Aubrey C Galloway, M.D.

Case report: separation from cardiopulmonary bypass with a rigid bronchoscope airway after hemoptysis and bronchial impaction with clot
Neuburger, Peter J; Galloway, Aubrey C; Zervos, Michael D; Kanchuger, Marc S
2012 Jan;114(1):89-92, Anesthesia & analgesia
Hemoptysis after cardiopulmonary bypass (CPB) occasionally occurs, and has varying clinical significance based upon amount of bleeding. Hemoptysis resulting in a clot and airway obstruction is an extremely rare event found almost exclusively in the intensive care unit. We describe a unique case of hemoptysis resulting in bronchial impaction from a clot requiring an emergent return to CPB during valve replacement surgery. We used a rigid bronchoscope, without an endotracheal tube, to facilitate airway patency in a patient with diffuse airway bleeding after bronchial disimpaction to separate from CPB
— id: 147685, year: 2012, vol: 114, page: 89, stat: Journal Article,

Mitral-valve surgery in the elderly: Comparative results of mitral repair and replacement
Balsam L.B.; Grossi E.A.; Galloway A.C.
2011 ;7(2):265-270, Aging Health
Evaluation of: Chikwe J, Goldstone AB, Passage J et al.: A propensity score-adjusted retrospective comparison of early- and mid-term results of mitral-valve repair versus replacement in octogenarians. Eur. Heart J. 32(5), 618-626 (2011). Mitral regurgitation (MR) is common in the elderly, increasing in prevalence with age. Common causes of MR include: degenerative disease of the valve and subvalvular apparatus; ischemic MR due to annular dilatation, papillary muscle displacement and left ventricular remodeling; rheumatic mitral valve disease and infectious endocarditis. The optimal treatment of severe mitral insufficiency in the elderly remains unknown. Mitral-valve repair or replacement have historically been considered high risk in older patients and, for this reason, many elderly patients are not offered surgery. Yet with recent advances in surgical techniques and outcomes, mitral-valve surgery is being increasingly utilized in elderly patients. A recent study by Chikwe et al. in the European Heart Journal examines overall and comparative outcomes of mitral-valve repair and mitral-valve replacement in an elderly cohort. This study finds that mitral-valve repair confers a survival benefit relative to mitral-valve replacement in octogenarians, particularly in patients undergoing surgery for degenerative disease. 2011 Future Medicine Ltd
— id: 132598, year: 2011, vol: 7, page: 265, stat: Journal Article,

Historical perspectives of The American Association for Thoracic Surgery: Frank C. Spencer
Deanda A Jr; Galloway AC
2011 Oct 10;:?-? #, Journal of thoracic & cardiovascular surgery
— id: 149864, year: 2011, vol: , page: ?, stat: Journal Article,

Giant Coronary Artery Aneurysm in a Patient with Behcet's Disease
Greenhouse, David G; Hackett, Katherine; Kahn, Philip; Balsam, Leora B; Galloway, Aubrey C
2011 May;26(3):268-270, Journal of cardiac surgery
Abstract Behcet's disease is a rare autoimmune vasculitis that may cause coronary artery aneurysms. We discuss the evaluation and management decisions for a 19-year-old female with a giant rapidly expanding aneurysm of the proximal left anterior descending coronary artery and Behcet's disease. (J Card Surg 2011;26:268-270)
— id: 132574, year: 2011, vol: 26, page: 268, stat: Journal Article,

Minimally invasive valve surgery with antegrade perfusion strategy is not associated with increased neurologic complications
Grossi, Eugene A; Loulmet, Didier F; Schwartz, Charles F; Solomon, Brian; Dellis, Sophia L; Culliford, Alfred T; Zias, Elias; Galloway, Aubrey C
2011 Oct;92(4):1346-1350, Annals of thoracic surgery
BACKGROUND: A Society of Thoracic Surgeons' publication recently associated 'minimally invasive' approaches with increased neurologic complications; this proposed association was questionable due to imprecise definitions. To critically reevaluate this issue, we reviewed a large minimally invasive valve experience with robust definitions. METHODS: From November 1995 to January 2007, 3,180 isolated, non-reoperative valve operations were performed; 1,452 (45.7%) were aortic replacements and 1,728 (54.3%) were mitral valve procedures. Surgical approach was standard sternotomy (28%) or minimally invasive technique (72%). Antegrade arterial perfusion was used in 2,646 (83.2%) patients and retrograde perfusion in 534 (16.8%). Aortic clamping was direct in 83.4%, with endoclamp in 16.4% and no clamp in 0.2%. Patients were prospectively followed in a proprietary database and the New York State Cardiac Surgery Reporting System (mandatory, government audited). A neurologic event was defined as a permanent deficit, a transient deficit greater than 24 hours, or a new lesion on cerebral imaging. RESULTS: Hospital mortality for aortic valve replacement was 4.0% (sternotomy [5.1%] versus minimally invasive [3.4%] p = 0.13); for mitral procedures it was 2.4% (sternotomy [4.8%] versus minimally invasive [1.8%] p = 0.001). Multivariate analysis revealed that age, female gender, renal disease, ejection fraction less than 0.30, chronic obstructive pulmonary disease, and emergent operation were risk factors for mortality. Stroke occurred in 71 patients (2.2%) (sternotomy [2.1%] versus minimally invasive [2.3%] p = 0.82). Multivariate analysis of neurologic events revealed that cerebrovascular disease, emergency procedure, no-clamp, and retrograde perfusion were risk factors. In patients 50 years old or younger (n = 662), retrograde perfusion had no significant impact on neurologic events (1.6% vs 1.1%, p = 0.57). CONCLUSIONS: A minimally invasive approach with antegrade perfusion does not result in increased neurologic complications. Retrograde perfusion, however, is associated with increased neurologic risk in older patients
— id: 138113, year: 2011, vol: 92, page: 1346, stat: Journal Article,

Simulating video-assisted thoracoscopic lobectomy: A virtual reality cognitive task simulation
Solomon, Brian; Bizekis, Costas; Dellis, Sophia L; Donington, Jessica S; Oliker, Aaron; Balsam, Leora B; Zervos, Michael; Galloway, Aubrey C; Pass, Harvey; Grossi, Eugene A
2011 Jan;141(1):249-255, Journal of thoracic & cardiovascular surgery
OBJECTIVE: Current video-assisted thoracoscopic surgery training models rely on animals or mannequins to teach procedural skills. These approaches lack inherent teaching/testing capability and are limited by cost, anatomic variations, and single use. In response, we hypothesized that video-assisted thoracoscopic surgery right upper lobe resection could be simulated in a virtual reality environment with commercial software. METHODS: An anatomy explorer (Maya [Autodesk Inc, San Rafael, Calif] models of the chest and hilar structures) and simulation engine were adapted. Design goals included freedom of port placement, incorporation of well-known anatomic variants, teaching and testing modes, haptic feedback for the dissection, ability to perform the anatomic divisions, and a portable platform. RESULTS: Preexisting commercial models did not provide sufficient surgical detail, and extensive modeling modifications were required. Video-assisted thoracoscopic surgery right upper lobe resection simulation is initiated with a random vein and artery variation. The trainee proceeds in a teaching or testing mode. A knowledge database currently includes 13 anatomic identifications and 20 high-yield lung cancer learning points. The 'patient' is presented in the left lateral decubitus position. After initial camera port placement, the endoscopic view is displayed and the thoracoscope is manipulated via the haptic device. The thoracoscope port can be relocated; additional ports are placed using an external 'operating room' view. Unrestricted endoscopic exploration of the thorax is allowed. An endo-dissector tool allows for hilar dissection, and a virtual stapling device divides structures. The trainee's performance is reported. CONCLUSIONS: A virtual reality cognitive task simulation can overcome the deficiencies of existing training models. Performance scoring is being validated as we assess this simulator for cognitive and technical surgical education
— id: 116215, year: 2011, vol: 141, page: 249, stat: Journal Article,

Surgical revision after percutaneous mitral repair with the MitraClip device
Argenziano, Michael; Skipper, Eric; Heimansohn, David; Letsou, George V; Woo, Y Joseph; Kron, Irving; Alexander, John; Cleveland, Joseph; Kong, Bobby; Davidson, Michael; Vassiliades, Thomas; Krieger, Karl; Sako, Ed; Tibi, Pierre; Galloway, Aubrey; Foster, Elyse; Feldman, Ted; Glower, Donald
2010 Jan;89(1):72-80, Annals of thoracic surgery
BACKGROUND: Percutaneous mitral repair with the MitraClip device (Evalve, Menlo Park, CA) has been reported. Preserving conventional surgical options in the event of percutaneous treatment failure is important. We describe surgical treatment at varying intervals after the MitraClip procedure in 32 patients. METHODS: One hundred seven patients with moderate-to-severe or severe mitral regurgitation who were either symptomatic (91%) or, if asymptomatic (9%), had evidence of left ventricular dysfunction were enrolled as part of the Endovascular Valve Edge-to-Edge REpair STudy (EVEREST) phase I registry study or as 'roll-in' subjects in the EVEREST II study. Thirty-two of the 107 patients (30%) underwent surgery after an attempted MitraClip procedure. RESULTS: Of the 32 patients undergoing post-clip mitral valve surgery, 23 patients (72%) had one or more clips implanted and 9 patients (28%) received no clip implant. The indications for mitral valve surgery in the 23 patients with a clip included partial clip detachment (n = 10), residual or recurrent mitral regurgitation greater than 2+ (n = 9), and other (atrial septal defect [n = 2], device malfunction [n = 1], and incorrectly diagnosed mitral stenosis [n = 1]). Twenty-seven of 31 patients (87%) underwent the surgical procedure planned before surgery (planned procedure unknown in 1 patient). Four of 25 patients (16%) with planned repair underwent mitral valve replacement. CONCLUSIONS: Standard surgical options were preserved in patients who had surgery after percutaneous repair with the MitraClip device. Successful repair was feasible in the majority of patients after the MitraClip procedure, with repair performed as late as 18 months after clip implantation
— id: 149865, year: 2010, vol: 89, page: 72, stat: Journal Article,

Reoperative valve surgery in the elderly: predictors of risk and long-term survival
Balsam, Leora B; Grossi, Eugene A; Greenhouse, David G; Ursomanno, Patricia; Deanda, Abelardo; Ribakove, Greg H; Culliford, Alfred T; Galloway, Aubrey C
2010 Oct;90(4):1195-1200, Annals of thoracic surgery
BACKGROUND: Elderly patients requiring reoperative cardiac surgery for valve disease are considered high risk for immediate outcomes, but little is known about their long-term survival. It is often conjectured that medical therapy provides equivalent late survival in this population, which may dissuade both patient and surgeon from considering reoperation. We analyzed a cohort of such patients undergoing reoperative valve surgery to determine their long-term survival. METHODS: From 1992 through 2007, 363 patients aged 75 years or more underwent reoperative isolated valve surgery; 211 (58%) had aortic valve replacement and 152 (42%) had mitral valve surgery. Mean age was 80.5 years. Hospital outcomes were prospectively recorded. Survival from all-cause death was determined from the Social Security Death Index. RESULTS: Hospital mortality was 13.8% (12.8% for aortic and 15.1% for mitral valve operations; p = 0.52). Multivariable predictors of hospital death were New York Heart Association functional class III or IV heart failure (odds ratio = 3.19, p = 0.012), dialysis (odds ratio = 15.63, p = 0.003), and more than one reoperation (odds ratio = 2.59, p = 0.058). At 5 years, overall survival was 62% +/- 3% for all patients (66% +/- 4% for aortic and 56% +/- 4% for mitral valve patients). For aortic valve patients aged 80 years or more, 5-year survival was 60% +/- 0.6%. Life expectancy table analysis predicted a 5-year survival of 57% for an age-matched and sex-matched comparison group. CONCLUSIONS: Reoperative surgery for elderly patients with isolated aortic or mitral valve pathology is associated with excellent long-term survival, particularly when treating aortic valve disease. While in-hospital mortality is higher among the elderly than among younger patients, specific predictors of poor outcome can be identified preoperatively to risk stratify these patients
— id: 113664, year: 2010, vol: 90, page: 1195, stat: Journal Article,

Retrograde arterial perfusion, not incision location, significantly increases the risk of stroke in reoperative mitral valve procedures
Crooke, Gregory A; Schwartz, Charles F; Ribakove, Gregory H; Ursomanno, Patricia; Gogoladze, George; Culliford, Alfred T; Galloway, Aubrey C; Grossi, Eugene A
2010 Mar;89(3):723-729, Annals of thoracic surgery
BACKGROUND: A recent report suggested that a thoracotomy approach for reoperative mitral valve (MV) procedures was associated with an equivalent mortality and an unacceptable risk of stroke. We assessed these outcomes in a single institution's experience. METHODS: From 1992 through 2007, 905 patients underwent reoperative MV procedures. The approach was a median sternotomy in 612 (67.6%), right anterior thoracotomy in 242 (26.7%), and left posterior thoracotomy in 51 (5.6%). Concomitant procedures in 411 patients (67.6%) included aortic procedures in 189, tricuspid procedures in 170, and coronary artery bypass grafting in 90. Hypothermic fibrillation was used in 65 patients. Logistic analysis was used to analyze risk factors and outcomes. RESULTS: Overall mortality was 12.7% (115 of 905), 6.7% (25 of 371) for first time isolated MV reoperations, and 10.1% (50 of 494) for all isolated MV operations. Overall incidence of stroke was 3.8% (34 of 905); 10.9% (9 of 82) with retrograde arterial perfusion and 3.0% (25 of 824) with central aortic cannulation (p < 0.001). For isolated MV reoperations, the incidence of stroke was 4.3% (21 of 494): 2.9% (7 of 241) for antegrade perfusion and 5.5% (14 of 253) for retrograde perfusion (p = 0.15). Risk factors for death were age (p < 0.001), renal failure (p < 0.01), tricuspid valve disease (p < 0.001), chronic obstructive pulmonary disease (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.8 to 4.9; p < 0.001), emergency procedure (OR, 2.9; 95% CI, 1.2 to 6.9; p = 0.02), and ejection fraction less than 0.30 (OR, 1.9; 95% CI, 1.1 to 3.3, p = 0.018). Risk factors for stroke were retrograde perfusion (OR, 4.4; 95% CI, 1.8 to 10.3; p < 0.01) and ejection fraction below 0.30 (OR, 2.1; 95% CI, 0.9 to 5.0; p = 0.09). CONCLUSIONS: The incidence of stroke in reoperative MV operations is associated with perfusion strategies, not with the incisional approach. Reoperative sternotomy and minithoracotomy with central cannulation are both useful for reoperative MV procedures and are associated with low stroke rates
— id: 107778, year: 2010, vol: 89, page: 723, stat: Journal Article,

Validation of plasma biomarkers in degenerative calcific aortic stenosis
Ferrari, Giovanni; Sainger, Rachana; Beckmann, Erik; Keller, Gianluca; Yu, Pey-Jen; Monti, Maria Cristina; Galloway, Aubrey C; Weiss, Richard L; Vernick, William; Grau, Juan B
2010 Sep;163(1):12-17, Journal of surgical research
BACKGROUND: Calcific aortic stenosis (CAS) is the most common acquired valvular disorder in industrialized countries. This study investigates the correlation of different known biomarkers for CAS as a first step towards the development of a panel of biomarkers that can be used in prognostic staging. METHODS: Venous blood samples were obtained from both patients with CAS scheduled for surgery and healthy individuals. Plasma levels of fetuin-A, NT-proBNP, BNP, homocysteine and osteopontin were measured by enzyme-linked immunosorbent assay (ELISA). CAS was measured by echocardiography and was defined as an aortic valve area of less than 2.0 cm(2). Non-paired t-tests were used for comparison. RESULTS: CAS was present in 33 subjects (mean age 75.9 y) and absent in 11 subjects (mean age 55.36 y). Individuals with CAS exhibited higher plasma levels of NT-proBNP (1.33 versus 0.73 pmol/mL, P < 0.05), BNP fragment (1.47 versus 0.34 ng/mL P < 0.05), and osteopontin (60.79 versus 25.42 ng/mL P < 0.05) compared with controls. Fetuin-A levels were lower in individuals with CAS than in healthy controls (0.25 versus 0.34g/L, P < 0.05). Asymmetric dimethylarginine (ADMA) were lower (1.08 versus 1.1 micromol/L, P > 0.05) while homocysteine levels (20.34 +/- 2.14 versus 19.23 +/- 4.19 P > 0.05) were higher in the CAS patients. CONCLUSION: This study demonstrates a direct correlation of NT-pro-BNP, BNP, and osteopontin and the presence of CAS, while fetuin A showed an inverse correlation. Plasma ADMA and homocysteine levels were comparable in the CAS patients and healthy individuals. This is the first study in which several biomarkers previously studied independently in patients with CAS have been investigated simultaneously in the same study population
— id: 133782, year: 2010, vol: 163, page: 12, stat: Journal Article,

Analysis of the mitral coaptation zone in normal and functional regurgitant valves
Gogoladze, George; Dellis, Sophia L; Donnino, Robert; Ribakove, Greg; Greenhouse, David G; Galloway, Aubrey; Grossi, Eugene
2010 Apr;89(4):1158-1161, Annals of thoracic surgery
BACKGROUND: Functional mitral regurgitation (FMR) is associated with leaflet displacement and tethering. Little is known about regional coaptation zones, including variations in coaptation length (CL) and contributions of anterior and posterior leaflets. Regional coaptation zones were analyzed in patients with normal mitral valves and with FMR. METHODS: Cardiac surgery patients underwent a three-dimensional transesophageal echocardiography. Four-dimensional volumetric datasets were acquired with Doppler interrogation. Offline analysis was performed. Orthogonal views were extracted in diastole and systole. Leaflet dimensions and coaptation distance and depth were examined for posterior and apical displacement of the coaptation zones. RESULTS: Twenty patients were analyzed (10 normal and 10 with 2 to 4+ FMR). Anterior leaflet CL was greater than posterior leaflet CL: 2.2+/-0.6 mm versus 0.9+/-0.3 mm in region 1, 3.2+/-0.7 mm versus 1.2+/-0.6 mm in region 2, and 1.8+/-0.4 mm versus 0.6+/-0.3 mm in region 3 (p<0.001). The FMR was associated with shorter leaflet CLs, with a mean anterior CL of 1.7+/-0.4 mm versus 3.1+/-0.4 mm (p=0.04), and a mean posterior CL of 0.7+/-0.3 mm versus 1.1+/-0.3 mm (p=0.03). The biggest difference in CLs was in A2-P2. Coaptation distance and depth were higher in the FMR group: 21.7+/-1.0 mm versus 17.9+/-1.0 mm (p=0.01), and 8.6+/-0.7 mm versus 5.0+/-0.7 mm (p<0.01). CONCLUSIONS: Mitral valve leaflet CL is asymmetric in normal valves, with anterior dominance. Functional mitral regurgitation is associated with a relocated coaptation zone, regional changes, and diminished coaptation. These data suggest an 'anterior leaflet reserve.' Posterior movement of the coaptation line compensates for annular dilation and presumed left ventricular enlargement in order to maintain competency until inadequate anterior leaflet CL occurs
— id: 108926, year: 2010, vol: 89, page: 1158, stat: Journal Article,

Invited commentary
Grossi, Eugene A; Galloway, Aubrey C
2010 Sep;90(3):794-795, Annals of thoracic surgery
— id: 111979, year: 2010, vol: 90, page: 794, stat: Journal Article,

Ten-year results of folding plasty in mitral valve repair
Schwartz, Charles F; Grossi, Eugene A; Ribakove, Greg H; Ursomanno, Patricia; Mirabella, Meg; Crooke, Gregory A; Galloway, Aubrey C
2010 Feb;89(2):485-488, Annals of thoracic surgery
BACKGROUND: Folding plasty (FP) for posterior mitral leaflet repair (PLR) is a technique that reduces the height of the repaired leaflet, closes the gap created by leaflet resection by rotation of residual leaflet, and reduces the need for localized annular plication. This report reviews late outcomes with FP repair. METHODS: From January 1994 to August 2006, 1,402 mitral valve repairs were performed for degenerative disease: 1,012 had PLR and 531 had FP technique. RESULTS: Overall hospital mortality was 2.4% (33 of 1,402 patients) and 1.3% (14 of 1,103 patients) for isolated mitral repair. For those patients with PLR, mortality for all procedures was 1.5% (15 of 1,012 patients) and 1.2% (11 of 891 patients) for isolated PLR repairs. Mortality was 0.9% (5 of 531 patients) for FP. In the last 5 years FP was used in 64.4% of PLR, compared with 35.6% of PLR in the prior era (p < 0.001). The 10-year actuarial freedom from mitral reoperation was 89%; 10-year freedom from reoperation or recurrent severe mitral insufficiency was 86% with FP and 87% without (p = 0.76). The 5-year freedom from reoperation or recurrent severe insufficiency was 89% when an annuloplasty device was used and 62% when not used (p < 0.001). CONCLUSIONS: Repair of posterior leaflet prolapse with FP is straightforward and durable. In our experience, FP is currently used for two thirds of PLR. These data also confirm that valve repair for degenerative disease should include an annuloplasty device for optimal late results
— id: 106376, year: 2010, vol: 89, page: 485, stat: Journal Article,

Protein targets of inflammatory serine proteases and cardiovascular disease
Sharony, Ram; Yu, Pey-Jen; Park, Joy; Galloway, Aubrey C; Mignatti, Paolo; Pintucci, Giuseppe
2010 ;7:45-45, Journal of inflammation (London, England)
ABSTRACT: Serine proteases are a key component of the inflammatory response as they are discharged from activated leukocytes and mast cells or generated through the coagulation cascade. Their enzymatic activity plays a major role in the body's defense mechanisms but it has also an impact on vascular homeostasis and tissue remodeling. Here we focus on the biological role of serine proteases in the context of cardiovascular disease and their mechanism(s) of action in determining specific vascular and tissue phenotypes. Protease-activated receptors (PARs) mediate serine protease effects; however, these proteases also exert a number of biological activities independent of PARs as they target specific protein substrates implicated in vascular remodeling and the development of cardiovascular disease thus controlling their activities. In this review both PAR-dependent and -independent mechanisms of action of serine proteases are discussed for their relevance to vascular homeostasis and structural/functional alterations of the cardiovascular system. The elucidation of these mechanisms will lead to a better understanding of the molecular forces that control vascular and tissue homeostasis and to effective preventative and therapeutic approaches
— id: 112200, year: 2010, vol: 7, page: 45, stat: Journal Article,

Extended cardiac resection for obstructing pseudotumor due to ormond disease
Solomon, Brian; Grossi, Eugene A; Monteith, Duane; Donnino, Robert M; Srichai, Barbara; Dellis, Sophie L; Galloway, Aubrey C
2010 Aug;90(2):636-638, Annals of thoracic surgery
A 60-year-old man presented with symptoms from an intracardiac mass. His medical history included retroperitoneal fibrosis (Ormond disease). Magnetic resonance imaging revealed an obstructing bilobular mass in the right atrium, located at the caval junction and extending intramurally into the atria, septum, and right ventricle. En bloc resection of the right atrium, interatrial septum, dome of the left atrium, vena cava, anterior tricuspid annulus, right coronary artery, and partial right ventriculectomy was completed with right ventricular repair, tricuspid valve replacement, and left and right atrial replacement with bovine pericardium. This lesion was a myofibroblastic tumor with the same histologic features as his retroperitoneal fibrosis
— id: 111587, year: 2010, vol: 90, page: 636, stat: Journal Article,

A decade of minimally invasive mitral repair: long-term outcomes
Galloway, Aubrey C; Schwartz, Charles F; Ribakove, Greg H; Crooke, Gregory A; Gogoladze, George; Ursomanno, Patricia; Mirabella, Margaret; Culliford, Alfred T; Grossi, Eugene A
2009 Oct;88(4):1180-1184, Annals of thoracic surgery
BACKGROUND: Short-term results with minimally invasive approaches for mitral valve repair in degenerative disease have been encouraging, with potential for diminishing blood loss and hospital length of stay. Little is known, however, about the long-term efficacy of this approach. This report analyzes a single institution's results over 12 years with minimally invasive mitral repair. METHODS: Since 1986, 3,057 patients have undergone mitral valve repair; 1,601 patients had degenerative disease and are the subject of this report. Minimally invasive mitral repair was done in 1071 patients with a right anterior minithoracotomy and direct vision. Clinical and echocardiographic variables were entered prospectively into a database. RESULTS: Hospital mortality was 2.2% for all patients (36 of 1601); 1.3% for isolated minimally invasive (9 of 712) and 1.3% (3 of 223) for isolated sternotomy mitral valve repair; and 3.6% (24 of 666) for valve repair plus a concomitant cardiac procedure. For isolated valve repair, 8-year freedom from reoperation was 91% +/- 2% for sternotomy and 95% +/- 1% for minimally invasive (p = 0.24), and 8-year freedom from reoperation or severe recurrent insufficiency was 90% +/- 2% for sternotomy and 93% +/- 1% for minimally invasive (p = 0.30). Eight-year freedom from all valve-related complications was 86% +/- 3% for sternotomy and 90% +/- 2% for minimally invasive (p = 0.14). CONCLUSIONS: These data indicate that long-term outcomes after minimally invasive mitral repair are excellent and equivalent to results achieved with sternotomy. In view of previously published advantages of short-term morbidity, minimally invasive approaches to mitral valve surgery deserve expanded use
— id: 102502, year: 2009, vol: 88, page: 1180, stat: Journal Article,

Topical Mitogen-Activated Protein Kinases Inhibition Reduces Intimal Hyperplasia in Arterialized Vein Grafts
Gulkarov, Iosif; Bohmann, Katja; Cinnante, Karma M; Pirelli, Luigi; Yu, Pey-Jen; Grau, Juan B; Pintucci, Giuseppe; Galloway, Aubrey C; Mignatti, Paolo
2009 Jun 1;154(1):150-156, Journal of surgical research
OBJECTIVE: Vein graft arterialization results in activation of the mitogen-activated protein kinases (MAPKs) extracellular signal-regulated kinases-1 and -2 (ERK1/2), which have been implicated in cell proliferation, migration, and apoptosis. The goal of our study was to characterize the effect of MAPK inhibition on intimal hyperplasia (IH) in arterialized vein grafts in hypercholesterolemic rabbits. METHODS: Reversed bilateral jugular vein to common carotid artery interposition grafts were constructed in 16 New Zealand White rabbits. The veins were incubated for 30 min prior to grafting with either the synthetic ERK1/2 activation inhibitor UO126 or the control vehicle. Vein graft and control jugular vein were harvested 3 h, 1 d, and 28 d after arterialization for histological and biochemical analyses. RESULTS: Treatment with UO126 was associated with 31% reduction in mean intimal area (1.68 +/- 0.78 mm(2)versus 2.44 +/- 1.65 mm(2); mean +/- SD; P = 0.036) relative to controls. The intima-to-media ratio of UO126-treated vein grafts decreased by 29% (0.53 +/- 0.04 versus 0.74 +/- 0.06; mean +/- SD; P < 0.01) compared to controls, vehicle-treated vein grafts. There was also significant increase in apoptosis in UO126-treated vein graft medial cell layer at 1 d. CONCLUSION: Topical administration of UO126 before vein grafting significantly decreases IH in arterialized vein grafts in hypercholesterolemic rabbits. These results may have significant implications for the development of strategies aimed at blocking or reducing IH in bypass grafts. Therefore, further evaluation of this simple strategy to improve vein graft patency following coronary artery or peripheral vascular bypass surgery is warranted
— id: 96446, year: 2009, vol: 154, page: 150, stat: Journal Article,

Cardiac pheochromocytoma presenting as shortness of breath
Hong, Susie N; Srichai, Monvadi B; Morgan, Jeffrey A; Dimitrova, Kamellia; Galloway, Aubrey C
2009 Jul;122(7):e1-e2, American journal of medicine
— id: 149866, year: 2009, vol: 122, page: e1, stat: Journal Article,

Correlation between plasma osteopontin levels and aortic valve calcification: potential insights into the pathogenesis of aortic valve calcification and stenosis
Yu, Pey-Jen; Skolnick, Adam; Ferrari, Giovanni; Heretis, Katherine; Mignatti, Paolo; Pintucci, Giuseppe; Rosenzweig, Barry; Diaz-Cartelle, Juan; Kronzon, Itzhak; Perk, Gila; Pass, Harvey I; Galloway, Aubrey C; Grossi, Eugene A; Grau, Juan B
2009 Jul;138(1):196-199, Journal of thoracic & cardiovascular surgery
OBJECTIVE: The inflammatory process of aortic stenosis involves the differentiation of aortic valve myofibroblasts into osteoblasts. Osteopontin, a proinflammatory glycoprotein, both stimulates differentiation of myofibroblasts and regulates the deposition of calcium by osteoblasts. Osteopontin levels are increased in patients with such conditions as end-stage renal disease, ectopic calcification, and autoimmune disease. We hypothesized that increased plasma osteopontin levels might be associated with the presence of aortic valve calcification and stenosis. METHODS: Venous blood from volunteers older than 65 years undergoing routine echocardiographic analysis or aortic valve surgery for aortic stenosis was collected. Plasma osteopontin levels were measured by means of enzyme-linked immunosorbent assay. The presence of aortic stenosis was defined as an aortic valve area of less than 2.0 cm(2). Aortic valve calcification was assessed by using a validated echocardiographic grading system (1, none; 2, mild; 3, moderate; 4, severe). Comparisons were performed with nonpaired t tests. RESULTS: Aortic stenosis was present in 23 patients (mean age, 78 years) and was absent in 7 patients (mean age, 72 years). Aortic valve calcification scores were 3.5 +/- 0.6 and 1.3 +/- 0.5 in patients with and without aortic stenosis, respectively (P < .001). Patients with no or mild aortic valve calcification had lower osteopontin levels compared with patients with moderate or severe aortic valve calcification (406.1 +/- 165.8 vs 629.5 +/- 227.5 ng/mL, P = .01). Similarly, patients with aortic stenosis had higher osteopontin levels compared with patients without aortic stenosis (652.2 +/- 218.7 vs 379.7 +/- 159.9 ng/mL, P < .01). CONCLUSION: Increased levels of plasma osteopontin are associated with the presence of aortic valve calcification and stenosis. These findings suggest that osteopontin might play a functional role in the pathogenesis of calcific aortic stenosis
— id: 100629, year: 2009, vol: 138, page: 196, stat: Journal Article,

Tissue inhibitor of metalloproteinases-2 binding to membrane-type 1 matrix metalloproteinase induces MAPK activation and cell growth by a non-proteolytic mechanism
D'Alessio, Silvia; Ferrari, Giovanni; Cinnante, Karma; Scheerer, William; Galloway, Aubrey C; Roses, Daniel F; Rozanov, Dmitri V; Remacle, Albert G; Oh, Eok-Soo; Shiryaev, Sergey A; Strongin, Alex Y; Pintucci, Giuseppe; Mignatti, Paolo
2008 Jan 4;283(1):87-99, Journal of biological chemistry
Membrane-type 1 matrix metalloproteinase (MT1-MMP), a transmembrane proteinase with a short cytoplasmic domain and an extracellular catalytic domain, controls a variety of physiological and pathological processes through the proteolytic degradation of extracellular or transmembrane proteins. MT1-MMP forms a complex on the cell membrane with its physiological protein inhibitor, tissue inhibitor of metalloproteinases-2 (TIMP-2). Here we show that, in addition to extracellular proteolysis, MT1-MMP and TIMP-2 control cell proliferation and migration through a non-proteolytic mechanism. TIMP-2 binding to MT1-MMP induces activation of ERK1/2 by a mechanism that does not require the proteolytic activity and is mediated by the cytoplasmic tail of MT1-MMP. MT1-MMP-mediated activation of ERK1/2 up-regulates cell migration and proliferation in vitro independently of extracellular matrix proteolysis. Proteolytically inactive MT1-MMP promotes tumor growth in vivo, whereas proteolytically active MT1-MMP devoid of cytoplasmic tail does not have this effect. These findings illustrate a novel role for MT1-MMP-TIMP-2 interaction, which controls cell functions by a mechanism independent of extracellular matrix degradation
— id: 79292, year: 2008, vol: 283, page: 87, stat: Journal Article,

Differences in mitral valve disease presentation and surgical treatment outcome between Hispanic and non-Hispanic patients
DiGiorgi, Paul L; Baumann, F Gregory; O'Leary, Anne M; Schwartz, Charles F; Grossi, Eugene A; Ribakove, Greg H; Colvin, Stephen B; Galloway, Aubrey C; Grau, Juan B
2008 Summer;18(3):306-310, Ethnicity & disease
OBJECTIVES: This study analyzed the differences in clinical presentation, etiology, and hospital outcome between Hispanic and non-Hispanic patients who underwent surgical correction of mitral valve disease at a large urban medical center. DESIGN: All adult patients undergoing isolated mitral valve repair or replacement surgery at two hospitals between 1993 and 2003 were studied. Patients were grouped according to ethnicity as reported to the New York State Cardiac Surgery Reporting System. Preoperative variables compared included age, congestive heart failure (CHF), etiology, and pertinent medical and surgical histories, while perioperative variables included type of operation, mortality, and hospital complications. RESULTS: A total of 1683 patients (135 Hispanic,1548 non-Hispanic) underwent mitral valve surgery. Hispanic patients were younger (48.3+/-16.0 vs 59.7+/-15.9 years, P<.001) and had higher incidences of CHF (48.9% vs 35.3%, P=.002), endocarditis (8.9% vs 5.0%, P=.05), and rheumatic disease (12.6% vs 5.4%, P<.001). Non-Hispanic patients had a higher incidence of degenerative disease (68.0% vs 54.8%, P<.01). No differences in hospital mortality (Hispanic 5.9% vs 5.3%, P=.76) or perioperative complications were observed between the two groups, although Hispanic patients were less likely to undergo mitral valve repair than mitral valve replacement (35.6% vs 61.2%, P<.001). CONCLUSIONS: In the urban population studied, Hispanic patients presented for mitral valve surgery at a younger age and with a higher prevalence of CHF and rheumatic disease. Public health strategies to prevent rheumatic fever among Hispanics are needed, and improved screening might facilitate earlier referral for Hispanic patients, increasing the potential for benefitting from mitral valve repair
— id: 93367, year: 2008, vol: 18, page: 306, stat: Journal Article,

Mitral valve disease presentation and surgical outcome in African-American patients compared with white patients
DiGiorgi, Paul L; Baumann, F Gregory; O'Leary, Anne M; Schwartz, Charles F; Grossi, Eugene A; Ribakove, Greg H; Colvin, Stephen B; Galloway, Aubrey C; Grau, Juan B
2008 Jan;85(1):89-93, Annals of thoracic surgery
BACKGROUND: Disparities associated with race, particularly African-American race, in access to medical and surgical care for patients with cardiac disease have previously been documented. The purpose of this study was to determine the presentation, etiology, and hospital outcome differences between African-American patients and white patients with regard to surgically corrected mitral valve disease. METHODS: All 1,425 adult patients who underwent first time, isolated mitral valvuloplasty or mitral valve replacement by the same group of surgeons at New York University Medical Center and Bellevue Hospital Center between 1993 and 2003 were studied. RESULTS: African Americans (n = 123, 8.6%) were significantly younger (45.6 +/- 14.4 versus 60.5 +/- 15.3 years) and had significantly higher incidences of diabetes mellitus, renal failure, congestive heart failure, endocarditis, and rheumatic mitral disease; whereas whites (n = 1,302, 91.4%) more commonly had degenerative mitral disease. African Americans were less likely to undergo mitral valvuloplasty. There were no significant differences in the incidences of postoperative complications or hospital mortality (2.4% African American versus 5.1% white, p = 0.19). CONCLUSIONS: African Americans present for mitral valve surgery at a significantly younger age than whites and with higher incidences of many risk factors. Whether presentation at a significantly earlier age in African Americans is a result of failures in primary care or an enhanced susceptibility to the process of mitral disease and comorbidities remains to be determined. African Americans were less likely to undergo mitral valvuloplasty, which may have an effect on long-term outcome. Improved screening in this racial group will facilitate earlier referral, increasing the potential for mitral valvuloplasty
— id: 75718, year: 2008, vol: 85, page: 89, stat: Journal Article,

