The Experts below are selected from a list of 327 Experts worldwide ranked by ideXlab platform
Michael Poullis - One of the best experts on this subject based on the ideXlab platform.
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Off-Pump Conversion: In-hospital Mortality and Long-Term Survival
The Thoracic and cardiovascular surgeon, 2015Co-Authors: Mark Pullan, Michael PoullisAbstract:Background There is an ongoing debate on the benefits and risks of off-pump coronary artery bypass grafting (CABG) surgery. The fate of patients who start with their procedure being an off-pump one and then have to undergo conversion to an on-pump procedure is debated with regard to in-hospital mortality and unknown with regard to Long-Term Survival. We investigated the in-hospital mortality and Long-Term Survival of patients who underwent conversion from off- to on-pump surgery. Methods We performed a multivariate and propensity analysis on in-hospital mortality and Long-Term Survival of postisolated CABG patients in a single institution having 15,704 patients of which 5,353 who underwent off-pump CABG were analyzed. Results In-hospital mortality was 2.15% for the study cohort, and 73 (1.4%) off-pump cases were converted. Univariate analysis demonstrated that patients undergoing conversion had a significantly increased in-hospital mortality ( p p = 0.002). Logistic regression (receiver operating curve 0.77, Hosmer-Lemeshow test 0.46) and Cox analysis demonstrated that in-hospital mortality and Long-Term Survival were not significantly affected by conversion. Propensity analysis (one:many match) demonstrated that in-hospital mortality was not significantly affected ( p = 0.7), and Long-Term Survival - univariate, and multivariate were also not significantly reduced in patients undergoing conversion. Conclusion Conversion from off- to on-pump by a team of surgeons and anesthetists who are dedicated off-pump specialists does not have an impact on in-hospital mortality or Long-Term Survival.
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Long-Term Survival of non-smokers undergoing coronary artery bypass surgery.
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2013Co-Authors: Francesca O'boyle, John Chalmers, James Mcshane, Neeraj Mediratta, Richard Warwick, Matthew Shaw, Michael PoullisAbstract:OBJECTIVES: We sought to investigate Long-Term Survival of non-smokers undergoing coronary artery bypass surgery (CABG). METHODS: A prospective database of consecutive patients was retrospectively analysed and cross correlated with the UK strategic tracking service to evaluate Survival after primary CABG. Univariate, multivariate and a propensity analyses were performed. RESULTS: We analysed 13 337 primary CABG procedures. Median follow-up was 7 years. Kaplan–Meier Survival curves demonstrate that non-smokers have a significantly improved Long-Term Survival compared with ex- and current smokers, P< 0.0001. Cox regression analysis identified smoking status, age, diabetes, ejection fraction (EF), body mass index, cerebrovascular disease, dialysis, left internal mammary artery (LIMA) non-usage, postoperative creatinine kinase muscle-brain isoenzyme (CKMB), radial artery usage, preoperative rhythm, forced vital capacity (FVC) and logistic EuroSCORE as significant risk factors deTermining Long-Term Survival. Propensity matching resulted in 3575 non-smokers being matched 1:1, with ex-smokers. After matching, univariate analysis demonstrated the significantly worse LongTerm Survival of ex-smokers compared with non-smokers, P< 0.0001. Cox regression analysis identified smoking status, age, postoperative CKMB, cerebrovascular disease, dialysis, diabetes, EF, FVC, LIMA non-usage, radial artery used, sinus rhythm and logistic EuroSCORE as significant risk factors deTermining Long-Term Survival. Survival by smoking status plotted at the mean of the covariates, prepropensity matching, demonstrated that non-smokers had a significantly better Long-Term Survival than ex-smokers, P< 0.0001; however, after propensity matching, non-smokers under 65 years of age had a significantly worse Long-Term Survival compared with ex-smokers, P< 0.0001. CONCLUSIONS: Non-smokers under the age of 65 years of age have significantly worse Long-Term Survival compared with ex-smokers after risk factor adjustment. We speculate that this is because ex-smokers have had the causative factor, smoking, removed, but nonsmokers have not.
