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Item Acute respiratory distress syndrome in the cardiothoracic patient: State of the art and use of veno-venous extracorporeal membrane oxygenation(Elsevier, 2021-12) Copeland, Hannah; Levine, Deborah; Morton, John; Hayanga, J.W. Awori; Surgery, School of MedicineCentral Message: Acute respiratory distress syndrome after cardiopulmonary bypass can be managed with veno-venous extracorporeal membrane oxygenation.Item Aortic dissections in Marfan disease during pregnancy: Review article(Wiley, 2020-08) Cottrell, Jesse; Calhoun, John; Szczepanski, Jamie; Corvera, Joel; Cresswell, Lawrence; Kogon, Brian; Hasaniya, Nahidh; Copeland, Hannah; Surgery, School of MedicineWe want to thank Dr. Raveenthiran and Dr. Harky for their interest in our paper and in the topic of Marfans in the setting of pregnancy. Certainly, the reduction of adverse outcomes would be improved with early knowledge of Marfans syndrome in the mother which would aid in preparation and clinical consideration during the perioperative period, and, prior to pregnancy.Item Commentary: Cannulate, extubate, ambulate, but not so easy to replicate(Elsevier, 2022) Blitzer, David; Copeland, Hannah; Surgery, School of MedicineComment on doi: 10.1016/j.jtcvs.2022.02.049Item Commentary: COVID-19 extracorporeal membrane oxygenation: A long way from home(Elsevier, 2022) Baran, David A.; Copeland, Hannah; Surgery, School of MedicineItem Commentary: Two to tango and a team to DUET(Elsevier, 2021) Blitzer, David; Copeland, Hannah; Indiana University School of Medicine–Fort WayneA multidisciplinary approach to the management of infectious endocarditis resulting from intravenous drug use is an important step toward achieving the best results for these complex patients.Item Donor heart selection: Evidence-based guidelines for providers(Elsevier, 2023) Copeland, Hannah; Knezevic, Ivan; Baran, David A.; Rao, Vivek; Pham, Michael; Gustafsson, Finn; Pinney, Sean; Lima, Brian; Masetti, Marco; Ciarka, Agnieszka; Rajagopalan, Navin; Torres, Adriana; Hsich, Eileen; Patel, Jignesh K.; Adams Goldraich, Livia; Colvin, Monica; Segovia, Javier; Ross, Heather; Ginwalla, Mahazarin; Sharif-Kashani, Babak; Farr, MaryJane A.; Potena, Luciano; Kobashigawa, Jon; Crespo-Leiro, Maria G.; Altman, Natasha; Wagner, Florian; Cook, Jennifer; Stosor, Valentina; Grossi, Paolo A.; Khush, Kiran; Yagdi, Tahir; Restaino, Susan; Tsui, Steven; Absi, Daniel; Sokos, George; Zuckermann, Andreas; Wayda, Brian; Felius, Joost; Hall, Shelley A.; Medicine, School of MedicineThe proposed donor heart selection guidelines provide evidence-based and expert-consensus recommendations for the selection of donor hearts following brain death. These recommendations were compiled by an international panel of experts based on an extensive literature review.Item Donor Utilization in the Recent Era: Effect of Sex, Drugs, and Increased Risk(American Heart Association, 2022) Baran, David A.; Long, Ashleigh; Lansinger, Justin; Copeland, Jack G.; Copeland, Hannah; Surgery, School of MedicineBackground: Heart transplantation volumes have increased in recent years, yet less than a third of donors are typically accepted for transplantation. Whether donor sex, donor drug use, or perception of increased risk affects utilization for transplantation is unclear. Methods: The United Network for Organ Sharing database was queried for donors from January 1, 2007, to December 31, 2017. Donor toxicology was collected when available. Multivariate analysis was conducted to examine correlations with donor utilization. Results: Between January 1, 2007, and December 31, 2017, there were 87 816 heart donors aged ≥15 years. The mean age was 42.7±15.8 years, and 24 831 donors (28.3%) were utilized for heart transplantation. Subsequent analyses focused on donors between 15 and 39 years old. The strongest associations with donor acceptance were for male donor sex, blood type, hepatitis C antibody, donor age, left ventricular hypertrophy, and history of donor drug use. After removing hepatitis C, Public Health