High-risk aortic valve replacement: are the outcomes as bad as predicted?
Grossi, Eugene A; Schwartz, Charles F; Yu, Pey-Jen; Jorde, Ulrich P; Crooke, Gregory A; Grau, Juan B; Ribakove, Greg H; Baumann, F Gregory; Ursumanno, Patricia; Culliford, Alfred T; Colvin, Stephen B; Galloway, Aubrey C
2008 Jan;85(1):102-106, Annals of thoracic surgery
BACKGROUND: Percutaneous aortic valve replacement (PAVR) trials are ongoing in patients with an elevated European System for Cardiac Operative Risk Evaluation (EuroSCOREs), patients believed to have high mortality rates and poor long-term prognoses with valve replacement surgery. It is, however, uncertain that the EuroSCORE model is well calibrated for such high-risk AVR patients. We evaluated EuroSCORE prediction vs a single institution's surgical results in this target population. METHODS: From January 1996 through March 2006, 731 patients with EuroSCOREs of 7 or higher underwent isolated AVR. In this cohort, 313 (42.8%) were septuagenarians, 322 (44.0%) were octogenarians or nonagenarians, 233 (31.9%) had had previous cardiac procedures, 237 (32.4%) had atheromatous aortas, and 127 (17.4%) had cerebrovascular disease. A minimally invasive approach was used in 469 (64.2%). Data collection was prospective. Long-term survival was computed from the Social Security Death Benefit Index. RESULTS: The mean EuroSCORE was 9.7 (median, 10), and the mean logistic EuroSCORE was 17.2%. Actual hospital mortality was 7.8% (57 of 731). Multivariate analysis showed ejection fraction of less than 0.30 (p = 0.002; odds ratio [OR], 3.13), chronic obstructive pulmonary disease (p = 0.019; OR, 2.14), and peripheral vascular disease (p = 0.048; OR, 2.13) were significant predictors of hospital mortality. Complication(s) occurred in 73 patients (9.9%). Freedom from all-cause death (including hospital mortality) was 72.4% at 5 years (n = 152). Age (p < 0.001), previous cardiac operations (p < 0.014; OR, 1.51), renal failure (p < 0.002; OR, 2.37), and chronic obstructive pulmonary disease (p < 0.007; OR, 1.30) were predictors of worse survival. CONCLUSIONS: Logistic EuroSCORE greatly overpredicts mortality in these patients. Five-year survival is good, unlike suggestions from earlier EuroSCORE analyses. This raises concern about unknown long-term percutaneous prosthesis function. Clinical trials for these patients must include randomized surgical controls and have long-term end points
— id: 75719, year: 2008, vol: 85, page: 102, stat: Journal Article,

Minimally invasive approach for aortic valve replacement in the elderly is associated with lower mortality: A case matched study
Schwartz, CF; Grossi, EA; Grau, JB; Ribakove, GH; Crooke, GA; Baumann, FG; Ursomanno, P; Gogoladze, G; Culliford, AT; Colvin, SB; Galloway, AC
2008 MAR 11 ;51(10):A271-A271, Journal of the American College of Cardiology
— id: 78387, year: 2008, vol: 51, page: A271, stat: Journal Article,

Thrombin cleaves the high molecular weight forms of basic fibroblast growth factor (FGF-2): a novel mechanism for the control of FGF-2 and thrombin activity
Yu, P-J; Ferrari, G; Pirelli, L; Galloway, A C; Mignatti, P; Pintucci, G
2008 Apr 17;27(18):2594-2601, Oncogene
The fgf-2 gene encodes low molecular weight (LMW, 18 kDa) and high molecular weight (HMW, 22-24 kDa) forms that originate from alternative translation of a single mRNA and exhibit diverse biological functions. HMW fibroblast growth factor-2 (FGF-2) inhibits cell migration and induces cell transformation or growth arrest in a cell type- and dose-dependent fashion. Conversely, LMW FGF-2 upregulates both cell proliferation and migration in most cell types. Although transcriptional and translational regulation of HMW and LMW FGF-2 has been extensively investigated, little is known about post-translational control of their relative expression. Here we report that thrombin, a key coagulation factor and inflammatory mediator, cleaves HMW FGF-2 into an LMW FGF-2-like form that stimulates endothelial cell migration and proliferation. The effect of thrombin on these cell functions requires HMW FGF-2 cleavage. This post-translational control mechanism adds a novel level of complexity to the regulation of FGF-2, and links the activities of thrombin and FGF-2 in patho-physiological processes in which both molecules are expressed
— id: 79088, year: 2008, vol: 27, page: 2594, stat: Journal Article,

Reversing left ventricular remodeling in chronic heart failure: surgical approaches
Ahuja, Kartikya; Crooke, Gregory A; Grossi, Eugene A; Galloway, Aubrey C; Jorde, Ulrich P
2007 Jul-Aug;15(4):184-190, Cardiology in review
Chronic heart failure (CHF) has become an epidemic in the United States, with approximately 550,000 new cases annually. With the evolution of pharmacotherapy targeting neurohormonal pathways, the annual mortality in subjects with New York Heart Association (NYHA) class IV CHF has dramatically improved from 52% in the seminal CONSENSUS trial to less than 20% in more recent trials. Suppression of the renin-angiotensin-aldosterone system remains the first line of neurohormonal blockade followed by the addition of selective beta-adrenoreceptor blockers. For patients with NYHA class I and II symptoms, mortality rates have decreased to approximately 5% or less per year with the use of angiotensin-converting enzyme inhibitors, beta-blockers and aldosterone receptor blockers. However, after achieving optimal doses of the indicated pharmacotherapy, and despite the additional benefits obtained with biventricular pacemakers, there are still many patients who continue to experience signs and symptoms of CHF. Recognizing the beneficial effects of the above treatments on left ventricular (LV) remodeling, strategies have been developed to surgically reshape the left ventricle in patients with LV dilation who have associated poor LV function. This review will discuss the techniques and recent developments regarding surgical reshaping of the dilated, dysfunctional, and remodeled left ventricle
— id: 73581, year: 2007, vol: 15, page: 184, stat: Journal Article,

The genetics of mitral valve prolapse
Grau, J B; Pirelli, L; Yu, P-J; Galloway, A C; Ostrer, H
2007 Oct;72(4):288-295, Clinical genetics
Mitral valve prolapse (MVP) is a very common clinical condition that refers to a systolic billowing of one or both mitral valve leaflets into the left atrium. Improvements of echocardiographic techniques and new insights in mitral valve anatomy and physiology have rendered the diagnosis of this condition more accurate and reliable. MVP can be sporadic or familial, demonstrating autosomal dominant and X-linked inheritance. Three different loci on chromosomes 16, 11 and 13 have been found to be linked to MVP, but no specific gene has been described. Another locus on chromosome X was found to cosegregate with a rare form of MVP called 'X-linked myxomatous valvular dystrophy'. MVP is more frequent in patients with connective tissue disorders including Marfan syndrome, Ehlers-Danlos and osteogenesis imperfecta. The purpose of this review is to describe previous studies on the genetics and prevalence of MVP. The report warrants the need for further genetically based studies on this common, albeit not fully understood, clinical entity
— id: 74670, year: 2007, vol: 72, page: 288, stat: Journal Article,

Basic fibroblast growth factor (FGF-2): the high molecular weight forms come of age
Yu, Pey-Jen; Ferrari, Giovanni; Galloway, Aubrey C; Mignatti, Paolo; Pintucci, Giuseppe
2007 Apr 1;100(5):1100-1108, Journal of cellular biochemistry
After over thirty years from its discovery, research on basic fibroblast growth factor (FGF-2) keeps revealing new aspects of the complexity of its gene expression as it evolved in the eukaryotic organisms. The discovery of multiple forms of FGF-2 generated by alternative translation from AUG and non-canonical CUG codons on the same mRNA transcript has led to the characterization of a low molecular weight (LMW) FGF-2 form and various high molecular weight (HMW) forms (four in humans). In this review, we discuss the biochemical features and biological activities of the different FGF-2 forms. In particular, we focus on the properties that are unique to the HMW forms and its biological functions
— id: 72034, year: 2007, vol: 100, page: 1100, stat: Journal Article,

Vascular injury and modulation of MAPKs: A targeted approach to therapy of restenosis
Yu, Pey-Jen; Ferrari, Giovanni; Pirelli, Luigi; Gulkarov, Iosif; Galloway, Aubrey C; Mignatti, Paolo; Pintucci, Giuseppe
2007 Jul;19(7):1359-1371, Cellular signalling
Cardiovascular interventions that restore blood circulation to ischemic areas are accompanied by significant tissue damage, which triggers a vascular remodeling response that may result in restenosis of blood conduits. Early endothelial dysfunction and/or impairment is the early event of a cascade that leads, through an inflammatory response and dedifferentiation of medial smooth muscle cells with abundant deposition of extracellular matrix, to intimal hyperplasia. Here we present the molecular and cellular mechanisms of intimal hyperplasia secondary to vascular injury and discuss the potential role of therapeutic modulation of the intracellular signaling pathways that differentially effect vascular endothelial and smooth muscle cells. The role of mitogen-activated protein kinases (MAPKs) and the outcome of their modulation in these processes are highlighted here as they provide a promising therapeutic target for prevention of restenosis
— id: 72033, year: 2007, vol: 19, page: 1359, stat: Journal Article,

VEGF, a prosurvival factor, acts in concert with TGF-beta1 to induce endothelial cell apoptosis
Ferrari, Giovanni; Pintucci, Giuseppe; Seghezzi, Graziano; Hyman, Kevin; Galloway, Aubrey C; Mignatti, Paolo
2006 Nov 14;103(46):17260-17265, Proceedings of the National Academy of Sciences of the United States of America
VEGF and TGF-beta1 are potent angiogenesis inducers with opposing effects on endothelial cells. TGF-beta1 induces apoptosis; VEGF protects endothelial cells from apoptosis. We found that TGF-beta1 promotes endothelial cell expression of FGF-2, which up-regulates VEGF synthesis. Inhibition of VEGF signaling through VEGF receptor 2 (flk-1) abrogates TGF-beta1-induced apoptosis and p38(MAPK) activation. Inhibition of p38(MAPK) blocks TGF-beta1-induced apoptosis, showing that VEGF/flk-1-mediated activation of p38(MAPK) is required for TGF-beta1 induction of apoptosis. In the absence of TGF-beta1, VEGF activates p38(MAPK) and promotes endothelial cell survival. However, in context with TGF-beta1, VEGF/flk-1-mediated activation of p38(MAPK) results in apoptosis. Thus, cross-talk between TGF-beta1 and VEGF signaling converts VEGF/flk-1-activated p38(MAPK) into a proapoptotic signal. This finding illustrates an unexpected role of VEGF and indicates that VEGF can be pharmacologically converted into an apoptotic factor, a novel approach to antiangiogenesis therapy
— id: 69698, year: 2006, vol: 103, page: 17260, stat: Journal Article,

Impact of moderate functional mitral insufficiency in patients undergoing surgical revascularization
Grossi, Eugene A; Crooke, Gregory A; DiGiorgi, Paul L; Schwartz, Charles F; Jorde, Ulrich; Applebaum, Robert M; Ribakove, Greg H; Galloway, Aubrey C; Grau, Juan B; Colvin, Stephen B
2006 Jul 4;114(1 Suppl):I573-I576, Circulation
BACKGROUND: Mild and moderate functional ischemic mitral insufficiency present at the time of surgical revascularization present clinical uncertainty. It is unclear whether the relatively poor outcomes in this cohort are dependent on valvular function or related to left ventricular dysfunction. The purpose of this study was to examine the early and late outcomes in patients with less-than-severe functional ischemic mitral insufficiency at the time of isolated coronary artery bypass grafting (CABG). METHODS AND RESULTS: From 1996 through 2004, 2242 consecutive patients undergoing isolated CABG were identified as having none to moderate mitral regurgitation (MR) and no valve leaflet pathology. All of the patients at this single institution routinely had an intraoperative transesophageal echocardiography, prospectively quantified MR, and ejection fraction (EF). The New York State Cardiac Surgery Reporting System infrastructure was used to prospectively collect in-hospital patient variables and outcomes. Social Security Death Benefit Index was used to determine long-term survival. Odds ratio and significance (P value) are presented for each determined risk factor. There were 841 patients (37.5%) with no MR, 1137 (50.7%) with mild MR, and 264 (11.8%) with moderate MR. The patients with moderate MR were more likely to be older, female, and have more renal disease, previous MI, congestive heart failure, previous cardiac surgery, and lower EFs. Hospital mortality was independently and significantly associated with renal disease, decreasing EF, increasing age, previous cardiac operation, and cerebral vascular disease. Multivariable analysis revealed decreased survival with increasing age, previous operation, congestive heart failure, diabetes, nonelective operation, decreasing EF, and the presence of moderate MR (expbeta = 1.49; P=0.007) and mild MR (expbeta = 1.34; P=0.033). CONCLUSIONS: Independent of ventricular function, mild and moderate functional mitral insufficiency are associated with significantly decreased survival in patients undergoing CABG. Whether correction of moderate functional MR at the time of CABG improves outcome still needs to be determined
— id: 67535, year: 2006, vol: 114, page: I573, stat: Journal Article,

Mechanisms of c-reactive protein up-regulation in arterialized vein grafts
Gulkarov, Iosif; Pintucci, Giuseppe; Bohmann, Katja; Saunders, Paul C; Sullivan, Raymond F; Ferrari, Giovanni; Mignatti, Paolo; Galloway, Aubrey C
2006 Feb;139(2):254-262, Surgery
BACKGROUND: C-reactive protein (CRP), an acute phase reactant, is an independent predictor of coronary artery syndromes and a mediator of the vascular response to injury. CRP has been found in arterialized vein grafts and has been linked to atherogenesis; however, its involvement in vein graft early failure or intimal hyperplasia has not been assessed. This study was designed to investigate the mechanism(s) of CRP up-regulation in arterialized vein grafts. METHODS: Carotid artery bypass with arterialized jugular vein grafts (AVG) was performed in 18 dogs. AVG were harvested at 3, 8, and 24 hours and 4, 14, and 28 days, using the femoral vein obtained at the time of AVG harvest as a control. Serum CRP levels were characterized by enzyme-linked immunosorbent assay; AVG expression of CRP was studied by immunofluorescence, Western blotting, in situ hybridization, Northern blotting, and quantitative RT-PCR. RESULTS: CRP levels peaked at 24 hours in serum and AVG but remained at baseline in control veins. By double immunofluorescence, CRP was associated with the media and adventitia of AVG. However, Northern blotting analysis showed no CRP mRNA expression in AVG. Reverse transcriptase polymerase chain reaction analysis confirmed the lack of up-regulation of CRP in AVG. CONCLUSION: CRP levels are increased in AVG, peaking 24 hours after arterialization. However, no significant production of CRP was detected in AVG. Therefore, increased CRP levels within AVG appear to originate mostly from CRP diffusion from the systemic circulation. These results have significant implications for the development of strategies aimed at blocking CRP up-regulation in bypass grafts
— id: 72035, year: 2006, vol: 139, page: 254, stat: Journal Article,

Anti-proliferative and anti-inflammatory effects of topical MAPK inhibition in arterialized vein grafts
Pintucci, Giuseppe; Saunders, Paul C; Gulkarov, Iosif; Sharony, Ram; Kadian-Dodov, Daniella L; Bohmann, Katja; Baumann, F Gregory; Galloway, Aubrey C; Mignatti, Paolo
2006 Feb;20(2):398-400, FASEB journal
Vein graft failure following bypass surgery is a frequent and important clinical problem. The vascular injury caused by arterialization is responsible for vein graft intimal hyperplasia, a lesion generated by medial smooth muscle cell proliferation and migration into the intima, increased extracellular matrix deposition, and formation of a thick neointima. Development of the neointima into a typical atherosclerotic lesion and consequent stenosis ultimately result in vein graft failure. Endothelial damage, inflammation, and intracellular signaling through mitogen-activated protein kinases (MAPKs) have been implicated in the early stages of this process. We therefore investigated the effects of topical inhibition of ERK-1/2 MAPK activation on vascular cell proliferation and apoptosis, and on the inflammatory response in a canine model of vein graft arterialization. For this purpose, vein grafts were incubated with the MEK-1/2 inhibitor, UO126, ex vivo for 30 min before grafting. This treatment effectively abolished arterialization-induced ERK-1/2 activation, decreased medial cell proliferation, and increased apoptosis. UO126 treatment also inhibited the vein graft infiltration by myeloperoxidase-positive inflammatory cells that follows vein graft arterialization. Thus, topical ex vivo administration of MAPK inhibitors can provide a pharmacological tool to prevent or reduce the vascular cell responses that lead to vein graft intimal hyperplasia and graft failure
— id: 62809, year: 2006, vol: 20, page: 398, stat: Journal Article,

Inhibition of mitogen-activated protein kinases (MAPKs) as a strategy to prevent intimal hyperplasia following cardiovascular interventions
Pirelli L; Yu P-J; Gulkarov I; Galloway AC; Mignatti P; Pintucci G
2006 ;3(3):173-183, Vascular Disease Prevention
Upon injury, blood vessels undergo a significant remodeling characterized by intimal damage and dedifferentiation of medial smooth muscle cells. Normally quiescent medial cells lose their contractile phenotype and begin to proliferate, migrate, and secrete abundant extracellular matrix. The resulting neointima formation, also referred to as intimal hyperplasia, precedes atherosclerosis of the vascular conduits. Restenosis greatly limits the success of percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG), two common procedures widely used to restore circulation in occluded vascular districts. Growth factors, cytokines, inflammatory mediators, and oxidative and shear stress are among the culprits that initiate this process. More recent studies have been directed towards the intracellular sensors of these stimuli in the hope of discovering the common mechanisms that control the response to injury. A group of enzymes called mitogen-activated protein kinases (MAPKs) play a central role in relaying extracellular stimuli to the cellular core, the nucleus. The discovery that MAPK intracellular signaling pathways control processes as diverse as cell proliferation, migration, and survival via fine modulation of gene expression has prompted a number of studies on MAPK involvement in the response to vascular injury. Here we review the studies that characterized MAPK activation upon arterial or vein graft injury and its involvement in vascular remodeling. The experimental findings indicate that the MAPK signaling pathways are suitable targets for novel therapies to prevent restenosis of blood conduits and extend their life span. copyright 2006 Bentham Science Publishers Ltd
— id: 67520, year: 2006, vol: 3, page: 173, stat: Journal Article,

Minimally invasive reoperative isolated valve surgery: early and mid-term results
Sharony, Ram; Grossi, Eugene A; Saunders, Paul C; Schwartz, Charles F; Ursomanno, Patricia; Ribakove, Greg H; Galloway, Aubrey C; Colvin, Steven B
2006 May-Jun;21(3):240-244, Journal of cardiac surgery
OBJECTIVE: Minimally invasive, nonsternotomy approaches for valve procedures may reduce the risks associated with cardiac surgery after prior sternotomy and may improve outcomes. We analyzed our institutional experience to test this hypothesis. METHODS: Between 1995 and 2002, 498 patients with previous cardiac operations via sternotomy underwent isolated valve surgery: 337 via median sternotomy (aortic = 160; mitral = 177) and 161 via mini-thoracotomy (aortic = 61; mitral = 100). Data were collected prospectively using the New York State Cardiac Surgery Report Form. RESULTS: Preoperative incidences of congestive heart failure, renal disease, and nonelective procedures were higher in the sternotomy group. Hospital mortality was significantly lower with the minimally invasive approach, 5.6% (9/161) versus 11.3% (38/337) (univariate, p = 0.04). However, multivariate analysis (odds ratio: 95% confidence intervals, p value) revealed that chronic obstructive pulmonary disease (6.6: 1.4 to 3.1, p = 0.001), renal disease (4.1: 1.52 to 11.2, p = 0.01), cerebrovascular disease (2.2: 1.03 to 4.78, p = 0.04), and ejection faction <30% (1.5: 0.96 to 5.5, p = 0.06) were associated with increased mortality. While mean bypass time, cross-clamp times, and stroke rates were comparable between groups, patients undergoing minimally invasive valve surgery had no deep wound infections (0% vs 2.4%, p = 0.05), less need for blood products (p = 0.02), and shorter hospital stays (p = 0.009). Five-year survival was higher with minimally invasive techniques as compared to a sternotomy approach (92.4 +/- 2% and 86.0 +/- 2%, respectively, p = 0.08). CONCLUSIONS: Reoperative valve surgery can be safely performed using a nonsternotomy, minimally invasive approach, with at least equal mortality, less hospital morbidity, decreased hospital length of stay, and slightly favorable mid-term survival as compared to sternotomy
— id: 68978, year: 2006, vol: 21, page: 240, stat: Journal Article,

Matrix metalloproteinase expression in vein grafts: role of inflammatory mediators and extracellular signal-regulated kinases-1 and -2
Sharony, Ram; Pintucci, Giuseppe; Saunders, Paul C; Grossi, Eugene A; Baumann, F Gregory; Galloway, Aubrey C; Mignatti, Paolo
2006 Apr;290(4):H1651-H1659, American journal of physiology. Heart & circulatory physiology
Matrix metalloproteinases (MMPs) play key roles in vascular remodeling. We characterized the role of inflammatory mediators and extracellular signal-regulated kinases (ERKs) in the control of arterialized vein graft expression of MMP-9, MMP-2, and membrane-type 1-MMP (MT1-MMP) and of the tissue inhibitor of metalloproteinases-2 (TIMP-2). For this purpose we used a canine model of jugular vein to carotid artery interposition graft and analyzed the vein grafts at various postoperative times (30 min to 28 days) using the contralateral vein as a control. To study the role of ERK-1/2, veins were incubated with the mitogen-activated protein kinase kinase (MEK-1/2) inhibitor UO126 for 30 min before being grafted. Vein graft extracts were analyzed for MMPs, TIMP-2, tumor necrosis factor-alpha (TNF-alpha), polymorphonuclear neutrophil (PMN) infiltration, myeloperoxidase (MPO), and thrombin activity, and for ERK-1/2 activation. Vein graft arterialization resulted in rapid and sustained (8 h to 28 days) upregulation of vein graft-associated MMP-9, MMP-2, MT1-MMP, thrombin activity, and TNF-alpha levels with concomitant TIMP-2 downregulation. MMP-2 activation preceded MT1-MMP upregulation. PMN infiltration and vein graft-associated MPO activity increased within hours after arterialization, indicating a prompt, local inflammatory response. In cultured smooth muscle cells, both thrombin and TNF-alpha upregulated MT1-MMP expression; however, only thrombin activated MMP-2. Inhibition of ERK-1/2 activation blocked arterialization-induced upregulation of MMP-2, MMP-9, and MT1-MMP. Thus, thrombin, inflammatory mediators, and activation of the ERK-1/2 pathway control MMP and TIMP-2 expression in arterialized vein grafts
— id: 72036, year: 2006, vol: 290, page: H1651, stat: Journal Article,

Acquired heart disease
Galloway AC; Grossi EA; Schwartz CF; Sharony R; Colvin SB
Schwartz's principles of surgery New York : McGraw-Hill, 2005,
— id: 3837, year: 2005, vol: , page: ?, stat: Chapter,

Impact of moderate functional mitral insufficiency in patients undergoing surgical revascularization
Grossi, EA; DiGiorgi, PL; Schwartz, CF; Ulrich, J; Applebaum, RM; Ribakove, GH; Galloway, AC; Grau, JB; Colvin, SB
2005 OCT 25 ;112(17):U556-U556, Circulation
— id: 60207, year: 2005, vol: 112, page: U556, stat: Journal Article,

Arterial injuries from femoral artery cannulation with port access cardiac surgery
Muhs, Bart E; Galloway, Aubrey C; Lombino, Michael; Silberstein, Michael; Grossi, Eugene A; Colvin, Stephen B; Lamparello, Patrick; Jacobowitz, Glenn; Adelman, Mark A; Rockman, Caron; Gagne, Paul J
2005 Mar-Apr;39(2):153-158, Vascular & endovascular surgery
Although minimally invasive (MI) cardiac surgery reduces blood loss, hospital stay, and recovery time, some MI approaches require femoral arterial cannulation, which introduces a heretofore unknown risk of femoral arterial injury. This study was performed to examine the risk of femoral arterial injury after Port Access MI cardiac surgery (PA-MICS) with femoral cannulation. Data were prospectively obtained on 739 consecutive patients who had PA-MICS with femoral cannulation between June 1996 and April 2000, identifying any patient with new (<30 days postoperative) arterial insufficiency from the cannulation site. Patient characteristics (gender, age, height, weight, body surface area, smoking, peripheral vascular disease, diabetes) and operative variables (cannula size, cross-clamp time) were examined with univariate and multivariate analysis to identify risk factors for arterial injury. Injuries were defined and classified by radiologic and intraoperative assessment, and follow-up was obtained by patient examination and from the medical records. Femoral arterial occlusion (FAC) occurred in 0.68% (5/739) of patients (4 women, 1 man; age range 26-74 years). The risk of femoral injury was higher in women: 1.31% vs 0.23% (p = 0.07). One patient had intraoperative limb ischemia from iliofemoral dissection and was treated by axillopopliteal bypass. Four patients presented postoperatively with claudication. Three of these had iliofemoral arterial occlusion or localized iliofemoral dissection and were treated with iliofemoral bypass, and 1 patient had localized femoral artery stenosis treated by angioplasty. With a mean follow-up of 17.8 months (range 13-26 months) limb salvage was achieved in all patients. Secondary or tertiary interventions were required in 40% (2/5), both in patients with iliofemoral occlusion, and 1 patient (20% of femoral injuries, 0.135% of overall series) has chronic graft occlusion and long-term claudication. The risk of arterial injury after femoral arterial cannulation and perfusion for Port Access surgery was low (0.68%). This risk is increased in women and is unpredictable. Initial vascular repair has a significant failure rate, and secondary interventions are often necessary. Although the femoral cannulation and perfusion technique is safe overall, the risk must be clearly recognized
— id: 55954, year: 2005, vol: 39, page: 153, stat: Journal Article,

PDGF-BB induces vascular smooth muscle cell expression of high molecular weight FGF-2, which accumulates in the nucleus
Pintucci, Giuseppe; Yu, Pey-Jen; Saponara, Fiorella; Kadian-Dodov, Daniella L; Galloway, Aubrey C; Mignatti, Paolo
2005 Aug 15;95(6):1292-1300, Journal of cellular biochemistry
Basic fibroblast growth factor (FGF-2) and platelet-derived growth factor (PDGF) are implicated in vascular remodeling secondary to injury. Both growth factors control vascular endothelial and smooth muscle cell proliferation, migration, and survival through overlapping intracellular signaling pathways. In vascular smooth muscle cells PDGF-BB induces FGF-2 expression. However, the effect of PDGF on the different forms of FGF-2 has not been elucidated. Here, we report that treatment of vascular aortic smooth muscle cells with PDGF-BB rapidly induces expression of 20.5 and 21 kDa, high molecular weight (HMW) FGF-2 that accumulates in the nucleus and nucleolus. Conversely, PDGF treatment has little or no effect on 18 kDa, low-molecular weight FGF-2 expression. PDGF-BB-induced upregulation of HMW FGF-2 expression is controlled by sustained activation of extracellular signal-regulated kinase (ERK)-1/2 and is abolished by actinomycin D. These data describe a novel interaction between PDGF-BB and FGF-2, and indicate that the nuclear forms of FGF-2 may mediate the effect of PDGF activity on vascular smooth muscle cells. (c) 2005 Wiley-Liss, Inc
— id: 56377, year: 2005, vol: 95, page: 1292, stat: Journal Article,

Computer-generated three-dimensional animation of the mitral valve
Dayan, Joseph H; Oliker, Aaron; Sharony, Ram; Baumann, F Gregory; Galloway, Aubrey; Colvin, Stephen B; Miller, D Craig; Grossi, Eugene A
2004 Mar;127(3):763-769, Journal of thoracic & cardiovascular surgery
OBJECTIVE: Three-dimensional motion-capture data offer insight into the mechanical differences of mitral valve function in pathologic states. Although this technique is precise, the resulting time-varying data sets can be both difficult to interpret and visualize. We used a new technique to transform these 3-dimensional ovine numeric analyses into an animated human model of the mitral apparatus that can be deformed into various pathologic states. METHODS: In vivo, high-speed, biplane cinefluoroscopic images of tagged ovine mitral apparatus were previously analyzed under normal and pathologic conditions. These studies produced serial 3-dimensional coordinates. By using commercial animation and custom software, animated 3-dimensional models were constructed of the mitral annulus, leaflets, and subvalvular apparatus. The motion data were overlaid onto a detailed model of the human heart, resulting in a dynamic reconstruction. RESULTS: Numeric motion-capture data were successfully converted into animated 3-dimensional models of the mitral valve. Structures of interest can be isolated by eliminating adjacent anatomy. The normal and pathophysiologic dynamics of the mitral valve complex can be viewed from any perspective. CONCLUSION: This technique provides easy and understandable visualization of the complex and time-varying motion of the mitral apparatus. This technology creates a valuable research and teaching tool for the conceptualization of mitral valve dysfunction and the principles of repair
— id: 42581, year: 2004, vol: 127, page: 763, stat: Journal Article,

Anterior leaflet resection of the mitral valve
Saunders, Paul C; Grossi, Eugene A; Schwartz, Charles F; Grau, Juan B; Ribakove, Greg H; Culliford, Alfred T; Applebaum, Robert M; Galloway, Aubrey C; Colvin, Steven B
2004 Summer;16(2):188-193, Seminars in thoracic & cardiovascular surgery
Triangular resection is a reconstructive option for treatment of anterior leaflet mitral disease with segmental prolapse. In our experience, it is a safe and reproducible technique, associated with low rates of recurrent MR or need for reoperation, as well as decreased likelihood for systolic anterior motion after mitral repair. We review our experience with this technique over a 25-year experience with mitral valve reconstruction
— id: 45685, year: 2004, vol: 16, page: 188, stat: Journal Article,

Minimally invasive technology for mitral valve surgery via left thoracotomy: experience with forty cases
Saunders, Paul C; Grossi, Eugene A; Sharony, Ram; Schwartz, Charles F; Ribakove, Greg H; Culliford, Alfred T; Delianides, Julie; Baumann, F Gregory; Galloway, Aubrey C; Colvin, Stephen B
2004 May;127(4):1026-1031, Journal of thoracic & cardiovascular surgery
BACKGROUND: Recent evolution of minimally invasive technology has expanded the application of the right thoracotomy approach for mitral valve surgery. These same technological advances have also made the left posterior minithoracotomy approach attractive in complex mitral procedures. METHODS: From 1996 to 2003, 921 isolated mitral valve procedures were performed without sternotomy; 40 (4.3%) of these were performed via left posterior minithoracotomy. In the left posterior minithoracotomy group, ages ranged from 18 to 84 years; 36 patients had had previous cardiac surgery (9 on > or =2 occasions). Other factors precluding right thoracotomy included mastectomy/radiation and pectus excavatum. RESULTS: Arterial perfusion was via femoral artery (n = 26) or descending aorta (n = 14); long femoral venous cannulas with vacuum-assisted drainage were used in 39 procedures. Two patients had direct aortic crossclamping, 18 had hypothermic fibrillation, and 20 had balloon endoaortic occlusion. The mean crossclamp and bypass times were 81.9 and 117.2 minutes, respectively. Hospital mortality was 5.0% (2/40); both deaths occurred in octogenarians. There were no injuries to bypass grafts or conversions to sternotomy. Complications included perioperative stroke (2/40; 5.0%), bleeding (2/40; 5.0%), and respiratory failure (1/40; 2.5%); 28 patients (70%) had no postoperative complications. There was no incidence of perioperative myocardial infarction, renal failure, sepsis, or wound infection. The median length of stay was 7 days. CONCLUSIONS: Advances in minimally invasive cardiac surgery technology are readily adaptable to a left-sided minithoracotomy approach to the mitral valve. The left posterior minithoracotomy approach is a valuable option in complicated reoperative mitral procedures with acceptable perioperative morbidity and mortality
— id: 45686, year: 2004, vol: 127, page: 1026, stat: Journal Article,

Vein graft arterialization causes differential activation of mitogen-activated protein kinases
Saunders, Paul C; Pintucci, Giuseppe; Bizekis, Costas S; Sharony, Ram; Hyman, Kevin M; Saponara, Fiorella; Baumann, F Gregory; Grossi, Eugene A; Colvin, Stephen B; Mignatti, Paolo; Galloway, Aubrey C
2004 May;127(5):1276-1284, Journal of thoracic & cardiovascular surgery
OBJECTIVE: Vascular injury results in activation of the mitogen-activated protein kinases-extracellular-signal regulated kinases, c-jun N-terminal kinase, and p38(MAPK)-which have been implicated in cell proliferation, migration, and apoptosis. The goal of this study was to characterize mitogen-activated protein kinase activation in arterialized vein grafts. METHODS: Carotid artery bypass using reversed external jugular vein was performed in 29 dogs. Vein grafts were harvested after 30 minutes and 3, 8, and 24 hours, and 4, 7, 14, and 28 days. Contralateral external jugular vein and external jugular vein interposition vein-to-vein grafts were used as controls. Vein graft extracts were analyzed for extracellular-signal regulated kinases, c-jun N-terminal kinase, and p38(MAPK) activation. Proliferating cell nuclear antigen expression was investigated as a parameter of cell proliferation. Apoptosis was assessed by terminal deoxynucleotidyl transferase-mediated 2'-deoxyuridine 5'-triphosphate nick end labeling staining and intimal hyperplasia by morphometric examination of tissue sections. RESULTS: Significant intimal hyperplasia was observed at 28 days. Over the time points studied, vein graft arterialization resulted in bimodal activation of both extracellular-signal regulated kinase and p38(MAPK) (30 minutes through 3 hours; 4 days) but did not induce activation of c-jun N-terminal kinase. Proliferating cell nuclear antigen expression increased from days 1 through 28, and apoptosis increased between 8 and 24 hours. CONCLUSION: Vein graft arterialization induces bimodal activation of extracellular-signal regulated kinase and p38(MAPK); however, in contrast with what is described in arterial injury, it does not induce c-jun N-terminal kinase activation. These results provide the first comprehensive characterization of the mitogen-activated protein kinase signaling pathways activated in vein graft arterialization and identify mitogen-activated protein kinases as potential mediators of vein graft remodeling and subsequent intimal hyperplasia
— id: 45314, year: 2004, vol: 127, page: 1276, stat: Journal Article,

Revascularization alone for functional mitral regurgitation: A propensity case-match analysis of the off pump coronary artery bypass approach
Saunders, PC; Grossi, EA; Schwartz, CF; Applebaum, RM; Ribakove, GH; Culliford, AT; Galloway, AC; Colvin, SB
2004 MAR 3 ;43(5):274A-274A, Journal of the American College of Cardiology
— id: 42552, year: 2004, vol: 43, page: 274A, stat: Journal Article,

Advances in mitral valve reconstruction
Schwartz CF; Grossi EA; Sharony R; Saunders PC; Colvin SB; Galloway AC
Current therapy in thoracic and cardiovascular surgery St. Louis : Mosby, 2004,
— id: 3836, year: 2004, vol: , page: ?, stat: Chapter,

The role of annuloplasty in mitral valve repair
Schwartz, C F; Gulkarov, I; Bohmann, K; Colvin, S B; Galloway, A C
2004 Oct;45(5):419-425, Journal of cardiovascular surgery
Mitral valve repair surgery has progressed dramatically since its inception over 40 years ago. As techniques have evolved, complicated mitral valve reconstruction has become commonplace, with durable late results. Likewise, the value of concomitant annuloplasty during valve repair has been firmly established as contributing to late valve repair durability. This review discusses the evolution of annuloplasty techniques and the physiologic reasoning behind various approaches
— id: 49348, year: 2004, vol: 45, page: 419, stat: Journal Article,

Aortic valve and non-ischemic mitral valve surgery in patients undergoing coronary artery bypass grafting
Schwartz, Charles E; Saunders, Paul C; Galloway, Aubrey C
2004 ;41:172-178, Advances in cardiology
— id: 72037, year: 2004, vol: 41, page: 172, stat: Journal Article,

