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Article ; Online: What drives variability in postoperative cardiac surgery transfusion rates?

Mauney, Carrinton / Etchill, Eric / Rea, Amanda / Edwin Fonner, Clifford / Whitman, Glenn / Salenger, Rawn

The Journal of thoracic and cardiovascular surgery

2024

Abstract: Objective: Wide interhospital variation exists in cardiac surgical postoperative transfusion rates. We aimed to compare transfusion rates at 2 hospitals and identify the institutional practice factors, unrelated to patient or operative characteristics, ... ...

Abstract	Objective: Wide interhospital variation exists in cardiac surgical postoperative transfusion rates. We aimed to compare transfusion rates at 2 hospitals and identify the institutional practice factors, unrelated to patient or operative characteristics, associated with postoperative transfusion rates. Methods: Records for adult patients undergoing routine cardiac surgery at 2 hospitals (H and L) from February 2020 to August 2022 were analyzed. Patient and operative characteristics, preoperative and intensive care unit hemoglobin values, and postoperative transfusion rates were compared. Transfusion indication was recorded prospectively. Propensity matching was completed to assess comparability of patient populations. Results: After propensity matching patients at H and L on age, procedure type, predicted morbidity or mortality, crossclamp time, preoperative hypertension, preoperative heart failure, and preoperative stroke, 2111 patients remained, with similar characteristics except hypertension. Matched results showed no significant differences in mortality, reoperation, or other major outcomes. Hospital H transfused 36% of patients (mean postoperative hemoglobin [Hb] 10.5) with 1483 units of packed red blood cells whereas hospital L transfused 12% of patients (mean postoperative Hb 9.4) with 198 units of packed red blood cells (P < .001). For all patients with a Hb >7.5, hospital H versus L transfused 27% versus 0.9% (P < .001). Hospital L's sole transfusion indication for pretransfusion hemoglobin trigger >7.5 was bleeding versus hospital H, which had multiple indications. When Hb concentration alone was the indication for transfusion, the threshold at hospital H was <7.5 g/dL versus <6 g/dL at hospital L. Conclusions: Variation in transfusion rates between hospitals H and L resulted from strict adherence at hospital L to a transfusion trigger of <6 g/dL with narrow indications for transfusions above that Hb concentration.
Language	English
Publishing date	2024-02-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2024.02.004
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Article ; Online: Commentary: Postcardiotomy shock: Are stones still unturned?

Etchill, Eric / Whitman, Glenn J R

The Journal of thoracic and cardiovascular surgery

2019 Volume 160, Issue 5, Page(s) 1217–1218

MeSH term(s)	Extracorporeal Membrane Oxygenation ; Heart-Assist Devices ; Humans ; Registries ; Shock, Cardiogenic/diagnosis ; Shock, Cardiogenic/etiology
Language	English
Publishing date	2019-12-06
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2019.10.180
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Article ; Online: Non-resectional cordal repair for Barlow mitral valve disease.

Florissi, Isabella S / Acton, Matthew / Kolesnik, Irina / Pasrija, Chetan / Patel, Ishani / Etchill, Eric / Holmes, Sari D / Quinn, Rachael / Gammie, James S

The Journal of cardiovascular surgery

2024

Abstract: Background: The redundant leaflet tissue and annular pathology of Barlow disease can make surgical repair challenging. We examined perioperative and late outcomes of a large cohort of patients with Barlow disease undergoing surgical repair.: Methods: ...

