Michael Mazzeffi

• MD MPH MSc
• Vice Chair for Faculty Affairs and Development at University of Virginia

Introduction Thoracic surgery is associated with an 8–10% incidence of postoperative pulmonary complications (PPCs). Introduction of minimally invasive Video-assisted thoracoscopic surgery (VATS) aimed to reduce pain related and pulmonary complications. However, PPCs remain a common cause of morbidity after VATS. Methods The American College of Su...

Background Patients with spontaneous and traumatic intracranial hemorrhage (ICH) are frequently transfused platelets to treat thrombocytopenia, platelet function defects, and reverse antiplatelet drugs. ABO-identical platelet transfusion has been suggested to lead to higher post-transfusion platelet increments compared to major-ABO incompatible tra...

Background To investigate if intraoperative very short-term variability in blood pressure measured by sample entropy improves discrimination of postoperative acute kidney injury after noncardiac surgery. Methods Adult surgical patients undergoing general, thoracic, urological, or gynecological surgery between August 2016 to June 2017 at Seoul Nati...

OBJECTIVES Extracorporeal membrane oxygenation (ECMO) is often withheld in patients with significant neurologic injury or recent neurosurgical intervention due to perceived futility. Studies of neurosurgical interventions before or during ECMO are limited to case reports or single-center series, limiting generalizability, and outcomes in this popul...

P2Y12 receptor inhibitor use increases bleeding risk in surgical patients by inhibiting platelet aggregation. Preoperative monitoring, platelet transfusion, and targeted reversal strategies with novel therapies may help to optimize patient management.

Objectives Explore whether extracorporeal cardiopulmonary resuscitation (ECPR) mortality differs by in-hospital cardiac arrest location and whether moving patients for cannulation impacts outcome. Design Retrospective cohort study. Setting ECPR hospitals that report data to the Extracorporeal Life Support Organization (ELSO). Patients Patients h...

Background: Ultrafiltration is used with cardiopulmonary bypass to reduce the effects of hemodilution and restore electrolyte balance. We performed a systematic review and meta-analysis to analyze the effect of conventional and modified ultrafiltration on intraoperative blood transfusion. Methods: Utilizing the Preferred Reporting Items for Systema...

Many scientific journals have made the transition from print and online to online-only publication. The printed version offers something tangible that carries the distinct brand of the journal and/or the society it represents. Journals’ transition to electronic-only publication may reduce the environmental impact of publication and its cost (Wymbs...

Introduction There are no randomized controlled trials comparing low and high activated partial thromboplastin time (aPTT) targets in heparinized adult veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) patients. Our systematic review and meta-analysis summarized complication rates in adult VA ECMO patients treated with low and high aPTT...

BACKGROUND The objective of this study was to examine insurance-based disparities in mortality, non-home discharges, and ECMO utilization in patients hospitalized with COVID-19. METHODS Using a national database of U.S. academic medical centers and their affiliated hospitals, the risk-adjusted association between mortality, non-home discharge, and...

The use of extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest has grown rapidly over the previous decade. Considerations for the implementation and management of extracorporeal cardiopulmonary resuscitation are presented for the perioperative physician.

Background Adult extracorporeal membrane oxygenation (ECMO) patients are at high risk for allogeneic blood transfusion. Few studies have characterized iatrogenic blood loss from phlebotomy in adult ECMO patients. We hypothesized that iatrogenic phlebotomy would be a significant source of blood loss during ECMO. Methods Adults who had their entire...

Twitter (recently renamed X) is used by academic anesthesiology departments as a social media platform for various purposes. We hypothesized that Twitter (X) use would be prevalent among academic anesthesiology departments and that the number of tweets would vary by region, physician faculty size, and National Institutes of Health (NIH) research fu...

Background: Preoperative anemia is common in patients undergoing cardiac surgery, with iron deficiency being the most common cause of anemia in these patients. Patients who are anemic in the preoperative setting have worse perioperative outcomes than patients with normal hemoglobin levels including higher rates of red cell transfusions, acute kidne...

Coronavirus disease-2019 (COVID-19) may have increased morbidity and mortality in patients having Cesarean delivery (CD) in the USA. We performed a retrospective cohort study of patients who had CD in 2020 using the national inpatient sample. After stratification by COVID-19 status, demographics, comorbidities, complications, mortality, and costs w...

ABO blood group has been shown to be a major determinant of plasma von Willebrand factor (vWF) levels. O blood group is associated with the lowest vWF levels and confers an increased risk of hemorrhagic events, while AB blood group has the highest levels and is associated with thromboembolic events. We hypothesized in extracorporeal membrane oxygen...

Please confirm that an ethics committee approval has been applied for or granted Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes I don’t wish to apply for the ESRA Prizes Background and Aims Thoracic surgery is associated with a high incidence of PPCs. Despite advancements in surgical technique, pulm...

Racial/ethnic disparities in mortality were observed during the coronavirus disease-2019 pandemic, but investigations examining the association between race/ethnicity and mortality during extracorporeal membrane oxygenation (ECMO) are limited. We performed a retrospective observational cohort study using the 2020 national inpatient sample. Multivar...

