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Article ; Online: Discussion.

Varghese, Robin

The Journal of thoracic and cardiovascular surgery

2022 Volume 167, Issue 3, Page(s) 1112–1114

Language	English
Publishing date	2022-08-26
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.2022.07.014
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Article ; Online: Discussion.

Varghese, Robin

The Journal of thoracic and cardiovascular surgery

2022 Volume 167, Issue 1, Page(s) 267–268

Language	English
Publishing date	2022-05-09
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.2022.01.063
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Article: Perioperative Management of Novel Pharmacotherapies for Heart Failure and Pulmonary Hypertension.

Gross, Caroline R / Varghese, Robin / Zafirova, Zdravka

Anesthesiology clinics

2023 Volume 42, Issue 1, Page(s) 117–130

Abstract: Heart failure (HF) and pulmonary hypertension (PH) are increasingly prevalent comorbidities in patients presenting for noncardiac surgery. The unique pathophysiology and pharmacotherapies associated with these syndromes have important perioperative ... ...

Abstract	Heart failure (HF) and pulmonary hypertension (PH) are increasingly prevalent comorbidities in patients presenting for noncardiac surgery. The unique pathophysiology and pharmacotherapies associated with these syndromes have important perioperative implications. As new medications for HF and PH emerge, it is imperative that anesthesiologists and other perioperative providers understand their mechanisms of action, pharmacokinetics, and potential adverse effects. We present an overview of the novel HF and PH pharmacotherapies and strategies for their perioperative management.
MeSH term(s)	Humans ; Hypertension, Pulmonary/drug therapy ; Heart Failure/complications ; Heart Failure/drug therapy
Language	English
Publishing date	2023-10-14
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2228899-5
ISSN	2210-3538 ; 1932-2275 ; 0889-8537
ISSN (online)	2210-3538
ISSN	1932-2275 ; 0889-8537
DOI	10.1016/j.anclin.2023.09.004
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Article ; Online: Failure to Rescue: A Quality Metric for Cardiac Surgery and Cardiovascular Critical Care.

Gross, Caroline R / Adams, David H / Patel, Parth / Varghese, Robin

The Canadian journal of cardiology

2023 Volume 39, Issue 4, Page(s) 487–496

Abstract: Failure to rescue, defined as mortality after a surgical complication, is a widely accepted quality metric across many specialties and is becoming an important metric in cardiac surgery. The failure to rescue metric provides a target for improvements in ... ...

Abstract	Failure to rescue, defined as mortality after a surgical complication, is a widely accepted quality metric across many specialties and is becoming an important metric in cardiac surgery. The failure to rescue metric provides a target for improvements in patient outcomes after complications occur. To be used appropriately, the failure to rescue metric must be defined using a prespecified set of life-threatening and rescuable complications. Successful patient rescue requires a systematic approach of complication recognition, timely escalation of care, effective medical management, and mitigation of additional complications. This process requires contributions from cardiac surgeons, intensivists, and other specialists including cardiologists, neurologists, and anaesthesiologists. Factors that affect failure to rescue rates in cardiac surgery and cardiovascular critical care include nurse staffing ratios, intensivist coverage, advanced specialist support, hospital and surgical volume, the presence of trainees, and patient comorbidities. Strategies to improve patient rescue include working to understand the mechanisms of failure to rescue, anticipating postoperative complications, prioritizing microsystem factors, enhancing early escalation of care, and educating and empowering junior clinicians. When used appropriately, the failure to rescue quality metric can help institutions focus on improving processes of care that minimize morbidity and mortality from rescuable complications after cardiac surgery.
MeSH term(s)	Humans ; Hospital Mortality ; Cardiac Surgical Procedures ; Postoperative Complications/epidemiology ; Critical Care ; Hospitals
Language	English
Publishing date	2023-01-05
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	632813-1
ISSN	1916-7075 ; 0828-282X
ISSN (online)	1916-7075
ISSN	0828-282X
DOI	10.1016/j.cjca.2023.01.001
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Zs.A 2150: Show issues

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Article ; Online: Commentary: Epinephrine's meager benefit in resuscitation illustrates the need for shrewd bedside judgment when resuscitating cardiothoracic surgery patients.

Varghese, Robin / Patel, Parth

The Journal of thoracic and cardiovascular surgery

2020 Volume 160, Issue 6, Page(s) 1523–1524

MeSH term(s)	Allied Health Personnel ; Cardiac Surgical Procedures/adverse effects ; Epinephrine ; Humans ; Judgment ; Resuscitation
Chemical Substances	Epinephrine (YKH834O4BH)
Language	English
Publishing date	2020-06-29
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.2020.06.065
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Article ; Online: Reply to the editor.

