversely affect mid-term survival (average follow-up 4.1±1.8 years, median 3.9 years, range 0.01 to 8 years). There were no reoperations for PPM. -In patients with normal systolic function undergoing bovine pericardial AVR, the prevalence of PPM using the algorithmic-ASE approach was low and correlates well with manufacturer-provided PPM. Independent of the method of PPM assessment, PPM was not associated with medium-term mortality.
    Circulation Cardiovascular Imaging 08/2013; · 5.80 Impact Factor
  • Patrick M McCarthy
    Circulation 08/2013; 128(6):653-8. · 15.20 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Randomized controlled trials of permanent atrial fibrillation ablation surgery have shown improved outcomes compared with control patients undergoing concomitant cardiac surgery. Little has been reported regarding patients with paroxysmal atrial fibrillation. We hypothesized that treating paroxysmal atrial fibrillation during cardiac surgery would not adversely affect the perioperative risk and would improve the midterm outcomes. From April 2004 to June 30 2012, 4947 patients (excluding those with transcatheter aortic valve implants, left ventricular assist devices, trauma, transplantation, and isolated atrial fibrillation surgery) underwent cardiac surgery, and 1150 (23%) had preoperative atrial fibrillation. Of these, 552 (48%) had paroxysmal atrial fibrillation. Three groups were compared using propensity score matching: treated (n = 423, 77%), untreated (n = 129, 23%), and no atrial fibrillation (n = 3797). The treated patients had 30-day mortality similar to that of the untreated patients and those without atrial fibrillation. They had fewer perioperative complications (26% vs 46%, P = .001), greater freedom from atrial fibrillation at the last follow-up visit (81% vs 60%, P = .007), and lower mortality (hazard ratio 0.47, P = .007) compared with the untreated patients. Compared with those without atrial fibrillation, the treated patients had fewer perioperative complications (25% vs 48%, P < .001), lower freedom from atrial fibrillation at the last follow-up visit (84% vs 93%, P = .001), and similar mortality. Concomitant surgical ablation of paroxysmal atrial fibrillation was not associated with increased perioperative risk. The treated patients had greater late freedom from atrial fibrillation and midterm survival compared with the untreated patients, and similar midterm survival compared with the patients without atrial fibrillation. These results suggest that paroxysmal atrial fibrillation warrants treatment consideration in select patients undergoing cardiac surgery.
    The Journal of thoracic and cardiovascular surgery 07/2013; · 3.41 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Given declining interest in cardiothoracic (CT) training programs during the last decade, increasing emphasis has been placed on engaging candidates early in their training. We examined the effect of supervised and unsupervised practice on medical students' interest in CT surgery. METHODS: Forty-five medical students participated in this study. Participants' interest level in surgery, CT surgery, and simulation were collected before and after a pretest session. Subsequently, participants were randomized to one of three groups: control (n = 15), unsupervised training on a low-fidelity task simulator (n = 15), or supervised training with a CT surgeon or fellow on the same simulator (n = 15). After 3 weeks, attitudes were reassessed at a posttest session. Interest levels were compared before and after the pretest using paired t tests, and the effects of training on interests were assessed with multiple linear regression analyses. RESULTS: After the pretest session, participants were significantly more interested in simulation (p = 0.001) but not in surgery or CT surgery. After training, compared with control group participants, supervised trainees demonstrated a significant increase in their interest level in pursuing a career in surgery (p = 0.028) and an increasing trend towards a career in CT surgery (p = 0.060), whereas unsupervised trainees did not. CONCLUSIONS: Supervised training on low-fidelity simulators enhances interest in a career in surgery. Practice that lacks supervision does not, possibly related to the complexity of the simulated task. Mentorship efforts may need to involve sustained interaction to provide medical students with enough exposure to appreciate a surgical career.
    The Annals of thoracic surgery 06/2013; 95(6):2057-2063. · 3.45 Impact Factor

Publication Stats

13k Citations
2,064.03 Total Impact Points


  • 2005–2014
    • Northwestern Memorial Hospital
      • Bluhm Cardiovascular Institute
      Chicago, Illinois, United States
    • Northwestern University
      • • Division of Cardiac Surgery
      • • Feinberg School of Medicine
      • • Division of Thoracic Surgery
      Evanston, Illinois, United States
    • Rice University
      • Department of Bioengineering
      Houston, TX, United States
  • 2005–2013
    • University of Illinois at Chicago
      Chicago, Illinois, United States
  • 2012
    • Johns Hopkins Medicine
      Baltimore, Maryland, United States
    • The University of Chicago Medical Center
      • Department of Anesthesia and Critical Care
      Chicago, Illinois, United States
  • 2008
    • The University of Calgary
      • Department of Cardiac Sciences
      Calgary, Alberta, Canada
  • 2007
    • Cleveland Clinic Laboratories
      Cleveland, Ohio, United States
  • 1994–2007
    • Cleveland Clinic
      • • Department of Cardiovascular Medicine
      • • Department of Cardiology
      • • Transplant Center
      • • Department of Biomedical Engineering
      Cleveland, OH, United States
  • 2006
    • Ulsan University Hospital
      Urusan, Ulsan, South Korea
  • 2001–2006
    • Lerner Research Institute
      Cleveland, Ohio, United States
  • 2004
    • AtriCure, Inc.
      Cincinnati, Ohio, United States
  • 2002
    • Cleveland State University
      • Department of Biological, Geological, and Environmental Sciences
      Cleveland, Ohio, United States
  • 2001–2002
    • Università degli Studi dell'Aquila
      • Department of Internal Medicine and Public Health
      Aquila, Abruzzo, Italy
  • 1995–2001
    • Texas Heart Institute
      • Division of Cardiovascular Surgery
      Houston, Texas, United States
    • Case Western Reserve University
      • Department of Macromolecular Science and Engineering
      Cleveland, OH, United States
  • 1999
    • Ochsner
      • Department of Cardiology
      New Orleans, LA, United States
  • 1993–1999
    • The Ohio State University
      • Department of Biomedical Engineering
      Columbus, Ohio, United States