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Article ; Online: Quiet & deadly: Painless aortic dissection.

Chawla, Karan / Al-Embideen, Somya / Riordan, Christopher

International journal of cardiology. Cardiovascular risk and prevention

2023 Volume 16, Page(s) 200175

Abstract: Aortic dissection is a life-threatening condition that classically presents as a sudden, sharp pain with a ripping sensation. This disease is caused by a weakened area within the aortic arterial wall, which can be classified using the Stanford ... ...

Abstract	Aortic dissection is a life-threatening condition that classically presents as a sudden, sharp pain with a ripping sensation. This disease is caused by a weakened area within the aortic arterial wall, which can be classified using the Stanford classifications into type A or type B dissections, depending on the location of the tear. It is described that 17.6% of patients died before arriving at the hospital, and 45.2% of patients died within 30 days of diagnosis (Melvinsdottir et al., 2016). However, 10% of patients present without pain, leading to delayed diagnosis. In this case, a 53-year-old male with prior history of hypertension, sleep apnea, and diabetes mellitus presented to the emergency department with complaints of chest pain earlier that day. However, he was asymptomatic on presentation. He had no cardiac history. He was admitted, and a subsequent workup was performed to rule out myocardial infarction. The following morning a slight bump in troponin consistent with a Non-ST Elevated Myocardial Infarction (NSTEMI) was noted. An echocardiogram was ordered and showed aortic regurgitation. This was followed by computed tomography angiography (CTA), which revealed acute type A ascending aortic dissection. He was transferred to our facility and underwent an emergent Bentall procedure. Ultimately, the patient tolerated the surgery well and is recovering. This case is essential because it emphasizes the painless presentation of type A aortic dissection. Mis- or undiagnosed, this condition often leads to death.
Language	English
Publishing date	2023-01-20
Publishing country	Netherlands
Document type	Case Reports
ISSN	2772-4875
ISSN (online)	2772-4875
DOI	10.1016/j.ijcrp.2023.200175
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Toward an accurate assessment of the adverse effects of packed red blood cell transfusions in cardiac surgery.

Habib, Robert H / Schwann, Thomas A / Zacharias, Anoar / Riordan, Christopher J

Critical care medicine

2006 Volume 34, Issue 12, Page(s) 3067–8; author reply 3068–9

MeSH term(s)	Coronary Artery Bypass/adverse effects ; Coronary Artery Bypass/mortality ; Erythrocyte Transfusion/adverse effects ; Erythrocyte Transfusion/mortality ; Humans ; Postoperative Complications ; Time Factors
Language	English
Publishing date	2006-12
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/01.CCM.0000248869.87834.44
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Article: The independent effects of cardiopulmonary bypass hemodilutional anemia and transfusions on CABG outcomes.

Habib, Robert H / Zacharias, Anoar / Schwann, Thomas A / Riordan, Christopher J

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

2005 Volume 28, Issue 3, Page(s) 512–3; author reply 513–4

MeSH term(s)	Anemia/etiology ; Anemia/physiopathology ; Blood Transfusion ; Cardiopulmonary Bypass ; Coronary Artery Bypass/methods ; Coronary Disease/physiopathology ; Coronary Disease/surgery ; Hematocrit ; Humans ; Treatment Outcome
Language	English
Publishing date	2005-09
Publishing country	Germany
Document type	Comment ; Letter
ZDB-ID	639293-3
ISSN	1873-734X ; 1010-7940 ; 1567-4258
ISSN (online)	1873-734X
ISSN	1010-7940 ; 1567-4258
DOI	10.1016/j.ejcts.2005.05.019
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Article: Arterial versus vein graft patency in coronary artery bypass grafting patients with ischemia-directed repeat angiography.

Zacharias, Anoar / Habib, Robert H / Schwann, Thomas A / Riordan, Christopher J

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

2005 Volume 28, Issue 3, Page(s) 510–1; author reply 511–2

MeSH term(s)	Coronary Angiography ; Coronary Artery Bypass/methods ; Coronary Disease/surgery ; Graft Survival ; Humans ; Internal Mammary-Coronary Artery Anastomosis ; Recurrence ; Saphenous Vein
Language	English
Publishing date	2005-09
Publishing country	Germany
Document type	Comment ; Letter
ZDB-ID	639293-3
ISSN	1873-734X ; 1010-7940 ; 1567-4258
ISSN (online)	1873-734X
ISSN	1010-7940 ; 1567-4258
DOI	10.1016/j.ejcts.2005.06.013
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Article: Excess long-term mortality in patients with new-onset atrial fibrillation following coronary artery bypass grafting.

