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Article ; Online: Expanding the supply of donor hearts through donation after circulatory death.

Urban, Marian / Duncan, Kim F

American journal of physiology. Heart and circulatory physiology

2024 Volume 326, Issue 3, Page(s) H857–H859

MeSH term(s)	Humans ; Tissue Donors ; Brain Death ; Heart Transplantation ; Heart ; Cardiovascular System
Language	English
Publishing date	2024-02-09
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	603838-4
ISSN	1522-1539 ; 0363-6135
ISSN (online)	1522-1539
ISSN	0363-6135
DOI	10.1152/ajpheart.00049.2024
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Article ; Online: Considerations for the use of porcine organ donation models in preclinical organ donor intervention research.

Heinis, Frazer I / Merani, Shaheed / Markin, Nicholas W / Duncan, Kim F / Moulton, Michael J / Fristoe, Lance / Thorell, William E / Sherrick, Raechel A / Wells, Tami R / Andrews, Matthew T / Urban, Marian

Animal models and experimental medicine

2024

Abstract: Use of animal models in preclinical transplant research is essential to the optimization of human allografts for clinical transplantation. Animal models of organ donation and preservation help to advance and improve technical elements of solid organ ... ...

Abstract	Use of animal models in preclinical transplant research is essential to the optimization of human allografts for clinical transplantation. Animal models of organ donation and preservation help to advance and improve technical elements of solid organ recovery and facilitate research of ischemia-reperfusion injury, organ preservation strategies, and future donor-based interventions. Important considerations include cost, public opinion regarding the conduct of animal research, translational value, and relevance of the animal model for clinical practice. We present an overview of two porcine models of organ donation: donation following brain death (DBD) and donation following circulatory death (DCD). The cardiovascular anatomy and physiology of pigs closely resembles those of humans, making this species the most appropriate for pre-clinical research. Pigs are also considered a potential source of organs for human heart and kidney xenotransplantation. It is imperative to minimize animal loss during procedures that are surgically complex. We present our experience with these models and describe in detail the use cases, procedural approach, challenges, alternatives, and limitations of each model.
Language	English
Publishing date	2024-04-30
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2576-2095
ISSN (online)	2576-2095
DOI	10.1002/ame2.12411
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Article: Bloodless Repair of Aortic Arch with Dual Aortic Cannulation in a Jehovah's Witness Patient.

Valleley, Melinda S / Glogowski, Kimberly R / Duncan, Kim F / Dutoit, Andrea / Hagedorn, Corinna

The journal of extra-corporeal technology

2017 Volume 49, Issue 3, Page(s) 206–209

Abstract: Various methods for surgical repair of the aortic arch are described throughout the literature with many focused on cannulation techniques and degree of systemic cooling in an effort to reduce postoperative morbidities. Despite advancements in techniques, ...

Abstract	Various methods for surgical repair of the aortic arch are described throughout the literature with many focused on cannulation techniques and degree of systemic cooling in an effort to reduce postoperative morbidities. Despite advancements in techniques, this surgery is still often associated with higher levels of blood loss and subsequent allogenic blood transfusions. Although blood products can be safely transfused to the majority of patients undergoing repair of the aortic arch, the complexity and risk is further multiplied when the patient is of Jehovah's Witness faith and refuses blood transfusions. This paper will detail our technique of surgical repair of the aortic arch in a Jehovah's Witness patient with dual aortic cannulation and our multidisciplinary approach to avoiding blood products.
Language	English
Publishing date	2017-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	390977-3
ISSN	0022-1058
ISSN	0022-1058
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Article ; Online: Thoracoabdominal Normothermic Perfusion in Donation After Circulatory Death.

Urban, Marian / Castleberry, Anthony W / Duncan, Kim F / Markin, Nicholas W / Chacon, M Megan / Siddique, Aleem / Merani, Shaheed / Robertson, Ryan / Fristoe, Lance / Um, John Y

The Annals of thoracic surgery

2021 Volume 113, Issue 6, Page(s) e473–e476

Abstract: Donation after circulatory death is emerging as an alternative pathway to donation after brain death to expand the cardiac organ donor pool. We describe the surgical technique and circuit configuration for in-situ organ reperfusion with thoracoabdominal ... ...