Propensity case-matched analysis of off-pump coronary artery bypass grafting in patients with atheromatous aortic disease
Sharony, Ram; Grossi, Eugene A; Saunders, Paul C; Galloway, Aubrey C; Applebaum, Robert; Ribakove, Greg H; Culliford, Alfred T; Kanchuger, Marc; Kronzon, Itzhak; Colvin, Stephen B
2004 Feb;127(2):406-413, Journal of thoracic & cardiovascular surgery
OBJECTIVE: Atheromatous aortic disease is a risk factor for excessive mortality and stroke in patients undergoing coronary artery bypass grafting. Outcomes of off-pump coronary artery bypass grafting and coronary artery bypass grafting with cardiopulmonary bypass in patients with severe atheromatous aortic disease were compared by propensity case-match methods. METHODS: Routine intraoperative transesophageal echocardiography identified 985 patients undergoing isolated coronary artery bypass grafting with severe atheromatous disease in the aortic arch or ascending aorta. Off-pump coronary artery bypass grafting was performed in 281 patients (28.5%). Propensity matched-pairs analysis was used to match patients undergoing off-pump coronary artery bypass grafting (n = 245) with patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. RESULTS: Univariate analysis revealed decreased hospital mortality (16/245, 6.5% vs 28/245, 11.4%; P =.058) and stroke prevalence (4/245, 1.6% vs 14/245, 5.7%; P =.03) in off-pump coronary artery bypass grafting compared with coronary artery bypass grafting with cardiopulmonary bypass. Freedom from any postoperative complication was higher in off-pump coronary artery bypass grafting compared with coronary artery bypass grafting with cardiopulmonary bypass (226/245, 92.2% vs 196/245, 80.0%; P <.001). Multivariable analysis of preoperative risk factors showed that increased hospital mortality was associated with coronary artery bypass grafting with cardiopulmonary bypass (odds ratio = 2.7; P =.01), fewer grafts (P =.05), acute myocardial infarction (odds ratio = 11.5; P <.001), chronic obstructive pulmonary disease (odds ratio = 2.4; P =.03), previous cardiac surgery (odds ratio = 10.2, P =.05), and peripheral vascular disease (odds ratio = 2.1; P =.05). Cardiopulmonary bypass was the only independent risk factor for stroke (odds ratio = 3.6, P =.03). At 36 months' follow-up, comparable survival was observed in the off-pump coronary artery bypass grafting and coronary artery bypass grafting with cardiopulmonary bypass groups (74% vs 72%). Multivariable analysis revealed that renal disease (P <.001), advanced age (P <.001), previous myocardial infarction (P =.03), and lower number of grafts (P =.02) were independent risks for late mortality. CONCLUSIONS: Patients with severe atherosclerotic aortic disease who undergo off-pump coronary artery bypass grafting have a significantly lower prevalence of hospital mortality, perioperative stroke, and overall complications than matched patients who underwent coronary artery bypass grafting with cardiopulmonary bypass. Routine intraoperative transesophageal echocardiography identifies severe atheromatous aortic disease and directs the choice of surgical technique
— id: 42050, year: 2004, vol: 127, page: 406, stat: Journal Article,

Propensity score analysis of a six-year experience with minimally invasive isolated aortic valve replacement
Sharony, Ram; Grossi, Eugene A; Saunders, Paul C; Schwartz, Charles F; Ribakove, Greg H; Baumann, F Gregory; Galloway, Aubrey C; Colvin, Stephen B
2004 Nov;13(6):887-893, Journal of heart valve disease
BACKGROUND AND AIM OF THE STUDY: Although minimally invasive aortic valve replacement (MIAVR) is becoming an accepted technique, additional outcome evaluation is required. To correct for non-randomized treatment, the propensity score was used to analyze the present authors' experience with MIAVR compared to standard sternotomy (SS). METHODS: Between January 1995 and December 2002, a total of 921 consecutive patients underwent isolated AVR; 438 of these patients had MIAVR. Two matched cohorts each of 233 patients, and with comparable distributions of risk factors, were constructed using propensity analysis of prospectively collected data. Matching variables included left ventricular ejection fraction <30%, previous myocardial infarction, congestive heart failure, previous cardiac surgery, renal insufficiency, age, gender, chronic obstructive pulmonary disease (COPD), peripheral vascular disease, previous stroke or carotid disease, urgent/emergent operation, valvular pathophysiology, and atheromatous aortic disease. RESULTS: Hospital mortality and major morbidity were similar in the MIAVR and SS groups: 5.6% versus 7.3% (p = 0.45) and 13.3% versus 14.2% (p = 0.79), respectively. Multivariable analysis of all patients revealed increased mortality with severe atheromatous aortic disease (p = 0.001), COPD (p = 0.002), and urgent operation (p = 0.02). Freedom from any major perioperative morbidity was similar in both groups (86.7% versus 85.8%; p = 0.79). However, the median length of stay was shorter with MIAVR (6 versus 8 days; p <0.001). During the past three years, a greater percentage of MIAVR patients than SS patients was discharged home rather than sent to rehabilitation facilities or nursing homes (65.7% versus 52.9%; p = 0.05). CONCLUSION: MIAVR can be performed safely, with morbidity and mortality outcomes similar to those of standard sternotomy. MIAVR is associated with a decreased length of hospital stay, and a greater proportion of patients are discharged home directly
— id: 55973, year: 2004, vol: 13, page: 887, stat: Journal Article,

Semirigid partial annuloplasty band allows dynamic mitral annular motion and minimizes valvular gradients: an echocardiographic study
Sharony, Ram; Saunders, Paul C; Nayar, Ambika; McAleer, Eileen; Galloway, Aubrey C; Delianides, Julie; Schwartz, Charles F; Applebaum, Robert M; Kronzon, Itzhak; Colvin, Stephen B; Grossi, Eugene A
2004 Feb;77(2):518-522, Annals of thoracic surgery
BACKGROUND: Traditional mitral annuloplasty devices include both rigid rings, which restrict annular motion, and soft rings and bands, which can locally deform. Conflicting data exist regarding their impact on annular dynamics. We studied mitral annuloplasty with a semirigid partial band and with a nearly complete rigid ring. METHODS: Intraoperative three-dimensional transesophageal echocardiograms (n = 14) and predischarge transthoracic echocardiograms were retrospectively analyzed in patients undergoing mitral valve repair for degenerative disease with either a rigid ring (n = 77) or a semirigid partial band (n = 38). Each transesophageal echocardiogram was analyzed with TomTec three-dimensional software to produce cardiac cycle frame planimetry and to measure device geometry. Actual device sizes provided reference dimensions. Blinded analysis of Doppler data from transthoracic echocardiograms was performed. RESULTS: Validation of the quantitative transesophageal echocardiogram methodology revealed a 1.3% +/- 0.3% (mean +/- standard error of the mean) underestimation of actual linear dimension. With the semirigid partial band, systolic valve orifice area and intertrigonal distance decreased from 6.14 +/- 0.37 to 5.55 +/- 0.24 cm(2) (-9.6%; p = 0.01) and from 2.69 +/- 0.08 to 2.55 +/- 0.13 cm (-5.2%; p = 0.03), respectively. Systolic anterior-posterior distance decreased from 2.1 +/- 0.10 to 1.95 +/- 0.06 cm (-7.1%; p = 0.01) compared with diastole. In contrast, rigid ring orifice area was unchanged (4.12 +/- 0.15 to 4.10 +/- 0.16 cm(2); -0.5%; p = 0.48) during the cardiac cycle. Transthoracic echocardiography revealed significantly lower mitral inflow gradients with semirigid partial band (mean gradients compared with rigid ring, 4.0 +/- 0.3 versus 5.0 +/- 0.3 mm Hg; p = 0.02; peak gradients, 8.9 +/- 0.5 versus 11.1 +/- 0.5 mm Hg; p = 0.01). CONCLUSIONS: Three-dimensional transesophageal echocardiographic measurements of annular dynamics are valid and reliable when discrete annuloplasty devices are present. In contrast to the rigid ring, the semirigid partial band permits more physiologic geometric changes and is associated with lower postoperative mitral valve gradients
— id: 42597, year: 2004, vol: 77, page: 518, stat: Journal Article,

Activation of mitogen-activated protein kinases during preparation of vein grafts and modulation by a synthetic inhibitor
Bizekis, Costas; Pintucci, Giuseppe; Derivaux, Christopher C; Saponara, Fiorella; Kim, Jin-Hee; Hyman, Kevin M; Sharony, Ram; Grossi, Eugene A; Baumann, F Gregory; Mignatti, Paolo; Galloway, Aubrey C
2003 Sep;126(3):659-665, Journal of thoracic & cardiovascular surgery
OBJECTIVE: Long-term durability of saphenous vein grafts used for coronary artery bypass grafting is limited by neointimal formation. Arterial vascular injury is known to activate intracellular mitogen-activated protein kinases, including extracellular signal-regulated kinases and c-jun N-terminal kinases, that affect cell differentiation, proliferation, migration, and apoptosis. This study tests the hypothesis that these mitogen-activated protein kinases are activated in saphenous veins during preparation for coronary artery bypass grafting. METHODS: Saphenous veins were harvested from 10 patients undergoing coronary artery bypass grafting. A specimen from each vein was placed in ice-cold lysis buffer immediately after harvesting (t = 0). The remaining tissue was incubated at room temperature in normal saline, 0.1% dimethylsulfoxide (vehicle), or 50 mmol/L PD98059 (mitogen-activated protein kinase kinase-1/2 inhibitor) until the vein was grafted (mean 50 minutes). To study kinetics of intracellular signaling pathways, canine saphenous veins were harvested, and mitogen-activated protein kinases and PI-3 kinase pathways were studied after different incubation time intervals. Extracted proteins were analyzed by Western blotting or in vitro kinase assay. RESULTS: The human saphenous veins showed elevated levels of active extracellular signal-regulated kinase after harvesting (t = 0) and prior to implant (t = 1). Incubation with PD98059 resulted in decreased activation of extracellular signal-regulated kinase. Kinetics of canine saphenous veins showed extracellular signal-regulated kinase and c-jun N-terminal kinase activation, in a time-dependent manner, along with activation of the growth factor-regulated PI3 kinase pathway. CONCLUSIONS: This study characterizes activation of extracellular signal-regulated kinases and c-jun N-terminal kinases during vein graft preparation and demonstrates the ability to inhibit extracellular signal-regulated kinase activation by simple incubation with a specific inhibitor. Further studies are needed to evaluate the significance of these findings with respect to graft durability
— id: 39061, year: 2003, vol: 126, page: 659, stat: Journal Article,

Routine intraoperative transesophageal echocardiography identifies patients with atheromatous aortas: Impact on "off-pump" coronary artery bypass and perioperative stroke
Grossi, Eugene A; Bizekis, Costas S; Sharony, Ram; Saunders, Paul C; Galloway, Aubrey C; Lapietra, Angelo; Applebaum, Robert M; Esposito, Rick A; Ribakove, Greg H; Culliford, Alfred T; Kanchuger, Marc; Kronzon, Itzhak; Colvin, Stephen B
2003 Jul;16(7):751-755, Journal of the American Society of Echocardiography
BACKGROUND: Patients with severe atheromatous aortic disease (AAD) undergoing coronary artery bypass grafting (CABG) have increased operative risks. The 'off-pump' CABG (OPCAB) technique was evaluated in patients given the diagnosis of severe AAD by routine transesophageal echocardiography. METHODS: A total of 5737 patients underwent CABG, with 913 having transesophageal echocardiography findings of severe AAD. Of the patients with severe AAD, 678 (74.3%) had conventional CABG and 235 (25.7%) had OPCAB. RESULTS: Hospital mortality was 8.7% for conventional CABG and 5.1% for OPCAB (P =.08). Multivariate analysis revealed that increased mortality was significantly associated with acute myocardial infarction, conventional CABG, age, renal disease, history of stroke, and ejection fraction < 30%. Neurologic complications occurred in 6.3% of patients undergoing CABG and in 2.1% undergoing OPCAB (P =.01). Freedom from any complication was significantly greater with OPCAB. CONCLUSION: Routine intraoperative transesophageal echocardiography identifies patients with severe AAD. In these patients, OPCAB technique is associated with a lower risk of death, stroke, and all complications
— id: 36724, year: 2003, vol: 16, page: 751, stat: Journal Article,

A quantitative in vitro model of smooth muscle cell migration through the arterial wall using the human amniotic membrane
Kallenbach, Klaus; Fernandez, Harold A; Seghezzi, Graziano; Baumann, F Gregory; Patel, Sundeep; Grossi, Eugene A; Galloway, Aubrey C; Mignatti, Paolo
2003 Jun 1;23(6):1008-1013, Arteriosclerosis, thrombosis, & vascular biology
OBJECTIVE: The development of intimal hyperplasia involves smooth muscle cell (SMC) migration into the intima and proliferation. Matrix metalloproteinases and their tissue inhibitors play important roles in this process. In this study, we describe a novel in vitro model for studying SMC migration through the vessel wall. METHODS AND RESULTS: Human aortic SMCs (hASMCs) labeled with 125I-iododeoxyuridine or unlabeled were grown on the stromal aspect of the human amniotic membrane. Mechanical damage to endothelial cells grown on the basement membrane and addition of growth factors or platelets were characterized for their effect on SMC migration into the stroma both by histological methods and by measuring the radioactivity associated with the membrane after removal of noninvasive SMCs. To assess the reliability of the model, the cells were infected with a recombinant adenovirus encoding the tissue inhibitor of metalloproteinase-1 (TIMP-1). Addition of a platelet-derived growth factor gradient stimulated hASMC infiltration into the stroma. This effect was abolished with TIMP-1-transduced hASMC, confirming that TIMP-1 overexpression blocks SMC invasion of the stroma. CONCLUSIONS: This in vitro model of SMC migration in the vessel wall provides an inexpensive, quantitative, and reliable tool to study the molecular and cellular mechanisms of intimal hyperplasia
— id: 39254, year: 2003, vol: 23, page: 1008, stat: Journal Article,

Induction of stromelysin-1 (MMP-3) by fibroblast growth factor-2 (FGF-2) in FGF-2-/- microvascular endothelial cells requires prolonged activation of extracellular signal-regulated kinases-1 and -2 (ERK-1/2)
Pintucci, Giuseppe; Yu, Pey-Jen; Sharony, Ram; Baumann, F Gregory; Saponara, Fiorella; Frasca, Antonio; Galloway, Aubrey C; Moscatelli, David; Mignatti, Paolo
2003 Dec 1;90(5):1015-1025, Journal of cellular biochemistry
Basic fibroblast growth factor (FGF-2) and matrix metalloproteinases (MMPs) play key roles in vascular remodeling. Because FGF-2 controls a number of proteolytic activities in various cell types, we tested its effect on vascular endothelial cell expression of MMP-3 (stromelysin-1), a broad-spectrum proteinase implicated in coronary atherosclerosis. Endothelial cells (EC) from FGF-2-/- mice are highly responsive to exogenous FGF-2 and were therefore used for this study. The results showed that treatment of microvascular EC with human recombinant FGF-2 results in strong induction of MMP-3 mRNA and protein expression. Upregulation of MMP-3 mRNA by FGF-2 requires de novo protein synthesis and activation of the ERK-1/2 pathway. FGF-2 concentrations (5-10 ng/ml) that induce rapid and prolonged (24 h) activation of ERK-1/2 upregulate MMP-3 expression. In contrast, lower concentrations (1-2 ng/ml) that induce robust but transient (<8 h) ERK-1/2 activation are ineffective. Inhibition of ERK-1/2 activation at different times (-0.5 h to +8 h) of EC treatment with effective FGF-2 concentrations blocks MMP-3 upregulation. Thus, FGF-2 induces EC expression of MMP-3 with a threshold dose effect that requires sustained activation of the ERK-1/2 pathway. Because FGF-2 controls other EC functions with a linear dose effect, these features indicate a unique role of MMP-3 in vascular remodeling
— id: 44759, year: 2003, vol: 90, page: 1015, stat: Journal Article,

Substernal epicardial echocardiography: review of a new technique
Reynolds, Harmony R; Nayar, Ambika C; McAleer, Eileen P; Schwartz, Jesse D; Tunick, Paul A; Applebaum, Robert M; Colvin, Stephen B; Culliford, Alfred T; Galloway, Aubrey C; Grossi, Eugene A; Ribakove, Gregory H; Kronzon, Itzhak
2003 Nov;16(11):1204-1210, Journal of the American Society of Echocardiography
BACKGROUND: Patients after cardiac operation pose a challenge to the treating physician-these patients may become critically ill and are among the most difficult to image using transthoracic echocardiography. Several factors contribute to this, including difficulties in positioning the patient, inability of the patient to cooperate with instructions, surgical dressings, and hyperinflated lungs. Transesophageal echocardiography may be performed when transthoracic echocardiography is not diagnostic; however, transesophageal echocardiography is semi-invasive and does not lend itself to prolonged or repeated monitoring. METHODS: Recently, a new approach to echocardiography for use in the patient after operation has been introduced with the modification of the standard mediastinal drainage tube to allow for substernal epicardial echocardiography (SEE). The SEE tube has 2 lumens. The first allows for routine mediastinal drainage and the second has a blind end that permits the insertion of a standard transesophageal echocardiographic probe for high-resolution imaging as often as is desired over the period during which the mediastinal tube is in place. CONCLUSION: This article reviews the technique of SEE including a description of the method of performance of SEE (with representative images), a review of the published literature on this new modality, examples of clinical use, and a discussion of the advantages, indications, and limitations of SEE with an eye toward future directions for research
— id: 42051, year: 2003, vol: 16, page: 1204, stat: Journal Article,

Minimally invasive cardiac valve surgery
Sharony R; Grossi EA; Ribakove GH; Ursomanno P; Baumann FG; Colvin SB; Galloway AC
Advanced therapy in cardiac surgery Hamilton Ont : BC Dekker, 2003,
— id: 3820, year: 2003, vol: , page: 147, stat: Chapter,

Repair of tricuspid regurgitation: The posterior annuloplasty technique
Sharony R; Grossi EA; Saunders PC; Galloway AC; Colvin SB
2003 ;8(4):177-183, Operative Techniques in Thoracic & Cardiovascular Surgery
— id: 46351, year: 2003, vol: 8, page: 177, stat: Journal Article,

Nonsternotomy, minimally invasive aortic valve surgery: a six-year experience with 482 patients
Sharony R; Grossi EA; Saunders PC; Schwartz CF; Delianides J; Ursomanno P; Galloway AC; Ribakove GH; Culliford AT; Colvin SB
2003 ;6 Supp 1(6):S12-S12, Heart surgery forum
OBJECTIVE: Although minimally invasive aortic valve replacement (MIAVR) has recently become popular, additional outcome evaluation is required. This study analyzed a single institutional experience with MIAVR with respect to hospital morbidity and mortality. METHODS: Between 12/96 and 06/02, 482 consecutive patients at a single institution underwent MIAVR, including concomitant procedures in 123 pts: 55 multiple valves, 18 CABGs, 21 myomectomies, and 29 other procedures. These patients (mean age 65 yrs; range 15-94) had severe stenosis (58.9%), severe insufficiency (33.0%), or mixed disease (8.1%). Thirty-three percent had a previous MI, 13.3% had a previous cardiac operation, and 17.3% were >80 years old. Right anterior minithoracotomy was performed in 87.3%. Ascending aortic cannulation was used in 68% of the patients while direct external cross clamping was used in 97% of cases. RESULTS: Hospital mortality was 6.2% (30/482) overall and 5.3% (19/359) for isolated AVR. Mean aortic crossclamp and cardiopulmonary bypass times were 87 and 122 min, respectively. Postoperative complications included stroke in 2.3% (11/482) and 82.5% of patients were free from any complications. Neither aortic dissection nor mediastinitis was observed. Univariant analysis demonstrated that female gender, renal failure, CHF, and age >80 years were risk factors for mortality. Multivariable analysis revealed that age and CHF were independently associated with increased risk of mortality (p<0.05). CONCLUSIONS: These results demonstrate that MIAVR is a safe procedure, with low morbidity and acceptable perioperative mortality, and may be used routinely in a large series of patients
— id: 36726, year: 2003, vol: 6 Supp 1, page: S12, stat: Journal Article,

Off-pump coronary artery bypass grafting reduces mortality and stroke in patients with atheromatous aortas: a case control study
Sharony, Ram; Bizekis, Costas S; Kanchuger, Marc; Galloway, Aubrey C; Saunders, Paul C; Applebaum, Robert; Schwartz, Charles F; Ribakove, Greg H; Culliford, Alfred T; Baumann, F Gregory; Kronzon, Itzhak; Colvin, Stephen B; Grossi, Eugene A
2003 Sep 9;108 Suppl 1(19):II15-II20, Circulation
BACKGROUND: Patients with severe atheromatous aortic disease (AAD) who undergo coronary artery bypass (CABG) have an increased risk of death and stroke. We hypothesized that in these high risk patients, off-pump coronary artery bypass (OPCAB) technique is associated with lower morbidity and mortality. METHODS AND RESULTS: Between June 1993 and January 2002, 5737 patients undergoing CABG had routine intra-operative TEE with 913 (15.9%) found to have severe AAD in the aortic arch or ascending aorta. Of these, 211 patients who underwent OPCAB were matched with 211 on-pump CABG patients by age, ejection fraction, history of stroke, cerebrovascular disease, diabetes, renal disease, nonelective operation, and previous cardiac surgery. Hospital mortality was 11.4% (24/211) for on-pump CABG and 3.8% (8/211) for OPCAB (P=0.003). Multivariate analysis revealed that increased mortality was associated with on-pump CABG (P=0.001), acute MI (P=0.03), number of grafts (P=0.01), age (P=0.01), history of stroke or cerebrovascular disease (P=0.04), CHF (P=0.02), and peripheral vascular disease (P=0.03). Multivariate analysis showed that OPCAB technique was associated with decreased stroke (P=0.05). Freedom from any complication was 78.7% for on-pump CABG and 91.9% for OPCAB (P<0.001). At 36 month follow-up multivariate analysis revealed that increased mortality was associated with age (P=0.001), previous MI (P=0.03), and renal disease (P=0.04), whereas increased survival was associated with increased number of grafts (P=0.001) and OPCAB (P=0.01). CONCLUSIONS: OPCAB surgery in patients with severe AAD is associated with lower risk of death, stroke and complications and improved mid-term survival. Routine intra-operative TEE allows identification of these patients and directs choice of appropriate surgical technique
— id: 39076, year: 2003, vol: 108 Suppl 1, page: II15, stat: Journal Article,

Aortic valve replacement in patients with impaired ventricular function
Sharony, Ram; Grossi, Eugene A; Saunders, Paul C; Schwartz, Charles F; Ciuffo, Giovanni B; Baumann, F Gregory; Delianides, Julie; Applebaum, Robert M; Ribakove, Greg H; Culliford, Alfred T; Galloway, Aubrey C; Colvin, Stephen B
2003 Jun;75(6):1808-1814, Annals of thoracic surgery
BACKGROUND: Patients with reduced ventricular function undergoing aortic valve replacement have increased operative risks, but the impact of valvular pathophysiology and other risk factors has not been clearly defined. METHODS: From June 1992 through June 2002, 1,402 consecutive patients underwent isolated aortic valve surgery with or without coronary artery bypass grafting; of these patients, 416 had an ejection fraction less than 40% and are the subject of this report. These patients (mean age, 68.6) had severe stenosis (62.5%), severe regurgitation (30.3%), or mixed disease (7.2%). Aortic valve replacement plus coronary artery bypass grafting was performed in 48.4% of patients, and 27% had previous cardiac surgery. Follow-up included echocardiography and survival analysis. RESULTS: Hospital mortality was 10.1% (42 of 416), with no difference between aortic stenosis (9.6%) and regurgitation (11.1%). Multivariate analysis revealed that age (p = 0.002) and renal disease (odds ratio = 4.2; 95% confidence interval, 1.9 to 9.3; p = 0.001) were independently associated predictors of mortality. Valvular pathophysiology had no impact on mortality. Peripheral vascular disease, multivessel coronary disease, and renal disease were associated risks for any postoperative complication. Peripheral vascular disease (odds ratio = 12.3, p = 0.02), history of cerebrovascular disease (odds ratio = 4.8, p = 0.038), and diabetes (odds ratio = 2.7, p = 0.04) were associated risks for stroke. The ejection fraction was more than 40% in 52% of the patients who had postoperative echocardiography (mean follow-up, 6 months). Actuarial survival revealed no difference between pathophysiologic groups. CONCLUSIONS: Aortic valve surgery in patients with impaired ventricular function carries an acceptable operative risk that can be stratified by age and comorbidities. The type of valvular pathophysiology does not significantly affect mortality
— id: 36725, year: 2003, vol: 75, page: 1808, stat: Journal Article,

Minimally invasive aortic valve surgery in the elderly: a case-control study
Sharony, Ram; Grossi, Eugene A; Saunders, Paul C; Schwartz, Charles F; Ribakove, Greg H; Culliford, Alfred T; Ursomanno, Patricia; Baumann, F Gregory; Galloway, Aubrey C; Colvin, Stephen B
2003 Sep 9;108 Suppl 1(19):II43-II47, Circulation
INTRODUCTION: Although minimally invasive aortic valve surgery (MIAVR) is performed in many centers, few studies have compared its results to a standard sternotomy (SS) approach. We assessed the hypothesis that, when compared with SS in the elderly population, MIAVR has similar morbidity and mortality and allows faster hospital recovery. METHODS AND RESULTS: From January 1995 through February 2002, 515 patients over age 65 underwent isolated aortic valve replacement. Using data gathered prospectively, 189 MIAVR patients were matched with 189 SS patients by age, ventricular function, valvular pathology, urgency of operation, diabetes, previous cardiac surgery, renal disease, and history of stroke. In each group, 56.1% of patients underwent non-elective procedures, and 28% were >or=80 years old. Hospital mortality (6.9%) and freedom from postoperative morbidity (82.5% versus 81.5%, P=0.79) were similar. Multivariate analysis revealed that urgent procedures [Odds Ratio (OR)=3.97; P=0.03], congestive heart failure (OR=3.94; P=0.03), and ejection fraction <30% (OR=4.16; P=0.03) were significant predictors of hospital mortality. Prolonged length of stay was associated with age (P=0.05), preoperative stroke (OR=3.5,P=0.001), CHF (OR=2.2, P=0.004), and sternotomy approach (OR=2.3,P=0.002) by multivariate analysis. More MIAVR patients were discharged home (52.6% versus 38.6%,P=0.03) rather than to rehabilitation facilities. Three year actuarial survival revealed no difference between groups. CONCLUSIONS: Minimally invasive aortic valve surgery is safe in elderly patients, with morbidity and mortality comparable to sternotomy approach. The shorter hospital stay and greater percentage of patients discharged home after MIAVR reflect enhanced recovery with this technique
— id: 39075, year: 2003, vol: 108 Suppl 1, page: II43, stat: Journal Article,

Off pump CABG reduces mortality and neurologic complications in patients with atheromatous aortas: A case control study
Bizekis, CS; Grossi, EA; Sharony, R; Galloway, AC; Applebaum, R; Esposito, RA; Ribakove, GH; Culliford, AT; Kanchuger, M; Kronzon, I; Colvin, SB
2002 NOV 5 ;106(19):638-638, Circulation
— id: 37208, year: 2002, vol: 106, page: 638, stat: Journal Article,

Impact of a clinical pathway on the postoperative care of children undergoing surgical closure of atrial septal defects
DeSomma, Michelle; Divekar, Abhay; Galloway, Aubrey C; Colvin, Stephen B; Artman, Michael; Auslender, Marcelo
2002 Nov;15(4):243-248, Applied nursing research
The purpose of this study was to impact of a clinical pathway on the postoperative management of children undergoing surgical closure of atrial septal defects (ASDs). Three groups of children were studied: group 1 (14 patients), before introduction of an intensive care team, minimally invasive surgery, and the clinical pathway; group 2 (17 patients), after the introduction of the intensive care team and minimally invasive surgical techniques but before the pathway; and group 3 (30 patients), after implementation of the clinical pathway. Average hospital length of stay fell from 118.52 +/- 19.83 hours (4.9 +/- 0.83 days) in group 1 to 95.92 +/- 66.48 hours (3.99 +/-2.77 days) in group 2 and declined further to 54.29 +/- 20.17 hours (2.26 +/- 0.84 days) in group 3 (p <.05). There were statistically significant decreases in laboratory resource utilization (p <.05). The addition of a dedicated intensive care team and utilization of minimally invasive surgical techniques reduced mean length of stay (by 20%) and resource utilization (by 50%). However, only the implementation of the pathway provided the consistency necessary for maximal quality management, cost saving, and reduction in length of stay (additional 44% reduction in mean length of stay and 40% reduction in resource utilization). These results show the incremental advantage of implementing a defined clinical pathway for postoperative management of children with atrial septal defects
— id: 32916, year: 2002, vol: 15, page: 243, stat: Journal Article,

Evolving techniques for mitral valve reconstruction
Galloway, Aubrey C; Grossi, Eugene A; Bizekis, Costas S; Ribakove, Greg; Ursomanno, Patricia; Delianides, Julie; Baumann, F Gregory; Spencer, Frank C; Colvin, Stephen B
2002 Sep;236(3):288-293, Annals of surgery
OBJECTIVE: To analyze the effectiveness of new techniques of mitral valve reconstruction (MVR) that have evolved over the last decade, such as aggressive anterior leaflet repair and minimally invasive surgery using an endoaortic balloon occluder. SUMMARY BACKGROUND DATA: MVR via conventional sternotomy has been an established treatment for mitral insufficiency for over 20 years, primarily for the treatment of patients with posterior leaflet prolapse. METHODS: Between June 1980 and June 2001, 1,195 consecutive patients had MVR with ring annuloplasty. Conventional sternotomy was used in 843 patients, minimally invasive surgery in 352 (since June 1996). Anterior leaflet repair was performed in 374 patients, with increasing use over the last 10 years. Follow-up was 100% complete (mean 4.6 years, range 0.5-20.5). RESULTS: Hospital mortality was 4.7% overall and 1.4% for isolated MVR (1.1% for minimally invasive surgery vs. 1.6% for conventional sternotomy; =.4). Multivariate analysis showed the factors predictive of increased operative risk to be age, NYHA functional class, concomitant procedures, and previous cardiac surgery. The 5-year results for freedom from cardiac death, reoperation, and valve-related complications among the 782 patients with degenerative etiology are, respectively, as follows ( >.05 for all end points): for anterior leaflet repair, 93%, 94%, 90%; for no anterior leaflet repair, 91%, 92%, 91%; for minimally invasive surgery, 97%, 89%, 93%; and for conventional sternotomy, 93%, 94%, 90%. CONCLUSIONS: These findings indicate that late results of MVR after minimally invasive surgery and after anterior leaflet repair are equivalent to those achievable with conventional sternotomy and posterior leaflet repair. These options significantly expand the range of patients suitable for mitral valve repair surgery and give further evidence to support wider use of minimally invasive techniques
— id: 33332, year: 2002, vol: 236, page: 288, stat: Journal Article,

Minimally invasive mitral valve surgery: a 6-year experience with 714 patients
Grossi, Eugene A; Galloway, Aubrey C; LaPietra, Angelo; Ribakove, Greg H; Ursomanno, Patricia; Delianides, Julie; Culliford, Alfred T; Bizekis, Costas; Esposito, Rick A; Baumann, F Gregory; Kanchuger, Marc S; Colvin, Stephen B
2002 Sep;74(3):660-663, Annals of thoracic surgery
BACKGROUND: This study analyzes a single institutional experience with minimally invasive mitral valve operations of 6 years, reviewing short-term morbidity and mortality and long-term echocardiographic follow-up data. METHODS: Seven hundred fourteen consecutive patients had minimally invasive mitral valve procedures between November 1995 and November 2001; concomitant procedures included 91 multiple valves and 18 coronary artery bypass grafts. Of these 714 patients, 561 patients had isolated mitral valve operations (375 repairs, 186 replacements). Mean age was 58.3 years (range, 14 to 96 years; 30.1% > 70 years), and 15.4% of patients had previous cardiac operations. Arterial cannulation was femoral in 79.0% and central in 21%, with the port access balloon endo-occlusion used in 82.3%. Cardioplegia was transjugular retrograde (54.1%) or antegrade (29.4%). Right anterior minithoracotomy was used in 96.6% and left posterior minithoracotomy in 2.2%. RESULTS: Hospital mortality for primary isolated mitral valve repair was 1.1% and 5.8% for isolated mitral valve replacement. Overall hospital mortality was 4.2% (30 of 714). Mean cross-clamp time was 92 minutes and mean cardiopulmonary bypass time was 127 minutes. Postoperatively, median ventilation time was 11 hours, intensive care unit time was 19 hours, and total hospital stay was 6 days. Complications for all patients included permanent neurologic deficit (2.9%), aortic dissection (0.3%); there was no mediastinal infection (0.0%). Follow-up echocardiography demonstrated 89.1% of the repair patients had only trace or no residual mitral insufficiency. CONCLUSIONS: This study demonstrates that the minimally invasive port access approach to mitral valve operations is reproducible with low perioperative morbidity and mortality and with late outcomes that are equivalent to conventional operations
— id: 33330, year: 2002, vol: 74, page: 660, stat: Journal Article,

Transforming growth factor-beta1 induces apoptosis in vascular endothelial cells by activation of mitogen-activated protein kinase
Hyman, Kevin M; Seghezzi, Graziano; Pintucci, Giuseppe; Stellari, Giulia; Kim, Jee Hyun; Grossi, Eugene A; Galloway, Aubrey C; Mignatti, Paolo
2002 Aug;132(2):173-179, Surgery
BACKGROUND: Vascular endothelial cell apoptosis is central in atherosclerosis and intimal hyperplasia. Transforming growth factor (TGF)-beta1 induces endothelial cell apoptosis through unidentified mechanism(s). Although TGF-beta1 signals through the Smad proteins, in some nonendothelial cell types it also activates the mitogen-activated protein kinase (MAPK) (extracellular signal-regulated kinase, c-Jun N-terminal kinase, and p38 MAPK [p38(MAPK)]). p38(MAPK) relays apoptotic signals in several cell types. We hypothesized that TGF-beta1 activates endothelial cell MAPKs and induces apoptosis through p38(MAPK) activation. METHODS: Human umbilical vein or bovine capillary endothelial cells were incubated with TGF-beta1 for 0.5 to 12 hours. MAPK activation was characterized by Western blotting with antibodies to phosphorylated extracellular signal-regulated kinase 1/2, p38(MAPK), or c-Jun N-terminal kinases 1/2. To study apoptosis, extracts of cells incubated with TGF-beta1 for 6 hours with or without MAPK inhibitors were characterized by Western blotting analysis of poly (ADP-Ribose) polymerase degradation. RESULTS: TGF-beta1 induced p38(MAPK), extracellular signal-regulated kinase 1/2, and c-Jun N-terminal kinase 1/2 activation and increased apoptosis. Inhibition of p38(MAPK) significantly reduced TGF-beta1-induced apoptosis. In contrast, inhibition of other signaling pathways was ineffective. CONCLUSIONS: TGF-beta1 induces endothelial cell apoptosis through p38(MAPK) activation. Because TGF-beta1 is upregulated in vascular remodeling, p38(MAPK) is a potential target to prevent endothelial cell apoptosis during this process
— id: 33331, year: 2002, vol: 132, page: 173, stat: Journal Article,

Pulmonary vein isolation during minimally invasive mitral valve surgery: One-year follow-up
Mirchandani, S; Holmes, DS; Chinitz, LA; Bernstein, NE; Applebaum, RM; Colvin, SB; Galloway, AC; Grossi, EA
2002 Mar 6;39(5):120A-120A, Journal of the American College of Cardiology
— id: 27516, year: 2002, vol: 39, page: 120A, stat: Journal Article,

Lack of ERK activation and cell migration in FGF-2-deficient endothelial cells
Pintucci, Giuseppe; Moscatelli, David; Saponara, Fiorella; Biernacki, Peter R; Baumann, F Gregory; Bizekis, Costas; Galloway, Aubrey C; Basilico, Claudio; Mignatti, Paolo
2002 Apr;16(6):598-600, FASEB journal
The formation of blood capillaries from preexisting vessels (angiogenesis) and vascular remodeling secondary to atherosclerosis or vessel injury are characterized by endothelial cell migration and proliferation. Numerous growth factors control these cell functions. Basic fibroblast growth factor (FGF-2), a potent angiogenesis inducer, stimulates endothelial cell proliferation, migration, and proteinase production in vitro and in vivo. However, mice genetically deficient in FGF-2 have no apparent vascular defects. We have observed that endothelial cell migration in response to mechanical damage in vitro is accompanied by activation of the extracellular signal-regulated kinase (ERK) pathway, which can be blocked by neutralizing anti-FGF-2 antibodies. Endothelial cells from mice that are genetically deficient in FGF-2 neither migrate nor activate ERK in response to mechanical wounding. Addition of exogenous FGF-2 restores a normal cell response, which shows that impaired migration results from the genetic deficiency of this growth factor. Injury-induced ERK activation in endothelial cells occurs only at the edge of the wound. In addition, FGF-2-induced ERK activation mediates endothelial cell migration in response to wounding without a significant effect on proliferation. These data show that FGF-2 is a key regulator of endothelial cell migration during wound repair
— id: 34522, year: 2002, vol: 16, page: 598, stat: Journal Article,