Abstract	Background: The redundant leaflet tissue and annular pathology of Barlow disease can make surgical repair challenging. We examined perioperative and late outcomes of a large cohort of patients with Barlow disease undergoing surgical repair. Methods: Patients included in this analysis underwent mitral valve repair from 01/2004-11/2021 by a single surgeon. Results: Of 2798 patients undergoing mitral valve operations, 46% (N.=1292) had degenerative pathology and 7% (N.=184) had Barlow disease. Of the 179 Barlow patients, median age at surgery was 62 (51-70) years; 64% were male (115/179). Rates of non-resectional cordal repair and resectional repair were 86% (154/179) and 14% (25/179). Among patients undergoing non-resectional repair, the median number of cordal pairs inserted on the anterior and posterior leaflets was 2 (2-3) and 4 (3-4). Incidence of return to bypass for systolic anterior motion of the mitral valve, perioperative death, stroke, and renal failure was 2% (4/179), 1% (2/179), 0% (0/179), and 0% (0/179). Rates of clinical and echocardiographic follow-up were 93% (165/177) and 89% (157/177). Median time to latest postoperative clinical and echocardiographic follow-up was 2.4 (0.8-6.1) and 2.1 (0.6-4.7) years. Mitral regurgitation grade at latest follow-up or time of repair failure was none/trace, mild, mild to moderate, and severe in 63% (98/157), 26% (41/157), 8% (12/157), and 4% (6/157); five of six patients with severe MR underwent reoperation. Since 2011 97% (139/144) of patients underwent cordal repair without resection. Conclusions: Non-resectional artificial cordal repair is safe and feasible in almost all patients with Barlow valves and is associated with excellent mid-term results.
Language	English
Publishing date	2024-03-20
Publishing country	Italy
Document type	Journal Article
ZDB-ID	80143-4
ISSN	1827-191X ; 0021-9509
ISSN (online)	1827-191X
ISSN	0021-9509
DOI	10.23736/S0021-9509.24.12899-6
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Article: Cystic tumor of the atrioventricular node.

Giuliano, Katherine / Scully, Brandi / Etchill, Eric / Lawton, Jennifer

Global cardiology science & practice

2020 Volume 2020, Issue 2, Page(s) e202028

Abstract: We present a case of a 71-year-old female with complete heart block and an incidentally found atrioventricular nodal inclusion cyst. ...

Abstract	We present a case of a 71-year-old female with complete heart block and an incidentally found atrioventricular nodal inclusion cyst.
Language	English
Publishing date	2020-11-30
Publishing country	Qatar
Document type	Case Reports
ZDB-ID	2738381-7
ISSN	2305-7823
ISSN	2305-7823
DOI	10.21542/gcsp.2020.28
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Article ; Online: Aortitis masquerading as intramural hematoma: When to observe, when to operate? A case report.

Velez, Ana K / Etchill, Eric / Halushka, Marc K / Schena, Stefano

Journal of cardiac surgery

2021 Volume 36, Issue 4, Page(s) 1554–1556

Abstract: Radiologic evidence of aortic disease is not always consistent with the diagnosis. With a lack of accompanying symptoms or with an atypical presentation, diagnosis, and management of aortic pathology rely greatly on imaging techniques. We report the case ...

Abstract	Radiologic evidence of aortic disease is not always consistent with the diagnosis. With a lack of accompanying symptoms or with an atypical presentation, diagnosis, and management of aortic pathology rely greatly on imaging techniques. We report the case of a 58-year-old female who presented with incidental radiographic findings consistent with a type A aortic intramural hematoma and a vague left-sided chest discomfort. After follow-up, imaging was consistent with disease progression and hematoma expansion; the affected segment was resected and pathology reported lymphoplasmacytic aortitis as the underlying etiology of the imaging findings rather than an intramural hematoma. The patient lacked symptoms or serology consistent with the rheumatologic disease, and the postoperative course was uneventful. The management of a suspected ascending intramural hematoma is controversial, especially when the patient presents with atypical signs and symptoms. Features of disease progression may warrant urgent surgical intervention.
MeSH term(s)	Aorta ; Aortic Diseases/diagnostic imaging ; Aortic Diseases/surgery ; Aortitis/diagnostic imaging ; Aortitis/surgery ; Diagnostic Imaging ; Female ; Hematoma/diagnostic imaging ; Hematoma/surgery ; Humans ; Middle Aged
Language	English
Publishing date	2021-01-27
Publishing country	United States
Document type	Case Reports
ZDB-ID	639059-6
ISSN	1540-8191 ; 0886-0440
ISSN (online)	1540-8191
ISSN	0886-0440
DOI	10.1111/jocs.15348
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Article: Patent anomalous circumflex coronary artery stent occlusion following aortic valve replacement with coronary artery bypass.

