Edward Y. Sako's research while affiliated with University of Texas Health Science Center at San Antonio and other places

Publications (42)

Article
PURPOSE: There is a recent trend towards performing more bilateral lung transplants (BLT) for COPD. However, there is a substantial number of patients who clinically do very well with a SLT with survival rates comparable to those undergoing BLT. We sought to examine this observation by analyzing multicenter data on survival following SLT for COPD....
Article
One of the limitations associated with lung transplantation is the lack of available organs. To determine whether a lung donor-management protocol could increase the number of lungs for transplantation without affecting the survival rates of the recipients. We implemented the San Antonio Lung Transplant protocol for managing potential lung donors a...
Article
Associated comorbidities in potential lung transplant recipients may significantly impact operative morbidity and mortality. We undertook this review to specifically study whether patients who underwent associated cardiac procedures either before (as a prerequisite) or during their lung transplantation had different outcomes when compared with the...
Article
Tracheobronchial disruption is a rare finding among the spectrum of injuries associated with blunt chest trauma. Furthermore, the presence of bronchial rupture is seldom appreciated in the acute setting, permitting a variety of potential subacute and long-term complications to ensue. Fiberoptic bronchoscopy, computed tomography, and magnetic resona...
Article
The search for the ideal therapy for valve replacement continues. The major options include mechanical or tissue valves, with an increasing variety of tissue valves becoming available. The key factor continues to be thrombogenicity versus durability. Aortic valve surgery primarily consists of replacement. This is aided by the increased variety of o...
Article
PURPOSE: The primary limiting factor to lung transplantation is the shortage of donor lungs. A number of single center studies have suggested that the use of extended donor criteria may improve the donor supply and decrease waiting times without compromising outcomes. Despite these encouraging results, the use of extended donors is still a controve...
Article
Because of the content of the American Board of Surgery (ABS) certifying (oral) examination, there is a perception that those in some subspecialty surgical training programs at the time of the examination may have a lower pass rate. In addition, the format of the oral examination has prompted the use of specialized preparation such as "mock orals"...
Article
At many lung transplant centers, right heart catheterization and transthoracic echocardiogram are part of the routine pre-transplant evaluation to measure pulmonary pressures. Because decisions regarding single vs bilateral lung transplant procedures and the need for cardiopulmonary bypass are often made based on pulmonary artery systolic pressures...
Article
Single-lung transplantation (SLT) is a viable option for patients with end-stage pulmonary disease. After successful SLT, pulmonary blood flow is preferentially shifted to the transplanted lung, creating a flow differential. Lack of flow differential may be indicative of potential vascular complications such as anastomotic stenosis or thrombosis. T...
Article
To the Editor: I read with interest the contribution by Cai et al in the “Images in Cardiovascular Medicine” section of the journal.1 They described a patient who developed severe aortic regurgitation and a mitral valve aneurysm 1 month after successful treatment of Streptococcus mitis endocarditis. The case presentation and the title implied tha...
Article
Filamentous fungal infections are associated with high morbidity and mortality in solid organ transplant patients, and prevention is warranted whenever possible. An increase in invasive aspergillosis was detected among solid organ transplant recipients in our institution during 1991-92. Rates of Aspergillus infection (18.2%) and infection or coloni...
Article
Posttransplant lymphoproliferative disorders (PTLD) can be a significant cause of morbidity in lung transplant (LT) recipients. Risk factors include Epstein-Barr virus (EBV) infection, particularly primary infection, and immunosuppression. This article updates the incidence and presentation of PTLD at our lung transplant program. We retrospectively...
Article
The incidence of posttransplant lymphoproliferative disorder (PTLD) has been reported to range from 6.4 to 20% in lung transplant (LT) recipients. Postulated contributing factors include Epstein-Barr virus (EBV) infection and the use of immunosuppression, particularly muromonab-CD3 (OKT3)(Orthoclone OKT-3; Ortho Biotech; Raritan, NJ). We sought to...
Article
A 33-year-old man presented to the hospital with shortness of breath and chest pain. He was subsequently diagnosed with Streptococcus mitis endocarditis involving the aortic valve. The initial echocardiogram revealed moderate aortic valve regurgitation and a normal mitral valve without regurgitation. The patient was treated with afterload reduction...
Article
Bronchial stenosis (BS) and bronchomalacia (BM) are often associated with lung allograft rejection or infection in lung transplant (LT) recipients. We reviewed our experience using balloon-expandable metallic (Palmaz) stents in the management of BS and BM in LT. Retrospective review of cases. LT recipients with bronchoscopic and spirometric evidenc...
