Domenico Calcaterra

Miami Vererans Affairs Healthcare Florida

A 67-year-old woman was brought to the emergency department following a motor vehicle accident with blunt chest wall trauma. She was hypotensive and in acute respiratory distress requiring emergent endotracheal intubation. Contrast computed tomography showed bilateral pneumothoraxes and a levorotated posteriorly directed cardiac apex with herniatio...

Traumatic aortic injuries represent a leading cause of death following motor-vehicular accidents. These injuries curry a very high mortality rate even though a significant number of patients reaches the hospital alive. These injuries are identified in the contest of a polytrauma work up and are almost always associated with multiple other severe tr...

Prosthetic valve endocarditis after transcatheter aortic valve implantation (TAVI) is a rare complication associated with a high mortality rate. Nonetheless, the rapid expansion of TAVI in recent years has proportionally increased the number of patients exposed to the risk of developing transcatheter valve infection. A 71-year-old female with recen...

Background Coronary flow compromise is a significant risk of transcatheter aortic valve therapy. Warranting preservation of coronary flow is even more challenging with transcatheter aortic valve re-intervention since the implantation of a transcatheter valve within a degenerated bioprosthetic or transcatheter valve increases significantly this haza...

Background Patients with acute aortic dissection remain at risk for long-term complications and thus are recommended to closely adhere to ACC/AHA aorta guideline-based follow-up imaging and clinic visits. The long term outcomes of compliance with such a model is not well understood. Methods Retrospective cohort study of patients at a regional aort...

Current principles of surgical treatment of type A dissections are for the most part based on best evidence practice for the lack of controlled randomized studies providing definitive scientific evidence. Despite its widespread use, axillary cannulation still remains a debated topic as the preferred method of cannulation and perfusion strategy in t...

Surgical treatment of type A dissections is based on best evidence practice for the lack of controlled randomized studies providing definitive scientific evidence. Despite its widespread use, axillary cannulation still remains a debated topic as the preferred method of cannulation and perfusion strategy in the treatment of this complex condition.

Background Over the last decade, preoperative anemia has become recognized as a clinical condition in need of management. Although the etiology of preoperative anemia can be multifactorial, two-thirds of anemic elective surgical patients have iron deficiency anemia. At the same time, one-third of non-anemic elective surgical patients are also iron...

Severe hypothermia and frostbite can result in significant morbidity and mortality. We present a case of a patient with severe hypothermia and frostbite due to cold exposure after a snowmobile crash. He presented in cardiac arrest with a core temperature of 19 degrees Celsius requiring prolonged cardiopulmonary resuscitation, active internal rewarm...

Background Patient selection and cannulation arguably represent the key steps for the successful implementation of extracorporeal membrane oxygenation (ECMO) support. Cannulation is traditionally performed in the operating room or the catheterization laboratory for a number of reasons, including physician preference and access to real‐time imaging,...

TRANSESOPHAGEAL ECHOCARDIOGRAPHY TO DIAGNOSE WATCHMAN DEVICE INFECTION (10/2 EDITS OF KH EDITS FROM 8/27) Joseph Jensen MDb, Christina Thaler MD PhDa,b, Retu Saxena MDa,b, Domenico Calcaterra MDa,b, Jason Sanchez MD,b, Quirino Orlandi MDa,b, Kevin M. Harris, MD FASEa,b. aMinneapolis Heart Institute Foundation and bAbbott Northwestern Hospital, Min...

Purpose Blunt aortic injuries (BAI) have historically been considered an indication for emergent surgical intervention. Nevertheless, the observation that the outcome of the concomitant traumatic injuries has a major impact on prognosis and the rise of thoracic endovascular aortic repair (TEVAR) as an effective therapy for BAI have significantly ch...

Introduction Severe hypothermia and frostbite can result in significant morbidity and mortality. We present a case study of a patient with profound hypothermia resulting in cardiac arrest who was successfully resuscitated and remained neurologically intact. Methods A 47-year-old male was found down after a snowmobile accident. Upon EMS arrival, hi...

Aortic sarcomas are a very rare condition typically characterized by a deceiving presentation. Making a correct diagnosis is based on the application of an algorithm which allows to identify the primary disease site and to obtain a tissue diagnosis. Surgical aortic resection with adjuvant therapy offers the best palliation, particularly in cases of...

Minimally Invasive Cardiac Surgery

OBJECTIVE: the standard paradigm of completing cardiac surgery operations through a median sternotomy has been modified in recent years by the upsurge of minimally invasive techniques which allow to safely perform cardiac operations with better cosmetic results and the potential benefits of faster postoperative recovery and faster retum to baseline...

Aim Intravenous vasodilators are often added to beta-blocking agents to reach BP goals in aortic dissection. Control of BP using clevidipine has been described in hypertensive emergencies and cardiac surgery but not in aortic dissection. The aim of this study was to compare clevidipine versus sodium nitroprusside (SNP) as adjunct agents to esmolol...