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Long-Term Survival of patients with pulmonary disease undergoing coronary artery bypass surgery
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2012Co-Authors: Francesca O'boyle, John Chalmers, Neeraj Mediratta, Matthew Shaw, Omar Al-rawi, K. Mohan, Michael PoullisAbstract:RESULTS: We analysed 13 337 primary CABG procedures. The median follow-up was 7 years. Univariate analysis demonstrated that obstructive (P< 0.0001), restrictive (P< 0.0001) and mixed obstructive and restrictive pulmonary disease (P< 0.0001), and COPD as defined by the GOLD criteria (P< 0.0001), are all significant factors deTermining Long-Term Survival. Cox regression analysis identified age, diabetes, moderate LV, poor LV, peripheral vascular disease, dialysis, left internal mammary artery (LIMA) usage, EuroSCORE, cardiopulmonary bypass and creatinine kinase muscle-brain isoenzyme as significant factors in addition to pulmonary disease that deTermine Long-Term Survival. Moderate and severe COPD defined by GOLD criteria were significant factors deTermining Long-Term Survival, but mild COPD had no significant effect. Obstructive and restrictive lung disease were both significant factors deTermining Long-Term Survival. Restrictive lung disease, however, carried a greater prognostic significance (higher hazard ratio 2.2 vs 1.6) than obstructive. LIMA utilization in patients with COPD was not associated with an increased intensive care unit stay, re-intubation rate or in-hospital mortality rate. CONCLUSIONS: Pulmonary disease is a significant factor deTermining Long-Term Survival. Patients with severe COPD still have a relatively good Long-Term Survival and should not be denied surgery. LIMA utilization in patients with COPD results in a significantly increased Long-Term Survival, without an increased intensive care unit stay, re-intubation rate or in-hospital mortality rate.
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Long Term Survival after coronary artery bypass surgery stratified by euroscore
European Journal of Cardio-Thoracic Surgery, 2012Co-Authors: Francesca Oboyle, John Chalmers, Mark Pullan, Brian M. Fabri, James Mcshane, Neeraj Mediratta, Mathew Shaw, Michael PoullisAbstract:OBJECTIVES: Coronary artery bypass grafting (CABG) is performed for symptoms and for prognostic reasons. The EuroSCORE is widely utilized as a pre-operative risk prediction tool. We evaluated our Long-Term Survival figures based on EuroSCORE. METHODS: A prospective database was retrospectively analysed and cross correlated with the UK strategic tracking service to evaluate Survival after primary CABG. Patients were grouped based on their logistic EuroSCORE 0 to 5 and <25. Cox multivariate regression and neuronal network analysis confirmed that the additional factors, diabetes, body mass index (BMI), post-operative myocardial creatinine kinase myocardial isoenzyme (CKMB) and left internal mammary artery (LIMA) usage, which are not incorporated in EuroSCORE significantly predict Long-Term Survival. CONCLUSIONS: Logistic EuroSCORE is a reasonable approximation for Long-Term Survival after CABG, if the score is <5; however, its predictive capacity is limited due to the absence of LIMA usage, BMI, diabetes and CKMB in its calculation, all of which are significant factors affecting Long-Term Survival.
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Long-Term Survival after coronary artery bypass surgery stratified by EuroSCORE
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2012Co-Authors: Francesca O'boyle, John Chalmers, Mark Pullan, Brian M. Fabri, James Mcshane, Neeraj Mediratta, Mathew Shaw, Michael PoullisAbstract:Coronary artery bypass grafting (CABG) is performed for symptoms and for prognostic reasons. The EuroSCORE is widely utilized as a pre-operative risk prediction tool. We evaluated our Long-Term Survival figures based on EuroSCORE. A prospective database was retrospectively analysed and cross correlated with the UK strategic tracking service to evaluate Survival after primary CABG. Patients were grouped based on their logistic EuroSCORE 0 to <5, 5 to <10, 10 to <15, 15 to <20, 20 to <25 and ≥25. We analysed 13,337 primary cardiac procedures. A total of 9961 procedures had a logistic EuroSCORE of 0 to <5, 2041 of 5 to <10, 636 of 10 to <15, 281 of 15 to <20, 137 of 20 to <25 and 281≥25. Long-Term Survival is significantly affected by logistic EuroSCORE, P < 0.001. Patients with a logistic EuroSCORE <5% had significantly better initial Survival and a lower rate of death over a 10-year period, P<0.001. Patients with a logistic score over 25 had a significantly worse 5-year Survival, P<0.001. Logistic EuroSCORE was poor at predicting Survival when >5 and <25. Cox multivariate regression and neuronal network analysis confirmed that the additional factors, diabetes, body mass index (BMI), post-operative myocardial creatinine kinase myocardial isoenzyme (CKMB) and left internal mammary artery (LIMA) usage, which are not incorporated in EuroSCORE significantly predict Long-Term Survival. Logistic EuroSCORE is a reasonable approximation for Long-Term Survival after CABG, if the score is <5; however, its predictive capacity is limited due to the absence of LIMA usage, BMI, diabetes and CKMB in its calculation, all of which are significant factors affecting Long-Term Survival.
John R. Bach - One of the best experts on this subject based on the ideXlab platform.