Varghese, Robin

The Journal of thoracic and cardiovascular surgery

2013 Volume 145, Issue 3, Page(s) 895

MeSH term(s)	Algorithms ; Cardiac Surgical Procedures/adverse effects ; Female ; Heart Valve Diseases/surgery ; Humans ; Male ; Mitral Valve/surgery ; Mitral Valve Prolapse/therapy
Language	English
Publishing date	2013-03
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.2012.12.044
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Article ; Online: Operative risks of the Ross procedure.

Stelzer, Paul / Mejia, Javier / Varghese, Robin

The Journal of thoracic and cardiovascular surgery

2021 Volume 161, Issue 3, Page(s) 905–915.e3

Abstract: Background: The risk of the Ross procedure continues to be debated. We sought to determine the immediate outcomes of the Ross procedure in a large consecutive cohort that included patients undergoing reoperative cardiac surgery and/or concomitant ... ...

Abstract	Background: The risk of the Ross procedure continues to be debated. We sought to determine the immediate outcomes of the Ross procedure in a large consecutive cohort that included patients undergoing reoperative cardiac surgery and/or concomitant cardiac procedures. Methods: Between March 1987 and September 2019, 702 patients underwent a full root Ross procedure. There were 530 male patients and 172 female patients, with a mean age of 41.6 years. One hundred and one patients had at least one previous sternotomy; 323 patients had concomitant procedures. Patients were stratified into 2 groups: simple and complex. Simple Ross patients were those who had no previous sternotomy and had only minor concomitant procedures performed at the time of their Ross, such as aortoplasty or closure of patent foramen ovale. The complex Ross group included patients with at least one previous sternotomy and/or additional procedures that we deemed complex, such as ascending aortic replacement and mitral valve repair. Complexity and group outcomes were evaluated in consecutive terciles of time. Results: There were 7 (1%) operative deaths. Morbidity affected 46 other patients (6.6%). The simple Ross group comprised 419 patients (59.7%), with mortality in 3 (0.7%) and morbidity in 20 (4.8%). The complex Ross comprised 283 patients (40.3%), with mortality in 4 (1.4%) and morbidity in 26 (9.2%). Simple Ross cases decreased in volume over time, with complex cases increasing from 34% to 48%. Conclusions: Excellent results can be achieved with the Ross procedure despite broader indications that include patients with previous sternotomy and with the need for concomitant procedures.
MeSH term(s)	Adolescent ; Adult ; Aortic Aneurysm/diagnostic imaging ; Aortic Aneurysm/mortality ; Aortic Aneurysm/physiopathology ; Aortic Aneurysm/surgery ; Aortic Valve/diagnostic imaging ; Aortic Valve/physiopathology ; Aortic Valve/surgery ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation/adverse effects ; Blood Vessel Prosthesis Implantation/instrumentation ; Child ; Child, Preschool ; Databases, Factual ; Female ; Heart Valve Diseases/diagnostic imaging ; Heart Valve Diseases/mortality ; Heart Valve Diseases/physiopathology ; Heart Valve Diseases/surgery ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation/adverse effects ; Heart Valve Prosthesis Implantation/instrumentation ; Humans ; Male ; Middle Aged ; Postoperative Complications/etiology ; Postoperative Complications/mortality ; Reoperation ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Sternotomy/adverse effects ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2021-01-12
Publishing country	United States
Document type	Journal Article ; Webcast
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2020.11.161
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Article ; Online: The Ross Outlasts its Critics and Competition.

Stelzer, Paul / Varghese, Robin

Journal of the American College of Cardiology

2017 Volume 70, Issue 15, Page(s) 1900–1901

MeSH term(s)	Adult ; Aortic Valve/surgery ; Heart Valve Prosthesis Implantation ; Humans ; Longitudinal Studies
Language	English
Publishing date	2017-10-05
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	605507-2
ISSN	1558-3597 ; 0735-1097
ISSN (online)	1558-3597
ISSN	0735-1097
DOI	10.1016/j.jacc.2017.08.034
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Zs.A 1846: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 196: Show issues

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Article: Fast pyrolysis of polyurethanes and polyisocyanurate with and without flame retardant: Compounds of interest for chemical recycling

Eschenbacher, Andreas / Varghese, Robin John / Weng, Junjie / Van Geem, Kevin M.

Journal of analytical and applied pyrolysis. 2021 Nov., v. 160

2021

Abstract: To date, the recycling of polyurethane (PU) and polyisocyanurate (PIR) waste still poses a significant problem. Within this contribution, the thermal degradation of high-resilient ether PU, semirigid PU, rigid PU, and (PIR) with and without TCPP flame ... ...