Article
Neurologic complications are already well documented after cardiopulmonary bypass (CPB) procedures in neonates and infants. Physiologic pulsatile flow CPB systems may be the alternative to the currently used steady-flow CPB circuits. In addition to the pulsatile pump, a membrane oxygenator should be chosen carefully, because only a few membrane oxy...
Article
Observation is appropriate for patients with an asymptomatic, first-time primary spontaneous pneumothorax that occupies less than 20% of the hemithorax; supplemental oxygen may be added to hasten the absorption of the pleural gas. Patients with symptoms or whose pneumothorax is greater than 20% require either catheter aspiration or long-term placem...
Article
Consider primary spontaneous pneumothorax in an otherwise healthy person with acute chest pain and dyspnea if the affected side of the chest is enlarged, moves less during respiration, and is hyperresonant on percussion; tactile fremitus is absent; and breath sounds are reduced or absent. On a standard inspiratory chest film, a thin pleural line th...
Article
Tracheobronchial injuries are rare but potentially life threatening. Their successful diagnosis and treatment often require a high level of suspicion and surgical repairs unique to the given injury. We reviewed our experience with 32 patients with tracheobronchial injuries treated over the past 28 years. Forty-one percent (13/32) of the injuries we...
Article
There are well-recognized adverse interactions between the monoamine oxidase inhibitors and anesthetic drugs, particularly narcotics. Patients having cardiopulmonary bypass procedures are commonly anesthetized using high-dose narcotic techniques. We describe an uneventful perioperative course in a parkinsonian patient who required urgent coronary a...
Article
Aneurysms constitute uncommon sequelae of injuries to the thoracic outlet. Most such aneurysms are secondary to blunt trauma and usually involve the great vessels at their take-off from the aortic arch. Penetrating injuries are more often identified in the more distal vessels and only very rarely present as pseudoaneurysms. Reported here is a singl...
Article
Systemic availability of itraconazole in lung transplantation was evaluated by serially measuring the bioactivity of itraconazole in lung transplant patients who received itraconazole for prophylaxis (n = 12) or therapy (n = 5). These patients also received concomitant antacid and H2 blocker therapy. In patients receiving itraconazole at 200 and 40...
Article
Purpose: Previous studies in other solid organ transplant populations suggest that profound cellular immunosuppression such as that associated with Orthoclone OKT3® predisposes patients to CMV disease. We reviewed the incidence of CMV disease in our lung transplant recipients treated with OKT3 for refractory rejection. Methods: 85 of 120 patients r...
Article
Purpose: Cytomegalovirus (CMV) infection remains the most common opportunistic infection after lung transplantation. The reported incidence has approached 70%, and CMV pneumonitis is documented in 10 to 15% of infected patients. We studied 88 consecutive lung transplants at the University of Texas Health Science Center that survived more than 1 mon...
Article
Purpose: From March 1988 to June 1995, 35 patients underwent single lung transplantation (SLT) for end-stage interstitial lung disease (ILD). We have evaluated the status of the non transplanted lung to assess the effect of the combination of cyclosporin-A (CSA), Imuran, and corticosteroids on the native lung. Methods: Thirty-five patients had radi...
Article
Purpose: Gender mismatch has recently been associated with decreased survival in heart transplantation when a female donor heart was transplanted to a male recipient. (J Heart Lung Transplant 1996;15(1):33A). The effect of gender mismatch in lung transplantation is not clear. This study investigated the impact of gender mismatch on lung transplant...
Article
Cardiac transplantation is limited to an ischemic time of around 6 hours by available preservation solution and technique. Complex organ preservation devices have been developed that extend this time to 24 hours or more, but are clinically impractical. This study evaluates a portable oxygen-driven organ perfusion device weighing approximately 13.5...
Article
Donor selection has been shown to be of critical importance to the outcome of successful pulmonary transplantation. Further studies in prospective fashion concerning donor criteria coupled with recipient outcome will aid us in appropriately selecting marginal donors. Donor management is clearly important in enlarging and improving our donor pool. F...
Article
Hemorrhage from the heart and great vessels is a potentially lethal complication of post-sternotomy mediastinitis. We report 2 cases in which a cryopreserved descending thoracic aortic homograft was used successfully to repair defects of the ascending aorta and right ventricle in the setting of active mediastinal infection. An overview of mediastin...
Article
From 1972 to 1977, a treatment protocol was developed at our institution for patients with suspected penetrating intrapericardial wounds. It consists of immediate transport to the operating room, pericardial decompression by subxiphoid pericardial window under local or light general anesthesia in patients in stable condition, and median sternotomy...
Article
Single lung transplantation (SLT) is a viable treatment option in end-stage pulmonary disease. The post-operative period following SLT may be complicated by hemodynamic and gas exchange abnormalities which may be related to vascular complications of the left atrial/pulmonary venous anastomosis. After successful SLT, the pulmonary flow into the tran...