Minimally invasive aortic valve surgery in the elderly: A case-control study
Sharony, R; Grossi, EA; Bizekis, CS; Ribakove, G; Galloway, AC; Esposito, RA; Culliford, AT; Ursomanno, P; Sennet, DM; Baumann, GF; Colvin, SB
2002 NOV 5 #2743;106(19):555-555, Circulation
— id: 37205, year: 2002, vol: 106, page: 555, stat: Journal Article,

Minimally invasive valve surgery: evolution of technique and clinical results
Sharony, Ram; Grossi, Eugene A; Ribakove, Greg H; Ursomanno, Patricia; Colvin, Stephen B; Galloway, Aubery C
2002 ;39(3):164-172, Advances in cardiology
— id: 33333, year: 2002, vol: 39, page: 164, stat: Journal Article,

Exclusion of mitral valvuloplasty from predictors of mortality for patients undergoing cardiac valve replacements in New York State
Colvin SB; Galloway AC; Grossi EA
2001 Aug;72(2):663-663, Annals of thoracic surgery
— id: 33336, year: 2001, vol: 72, page: 663, stat: Journal Article,

Minimally invasive atrial septal defect repair in adults
Galloway, AC; LaPietra, A; Grossi, EA; Baumann, GF; Bizekis, CS; Ursomanno, P; Ribakove, G; Colvin, SB
2001 FEB ;37(2):459A-459A, Journal of the American College of Cardiology
— id: 33423, year: 2001, vol: 37, page: 459A, stat: Journal Article,

Predictors of operative time in multicenter port-access valve registry: institutional differences in learning
Glower, D D; Siegel, L C; Galloway, A C; Ribakove, G; Grossi, E; Robinson, N; Ryan, W H; Colvin, S; Shemin, R
2001 ;4(1):40-46, Heart surgery forum
BACKGROUND: The predictors of operative time and the effects of learning in isolated valve operations using port-access techniques have not been defined. METHODS: Analysis of covariance was used to examine the determinants of procedure time, pump time, and aortic clamp time. In the largest prospective, registry of patients undergoing isolated aortic valve replacement (AVR, N=199), mitral repair (MVP, N=307), or mitral replacement (MVR, N=232) using port-access techniques 1997-1999 at 27 institutions. RESULTS: Institutional case volume ranged from one to 214 (median 6). Operative time was longer in redo procedures (5.3 +/- 1.6 vs. 4.4 +/- 1.3 hr, p = 0.0001), longer with MVP or MVR vs. AVR (4.8 +/- 1.2 vs. 5.0 +/- 1.5 vs. 3.8 +/- 1.2 hr, p = 0.0001), and decreased with case number (mean decrease 1.00 +/- 0.19 min/case, p = 0.04). Operative time also varied between institutions (p = 0.001). Rate of learning (decrease in time per case) varied significantly between institutions only for MVP (p = 0.03). Similar analysis showed that pump time and clamp times did not significantly change over time (p > 0.17) but varied significantly between institutions. Institutional volume did not affect operative, pump, or clamp times or rate of learning (decrease in operative time/case). CONCLUSIONS: These prospective registry data demonstrate that, for port-access valve procedures, procedure times continue to improve (learning) even after 100 cases. Procedure time and learning are affected by institutional differences and by the type of procedure, but are little affected by institutional volume. This data provides a model to understand learning of new surgical procedures, and this data suggests that port-access valve procedures can be mastered by a variety of institutions
— id: 149867, year: 2001, vol: 4, page: 40, stat: Journal Article,

History of mitral valve anterior leaflet repair with triangular resection
Grossi A; LaPietra A; Galloway AC; Colvin SB
2001 Nov;72(5):1794-1795, Annals of thoracic surgery
— id: 36728, year: 2001, vol: 72, page: 1794, stat: Journal Article,

Late results of isolated mitral annuloplasty for "functional" ischemic mitral insufficiency
Grossi EA; Bizekis CS; LaPietra A; Derivaux CC; Galloway AC; Ribakove GH; Culliford AT; Esposito RA; Delianides J; Colvin SB
2001 ;16(4):328-332, Journal of cardiac surgery
BACKGROUND: Repair of functional ischemic mitral regurgitation (MR) due to annular deformity and leaflet restriction remains a challenge for the surgeon and lacks well-documented outcomes. We investigated outcomes in the treatment of functional ischemic MR corrected by annuloplasty techniques alone. METHODS: From May 1980 to July 1999, 174 patients underwent repair for functional ischemic mitral insufficiency with annuloplasty alone (128 ring annuloplasty; 46 suture annuloplasty). Acute insufficiency was present in 25 (14.4%). Concomitant procedures included CABG (n = 152; 87.4%). Patients were studied longitudinally with annual follow-up and echocardiograms. RESULTS: Overall hospital mortality was 17.8% and was increased by NYHA Class 4 (23.8% vs. 8.7%; p = 0.011), diabetes (25.0% vs. 13.6%; p = 0.059), and chronic mitral insufficiency (16.4% vs. 8.0%; p = 0.070). Multivariate analysis revealed age (beta = 0.099; p = 0.049) and ejection fraction < 30% (beta = 1.260; p = 0.097) as significant predictors of hospital death. Mean postoperative mitral insufficiency was 0.84 +/- 0.86 (scale of 0-4). NYHA Class 4 (beta = 2.33; p = 0.034) and simple suture annuloplasty (beta = 2.08; p = 0.07) were associated with increased risk of late cardiac death. Cumulative incidence of mitral reoperation was 7.7% at 5 years. At follow-up, 89.7% of patients were in NYHA Class 1 or 2 with 83.4% having none or only mild mitral insufficiency. CONCLUSIONS: Ring annuloplasty is associated with a survival benefit when compared to simple suture repair in ischemic patients who require annuloplasty alone to correct the MR. Mitral reconstruction with a ring annuloplasty offers durable results in this homogeneous subset of functional ischemic MR patients. Ischemic mitral insufficiency is associated with significant late mortality
— id: 28917, year: 2001, vol: 16, page: 328, stat: Journal Article,

Impact of minimally invasive valvular heart surgery: a case-control study
Grossi EA; Galloway AC; Ribakove GH; Zakow PK; Derivaux CC; Baumann FG; Schwesinger D; Colvin SB
2001 Mar;71(3):807-810, Annals of thoracic surgery
BACKGROUND: The port access (PA) approach for valvular heart surgery is widely used, but few studies evaluating outcomes compared with the sternotomy approach have been performed. METHODS: One hundred nine consecutive patients undergoing PA-isolated valve surgery were compared with 88 matched patients who underwent sternotomy-isolated valve surgery before the institution of the PA program. Case matching was performed by age, surgeon, congestive heart failure, position of operated valve, and history of previous surgery. RESULTS: Analysis revealed that PA was associated with similar hospital mortality (p = 0.62), longer bypass times (p < 0.001), shorter length of stay (p = 0.02), fewer transfusions (p = 0.02), and fewer septic complications (p = 0.05). CONCLUSIONS: The PA approach for isolated valvular heart surgery provided patients with significantly improved clinical outcomes in their immediate perioperative course. Further studies are required to measure the impact of the PA approach on the patients' recovery after hospitalization
— id: 21225, year: 2001, vol: 71, page: 807, stat: Journal Article,

Ischemic mitral valve reconstruction and replacement: Comparison of long-term survival and complications
Grossi EA; Goldberg JD; LaPietra A; Ye X; Zakow P; Sussman M; Delianides J; Culliford AT; Esposito RA; Ribakove GH; Galloway AC; Colvin SB
2001 Dec;122(6):1107-1124, Journal of thoracic & cardiovascular surgery
OBJECTIVE: This study reviews the 223 consecutive mitral valve operations for ischemic mitral insufficiency performed at New York University Medical Center between January 1976 and January 1996. The results for mitral valve reconstruction are compared with those for prosthetic mitral valve replacement. METHODS: From January 1976 to January 1996, 223 patients with ischemic mitral insufficiency underwent mitral valve reconstruction (n = 152) or prosthetic mitral valve replacement (n = 71). Coronary artery bypass grafting was performed in 89% of cases of mitral reconstruction and 80% of cases of prosthetic replacement. In the group undergoing reconstruction, 77% had valvuloplasty with a ring annuloplasty and 23% had valvuloplasty with suture annuloplasty. In the group undergoing prosthetic replacement, 82% of patients received bioprostheses and 18% received mechanical prostheses. RESULTS: Follow-up was 93% complete (median 14.6 mo, range 0-219 mo). Thirty-day mortality was 10% for mitral reconstruction and 20% for prosthetic replacement. The short-term mortality was higher among patients in New York Heart Association functional class IV than among those in classes I to III (odds ratio 5.75, confidence interval 1.25-26.5) and was reduced among patients with angina relative to those without angina (odds ratio 0.26, confidence interval 0.05-1.2). The 30-day death or complication rate was similarly elevated among patients in functional class IV (odds ratio 5.53; confidence interval 1.23-25.04). Patients with mitral valve reconstruction had lower short-term complication or death rates than did patients with prosthetic valve replacement (odds ratio 0.43, confidence interval 0.20-0.90). Eighty-two percent of patients with mitral valve reconstruction had no insufficiency or only trace insufficiency during the long-term follow-up period. Five-year complication-free survivals were 64% (confidence interval 54%-74%) for patients undergoing mitral valve reconstruction and 47% (confidence interval 33%-60%) for patients undergoing prosthetic valve replacement. Results of a series of statistical analyses suggest that outcome was linked primarily to preoperative New York Heart Association functional class. CONCLUSIONS: Initial mortalities were similar among patients undergoing prosthetic replacement and valve reconstruction. Poor outcome was primarily related to preexisting comorbidities. Patients undergoing valve reconstruction had fewer valve-related complications. Valve reconstruction resulted in excellent durability and freedom from complications. These findings suggest that mitral valve reconstruction should be considered for appropriate patients with ischemic mitral insufficiency
— id: 24634, year: 2001, vol: 122, page: 1107, stat: Journal Article,

Videoscopic mitral valve repair and replacement using the port-access technique
Grossi EA; La Pietra A; Galloway AC; Colvin SB
2001 ;13(6):77-88, Advances in cardiac surgery
— id: 21246, year: 2001, vol: 13, page: 77, stat: Journal Article,

Minimally invasive versus sternotomy approaches for mitral reconstruction: comparison of intermediate-term results
Grossi EA; LaPietra A; Ribakove GH; Delianides J; Esposito R; Culliford AT; Derivaux CC; Applebaum RM; Kronzon I; Steinberg BM; Baumann FG; Galloway AC; Colvin SB
2001 Apr;121(4):708-713, Journal of thoracic & cardiovascular surgery
BACKGROUND: This study compares intermediate-term outcomes of mitral valve reconstruction after either the standard sternotomy approach or the new minimally invasive approach. Although minimally invasive mitral valve operations appear to offer certain advantages, such as reduced postoperative discomfort and decreased postoperative recovery time, the intermediate-term functional and echocardiographic efficacy has not yet been documented. METHODS: From May 1996 to February 1999, 100 consecutive patients underwent primary mitral reconstruction through a minimally invasive right anterior thoracotomy and peripheral cardiopulmonary bypass and Port-Access technology (Heartport, Inc, Redwood City, Calif). Outcomes were compared with those for our previous 100 patients undergoing primary mitral repair who were operated on with the standard sternotomy approach. RESULTS: Although patients were similar in age, the patients undergoing the minimally invasive approach had a lower preoperative New York Heart Association classification (2.1 +/- 0.5 vs 2.6 +/- 0.6, P <.001). There was one (1.0%) hospital mortality with the sternotomy approach and no such case with the minimally invasive approach. Follow-up revealed that residual mitral insufficiency was similar between the minimally invasive and sternotomy approaches (0.79 +/- 0.06 vs 0.77 +/- 0.06, P =.89, 0- to 3-point scale); likewise, the cumulative freedom from reoperation was not significantly different (94.4% vs 96.8%, P =.38). Follow-up New York Heart Association functional class was significantly better in the patients undergoing the minimally invasive approach (1.5 +/- 0.05 vs 1.2 +/- 0.05, P <.01). CONCLUSIONS: These findings demonstrate comparable 1-year follow-up results after minimally invasive mitral valve reconstruction. Both echocardiographic results and New York Heart Association functional improvements were compatible with results achieved with the standard sternotomy approach. The minimally invasive approach for mitral valve reconstruction provides equally durable results with marked advantages for the patient and should be more widely adopted
— id: 21220, year: 2001, vol: 121, page: 708, stat: Journal Article,

Aortic valve surgery in patients with impaired ventricular function
Grossi, EA; Esposito, RA; Lapietra, A; Baumann, FG; Bizekis, CS; Delianides, J; Applebaum, RM; Ribakove, GH; Culliford, AT; Galloway, AC; Colvin, SB
2001 OCT 23 abstract #2613;104(17):553-553, Circulation
— id: 33420, year: 2001, vol: 104, page: 553, stat: Journal Article,

Decreased stroke with routine intraoperative transesophogeal echocardiography in coronary artery bypass grafting
Grossi, EA; Galloway, AC; Lapietra, A; Applebaum, RM; Esposito, RA; Bizekis, CS; Ribakove, GH; Culliford, AT; Kanchugar, M; Kronzon, I; Colvin, SB
2001 OCT 23 abstract #2091;104(17):441-441, Circulation
— id: 33419, year: 2001, vol: 104, page: 441, stat: Journal Article,

Impact of left ventricular function upon late survival after mitral reconstruction for functional ischemic mitral insufficiency
Grossi, EA; Lapietra, A; Galloway, AC; Bizekis, CS; Baumann, FG; Culliford, AT; Esposito, RA; Ribakove, GH; Colvin, SB
2001 OCT 23 abstract #3239;104(17):686-686, Circulation
— id: 33421, year: 2001, vol: 104, page: 686, stat: Journal Article,

Minimally invasive aortic valve replacement: echocardiographic and clinical results
Kort S; Applebaum RM; Grossi EA; Baumann FG; Colvin SB; Galloway AC; Ribakove GH; Steinberg BM; Piedad B; Tunick PA; Kronzon I
2001 Sep;142(3):476-481, American heart journal
BACKGROUND: Port access has been described for mitral and bypass surgery. The purpose of this study was to review the clinical and echocardiographic outcomes of aortic valve replacement by use of port access. METHODS: Between 1996 and 1999, 153 port-access aortic valve replacements were performed at our institution. The mean age was 63 years (range 16-91 years); 58% were male. The New York Heart Association mean class was III; 18% were in class IV. Thirteen percent had diabetes, 42% hypertension, 7% prior transient ischemic episode or stroke, 7% lung disease, 3% renal failure, and 13% previous surgery. Echocardiograms were obtained after valve replacement in 125 patients (96 intraoperative transesophageal and 97 transthoracic echoes). RESULTS: Median length of stay was 8 days. There were no intraoperative deaths; 10 patients (6.5%) died in the postoperative period. Stroke occurred in 4 (2.6%), sepsis in 5 (3.3%), renal failure in 5 (3.3%), pneumonia in 3 (2%), and wound infection in 1 (0.7%). Tissue prosthesis was present in 83 and a mechanical prosthesis in 42. No or trace regurgitation was seen on 94 of 96 (98%) postbypass intraoperative echocardiograms and mild on 2. On follow-up echocardiograms, moderate regurgitation was seen in 4 of 97 (4.1%), mild-to-moderate in 2 (2.1%), mild in 18 (18.6%), and no or trace in 71 (73.2%). Of those who had aortic regurgitation on intraoperative or follow-up echocardiograms, it was paravalvular in 8. CONCLUSIONS: Minimally invasive aortic valve replacement with a port-access approach is feasible, even in high-risk patients. Small incisions, a low infection rate, and a short length of stay are attainable. However, the complications associated with traditional aortic valve replacement still occur. Echocardiography is valuable both for intraoperative monitoring and follow-up of this new procedure
— id: 26678, year: 2001, vol: 142, page: 476, stat: Journal Article,

Port-Access aortic valve replacement: Echocardiographic and clinical results
Kort, S; Applebaum, RM; Grossi, EA; Colvin, SB; Galloway, AC; Ribakove, GH; Baumann, FG; Piedad, B; Tunick, PA; Kronzon, I
2001 FEB ;37(2):422A-422A, Journal of the American College of Cardiology
— id: 33422, year: 2001, vol: 37, page: 422A, stat: Journal Article,

Beating-heart coronary artery bypass grafting for left ventricular failure assisted by the Abiomed BVS 5000
LaPietra A; Grossi EA; Galloway AC; Colvin SB; Ribakove GH
2001 Mar-Apr;16(2):170-172, Journal of cardiac surgery
Two cases of postmyocardial infarction cardiogenic shock were treated with left ventricular assist device (LVAD) implantation. With the left ventricular function bypassed, beating-heart coronary artery bypass grafting (CABG) was performed. This technique may be useful in the setting of acute myocardial dysfunction where limited coronary revascularization is required
— id: 33334, year: 2001, vol: 16, page: 170, stat: Journal Article,

Regarding ethics of rapid surgical technological advancement
Colvin SB; Grossi EA; Galloway AC
2000 Nov;70(5):1758-1758, Annals of thoracic surgery
— id: 33338, year: 2000, vol: 70, page: 1758, stat: Journal Article,

Predictors of outcome in a multicenter port-access valve registry
Glower DD; Siegel LC; Frischmeyer KJ; Galloway AC; Ribakove GH; Grossi EA; Robinson NB; Ryan WH; Colvin SB
2000 Sep;70(3):1054-1059, Annals of thoracic surgery
BACKGROUND: The aim of this study was to examine the predictors of outcome in patients undergoing isolated valve operation using port-access techniques. METHODS: Logistic regression analysis was performed in a prospective, multi-institutional registry of patients undergoing isolated aortic valve replacement (AVR, n = 252), mitral repair (MVP, n = 491), or mitral replacement (MVR, n = 568) using port-access techniques from 1997 to 1999. RESULTS: Endoaortic balloon occlusion was used in 2% (AVR), 93% (MVP), and 90% (MVR) of cases. Conversion to full sternotomy occurred in 3.8% of all cases. For all patients, early mortality was 50 of 1,311 (3.8%) and onset of new atrial fibrillation occurred in 140 of 1,311 (11%) patients. The determinants of 30-day mortality were redo, age, and MVR or AVR. The determinants of reoperation for bleeding were age, reoperation, and MVR. Age was a predictor for stroke, and age and low or medium volume center were predictors of new atrial fibrillation. CONCLUSIONS: Excellent short-term results can be obtained using port-access techniques in isolated mitral or aortic valve operations. Patient outcome is not related to institutional case volume, and the primary determinants of outcome after port-access valve procedures are generally patient-related factors
— id: 33342, year: 2000, vol: 70, page: 1054, stat: Journal Article,

Impact of heparin bonding on pediatric cardiopulmonary bypass: a prospective randomized study
Grossi EA; Kallenbach K; Chau S; Derivaux CC; Aguinaga MG; Steinberg BM; Kim D; Iyer S; Tayyarah M; Artman M; Galloway AC; Colvin SB
2000 Jul;70(1):191-196, Annals of thoracic surgery
BACKGROUND: Heparin-coated circuits reduce the inflammatory response to cardiopulmonary bypass in adult patients; however, little is known about its effects in the pediatric population. Two studies were performed to assess this technology's impact on inflammation and clinical outcomes. METHODS: In a pilot study, complement and interleukins were measured in 19 patients who had either uncoated cardiopulmonary bypass circuits or heparin-bonded circuits. Subsequently, 23 additional patients were studied in a randomized fashion. Respiratory function and blood product utilization were recorded. RESULTS: In the pilot study, heparin-bonded circuit patients had less complement 3a (p < 0.001) and interleukin-8 (p < 0.05) compared with uncoated cardiopulmonary bypass circuit patients. The randomized study revealed that the heparin-bonded circuit was associated with reduced complement 3a (p = 0.02). Multiple variable analysis revealed that the following postoperative variables were increased with bypass time (p = 0.01) and diminished with heparin-bonded circuits: interleukins (p = 0.01), peak airway pressures (p = 0.05), and prothrombin time (p = 0.03). CONCLUSIONS: Heparin-bonded circuits significantly reduce cytokines and complement during cardiopulmonary bypass and lower interleukin levels postbypass; they were also associated with improved pulmonary and coagulation function. Heparin-bonded circuits ameliorate the systemic inflammatory response in pediatric patients from cardiopulmonary bypass
— id: 11576, year: 2000, vol: 70, page: 191, stat: Journal Article,

Case report of robotic instrument-enhanced mitral valve surgery
Grossi EA; Lapietra A; Applebaum RM; Ribakove GH; Galloway AC; Baumann FG; Ursomanno P; Steinberg BM; Colvin SB
2000 Dec;120(6):1169-1171, Journal of thoracic & cardiovascular surgery
— id: 33339, year: 2000, vol: 120, page: 1169, stat: Journal Article,

Minimal access reoperative mitral and aortic valve surgery
Grossi EA; LaPietra A; Bizekis C; Ribakove G; Galloway AC; Colvin SB
2000 Nov;2(6):572-574, Current cardiology reports
Minimally invasive cardiac surgery has allowed surgeons to perform valve procedures with a morbidity and mortality comparable with conventional resternotomy approaches while reducing postoperative ventilatory and intensive care unit requirements and overall hospital length of stay. Additionally, patient satisfaction with rapid recovery, earlier return to work, and improved cosmetic results has pushed the pendulum of reoperative valve surgery towards minimally invasive techniques. We reviewed our institutional data consisting of 129 patients requiring reoperative valve surgery over the past 4 years, which was accomplished using these minimally invasive approaches
— id: 33341, year: 2000, vol: 2, page: 572, stat: Journal Article,

Late results of mitral valve reconstruction in the elderly
Grossi EA; Zakow PK; Sussman M; Galloway AC; Delianides J; Baumann G; Colvin SB
2000 Oct;70(4):1224-1226, Annals of thoracic surgery
BACKGROUND: This study attempts to confirm favorable results with mitral valve reconstruction (MVP) in patients greater than or equal to 70 years of age and to examine complication rates by actual analysis. METHODS: Between June of 1980 and December of 1997, 278 patients 70 years of age or older (mean, 75.2 years; range, 70 to 87 years) underwent MVP for mitral regurgitation. Most involved insertion of an annuloplasty ring. Concomitant procedures were performed in 72.3%, and 55.0% required coronary revascularization. RESULTS: For isolated MVP, the in-hospital mortality rate was 6.5% and 17.0% when combined with coronary revascularization. The mortality rate when combined with another valve procedure was 13.2%. The 5-year freedom from late cardiac death was 100% in the isolated MVP group and 79.7% for MVP with a concomitant procedure (p = 0.006). Complications were analyzed using actual (cumulative incidence) analysis to eliminate the competing risk of noncardiac death. Mean NYHA class improved from 3.32 to 1.71 postoperatively. Repair failure was rare, with a 5-year freedom from reoperation of 91.2%. CONCLUSIONS: These findings confirm the favorable outcome of MVP in elderly patients. Late repair failures are rare; comorbid disease is an important predictor of outcome
— id: 33340, year: 2000, vol: 70, page: 1224, stat: Journal Article,

Late results of isolated mitral annuloplasty for ischemic mitral insufficiency
Grossi, EA; Derivaux, CC; Lapietra, A; Galloway, AC; Ribakove, GH; Culliford, AT; Esposito, RA; Steinberg, BM; Delianides, J; Colvin, SB
2000 OCT 31 abstract #2389;102(18):491-492, Circulation
— id: 33425, year: 2000, vol: 102, page: 491, stat: Journal Article,

Rapid pulmonary vein isolation for atrial fibrillation during minimally invasive mitral valve surgery
Holmes, DS; Chinitz, LA; Pierce, WJ; Bernstein, NE; Applebaum, RM; Colvin, SB; Galloway, AC; Grossi, EA
2000 OCT 31 abstract #2351;102(18):484-484, Circulation
— id: 33424, year: 2000, vol: 102, page: 484, stat: Journal Article,

Robotic-assisted instruments enhance minimally invasive mitral valve surgery
LaPietra A; Grossi EA; Derivaux CC; Applebaum RM; Hanjis CD; Ribakove GH; Galloway AC; Buttenheim PM; Steinberg BM; Culliford AT; Colvin SB
2000 Sep;70(3):835-838, Annals of thoracic surgery
BACKGROUND: The potential for totally endoscopic mitral valve surgery has been advanced by the development of minimally invasive techniques. Recently surgical robots have offered instrument access through small ports, obviating the need for a significant thoracotomy. This study tested the hypothesis that a microsurgical robot with 5 degrees of freedom is capable of performing an endoscopic mitral valve replacement (MVR). METHODS: Dogs (n = 6) were placed on peripheral cardiopulmonary bypass; aortic occlusion was achieved with endoaortic clamping and transesophageal echocardiographic control. A small left seventh interspace 'service entrance' incision was used to insert sutures, retractor blade, and valve prosthesis. Robotically controlled instruments included a thoracoscope and 5-mm needle holders. MVR was performed using an interrupted suture technique. RESULTS: Excellent visualization was achieved with the thoracoscope. Instrument setup required 25.8 minutes (range 12 to 37); valve replacement required 69.3+/-5.39 minutes (range 48 to 78). MVR was accomplished with normal prosthetic valve function and without misplaced sutures or inadvertent injuries. CONCLUSIONS: This study demonstrates the feasibility of adjunctive use of robotic instrumentation for minimally invasive MVR. Clinical trials are indicated
— id: 28921, year: 2000, vol: 70, page: 835, stat: Journal Article,

Assisted venous drainage presents the risk of undetected air microembolism
Lapietra A; Grossi EA; Pua BB; Esposito RA; Galloway AC; Derivaux CC; Glassman LR; Culliford AT; Ribakove GH; Colvin SB
2000 Nov;120(5):856-862, Journal of thoracic & cardiovascular surgery
OBJECTIVES: The proliferation of minimally invasive cardiac surgery has increased dependence on augmented venous return techniques for cardiopulmonary bypass. Such augmented techniques have the potential to introduce venous air emboli, which can pass to the patient. We examined the potential for the transmission of air emboli with different augmented venous return techniques. METHODS: In vitro bypass systems with augmented venous drainage were created with either kinetically augmented or vacuum-augmented venous return. Roller or centrifugal pumps were used for arterial perfusion in combination with a hollow fiber oxygenator and a 40-micrometer arterial filter. Air was introduced into the venous line via an open 25-gauge needle. Test conditions involved varying the amount of negative venous pressure, the augmented venous return technique, and the arterial pump type. Measurements were recorded at the following sites: pre-arterial pump, post-arterial pump, post-oxygenator, and patient side. RESULTS: Kinetically augmented venous return quickly filled the centrifugal venous pump with macrobubbles requiring continuous manual clearing; a steady state to test for air embolism could not be achieved. Vacuum-augmented venous return handled the air leakage satisfactorily and microbubbles per minute were measured. Higher vacuum pressures resulted in delivery of significantly more microbubbles to the 'patient' (P <.001). The use of an arterial centrifugal pump was associated with fewer microbubbles (P =.02). CONCLUSIONS: Some augmented venous return configurations permit a significant quantity of microbubbles to reach the patient despite filtration. A centrifugal pump has air-handling disadvantages when used for kinetic venous drainage, but when used as an arterial pump in combination with vacuum-assisted venous drainage it aids in clearing air emboli
— id: 28920, year: 2000, vol: 120, page: 856, stat: Journal Article,

Port-access minimally invasive CABG: techniques and results
Ribakove GH; Grossi EA; Steinberg BM; Ursomanno P; Colvin SB; Galloway AC
2000 Jul-Aug;15(4):296-302, Journal of cardiac surgery
— id: 33335, year: 2000, vol: 15, page: 296, stat: Journal Article,

Transforming growth factor beta 1 (TGF-b1) induces a growth factor cascade that results in extracellular-regulated kinase (ERK) and p38 mitogen-activated protein kinase activation in endothelial cells
Seghezzi, G; Pintucci, G; Yun, J; Steinberg, BM; Ferdinand, B; Grossi, EA; Baumann, FG; Colvin, SB; Galloway, AC; Mignatti, P
2000 FEB ;35(2):296A-296A, Journal of the American College of Cardiology
— id: 33427, year: 2000, vol: 35, page: 296A, stat: Journal Article,

Neutrophil-derived serine proteinases enhance membrane type-1 matrix metalloproteinase-dependent tumor cell invasion
Shamamian P; Pocock BJ; Schwartz JD; Monea S; Chuang N; Whiting D; Marcus SG; Galloway AC; Mignatti P
2000 Feb;127(2):142-147, Surgery
BACKGROUND: Matrix metalloproteinase-2 degrades a variety of basement membrane components and is essential for tumor invasion. We have previously reported that membrane type-1 matrix metalloproteinase (MT1-MMP) cooperates with neutrophil-derived serine proteinases (NDPs; elastase, cathepsin G, protease-3) to activate matrix metalloproteinase-2. We therefore hypothesized that NDPs enhance tumor-cell invasion. METHODS: Clones of human HT1080 fibrosarcoma cells transfected with MT1-MMP sense (HT-SE) or antisense CDNA (HT-AS) were used. These cells express either high (HT-SE) or extremely low levels (HT-AS) of MT1-MMP relative to nontransfected HT1080 cells (HT-WT). The cells were incubated in the presence or absence of purified NDP, with or without alpha 1-antitrypsin or the MMP inhibitor batimastat. Cell invasion was measured with the use of Boyden chambers with polycarbonate membranes coated with a reconstituted extracellular matrix. RESULTS: Under control conditions HT-WT and HT-SE cells were 4-fold more invasive than HT-AS cells. The addition of NDP increased HT-WT and HT-SE cell invasion 60% to 100% but had no effect on HT-AS cells. alpha 1-antitrypsin or batimastat did not decrease the baseline invasiveness of HT-WT and HT-SE cells; however, they abrogated the stimulatory effect of NDP. CONCLUSIONS: HT1080 cell invasion depends on MT1-MMP expression. MT1-MMP overexpression does not increase invasiveness by itself. NDPs increase invasion by MT1-MMP expressing cells by activating matrix metalloproteinase-2
— id: 9013, year: 2000, vol: 127, page: 142, stat: Journal Article,

Strategy for the selective use of alternative techniques in surgical coronary revascularization
Steinberg, BM; Ribakove, GH; Esposito, RA; Culliford, AT; Grossi, EA; Baumann, FG; Colvin, SB; Galloway, AC
2000 OCT 31 abstract #3141;102(18):648-648, Circulation
— id: 33426, year: 2000, vol: 102, page: 648, stat: Journal Article,

Diagnosis of a giant coronary aneurysm with multiple imaging modalities
Strouse D; Katz ES; Tunick PA; Winer HE; Krinsky GA; Galloway AC; Kronzon I
2000 Feb;17(2):173-176, Echocardiography
Echocardiography demonstrated an 8-cm mass adjacent to the right side of the heart in a 79-year-old man with a history of hypertension and a repaired abdominal aortic aneurysm. The results of Doppler echocardiography and magnetic resonance imaging suggested the diagnosis of an unusually large coronary artery aneurysm, and this was confirmed with coronary angiography. At surgery, the 8- to 10-cm coronary aneurysm was resected, and the patient made an uneventful recovery
— id: 27877, year: 2000, vol: 17, page: 173, stat: Journal Article,

Low stroke risk and mortality rate with off-pump coronary bypass in patients with high-risk aortic arch atheromas
Trehan, N; Subramanian, VA; Misra, M; Galloway, AC
2000 FEB ;35(2):282A-282A, Journal of the American College of Cardiology
— id: 54750, year: 2000, vol: 35, page: 282A, stat: Journal Article,

The Role of Transesophageal Echocardiography During Port-Access Minimally Invasive Cardiac Surgery: A New Challenge for the Echocardiographer
Applebaum RM; Colvin SB; Galloway AC; Ribakove GH; Grossi EA; Tunick PA; Kronzon I I
1999 Aug;16(6):595-602, Echocardiography
The recent development of endovascular catheters that are placed via the femoral artery and vein has enabled patients to be placed on cardiopulmonary bypass without the need for direct visualization of the heart or great vessels via sternotomy. This has allowed cardiac surgery to be performed through smaller, thoracotomy incisions. Placement of these catheters initially was performed under fluoroscopic guidance, which has major imaging limitations. Now, transesophageal echocardiography (TEE) has replaced fluoroscopy as the primary imaging technique to assist in the placement of endovascular catheters during minimally invasive, port-access cardiac surgery. In our institution, 449 port-access procedures have been performed from May 1996 through July 1998. We found that TEE is able to adequately visualize the cardiac structures and assist in the placement of the endovascular catheters in all patients. Fluoroscopy is helpful only as an aid to the use of TEE for placement of the coronary sinus catheter
— id: 33337, year: 1999, vol: 16, page: 595, stat: Journal Article,

Impact of a surgical pathway for the postoperative care of children with atrial septal defects
Auslender, M; DeSomma, ML; Galloway, A; Colvin, S; Artman, M
1999 APR ;45(4):19A-19A, Pediatric research
— id: 54062, year: 1999, vol: 45, page: 19A, stat: Journal Article,

Inhibition of endothelial cell migration by gene transfer of tissue inhibitor of metalloproteinases-1
Fernandez HA; Kallenbach K; Seghezzi G; Grossi E; Colvin S; Schneider R; Mignatti P; Galloway A
1999 Apr;82(2):156-162, Journal of surgical research
BACKGROUND. Angiogenesis requires degradation of the vessel's basal lamina and endothelial cell migration into the tissue stroma. Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) play important roles in this process. MMP activity is tightly regulated during vessel growth. This work was designed to characterize the effect of TIMP-1 upregulation on endothelial cell invasion of the extracellular matrix. METHODS. We constructed replication-deficient recombinant adenoviruses that encode either TIMP-1 (Ad.TIMP-1) or Escherichia coli lac Z (Ad.beta gal) cDNA. Bovine aortic endothelial (BAE) cells were infected with 100 infectious particles/cell. Gene expression was assessed by Northern and Western blotting. TIMP-1 activity in cell-conditioned media was measured by a resorufin-labeled casein protease assay. BAE cell migration was measured by Boyden chamber assays with 0.2% gelatin-coated, 8. 0-mcm polycarbonate membranes. RESULTS. TIMP-1 was overexpressed by Ad.TIMP-1-infected BAE cells relative to control, Ad. beta gal-infected or uninfected cells. TIMP-1 activity in Ad.TIMP-1 cell-conditioned medium was 2.8-fold higher than in control cells. By Boyden chamber assays with gelatin-coated membranes, Ad. TIMP-1-infected BAE cells showed 89.97 +/-1.64% (mean +/- SEM) reduction in migration relative to Ad.beta gal-infected cells (P < 0. 02) and 90.53 +/- 1.12% relative to uninfected cells (P < 0.02). Without gelatin coating, migration was equivalent in all groups. CONCLUSION. The replication-deficient recombinant adenovirus we constructed affords rapid and efficient upregulation of functional TIMP-1 in endothelial cells. Infection results in a dramatic decrease in cell migration and invasion of extracellular matrix. Thus, such a recombinant vector may provide a useful tool for the gene therapy of vascular remodeling and inhibition of angiogenesis.
— id: 12038, year: 1999, vol: 82, page: 156, stat: Journal Article,

Acquired heart disease
Galloway AC; Anderson RV; Grossi EA; Spencer FC; Colvin SB
Principles of surgery New York : McGraw-Hill, 1999,
— id: 3832, year: 1999, vol: , page: ?, stat: Chapter,

Congenital heart disease
Galloway AC; Artman M; Colvin SB
Principles of surgery New York : McGraw-Hill, 1999,
— id: 3834, year: 1999, vol: , page: ?, stat: Chapter,