Computational Fluid Dynamics Assessment of Type-B dissections

Topical hemostatic agents are used in conjunction with conventional procedures to reduce blood loss. They are often used in cardiothoracic surgery, which is particularly prone to bleeding risks. Variation in their use exists because detailed policy and practice guidelines reflecting the current medical evidence have not been developed to promote be...

Background: Coronary button reimplantation can represent a technical challenge of aortic root reconstruction that can be associated with significant morbidity and mortality. With the goal of simplifying coronary reimplantation and reducing the incidence of related complications, we designed a new Dacron graft with prefabricated coronary branches t...

Background: A recent retrospective comparative effectiveness study found that use of FLOSEAL® Hemostatic Matrix in cardiac surgery was associated with significantly lower risks of complications, blood transfusions, surgical revisions and shorter length of surgery than use of SURGIFLO® Hemostatic Matrix. These outcome improvements in cardiac surgery...

Patients with acute aortic dissection suffer a high early mortality. However, limited data delineate the factors that contribute to initial delays in establishing the acute aortic dissection diagnosis. We reviewed consecutive patients with acute aortic dissection presenting to a tertiary hospital system over a 10-year period. Patient clinical chara...

Operative repair for anomalous aortic origin of a coronary artery (AAOCA) has been described using various innovative techniques. Common to each series is the use of a full sternotomy. As demand for minimally invasive approaches to adult cardiac surgery has increased, the upper hemisternotomy has emerged as a safe and effective technique for aortic...

Aortic root reconstruction is a demanding surgical procedure still associated with a significant morbidity. Arguably, the most demanding aspect of the operation is reestablishing continuity between the prosthetic graft replacing the aortic root and the coronary arteries. With the objective of simplifying the possible challenges of coronary reimplan...

Aortic root reconstruction is a demanding surgical procedure still associated with a significant morbidity. Arguably, the most demanding aspect of the operation is reestablishing continuity between the prosthetic graft replacing the aortic root and the coronary arteries. With the objective of simplifying the possible challenges of coronary reimplan...

Left hilar exposure can be challenging during bilateral sequential lung transplantation, particularly in patients with idiopathic pulmonary fibrosis due to the overlying heart and limited space. We describe a cost-effective technique that has been used in off-pump cardiopulmonary bypass to retract the heart away from the left hilum, without causing...

Objective While hemostatic matrices are efficacious in achieving hemostasis, outcomes research is limited; therefore, this study analyzed clinical outcomes of flowable hemostatic matrices in a real-world cardiac surgical population. Design Retrospective database analysis of cardiac surgical cases from 2006 to 2012. Setting Data were extracted fro...

Unilateral absence of a proximal pulmonary artery (UAPA) is rare and occurs in an isolated form or in the presence of other cardiovascular anomalies. There is a paucity of literature describing surgical correction of this anomaly. Most commonly, a primary anastomosis between the main and proximal right pulmonary arteries has been described. However...

Renal cell carcinoma is occasionally complicated by the formation of a neoplastic thrombus invading the inferior vena cava. Rarely, the thrombus extends into the vena cava, reaching the right atrium. In these situations, despite the advanced tumor stage, surgical resection continues to offer the best chance for effective treatment. The operation re...

Fusarium is a mould widely distributed in soil and water which causes various diseases in plants and occasionally in animals. The Fusarium species cause a broad spectrum of infections in humans, of which, the degree of severity is largely determined by the immune-status of the host, occurring in the most severe and invasive forms in immunocompromis...

Previous reports have demonstrated that advanced age, chronic lung disease, diabetes, renal dysfunction, atheromatous aorta and severe left ventricular dysfunction are important independent predictors of operative mortality and morbidity after coronary artery bypass grafting (CABG). In addition, cardiopulmonary bypass (CPB) is associated with diffu...

We present a 43-year-old man who underwent emergent replacement of the ascending aorta for type A dissection and hemiarch reconstruction with a 28-mm prosthetic graft. Dramatic neurologic symptoms, renal failure, and bowel ischemia developed on postoperative day 5. A computed tomography scan showed a large floating thrombus in the ascending aortic...

Conference of Biomedical engineering.

Biiomedical engeneering conference

Endovascular stent grafting has emerged as an effective method for the treatment of complicated acute type B aortic dissections. In cases where access to the aorta cannot be established through the ileofemoral trunks, the axillary arteries are used as an alternative route. Often, however, these arteries are too small to accommodate the device sheat...

Reduction ascending aortoplasty has been advocated as a possible alternative to traditional graft replacement for treatment of aneurysms of the ascending aorta and root. We report a case of a 58-year-old Jehovah's Witness female, with a 5.5-cm ascending aortic aneurysm and critical aortic stenosis. She underwent aortic valve replacement and reducti...