Habib, Robert H / Zacharias, Anoar / Schwann, Thomas A / Riordan, Christopher J

Journal of the American College of Cardiology

2004 Volume 44, Issue 12, Page(s) 2415; author reply 2415–6

MeSH term(s)	Atrial Fibrillation/surgery ; Coronary Artery Bypass/mortality ; Humans ; Survival Analysis
Language	English
Publishing date	2004-12-21
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	605507-2
ISSN	1558-3597 ; 0735-1097
ISSN (online)	1558-3597
ISSN	0735-1097
DOI	10.1016/j.jacc.2004.09.027
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Article ; Online: The prevalence of elevated hemoglobin A1c in patients undergoing coronary artery bypass surgery

Durham Samuel J / Riordan Christopher J / Schwann Thomas A / Zacharias Anoar / Habib Robert H / Engoren Milo / Shah Aamir

Journal of Cardiothoracic Surgery, Vol 3, Iss 1, p

2008 Volume 63

Abstract: Abstract Background Diabetes mellitus has become a major health issue in the United States and contributes to morbidity and mortality from coronary artery disease. Despite lifestyle changes and medications that have been shown to decrease complications ... ...

Abstract	Abstract Background Diabetes mellitus has become a major health issue in the United States and contributes to morbidity and mortality from coronary artery disease. Despite lifestyle changes and medications that have been shown to decrease complications and death, many persons have poor glycemic control. The purpose of this study is to determine the prevalence of elevated Hemoglobin A1c levels, a marker of glycemic control in patients presenting for coronary artery bypass surgery, and to determine if risk factors for diabetes mellitus could identify those patients with an elevated hemoglobin A1c. Methods All patients undergoing coronary artery bypass surgery had hemoglobin A1c levels determined immediately preoperatively. Proportions were used to describe the number of patients with elevated levels. Linear regression and receiver operator characteristic curves were used to evaluate the accuracy of risk factors to identify patients with elevated levels. Results 83 of 87 (95%) diabetic patients had elevated A1c levels (≥ 6.0%), with 55 of 87 (63%) having inadequate control – A1c levels ≥ 7.0. 93 of 163 (57%) non-diabetic patients had elevated A1c levels (≥ 6.0%), with 19 (12%) having levels ≥ 7.0%. Risk factors for diabetes mellitus poorly predicted which patient had elevated A1c levels. Conclusion The prevalence of elevated hemoglobin levels in patients undergoing coronary artery bypass surgery is high and routine measurement should be done to permit institution of lifestyle modifications and medication changes that decrease complications and death from diabetes mellitus.
Keywords	Diseases of the circulatory (Cardiovascular) system ; RC666-701 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Cardiovascular ; DOAJ:Medicine (General) ; DOAJ:Health Sciences ; Surgery ; RD1-811 ; DOAJ:Surgery
Subject code	610 ; 616
Language	English
Publishing date	2008-11-01T00:00:00Z
Publisher	BioMed Central
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Late outcomes after radial artery versus saphenous vein grafting during reoperative coronary artery bypass surgery.

Zacharias, Anoar / Schwann, Thomas A / Riordan, Christopher J / Durham, Samuel J / Shah, Aamir S / Engoren, Milo / Habib, Robert H

The Journal of thoracic and cardiovascular surgery

2010 Volume 139, Issue 6, Page(s) 1511–1518.e4

Abstract: Objective: We investigated whether use of radial artery versus saphenous vein grafts during coronary artery bypass grafting reoperations is associated with a significant long-term survival benefit.: Methods: We reviewed a series of 347 consecutive ... ...