Thoracic aneurysms and aortic dissection
Galloway AC; Miller JS; Spencer FC; Colvin SB
Principles of surgery New York : McGraw-Hill, 1999,
— id: 3833, year: 1999, vol: , page: ?, stat: Chapter,

First report of the Port Access International Registry
Galloway AC; Shemin RJ; Glower DD; Boyer JH Jr; Groh MA; Kuntz RE; Burdon TA; Ribakove GH; Reitz BA; Colvin SB
1999 Jan;67(1):51-56, Annals of thoracic surgery
BACKGROUND: For minimally invasive cardiac operations to be widely applicable, the risks must be equivalent to those of standard open-chest operations. This study analyzed the outcomes of patients recorded in the multicenter Port Access (PA) International Registry to establish operative risks. METHODS: Data were analyzed for intent to treat in 583 patients who underwent PA coronary artery bypass grafting (CABG), 184 who underwent PA mitral valve replacement, and 137 who underwent PA mitral valve repair at 121 centers. RESULTS: Port Access was attempted in 1,063 patients and completed in 1,004 (94%). The operative mortality rate was 1% for PA CABG, 3.3% for PA mitral valve replacement, and 1.5% for PA mitral valve repair. Perioperative morbidity was low in all categories: stroke = 1.1% to 3.6%, myocardial infarction = 0 to 1%, primary procedure reoperation = 0 to 0.7%, renal failure = 0.2% to 0.7%, multiorgan failure = 0 to 0.5%, and atrial fibrillation = 5% to 7.3%. CONCLUSIONS: Data on 1,063 patients from 121 centers demonstrate that PA CABG and PA mitral valve operations can be performed safely, with morbidity and mortality rates similar to those associated with open-chest operations. Further studies are indicated to establish the long-term efficacy of this method and to analyze its effect on recovery time
— id: 57033, year: 1999, vol: 67, page: 51, stat: Journal Article,

Repair of pediatric pectus deformity and congenital heart disease as a combined procedure
Gittes GK; Crisera CA; Ginsburg HB; Galloway AC; Colvin SB
1999 Aug;34(8):1282-1283, Journal of pediatric surgery
Coexisting pectus deformity and congenital heart disease is not uncommon. Traditionally, the approach to this problem has been to repair each one with a separate surgical procedure because of fear of increased complications from bleeding, infections, and anesthesia. More recently, many reports of successful combined repair have been published, particularly in adults with coronary artery or aortic pathology. The authors wished to determine the feasibility of this combined procedure in younger patients, particularly those with a severe pectus deformity. Three patients underwent repair, including a 17 year old with Marfan's syndrome and a severe pectus excavatum deformity. The postoperative course was smooth for these patients, and all had good short- and long-term (over 18 months) results
— id: 56471, year: 1999, vol: 34, page: 1282, stat: Journal Article,

Minimally invasive port access surgery reduces operative morbidity for valve replacement in the elderly
Grossi EA; Galloway AC; Ribakove GH; Buttenheim PM; Esposito R; Baumann FG; Colvin SB
1999 ;2(3):212-215, Heart surgery forum
BACKGROUND: Although minimally invasive techniques for valvular surgery have rapidly come into widespread use, whether such an approach can be safely applied to elderly patients remains an open question. To help resolve this issue, we reviewed our experience with minimally invasive port access (MIPA) valve surgery in elderly patients and compared it to the results obtained with the standard sternotomy (STD) approach in the same age group. METHODS: From January 1994 through December 1998, 370 consecutive patients at least 70 years of age underwent isolated aortic or mitral valve surgery at our institution. The standard sternotomy operative approach was used in 259 patients (mean age 77.5 years) and the minimally invasive port access approach was used in 111 patients (mean age 76.0; p=.006). A mitral valve procedure was performed more often in the MIPA patients than in the STD patients (49.5% vs. 35.9%; p < .001). RESULTS: Hospital mortality was comparable in the two groups, 9.7% (25/259) in the STD group and 7.2% (8/111) in the MIPA group (p = .50), as was the incidence of many perioperative complications. The MIPA group, however, had a significantly lower incidence of sepsis or wound complications (1.8% vs 7.7%; p = .027), required less fresh frozen plasma transfusion (median 1.0 unit vs 2.0 units; p =.04), and had a shorter length of hospital stay (11.6 days vs 17.6 days; p = .001). CONCLUSIONS: These results indicate that with appropriate surgical techniques the MIPA approach for isolated valve surgery can be safely applied to the elderly patient population with excellent results. In our initial experience the MIPA approach is associated with significantly less plasma transfusion, fewer postoperative complications, and shorter length of hospital stay
— id: 21221, year: 1999, vol: 2, page: 212, stat: Journal Article,

Results of a prospective multicenter study on port-access coronary bypass grafting
Grossi EA; Groh MA; Lefrak EA; Ribakove GH; Albus RA; Galloway AC; Colvin SB
1999 Oct;68(4):1475-1477, Annals of thoracic surgery
BACKGROUND: We reviewed the initial patient series of three institutions performing large volume port-access (PA) coronary artery bypass grafting (CABG) to evaluate the efficacy of this new procedure. METHODS: From October 1996 until June 1998, 302 consecutive patients underwent isolated CABG using the PA approach. Patients (mean age 60.7 years) were predominantly male (77.5%) and received a mean of 2.3 distal anastomoses; few were New York Heart Association class III or IV (15.9%). The distribution of the number of grafts was: 76 (25.2%) single, 110 (36.4%) double, 73 (24.2%) triple, and 43 (14.2%) four or more bypass grafts. The Society of Thoracic Surgeons (STS) Database data collection form was used prospectively by all three institutions to define patient risk factors and record outcomes. RESULTS: Total 30-day hospital mortality was 0.99% compared to the STS-database-model-predicted risk of 1.2%. Complication rates for the PA CABG patients compared with risk-matched morbidity rates from the STS data for CABG alone were: reoperation for bleeding, 3.3% versus 1.9%; ventilatory support more than 1 day, 1.7% versus 3.8%; stroke, 1.7% versus 1.2%; and perioperative transmural myocardial infarction 0% versus 1.3%. CONCLUSIONS: The STS CABG risk-adjusted model demonstrates that the 30-day mortality for patients undergoing PA CABG is lower than predicted for traditional CABG patients (confidence intervals not available). Likewise, the morbidity was low, with minimal ventilatory support, pulmonary complications, and atrial fibrillation. The port-access technique is an acceptable strategy for multivessel bypass grafting
— id: 11937, year: 1999, vol: 68, page: 1475, stat: Journal Article,

Comparison of post-operative pain, stress response, and quality of life in port access vs. standard sternotomy coronary bypass patients
Grossi EA; Zakow PK; Ribakove G; Kallenbach K; Ursomanno P; Gradek CE; Baumann FG; Colvin SB; Galloway AC
1999 Nov;16 Suppl 2:S39-S42, European journal of cardio-thoracic surgery
OBJECTIVE: Although it has been postulated that minimally invasive cardiac surgery using the port access method would reduce operative stress and postoperative pain and accelerate postoperative recovery to a good quality of life, few data are currently available to document this intuitively appealing claim. Therefore, this study was designed to examine differences in stress response, postoperative pain, rapidity of recovery, and quality of life after port access (PA) isolated coronary artery bypass surgery compared with standard sternotomy (STD) isolated coronary bypass surgery. METHODS: Fourteen PA and 15 STD coronary bypass patients were studied postoperatively for pain score, FEV, catecholamine and cortisol levels, resumption of activity, and Duke Activity Scale ratings. The surgical approach was based on the surgeon's preference. Although the PA patients were younger, there were no other differences between the groups in gender or preoperative risk factors. RESULTS: There were no operative deaths and no differences between the groups in perioperative complications. Repeated measures analysis of variance showed lower pain scale ratings over the first 4 postoperative weeks in the PA group (P < 0.001). The PA patients also had less muscle soreness, shortness of breath, fatigue, and poor appetite at 1, 2, 4, and 8 weeks (P < 0.05), better FEV at 1 day (1.59 vs. 0.97 l/s; P < 0.02) and 3 days (2.20 vs. 1.49 l/s; P < 0.03), and lower norepinephrine levels at days 1, 2, and 3 (P = 0.005). The Duke Activity Scale questionnaire results demonstrated that more PA patients were able to walk 1-2 blocks at 1 week, climb stairs at 1 and 2 weeks, perform light or moderate housework at 1 and 2 weeks, and engage in moderate recreational activities and perform heavy housework at 4 and 8 weeks (P < 0.05). CONCLUSIONS: These results show that compared with STD coronary bypass patients PA patients enjoyed significant postoperative physiologic and quality of life advantages with less pain, less early stress response, better pulmonary function, and superior Duke Activity scores during the first 2 postoperative months
— id: 11887, year: 1999, vol: 16 Suppl 2, page: S39, stat: Journal Article,

Impact of minimally invasive approach on valvular heart surgery: A case controlled study
Grossi, Eugene A; Galloway, Aubrey C; Ribakove, Greg H; Zakow, Peter K; Buttenheim, Patricia M; Baumann, F Gregory; Green, Jesse; Schwesinger, Dennis W; Colvin, Stephen B
1999 Mar 7-10;33(2 SUPPL. A):554A-555A, Journal of the American College of Cardiology
— id: 15891, year: 1999, vol: 33, page: 554A, stat: Journal Article,

Atypical presentation of dissection of the ascending aorta in young men with cystic medial necrosis: MR findings
Krinsky GA; Lee VS; Rofsky NM; Roy MC; Colvin S; Galloway A
1999 Sep-Oct;23(5):289-294, Clinical imaging
Dissection of the ascending aorta is usually associated with severe chest and/or back pain. We describe three young men, with pathologically proven cystic medial necrosis, who presented with atypical clinical symptoms and ascending aortic dissection diagnosed by MR imaging and surgery. Patients with cystic medial necrosis and aortic dissection may not present with a classic acute chest pain syndrome
— id: 11844, year: 1999, vol: 23, page: 289, stat: Journal Article,

Mechanical endothelial damage results in basic fibroblast growth factor-mediated activation of extracellular signal-regulated kinases
Pintucci G; Steinberg BM; Seghezzi G; Yun J; Apazidis A; Baumann FG; Grossi EA; Colvin SB; Mignatti P; Galloway AC
1999 Aug;126(2):422-427, Surgery
BACKGROUND: Endothelial damage, such as that associated with balloon angioplasty or preparation of veins for bypass grafts, results in intimal hyperplasia. Growth factors and cytokines that modulate endothelial cell functions through various intracellular signaling pathways mediate rapid endothelial repair, which may prevent or reduce restenosis. Here we investigated the effect of mechanical injury of endothelial cells on the mitogen-activated kinase signaling pathways, extracellular-signal-regulated kinases (ERKs), C-Jun N-terminal kinase (JNK/SAPK), and p38. METHODS: Confluent human umbilical vein endothelial cells or bovine aortic endothelial cells were wounded with a razor blade; mitogen-activated kinase activation was monitored by immunoblotting with antibodies to active ERK, JNK/SAPK, or p38. RESULTS: Wounding of human umbilical vein endothelial cell or bovine aortic endothelial cell monolayers resulted in rapid (5-minute) activation of ERK-1 and -2, which was abolished by monoclonal antibody to basic fibroblast growth factor (FGF-2). This antibody or an inhibitor of ERK activation, PD98059, also blocked endothelial cell migration after the wounding. Thus FGF-2-induced ERK activation mediates the endothelial response to wounding. CONCLUSIONS: ERK-1 and -2 are activated by FGF-2 released from endothelial cells in response to injury. Therapeutic strategies aimed at reducing FGF-2-induced intimal hyperplasia should preserve ERK activation in endothelial cells while abolishing it in smooth muscle cells
— id: 8488, year: 1999, vol: 126, page: 422, stat: Journal Article,

Principios de cirurgia : compendio
Schwartz, Seymour I; Shires, G. Tom; Spencer, Frank C; Daly, John M; Fischer, Josef E; Galloway, Aubrey C; Cosendey, Carlos Henrique; Vasconcelos, Marcio Moacyr; Pinho, Patricia Lydie Voeux; Azevedo, Maria de Fatima
Rio de Janeiro : McGraw-Hill, 1999,
— id: 1584, year: 1999, vol: , page: , stat: ,

Utility of transesophageal echocardiography during port-access minimally invasive cardiac surgery
Applebaum RM; Cutler WM; Bhardwaj N; Colvin SB; Galloway AC; Ribakove GH; Grossi EA; Schwartz DS; Anderson RV; Tunick PA; Kronzon I
1998 Jul 15;82(2):183-188, American journal of cardiology
In this study, we sought to determine the use of transesophageal echocardiography (TEE) as the primary imaging technique to assist in the placement of endovascular catheters during minimally invasive, port-access cardiac surgery. The recent development of endovascular catheters that are placed via the femoral artery and vein has enabled patients to be placed on cardiopulmonary bypass without the need for direct visualization of the heart or great vessels via sternotomy. This has allowed cardiac surgery to be performed through smaller thoracotomy incisions. Placement of these catheters has previously been performed with fluoroscopic guidance, which has major imaging limitations. Thirty-six patients underwent port-access cardiac surgery at our institution during the study period. All patients underwent intraoperative TEE. We used TEE to visualize the coronary sinus os, right atrium and superior vena cava, and thoracic aorta to assist with placement of the coronary sinus catheter, venous cannula, and endoaortic clamp. Twenty patients underwent mitral valve surgery, 14 patients coronary artery bypass grafting, 1 patient aortic valve replacement, and 1 patient repair of an atrial septal defect by the port-access approach. TEE was able to adequately visualize the cardiac structures and assist in the placement of the endovascular catheters in all patients. Fluoroscopy was only helpful as an aid to TEE for placement of the coronary sinus catheter. TEE is an excellent imaging modality for the proper placement of these new endovascular catheters, obviating the need for fluoroscopy, except to be on standby and for placement of the coronary sinus catheter
— id: 12089, year: 1998, vol: 82, page: 183, stat: Journal Article,

Transesophageal echocardiography as the guiding imaging technique during port access minimally invasive cardiac surgery
Applebaum, RM; Cutler, WM; Bhardwaj, N; Colvin, SB; Galloway, AC; Ribakove, GH; Grossi, EA; Schwartz, DS; Anderson, RV; Tunick, PA; Kronzon, I
1998 FEB ;31(2):87A-87A, Journal of the American College of Cardiology
— id: 33432, year: 1998, vol: 31, page: 87A, stat: Journal Article,

Port-Access mitral valve surgery: summary of results
Colvin SB; Galloway AC; Ribakove G; Grossi EA; Zakow P; Buttenheim PM; Baumann FG
1998 Jul;13(4):286-289, Journal of cardiac surgery
BACKGROUND: The purpose of this study was to review the short-term results of an initial experience with minimally invasive cardiac valve surgery using the Port-Access approach in terms of feasibility, safety, and reproducibility. METHODS: Between October 1995 and October 1997, 151 minimally invasive cardiac valve procedures were performed at our institution using the Port-Access approach. The patients' mean age was 58.1 years (range 21 to 91 years) and 50% were male. Aortic valve replacement was performed in 35 (23.2%) patients, mitral valve repair in 56 (37.1%) patients, mitral valve replacement in 36 (23.8%) patients, and complex valve procedures in 24 (15.9%) patients. RESULTS: The operative mortality rate for isolated mitral valve surgery was 1.1% (1/92) and for all mitral valve surgery 3.5% (4/113). The operative mortality rate for isolated aortic valve patients was 5.7% (2/35). For the total group the operating mortality was 4% (6/151). Early complications for mitral valve patients included reoperation for bleeding or tamponade in 5 (4.4%) patients, myocardial infarction in 2 (1.2%) patients, and transient ischemic attack and wound infection in 1 (0.1%) patient each. One patient required reoperation for mitral valve failure that resulted in aortic dissection unrelated to the Endoaortic Clamp catheter and ultimately led to death. Two (5.6%) aortic valve patients required reoperation for bleeding and two (5.6%) required reoperation for tamponade. CONCLUSIONS: Minimally invasive Port-Access techniques can be applied to most patients with valvular heart disease with minimal morbidity and mortality and good postoperative valve function and may be the preferred approach for isolated mitral and aortic valve surgery
— id: 6108, year: 1998, vol: 13, page: 286, stat: Journal Article,

Modulation of matrix metalloproteinase activity in human saphenous vein grafts using adenovirus-mediated gene transfer
Fernandez HA; Kallenbach K; Seghezzi G; Mehrara B; Apazidis A; Baumann FG; Grossi EA; Colvin S; Mignatti P; Galloway AC
1998 Aug;124(2):129-136, Surgery
BACKGROUND: Neointima formation after human saphenous vein grafting (hSVG) involves several matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs). This study assessed the feasibility of modulating MMP activity in hSVGs by adenovirus-mediated gene transfer. METHODS: First, 1 x 10(9) plaque-forming units (pfu) of replication-deficient recombinant adenoviruses encoding either beta-galactosidase (ad beta gal), MMP-3 (AdMMP-3), or TIMP-1 (AdTIMP-1) were added into the lumen of hSVGs for 1 hour. After incubation at 37 degrees C for 24 hours, specimens were analyzed by immunohistochemistry, in situ zymography, and X-gal staining. RESULTS: By X-gal staining ad beta gal-infected hSVGs stained positively in the intima and occasionally in the media. Immunohistochemistry of AdMMP-3- and AdTIMP-1-infected hSVGs localized these proteins to the intima. In situ zymography showed increased MMP activity in the intima of AdMMP-3-infected hSVGs relative to AdTIMP-1- or Ad beta gal-infected vessels. CONCLUSIONS: MMP-3 and TIMP activity can be regulated in hSVGs by replication-deficient recombinant adenoviruses. We have previously demonstrated that MMP-3 or TIMP-1 transduction, or both, inhibit SMC migration in an in vitro reconstituted vessel wall. Modulation of MMP activity may thus afford high patency rates in genetically engineered hSVGs. However, adenovirus-mediated gene delivery is limited to the vessel's intima; strategies to infect medial smooth muscle cells need to be developed
— id: 7562, year: 1998, vol: 124, page: 129, stat: Journal Article,

Minimally invasive cardiac surgery
Galloway AC; Grossi EA; Ribakove GH; Colvin SB
Textbook of cardiovascular medicine Philadelphia : Lippincott-Raven, 1998,
— id: 3835, year: 1998, vol: , page: ?, stat: Chapter,

Port-Access coronary artery bypass grafting: technical considerations and results
Galloway AC; Ribakove GH; Grossi EA; Sternberg B; Zakow PK; Baumann FG; Buttenheim P; Colvin SB
1998 Jul;13(4):281-285, Journal of cardiac surgery
BACKGROUND: This study reviews the results of an initial experience with minimally invasive coronary bypass surgery using the Port-Access approach in terms of early outcome and safety. METHODS: Between October 1996 and July 1997 49 Port-Access minimally invasive coronary artery bypass grafting procedures were performed at our institution. The patients' mean age was 59.8 years (range 34 to 82 years). Sixteen patients received single vessel and 37 patients received multivessel bypass grafts. RESULTS: There were no operative deaths and no perioperative myocardial infarctions, neurological deficits, or conversions to sternotomy. Early complications included reoperation due to bleeding in 4 patients, reoperation for a pulmonary embolus in 1 patient, and angioplasty for occlusion of a right coronary artery graft in 2 patients. Postoperative angiograms were obtained in 86% (42/49) of the patients and showed 100% patency for left internal mammary artery to left anterior descending artery grafts and 96% patency for all grafts. CONCLUSIONS: These results demonstrate that Port-Access coronary artery bypass grafting using endovascular techniques for cardiopulmonary bypass and cardioplegic arrest can be performed safely with minimal morbidity and mortality. This technique allows multivessel revascularization on a protected, arrested heart with excellent anastomotic precision and reproducible early graft patency. Expanded use of Port-Access techniques is indicated in patients with multivessel coronary artery disease and the technique should be considered for patients with left anterior descending artery restenosis and patients with complex left anterior descending artery lesions where angioplasty results are suboptimal
— id: 6107, year: 1998, vol: 13, page: 281, stat: Journal Article,

Minimally invasive approach for ASD repair
Galloway, AC; Anderson, RV; Miller, JS; Grossi, EA; Baumann, FG; Delianides, J; Verma, R; Artman, M; Colvin, SB
1998 FEB ;31(2):189A-190A, Journal of the American College of Cardiology
— id: 33433, year: 1998, vol: 31, page: 189A, stat: Journal Article,

Port access MIDCAB: Clinical experience and angiographic follow-up
Galloway, AC; Ribakove, GH; Esposito, RA; Miller, JS; Anderson, RV; Baumann, FG; Buttenheim, PM; Ayala, WI; Grossi, EA; Colvin, SB
1998 FEB ;31(2):69A-69A, Journal of the American College of Cardiology
— id: 53548, year: 1998, vol: 31, page: 69A, stat: Journal Article,

Early results of posterior leaflet folding plasty for mitral valve reconstruction
Grossi EA; Galloway AC; Kallenbach K; Miller JS; Esposito R; Schwartz DS; Colvin SB
1998 Apr;65(4):1057-1059, Annals of thoracic surgery
BACKGROUND: Standard reconstruction for posterior mitral leaflet (PML) disease is quadrangular resection and annular plication; when the PML is excessively high, a sliding plasty is used. We have developed an alternative technique, a posterior leaflet folding plasty. It is performed by folding down the cut vertical edges of the PML. The central height of the PML is reduced, leaflet coaptation is moved posteriorly, and annular plication is unnecessary. METHODS: From March 1995 to August 1996, 26 (17.9%) of 145 patients undergoing mitral reconstruction had a posterior leaflet folding plasty. Concomitant procedures included anterior leaflet resection or resuspension and myotomy and myectomy. In 3 patients, the PML resection extended to a commissure. RESULTS: There was one death and no reoperations. The mean New York Heart Association class was improved from 2.4 preoperatively to 1.4. There was no major postoperative mitral insufficiency in the 26 patients. Systolic anterior motion was transiently seen in 1 patient in whom left ventricular outflow tract obstruction was present preoperatively. CONCLUSIONS: The data demonstrate the safety and short-term efficacy of posterior leaflet folding plasty. This technique may help avoid systolic anterior motion after reconstruction of the PML
— id: 57160, year: 1998, vol: 65, page: 1057, stat: Journal Article,

Valve repair versus replacement for mitral insufficiency: when is a mechanical valve still indicated?
Grossi EA; Galloway AC; Miller JS; Ribakove GH; Culliford AT; Esposito R; Delianides J; Buttenheim PM; Baumann FG; Spencer FC; Colvin SB
1998 Feb;115(2):389-394, Journal of thoracic & cardiovascular surgery
OBJECTIVES: Although many advantages of mitral valve reconstruction have been demonstrated, whether specific subgroups of patients exist in whom mechanical valve replacement offers advantages over mitral reconstruction remains undetermined. METHODS: This study examined the late results of mitral valve surgery in patients with mitral insufficiency who received either a St. Jude Medical valve (n = 514) or a mitral valve reconstruction with ring annuloplasty (n = 725) between 1980 and 1996. RESULTS: Overall operative mortality was 7.2% in the patients receiving a St. Jude Medical mitral valve and 5.4% in those undergoing mitral valve reconstruction (no significant difference); isolated mortality was 2.5% in the St. Jude Medical group and 2.2% in the valve reconstruction group (no significant difference). The follow-up interval was more than 5 years for 340 patients with a mean of 39.8 months (98.5% complete). Overall 8-year freedom from late cardiac death, reoperation, and all valve-related complications was 72.8% for the St. Jude Medical group and 64.8% for valve reconstruction group (no significant difference). For patients with isolated, nonrheumatic mitral valve disease, 8-year freedom from late cardiac death and reoperation was better in the mitral valve reconstruction group (88.3%) than in the St. Jude Medical valve group (86.0%; p = 0.05). Furthermore, Cox proportional hazards regression revealed that mitral valve reconstruction was independently associated with a lesser incidence of late cardiac death (p = 0.04), irrespective of preoperative New York Heart Association class. However, the St. Jude Medical valve offered better 8-year freedom from late cardiac death, reoperation, and all valve-related complications than did mitral valve reconstruction in patients with multiple valve disease (77.0% vs 45.3%; p < 0.01). CONCLUSIONS: Therefore, mitral valve reconstruction appears to be the procedure of choice for isolated, nonrheumatic disease, whereas insertion of a St. Jude Medical valve should be preferred for patients with multiple valve disease
— id: 7585, year: 1998, vol: 115, page: 389, stat: Journal Article,

Choice of mitral prosthesis in the elderly. An analysis of actual outcome
Grossi EA; Galloway AC; Zakow PK; Miller JS; Buttenheim PM; Baumann FG; Culliford AT; Spencer FC; Colvin SB
1998 Nov 10;98(19 Suppl):II116-II119, Circulation
BACKGROUND: In younger patients requiring mitral valve replacement (MVR), mechanical prostheses (MPs) have been reported to give better freedom from all valve-related complications (VRCs) because of the high incidence of late valve degeneration (VD) associated with bioprostheses (BPs). In older patients, however, the risk of VD may be reduced because of the large competing risk of noncardiac death (NCD). Previous studies on VD in the elderly have used actuarial analysis, which overestimates the risk of VD in this population because it assumes that dead patients are still at risk. In contrast, cumulative incidence (actual) analysis acknowledges that patients who die have no risk of VD. This study compares the results of both 'actual' and 'actuarial' analyses of the freedom from VD in elderly patients undergoing MVR. METHODS AND RESULTS: From June 1976 through January 1996, 504 patients > or = 70 years of age underwent MVR at our institution. Isolated mitral operations were performed in 159 patients, and 169 had concomitant CABG. Hospital mortality was 59 of 374 (15.9%) for tissue prosthesis versus 24 of 130 (18.5%) for mechanical prosthesis (P = NS). For tissue versus mechanical prosthesis, 10-year freedom from noncardiac death was 75.0% versus 67.6% (P = NS); 10-year actuarial freedom from valve degeneration was 79.8% versus 93.4% (P = NS); 10-year actual freedom from valve degeneration was 92.6% versus 95.4% (P = NS); and 10-year actual freedom from all VRCs was 84.4% versus 92.3% (P = NS). CONCLUSIONS: In elderly patients undergoing MVR, actuarial analysis overestimates the 10-year risk of VD compared with actual analysis (20.2% versus 7.4% for BP, 6.6% versus 4.6% for MP). In these patients, the actual freedoms from VD and all VRCs do not differ significantly between BP and MP. Thus, in this age group, the necessity for anticoagulation or its avoidance may be the predominant factor in choosing a replacement mitral valve
— id: 7337, year: 1998, vol: 98, page: II116, stat: Journal Article,

Mitral valve repair in the elderly
Grossi EA; Sussman MJ; Galloway AC
Clinical cardiology in the elderly Armonk NY : Futura, 1999,
— id: 3818, year: 1998, vol: , page: ?, stat: Chapter,

Initial echocardiogram after mitral valve reconstruction predicts durability of repair
Grossi, EA; Applebaum, RM; Galloway, AC; Spencer, FC; Kronzon, I; Colvin, SB
1998 FEB ;31(2):399A-399A, Journal of the American College of Cardiology
— id: 33434, year: 1998, vol: 31, page: 399A, stat: Journal Article,

Mitral valve reconstruction for ischemic mitral insufficiency results in equal long-term survival and fewer complications than mitral valve replacement
Grossi, EA; Zakow, PK; Galloway, AC; Esposito, RA; Culliford, AT; Ribakove, GH; Sussman, M; Kallenbach, K; Delianldes, J; Buttenhelm, PM; Baumann, FG; Colvin, SB
1998 OCT 27 abstact #4363;98(17):831-831, Circulation
— id: 33430, year: 1998, vol: 98, page: 831, stat: Journal Article,

Mitral reconstruction in septuagenarians
Grossi, EA; Zakow, PK; Sussman, M; Galloway, AC; Delianides, J; Baumann, FG; Colvin, SB
1998 OCT 27 abstract #294;98(Suppl S):59-59, Circulation
— id: 33429, year: 1998, vol: 98, page: 59, stat: Journal Article,

Matrix metalloproteinase (MMP) 2 and 9 activity in experimental acute pancreatitis
Patel, S; Schwartz, J; Chaung, N; Marcus, SG; Pachter, HL; Deutsch, E; Galloway, AC; Eng, K; Mignatti, P; Shamamian, P
1998 APR 15 ;114(4):A1416-A1416, Gastroenterology
— id: 53478, year: 1998, vol: 114, page: A1416, stat: Journal Article,

Occupancy of C1Q receptors on endothelial cells (EC) by immune complexes (IC) downregulates mRNA for sterol 27-hydroxylase (27-OH ' ASE), the major mediator of extra-hepatic cholesterol metabolism
Reiss, AB; Malhotra, S; Javitt, NB; Grossi, EA; Galloway, AC; Montesinos, MC; Cronstein, BN
1998 SEP abstract #281;41(Suppl S):S79-S79, Arthritis & rheumatism
— id: 33431, year: 1998, vol: 41, page: S79, stat: Journal Article,

Ischemic heart disease: coronary bypass, atherosclerotic aorta
Ribakove G; Galloway AC; Colvin SB
Mastery of cardiothoracic surgery Philadelphia : Lippincott-Raven, 1998,
— id: 3839, year: 1998, vol: , page: ?, stat: Chapter,

The atheroscierotic aorta
Ribakove GH; Galloway AC; Colvin SB
Mastery of cardiothoracic surgery Philadelphia : Lippincott-Raven, 1998,
— id: 3817, year: 1998, vol: , page: ?, stat: Chapter,

Port-access coronary artery bypass
Ribakove GH; Galloway AC; Grossi EA; Colvin SB
Minimally invasive cardiac surgery Totowa NJ : Humana, 1998,
— id: 3819, year: 1998, vol: , page: 117, stat: Chapter,

Minimally invasive port-access coronary artery bypass grafting with early angiographic follow-up: initial clinical experience
Ribakove GH; Miller JS; Anderson RV; Grossi EA; Applebaum RM; Cutler WM; Buttenheim PM; Baumann FG; Galloway AC; Colvin SB
1998 May;115(5):1101-1110, Journal of thoracic & cardiovascular surgery
OBJECTIVE: New techniques for minimally invasive coronary artery bypass grafting have recently emerged. The purpose of this study was to determine the safety and efficacy of Port-Access (Heartport, Inc., Redwood City, Calif.) coronary revascularization and to evaluate with angiography the early graft patency rate with this new approach. METHODS: From October 1996 to May 1997, 31 patients underwent Port-Access coronary artery bypass grafting with an anterior minithoracotomy and endovascular-occlusion cardiopulmonary bypass. There were 26 men and 5 women with a mean age of 62 years (range 42 to 82 years). Fifteen patients underwent single bypass; 12 patients underwent double bypass, and 4 patients underwent triple bypass. Bypass conduits included the left internal thoracic artery (n = 30), right internal thoracic artery (n = 2), radial artery (n = 10), and saphenous vein (n = 6). Three sequential grafts were used. Angiographic studies of the bypass grafts were performed in 27 of 31 patients (87%). RESULTS: There were no deaths, neurologic deficits, myocardial infarctions, or aortic dissections. Conversion to sternotomy was not required in any case. There were two reoperations for bleeding, one reoperation for tamponade, and one reoperation for pulmonary embolus. Postoperative angiography revealed anastomotic patency of the left internal thoracic artery to left anterior descending artery in 26 of 26 grafts (100%) with overall anastomotic patency in 43 of 44 grafts (97.7%). CONCLUSION: These results demonstrate that Port-Access coronary artery bypass can be performed accurately and safely with acceptable morbidity. This approach allows for multivessel revascularization on an arrested, protected heart with excellent anastomotic precision and reproducible early graft patency
— id: 7756, year: 1998, vol: 115, page: 1101, stat: Journal Article,

Soluble factor(s) released from neutrophils activates endothelial cell matrix metalloproteinase-2
Schwartz JD; Monea S; Marcus SG; Patel S; Eng K; Galloway AC; Mignatti P; Shamamian P
1998 Apr;76(1):79-85, Journal of surgical research
OBJECTIVE: Polymorphonuclear leukocyte (PMN) infiltration and microvascular injury are hallmarks of the tissue remodeling associated with multiple organ failure. These processes require the concerted action of various proteolytic enzymes, including serine and matrix metalloproteinases (MMPs). Matrix metalloproteinase-2 (MMP-2) plays an important role in the turnover of various ECM components, including type IV collagen, fibronectin, and gelatins. Like all MMPs, MMP-2 is secreted as an inactive zymogen (proMMP-2) and activated extracellularly by limited proteolytic cleavage. The physiologic mechanism(s) of proMMP-2 activation remains unclear. This study was designed to characterize the effect of PMNs on the activation of proMMP-2 produced by endothelial cells. METHODS: PMNs and human umbilical vein endothelial cells (HUVECs) were grown either separately or together for 2-16 h. To evaluate the role of cell-cell contact, cocultures were also established in which the two cell types were separated by a semipermeable polycarbonate membrane. Alternatively, PMN-conditioned medium was added to HUVEC cultures with or without various proteinase inhibitors (aprotinin, 1,10-phenanthroline, Batimastat, E-64, eglin c peptide, or pepstatin A). After incubation, the culture supernatants were analyzed by gelatin zymography to characterize the gelatinases. RESULTS: HUVECs produce MMP-2 in its inactive (72 kDa) form. PMNs produce high levels of MMP-9 (gelatinase B, 92 kDa) but no MMP-2. Coculture of PMNs with or addition of PMN-conditioned medium to HUVECs results in the production of active (62 kDa) MMP-2. ProMMP-2 activation by PMN-conditioned medium is not blocked by inhibitors of plasmin, cysteine-, acid-, or metalloproteinases. CONCLUSION: PMNs release a soluble factor that activates endothelial cell MMP-2 through a novel mechanism independent of cell-cell contact and not attributable to the activities of plasmin, cysteine-, acid-, or metalloproteinases. These findings may provide insight into the tissue remodeling that accompanies PMN-mediated microvascular injury
— id: 9018, year: 1998, vol: 76, page: 79, stat: Journal Article,

Activation of tumor cell matrix metalloproteinase-2 by neutrophil proteinases requires expression of membrane-type 1 matrix metalloproteinase
Schwartz JD; Shamamian P; Monea S; Whiting D; Marcus SG; Galloway AC; Mignatti P
1998 Aug;124(2):232-238, Surgery
BACKGROUND: Matrix metalloproteinase-2 (MMP-2), an enzyme involved in tumor invasion, is secreted as an inactive proenzyme and requires interaction with membrane-type 1 MMP (MT1-MMP) for activation. We have previously demonstrated that polymorphonuclear neutrophils (PMNs) release a soluble factor(s) that activates pro-MMP-2. Therefore, we tested the hypothesis that PMN-derived proteinases act in concert with MT1-MMP to activate pro-MMP-2. METHODS: Human HT-1080 cells transfected with MT1-MMP cDNA (HT-SE) or the corresponding antisense cDNA (HT-AS) or an empty vector (HT-V), which expressed differing levels of MT1-MMP, were incubated with serum-free, human PMN-conditioned medium with or without proteinase inhibitors. The culture supernatants were analyzed by gelatin zymography. RESULTS: Ht-1080 cells expressing basal (HT-V) or low levels (HT-AS) of MT1-MMP secreted MMP-2 in proenzyme from (72 kd). Ht-1080 cells with high levels of MT1-MMP (HT-SE) secreted pro MMP-2 and a 68 kd intermediate activation product. Addition of PMN-conditioned medium to either HT-SE or HT-V clones resulted in dose-dependent generation of active, 62 kd MMP-2. In contrast, when PMN-conditioned medium was added to HT-AS clones, no MMP-2 activation occurred. CONCLUSIONS: PMN-derived serine proteinases act in concert with MT1-MMP to activate proMMP-2. This finding indicates a potential role for inflammatory cells in promoting extracellular matrix breakdown during tumor invasion
— id: 9017, year: 1998, vol: 124, page: 232, stat: Journal Article,