Kapoor, Shrey / Giuliano, Katherine / Etchill, Eric / Aziz, Hamza / Lawton, Jennifer S

Global cardiology science & practice

2022 Volume 2022, Issue 1-2, Page(s) e202212

Abstract: An anomalous left circumflex artery branching arising from the right coronary artery is one of the most common congenital coronary artery abnormalities. Despite this, the incidence is low and our clinical understanding of the nuances in patients with ... ...

Abstract	An anomalous left circumflex artery branching arising from the right coronary artery is one of the most common congenital coronary artery abnormalities. Despite this, the incidence is low and our clinical understanding of the nuances in patients with such abnormalities remains limited. We present a case of a 73-year-old male with coronary artery disease status-post stenting of an anomalous circumflex artery who subsequently underwent coronary artery bypass grafting and surgical aortic valve replacement with EKG changes post-operatively. He was emergently taken to the cardiac catheterization lab, where catheterization revealed total occlusion of the proximal circumflex artery, just distal to the previous stent. Acute inferior ST-elevation myocardial infarction was suspected to be secondary to intraoperative external manipulation at the site of occlusion in the retro-aortic segment of the vessel. In patients with abnormal coronary artery anatomy, it is imperative to monitor for new EKG changes that may be indicative of new ischemia requiring further intervention.
Language	English
Publishing date	2022-06-30
Publishing country	Qatar
Document type	Case Reports
ZDB-ID	2738381-7
ISSN	2305-7823
ISSN	2305-7823
DOI	10.21542/gcsp.2022.12
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Article ; Online: Contemporary Role of Computed Tomography in Managing Pediatric Primary Spontaneous Pneumothorax.

Rahal, Simon / Engwall-Gill, Abigail J / Etchill, Eric / Kunisaki, Shaun M / Nasr, Isam W

The Journal of surgical research

2022 Volume 276, Page(s) 256–260

Abstract: Introduction: The value of chest computed tomography (CT) in pediatric primary spontaneous pneumothorax (PSP) remains controversial. This study sought to evaluate the utility of CT scans in a contemporary cohort of children with PSP.: Materials and ... ...

Abstract	Introduction: The value of chest computed tomography (CT) in pediatric primary spontaneous pneumothorax (PSP) remains controversial. This study sought to evaluate the utility of CT scans in a contemporary cohort of children with PSP. Materials and methods: An institutional review board approval was obtained for a retrospective review of all children (aged ≤18 y) who underwent video-assisted thoracoscopic surgery (VATS) for PSP between 2009 and 2019 at a university-affiliated pediatric hospital. Preoperative CT scans were evaluated for diagnostic accuracy of the CT of bleb disease. Results: Thirty nine patients underwent VATS procedures for PSP, 34 (87%) of the patients were noted to have blebs. Twenty eight (72%) patients received preoperative CT scans with a 5.5:1 male to female ratio. On CT, 17 (61%) were diagnosed with blebs and all had blebs intraoperatively. CT did not identify disease in 11 patients, but seven had blebs intraoperatively. The positive and negative predictive values of preoperative CT for detecting ipsilateral bleb disease were 100% and 36%, respectively, with a sensitivity of 71%. Eleven patients had a contralateral disease on CT (39%). Five received elective contralateral VATS and three developed spontaneous PSP, with intraoperative blebs in all eight patients. Three never developed contralateral PSP. Six (21%) patients with no contralateral disease on CT developed spontaneous PSP with intraoperative blebs. Conclusions: The decision to operate for PSP should be made based on clinical findings rather than on the presence or absence of blebs identified by CT.
MeSH term(s)	Child ; Female ; Humans ; Male ; Pneumothorax/diagnostic imaging ; Pneumothorax/surgery ; Recurrence ; Retrospective Studies ; Thoracic Surgery, Video-Assisted/methods ; Tomography, X-Ray Computed/methods ; Treatment Outcome
Language	English
Publishing date	2022-04-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2022.03.007
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Article ; Online: Sex-Related Differences in Utilization and Outcomes of Extracorporeal Cardio-Pulmonary Resuscitation for Refractory Cardiac Arrest.