Abstract	Objective: We investigated whether use of radial artery versus saphenous vein grafts during coronary artery bypass grafting reoperations is associated with a significant long-term survival benefit. Methods: We reviewed a series of 347 consecutive coronary artery bypass grafting reoperations (1996-2007; 270 [78%] male patients; age, 65.3 +/- 9.2 years). Internal thoracic artery grafts were used in 248 (71%) patients at the time of the first coronary artery bypass grafting operation and in 154 (44%) patients at reoperation. Patients were grouped based on whether a functional radial artery graft was present after coronary artery bypass grafting reoperation (radial artery cohort, n = 203 [59%]) or not (saphenous vein cohort, n = 144 [41%]). Median time to reoperation was similar for the radial artery (10.3 years) and saphenous vein (10.1 years) cohorts (P = .55). Angiographic data were used to ascertain the number and type of grafts that remained functional from initial coronary artery bypass grafting. Survival data (< or = 12 years) were time segmented based on multiphase hazard modeling at 90 days, and late survival was then analyzed by using proportional hazard Cox regression, with risk adjustment based on a radial artery-use propensity score computed from 48 covariates, including time to reoperation, month of surgical intervention, and total arterial and vein grafts after reoperation. Propensity-matched and propensity quintile comparisons were also done. Results: Follow-up was similar for the radial artery versus saphenous vein cohorts (5.7 +/- 3.4 vs 5.8 +/- 4.0 years, P = .86), and 112 (50 in the radial artery and 62 in the saphenous vein cohorts) deaths were documented. Early mortality (< or = 90 days) did not differ for the radial artery (7.4%) and saphenous vein (12.5%) cohorts (P = .14). Unadjusted late outcomes were superior for the radial artery versus saphenous vein cohorts, with survival of 97.3% versus 92.9%, 84.9% versus 77.2%, and 74.1% versus 60.3% at 1, 5, and 10 years, respectively. Propensity-adjusted radial artery survival was superior, with a hazard ratio of 0.58 (P = .04), and this result was confirmed in a propensity-matched comparison. Conclusions: We conclude that the use of radial artery as opposed to saphenous vein grafting for reoperative coronary artery bypass grafting, either with or without concomitant internal thoracic artery grafts, is associated with a substantial improvement in late survival. This benefit is likely derived from the increased overall number of arterial grafts.
MeSH term(s)	Aged ; Coronary Artery Bypass ; Coronary Artery Disease/mortality ; Coronary Artery Disease/surgery ; Female ; Humans ; Male ; Radial Artery/transplantation ; Reoperation ; Retrospective Studies ; Saphenous Vein/transplantation ; Survival Rate ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2010-06
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2009.07.068
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Article ; Online: Operative and late coronary artery bypass grafting outcomes in matched African-American versus Caucasian patients: evidence of a late survival-Medicaid association.

Zacharias, Anoar / Schwann, Thomas A / Riordan, Christopher J / Durham, Samuel J / Shah, Aamir / Habib, Robert H

Journal of the American College of Cardiology

2005 Volume 46, Issue 8, Page(s) 1526–1535

Abstract: Objectives: This study sought to determine whether African-American versus Caucasian race is a determinant of early or late coronary artery bypass surgery (CABG) outcomes.: Background: African Americans are referred to CABG less frequently than ... ...

Abstract	Objectives: This study sought to determine whether African-American versus Caucasian race is a determinant of early or late coronary artery bypass surgery (CABG) outcomes. Background: African Americans are referred to CABG less frequently than Caucasians and Medicaid coverage is disproportionately common among those who are referred. How these factors affect the relative early and late CABG outcomes in these groups is incompletely elucidated. Methods: A retrospective cohort comparison of operative and 12-year outcomes for 304 African-American and 6,073 Caucasian consecutive patients who underwent isolated CABG (1991 to 2003) at an urban community hospital was used. Results were further confirmed in propensity-matched subgroups (n = 301 each). Results: African Americans were younger (62 vs. 64 years, median), more were female (46% vs. 30%), more were on Medicaid (29% vs. 6.3%) and had more comorbidities. These differences were eliminated after matching. A total of 161 operative and 1,080 late deaths have been documented. Operative mortality was similar (African American versus Caucasian: 3.0% vs. 2.5%; p = 0.81). Unadjusted Kaplan-Meier survival at 1, 5, and 10 years (93.4%, 80.3%, and 66.1% vs. 94.8%, 86.5%, and 71.7%) was worse in African Americans (hazard ratio [HR] = 1.38; p = 0.004), but similar for matched groups (HR = 1.03; p = 0.97). After risk adjustment, race did not predict operative (odds ratio = 1.17; p = 0.69) or late (HR = 1.15; p = 0.28) mortality. However, Medicaid status (HR = 1.54; p < 0.005) predicted worse survival, which was verified in a case-matched Medicaid (n = 469) versus non-Medicaid analysis. The latter showed that in younger Medicaid patients without companion Medicare coverage, late mortality was nearly doubled (HR = 1.96; p = 0.003) with systematically increasing death hazard after the second year. Conclusions: African-American race per se is not associated with worse operative or late outcomes underscoring that CABG should be based on clinical characteristics only. Alternatively, Medicaid status, which is more prevalent among African Americans, is associated with worse late survival, especially in non-Medicare patients. Studies are needed to elucidate this late Medicaid-CABG outcome association.
MeSH term(s)	African Americans ; Coronary Artery Bypass/adverse effects ; Coronary Artery Bypass/mortality ; European Continental Ancestry Group ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Retrospective Studies ; Survival Rate ; Time Factors
Language	English
Publishing date	2005-10-18
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	605507-2
ISSN	1558-3597 ; 0735-1097
ISSN (online)	1558-3597
ISSN	0735-1097
DOI	10.1016/j.jacc.2005.06.071
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Article ; Online: Effects of obesity and small body size on operative and long-term outcomes of coronary artery bypass surgery: a propensity-matched analysis.