Service Increased Risk was identified as a strong negative predictor. Most positive drug toxicology results were associated with donor nonuse except for donors between 15 and 19 years of age. Exceptions included alcohol, marijuana, and cocaine. Opiates were associated with less utilization at all donor ages. The Public Health Service Increased Risk status was associated with significantly less utilization in all age groups except 15- to 19-year-old donors. Conclusions: While male donors were preferentially utilized, donors with drug use or those deemed Public Health Service Increased Risk were significantly less utilized for heart transplantation. Further consideration of such donors would be appropriate particularly as the demand for transplantation continues to increase.Item Indications, Complications, and Outcomes of Cardiac Surgery After Heart Transplantation: Results From the Cash Study(Frontiers Media, 2022-06-09) Gökler, Johannes; Aliabadi-Zuckermann, Arezu Z.; Kaider, Alexandra; Ambardekar, Amrut V.; Antretter, Herwig; Artemiou, Panagiotis; Bertolotti, Alejandro M.; Boeken, Udo; Brossa, Vicens; Copeland, Hannah; Crespo-Leiro, Maria Generosa; Eixerés-Esteve, Andrea; Epailly, Eric; Farag, Mina; Hulman, Michal; Khush, Kiran K.; Masetti, Marco; Patel, Jignesh; Ross, Heather J.; Rudež, Igor; Silvestry, Scott; Martin Suarez, Sofia; Vest, Amanda; Zuckermann, Andreas O.; Surgery, School of MedicineBackground: Allograft pathologies, such as valvular, coronary artery, or aortic disease, may occur early and late after cardiac transplantation. Cardiac surgery after heart transplantation (CASH) may be an option to improve quality of life and allograft function and prolong survival. Experience with CASH, however, has been limited to single-center reports. Methods: We performed a retrospective, multicenter study of heart transplant recipients with CASH between January 1984 and December 2020. In this study, 60 high-volume cardiac transplant centers were invited to participate. Results: Data were available from 19 centers in North America (n = 7), South America (n = 1), and Europe (n = 11), with a total of 110 patients. A median of 3 (IQR 2-8.5) operations was reported by each center; five centers included ≥ 10 patients. Indications for CASH were valvular disease (n = 62), coronary artery disease (CAD) (n = 16), constrictive pericarditis (n = 17), aortic pathology (n = 13), and myxoma (n = 2). The median age at CASH was 57.7 (47.8-63.1) years, with a median time from transplant to CASH of 4.4 (1-9.6) years. Reoperation within the first year after transplantation was performed in 24.5%. In-hospital mortality was 9.1% (n = 10). 1-year survival was 86.2% and median follow-up was 8.2 (3.8-14.6) years. The most frequent perioperative complications were acute kidney injury and bleeding revision in 18 and 9.1%, respectively. Conclusion: Cardiac surgery after heart transplantation has low in-hospital mortality and postoperative complications in carefully selected patients. The incidence and type of CASH vary between international centers. Risk factors for the worse outcome are higher European System for Cardiac Operative Risk Evaluation (EuroSCORE II) and postoperative renal failure.Item Open repair of chronic thoracic and thoracoabdominal aortic dissection using deep hypothermia and circulatory arrest(Elsevier, 2017) Corvera, Joel; Copeland, Hannah; Blitzer, David; Hicks, Adam; Manghelli, Joshua; Hess, Philip; Fehrenbacher, John; Department of Surgery, IU School of MedicineBackground Chronic dissection of the thoracic and thoracoabdominal aorta as sequela of a prior type A or B dissection is a challenging problem that requires close radiographic surveillance and prompt operative intervention in the presence of symptoms or aneurysm formation. Open repair of chronic thoracic and thoracoabdominal aortic dissection using deep hypothermia has been our preferred method to treat this complex pathology. The advantages of this technique include organ and spinal cord protection, the flexibility to extend the repair proximally into the arch, and