Balucani, Clotilde / Canner, Joseph K / Tonna, Joseph E / Dalton, Heidi / Bianchi, Riccardo / Al-Kawaz, Mais N G / Choi, Chun Woo / Etchill, Eric / Kim, Bo Soo / Whitman, Glenn J / Cho, Sung-Min

ASAIO journal (American Society for Artificial Internal Organs : 1992)

2024

Abstract: Sparse data exist on sex-related differences in extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest (rCA). We explored the role of sex on the utilization and outcomes of ECPR for rCA by retrospective analysis of the ... ...

Abstract	Sparse data exist on sex-related differences in extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest (rCA). We explored the role of sex on the utilization and outcomes of ECPR for rCA by retrospective analysis of the Extracorporeal Life Support Organization (ELSO) International Registry. The primary outcome was in-hospital mortality. Exploratory outcomes were discharge disposition and occurrence of any specific extracorporeal membrane oxygenation (ECMO) complications. From 1992 to 2020, a total of 7,460 adults with ECPR were identified: 30.5% women; 69.5% men; 55.9% Whites, 23.7% Asians, 8.9% Blacks, and 3.8% Hispanics. Women's age was 50.4 ± 16.9 years (mean ± standard deviation) and men's 54.7 ± 14.1 (p < 0.001). Ischemic heart disease occurred in 14.6% women vs. 18.5% men (p < 0.001). Overall, 28.5% survived at discharge, 30% women vs. 27.8% men (p = 0.138). In the adjusted analysis, sex was not associated with in-hospital mortality (odds ratio [OR] = 0.93 [confidence interval {CI} = 0.80-1.08]; p = 0.374). Female sex was associated with decreased odds of neurologic, cardiovascular, and renal complications. Despite being younger and having fewer complications during ECMO, women had in-hospital mortality similar to men. Whether these findings are driven by biologic factors or disparities in health care warrants further investigation.
Language	English
Publishing date	2024-04-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	759982-1
ISSN	1538-943X ; 0162-1432 ; 1058-2916
ISSN (online)	1538-943X
ISSN	0162-1432 ; 1058-2916
DOI	10.1097/MAT.0000000000002210
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Article ; Online: What Kind of Surgeon Will You Be? An Analysis of Specialty Interest Changes Over the Course of General Surgery Residency.

Giuliano, Katherine / Etchill, Eric / DiBrito, Sandra / Sacks, Bethany

Medical science educator

2020 Volume 30, Issue 4, Page(s) 1599–1604

Abstract: Background: Integrated surgical residency programs and early specialization tracts have increased, with proposed benefits including shorter training time and increased exposure. Drawbacks include a loss of breadth and the need for earlier trainee career ...

Abstract	Background: Integrated surgical residency programs and early specialization tracts have increased, with proposed benefits including shorter training time and increased exposure. Drawbacks include a loss of breadth and the need for earlier trainee career decisions. We sought to assess the rate of changing specialty interests over the course of general surgery residency, and what, if any, factors influenced that decision. Methods: An 11-question, web-based survey was sent to alumni (2009-2019) of a single academic general surgery residency training program. It queried demographics and experiences during medical school and residency, whether specialty interest changed, and if so, what factors influenced that decision. Results: The survey was emailed to 53 alumni and completed by 59% ( Conclusions: Nearly two-thirds of general surgery residents at a single academic institution changed their specialty interest over the course of residency. Our findings suggest that while integrated programs may provide benefits, many medical students are not being exposed to these potential fields.
Language	English
Publishing date	2020-10-14
Publishing country	United States
Document type	Journal Article
ISSN	2156-8650
ISSN (online)	2156-8650
DOI	10.1007/s40670-020-01110-z
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Article ; Online: Cardiothoracic surgery educational research and training innovation: A review of 2018-2019.

Hunt, Megan F / Giuliano, Katherine / Etchill, Eric / Yang, Stephen C

The Journal of thoracic and cardiovascular surgery

2020 Volume 160, Issue 4, Page(s) 1133–1137

MeSH term(s)	Humans ; Cardiac Surgical Procedures/education ; Curriculum ; Internship and Residency ; Surgeons/education ; Thoracic Surgery/education ; Thoracic Surgical Procedures/education
Language	English
Publishing date	2020-04-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2020.04.049
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