Amit Patel

Loyola University Chicago, Chicago, IL, United States

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Publications (4)2.22 Total impact

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    ABSTRACT: Repair of the ascending aorta and aortic arch carries a high morbidity and mortality, which can be complicated by the often emergent nature of the intervention. We retrospectively evaluated the morbidity, mortality, and long-term survival in 101 patients who underwent repair of ascending aorta and aortic arch. Depending on the urgency of the operation, the patients were categorized as elective (EL, n=82) or emergent (EM, n=19). Log-rank-list and SPS were used to evaluate the data. The average age was 58+/-16 years. The aortic diameter was 5.5+/-1 cm in the EL group and 6.1+/-1.4 cm for EM group. The aortic dissection in EL and EM groups was 15% and 79%, respectively. The mean circulatory arrest time (n=32 patients) was 38+/-18.5 min. The overall 30-day mortality was 4%: 0% for the EL group and 26% for the EM group. The overall 6-month mortality was 8%: 3.7% and 26% in EL and EM groups, respectively. Overall CVA was 3%: 0% in the EL group and 15.7% in the EM group. The mean CPB time was 176+/-81 min. The prolonged CPB time correlated with increased need for blood transfusion. The LOS was 12+/-8 days and correlated with increasing age (95% CI 0.06860-0.2307, P=0.0004), with NYHA stage of patients at the time of surgery (95% confidence intervals, 1.328-4.202, P=0.0003), with left ventricular ejection fraction (95% CI 0.2357 to -0.003029, P=0.0442) and with postoperative atrial fibrillation (95% CI 0.1192-0.4745, P=0.0018). The average ICU stay was 123+/-145 h. A prolonged CPB time resulted in extended ICU stay (95% CI 0.3655-1.486, P=0.0014). Further, the length of ICU stay correlated with NYHA status (95% CI 19.98-73.42, P=0.0008), age (95% confidence intervals 0.01668-3.761, P=0.0477), urgency of surgery (95% CI 65.00-124.0, P<0.0001), and length of CPB time (95% CI 0.3655-1.486, P=0.0014). Emergent operations are associated with high morbidity and mortality. Pre-existing heart failure, advanced age, and prolonged cardiopulmonary bypass are associated with prolonged monitoring in the ICU.
    Interactive Cardiovascular and Thoracic Surgery 07/2008; 7(5):850-4. · 1.11 Impact Factor
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    ABSTRACT: Aortic arch replacement is associated with high morbidity and mortality. We evaluated the postoperative complications and risk factors in 32 consecutive patients after aortic arch replacement. The mean age was 61+/-15 years and male to female ratio was 24/8. Diameter of ascending aorta was 6.0+/-0.8 cm and diameter of aortic arch was 5.2+/-1.2 cm. The average New York heart association (NYHA) class was 2+/-1. The 30-day mortality was 6.2% (2 of 32 patients), one patient died intraoperatively (3%); all surviving 30 patients had f/u for at least six months, a total of 3 of 32 patients had died within six months, actuarial survival was 90% at six months. The overall incidence of neurologic adverse events was 9%; however, only one patient had a cerebrovascular accident (CVA) with a focal deficit (3%). The other two patients had global neurologic dysfunction. Other significant postoperative complications included atrial fibrillation in 15 patients (46%), ventricular fibrillation requiring cardiopulmonary resuscitation (CPR) in one patient (3%), and pericardial effusion requiring pericardicentesis in eight patients (25%). The need for blood transfusion correlated with the cross-clamping length (Pearson r 0.62; 95% confidence interval (CI), 0.35-0.79; P-value 0.0001; R(2)=0.38). Cross-clamp time (139+/-58 min) did not have an impact on length of intensive care unit (ICU) stay (Pearson r -0.09; 95% CI -0.39-0.23; P=0.58; R(2)=0.008) nor did the length of circulatory arrest (95% CI -0.44-0.21, P=0.44). The length of stay in the ICU (142+/-128 h) correlated with the NYHA stage of the patient (95% CI 0.001-0.62, P=0.04). The length of stay (LOS) (12+/-6 days) correlated with age of the patients (95% CI 0.03-0.57, P=0.03). Elderly patients and patients with high NYHA class need close postoperative monitoring in the ICU. A short circulatory arrest and aortic clamp time do not extend the LOS in ICU or in the hospital.
    Interactive Cardiovascular and Thoracic Surgery 06/2008; 7(3):425-9. · 1.11 Impact Factor
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    ABSTRACT: a 38 Overall CVA was 3%: 0% in the EL group and 15.7% in the EM group. The mean CPB time was 176"81 min. The prolonged CPB time correlated 39 with increased need for blood transfusion. The LOS was 12"8 days and correlated with increasing age (95% CI 0.06860-0.2307, Ps0.0004), 40 with NYHA stage of patients at the time of surgery (95% confidence intervals, 1.328-4.202, Ps0.0003), with left ventricular ejection 41 fraction (95% CI 0.2357 to y0.003029, Ps0.0442) and with postoperative atrial fibrillation (95% CI 0.1192-0.4745, Ps0.0018). The average 42 ICU stay was 123"145 h. A prolonged CPB time resulted in extended ICU stay (95% CI 0.3655-1.486, Ps0.0014). Further, the length of ICU 43 stay correlated with NYHA status (95% CI 19.98-73.42, Ps0.0008), age (95% confidence intervals 0.01668-3.761, Ps0.0477), urgency of 44 surgery (95% CI 65.00-124.0, P-0.0001), and length of CPB time (95% CI 0.3655-1.486, Ps0.0014). Conclusion: Emergent operations are 45 associated with high morbidity and mortality. Pre-existing heart failure, advanced age, and prolonged cardiopulmonary bypass are associated 46 with prolonged monitoring in the ICU.