Abstract	Donation after circulatory death is emerging as an alternative pathway to donation after brain death to expand the cardiac organ donor pool. We describe the surgical technique and circuit configuration for in-situ organ reperfusion with thoracoabdominal normothermic regional perfusion using portable venoarterial extracorporeal membrane oxygenation.
MeSH term(s)	Death ; Heart Transplantation ; Humans ; Organ Preservation/methods ; Perfusion/methods ; Tissue Donors ; Tissue and Organ Procurement
Language	English
Publishing date	2021-10-08
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2021.08.075
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Article ; Online: Development of a train-to-proficiency curriculum for the technical skills component of the fundamentals of endoscopic surgery exam.

Gearhart, Susan / Marohn, Michael / Ngamruengphong, Saowanee / Adrales, Gina / Owodunni, Oluwafemi / Duncan, Kim / Petrusa, Emil / Lipsett, Pamela

Surgical endoscopy

2018 Volume 32, Issue 7, Page(s) 3070–3075

Abstract: Background: The demonstration of competency in endoscopy is required prior to obtaining American Board of Surgery Certification. To demonstrate competency, the resident must pass a national high-stakes cognitive test and a technical skills exam on a ... ...

Abstract	Background: The demonstration of competency in endoscopy is required prior to obtaining American Board of Surgery Certification. To demonstrate competency, the resident must pass a national high-stakes cognitive test and a technical skills exam on a virtual reality simulator. The purpose of this preliminary study was to design a proficiency-based endoscopy simulation curriculum to meet this competency requirement. Methods: This is a mixed methods prospective cohort study at a single academic medical institution. Prior to taking the national exam, surgery residents were required to participate in a skills lab and demonstrate proficiency on 10 simulation tasks. Proficiency was based on time and percent of objects targeted/mucosa seen. Simulation practice time, number of task repetitions to proficiency, and prior endoscopic experience were recorded. Resident's self-reported confidence scores in endoscopic skills prior to and following simulation lab training were obtained. Results: From January 1, 2016 through August 1, 2017, 20 surgical residents (8 PGY2, 8 PGY3, 4 PGY4) completed both a faculty-supervised endoscopy skills lab and independent learning with train-to-proficiency simulation tasks. Median overall simulator time per resident was 306 min (IQR: 247-405 min). Median overall time to proficiency in all tasks was 235 min (IQR: 208-283 min). The median time to proficiency decreased with increasing PGY status (r = 0.4, P = 0.05). There was no correlation between prior real-time endoscopic experience and time to proficiency. Reported confidence in endoscopic skills increased significantly from mean of 5.75 prior to 7.30 following the faculty-supervised endoscopy skills lab (P = 0.0002). All 20 residents passed the national exam. Conclusions: In this preliminary study, a train-to-proficiency curriculum in endoscopy improved surgical resident's confidence in their endoscopic skills and 100% of residents passed the FES technical skills test on their first attempt. Our findings also indicate that uniform proficiency was not achieved by real-time experience alone.
MeSH term(s)	Certification ; Clinical Competence ; Curriculum/standards ; Endoscopy/education ; Female ; General Surgery/education ; Humans ; Internship and Residency/methods ; Male ; Prospective Studies ; Simulation Training/methods ; Virtual Reality
Language	English
Publishing date	2018-01-08
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-017-6018-7
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Article ; Online: Two-stage biventricular rehabilitation for critical aortic stenosis with severe left ventricular dysfunction.

Hammel, James M / Duncan, Kim F / Danford, David A / Kutty, Shelby

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

2013 Volume 43, Issue 1, Page(s) 143–148

Abstract: Objectives: Critical aortic valve stenosis (CAS) in the newborn is treated by balloon or surgical aortic valve intervention with nearly equal success, but the subset of patients with severe left ventricular (LV) dilation and dysfunction present a ... ...

