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Routine Extubation in the Operating Room After Isolated Coronary Artery Bypass

James, Les; Smith, Deane E; Galloway, Aubrey C; Paone, Darien; Allison, Michael; Shrivastava, Shashwat; Vaynblat, Mikhail; Swistel, Daniel G; Loulmet, Didier F; Grossi, Eugene A; Williams, Mathew R; Zias, Elias
BACKGROUND:The benefits of fast-track extubation in the intensive care unit (ICU) after cardiac surgery are well established. Although extubation in the operating room (OR) is safe in carefully selected patients, widespread use of this strategy in cardiac surgery remains unproven. This study was designed to evaluate perioperative outcomes with OR vs ICU extubation in patients undergoing nonemergency, isolated coronary artery bypass grafting (CABG). METHODS:The Society of Thoracic Surgeons (STS) data for all single-center patients who underwent nonemergency isolated CABG over a 6-year interval were analyzed. Perioperative morbidity and mortality with ICU vs OR extubation were compared. RESULTS:Between January 1, 2017 and December 31, 2022, 1397 patients underwent nonemergency, isolated CABG; 891 (63.8%) of these patients were extubated in the ICU, and 506 (36.2%) were extubated in the OR. Propensity matching resulted in 414 pairs. In the propensity-matched cohort, there were no differences between the 2 groups in incidence of reintubation, reoperation for bleeding, total operative time, stroke or transient ischemic attack, renal failure, or 30-day mortality. OR-extubated patients had shorter ICU hours (14 hours vs 20 hours; P < .0001), shorter postoperative hospital length of stay (3 days vs 5 days; P < .0001), a greater likelihood of being discharged directly to home (97.3% vs 89.9%; P < .0001), and a lower 30-day readmission rate (1.7% vs 4.1%; P = .04). CONCLUSIONS:Routine extubation in the OR is a feasible and safe strategy for a broad spectrum of patients after nonemergency CABG, with no increase in perioperative morbidity or mortality. Wider adoption of routine OR extubation for nonemergency CABG is indicated.
PMID: 37806334
ISSN: 1552-6259
CID: 5605312

Third-time aortic valve replacement in a patient with a totally calcified (Porcelain) aortic homograft [Meeting Abstract]

Geraci, T C; Vaynblat, M
Objective: Homograft aortic root replacement provides an excellent hemodynamic restoration of valve function for prosthetic aortic valve endocarditis, but is susceptible to degeneration and calcification. The optimal surgical intervention for valvular disease after homograft root replacement is controversial due to the high risk of morbidity and mortality with reintervention.
Method(s): This video demonstrates a case of redo sternotomy with mechanical aortic valve replacement (AVR) in a patient post 2 previous AVRs and a porcelain homograft. A 38-year-old female presented in heart failure from prosthetic valve endocarditis, with a history of systemic lupus erythematosus, complicated by end-stage renal failure requiring dialysis and lupus anticoagulant.
Result(s): The patient had severe prosthetic aortic insufficiency, severe mitral regurgitation, and severe tricuspid regurgitation. A third-time redo sternotomy was performed. A mechanical sized #17 valve was placed in the aortic position and a #23 sized mechanical valve was placed in the mitral position. A bovine patch aortoplasty of the aorta was required after the calcified wall shattered into fragments upon transection with a patch of bovine pericardium. Postoperative echo revealed preserved left ventricular and right ventricular function with good function of the mechanical aortic and mitral valves.
Conclusion(s): Mechanical AVR, without replacement of the aortic root, is a feasible and potentially effective method of reestablishing a functional aortic valve in a patient with a severely calcified aortic homograft
ISSN: 1559-0879
CID: 4806092

Constrictive Pericarditis Caused by IgG4-Related Disease Requiring Pericardiectomy After Partial Response to Corticosteroids [Case Report]