Cardiopulmonary bypass primes polymorphonuclear leukocytes
Schwartz JD; Shamamian P; Schwartz DS; Grossi EA; Jacobs CE; Steiner F; Minneci PC; Baumann FG; Colvin SB; Galloway AC
1998 Mar;75(2):177-182, Journal of surgical research
Polymorphonuclear leukocyte (PMN) superoxide (.O2-) production has been implicated in the pathogenesis of cardiopulmonary bypass (CPB)-related end organ injury. PMN 'priming' has been described as an event which enhances the release of .O2- following a second, activating insult. We hypothesized that PMN priming occurs during CBP and is temporally related to the plasma level of complement (C3a), interleukin (IL)-6, and IL-8. PMNs were isolated from 10 CPB patients pre-bypass (preCPB), 5 min after protamine administration (PROT), and at 6 and 24 h post-CPB. PMN .O2- production was measured by a cytochrome c reduction assay in the presence or absence of either phorbol 12-myristate-13-acetate (PMA, 0.4 microgram/ml) or N-formyl-methionyl-leucyl-phenylalanine (FMLP, 1 microM) and also after priming with 2000 nM platelet-activating factor (PAF) followed by activation with either PMA or FMLP. Plasma levels of C3a, IL-6, and IL-8 were determined by enzyme-linked immunosorbent assay. PMA-activated PMN .O2- production was significantly elevated at 6 h post-CPB compared to pre-CPB levels (11.04 +/- 0.9 vs 7.62 +/- 0.57, P = 0.009), indicating that CPB is associated with in vivo PMN priming. When PMNs were primed in vitro with PAF and then activated with PMA or FMLP, .O2- release at 6 h post-CPB was also significantly greater than pre-CPB levels (16.04 +/- 0.74 vs 12.2 +/- 0.92, P = 0.038; and 17.33 +/- 1.38 vs 13.33 +/- 1.35, P < 0.05), indicating that CPB acts synergistically with PAF to prime PMNs. Levels of C3a rose significantly over pre-CPB levels at PROT (P = 0.001), and IL-6 and IL-8 rose over pre-CPB levels at 6 h post-CPB (P = 0.01 and P = 0.006, respectively). These findings demonstrate that CPB not only directly primes PMNs, but also potentiates priming of PMNs by PAF. This 'primed' PMN state, which coincided with the increased plasma levels of inflammatory mediators, may suggest a mechanism of predisposition to organ dysfunction following CPB
— id: 57256, year: 1998, vol: 75, page: 177, stat: Journal Article,

Fibroblast growth factor-2 (FGF-2) induces vascular endothelial growth factor (VEGF) expression in the endothelial cells of forming capillaries: an autocrine mechanism contributing to angiogenesis
Seghezzi G; Patel S; Ren CJ; Gualandris A; Pintucci G; Robbins ES; Shapiro RL; Galloway AC; Rifkin DB; Mignatti P
1998 Jun 29;141(7):1659-1673, Journal of cell biology
FGF-2 and VEGF are potent angiogenesis inducers in vivo and in vitro. Here we show that FGF-2 induces VEGF expression in vascular endothelial cells through autocrine and paracrine mechanisms. Addition of recombinant FGF-2 to cultured endothelial cells or upregulation of endogenous FGF-2 results in increased VEGF expression. Neutralizing monoclonal antibody to VEGF inhibits FGF-2-induced endothelial cell proliferation. Endogenous 18-kD FGF-2 production upregulates VEGF expression through extracellular interaction with cell membrane receptors; high-Mr FGF-2 (22-24-kD) acts via intracellular mechanism(s). During angiogenesis induced by FGF-2 in the mouse cornea, the endothelial cells of forming capillaries express VEGF mRNA and protein. Systemic administration of neutralizing VEGF antibody dramatically reduces FGF-2-induced angiogenesis. Because occasional fibroblasts or other cell types present in the corneal stroma show no significant expression of VEGF mRNA, these findings demonstrate that endothelial cell-derived VEGF is an important autocrine mediator of FGF-2-induced angiogenesis. Thus, angiogenesis in vivo can be modulated by a novel mechanism that involves the autocrine action of vascular endothelial cell-derived FGF-2 and VEGF
— id: 7787, year: 1998, vol: 141, page: 1659, stat: Journal Article,

Recent developments and evolving techniques of mitral valve reconstruction
Spencer FC; Galloway AC; Grossi EA; Ribakove GH; Delianides J; Baumann FG; Colvin SB
1998 Feb;65(2):307-313, Annals of thoracic surgery
Experiences with 1,000 patients undergoing mitral valve reconstruction at New York University over the past 18 years are summarized. A continuing follow-up (98% complete) demonstrated that 88% of patients are free from recurrent insufficiency 10 years after the operation. Reconstruction is feasible in nearly 90% of patients with mitral valve prolapse, with an operative mortality near 2%. Accordingly, operation is now recommended at an early stage with the first sign of left ventricular systolic dysfunction, while the patient is still in sinus rhythm. Most operations have been done with the Carpentier techniques of segmental resection with annuloplasty and insertion of a Carpentier ring. Recently, two other repair techniques and a minimally invasive operative approach have been evaluated. A triangular resection of a prolapsing anterior leaflet has been done in more than 100 patients with excellent results. Also, a posterior 'folding plasty' has been employed in more than 40 patients with a large redundant posterior leaflet, minimizing the need for annular plication. A minimally invasive approach to the mitral valve has now been employed in 130 patients over the past year, using a right mini-thoracotomy and the Port-Access (Heartport, Inc, Menlo Park, CA) approach. This technique employs catheters introduced through femoral vessels to institute cardiopulmonary bypass and cardioplegic arrest. The operative approach and techniques for mitral valve reconstructive operations continue to evolve, with excellent results and improved patient benefits
— id: 57261, year: 1998, vol: 65, page: 307, stat: Journal Article,

Minimally invasive port-access valvular surgery: Initial clinical experience
Galloway, AC; Ribakove, GH; Miller, JS; Anderson, RV; Buttenheim, PM; Baumann, FG; Grossi, EA; Colvin, SB
1997 OCT 21 ;96(8):2845-2845, Circulation
— id: 33438, year: 1997, vol: 96, page: 2845, stat: Journal Article,

The port-access triple-vessel CABG
Galloway, Aubrey C
St. Louis MO : Medical Video Productions, 1997,
— id: 1583, year: 1997, vol: , page: , stat: ,

Choice of mitral prosthesis in the elderly: An analysis of ''actual'' outcome
Grossi, EA; Galloway, AC; Miller, JS; Ribakove, GH; Buttenheim, PM; Baumann, FG; Culliford, AT; Colvin, SB
1997 OCT 21 ;96(8):3820-3820, Circulation
— id: 33439, year: 1997, vol: 96, page: 3820, stat: Journal Article,

Thoracic aorta: comparison of gadolinium-enhanced three-dimensional MR angiography with conventional MR imaging
Krinsky GA; Rofsky NM; DeCorato DR; Weinreb JC; Earls JP; Flyer MA; Galloway AC; Colvin SB
1997 Jan;202(1):183-193, Radiology
PURPOSE: To evaluate gadolinium-enhanced three-dimensional magnetic resonance (MR) angiography for thoracic aortic disease and to compare this technique with conventional thoracic MR imaging. MATERIALS AND METHODS: One hundred eight consecutive patients underwent 122 thoracic MR examinations, including conventional MR imaging followed by enhanced three-dimensional MR angiography. A gradient-echo sequence was used at 1.5 T (116 examinations) and 1.0 T (6 examinations) during infusion of 0.2 mmol/kg gadopentetate dimeglumine. Two independent readers (A and B), with varied experience in thoracic MR angiography, retrospectively evaluated the images for presence of aortic dissection, aneurysm, arch vessel disease, and protruding atheroma. Correlation with findings of surgery or other imaging modalities was available in 98 cases. RESULTS: Enhanced MR angiography was sensitive (92%-96%) and specific (100%) for acute and chronic aortic dissection (n = 26) and was as useful as conventional MR imaging in the diagnosis of aneurysm (n = 43) and arch vessel disease (n = 7). One of two intramural hematomas were overlooked at MR angiography by reader A, and both were overlooked by reader B. CONCLUSION: Enhanced three-dimensional MR angiography is a rapid and accurate imaging modality in diagnosis of thoracic aortic disease but is insensitive to intramural hematoma
— id: 12435, year: 1997, vol: 202, page: 183, stat: Journal Article,

Requirement for plasmin and membrane type I matrix metalloproteinase in the cell surface activation of gelatinase A (MMP-2)
Monea, S; Lehti, K; Schwartz, J; Shamamian, P; Marcus, S; Galloway, AC; KeskiOja, J; Mignatti, P
1997 NOV ;8(5):434-434, Molecular biology of the cell
— id: 53159, year: 1997, vol: 8, page: 434, stat: Journal Article,

Sterol 27-hydroxylase: expression in human arterial endothelium
Reiss AB; Martin KO; Rojer DE; Iyer S; Grossi EA; Galloway AC; Javitt NB
1997 Jun;38(6):1254-1260, Journal of lipid research
Human endothelium obtained from both the aorta and the pulmonary artery has been evaluated for the presence of the messenger RNA coding for the expression of sterol 27-hydroxylase. Unique oligomers were designed to detect the mRNA by reverse transcription followed by the polymerase chain reaction. The amplified product was sequenced and was found to be identical to the published sequence for nucleotides 491 to 802 of the human sterol 27-hydroxylase cDNA. Northern blot analysis confirmed the presence of 27-hydroxylase mRNA in pulmonary artery and aortic endothelium. As part of these studies, enzymatic activity was assayed in cultured arterial endothelium using cholesterol as a substrate and isotope ratio gas-liquid chromatography-mass spectrometry to identify the metabolites, 27-hydroxycholesterol and 3 beta-hydroxy-5-cholestenoic acid, in the medium. Localization of sterol 27-hydroxylase to vascular endothelium indicates intracellular production of the biologically active metabolite 27-hydroxycholesterol
— id: 56982, year: 1997, vol: 38, page: 1254, stat: Journal Article,

Port-Access coronary artery bypass grafting
Ribakove GH; Galloway AC; Grossi EA; Cutler W; Miller JS; Baumann FG; Colvin SB
1997 Oct;9(4):312-319, Seminars in thoracic & cardiovascular surgery
New techniques for minimally invasive cardiac surgery have recently emerged. This report describes the Port-Access technique for coronary artery bypass grafting, which involves a small left anterior thoracotomy, femoral cannulation for endovascular cardiopulmonary bypass, and cardioplegic arrest using an endoaortic occlusion catheter and cardioplegia delivery system. This technique allows for minimally invasive single or multivessel revascularization in an arrested, protected heart, while maintaining a high level of anastomotic precision. The Port-Access surgical techniques are described, along with the indications and contraindications for this procedure. The initial New York University clinical results with Port-Access coronary bypass grafting are presented
— id: 12239, year: 1997, vol: 9, page: 312, stat: Journal Article,

Minimally invasive port-access coronary artery bypass grafting with early angiographic follow up: Initial clinical experience
Ribakove, GH; Miller, JS; Anderson, RV; Grossi, EA; Buttenheim, PM; Delianides, J; Galloway, AC; Colvin, SB
1997 OCT ;80(2):TCT23-TCT23, American journal of cardiology
— id: 33435, year: 1997, vol: 80, page: TCT23, stat: Journal Article,

Minimally invasive mitral valve replacement: port-access technique, feasibility, and myocardial functional preservation
Schwartz DS; Ribakove GH; Grossi EA; Buttenheim PM; Schwartz JD; Applebaum RM; Kronzon I; Baumann FG; Colvin SB; Galloway AC
1997 Jun;113(6):1022-1030, Journal of thoracic & cardiovascular surgery
OBJECTIVE: This experiment examined the feasibility of minimally invasive port-access mitral valve replacement via a 2.5 cm incision. METHODS: The study evaluated valvular performance and myocardial functional recovery in six mongrel dogs after port-access mitral valve replacement with a St. Jude Medical prosthesis (St. Jude Medical, Inc., St. Paul, Minn.). Femoro-femoral cardiopulmonary bypass and a balloon catheter system for myocardial protection with cardioplegic arrest (Heartport, Inc., Redwood City, Calif.) were used. The mitral valve was replaced through a 2.5 cm port in the left side of the chest, and the animals were weaned from bypass. Cardiac function was measured before and at 30 and 60 minutes after bypass. Left ventricular pressure and electrical conductance volume were used to calculate changes in load-independent indexes of ventricular function. RESULTS: Each procedure was successfully completed. Recovery of left ventricular function was excellent at 30 and 60 minutes after bypass compared with the prebypass values for elastance (30 minutes = 4.04 +/- 0.97 and 60 minutes = 4.27 +/- 0.57 vs prebypass = 4.45 +/- 0.96; p = 0.51) and for preload recruitable stroke work (30 minutes = 76.23 +/- 4.80 and 60 minutes = 71.21 +/- 2.99 vs prebypass = 71.23 +/- 3.75; p = 0.45). Preload recruitable work area remained at 96% and 85% of baseline at 30 and 60 minutes (p = not significant). In addition, transesophageal echocardiography demonstrated normal prosthetic valve function, as well as normal regional and global ventricular wall motion. Autopsy revealed secure annular-sewing apposition and normal leaflet motion. CONCLUSIONS: These results suggest that minimally invasive mitral valve replacement using percutaneous cardiopulmonary bypass with cardioplegic arrest is technically reproducible, achieves normal valve placement, and results in complete cardiac functional recovery. Minimally invasive mitral valve replacement is now feasible, and clinical trials are indicated
— id: 7256, year: 1997, vol: 113, page: 1022, stat: Journal Article,

Single and multivessel port-access coronary artery bypass grafting with cardioplegic arrest: technique and reproducibility
Schwartz DS; Ribakove GH; Grossi EA; Schwartz JD; Buttenheim PM; Baumann FG; Colvin SB; Galloway AC
1997 Jul;114(1):46-52, Journal of thoracic & cardiovascular surgery
OBJECTIVES: Although minimally invasive coronary artery bypass grafting is now feasible, using this technique to perform anastomoses on the beating or fibrillating heart may yield poorer graft patency than the standard open techniques that use cardioplegic arrest. This study tested the feasibility and anastomotic reproducibility of minimally invasive coronary bypass using newly developed port-access coronary artery bypass technology (Heartport, Inc., Redwood City, Calif.), which allows endovascular cardiopulmonary bypass, cardiac venting, aortic occlusion, and cardioplegic arrest for internal thoracic artery-coronary artery anastomoses. METHODS: Nineteen dogs had thoracoscopic takedown of either single (n = 14) or bilateral (n = 5) internal thoracic arteries followed by minimally invasive coronary bypass with cardioplegic arrest, done by means of the port-access system. The anastomotic technique was modified after the fourth animal by switching from a microscope to a 2.5 cm oval port and performing a conventional anastomosis with operative loupes. The adequacy of delivery of cardioplegic solution, ventricular decompression, and anastomotic patency was assessed. RESULTS: The crossclamp and bypass times were 50 +/- 15 minutes and 87 +/- 28 minutes (mean +/- standard deviation), respectively. The mean myocardial temperature after cardioplegia was 17 degrees +/- 1 degree C and the aortic pressure (-3 +/- 9 mm Hg) and pulmonary artery pressure (4 +/- 1 mm Hg) were low throughout the procedure. All animals were weaned from bypass without inotropic agents. Angiograms and autopsies demonstrated successful thoracic artery takedown and anastomotic patency in 18 of 19 animals, with 100% anastomotic patency after the technique had been modified after the fourth animal. CONCLUSION: This study describes a reproducible technique for minimally invasive coronary bypass that allows myocardial protection, anastomotic precision, and predictable thoracic artery graft patency. Clinical trials are indicated
— id: 7257, year: 1997, vol: 114, page: 46, stat: Journal Article,

Lexipafant inhibits platelet activating factor enhanced neutrophil functions
Schwartz JD; Shamamian P; Grossi EA; Schwartz DS; Marcus SG; Steiner F; Jacobs CE; Tayyarah M; Eng K; Colvin SB; Galloway AC
1997 May;69(2):240-248, Journal of surgical research
Platelet activating factor (PAF) enhances polymorphonuclear leukocyte (PMN) superoxide (.O2-) production, CD11b expression, and elastase release, all essential components in the pathophysiology of multiple-organ failure. This study was designed to determine the effects of Lexipafant, a PAF receptor antagonist, on PAF-mediated PMN functions. PMNs from 10 healthy volunteers were isolated and pretreated with various concentrations of Lexipafant (0-100 microM). PMNs were then incubated for 5 min with 200 nM PAF for .O2- detection or 2000 nM PAF for elastase measurement and activated with 1 microM N-formylmethionylleucylphenylalanine. The mean rate of .O2- production was determined by a cytochrome c reduction assay (nmole .O2-/min/1.33 x 10(5) PMN +/- SEM). Elastase release was measured by the cleavage of the synthetic elastase substrate Meo-Suc-Ala-Ala-Pro-Val-pNA (mean elastolytic activity +/- SEM). In parallel experiments, PMNs were incubated with 200 nM PAF for 30 min following pre-treatment with Lexipafant and CD11b expression was determined by flow cytometry (mean fluorescence intensity +/- SEM). Statistical analysis was performed using repeated-measures ANOVA (P < 0.05). Lexipafant inhibited PAF-enhanced PMN .O2- generation, CD11b expression and elastase release in a dose dependent fashion. The IC50 of Lexipafant for .O2- production, CD11b expression, and elastase release was 0.046, 0.285, and 0.05 microM, respectively. Lexipafant attenuated the PAF-mediated upregulation of PMN .O2- production, CD11b expression, and elastase release in a dose dependent fashion. These data support the hypothesis that Lexipafant may reduce the severity of the inflammatory response to injury produced by PAF-enhanced activation of PMNs
— id: 9020, year: 1997, vol: 69, page: 240, stat: Journal Article,

Activation of endothelial or tumor cell progelatinase A (MMP-2) by human polymorphonuclear neutrophils (PMN)
Schwartz, JD; Monea, S; Shamamian, P; Marcus, SG; Whiting, D; Galloway, AC; Mignatti, P
1997 NOV ;8(5):435-435, Molecular biology of the cell
— id: 53160, year: 1997, vol: 8, page: 435, stat: Journal Article,

Fibroblast growth factor-2 (FGF-2) induces vascular endothelial growth factor (VEGF) expression in the endothelial cells of forming capillaries: An autocrine mechanism of angiogenesis
Seghezzi, G; Patel, S; Ren, CJ; Pintucci, G; Gualandris, A; Robbins, E; Shapiro, RL; Galloway, AC; Rifkin, DB; Mignatti, P
1997 NOV ;8(5):1335-1335, Molecular biology of the cell
— id: 53166, year: 1997, vol: 8, page: 1335, stat: Journal Article,

Selective approach to descending thoracic aortic aneurysm repair: a ten-year experience
Galloway AC; Schwartz DS; Culliford AT; Ribakove GH; Grossi EA; Esposito RA; Baumann FG; Delianides J; Spencer FC; Colvin SB
1996 Oct;62(4):1152-1157, Annals of thoracic surgery
BACKGROUND: A variety of surgical techniques has been developed to attempt to minimize the risk of paraplegia after descending thoracic aortic aneurysm repair. This study reviews our institutional experience with several basic techniques over a period of 10 years. METHODS: Seventy-eight consecutive patients underwent repair of descending thoracic aortic aneurysm between 1983 and 1993. Two basic repair strategies were used: (1) distal perfusion with somatosensory evoked potential monitoring (n = 54) and (2) cross-clamping (n = 24), alone (n = 6) or with controlled distal exsanguination (n = 18). RESULTS: The operative mortality rate was 6.5% for elective repair (n = 62), 25.0% for emergent repair (n = 16), and 10.3% overall. Univariate predictors of increased operative risk were emergent operation, rupture, and shock. Neither death nor paraplegia was related to the operative technique used. The incidence of paraplegia was 3.7% in perfused patients and 4.2% in cross-clamping patients (p > 0.05). Paraplegia did not occur after any elective operation (zero of 62) but occurred in 18.6% of emergent cases (p < 0.01). In perfused patients, paraplegia did not occur when the distal pressure was maintained above 55 mm Hg and somatosensory evoked potentials remained intact. When somatosensory evoked potentials were lost (n = 7) in perfused patients, the operative technique was altered successfully in 5 patients, whereas in 2 patients (28.6%), paraplegia developed. CONCLUSIONS: The risks associated with elective descending thoracic aortic aneurysm repair were extremely low using an operative strategy that was flexible but skewed toward perfusion with somatosensory evoked potential monitoring. In perfused patients, paraplegia did not occur when distal pressure was greater than 55 mm Hg and somatosensory evoked potentials remained intact. However, the risks of death and paraplegia were primarily related to emergent presentation, not to technique, and the technique of cross clamping with controlled distal exsanguination was found to be valuable in unstable or in anatomically complicated subsets of patients
— id: 7071, year: 1996, vol: 62, page: 1152, stat: Journal Article,

Limited thoracotomy mitral valve surgery: A preliminary study of repair and replacement
Galloway, AC; Ribakove, GH; Schwartz, DS; Anderson, RV; Harris, LJ; Delianides, J; Grossi, EA; Colvin, SB
1996 OCT 15 ;94(8):3121-3121, Circulation
— id: 33444, year: 1996, vol: 94, page: 3121, stat: Journal Article,

Perioperative morbidity and mortality in combined vs. staged approaches to carotid and coronary revascularization
Giangola G; Migaly J; Riles TS; Lamparello PJ; Adelman MA; Grossi E; Colvin SB; Pasternak PF; Galloway A; Culliford AT; Esposito R; Ribacove G; Crawford BK; Glassman L; Baumann FG; Spencer FC
1996 Mar;10(2):138-142, Annals of vascular surgery
Between 1986 and 1994 we identified 57 patients who underwent carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) during the same hospitalization. Simultaneous CABG and CEA was performed in 28 patients (mean age 70.5 years, 58% male). Indications for CABG in these patients were myocardial infarction in two crescendo angina in 19, congestive heart failure in two and left main or triple-vessel coronary artery disease noted during carotid preoperative evaluation in five. Indications for CEA were transient ischemic attack (TIA) in 12, crescendo TIA in six, cerebrovascular accident (CVA) in five, and asymptomatic stenosis in five. There were no postoperative myocardial infarctions or perioperative deaths. Two patients developed atrial fibrillation, and four patients had CVAs (two were ipsilateral to the side of CEA). Twenty-nine patients underwent staged procedures (i.e., not performed concomitantly but during the same hospitalization). Indications for CABG and CEA were comparable to those in the group undergoing simultaneous procedures. In 17 patients CEA was performed before CABG. There was a single CVA, the result of an intracerebral hemorrhage. Five of the 17 patients had a myocardial infarction and two died; one patient had first-degree heart block requiring a pacemaker. Four additional patients developed atrial fibrillation, one of whom required cardioversion. The remaining 12 patients had CABG followed by CEA. There were no CVAs, myocardial infarctions, arrhythmias, or deaths in this subgroup. These data demonstrate that the performance of simultaneous CABG and CEA procedures is associated with increased neurologic morbidity (14.3%), both ipsilateral and contralateral to the side of carotid surgery in contrast to staged CABG and CEA (3.4%). In addition, when staged carotid surgery preceded coronary revascularization in those with severe coronary artery disease, the combined cardiac complication and mortality rate was significantly higher than when coronary revascularization preceded CEA. This evidence suggests that when CABG and CEA must be performed during the same hospitalization, the procedures should be staged with CABG preceding CEA
— id: 12638, year: 1996, vol: 10, page: 138, stat: Journal Article,

Early results of posterior leaflet folding plasty: A new technique for mitral valve reconstruction
Grossi, EA; Galloway, AC; Delianides, J; Schwartz, DS; Kronzon, I; Colvin, SB
1996 OCT 15 ;94(8):3119-3119, Circulation
— id: 33443, year: 1996, vol: 94, page: 3119, stat: Journal Article,

Characterization of different forms of cell-associated matrix metalloproteinase-9 (MMP-9)
Mazzieri, R; Zanetta, L; Monea, S; Galloway, AC; Rifkin, DB; Mignatti, P
1996 DEC ;7(3):350-350, Molecular biology of the cell
— id: 53347, year: 1996, vol: 7, page: 350, stat: Journal Article,

Expression of cholesterol 27-hydroxylase in peripheral blood monocytes macrophages: An independent risk factor for coronary artery disease?
Reiss, A; Galloway, A; Grossi, E; Schwartz, D; Iyer, S; Pasternack, F; Javitt, N
1996 MAR ;44(3):A282-A282, Journal of investigative medicine
— id: 52961, year: 1996, vol: 44, page: A282, stat: Journal Article,

Cholesterol homeostasis in HeLa cells: Expression of cholesterol 27-hydroxylase
Reiss, AB; Martin, KO; Pasternack, FR; Galloway, AC; Grossi, EA; Javitt, NB
1996 DEC ;7(6):1056-1056, Molecular biology of the cell
— id: 33440, year: 1996, vol: 7, page: 1056, stat: Journal Article,

Minimally invasive cardiopulmonary bypass with cardioplegic arrest: a closed chest technique with equivalent myocardial protection [see comments]
Schwartz DS; Ribakove GH; Grossi EA; Stevens JH; Siegel LC; St. Goar FG; Peters WS; McLoughlin D; Baumann FG; Colvin SB; Galloway AC
1996 Mar;111(3):556-566, Journal of thoracic & cardiovascular surgery
Thoracoscopic cardiac surgery is presently under intense investigation. This study examined the feasibility and efficacy of closed chest cardiopulmonary bypass and cardioplegic arrest in comparison with standard open chest methods in a dog model. The minimally invasive closed chest group (n = 6) underwent percutaneous cardiopulmonary bypass and cardiac venting, as well as antegrade cardioplegic arrest through use of a specially designed percutaneous endovascular aortic occluder and cardioplegic solution delivery system. The control group (n = 6) underwent standard sternotomy and conventional open chest cardiopulmonary bypass, aortic crossclamping, and antegrade cardioplegia. Ischemic arrest time was 1 hour in each group. Ventricular pressures and sonomicrometer segment lengths were recorded before bypass and at 30 and 60 minutes after bypass. Left ventricular function did not differ significantly between the two groups, as demonstrated by measurements of elastance and end-diastolic stroke work. Also, the preload recruitable work area was 69% and 60% of baseline at 30 and 60 minutes after bypass in the minimally invasive group versus 65% and 62% in the conventional control group (p = not significant); the stroke work end-diastolic length relationship was 78% and 71% of baseline in the minimally invasive group at these intervals versus 77% and 74% in the conventional control group (p = not significant). Myocardial temperatures were similar throughout bypass in the two groups, and ultrastructural examination of prebypass and postbypass biopsy specimens showed no differences between groups. These results demonstrate that minimally invasive cardiopulmonary bypass with cardioplegic arrest is as feasible, safe, and effective as conventional open chest cardiopulmonary bypass. Thus current technology may allow wider clinical application of closed chest cardiac surgery
— id: 6960, year: 1996, vol: 111, page: 556, stat: Journal Article,

Port-access coronary artery bypass grafting with cardioplegic arrest: A canine study
Schwartz, DS; Ribakove, GH; Grossi, EA; Buttenheim, PM; Schwartz, JD; Patel, SS; Baumann, FG; Colvin, SB; Galloway, AC
1996 OCT 15 ;94(8):295-295, Circulation
— id: 33441, year: 1996, vol: 94, page: 295, stat: Journal Article,

Autocrine regulation of vascular endothelial growth factor (VEGF) expression by fibroblast growth factor-2 (FGF-2)
Seghezzi, G; Patel, S; Pintucci, G; Galloway, A; Rifkin, D; Mignatti, P
1996 DEC ;7(3):2045-2045, Molecular biology of the cell
— id: 53358, year: 1996, vol: 7, page: 2045, stat: Journal Article,

Resuscitative retrograde blood cardioplegia. Are amino acids or continuous warm techniques necessary?
Asai T; Grossi EA; LeBoutillier M 3rd; Parish MA; Baumann FG; Spencer FC; Colvin SB; Galloway AC
1995 Feb;109(2):242-248, Journal of thoracic & cardiovascular surgery
This experiment was designed to determine the relative degree of cardiac functional recovery provided by various forms of resuscitative retrograde blood cardioplegia after global ischemic injury. Twenty-four dogs were subjected to 20 minutes of normothermic global myocardial ischemia followed by 60 minutes of cardioplegic arrest by one of three methods: group 1, standard cold blood cardioplegia with a cold terminal dose (n = 8); group 2, aspartate-glutamate-enhanced blood cardioplegia with warm induction and terminal enhancement (n = 8); and group 3, continuous warm blood cardioplegia (n = 8). Sonomicrometry was used to analyze left ventricular function for maximal elastance and preload recruitable stroke work area. Data were recorded at baseline and after 30 and 60 minutes of unloaded reperfusion. The results showed improved early recovery of preload recruitable stroke work area, but not of maximal elastance, after reperfusion of ischemic hearts with warm resuscitative blood cardioplegic solution enhanced with amino acids. The functional improvement provided by this technique was transient, however, and no significant differences were detectable among the groups after 60 minutes of unloaded reperfusion. Neither amino acid enhancement nor continuous warm cardioplegia offered a significant advantage in functional recovery over the standard method of cold blood cardioplegia reperfusion
— id: 6568, year: 1995, vol: 109, page: 242, stat: Journal Article,

Operative therapy for mitral insufficiency from coronary artery disease
Galloway AC; Grossi EA; Spencer FC; Colvin SB
1995 Oct;7(4):227-232, Seminars in thoracic & cardiovascular surgery
This report reviews the results of combined coronary bypass and Carpentier-type mitral valve reconstruction in 115 patients with ischemic mitral insufficiency. Overall operative mortality was 15.7%. Factors that increased operative risk in the overall valve repair population of 638 patients included ischemic etiology, previous cardiac surgery, NYHA functional classification, and age. Variables predicting increased risk of late cardiac death were ischemic etiology, concomitant procedures, and pulmonary hypertension. Late survival was diminished in ischemic patients, but 10-year freedom from reoperation was 93%, suggesting excellent durability after repair for ischemic mitral insufficiency. These results are compared with published reports of operative treatment for mitral insufficiency from coronary artery disease. Guidelines for use of coronary bypass alone versus coronary bypass in association with valve repair or replacement are developed. In most patients with moderate to severe mitral insufficiency secondary to coronary artery disease, the valvular pathology must be corrected, and valve repair with ring annuloplasty is the preferred method. Preoperative planning based on transesophageal echocardiography and cardiac catheterization data is essential for proper operative strategy, and attention to cardioplegia delivery and techniques to minimize reperfusion injury are necessary for optimal results. With these guidelines, late results are excellent after operative treatment for ischemic mitral insufficiency
— id: 56869, year: 1995, vol: 7, page: 227, stat: Journal Article,

Atrial spetal defects, atrioventricular canal defect and total anomalous pulmoarny venous return
Galloway AC; Spencer FC; Colvin SB
Surgery of the chest Philadelphia : Saunders, 1995,
— id: 3828, year: 1995, vol: , page: ?, stat: Chapter,

STATISTICAL APPROACH OF NEW-YORK CARDIAC REPORTING SYSTEM REQUIRES ADJUSTMENT
GREEN, J; WINTFELD, N; GROSSI, EA; BAUMANN, FG; RIBAKOVE, G; GALLOWAY, AC; COLVIN, SB; SPENCER, FC
1995 OCT 15 ;92(8):3089-3089, Circulation
— id: 33446, year: 1995, vol: 92, page: 3089, stat: Journal Article,

Endoventricular remodeling of left ventricular aneurysm. Functional, clinical, and electrophysiological results
Grossi EA; Chinitz LA; Galloway AC; Delianides J; Schwartz DS; McLoughlin DE; Keller N; Kronzon I; Spencer FC; Colvin SB
1995 Nov 1;92(9 Suppl):II98-I100, Circulation
BACKGROUND: Recent advances in surgical techniques for the repair of left ventricular aneurysms (LVAs) include the use of an endoventricular patch to exclude the aneurysm cavity. This technique has replaced conventional linear plication of the aneurysm. The endoventricular patch technique remodels the left ventricular cavity to a more physiological geometry that improves function. METHODS AND RESULTS: From December 1989 through November 1993, 45 patients underwent an LVA repair with an endoventricular patch. This procedure was performed in association with coronary artery bypass grafting in 40 patients. Twenty-eight patients (62.2%) also had nonguided encircling subendocardial incisions. Operative procedures included 7 emergency operations, 3 concomitant valve procedures, and a mean of 2.2 bypass grafts per patient. Eight patients had previous cardiac operations. Hospital mortality was 15.6% (7/45) for all patients and 9.1% (3/33) for nonemergent revascularization and LVA repairs. Ejection fraction improved from a mean of 25.8% preoperatively to 37.8% postoperatively; the mean New York Heart Association classification improved from 3.5 to 1.5. Of patients known to have preoperative arrhythmias (inducible or sudden death), 69% were not inducible postoperatively without antiarrhythmic medication. Survival from late cardiac death (including death of unknown origin) was 86.5% at 2 years. Freedom from documented ventricular arrhythmias was 94.3% at 2 years. CONCLUSIONS: These results indicate that the patch endoaneurysmorrhaphy technique can provide an excellent functional and physiological outcome in patients with LVAs and severely impaired ventricular function
— id: 56759, year: 1995, vol: 92, page: II98, stat: Journal Article,

Anterior leaflet procedures during mitral valve repair do not adversely influence long-term outcome
Grossi EA; Galloway AC; LeBoutillier M 3rd; Steinberg B; Baumann FG; Delianides J; Spencer FC; Colvin SB
1995 Jan;25(1):134-136, Journal of the American College of Cardiology
OBJECTIVES. This study was done to assess the impact of anterior mitral leaflet reconstructive procedures on initial and long-term results of mitral valve repair. BACKGROUND. It has been suggested that involvement of the anterior leaflet in mitral valve disease adversely affects the long-term outcome of mitral valve repair. Our policy has been to aggressively repair such anterior leaflets with procedures that include triangular resections in some cases. METHODS. From June 1979 through June 1993, 558 consecutive Carpentier-type mitral valve repairs were performed. The anterior mitral leaflet and chordae tendineae were repaired in 156 patients (mean age 58 years). The procedures included anterior chordal shortening in 78 patients (50%), anterior leaflet resections in 44 (28%), resuspension of the anterior leaflet to secondary chordae in 42 (27%) and anterior chordal transposition in 27 (17%). Concomitant cardiac surgical procedures were performed in 75 patients (48%). RESULTS. The operative mortality rate was 2.5% (2 of 81) for isolated mitral valve anterior leaflet repair and 3.8% (6 of 156) for all mitral valve anterior leaflet repair. Freedom from reoperation at 5 and 10 years was, respectively, 89.7% (n = 160) and 83.4% (n = 24) for the entire series of 558 patients, 91.9% (n = 51) and 81.2% (n = 10) for patients with anterior leaflet procedures, 88.8% (n = 109) and 84.4% (n = 14) for patients without anterior leaflet procedures and 91.7% (n = 118) and 88.9% (n = 18) for patients without rheumatic disease. Logistic regression showed that rheumatic origin of disease (odds ratio 2.99), but not anterior leaflet repair, increased the risk for reoperation. CONCLUSIONS. These results demonstrate that expansion of mitral valve techniques to include anterior leaflet disease yields immediate and long-term results equal to those seen in patients with posterior leaflet disease
— id: 6637, year: 1995, vol: 25, page: 134, stat: Journal Article,

Effect of cannula length on aortic arch flow: protection of the atheromatous aortic arch
Grossi EA; Kanchuger MS; Schwartz DS; McLoughlin DE; LeBoutillier M 3rd; Ribakove GH; Marschall KE; Galloway AC; Colvin SB
1995 Mar;59(3):710-712, Annals of thoracic surgery
Atheromatous disease in the transverse aortic arch is associated with an increased incidence of perioperative stroke. In addition, tissue erosion in the aortic arch is caused by the high-velocity jet emerging from an aortic cannula during cardiopulmonary bypass (CPB), termed the 'sandblast effect'. To quantify this phenomenon, flow in the aortic arch was measured intraoperatively by epiaortic ultrasonography in 18 patients undergoing CPB. All were cannulated in the ascending aorta, 10 with a short (1.5 cm) cannula and 8 with a long (7.0 cm) cannula. The peak forward aortic flow velocities (mean +/- standard deviation) measured on the caudal luminal surface of the aortic arch were 0.80 +/- 0.23 m/s off CPB and 2.42 +/- 0.69 m/s on CPB (p < 0.001) for the short cannula and 0.53 +/- 0.20 m/s off CPB and 0.18 m/s on CPB for the long cannula. Thus, during CPB the peak forward aortic flow velocity with the short cannula was significantly greater (p < 0.001) than before CPB, whereas the long cannula produced a lower peak forward aortic flow velocity during CPB. Furthermore, Doppler examination revealed severe turbulence in the aortic arch in all patients with a short cannula. No arch turbulence, however, was seen in 7 patients with a long cannula, and only mild turbulence appeared in the remaining patient with a long cannula. These results show that use of a long aortic cannula results in a significant decrease in peak forward aortic flow velocity and turbulence in the aortic arch during CPB, which may reduce the risk of erosion or disruption of existing atheroma and ensuing embolic complications
— id: 56874, year: 1995, vol: 59, page: 710, stat: Journal Article,