Habib, Robert H / Zacharias, Anoar / Schwann, Thomas A / Riordan, Christopher J / Durham, Samuel J / Shah, Aamir

The Annals of thoracic surgery

2005 Volume 79, Issue 6, Page(s) 1976–1986

Abstract: Background: The effects of body habitus on coronary artery bypass graft surgery (CABG) operative and long-term outcomes are not well defined. We aimed to elucidate the independent effects of small body size and obesity on CABG outcomes.: Methods: ... ...

Abstract	Background: The effects of body habitus on coronary artery bypass graft surgery (CABG) operative and long-term outcomes are not well defined. We aimed to elucidate the independent effects of small body size and obesity on CABG outcomes. Methods: Primary isolated CABG patients were grouped based on body surface area (BSA, m2) and body mass index (BMI, kg/m2) as follows: 611 very small (BSA < or = 1.70); 933 slightly small (1.70 < BSA < or = 1.85); 945 moderately obese (32 < BMI < 36); 594 very obese (BMI > or = 36); and 3,018 normal (BSA >1.85; BMI = 22 to 32). Subcohorts of very small (371 pairs, 61%), slightly small (717, 77%), moderately obese (874, 92%), and very obese (516, 87%) patients were propensity-matched to normal. Results: Compared with normal, very small had more transfusions (46% versus 32%; p < 0.001), reoperation for bleeding (3.2% versus 0.3%; p = 0.002), and pulmonary edema (2.4% versus 0.5%; p = 0.033). For slightly small, transfusion (41% versus 29%; p < 0.001) and bleeding (2.5% versus 1.0%; p = 0.04) were increased. For moderately obese, sternal wound infections (1.9% versus 0.8%; p = 0.04) were greater. Complications were most frequent in very obese: reoperation (5.2% versus 1.6%; p < 0.001), sternal wound infections (3.5% versus 0.2%; p < 0.001), pulmonary edema (2.9% versus 1.2%; p = 0.047), renal failure (6.0% versus 2.3%; p = 0.003), atrial fibrillation (20% versus 12%; p = 0.001), gastrointestinal problems (3.7% versus 1.6%; p = 0.032), and postoperative stay (8.0 versus 6.4 days; p = 0.003). When slightly small and very small are considered together, operative mortality was significantly greater (3.22% versus 1.65%; p = 0.026). Both very small (risk ratio [RR] = 1.39; p = 0.044) and very obese (RR = 1.44; p = 0.020) were independent predictors of worse 0- to 12-year mortality. Conclusions: Large deviations from normal body size in either direction--particularly extreme obesity--are associated with increased postoperative morbidity and worse long-term survival.
MeSH term(s)	Aged ; Body Mass Index ; Body Size ; Case-Control Studies ; Coronary Artery Bypass ; Coronary Artery Disease/surgery ; Female ; Humans ; Male ; Middle Aged ; Morbidity ; Obesity/complications ; Postoperative Complications ; Retrospective Studies ; Survival Analysis ; Treatment Outcome
Language	English
Publishing date	2005-06
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.2004.11.029
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Article: Radial artery conduits in coronary artery bypass grafting: current perspective.

Zacharias, Anoar / Habib, Robert H / Schwann, Thomas A / Riordan, Christopher J / Durham, Samuel J / Shah, Aamir

The Journal of thoracic and cardiovascular surgery

2005 Volume 130, Issue 1, Page(s) 232–3; author reply 233

MeSH term(s)	Coronary Artery Bypass/methods ; Coronary Artery Bypass/mortality ; Humans ; Radial Artery/transplantation ; Saphenous Vein/transplantation ; Vascular Patency
Language	English
Publishing date	2005-07
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2005.02.033
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