Article
Controversy has surrounded the use of single-lung transplantation (SLT) for the treatment of endstage obstructive lung disease. In recent years, several transplant centers have performed SLT for such indications. In this report, we describe functional results in patients undergoing SLT for obstructive lung disease, twenty-two followed over one year...

Citations

... The principal aim of this study was to determine the impact of the SALT donor-management protocol on the rates of lung donation and the clinical outcomes of lung transplant recipients. Some of the results of this study have been previously presented in abstract form (16)(17)(18)(19). ...
... El término "fibrosis pulmonar", refleja el hecho de que las enfermedades intersticiales difusas, pueden conducir en algunos casos, a la formación de fibrosis con la consiguiente destrucción del tejido pulmonar normal. Su existencia favorecería la existencia de complicaciones en el postoperatorio como la sobreinfección pulmonar y la insuficiencia cardiaca, y es que, éste tipo de enfermedades, como ocurre con la Enfermedad Pulmonar Obstructiva Crónica (EPOC), suelen ir asociadas a la existencia de hipertensión pulmonar 150 En los pacientes con síndrome de apnea obstructiva del sueño (SAOS), la disminución de la presión arterial de oxígeno durante el sueño conduce a la vasoconstricción pulmonar y a la estimulación del centro respiratorio para evitar el acúmulo de anhídrido carbónico en la sangre 151 . La sospecha de un síndrome obstructivo se obtendrá mediante la clínica de obstrucción de vía aérea superior y el diagnóstico mediante estudios polisomnográficos 152,153 . ...
... A rupture is seen near the right second carina (circle). and blunt trauma and the latter is usually the result of a high energy accident [3,4]. Previous studies report most patients with tracheobronchial injury to die at the scene of the accident, due to associated fatal injuries [2,3]. ...
... According to a report published in 1995 by the International Society for Heart and Lung Transplantation, 12% of lung transplants were conducted due to advanced emphysema resulting from AAT deficiency [32]; 5-year survival was approximately 50% [33]. In later years (1995-2014), patients with AAT deficiency constituted 5.4% of lung transplant recipients (n = 2459), and the average survival was 6.5 years. ...
... In contrast with this, some studies reported high survival rate up to 90 % but omit the physiologic status upon presentation of these critical patients and they are biased by reporting only patients in good physiologic condition at admission. Thus, this wide variation of mortality, between 10-90 %, reflecting patients selection have contributed to the false perception that the lethality of cardiac injuries has diminished [2][3][4]. The mortality rate in our study group was 60 %, explained by the fact that the majority of patients have pre-hospital factors predictive of poor outcome such as absence of vital signs during transfer, dilated pupils and absence of motion in the extremities. ...
... (43). In spite of this report, transplant centers started to perform SLT in the early 90's with good results (44,45). Majority of the centers prefer BLT, due to complications that might occur from the native lung (45)(46)(47)(48). ...
... Ex-vivo machine perfusion (MP) for organ preservation has been effective at maintaining tissue viability for extended periods in hearts [9][10][11] kidneys [12][13] lungs [14], livers [15][16][17], and other vascularized tissue, such as limbs [18][19][20], in both normothermic and hypothermic environments. While the optimal perfusate for limb preservation is still debated, some studies report positive preservation and transplantation results using autologous blood 20 and others report low edema and optimal viability with acellular perfusates [21]. ...
... In addition, no patient receiving prophylaxis developed invasive aspergillosis and withdrew from the trial due to side effects, nor were toxicities attributed to rising cyclosporine levels associated with itraconazole (Patterson et al: 0.5 mg/L, six patients; 3.5 mg/L, six patients). 71 Denning's study also exhibited that patients with serum concentrations of 8 mg/L tended to have better clinical outcomes when using itraconazole for primary treatment of invasive aspergillosis. 72 Quality assessment Using a 9-point scoring system, most studies we analyzed scored between 7 and 9. ...
... Subclavian artery aneurysms (SAAns) are infrequently seen peripheral aneurysms. [1][2][3][4][5] There are cases of intrathoracic and extrathoracic subclavian artery involvement. 3,6,7 In 1818, Mott reported the first unsuccessful treatment of an SAAn by ligation of the innominate artery. ...
... In 'uncomplicated' anaesthesia, apart from avoiding any use of narcotic analgesics with SRI potency, there are no major problems or interactions. The preponderance of published opinion has supported that view for some time [358][359][360][361][362][363][364][365][366]. There is further irony in the tendency for people to overemphasise the risks of MAOIs, but forget the risks associated with SSRIs (bleeding) and TCAs. ...