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Long-Term Survival in Werdnig-Hoffmann disease.
American journal of physical medicine & rehabilitation, 2007Co-Authors: John R. Bach, Katherine Saltstein, Diane Sinquee, Brian Weaver, Eugene KomaroffAbstract:ABSTRACTBach JR, Saltstein K, Sinquee D, Weaver B, Komaroff E: Long-Term Survival in Werdnig–Hoffmann disease. Am J Phys Med Rehabil 2007;86:339–345.Objectives:To report Long-Term Survival of spinal muscular atrophy type 1 (SMA 1) and consequences on speech and ventilator dependence as a function of
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Medical considerations of Long-Term Survival of Werdnig-Hoffmann disease.
American journal of physical medicine & rehabilitation, 2007Co-Authors: John R. BachAbstract:ABSTRACTBach JR: Medical considerations of Long-Term Survival of Werdnig–Hoffmann disease. Am J Phys Med Rehabil 2007;86:349–355.Objectives:To report intercurrent nonrespiratory complications of unprecedented Survival for Werdnig–Hoffman disease (spinal muscular atrophy type 1 [SMA 1]).Design:A retr
Daorong Wang - One of the best experts on this subject based on the ideXlab platform.
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impact of postoperative complications on Long Term Survival after radical resection for gastric cancer
World Journal of Gastroenterology, 2013Co-Authors: Dong Tang, Jie Chen, Daorong WangAbstract:Impact of postoperative complications on Long-Term Survival after radical resection for gastric cancer
Eugene Komaroff - One of the best experts on this subject based on the ideXlab platform.
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Long-Term Survival in Werdnig-Hoffmann disease.
American journal of physical medicine & rehabilitation, 2007Co-Authors: John R. Bach, Katherine Saltstein, Diane Sinquee, Brian Weaver, Eugene KomaroffAbstract:ABSTRACTBach JR, Saltstein K, Sinquee D, Weaver B, Komaroff E: Long-Term Survival in Werdnig–Hoffmann disease. Am J Phys Med Rehabil 2007;86:339–345.Objectives:To report Long-Term Survival of spinal muscular atrophy type 1 (SMA 1) and consequences on speech and ventilator dependence as a function of
Sun Whe Kim - One of the best experts on this subject based on the ideXlab platform.
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Actual Long-Term Survival Outcome of 403 Consecutive Patients with Hilar Cholangiocarcinoma
World Journal of Surgery, 2016Co-Authors: Mee Joo Kang, Jin-young Jang, Jihoon Chang, Yong Chan Shin, Doo-ho Lee, Hong Beom Kim, Sun Whe KimAbstract:Background Despite aggressive surgical resection, prognosis of patients with hilar cholangiocarcinoma is still unsatisfactory. There were limited data about actual Long-Term Survival outcome. This study was designed to explore actual Long-Term Survival outcome of hilar cholangiocarcinoma after surgical treatment, and to investigate the characteristics of patients with actual Long-Term Survival. Methods The study cohort consisted of 403 consecutive patients with at least 5-year follow-up after surgical treatment for hilar cholangiocarcinoma at Seoul National University Hospital between 1991 and 2010. Prognostic factors were analyzed with Cox proportional hazard models, and the effect of adjuvant treatment was evaluated by propensity score analysis. Results Of all patients, R0 resection rate was 41.2 and 63.8 % among intended curative resection. Adjuvant therapy was performed in 48.8 % after curative surgery. Actual 5-year overall Survival (OS) rate was 18.9, and 30.1 % after R0 resection. Actual 5-year disease-free Survival rate was 25.8 % after resection. Adjuvant treatment improved prognosis in patients with positive metastatic lymph nodes (median OS 21.9 vs. 11.5 months, p = 0.003). Overall recurrence rate was 55.0 %, and distant metastasis (39.7 %) was more frequent than loco-regional recurrence (20.8 %). Lymph node metastasis ( p = 0.021) and poor histologic grade ( p
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Actual Long-Term Survival Outcome of 403 Consecutive Patients with Hilar Cholangiocarcinoma
World journal of surgery, 2016Co-Authors: Mee Joo Kang, Jin-young Jang, Jihoon Chang, Yong Chan Shin, Doo-ho Lee, Hong Beom Kim, Sun Whe KimAbstract:Background Despite aggressive surgical resection, prognosis of patients with hilar cholangiocarcinoma is still unsatisfactory. There were limited data about actual Long-Term Survival outcome. This study was designed to explore actual Long-Term Survival outcome of hilar cholangiocarcinoma after surgical treatment, and to investigate the characteristics of patients with actual Long-Term Survival.