Abstract	Objectives: Critical aortic valve stenosis (CAS) in the newborn is treated by balloon or surgical aortic valve intervention with nearly equal success, but the subset of patients with severe left ventricular (LV) dilation and dysfunction present a significant mortality risk. We describe a two-stage surgical management approach for those infants who represent an unusually high failure risk for either aortic valvotomy or conventional stage 1 single ventricle (Norwood) palliation because of severe LV dysfunction at the time of presentation. Methods: A two-stage surgical palliation was undertaken consisting of surgical aortic valvotomy, bilateral pulmonary artery banding and atrial septectomy (stage 1), followed by patch closure of the atrial septal defect, ligation of the ductus arteriosus and removal of the pulmonary artery bands (stage 2) with prostaglandin infusion continued between stages to maintain right ventricular contribution to systemic perfusion via the ductus arteriosus. Results: Four neonates with CAS and severely depressed LV systolic function were treated using this strategy. LV dilation resolved and systolic function improved in three patients after 2, 2 and 4 weeks, enabling stage 2. LV dysfunction did not improve in one patient who expired before conversion to biventricular circulation. Of the three who proceeded to stage 2, one infant continued to have poor biventricular diastolic function that precluded conversion, and this patient also died. The remaining two infants are now alive and well at 34 and 44 months of age. These two had the most severe LV dilation (internal dimension Z-scores of 6.9 and 7.7) and the worst systolic function (fractional shortening 4 and 10%) at presentation, and both were born prematurely (32 and 35 weeks). Conclusions: A two-stage surgical approach may improve the likelihood of survival in selected patients with CAS presenting with severely depressed LV systolic function. Relief of LV distention may have contributed to the improvement of LV function in these infants.
MeSH term(s)	Aortic Valve/surgery ; Aortic Valve Stenosis/physiopathology ; Aortic Valve Stenosis/surgery ; Cardiac Surgical Procedures/methods ; Humans ; Infant ; Infant, Newborn ; Pulmonary Artery/surgery ; Retrospective Studies ; Ventricular Dysfunction, Left/physiopathology ; Ventricular Dysfunction, Left/surgery ; Ventricular Function, Left/physiology
Language	English
Publishing date	2013-01
Publishing country	Germany
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639293-3
ISSN	1873-734X ; 1010-7940 ; 1567-4258
ISSN (online)	1873-734X
ISSN	1010-7940 ; 1567-4258
DOI	10.1093/ejcts/ezs197
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Article ; Online: "Closed-vein" technique for primary sutureless repair of anomalous pulmonary venous connection.

Hammel, James M / Hunt, Peter W / Abdullah, Ibrahim / Duncan, Kim F

The Annals of thoracic surgery

2012 Volume 94, Issue 3, Page(s) 1021–1022

Abstract: Deep hypothermic circulatory arrest or low-flow bypass are commonly used in primary repair of total anomalous pulmonary venous connection, or individual veins may be dissected to allow clamp or snare application, in order to provide a bloodless field for ...

Abstract	Deep hypothermic circulatory arrest or low-flow bypass are commonly used in primary repair of total anomalous pulmonary venous connection, or individual veins may be dissected to allow clamp or snare application, in order to provide a bloodless field for anastomosis by the direct or sutureless marsupialization technique. In the described technical modification, the marsupialization of the opened atrium to the posterior pericardium is completed before opening the pulmonary venous confluence, allowing bloodless exposure during full-flow normothermic bypass. In addition, vein branch dissection is avoided.
MeSH term(s)	Anastomosis, Surgical/methods ; Arteriovenous Malformations/surgery ; Cardiopulmonary Bypass/methods ; Heart Atria/surgery ; Humans ; Pulmonary Veins/abnormalities ; Pulmonary Veins/surgery ; Risk Assessment ; Suture Techniques ; Sutures ; Treatment Outcome ; Vascular Surgical Procedures/methods
Language	English
Publishing date	2012-09
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2012.04.125
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Article ; Online: Self-reported functional health status following interrupted aortic arch repair: A Congenital Heart Surgeons' Society Study.

Jegatheeswaran, Anusha / Jacobs, Marshall L / Caldarone, Christopher A / Kirshbom, Paul M / Williams, William G / Blackstone, Eugene H / DeCampli, William M / Duncan, Kim F / Lambert, Linda M / Walters, Henry L / Tchervenkov, Christo I / McCrindle, Brian W

The Journal of thoracic and cardiovascular surgery

2019 Volume 157, Issue 4, Page(s) 1577–1587.e10

Abstract: Objectives: Improved survival after congenital heart surgery has led to interest in functional health status. We sought to identify factors associated with self-reported functional health status in adolescents and young adults with repaired interrupted ... ...