the ability to limit ischemia to all vascular beds. Methods Open repair of arch by left thoracotomy and descending thoracic and thoracoabdominal aortic pathology using deep hypothermia was performed in 664 patients from 1995 to 2015. A subset of this cohort had chronic thoracoabdominal aortic dissection (n = 196). All nonemergency cases received coronary angiography and echocardiography preoperatively. Significant coronary artery disease or severe aortic insufficiency was addressed before repair of the chronic dissection. In recent years, lumbar drains were placed preoperatively in the most extensive repairs (extents II and III). Important intercostal arteries from T8 to L1 were revascularized with smaller-diameter looped grafts. Multibranched grafts for the visceral segment have been preferred in recent years. Results Mean age of patients was 58 ± 14 years. Men comprised 74% of the cohort. Aortopathy was confirmed in 18% of the cohort. Prior thoracic aortic repair occurred in 57% of patients, and prior abdominal aortic repair occurred in 14% of patients. Prior type A aortic dissection occurred in 44% of patients, and prior type B occurred in 56% of patients. Operative mortality was 3.6%, permanent spinal cord ischemia occurred in 2.6% of patients, permanent hemodialysis occurred in 0% of patients, and permanent stroke occurred in 1% of patients. Reexploration for bleeding was 5.1%, and respiratory failure requiring tracheostomy occurred in 2.6%. Postoperative length of stay was 11.9 ± 9.7 days. Reintervention for pseudoaneurysm or growth of a distal aneurysm was 6.9%. The 1-, 5-, and 10-year survivals were 93%, 79%, and 57%, respectively. Conclusions Open repair of chronic thoracic and thoracoabdominal aortic dissection using deep hypothermia and circulatory arrest has low morbidity and mortality. The need for reintervention is low, and long-term survival is excellent. We believe that open repair continues to be the gold standard in patients who are suitable candidates for surgery.Item Repair of Thoracic and Thoracoabdominal Mycotic Aneurysms and Infected Aortic Grafts Using Allograft(Elsevier, 2018) Corvera, Joel S.; Blitzer, David; Copeland, Hannah; Murphy, Daniel; Hess, Philip J.; Pillai, Saila T.; Fehrenbacher, John W.; Surgery, School of MedicineBackground Mycotic aneurysm of the thoracic or thoracoabdominal aorta and infection of thoracic or thoracoabdominal aortic grafts are challenging problems with high mortality. In-situ reconstruction with cryopreserved allograft(CPA) avoids placement of prosthetic material in an infected field and avoids suppressive antibiotics or autologous tissue coverage. Methods Fifty consecutive patients with infection of a thoracic or thoracoabdominal aortic graft or mycotic aneurysm underwent resection and replacement with CPA from 2006 to 2016. Intravenous antibiotics were continued postoperatively for 6 weeks. Long-term suppressive antibiotics were uncommonly used (8 patients). Follow up imaging occurred at 6, 18 and 42 months postoperatively. Initial follow up was 93% complete. Results Males comprised 64% of the cohort. The mean age was 63±14 years. The procedures performed included reoperations in 37, replacement of the aortic root, ascending aorta or transverse arch in 19, replacement of the descending or thoracoabdominal aorta in 27 and extensive replacement of the ascending, arch and descending or thoracoabdominal aorta in 4. Intraoperative cultures revealed most commonly staphylococcus 24%), enterococcus (12%), candida (6%) and gram negative rods (14%). Operative mortality was 8%, stroke 4%, paralysis 2%, hemodialysis 6%, and respiratory failure requiring tracheostomy 6%. Early reoperation for pseudoaneurysm of the CPA was necessary in 4 patients. One, two and five year survival was 84%, 76% and 64%, respectively. Conclusions Radical resection and in-situ reconstruction with CPA avoids placing prosthetic material in an infected field and provides good early and mid-term outcomes. However, early postoperative imaging is necessary given the risk of pseudoaneurysm formation.