MITRAL-VALVE REPAIR IN THE ELDERLY
GROSSI, EA; GALLOWAY, AC; LEBOUTILLIER, M; STEINBERG, B; RIBAKOVE, G; DELIANIDES, J; BAUMANN, FG; SPENCER, FC; COLVIN, SB
1995 AUG ;3(4):269-272, Cardiology in the elderly
Aim: To document the short- and long-term effects of mitral valve reconstruction in patients 70 years of age and older. Recent favorable experience with mitral-valve reconstructive techniques has led to an attempt to apply them to elderly patients with mitral-valve defects, in the hope of improving ventricular function and freedom from complications in this higher-risk group. Methods: Between lune 1980 and June 1993, 160 consecutive mitral-valve reconstructions were performed using Carpentier techniques on patients 70 years of age and older (n=140 for 70-79 years, n=20 for greater than or equal to 80 years). All procedures were for either pure mitral regurgitation or mixed stenosis/regurgitation and involved placement of an annuloplasty ring. Concomitant cardiac operative procedures were performed in 109 patients (68%), including coronary bypass grafting in 67 (42%) and other valve procedures in 27 (17%). Results: Hospital mortality was 5.9% (three out of 51) for isolated mitral-valve reconstruction and 11.9% (19 out of 160) overall. Before surgery, 89.4% of the patients were in New York Heart Association (NYHA) class III or IV. At follow-up, 89.1% were in NYHA class I or II. In patients who underwent an isolated mitral-valve operation, cumulative freedom from cardiac death and reoperation, including hospital death, was 85.9% at 5 years. Conclusions: These results demonstrate that the encouraging results seen to date in younger patients who have undergone mitral-valve reconstruction can also be achieved in elderly patients
— id: 33445, year: 1995, vol: 3, page: 269, stat: Journal Article,

Effects of a single administration of fibroblast growth factor on vascular wall reaction to injury
Parish MA; Grossi EA; Baumann FG; Asai T; Rifkin DB; Colvin SB; Galloway AC
1995 Apr;59(4):948-954, Annals of thoracic surgery
Expansion of the vascular wall through formation of neointimal fibromuscular lesions is the basic mechanism underlying stenosis of vascular grafts, restenosis of arteries treated by balloon angioplasty, and other major cardiovascular problems. This study examined the effect of a single, systemic, low dose of basic fibroblast growth factor (bFGF) on formation of neointimal fibromuscular lesions in response to injury. New Zealand white rabbits (n = 76) were subjected to balloon injury of the abdominal aorta. Forty-five rabbits were given a single intravenous dose of bFGF (0.5 microgram/kg) immediately after injury, and 31 rabbits were given only the vehicle solution as controls. After 2 (n = 15), 5 (n = 21), 14 (n = 29), or 28 (n = 11) days the rabbits were sacrificed. Those rabbits receiving the single administration of bFGF exhibited significantly greater intimal thickening (intima/media ratio) than the control group at 5 days (mean +/- standard error of the mean, 0.091 +/- 0.009 versus 0.058 +/- 0.006; p < 0.002), but not at 14 or 28 days. These results were achieved without any significant differences in mitotic indices, as determined by a mitostatic method, between the two groups at any postinjury interval examined. The findings suggest that a single systemic dose of exogenous bFGF has a relatively long term effect on enhancing the neointimal response to vascular injury. Therefore, local control of endogenous bFGF may be useful in limiting formation of vascular neointimal fibromuscular lesions, thus improving the long-term results of vascular grafts, balloon angioplasty, and other cardiovascular procedures
— id: 56694, year: 1995, vol: 59, page: 948, stat: Journal Article,

MITOCHONDRIAL STEROL 27-HYDROXYLASE EXPRESSION AND CATALYTIC ACTIVITY IN HUMAN ARTERIAL ENDOTHELIUM
REISS, A; MARTIN, K; JAVITT, N; ROJER, D; IYER, S; GROSSI, E; GALLOWAY, A
1995 JAN ;8(1):63-63, Protein engineering
— id: 87244, year: 1995, vol: 8, page: 63, stat: Journal Article,

Acquired diseases of the mitral valve
Spencer FC; Galloway AC; Colvin SB
Surgery of the chest Philadelphia : Saunders, 1995,
— id: 3827, year: 1995, vol: , page: ?, stat: Chapter,

Heparin bonding of bypass circuits reduces cytokine release during cardiopulmonary bypass
Steinberg BM; Grossi EA; Schwartz DS; McLoughlin DE; Aguinaga M; Bizekis C; Greenwald J; Flisser A; Spencer FC; Galloway AC; et al.
1995 Sep;60(3):525-529, Annals of thoracic surgery
BACKGROUND. Heparin bonding of the cardiopulmonary bypass (CPB) pump circuit decreases complement activation and fibrinolysis. It is not known whether inflammatory cytokines produced during CPB can also be modulated by the more biocompatible heparin-coated circuit. METHODS. This initial study evaluated the impact of heparin-bonded CPB circuits on production of the cytokines interleukin-1 (IL-1), tumor necrosis factor-alpha (TNF-a), IL-6, and IL-8 in adults undergoing complex cardiac operations with prolonged CPB. Twenty patients had blood samples drawn immediately before and at hourly intervals after the start of CPB using either a conventional oxygenator and circuit (n = 14) or a covalently bonded heparin oxygenator and circuit (n = 6). Levels of IL-1, TNF-a, IL-6, and IL-8 were measured in all serum samples using a 'sandwich' enzyme-linked immunosorbent assay. RESULTS. The levels of IL-6 and IL-8 increased in a time-dependent fashion in both groups, but the response was significantly less over time in the heparin-bonded group (p < 0.05) for both IL-6 and IL-8. Levels of IL-1 and TNF-a were not significantly elevated with lengthening bypass interval in either group. CONCLUSIONS. These data indicate that the use of heparin-coated bypass pump circuits results in lower serum levels of the inflammatory cytokines IL-6 and IL-8 than standard circuits. Biocompatible materials that decrease the inflammatory response to CPB may ultimately reduce the morbidity associated with cardiac operations
— id: 56791, year: 1995, vol: 60, page: 525, stat: Journal Article,

EARLY CORRECTION OF COMPLETE ENDOCARDIAL CUSHION DEFECTS UTILIZING THE 2-PATCH TECHNIQUE - A 10-YEAR RETROSPECTIVE EXPERIENCE
GLICKSTEIN, JS; GROSSI, EA; PARISH, M; RUTKOWSKI, M; LANGSNER, A; DANILOWICZ, D; FRIEDMAN, DM; DOYLE, EF; BAUMANN, FG; GALLOWAY, AC; COLVIN, SB
1994 OCT ;12(2):87-92, Journal of cardiovascular ultrasonography
The goal of this study was to review the short-term and long- term results of aggressive corrective intervention in a consecutive series of patients with atrioventricular canal defects, especially with respect to minimizing progressive valvular insufficiency or pulmonary hypertension. A total of 46 consecutive patients with atrioventricular canal defects had operative repair between 1981 and 1991, using a two-patch technique in all but 4 patients. The median age was 8.5 months, with 29 patients (63%) < 1 year old. Left-to-right shunting was severe in all cases (mean Qp/Qs = 2.9:1), with a mean systolic pulmonary artery pressure of 63.6 mm Hg and a mean pulmonary vascular resistance of 4.03 Wood units. Preoperatively, 35 patients (76.1%) had moderate to severe congestive heart failure. Hospital mortality was 6.5% (3 patients), and the systolic pulmonary artery pressure dropped significantly in all cases, with a postrepair mean of 25.7 mm Hg. The 5 year actuarial survival rate was 70.3%. Late echocardiographic studies graded mitral insufficiency as 0-2+ in 41 patients (95.2%) and 3-4+ in 2 patients (4.6%); 2 patients required reoperation, and 41 (95.2%) were New York heart Association functional class I at follow-up. These data demonstrate excellent lat survival and functional results when complete atrioventricular canal correction is performed in infancy, despite significant preoperative pulmonary hypertension, valvular insufficiency, or symptoms. Prompt operative repair should be done for symptomatic patients and those with valvular incompetence; electrive repair is recommended before 1 year of age for most others
— id: 33450, year: 1994, vol: 12, page: 87, stat: Journal Article,

Thrombosis of a Starr-Edwards tricuspid prosthesis: diagnosis by Doppler echocardiography and treatment with thrombolysis
Glotzer TV; Tunick PA; Kloth H; Galloway AC; Kronzon I
1994 Mar;127(3):705-708, American heart journal
— id: 6385, year: 1994, vol: 127, page: 705, stat: Journal Article,

Severe calcification does not affect long-term outcome of mitral valve repair
Grossi EA; Galloway AC; Steinberg BM; LeBoutillier M 3rd; Delianides J; Baumann FG; Spencer FC; Colvin SB
1994 Sep;58(3):685-687, Annals of thoracic surgery
Some surgeons have suggested that the presence of severe calcification in the mitral valve annulus or leaflets precludes successful repair. Our institution has attempted to repair these calcified valves when good annular and leaflet mobility could be achieved by annular debridement and leaflet resection. From June 1979 through June 1993 558 mitral valve repairs were performed using Carpentier's techniques. When calcified valves were encountered, these techniques were modified to include annular debridement and mechanical leaflet decalcification. Calcification was identified preoperatively in 49 patients (8.8%) by either left ventricular fluoroscopy or echocardiography and was debrided in 64 patients (11.5%). This included 24 annular debridements, 28 leaflet debridements, and 12 annular and leaflet debridements. Patient ages ranged from 13 to 83 years (mean age, 62.3 years), and 25 patients (39.1%, 25/64) had concomitant cardiac procedures. Operative mortality was 6.2% (4/64) overall and 2.6% (1/39) for isolated mitral valve repairs. Calcium debridement was performed in 19.3% (23/119) of patients with a rheumatic cause compared with 9.3% (41/439) of the nonrheumatic patients (p < 0.01). Long-term follow-up revealed the necessity for reoperation in 7.8% (5/64) in patients with calcium debridement as compared with 7.7% (38/494) with no debridement (p = not significant). Cumulative freedom from reoperation at 10 years was 83.3% for all patients, 88.1% for debrided patients, and 82.6% for nondebrided patients (p = not significant). Cox proportional hazards analysis revealed that the presence of rheumatic disease significantly increased the risk of reoperation (odds ratio = 3.28; p < 0.001), whereas calcium debridement had no significant effect. These results demonstrate that when good annulus and leaflet motion can be achieved in calcified mitral valves, calcium debridement allows durable repairs
— id: 56649, year: 1994, vol: 58, page: 685, stat: Journal Article,

Decreasing incidence of systolic anterior motion after mitral valve reconstruction
Grossi EA; Steinberg BM; LeBoutillier M 3rd; Ribacove G; Spencer FC; Galloway AC; Colvin SB
1994 Nov;90(5 Pt 2):II195-II197, Circulation
BACKGROUND: With the widespread application of mitral valve reconstructive techniques, systolic anterior motion (SAM) of the anterior mitral leaflet causing left ventricular outflow tract obstruction has been recognized by several groups. SAM occurred in 9.1% of the first 441 patients operated on for mitral valve reconstruction at our institution. Fortunately, SAM subsided with medical therapy within 1 year for a majority of patients as reported in May 1993. Some surgeons, however, have considered abandoning repair for prosthetic replacement after SAM was detected on intraoperative echocardiogram. METHODS AND RESULTS: Since June 1991, a triangular anterior leaflet resection has been cautiously evaluated in patients with extensive anterior leaflet tissue. This has been performed in 23 of 119 patients. CONCLUSIONS: The frequency of SAM in the 119 study patients has decreased from 9.1% to 3.4%
— id: 56650, year: 1994, vol: 90, page: II195, stat: Journal Article,

ENDOVENTRICULAR REMODELING FOR LV ANEURYSM - FUNCTIONAL AND ELECTROPHYSIOLOGICAL RESULTS
GROSSI, EA; CHINITZ, LA; GALLOWAY, AC; DELIANIDES, J; KRONZON, I; SPENCER, FC; COLVIN, SB
1994 OCT ;90(4):640-640, Circulation
— id: 33449, year: 1994, vol: 90, page: 640, stat: Journal Article,

ANTERIOR LEAFLET PROCEDURES DURING MITRAL REPAIR DO NOT ADVERSELY INFLUENCE LONG-TERM OUTCOME
GROSSI, EA; GALLOWAY, AC; LEBOUTILLIER, M; STEINBERG, B; DELIANIDES, J; SPENCER, FC; COLVIN, SB
1994 FEB ;90(5):A277-A277, Journal of the American College of Cardiology
— id: 33447, year: 1994, vol: 90, page: A277, stat: Journal Article,

MITRAL-VALVE REPAIR IN THE ELDERLY
GROSSI, EA; GALLOWAY, AC; LEBOUTILLIER, M; STEINBERG, B; ESPOSITO, R; CULLIFORD, AT; SPENCER, FC; COLVIN, SB
1994 FEB ;90(5):A465-A465, Journal of the American College of Cardiology
— id: 33448, year: 1994, vol: 90, page: A465, stat: Journal Article,

Effect of retrograde warm continuous cardioplegia on right ventricular function
LeBoutillier M 3rd; Grossi EA; Steinberg BM; Baumann FG; Colvin SB; Spencer FC; Galloway AC
1994 Nov;90(5 Pt 2):II306-II309, Circulation
BACKGROUND: Although retrograde warm continuous cardioplegia (RWCC) has been recently advocated as a method of myocardial preservation during cardiac surgery, scant data exist on the effects of RWCC on right ventricular function. However, previous data have clearly shown that retrograde cardioplegia is poorly distributed to the right ventricle and interventricular septum. This experiment was performed to analyze functional preservation of the right ventricle after RWCC. METHODS AND RESULTS: Fourteen mongrel dogs were instrumented with sonomicrometers and pressure transducers to determine left and right ventricular (LV, RV) pressure-volume relationships and placed on cardiopulmonary bypass. All dogs underwent 90 minutes of aortic cross-clamping with either (1) RWCC (n = 7) after antegrade warm arrest or (2) retrograde cold multidose cardioplegia (RCMC) (n = 7) with topical hypothermia after antegrade cold arrest. All dogs received identical blood cardioplegia solutions. Ventricular function was measured before arrest and 30 and 60 minutes after unclamping. The end-diastolic-work area relationship was calculated, and the slope is presented as percent of baseline (mean +/- SEM; repeated measures ANOVA). At 30 minutes after unclamping, RWCC provided 68.77 +/- 9.09 for the left ventricle and 41.03 +/- 7.49 (P < .05 for RWCC versus RCMC for RV function at 30 minutes) for the right ventricle, and RCMC provided 62.80 +/- 7.23 for the left ventricle and 79.40 +/- 13.82 for the right ventricle. At 60 minutes after unclamping, RWCC provided 58.24 +/- 12.35 for the left ventricle and 48.05 +/- 9.72 for the right ventricle, and RCMC provided 65.38 +/- 6.76 for the left ventricle and 61.95 +/- 8.70 for the right ventricle. (P = NS for RWCC versus RCMC for LV function at either 30 or 60 minutes). These results demonstrate depressed recovery of RV function after 90 minutes of RWCC (P < .05 at 30 minutes after reperfusion) compared with RCMC. No difference in recovery of LV function was detected. CONCLUSION: RWCC may be harmful to the right ventricle and should be used with caution, particularly in patients with preexisting RV hypertrophy
— id: 56671, year: 1994, vol: 90, page: II306, stat: Journal Article,

Mammary artery versus saphenous vein grafts: assessment of basic fibroblast growth factor receptors
Nguyen HC; Grossi EA; LeBoutillier M 3rd; Steinberg BM; Rifkin DB; Baumann FG; Colvin SB; Galloway AC
1994 Aug;58(2):308-310, Annals of thoracic surgery
Neointimal hyperplasia limits the long-term patency of saphenous vein grafts (SVGs), but is notably absent from most internal mammary artery (IMA) grafts. Basic fibroblast growth factor (bFGF) is a local endothelial and vascular smooth muscle mitogen known to be involved in the pathogenesis of neointimal hyperplasia. This study used an animal model to compare the number of available high-affinity (HAR) and low-affinity (LAR) bFGF receptors in SVGs and IMA grafts and to determine whether distention injury causes an increase in receptor availability. The IMA and SVG specimens were harvested from 12 dogs and distended at 25 or 200 mm Hg for 15 minutes, and then the bFGF receptor uptake was measured in them using iodine 125-labeled bFGF. In the IMA conduits distended at low pressure, there were 2.54 +/- 0.10 (mean +/- standard error of the mean) HARs per mm2 of intimal surface area available and 5.19 +/- 0.40 LARs per mm2. High-pressure distention significantly (p < 0.001) increased the number of available HARs to 5.06 +/- 0.27 per mm2 and of LARs to 7.27 +/- 0.042 per mm2. At low pressure, the SVGs had significantly (p < 0.001) more HARs (9.14 +/- 0.84 per mm2) and LARs (18.2 +/- 0.57 per mm2) available than did the IMA conduits, and high pressure significantly (p < 0.001) increased the number of HARs available in SVGs to 24.1 +/- 2.43 per mm2 and the number of LARs to 44.7 +/- 2.34 per mm2.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 12923, year: 1994, vol: 58, page: 308, stat: Journal Article,

Suppression of neointimal lesions after vascular injury: a role for polyclonal anti-basic fibroblast growth factor antibody
Nguyen HC; Steinberg BM; LeBoutillier M 3rd; Baumann FG; Rifkin DB; Grossi EA; Galloway AC
1994 Aug;116(2):456-461, Surgery
BACKGROUND. Basic fibroblast growth factor (bFGF) is a potent local promoter of vascular smooth muscle cell migration and proliferation and may play a major role in the pathogenesis of intimal fibromuscular lesions. Preliminary studies have shown that exogenous bFGF localizes to injured rabbit aorta and suggest that this interaction might be inhibited by anti-bFGF immunoglobulin (Ig) G. This study was designed to evaluate the possible role of polyclonal anti-bFGF IgG in reducing intimal fibromuscular lesion formation in the injured rabbit aorta. METHODS. The abdominal aortic endothelium was subjected to balloon injury in 13 rabbits. Six rabbits received intravenous rabbit anti-bFGF IgG, and seven received irrelevant rabbit IgG (16 micrograms/kg) 30 minutes before injury and daily for 5 days after injury. At 14 days after injury the aorta was fixed and sectioned, and the intimal and medial areas were measured by computerized digital morphometry with the intimal/medial ratio as an index of neointimal lesion formation. RESULTS. In the control group the intimal/medial ratio was 0.538 +/- 0.046 (mean +/- SEM), which was significantly greater than the anti-bFGF-treated group value of 0.148 +/- 0.021 (p < 0.001). CONCLUSIONS. These results show that daily doses of intravenous polyclonal anti-bFGF IgG for 5 days after balloon aortic injury significantly inhibit intimal fibromuscular lesion formation at 14 days. The results suggest that the process of intimal fibromuscular lesion formation may be susceptible to modification by antagonists to bFGF
— id: 12925, year: 1994, vol: 116, page: 456, stat: Journal Article,

Sterol 27-hydroxylase: high levels of activity in vascular endothelium
Reiss AB; Martin KO; Javitt NB; Martin DW; Grossi EA; Galloway AC
1994 Jun;35(6):1026-1030, Journal of lipid research
Sterol 27-hydroxylase activity in bovine aortic endothelial (BAE) cells in culture has been compared with that in HepG2 cells and in Chinese hamster ovary (CHO) cells using identical culture conditions. The total enzyme activity of BAE cells (3.0 nmol/72 h per mg cell protein) was comparable with that of HepG2 cells (4.0 nmol/72 h per mg protein) and both values were significantly greater than that in CHO cells (0.002 nmol/72 h per mg protein). The enzyme was identified in the mitochondria extracted from BAE cells by Western blotting using an antibody of proven specificity, and its metabolites 27-hydroxycholesterol and 3 beta-hydroxy-5-cholestenoic acid were identified by mass spectrum analysis. The presence of the enzyme in endothelium provides a mechanism for preventing accumulation of intracellular cholesterol by initiating a pathway of bile acid synthesis different from that initiated by 7 alpha-hydroxylation of cholesterol in the liver
— id: 57476, year: 1994, vol: 35, page: 1026, stat: Journal Article,

Role of amino acids and enhancement cardioplegia in routine myocardial protection. Experimental results
Crooke GA; Harris LJ; Grossi EA; Baumann FG; Esposito R; Spencer FC; Colvin SB; Galloway AC
1993 Sep;106(3):497-501, Journal of thoracic & cardiovascular surgery
The purpose of this study was to determine the effects of the addition of amino acids to blood cardioplegic solution and the value of terminal cardioplegia enhancement techniques in routine myocardial protection. Forty-five open-chest adult dogs were instrumented with sonomicrometry crystals to measure left ventricular long axis, midequatorial short axis, and wall thickness. The aorta was clamped for 120 minutes of cardiopulmonary bypass. Animals were randomly separated into four myocardial protection groups: (1) blood cardioplegic solution with amino acids and no terminal cardioplegia (n = 12); (2) blood cardioplegic solution with amino acids and warm amino acid terminal cardioplegia (n = 11); (3) blood cardioplegic solution with amino acids and cold amino acid terminal cardioplegia (n = 12); and (4) blood cardioplegic solution plus cold terminal cardioplegia (no amino acids, n = 10). Data for preload recruitable stroke work were obtained by inflow occlusion before bypass (baseline) and at 30 and 60 minutes after reperfusion and analyzed for changes in x-intercept and slope. A significant rightward shift in x-intercept did not occur in any group. When cardiac function was expressed as a percentage of baseline preload recruitable stroke work slope, improved functional recovery was seen at both 30 and 60 minutes in groups 2 (88.6% and 91.8%), 3 (85.8% and 86.9%), and 4 (88.6% and 92.6%) compared with group 1 (77.3% and 79.2%, p < 0.05). No significant difference was found in the degree of functional recovery among groups 2, 3, and 4. These results suggest that for myocardial protection of 2 hours in nonischemic hearts, a terminal dose of blood cardioplegic solution before unclamping is beneficial, but this positive effect is independent of amino acid supplementation and temperature
— id: 13079, year: 1993, vol: 106, page: 497, stat: Journal Article,

Surgical repair of type A aortic dissection by the circulatory arrest-graft inclusion technique in sixty-six patients
Galloway AC; Colvin SB; Grossi EA; Parish MA; Culliford AT; Asai T; Rofsky NM; Weinreb JC; Shapiro S; Baumann FG; et al
1993 May;105(5):781-788, Journal of thoracic & cardiovascular surgery
During an 8-year period (1984 to 1991) 66 patients (mean age 59 years, range 26 to 84 years) with type A aortic dissection (60 ascending aorta tears, 6 arch tears; 35 acute, 31 chronic) had surgical repair by a continuous suture-graft inclusion technique. Hypothermic circulatory arrest (16 degrees C) was used in 58 patients (35/35 acute, 23/31 chronic; mean arrest time 26 minutes, range 10 to 55 minutes). Fifty-two patients had hemiarch repair and 6 had total arch replacement. Aortic valve disease necessitated treatment in 38 patients (1 valved conduit, 20 valve replacements, 17 valve repairs). Recently 11 patients had valve repair by reconstruction of the native aortic root, by means of techniques similar to those used for homograft valve insertion. Operative mortality was 9% (14% acute, 3% chronic). Stroke occurred in 2 patients (3%) and was fatal in both. Variables suggestive of increased operative risk by univariate analysis were acuteness (p = 0.12), visceral ischemia (p = 0.12), and preoperative shock (p = 0.13). No variable was significant by multivariate analysis. Overall actuarial survival at 48 months was 77%, with 3 late deaths from a ruptured distal aneurysm. Late computed tomography or magnetic resonance imaging scan was done in 28 patients at a mean interval of 33 months. These studies identified 1 patient with a pseudoaneurysm requiring reoperation and 3 patients with contained flow between the graft and the wrap. Three patients required late operation: 1 for pseudoaneurysm, 1 for arch dissection, and 1 for repair of a distal aneurysm
— id: 13173, year: 1993, vol: 105, page: 781, stat: Journal Article,

Acquired heart disease
Galloway AC; Colvin SB; Spencer FC
Principles of surgery New York : McGraw-Hill, 1993,
— id: 3825, year: 1993, vol: , page: ?, stat: Chapter,

Congenital heart disease
Galloway AC; Colvin SB; Spencer FC
Principles of surgery New York : McGraw-Hill, 1993,
— id: 3824, year: 1993, vol: , page: ?, stat: Chapter,

Diseases of great vessels
Galloway AC; Colvin SB; Spencer FC
Principles of surgery New York : McGraw-Hill, 1993,
— id: 3823, year: 1993, vol: , page: ?, stat: Chapter,

Acute myocardial infarction
Galloway AC; Feit F; Eiseman B
Surgical decision making Philadelphia : Saunders, 1993,
— id: 3816, year: 1993, vol: , page: ?, stat: Chapter,

LONG-TERM FOLLOW-UP OF 516 PATIENTS WITH CARPENTIER-TYPE MITRAL CARPENTIER TECHNIQUES
GALLOWAY, AC; GROSSI, EA; ESPOSITO, R; RIBAKOVE, GH; SPENCER, FC; COLVIN, SB
1993 OCT ;88(4):539-539, Circulation
— id: 33452, year: 1993, vol: 88, page: 539, stat: Journal Article,

Direct-current injury from external pacemaker results in tissue electrolysis
Grossi EA; Parish MA; Kralik MR; Glassman LR; Esposito RA; Ribakove GH; Galloway AC; Colvin SB
1993 Jul;56(1):156-157, Annals of thoracic surgery
In two patients undergoing open heart operations, electrochemical burns developed at the sites of connection to an external pacing system. Investigation revealed that failure of the pacing generator caused a small, continuous, direct current to pass through the patients, resulting in electrolysis at the sites of contact with the pacing and grounding wires. This electrolytic reaction was recreated in a mock pacing system and resulted in tissue injury and disintegration of the pacing wire. Guidelines to help recognize and prevent this complication are presented
— id: 57398, year: 1993, vol: 56, page: 156, stat: Journal Article,

DECREASING INCIDENCE OF SYSTOLIC ANTERIOR MOTION AFTER MITRAL-VALVE REPAIR
GROSSI, E; LEBOUTILLIER, M; GALLOWAY, A; RIBAKOVE, G; STEINBERG, B; SPENCER, F; COLVIN, S
1993 OCT ;88(4):574-574, Circulation
— id: 52205, year: 1993, vol: 88, page: 574, stat: Journal Article,

STERNAL WOUND INFECTIONS AND INTERNAL MAMMARY ARTERY GRAFTS - REPLY
GROSSI, EA; ESPOSITO, RA; GALLOWAY, A; BAUMANN, G
1993 JUL ;106(1):182-182, Journal of thoracic & cardiovascular surgery
— id: 33453, year: 1993, vol: 106, page: 182, stat: Journal Article,

SVC syndrome as a late complication of ascending aortic aneurysm repair: MR diagnosis
Haddad JL; Rofsky NM; Weinreb JC; Galloway AC
1993 Nov-Dec;17(6):982-985, Journal of computer assisted tomography
Imaging evaluation is important in the follow-up of patients who have undergone surgical repair of the aorta. We present a case in which MR imaging demonstrated compression of the superior vena cava (SVC) as a late complication of ascending aortic aneurysm surgery. This complication led to thrombosis and clinical SVC syndrome
— id: 6400, year: 1993, vol: 17, page: 982, stat: Journal Article,

EFFECT OF RETROGRADE WARM CONTINUOUS CARDIOPLEGIA ON RIGHT-VENTRICULAR FUNCTION
LEBOUTILLIER, M; GROSSI, E; STEINBERG, B; NGUYEN, H; GALLOWAY, A; COLVIN, S
1993 OCT ;88(4):288-288, Circulation
— id: 52204, year: 1993, vol: 88, page: 288, stat: Journal Article,

Aortic aneurysm and dissection: normal MR imaging and CT findings after surgical repair with the continuous-suture graft-inclusion technique
Rofsky NM; Weinreb JC; Grossi EA; Galloway AC; Libes RB; Colvin SB; Naidich DP
1993 Jan;186(1):195-201, Radiology
The normal range of postoperative imaging findings are described in 34 asymptomatic patients studied 5-66 months (mean, 28 months) after undergoing the continuous-suture graft-inclusion technique for repair of aortic aneurysms (n = 20) and dissections (n = 14) involving the ascending aorta. All 34 patients underwent magnetic resonance (MR) imaging, and 24 patients also underwent computed tomography (CT). Perigraft thickening was seen in 19 patients (56%) with MR imaging and in eight patients (33%) with CT. Flow outside the graft but contained within the native wrap was noted in five patients (15%) with MR imaging and in four patients (17%) with contrast material-enhanced CT. Thrombus was identified outside the graft and within the wrap in seven patients (21%) with MR imaging and in six patients (25%) with CT. Mass effect on the graft was depicted in four patients (12%) with MR imaging and in three patients (13%) with CT. Of the 14 patients who underwent repair of aortic dissections, an intimal flap was seen distal to the graft in seven of the 14 (50%) evaluated with MR imaging and in four of the 10 (40%) evaluated with contrast-enhanced CT. An accurate postoperative imaging evaluation requires precise knowledge of the surgical technique performed and its anatomic consequences
— id: 13311, year: 1993, vol: 186, page: 195, stat: Journal Article,

Coronary artery bypass
Spencer FC; Galloway AC; Colvin SB
Principles of surgery New York : McGraw-Hill, 1993,
— id: 3826, year: 1993, vol: , page: ?, stat: Chapter,

Treatment of AIDS-related bronchopleural fistula by pleurectomy [see comments]
Crawford BK; Galloway AC; Boyd AD; Spencer FC
1992 Aug;54(2):212-214, Annals of thoracic surgery
Spontaneous pneumothorax in patients with acquired immunodeficiency syndrome (AIDS) may require prolonged therapy for treatment of a persistent bronchopleural fistula, and treatment by standard methods often fails. This pilot study was done to test the effectiveness of aggressive surgical therapy for definitive treatment of persistent bronchopleural fistula in patients with AIDS. Between March 1989 and September 1991, 44 patients with AIDS were treated for spontaneous pneumothorax with closed tube thoracostomy; 14 of these patients had development of persistent bronchopleural fistula for more than 10 days, and 2 patients had subsequent bronchopleural fistula on the opposite side. Operative therapy in 14 patients included 15 thoracotomies and one sternotomy. The bronchopleural fistula was closed directly with suture or staples in 15 procedures and resected by lobectomy in 1 patient. All 14 patients received adjuvant parietal pleurectomy. Operative mortality was 7% (1 of 14 patients). The fistula was closed in all survivors and 13 patients were discharged between 7 and 28 days postoperatively. Pathologic examination confirmed Pneumocystis carinii in 13 patients with a high incidence of diffuse involvement and subpleural necrosis, further demonstrating the need for pleurectomy. These data suggest that in selected patients bronchopleural fistulas associated with AIDS can be effectively controlled by surgical closure combined with pleurectomy
— id: 13482, year: 1992, vol: 54, page: 212, stat: Journal Article,

Results of urgent or emergency repair for symptomatic infants under one year of age with single or multiple ventricular septal defect
Danilowicz D; Presti S; Colvin S; Galloway A; Langsner A; Doyle EF
1992 Mar 1;69(6):699-701, American journal of cardiology
— id: 13683, year: 1992, vol: 69, page: 699, stat: Journal Article,

Multiple valve operation for advanced valvular heart disease: results and risk factors in 513 patients [published erratum appears in J Am Coll Cardiol 1992 Jun;19(7):1677-8]
Galloway AC; Grossi EA; Baumann FG; LaMendola CL; Crooke GA; Harris LJ; Colvin SB; Spencer FC
1992 Mar 15;19(4):725-732, Journal of the American College of Cardiology
To assess the results and incremental risk factors affecting outcome after multiple-valve operation in the early blood cardioplegia era of cardiac surgery, follow-up data (mean +/- SD 3.1 +/- 2 years) were obtained on 97% of 513 patients (mean age +/- SD 58.8 +/- 10.5 years) who underwent a multiple-valve procedure between June 1976 and August 1985. Preoperatively 41% of patients were in New York Heart Association functional class III and 54% in class IV. Three groups accounted for 98.6% of the patients: 57.7% had an aortic and mitral valve procedure, 29% had a mitral and tricuspid valve procedure and 11.9% had a triple-valve procedure. The overall hospital mortality rate was 12.5% and overall 5-year survival rate was 67.1%. Hazard function analysis for all deaths revealed systolic pulmonary artery pressure (p less than 0.0001), age (p = 0.005), triple valve procedure (p less than 0.005), concomitant coronary bypass operation (p less than 0.005) and prior cardiac surgery (p less than 0.002) as the significant incremental risk factors predicting decreased survival in the early hazard phase; diabetes (p less than 0.005) predicted decreased survival in the late hazard phase. Postoperatively the condition of 80% of the patients improved to functional class I or II; only 0.6% remained in functional class IV. The 5-year rate of freedom from late combined valve-related morbidity was 81.7% and that of freedom from late combined valve-related morbidity and mortality was 71.7%. These results demonstrate excellent clinical improvement and late survival after multiple valve operation in patients with advanced valvular heart disease, justifying aggressive surgical therapy in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 13657, year: 1992, vol: 19, page: 725, stat: Journal Article,

Experience with twenty-eight cases of systolic anterior motion after mitral valve reconstruction by the Carpentier technique
Grossi EA; Galloway AC; Parish MA; Asai T; Gindea AJ; Harty S; Kronzon I; Spencer FC; Colvin SB
1992 Mar;103(3):466-470, Journal of thoracic & cardiovascular surgery
Systolic anterior motion of the mitral valve with left ventricular outflow tract obstruction after Carpentier-type mitral reconstruction with ring annuloplasty has led some surgeons to abandon an otherwise successful repair or to avoid use of a rigid ring. To assess the long-term significance of such motion, we studied 439 patients undergoing Carpenter mitral reconstruction at our institution between March 1981 and June 1990. The hospital mortality rate was 4.8% (21/439) overall and 3.7% (9/243) for isolated mitral reconstruction. Systolic anterior motion was found in 6.4% (28/438) after the operation, and 2.3% (10/438) had a coexisting left ventricular outflow tract gradient (mean 53 mm Hg). Of the 28 patients with systolic anterior motion, 27 (96.4%) had leaflet prolapse, 17 (60.7%) had undergone more than a 3 cm resection of the posterior leaflet, and two (7.1%) had preexisting idiopathic hypertrophic subaortic stenosis. All patients were treated medically, 14 with negative inotropic agents. Follow-up echocardiograms at a mean of 32 months demonstrated the disappearance of systolic anterior motion in 13 of 28 patients (46.4%) and resolution of the outflow tract gradient in 10 of 10 (100%). At follow-up only one patient was in New York Heart Association class III or IV and required reoperation for rheumatic mitral insufficiency. These data demonstrate that systolic anterior motion after Carpentier mitral reconstruction with ring annuloplasty is not prevalent and should be managed medically in most cases. Associated left ventricular outflow tract obstruction resolves with medical treatment
— id: 13676, year: 1992, vol: 103, page: 466, stat: Journal Article,