Abstract	Objectives: Improved survival after congenital heart surgery has led to interest in functional health status. We sought to identify factors associated with self-reported functional health status in adolescents and young adults with repaired interrupted aortic arch. Methods: Follow-up of survivors (aged 13-24 years) from a 1987 to 1997 inception cohort of neonates included completion of functional health status questionnaires (Child Health Questionnaire-CF87 [age <18 years, n = 51] or the Short Form [SF]-36 [age ≥18 years, n = 66]) and another about 22q11 deletion syndrome (22q11DS) features (n = 141). Factors associated with functional health status domains were determined using multivariable linear regression analysis. Results: Domain scores of respondents were significantly greater than norms in 2 of 9 Child Health Questionnaire-CF87 and 4 of 10 SF-36 domains and only lower in the physical functioning domain of the SF-36. Factors most commonly associated with lower scores included those suggestive of 22q11DS (low calcium levels, recurrent childhood infections, genetic testing/diagnosis, abnormal facial features, hearing deficits), the presence of self-reported behavioral and mental health problems, and a greater number of procedures. Factors explained between 10% and 70% of domain score variability (R Conclusions: Morbidities associated with 22q11DS, psychosocial issues, and recurrent medical issues affect functional health status more than initial morphology and repair in this population. Nonetheless, these patients largely perceive themselves as better than their peers. This demonstrates the chronic nature of interrupted aortic arch and suggests the need for strategies to decrease reinterventions and for evaluation of mental health and genetic issues to manage associated deteriorations.
MeSH term(s)	Adolescent ; Adolescent Behavior ; Age Factors ; Aorta, Thoracic/abnormalities ; Aorta, Thoracic/surgery ; Cost of Illness ; Cross-Sectional Studies ; DiGeorge Syndrome/diagnosis ; DiGeorge Syndrome/genetics ; DiGeorge Syndrome/mortality ; DiGeorge Syndrome/therapy ; Female ; Health Knowledge, Attitudes, Practice ; Health Status ; Heart Defects, Congenital/diagnosis ; Heart Defects, Congenital/genetics ; Heart Defects, Congenital/mortality ; Heart Defects, Congenital/surgery ; Humans ; Male ; Mental Health ; Prospective Studies ; Retreatment ; Self Report ; Social Determinants of Health ; Survivors/psychology ; Time Factors ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2019-01-11
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Video-Audio Media
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2018.11.152
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Article ; Online: Hepatic stiffness in the bidirectional cavopulmonary circulation: The Liver Adult-Pediatric-Congenital-Heart-Disease Dysfunction Study group.

Kutty, Shaija S / Zhang, Ming / Danford, David A / Hasan, Rimsha / Duncan, Kim F / Kugler, John D / Quiros-Tejeira, Ruben E / Kutty, Shelby

The Journal of thoracic and cardiovascular surgery

2016 Volume 151, Issue 3, Page(s) 678–684

Abstract: Objectives: We hypothesized that hepatic injury in single-ventricle CHD has origins that predate the Fontan operation. We aimed to measure hepatic stiffness using ultrasound and shear wave elastography (SWE) in a bidirectional cavopulmonary connection ( ... ...