Abstract	To date, the recycling of polyurethane (PU) and polyisocyanurate (PIR) waste still poses a significant problem. Within this contribution, the thermal degradation of high-resilient ether PU, semirigid PU, rigid PU, and (PIR) with and without TCPP flame retardant was studied at different temperatures to identify and quantify the main products. For this, a tandem micropyrolyzer coupled to GC × GC with FID and ToF-MS detectors was used, and the yield volatiles, light gases, and residue was quantified. The volatile pyrolysis vapours obtained from pyrolyzing high-resilient ether PU and semirigid PU at 600 °C were very similar, and the main products obtained were ethylene and propylene (combined yield of ~13 wt%), ~16 wt% of various oxygenates, and 4–6 wt% organic nitrogen compounds. The oxygenates included mostly poly-ether type compounds with varying molecular weight, and these are attributed to the decomposition of the polyol chains forming the soft segments of the polymer. The main semi-volatile nitrogen compound was 4,4′-methylenedianiline, attributed to the decomposition of the hard segments in the PU structure synthesized from MDI. The pyrolysis vapours from rigid PU contained several ether-type compounds and high yields of heteroatom-free monoaromatics—in particular styrene. The PIRs were more difficult to decompose and volatilize than the PUs, resulting in ~20 wt% higher residue yields. The charring propensity was even higher in the absence of a flame retardant in the formulation. Pyrolysis of TCPP-containing PIR produced Cl-containing pyrolysis vapours such as allyl chlorides. While the yield of H₂O was comparable for the different PUs and PIR, pyrolysis of PIR produced higher yields of CO₂ and less CO compared to the different PUs. The use of catalysts can help to convert PU waste pyrolysis vapours more efficiently to desirable chemicals.
Keywords	carbon dioxide ; ethylene ; flame retardants ; molecular weight ; organic nitrogen ; polyols ; polyurethanes ; propylene ; pyrolysis ; styrene ; wastes
Language	English
Dates of publication	2021-11
Publishing place	Elsevier B.V.
Document type	Article
ISSN	0165-2370
DOI	10.1016/j.jaap.2021.105374
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Propensity-Matched Comparison of the Ross Procedure and Prosthetic Aortic Valve Replacement in Adults.

El-Hamamsy, Ismail / Toyoda, Nana / Itagaki, Shinobu / Stelzer, Paul / Varghese, Robin / Williams, Elbert E / Erogova, Natalia / Adams, David H

Journal of the American College of Cardiology

2022 Volume 79, Issue 8, Page(s) 805–815

Abstract: Background: There has recently been renewed interest in the Ross procedure in adults.: Objectives: The goal of this study was to compare long-term outcomes after the Ross procedure vs biological and mechanical aortic valve replacement (AVR) in adults ...

Abstract	Background: There has recently been renewed interest in the Ross procedure in adults. Objectives: The goal of this study was to compare long-term outcomes after the Ross procedure vs biological and mechanical aortic valve replacement (AVR) in adults (aged 18-50 years) undergoing aortic valve surgery. Methods: Mandatory California and New York databases were queried between 1997 and 2014. Exclusion criteria included: ≥1 concomitant procedure, reoperations, infective endocarditis, intravenous drug use, hemodialysis, and out-of-state residency. Propensity matching (1:1:1) was used, resulting in 434 patients per group. The primary endpoint was all-cause mortality. Secondary endpoints were stroke, major bleeding, reoperation, and endocarditis. Median follow-up was 12.5 years (IQR: 9.3-15.7 years). Results: At 15 years, actuarial survival after the Ross procedure was 93.1% (95% CI: 89.1%-95.7%), similar to that of the age-, sex-, and race-matched U.S. general population. It was significantly lower after biological AVR (HR: 0.42; 95% CI: 0.23-0.075; P = 0.003) and mechanical AVR (HR: 0.45; 95% CI: 0.26-0.79; P = 0.006). At 15 years, the Ross procedure was associated with a lower cumulative risk of reintervention (P = 0.008) and endocarditis (P = 0.01) than biological AVR. In contrast, at 15 years, the Ross procedure was associated with a higher cumulative incidence of reoperation (P < 0.001) but lower risks of stroke (P = 0.03) and major bleeding (P = 0.016) than mechanical AVR. Thirty-day mortality after valve-related complications was lowest after a reintervention. Conclusions: In young adults, the Ross procedure is associated with better long-term survival and freedom from valve-related complications compared with prosthetic AVR. This confirms the notion that a living valve substitute in the aortic position translates into improved clinically relevant outcomes.
MeSH term(s)	Adolescent ; Adult ; Aortic Valve Disease/surgery ; Cardiac Surgical Procedures/methods ; Female ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Middle Aged ; Propensity Score ; Prosthesis Design ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2022-02-24
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	605507-2
ISSN	1558-3597 ; 0735-1097
ISSN (online)	1558-3597
ISSN	0735-1097
DOI	10.1016/j.jacc.2021.11.057
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Zs.A 1846: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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