The effects of different techniques of internal mammary artery harvesting on sternal blood flow
Parish MA; Asai T; Grossi EA; Esposito R; Galloway AC; Colvin SB; Spencer FC
1992 Nov;104(5):1303-1307, Journal of thoracic & cardiovascular surgery
We investigated chest wall blood flow in a canine model to determine if the technique used to harvest the mammary artery has a differential effect on residual chest wall blood flow. Eight dogs underwent bilateral internal mammary artery mobilization; one artery was harvested as a pedicle and the other was harvested as a skeletonized vessel. Residual blood flow to the chest wall distribution of each artery was measured with radioactive microspheres. Chest wall blood flow was significantly decreased from preharvest levels after internal mammary artery mobilization regardless of the technique used. Tissue blood flows decreased to 46.9%, 22.1%, and 41.2% of baseline values for the manubrium (p < 0.01), sternum (p < 0.001), and ribs (p < 0.05), respectively. Residual sternal blood flow on the side of the skeletonized vessel was significantly greater than on the side of the pedicle graft (2.60 +/- 0.68 versus 1.27 +/- 0.27 cm3/min/100 gm, p < 0.001). We conclude that minimization of tissue mobilization during internal mammary artery harvesting may reduce sternal devascularization. This finding may have clinical significance with respect to lowering the incidence of sternal wound complications in coronary bypass surgery using the internal mammary artery as a bypass conduit
— id: 13375, year: 1992, vol: 104, page: 1303, stat: Journal Article,

Surgical implications of transesophageal echocardiography to grade the atheromatous aortic arch
Ribakove GH; Katz ES; Galloway AC; Grossi EA; Esposito RA; Baumann FG; Kronzon I; Spencer FC
1992 May;53(5):758-761, Annals of thoracic surgery
Stroke is an especially serious complication of cardiopulmonary bypass with an incidence of 2% to 5%. This prospective study used transesophageal echocardiography (TEE) in 97 patients more than 65 years of age (mean age, 73 years) to identify those at high risk for aortic atheroemboli. The atheromatous disease of the aorta was graded by TEE: grade I = minimal intimal thickening (n = 29); II = extensive intimal thickening (n = 33); III = sessile atheroma (n = 15); IV = protruding atheroma (n = 10); V = mobile atheroma (n = 10). Clinical evaluation was also performed by intraoperative aortic palpation. Four patients who were graded as having normal aortas by palpation had intraoperative strokes. In contrast, 3 of these 4 patients were in grade V on TEE. The relationship of TEE to incidence of stroke was statistically significant (p less than 0.006), whereas there was no significant correlation between clinical grade and stroke incidence. Four of 10 TEE grade V patients were treated with hypothermic circulatory arrest and aortic arch debridement, and none suffered strokes. The other 6 patients were treated with standard techniques, and 3 had strokes. These results suggest that patients with mobile atheromatous disease are at high risk for embolic strokes that are not predicted by routine clinical evaluation. Selective use of circulatory arrest in the presence of TEE-detected mobile arch atheromas may reduce the risk of intraoperative stroke
— id: 13614, year: 1992, vol: 53, page: 758, stat: Journal Article,

Biventricular distribution of cold blood cardioplegic solution administered by different retrograde techniques
Crooke GA; Harris LH; Grossi EA; Baumann FG; Galloway AC; Colvin SB
1991 Oct;102(4):631-637, Journal of thoracic & cardiovascular surgery
Although retrograde cardioplegia has been shown to provide adequate overall protection to the myocardium, delivery of cardioplegic solution to the right ventricle and septum is poor. We used an animal model of occlusion of the left anterior descending coronary artery to study the effects of modifying the conditions of retrograde cardioplegia administration on delivery to the right and left ventricles. Adult mongrel dogs (n = 12) were each given five retrograde injections of microsphere-labeled cardioplegic solution at 10-minute intervals. Four injections were made directly into the coronary sinus with ostial balloon occlusion at the following dosages and pressures: (1) 10 ml/kg at 30 mm Hg, (2) 20 ml/kg at 30 mm Hg, (3) 10 ml/kg at 50 mmHg, and (4) 20 ml/kg at 50 mm Hg. A fifth dose (20 ml/kg) was given directly into the right atrium at 50 mm Hg. Delivery of cardioplegic solution to the left and right ventricles was significantly reduced when the right atrial route was compared with the coronary sinus route at the same dosage and pressure (for left ventricle, 6.0% +/- 1.4% versus 22.7% +/- 11.4%/100 gm, p less than 0.001; for right ventricle, 0.7% +/- 0.2% versus 4.1% +/- 0.4%/100 gm, p less than 0.001). Septal delivery was less than that to the anterior and posterior left ventricle (10.4% +/- 1.3% versus 30.3% +/- 3.9% and 27.9% +/- 3.1%/100 gm, p less than 0.0001) for all injections. Delivery to the body of the right ventricle was less than that to the inflow and outflow tracts (1.8% +/- 0.2% versus 4.5% +/- 0.7% and 8.4% +/- 1.5%/100 gm, p less than 0.0001). These results indicate that, in this model, (1) the right atrial route provides less overall cardioplegic solution to both ventricles than direct retrograde coronary sinus cardioplegia and (2) regional abnormalities in distribution with direct retrograde coronary sinus cardioplegia are not affected by changes in the dosage or pressure of injection
— id: 13879, year: 1991, vol: 102, page: 631, stat: Journal Article,

Aortic valve replacement for aortic stenosis in persons aged 80 years and over
Culliford AT; Galloway AC; Colvin SB; Grossi EA; Baumann FG; Esposito R; Ribakove GH; Spencer FC
1991 Jun 1;67(15):1256-1260, American journal of cardiology
Seventy-one patients aged greater than or equal to 80 years (mean +/- standard deviation 82 +/- 2) with aortic stenosis or mixed stenosis and regurgitation underwent aortic valve replacement alone (n = 35, group 1) or in combination with a coronary artery bypass procedure without any other valve procedure (n = 36, group 2). Preoperatively, 91% had severe cardiac limitations (New York Heart Association class III or IV). Hospital mortality was 12.7% overall (9 of 71), 5.7% (2 of 35) for group 1 and 19.4% (7 of 36) for group 2. Perioperatively, 1 patient (1.4%) had a stroke. Survival from late cardiac death at 1 and 3 years was 98.2 and 95.5%, respectively, for all patients, 100% for patients who underwent isolated aortic valve replacement, and 96.3 and 91.2%, respectively, for patients who underwent aortic valve replacement plus coronary artery bypass. Eighty-three percent of surviving patients had marked symptomatic improvement. Freedom from all valve-related complications (thromboembolism, anticoagulant, endocarditis, reoperation or prosthetic failure) was 93.3 and 80.4% at 1 and 3 years, respectively. Thus, short- and long-term morbidity and mortality after aortic valve replacement for aortic stenosis in patients aged greater than or equal to 80 years are encouragingly low, although the addition of coronary artery bypass grafting increases short- and long-term mortality
— id: 14001, year: 1991, vol: 67, page: 1256, stat: Journal Article,

Repair of posterior left ventricular aneurysm in a six-year-old boy
Grossi EA; Colvin SB; Galloway AC; Rutkowski M; Doyle EF; Crooke GA; Spencer FC
1991 Mar;51(3):484-487, Annals of thoracic surgery
Left ventricular aneurysms and diverticula are rarely encountered in the pediatric age group. This paper reports a case of congestive heart failure and mitral regurgitation in a 6-year-old boy with a large posterolateral left ventricular aneurysm. Complete repair was successfully performed by excision of the aneurysm and Dacron patch reconstruction of the left ventricular free wall. The patch extended onto the posterior annulus of the mitral valve, thus restoring the mitral valve to normal geometry and correcting the mitral insufficiency. The surgical literature on congenital cardiac diverticula and acquired aneurysms in children is reviewed and summarized
— id: 14116, year: 1991, vol: 51, page: 484, stat: Journal Article,

Sternal wound infections and use of internal mammary artery grafts [see comments]
Grossi EA; Esposito R; Harris LJ; Crooke GA; Galloway AC; Colvin SB; Culliford AT; Baumann FG; Yao K; Spencer FC
1991 Sep;102(3):342-346, Journal of thoracic & cardiovascular surgery
Previous studies have provided conflicting evidence as to whether an increased risk of mediastinitis is associated with use of the internal mammary artery as a coronary bypass graft. In this study the effects of internal mammary artery grafts on wound complications were analyzed in a prospective, nonrandomized fashion. At New York University Medical Center from January 1985 through May 1988, 2356 patients underwent isolated coronary revascularization. Among these patients 1394 received one or more internal mammary artery grafts (group I) and 962 had vein grafts only (group II). Group I had a mean age of 59.5 years versus 67.7 years in group II; diabetes was equally present in both groups (22.7% versus 24.7%). Operative mortality rate was 1.3% in group I and 5.6% in group II. Sternal infection was significantly more prevalent in group I (2.2%, 31/1394) than in group II (0.8%, 8/962). Multivariate analysis revealed that aortic crossclamp time, use of a single internal mammary artery graft, use of a double mammary graft, and diabetes were associated with increased risk of sternal infection. The use of bilateral internal mammary artery grafting doubled the odds ratio of the risk compared with use of a single mammary graft, and the combination of diabetes and double internal mammary artery grafts increased the odds ratio 13.9-fold. Patients with an internal mammary artery graft who had sternal infection had a longer period of hospitalization than patients without a mammary artery graft who had sternal infection. We conclude that the risk of sternal infection is increased by the use of an internal mammary artery graft, especially use of double mammary grafts in the presence of diabetes
— id: 13918, year: 1991, vol: 102, page: 342, stat: Journal Article,

Anatomic distribution of preservation solutions during canine hepatic procurement
Harris LJ; Crooke GA; Grossi EA; Teperman LW; Halff GA; Galloway AC; Spencer FC; Weil R 3d
1991 Oct;23(5):2430-2431, Transplantation proceedings
— id: 13878, year: 1991, vol: 23, page: 2430, stat: Journal Article,

THE BENEFICIAL-EFFECTS OF TERMINAL SUBSTRATE ENRICHED CARDIOPLEGIA ARE TEMPERATURE INDEPENDENT
Crooke, GA; Harris, LJ; Grossi, EA; Galloway, AC; Colvin, SB; Spencer, FC
1990 Oct;82(4):589-589, Circulation
— id: 31911, year: 1990, vol: 82, page: 589, stat: Journal Article,

Ten-year experience with aortic valve replacement in 482 patients 70 years of age or older: operative risk and long-term results
Galloway AC; Colvin SB; Grossi EA; Baumann FG; Sabban YP; Esposito R; Ribakove GH; Culliford AT; Slater JN; Glassman E; et al.
1990 Jan;49(1):84-91, Annals of thoracic surgery
A retrospective analysis of an institutional experience with aortic valve replacement (AVR) in patients 70 years of age or older during 1976 to 1987 was performed. The study was prompted in part by the current interest in palliative aortic valvoplasty, an interest based to a certain extent on the impression that AVR in the elderly has a high mortality. The mean age of the patients was 75.0 +/- 4.0 years (+/- the standard deviation) (range, 70 to 89 years). Eighty-three percent of patients received porcine valves and 17%, mechanical valves. Preoperatively 32% were in New York Heart Association class III, and 59% were in class IV. Operative mortality was 5.6% for elective isolated AVR for aortic stenosis (19% of all patients), 8.2% for all isolated AVR (38%), and 12.4% overall. Concomitant operative procedures were done in 62.0%; AVR with coronary artery bypass grafting (42%) had an operative mortality of 14.3%. Multivariate analysis showed significant predictors of operative mortality to be emergency operation (p less than 0.01), isolated aortic regurgitation (p = 0.01), and previous cardiac operation (p = 0.02). Follow-up (34 +/- 27 months) was 94% complete. Five-year survival from late cardiac-related death was 81.0%. The constant yearly hazard rate for late death for patients 70 years of age or older who underwent AVR was 5.42% per year, which is similar to the 5.77% per year rate calculated for age-matched and sex-matched controls. Five-year freedom from reoperation was 99%; from late thromboembolic complications, 91%; and from late anticoagulant-related complications, 94%. Freedom from all valve-related morbidity and mortality was 61% at 5 years.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 28923, year: 1990, vol: 49, page: 84, stat: Journal Article,

Left ventricular unloading during reperfusion
Grossi EA; Axelrod HI; Baumann FG; Galloway AC; Spencer FC
1990 Oct;82(4):1543-1545, Circulation
— id: 33349, year: 1990, vol: 82, page: 1543, stat: Journal Article,

Left ventricular stress during extracorporeal membrane oxygenation
Axelrod HI; Baumann FG; Galloway AC
1989 Feb;47(2):330-330, Annals of thoracic surgery
— id: 45030, year: 1989, vol: 47, page: 330, stat: Journal Article,

A comparison of mitral valve reconstruction with mitral valve replacement: intermediate-term results
Galloway AC; Colvin SB; Baumann FG; Grossi EA; Ribakove GH; Harty S; Spencer FC
1989 May;47(5):655-662, Annals of thoracic surgery
The continued good results after mitral valve reconstruction prompted this retrospective study to compare operative and late results from our institutional experience since 1976 with 975 porcine mitral valve replacements (MVRs) (1976 to December 1987), 169 mechanical MVRs (1976 to December 1987), and 280 Carpentier-type mitral valve reconstructions (CVRs) (1980 to mid-1988). The operative mortality was 2.0% for isolated CVR, 6.6% for isolated mechanical MVR, and 8.5% for isolated porcine MVR. The overall operative mortality was 5.0% for CVR, 16.6% for mechanical MVR, and 10.6% for porcine MVR. The overall 5-year survival including hospital deaths was 76% for CVR, 72% for mechanical MVR, and 69% for porcine MVR. By multivariate analysis, the predictors of increased operative risk and of decreased survival were age, New York Heart Association functional class IV status, previous cardiac operation, and performance of concomitant cardiac surgical procedures. The type of valvular procedure was not predictive of operative risk or overall survival. The 5-year freedom from reoperation was 94.4% for nonrheumatic patients having CVR, 77.4% for rheumatic patients having CVR, 96.4% for mechanical MVR, and 96.6% for porcine MVR (p less than 0.05, rheumatic patients with CVR versus both MVR groups). The 5-year freedom from all valve-related morbidity and mortality was significantly better for valve reconstruction compared with both types of valve replacement. Thus, the operative risk and late survival obtained after mitral valve reconstruction were at least equivalent to those obtained after MVR. In addition, patients receiving mitral valve reconstruction had less valve-related combined morbidity than patients receiving valve replacement, thus making mitral valve reconstruction preferable in some patients with mitral insufficiency
— id: 10632, year: 1989, vol: 47, page: 655, stat: Journal Article,

Ten-year operative experience with 165 aneurysms of the ascending aorta and aortic arch
Galloway AC; Colvin SB; LaMendola CL; Hurwitz JB; Baumann FG; Harris LJ; Culliford AT; Grossi EA; Spencer FC
1989 Sep;80(3 Pt 1):I249-I256, Circulation
Results of surgery in 165 patients with aneurysms of the ascending aorta and aortic arch during 1978-1988 were analyzed retrospectively. Etiology included 29% dissection, 22% atherosclerosis, 22% cystic-medial necrosis, and 27% other causes. Concomitant procedures on the aortic valve were performed in 65% of patients (valvular replacement in 37%, valve-conduit in 23%, and valvular resuspension in 5%), and 13% underwent concomitant coronary artery bypass surgery. Major changes in our operative technique for such aneurysms have been introduced during the last 5 years, especially use of a continuous suture-graft-inclusion technique in 99% of patients, use of circulatory arrest in 59%, and use of an open hemiarch repair in 32%. Hospital mortality dropped from 17.9% during the first 5 years of the study period to 12.3% in the last 5 years despite increasing complexity of the cases encountered. Operative mortality was 7.6% for ascending aortic aneurysmal repair; 5.3% for valve-conduit procedure; 8.8% for open hemiarch repair; and 30.8% for repair of extensive aneurysms involving the aortic arch and significant portions of the descending aorta. Multivariate analysis showed that, of the variables examined, significant predictors of increased operative risk were age (p less than 0.05) and extension of an ascending aortic aneurysm to the descending aorta or involvement of the aortic arch (p less than 0.001). The incidence of stroke was 2.4%, with only one stroke since 1983 despite more extensive use of circulatory arrest since that time. Follow-up was 94% complete, with a mean (+/- SD) follow-up interval of 28 +/- 24 months.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 10510, year: 1989, vol: 80, page: I249, stat: Journal Article,

The effect of ventilation on aortic blood gases during left ventricular ejection before separation from cardiopulmonary bypass
Kronenfeld MA; Lubarsky D; Feiler M; Galloway A; Thomas SJ
1989 Jun;3(3):301-304, Journal of cardiothoracic anesthesia
The time to begin ventilating a cardiac surgical patient recovering from hyperkalemic arrest is controversial. Those who advocate ventilating as soon as the left ventricle begins to eject believe that blood ejected from the left ventricle is likely to be hypoxic since it perfuses collapsed, nonventilated alveoli and that this may be the major blood supply perfusing the coronary arteries. The present study attempts to answer this question by sampling blood gases from the aorta in proximity to the coronary ostia in patients both before and after ventilation. Ten patients undergoing coronary artery bypass grafting using the left internal mammary artery were studied. Each patient served as his own control. Distal anastomoses were placed under hyperkalemic, hypothermic cardiac arrest. The aorta was unclamped, and an intrinsic or paced heart rate of 70 beats per minute was achieved. The heart was allowed to eject to a pulse pressure of 20 to 40 mmHg. Rectal temperatures were between 32 degrees C and 34 degrees C. Blood gases were drawn simultaneously from the proximal aortic root, radial artery, pulmonary artery, and the venous circuit of the cardiopulmonary bypass (CPB) machine. The lungs were then twice inflated with a sustained positive pressure of 30 cm H2O, and the patient was ventilated (10 mL/kg tidal volume, FIO2 1.0, 10 breaths per minute) for two minutes. Another set of blood gases was then obtained. Filling pressures, aortic systolic and diastolic pressures, and CPB flows were kept constant for both sets of samples. There was no significant difference in aortic root PaO2 attributable to ventilation. PCO2 was significantly lower, and pH was significantly higher in the ventilated group.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 10612, year: 1989, vol: 3, page: 301, stat: Journal Article,

Percutaneous cardiopulmonary bypass limits myocardial injury from ischemic fibrillation and reperfusion
Axelrod HI; Murphy MS; Galloway AC; Baumann FG; Laschinger JC; Colvin SB; Spencer FC
1988 Nov;78(5 Pt 2):III148-III152, Circulation
Percutaneous implementation of cardiopulmonary bypass (PCPB) with a synchronous pulsatile pump has been shown to be an efficient means of unloading the heart. Therefore, this technique may provide a practical and effective method for treating patients undergoing a major cardiac catastrophe who are unresponsive to the usual resuscitative efforts. We tested whether PCPB could effectively unload the heart and provide myocardial salvage during left anterior descending (LAD) coronary artery occlusion complicated by ventricular fibrillation in the canine model (n = 13). All 13 dogs fibrillated within 20 minutes of LAD occlusion, and none could be successfully resuscitated by manual cardiac compression, sodium bicarbonate administration, antiarrhythmic agent administration, and electrical defibrillation. All 13 dogs were then placed on PCPB by way of the right jugular vein and right femoral artery; in seven, we used a synchronous pulsatile pump and in six a standard roller pump. No vent was placed in the left ventricle. All animals returned to normal sinus rhythm within 20 minutes of institution of PCPB. The LAD snare was released after 2 hours, and all animals were maintained on PCPB during 3 hours of reperfusion. At sacrifice, the area of infarction was determined by staining with triphenyltetrazolium chloride and was expressed as a percentage of the left ventricular area-at-risk for infarction. The tension time index was also measured and expressed as percent change from baseline. The left ventricular area-at-risk for infarction was similar in both groups (31.5% for roller pump vs. 29.2% for pulsatile pump; p greater than 0.05), but the area of infarction as a percentage of the area at risk was significantly smaller in the pulsatile-pump group (22.0%) than in the roller-pump group (35.4%; p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 10905, year: 1988, vol: 78, page: III148, stat: Journal Article,

Surgical treatment for aneurysm of aberrant subclavian artery based on a case report and a review of the literature [see comments]
Esposito RA; Khalil I; Galloway AC; Spencer FC
1988 May;95(5):888-891, Journal of thoracic & cardiovascular surgery
Experiences with the recent successful treatment of a patient with an aneurysm arising from an aberrant subclavian artery are described. The reported experiences with surgical treatment by others were reviewed in detail: Only 16 such patients were found, with a surprising frequency of serious complications. These data led to the conclusion that a two-stage approach, through right cervical and left thoracotomy incisions, seems to offer the ideal method of treatment for this unusual problem
— id: 11113, year: 1988, vol: 95, page: 888, stat: Journal Article,

Long-term results of mitral valve reconstruction with Carpentier techniques in 148 patients with mitral insufficiency
Galloway AC; Colvin SB; Baumann FG; Esposito R; Vohra R; Harty S; Freeberg R; Kronzon I; Spencer FC
1988 Sep;78(3 Pt 2):I97-105, Circulation
There have been few relatively complete follow-up studies of long-term mitral valve function after Carpentier-type surgical reconstruction. Between January 1980 and May 1986, 148 patients underwent Carpentier reconstruction for mitral valve disease (43% degenerative and 30% rheumatic). Operative mortality was 5.4% overall (1.2% for isolated mitral reconstruction), and follow-up (mean, 26 months) was completed for all survivors. Five-year survival from late cardiac death was 90.0%, as was 5-year freedom from postreconstruction mitral valve replacement. Postreconstruction mitral replacement was needed in eight patients, in only five for failure of repair. Follow-up echocardiographic studies on 83.2% (104 of 125) of eligible patients showed 92.3% were free of significant (3+ or 4+) mitral regurgitation. Freedom from mitral valve replacement or recurrent severe (4+) insufficiency was 84.4% at 5 years overall, but was lower for the rheumatic type of mitral disease than for the degenerative type (71.6% vs. 88.3%). At 5 years, 95.2% of patients were free from thromboembolism without the necessity for long-term warfarin (Coumadin) therapy. At follow-up, 95.3% of survivors had improved to New York Heart Association Class I or II. The functional durability of mitral reconstruction and consistently high level of freedom from late endocarditis and thromboembolic and anticoagulant complications support the value of the Carpentier method of mitral reconstruction for mitral insufficiency, especially insufficiency due to degenerative disease
— id: 10965, year: 1988, vol: 78, page: I97, stat: Journal Article,

Current concepts of mitral valve reconstruction for mitral insufficiency
Galloway AC; Colvin SB; Baumann FG; Harty S; Spencer FC
1988 Nov;78(5 Pt 1):1087-1098, Circulation
In recent years, there has been a renewed interest in surgical reconstruction of the insufficient mitral valve because of reconfirmation of the limitations of existing prosthetic and bioprosthetic valves. A follow-up study, including late functional data, of 148 patients who underwent mitral valve reconstruction at our institution was combined with a review of the literature to assess the current status of mitral reconstruction. The results indicate that mitral reconstruction by Carpentier techniques is widely applicable, durable, and relatively free of complication. Freedom from late thromboembolic and anticoagulant complications is particularly notable. These factors could prove to justify earlier operative intervention in patients with mitral insufficiency before permanent myocardial damage evolves. As mitral valve reconstruction techniques become more familiar and widely used, mitral reconstruction may become the operative procedure of choice for mitral insufficiency, especially insufficiency due to degenerative disease
— id: 10918, year: 1988, vol: 78, page: 1087, stat: Journal Article,

Percutaneous cardiopulmonary bypass with a synchronous pulsatile pump combines effective unloading with ease of application
Axelrod HI; Galloway AC; Murphy MS; Laschinger JC; Baumann FG; Grossi EA; Glassman E; Spencer FC
1987 Mar;93(3):358-365, Journal of thoracic & cardiovascular surgery
Percutaneous total cardiopulmonary bypass offers the advantage of rapid, simple implementation without the need for thoracic incision and provides the ability to support both left and right ventricular failure as well as pulmonary insufficiency. Previous studies using roller pump percutaneous bypass were only partially successful because of the inability to effectively unload the left ventricle. In the present experiment we attempted to determine in a normal canine model whether use of synchronous pulsatile pumping for percutaneous bypass could overcome this problem. Fourteen dogs were placed on percutaneous bypass for 1 hour. A roller pump was used in seven and a synchronous pulsatile pump with an electrocardiogram triggering mechanism in the other seven. All animals were maintained on percutaneous bypass for 1 hour. In the pulsatile pump group there was a significantly greater percent decrease from baseline in tension-time index (-56.3% versus -19.1%, p less than 0.01) and in myocardial oxygen consumption (-45.8% versus +2.1%, p less than 0.05) and a significantly greater percent increase in the endocardial/epicardial blood flow ratio (27.6% versus -6.5%, p less than 0.01) than in the roller pump group. These results show that superior unloading can be achieved by percutaneous pulsatile bypass compared with percutaneous roller pump bypass. The findings suggest that percutaneous total cardiopulmonary bypass with a synchronous pulsatile pump offers a relatively simple but effective method for providing appropriate patients with temporary hemodynamic stability before cardiac catheterization or medical or surgical revascularization
— id: 33353, year: 1987, vol: 93, page: 358, stat: Journal Article,

A comparison of methods for limiting myocardial infarct expansion during acute reperfusion--primary role of unloading
Axelrod HI; Galloway AC; Murphy MS; Laschinger JC; Grossi EA; Baumann FG; Colvin SB; Hunter CE; Glassman E; Spencer FC
1987 Nov;76(5 Pt 2):V28-V32, Circulation
Current use of angioplasty, thrombolysis, and surgical techniques for prompt reperfusion of an acute myocardial infarction raises questions concerning the optimum reperfusion technique for maximum myocardial salvage. Alterations in the conditions of reperfusion and/or the composition of the initial reperfusate can exert a significant effect on the extent of myocardial salvage. In an effort to define an optimum reperfusion technique, we used 40 dogs in a series of experiments in which the left anterior descending coronary artery (LAD) was snared for 2 hr followed by reperfusion by one of five methods for 4 hr. In addition, in a control group(group I, n = 6) the LAD was occluded for 6 hr without any reperfusion. In group 2 (n = 12), simulating medical reperfusion, reperfusion was achieved by simply releasing the snare for 4 hr. Group 3 dogs (n = 6) were placed on pulsatile left atrial-femoral bypass throughout 4 hr of reperfusion. Group 4 dogs (n = 9) were placed on percutaneous, synchronized pulsatile cardiopulmonary bypass during reperfusion. The procedure in group 5 (n = 7) dogs simulated coronary artery bypass grafting with cardiopulmonary bypass and cold blood, low-Ca++ cardioplegia during reperfusion. Group 6 (n = 6) was treated similarly except that during reperfusion amino acid-enriched cardioplegia was administered by warm induction techniques. At the end of 4 hr of reperfusion, the left ventricular area of infarction was determined by triphenyltetrazolium chloride staining and expressed as a percentage of the left ventricular area at risk for infarction (area of infarction [AI]/area at risk [AR]).(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 11327, year: 1987, vol: 76, page: V28, stat: Journal Article,

Limitation of infarct size by acute reperfusion of ischemic myocardium: a comparison of three methods
Axelrod HI; Murphy MS; Galloway AC; Colvin SB; Baumann FG
1987 May-Jun;44(3):240-242, Current surgery
— id: 36731, year: 1987, vol: 44, page: 240, stat: Journal Article,

PERCUTANEOUS CARDIOPULMONARY BYPASS LIMITS MYOCARDIAL FIBRILLATION INJURY
Axelrod, HI; Murphy, MS; Galloway, AC; Baumann, FG; Laschinger, JC; Colvin, SB; Spencer, FC
1987 Oct;76(4):164-164, Circulation
— id: 31115, year: 1987, vol: 76, page: 164, stat: Journal Article,

LATE RESULTS OF CARPENTIER TECHNIQUE FOR MITRAL-VALVE RECONSTRUCTION IN 148 PATIENTS WITH MITRAL-INSUFFICIENCY
Galloway, AC; Colvin, SB; Baumann, FG; Esposito, R; Vohra, R; Harty, S; Freedberg, R; Kronzon, I; Spencer, FC
1987 Oct;76(4):445-445, Circulation
— id: 31117, year: 1987, vol: 76, page: 445, stat: Journal Article,

REPAIR OF ATRIOVENTRICULAR-CANAL DEFECTS UTILIZING CARPENTIER RECONSTRUCTIVE TECHNIQUES
Narrod, J; Galloway, AC; Rutkowski, M; Doyle, E; Colvin, SB
1987 Feb;9(2):A205-A205, Journal of the American College of Cardiology
— id: 31281, year: 1987, vol: 9, page: A205, stat: Journal Article,

"EXPERIMENTAL COMPARISON OF SURGICAL MEDICAL, AND ASSISTED REPERFUSION OF ACUTE MI"
AXELROD, HI; GALLOWAY, AC; MURPHY, MS; LASCHINGER, JC; GLASSMAN, E; BAUMANN, FG; SPENCER, FC
1986 OCT ;74(4):134-134, Circulation
— id: 41339, year: 1986, vol: 74, page: 134, stat: Journal Article,

Experiences with 1643 porcine prosthetic valves in 1492 patients
Spencer FC; Baumann FG; Grossi EA; Culliford AT; Galloway AC
1986 Jun;203(6):691-700, Annals of surgery
Sixteen hundred and forty-three porcine prosthetic values (1102 Carpentier-Edwards, 541 Hancock) were implanted in 1492 patients at New York University Medical Center between January 1976 and June 1983. The aortic valve alone was replaced in 786 patients (53%), mitral valve alone in 556 (37%), and multiple valves in 143 patients (9.6%). Concomitant coronary artery bypass was performed in 326 patients (22%). There were 116 deaths within 30 days of operation (7.8%). Follow-up (mean: 42 months) was completed in 94% of survivors and revealed that late survival from cardiac-related death was 87% at 5 years and 81% at 7 years, with no significant difference between the Carpentier-Edwards and Hancock patients. Late thromboembolic complications, however, were significantly more frequent in Hancock patients at all intervals from 1-7 years (p less than 0.05), whether in the aortic or mitral position. Patients with coronary artery disease who had concomitant coronary bypass showed a survival from late cardiac death that did not differ significantly from that of patients undergoing valve replacement alone. Before operation, 87% of patients were in New York Heart Association Class III or IV, but after operation 80% were in Class I or II. Late anticoagulant complications, endocarditis, and valve dysfunction were relatively rare. These results from a series of such size, duration, and representative numbers of two types of porcine bioprosthesis confirm excellent results with porcine prostheses in the first 4-5 years following operation
— id: 28925, year: 1986, vol: 203, page: 691, stat: Journal Article,

The value of early repair for total anomalous pulmonary venous drainage
Galloway, A C; Campbell, D N; Clarke, D R
1985 ;6(2):77-81, Pediatric cardiology
A total of 20 children with total anomalous pulmonary venous drainage (TAPVD) underwent complete repair within the past six years. The drainage was supracardiac in 11, infracardiac in seven, and into the coronary sinus in two. At repair mean age was nine weeks, and weight was 3.7 km. Operative technique in extracardiac types included complete mobilization of the common vein with division of anomalous channel when possible. The incision in the confluent vein was extended into the lobar veins when necessary to permit extensive incorporation of this structure into the posterior wall of the left atrium and resulted in a nonobstructing stellate-type anastomosis. Operative mortality was 10% (2 of 20). Deaths occurred only in the group of infants in whom severe obstruction to pulmonary venous return required emergency operation, and one of these patients has persistent neurologic deficit. Late cardiac catheterization has been performed in 11 of 18 survivors. Nine had no or only minor abnormalities and two required reoperation. There have been no late deaths with follow-up of 2-8 years (mean = 4 years). Currently, all of the survivors are without cardiac symptoms and only one requires cardiac medication. Our experience identifies pulmonary venous obstruction with critical symptoms as the major operative risk factor in patients with TAPVD. With early operation prior to onset of critical symptoms, mortality is low and functional results are excellent
— id: 149868, year: 1985, vol: 6, page: 77, stat: Journal Article,

A clinical evaluation of the hypothesis that rupture of the left ventricle following mitral valve replacement can be prevented by preservation of the chordae of the mural leaflet
Spencer FC; Galloway AC; Colvin SB
1985 Dec;202(6):673-680, Annals of surgery
Experiences with 14 patients undergoing rupture of the left ventricle following mitral valve replacement over a period of 9 years have been described. Three different types have been recognized. Before 1978, most injuries occurred in the atrioventricular groove, apparently resulting from traction that insidiously avulsed the mitral annulus from the underlying left ventricular muscle. Several changes in operative technique, described in the text, were made to prevent this traction avulsion. Following the adoption of these principles, rupture in the atrioventricular groove virtually disappeared. A second type of injury, strut perforation, has been recognized in only one patient, a small 81-year-old female in whom the prosthesis inserted was too large for the ventricular cavity. Translucent obturators were subsequently developed not only to size the left ventricle but also to note the location of the post of the porcine prosthesis before insertion. Further problems of this type have not been seen. The most puzzling, and currently the most significant, problem is a third type of rupture, the mid-ventricular rupture, suggested as Type III by Miller in 1978 and described in detail by Cobbs in 1977 and 1980. The phenomenon seems to be a true spontaneous rupture of a thin left ventricle, usually occurring in small elderly women with mitral valve disease. If the friability of the left ventricle is transiently increased with potassium cardioplegia, such ventricles may spontaneously rupture following division of the chordae to the annulus of the mural leaflet. If this concept is correct, a rupture in some patients can best be prevented by preserving these chordae. It is well realized, of course, that a fortunate narrative experience of 3 1/2 years does not have any statistical value concerning a complication that occurs in 1 to 2% of operations. The experiences are reported, however, because to our knowledge, the untethered loop hypothesis has not been previously evaluated in a large number of consecutive patients operated on. Future comparison of experiences reported by others should make it possible to determine whether or not this concept is correct
— id: 36732, year: 1985, vol: 202, page: 673, stat: Journal Article,

Do ischemic hearts stimulate endothelial cell growth?
Galloway, A C; Pelletier, R; D'Amore, P A
1984 Aug;96(2):435-439, Surgery
The development of myocardial ischemia is known to elicit the formation and enlargement of collateral vessels. The stimulus for these events is unknown. We have investigated the possibility that cardiac tissue releases a factor that can stimulate endothelial cell proliferation. Hearts from New Zealand rabbits were made progressively ischemic by differential hypothermia. Extracts from these hearts were tested for their growth-stimulating ability and were found to increase the proliferation of fetal bovine aortic endothelial cells as well as DNA synthesis by 3T3 cells. The level of activity in the extracts appears to be related to the degree of ischemia as measured by creatine phosphokinase levels. The liberation of an endothelial cell growth factor by ischemic cardiac tissue may function in the initiation and/or potentiation of coronary collateral formation
— id: 149869, year: 1984, vol: 96, page: 435, stat: Journal Article,

AVOID CRITICAL OBSTRUCTION IN TOTAL ANOMALOUS PULMONARY VENOUS DRAINAGE
GALLOWAY, A; CAMPBELL, D; CLARKE, D
1984 ;3(2):584-584, Journal of the American College of Cardiology
— id: 40853, year: 1984, vol: 3, page: 584, stat: Journal Article,

The evolution of abdominal stab wound management
Thompson, J S; Moore, E E; Van Duzer-Moore, S; Moore, J B; Galloway, A C
1980 Jun;20(6):478-484, Journal of trauma
The results of the selective management of 300 abdominal stab wound victims have been reviewed for a 5-year period. Initially the need for laparotomy was evaluated by sinography, later physical examination, and most recently by local wound exploration combined with peritoneal lavage. The use of sinography resulted in an unnecessary laparotomy rate of 38%. Exploration based upon physical findings eventuated in 36% unnecessary laparotomies, of which 79% were negative, 17% morbidity, and no mortality. Local wound exploration followed by peritoneal lavage when peritoneal violation was suspected resulted in 8% unnecessary laparotomies of which half were negative, 9% morbidity, and no mortality. Based on this experience we have adopted the following approach to abdominal stab wounds. Patients with unexplained blood loss or overt signs of visceral injury undergo prompt exploration. In all other cass with intact peritoneum are discharged from the Emergency Department. If peritoneal violation is evident peri toneal lavage is performed. If the lavage is positive laparotomy is undertaken, and if negative the patient is hospitalized for an additional 24 hours of observation
— id: 149870, year: 1980, vol: 20, page: 478, stat: Journal Article,

Emergency department thoracotomy
Moore, E E; Moore, J B; Galloway, A C; Eiseman, B
1979 Sep;8(9):387-387, JACEP
— id: 149872, year: 1979, vol: 8, page: 387, stat: Journal Article,

Postinjury thoracotomy in the emergency department: a critical evaluation
Moore, E E; Moore, J B; Galloway, A C; Eiseman, B
1979 Oct;86(4):590-598, Surgery
— id: 149871, year: 1979, vol: 86, page: 590, stat: Journal Article,