The Society of Cardiovascular Anesthesiologists (SCA) is committed to improving the quality, safety, and value that cardiothoracic anesthesiologists bring to patient care. To fulfill this mission, the SCA supports the creation of peer-reviewed manuscripts that establish standards, produce guidelines, critically analyze the literature, interpret pre...

Introduction It remains unclear whether patients who will not accept allogeneic blood transfusion can be managed successfully with veno-arterial (V-A) extracorporeal membrane oxygenation (ECMO). The objective of our study was to determine what percentage of V-A ECMO patients were managed without allogeneic blood transfusion. Methods This was a ret...

Introduction High-dose catecholamines can impair hypoxic pulmonary vasoconstriction and increase shunt fraction. We aimed to determine if Angiotensin II (Ang-2) is associated with improved PaO2/FiO2 and SpO2/FiO2 in patients in shock. Methods Adult patients at four tertiary care centers and one community hospital in the United States who received...

Introduction Veno-venous extracorporeal membrane oxygenation (VV ECMO) has become a support modality for patients with acute respiratory failure refractory to standard therapies. VV ECMO has been increasingly used during the current COVID-19 pandemic for patients with refractory respiratory failure. The object of this study was to evaluate the outc...

This is an annual review to cover highlights in transfusion and coagulation in patients undergoing cardiovascular surgery. The goal of this article is to provide readers with a focused summary of the most important transfusion and coagulation topics published in 2022. This includes a discussion covering the management of anemia and red blood cell t...

Background: High-quality evidence for post-cardiotomy extracorporeal life support (PC-ECLS) management is lacking. This study investigated the real-world PC-ECLS clinical practices. Methods: This cross-sectional, multi-institutional, international pilot survey explored center organization, anticoagulation management, left ventricular unloading,...

Recombinant activated factor VII has been widely used in an off-label manner for cardiac surgical bleeding. Recent reports have administered recombinant activated factor VII earlier in the course of bleeding and at lower doses than initially reported. This review will discuss the history, mechanism, current recommendations for use, and recent data...

Objective: The influence of Extracorporeal Life Support Organization (ELSO) center of excellence recognition (CoE) on failure to rescue (FTR) after cardiac surgery is unknown. We hypothesized that ELSO CoE would be associated with improved FTR. Methods: Patients undergoing a Society of Thoracic Surgeons (STS) index operation in a regional collab...

Objectives: Post-cardiotomy extracorporeal membrane oxygenation (ECMO) can be initiated intra-operatively or post-operatively based on indications, settings, patient profile and conditions. The topic of implantation timing only recently gained attention from the clinical community. We compare patients´ characteristics, in-hospital and long-term su...

Background: Warm, fresh whole blood (WB) has been used by the US military to treat casualties in Iraq and Afghanistan. Based on data in that setting, cold-stored WB has been used to treat hemorrhagic shock and severe bleeding in civilian trauma patients in the United States. In an exploratory study, we performed serial measurements of WB's composi...

A trace amount of thrombin cleaves factor VIII (FVIII) into an active form (FVIIIa), which catalyzes FIXa-mediated activation of FX on the activated platelet surface. FVIII rapidly binds to von Willebrand factor (VWF) after secretion and becomes highly concentrated via VWF-platelet interaction at a site of endothelial inflammation or injury. Circul...

BACKGROUND Obesity is an important health problem in cardiac surgery and among patients requiring post-cardiotomy veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Still, it remains unclear whether these patients are at risk for unfavorable outcomes after post-cardiotomy V-A ECMO. The current study aimed to evaluate the association betw...

Objectives: The aim was to characterize hospitalization costs, charges, and lengths of hospital stay for COVID-19 patients treated with venovenous (VV) extracorporeal membrane oxygenation (ECMO) in the United States during 2020. Secondarily, differences in hospitalization costs, charges, and lengths of hospital stay were explored based on hospital...

Ophthalmic manifestations and tissue tropism of SARS-CoV-2 have been reported in association with COVID-19, but the pathology and cellular localization of SARS-CoV-2 are not well characterized. The objective of this study was to evaluate macroscopic and microscopic changes and investigate cellular localization of SARS-CoV-2 across ocular tissues at...

Background: Delays in care can lead to worsened outcomes with acute appendicitis. To get timely treatment, patients must consent. Objective: To determine if there are racial and socioeconomic differences in discharge against medical advice (DAMA) rates from an emergency department after the diagnosis of acute appendicitis. Methods: Patients we...

Objectives: There have been sporadic reports of ischemic spinal cord injury (SCI) during venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. The authors observed a troubling pattern of this catastrophic complication and evaluated the potential mechanisms of SCI related to ECMO. Design: This study was a case series. Setting: Thi...

Veno-venous extracorporeal membrane oxygenation (VV ECMO) has become an important support modality for patients with acute respiratory failure refractory to optimal medical therapy, such as low tidal volume mechanical ventilator support, early paralytic infusion, and early prone positioning. The objective of this cohort study was to investigate the...