Abstract	Objectives: We hypothesized that hepatic injury in single-ventricle CHD has origins that predate the Fontan operation. We aimed to measure hepatic stiffness using ultrasound and shear wave elastography (SWE) in a bidirectional cavopulmonary connection (BCPC) cohort. Methods: Subjects were prospectively recruited for real-time, hepatic, ultrasound-SWE for hepatic stiffness (kPa) and echocardiography. Doppler velocities, a velocity-time integral, flow volume, and resistive index, pulsatility index, and acceleration index were measured in celiac and superior mesenteric arteries, and in the main portal vein (MPV). Comparisons were made among subjects who had BCPC, subjects who were healthy, and a cohort of patients who had undergone the Fontan procedure. Results: Forty subjects (20 patients who had BCPC; 20 age- and gender-matched control subjects) were studied. The hepatic stiffness in BCPC was elevated, compared with that in control subjects (7.2 vs 5.7 kPa; P = .039). Patients who had BCPC had significantly higher celiac artery resistive index (0.9 vs 0.8; P = .002); pulsatility index (2.2 vs 1.7; P = .002); and systolic-diastolic flow ratio (10.1 vs 5.9; P = .002), whereas the superior mesenteric artery acceleration index (796 vs 1419 mL/min in control subjects; P = .04) was lower. An elevated resistive index (0.42 vs 0.29; P = .002) and pulsatility index (0.55 vs 0.35; P = .001) were seen in MPV, whereas MPV flow was reduced (137.3 vs 215.7 mL/min in control subjects; P = .036). A significant correlation was found for hepatic stiffness with right atrial pressure obtained at catheterization (P = .002). Comparison with patients who underwent the Fontan procedure showed patients who had BCPC had lower hepatic stiffness (7.2 vs 15.6 kPa; P < .001). Conclusions: Hepatic stiffness is increased with BCPC physiology, and this finding raises concerns that hepatopathology in palliated, single-ventricle CHD is not exclusively attributable to Fontan physiology. Hepatic stiffness measurements using SWE are feasible in this young population, and the technique shows promise as a means for monitoring disease progression.
MeSH term(s)	Case-Control Studies ; Child, Preschool ; Elastic Modulus ; Elasticity Imaging Techniques/methods ; Female ; Fontan Procedure/adverse effects ; Heart Defects, Congenital/complications ; Heart Defects, Congenital/diagnosis ; Heart Defects, Congenital/physiopathology ; Heart Defects, Congenital/surgery ; Hemodynamics ; Humans ; Infant ; Liver/blood supply ; Liver/diagnostic imaging ; Liver Circulation ; Liver Diseases/diagnostic imaging ; Liver Diseases/etiology ; Liver Diseases/physiopathology ; Male ; Palliative Care ; Predictive Value of Tests ; Prospective Studies ; Risk Factors ; Treatment Outcome ; Ultrasonography, Doppler
Language	English
Publishing date	2016-03
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2015.09.079
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Article ; Online: Is delirium being detected in emergency?

Traynor, Victoria / Cordato, Nicholas / Burns, Pippa / Xu, Yun / Britten, Nicole / Duncan, Kim / DeVries, Loren / McKinnon, Colleen

Australasian journal on ageing

2016 Volume 35, Issue 1, Page(s) 54–57

Abstract: Objective: To report on the use of Delirium Care Pathways to screen for and recognise delirium by Aged Care Services in Emergency Teams (ASETs) at five metropolitan hospitals in New South Wales, Australia. Knowledge of delirium and the use of Delirium ... ...

Abstract	Objective: To report on the use of Delirium Care Pathways to screen for and recognise delirium by Aged Care Services in Emergency Teams (ASETs) at five metropolitan hospitals in New South Wales, Australia. Knowledge of delirium and the use of Delirium Care Pathways are vital to ensure that older people presenting with delirium receive best practice care. Methods: An audit of 205 randomly selected medical records of clients over 65 years presenting to an ASET was conducted. Results: Delirium was recorded in the medical records notes of four clients (2%). However, the auditors identified another 27 clients with symptoms of delirium. Conclusions: Delirium is still frequently undiagnosed and misdiagnosed in older people presenting to emergency departments. This indicates a need for further education and professional development for and by health-care practitioners. Only with greater awareness of delirium will the care and health outcomes of older adults presenting with delirium in acute care settings improve.
MeSH term(s)	Age Factors ; Aged ; Cognition ; Delirium/diagnosis ; Delirium/epidemiology ; Delirium/psychology ; Diagnostic Errors ; Emergency Services, Psychiatric ; Female ; Geriatric Assessment ; Hospitals, Urban ; Humans ; Incidence ; Male ; Medical Audit ; Medical Records ; New South Wales/epidemiology ; Predictive Value of Tests ; Psychiatric Status Rating Scales
Language	English
Publishing date	2016-03
Publishing country	Australia
Document type	Journal Article ; Multicenter Study
ZDB-ID	1457406-8
ISSN	1741-6612 ; 0726-4240 ; 1440-6381
ISSN (online)	1741-6612
ISSN	0726-4240 ; 1440-6381
DOI	10.1111/ajag.12255
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