L’antithrombine est un inhibiteur efficace de la cascade de la coagulation exerçant ses effets primaires sur les facteurs activés X, IX et II. C’est le mécanisme par lequel l’héparine et l’héparine de bas poids moléculaire exercent l’anti-coagulation. Le déficit en antithrombine se présente comme un état d’hypercoagulation, et peut avoir comme cons...

Hypothermia has been used for decades in cardiac surgery to limit the ischemic insult to the heart. With the diffusion of off-pump coronary artery surgery, the practice of arresting and cooling the heart has been abandoned. At University of Miami Miller School of Medicine, we tested a new warming device by performing a prospective study in which 50...

Antithrombin is a potent inhibitor of the coagulation cascade exerting its primary effects on activated factors X, IX and II. It is the mechanism by which heparin and low-molecular weight heparin cause anti-coagulation. Deficiency of antithrombin presents as a hypercoagulable state, and may result in unexplained deep venous thrombosis, arterial thr...

Wound vacuum may represent a new solution to the treatment of patients with mediastinitis. We herein present case reports of two patients with very serious deep wound infections of the sternum (mediastinitis) treated with wound vacuum without muscle flaps. The implications of this new modality of treatment are discussed.

Valve-sparing aortic root remodeling is associated with the risk of bleeding from the proximal aortic-graft suture line and subsequent annular dilation leading to aortic valve failure. Herein we describe a simple technique that may be used in valve-sparing root operations to prevent bleeding and improve annular stability.

Simultaneous antegrade/retrograde warm blood perfusion with a beating heart has not been previously reported as a mean of protecting hypertrophied hearts in cardiac valve and aortic root surgeries. Similarly, beating heart mitral valve surgery via the trans-septal approach with the aorta unclamped, is a novel technique. We, herein, report a series...

A case of massive gas embolization during endoscopic vein harvesting is presented. This potentially life-threatening condition should be promptly diagnosed and treated. A brief review of the current literature is presented.

Abstract A new technique of perfusion of the heart during aortic valvular and combined aortic valvular and coronary artery surgery on the beating heart is presented. The inflow for perfusion is via a dual system: the coronary sinus is perfused with blood from a calibrated centrifugal pump connected to the oxygenator; the coronary ostia are perfused...

The introduction of thoracic endografts has revolutionized the management of thoracic aortic disease. Currently, endografts are not FDA-approved for treating thoracic aortic injury (TAI). We report a case of TAI who presented in hemorrhagic shock and preoperative cardiac arrest who was successfully treated with large volume resuscitation, closed ch...

Acute intestinal graft-versus-host disease (GVHD) develops in about 30-50% of allogeneic bone-marrow transplant recipients: 10-20% have gastrointestinal emergencies (hemorrhage or perforation). Mortality reaches 30-60% in patients with acute, grade 2-4 GVHD. We studied 36 bone marrow recipients in whom acute intestinal GVHD developed. Seven had gas...

Blunt transhiatal esophagectomy is largely performed in selected cases of esophageal cancer according to the experience of Mark Orringer. We have recently performed eleven consecutive videolaparoscopy assisted transhiatal esophagectomies in order to help esophageal dissection and to avoid injuries to mediastinal structures. In our experience the ro...

Blunt transhiatal esophagectomy is largely performed in selected cases of esophageal cancer following the experience of Mark Orringer. We have recently performed five consecutive video-laparoscopy-assisted transhiatal esophagectomies in order to help the esophageal dissection and to avoid injuries to mediastinal structures. In our experience a rout...

Between 1989 and 1991, 66 women affected by breast cancer smaller than 2 cm in diameter, were treated with conservative procedure plus radiotherapy. Conservative procedure consisted in quadrantectomy and axillary dissection of the 3 axillary nodes levels. Neoplasms were grouped according to TNM classification. Eleven were classified as Tis, 9 as T1...

One-hundred seventy four consecutive patients who underwent curative resection for gastric and colorectal cancer between 1983 and 1985, were studied prospectively to evaluate the roles of sequential CEA, TPA and GICA determinations and independent clinical examinations, in the early diagnosis of resectable recurrences. Sixty-six recurrences (33 fro...

Hepatic uptake and biliary secretion have been evaluated in the isolated perfused rat liver for cholic, chenodeoxycholic, ursodeoxycholic acid, both free and taurine-conjugated; the physicochemical properties of the bile acids have also been calculated and related to these experimental parameters. Cholic acid disappearance rate from the perfusate w...

The intestinal absorption of bile acids has so far been studied from the measurement of the biliary secretion after their intestinal infusion. In the present investigation, the ileal absorption capacity for two different bile acids has been evaluated by means of an intestinal perfusion technique and the simultaneous blood drainage from the mesenter...