Coronavirus disease 2019 (COVID-19) is known to cause multi-organ dysfunction1–3 during acute infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with some patients experiencing prolonged symptoms, termed post-acute sequelae of SARS-CoV-2 (refs. 4,5). However, the burden of infection outside the respiratory tract and time t...

Objectives: The objective was to compare primary hemostasis between adult ECMO patients and cardiac surgical patients before heparinization and cardiopulmonary bypass. Furthermore, the authors explored whether in vitro treatment of ECMO patient blood samples with recombinant von Willebrand Factor (vWF) or lyophilized platelets improved primary hem...

Introduction: Cardiac surgeries have among the highest overall rate of packed red blood cell (PRBC) transfusion among all other surgeries. Recently published data suggests that intraoperative PRBC transfusion is associated with increased risk for postoperative venous thromboembolism (VTE) after non-cardiac surgery. However it is unknown whether sim...

Introduction: The effect of a preoperative pressure ulcer (PPU) in hip fracture patients on postoperative outcomes has not been well studied. We hypothesized that the presence of a PPU would be associated with increased mortality and serious complications in hip fracture surgery patients. Methods: We conducted a cohort study of 19,520 hip fractu...

Introduction: Knee arthroplasty (KA) can be performed using general anesthesia (GA), neuraxial anesthesia (NA) or regional anesthesia (RA). We believe proportion of types of anesthetics have changed but that there is a disparity based on socioeconomic factors. Methods: Unadjusted rates and adjusted odds ratios for the use of RA or PNB were compa...

Objective: We determined whether intraoperative packed red blood cell transfusion (PRBC) was associated with a higher incidence of hospital-acquired venous thromboembolic (HA-VTE) complications and adverse outcomes after isolated coronary artery bypass grafting (CABG) surgery. Background: Intraoperative PRBC has been associated with increased ri...

Background and Aims Sugammadex (SUG) has been associated with changes in coagulation studies. Most reports have concluded a lack of clinical significance based on surgical blood loss with SUG use at the end of surgery. Previous reports have not measured its use intraoperatively during ongoing blood loss. Our hypothesis was that the use of SUG intra...

Background Extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest has improved mortality in post-cardiac surgery patients; however, loss of neurologic function remains one of the main and devastating complications. We reviewed our experience with ECPR and investigated the effect of cannulation strategy on neurologic outco...

Vascular diseases and their sequelae increase perioperative risk for noncardiac surgical patients. In this review, the authors discuss vascular diseases, their epidemiology and pathophysiology, risk stratification, and management strategies to reduce adverse perioperative outcomes.

Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) is used to support adults with cardiogenic shock from multiple etiologies including myocardial infarction, massive pulmonary embolism, drug overdose, poisoning, electrical storm, rejection after heart transplantation, and post-cardiotomy shock following cardiopulmonary bypass (CBP). VA-E...

Background: Coronary artery bypass grafting (CABG) is the most common cardiac surgical procedure in the world and up to one-third of patients are transfused red blood cells (RBCs). RBC transfusion may increase the risk for health care-associated infection (HAI) after CABG, but previous studies have shown conflicting results and many did not establ...

Background Portal vein Doppler ultrasound pulsatility measured by transoesophageal echocardiography is a marker of the haemodynamic impact of venous congestion in cardiac surgery. We investigated whether the presence of abnormal portal vein flow pulsatility is associated with a longer duration of invasive life support and postoperative complication...

Introduction Our study aim was to explore how different protamine-heparin ratios impacted enzymatic coagulation and acellular fibrin clot growth in plasma using an in vitro model. We hypothesized that a low protamine-heparin ratio would be associated with superior fibrin clot growth dynamics. Methods We performed an in vitro study using 15 plasma...

Background: Fibrinogen thromboelastometry (FIBTEM) test is clinically used for rotational thromboelastometry as a surrogate measure of fibrinogen. Elevated fibrinogen might confer protection against bleeding after major surgery. This single-center study was conducted to assess any relationship between baseline FIBTEM value and exposure to allogene...

Background: Potentially preventable complications are monitored as part of the Maryland Hospital Acquired Conditions Program and are used to adjust hospital reimbursement. Few studies have evaluated racial-ethnic disparities in potentially preventable complications. Our study objective was to explore whether racial-ethnic disparities in potentiall...

Disseminated intravascular coagulation (DIC) is a life-threatening hematologic derangement characterized by dysregulated thrombin generation and excessive fibrinolysis. However, DIC is poorly characterized in the extracorporeal membrane oxygenation (ECMO) population, and the underlying mechanisms are not well understood. Several mechanisms contribu...

Disseminated intravascular coagulation (DIC) is a life-threatening hematologic derangement characterized by dysregulated thrombin generation and excessive fibrinolysis. However, DIC is poorly characterized in the extracorporeal membrane oxygenation (ECMO) population, and the underlying mechanisms are not well understood. Several mechanisms contribu...

Background: Peripheral nerve blocks (PNBs) are used to provide postoperative analgesia after total mastectomy. PNBs improve patient satisfaction and decrease postoperative opioid use, nausea, and vomiting. Few studies have examined whether there is racial-ethnic disparity in the use of PNBs for patients having total mastectomy. We hypothesized tha...