Yuriditsky, Eugene; Dwivedi, Aeshita; Narula, Navneet; Axel, Leon; Horowitz, James M; Vaynblat, Mikhail
Immunoglobulin G4-related disease is a systemic fibroinflammatory disease; pericardial involvement has occasionally been reported in publications. A 79-year-old man with biopsy-proven immunoglobulin G4-related disease with pleural involvement was admitted in acute heart failure, with imaging and hemodynamic studies consistent with constrictive pericarditis. He was treated with corticosteroids for 2 months with partial response manifest by decreases in pericardial thickening and immunoglobulin G4 levels. However, persistent constriction required pericardiectomy, leading to significant symptomatic improvement. (Level of Difficulty: Intermediate.).
PMID: 34317017
ISSN: 2666-0849
CID: 4949402

A case of nonvalvular endocarditis with biventricular apical infected thrombi [Case Report]

Vani, Anish; Ahluwalia, Monica; Donnino, Robert; Jung, Albert; Vaynblat, Mikhail; Latson, Larry; Saric, Muhamed
We report what appears to be the first case of biopsy-proven nonvalvular endocarditis with biventricular apical infected thrombi. A 47-year-old man presented with hypoxic respiratory failure from a multilobar pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA). Transthoracic echocardiography and cardiac magnetic resonance imaging revealed biventricular apical masses suggestive of nonvalvular endocarditis with infected thrombi. Given concern for ongoing septic embolization to the lungs and brain despite appropriate antimicrobial therapy, the masses were surgically resected. Culture and histopathology confirmed MRSA-positive infected thrombi. In this case report, we highlight the differential diagnosis of apical masses and the role of multimodality imaging.
PMID: 32654168
ISSN: 1540-8175
CID: 4527722

Mediastinal cystic teratoma masquerading as a hydatid cyst

Williams, David; Zhou, Fang; Grovenburg, Max; Vaynblat, Mikhail
A case is presented in which a preoperatively diagnosed hydatid cyst was found to be a mature cystic teratoma on pathological examination. Diagnostic dilemmas surrounding each disease are discussed.
PMID: 32601139
ISSN: 1757-790x
CID: 4504022

Intrathoracic Myxoid Spindle Cell Lipoma, A Rare Presentation of a Myxoid Neoplasm

Schulberg, Steven P; Lim, Derek; Hoda, Syed T; Vaynblat, Mikhail
Here we present a case of a 38 year old male with an incidentally found right upper lobe lung mass. The patient underwent thoracoscopic resection of the mass which revealed a myxoid spindle cell lipoma. This is an exceedingly rare location for this tumor biology and here we discuss its pathological features and treatment options.
PMID: 31589846
ISSN: 1552-6259
CID: 4129362

Pneumonectomy in a Patient with Synchronous Primary Lung Tumors and Endobronchial Metastasis [Meeting Abstract]

Zambrano, C.; DiRoma, F.; Vaynblat, M.
ISSN: 1073-449x
CID: 3513212

Pulmonary Mucoepidermoid Carcinoma, with Persistent Dyspnea in a 25 Year Old [Meeting Abstract]

Zakharov, K.; Lim, D.; Zambrano, C.; Bowen, M. X.; Vaynblat, M.
ISSN: 1073-449x
CID: 3513222

A Rare Case of a Chest Wall Atypical Epithelioid Schwannoma [Meeting Abstract]

Zakharov, K.; Jaikaran, O.; Gumer, J.; Rapkiewicz, A.; Vaynblat, M.
ISSN: 1073-449x
CID: 3513242

Selective use of the intra-aortic filter in high-risk cardiac surgical patients leads to better postoperative outcomes

Chiba, Shintaro; Janjua, Fatima; Schulhoff, Nancy; Homel, Peter; Kumar, Sathappan; Golek, Zigmunt; Abrol, Sunil; Jacobowitz, Israel J; Vaynblat, Mikhail
PMID: 28186286
ISSN: 1873-734x
CID: 2518002