Browsing by Author "Turek, Joseph W"

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    An approach to mycotic aneurysm in unrepaired coarctation of the aorta.
    (The Journal of thoracic and cardiovascular surgery, 2023-05) Parker, Lauren E; Kang, Lillian; Medina, Cathlyn K; Su, Bailey; Miller, Stephen; Turek, Joseph W; Overbey, Douglas M; Beckerman, Ziv
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    Association between preoperative respiratory support and outcomes in paediatric cardiac surgery.
    (Cardiology in the young, 2019-11-27) Ciociola, Elizabeth C; Kumar, Karan R; Zimmerman, Kanecia O; Thompson, Elizabeth J; Harward, Melissa; Sullivan, Laura N; Turek, Joseph W; Hornik, Christoph P
    BACKGROUND:Preoperative mechanical ventilation is associated with morbidity and mortality following CHD surgery, but prior studies lack a comprehensive analysis of how preoperative respiratory support mode and timing affects outcomes. METHODS:We retrospectively collected data on children <18 years of age undergoing cardiac surgery at an academic tertiary care medical centre. Using multivariable regression, we examined the association between modes of preoperative respiratory support (nasal cannula, high-flow nasal cannula/noninvasive ventilation, or invasive mechanical ventilation), escalation of preoperative respiratory support, and invasive mechanical ventilation on the day of surgery for three outcomes: operative mortality, postoperative length of stay, and postoperative complications. We repeated our analysis in a subcohort of neonates. RESULTS:A total of 701 children underwent 800 surgical procedures, and 40% received preoperative respiratory support. Among neonates, 243 patients underwent 253 surgical procedures, and 79% received preoperative respiratory support. In multivariable analysis, all modes of preoperative respiratory support, escalation in preoperative respiratory support, and invasive mechanical ventilation on the day of surgery were associated with increased odds of prolonged length of stay in children and neonates. Children (odds ratio = 3.69, 95% CI 1.2-11.4) and neonates (odds ratio = 8.97, 95% CI 1.31-61.14) on high-flow nasal cannula/noninvasive ventilation had increased odds of operative mortality compared to those on room air. CONCLUSION:Preoperative respiratory support is associated with prolonged length of stay and mortality following CHD surgery. Knowing how preoperative respiratory support affects outcomes may help guide surgical timing, inform prognostic conversations, and improve risk stratification models.
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    Borrowing from Adult Cardiac Surgeons-Bringing Congenital Heart Surgery Up to Speed in the Minimally Invasive Era.
    (Innovations (Philadelphia, Pa.), 2020-03) Alsarraj, Mohammed K; Nellis, Joseph R; Vekstein, Andrew M; Andersen, Nicholas D; Turek, Joseph W
    The majority of congenital and adult cardiac surgery is performed through a median sternotomy. For surgeons, this incision provides excellent exposure; however, for patients, a median sternotomy confers a poorer cosmetic outcome and the possibility of postoperative respiratory dysfunction, chronic pain, and deep sternal wound infections. Despite the advances in adult cardiac surgery, the use of minimally invasive techniques in pediatric patients is largely limited to small case series and less complex repairs. In this article, we review the risks, benefits, and limitations of the minimally invasive congenital cardiac approaches being performed today. The interest in these approaches continues to grow as more data supporting reduced morbidity, decreased length of stay, and faster recovery are published. In the future, as the technology and surgical familiarity improve, these alternative approaches will become more common, and may someday become the standard of care.
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    Commentary: Cavopulmonary assist: Closing in on the white whale of single-ventricle palliation.
    (The Journal of thoracic and cardiovascular surgery, 2019-12) Andersen, Nicholas D; Kirmani, Sonya; Turek, Joseph W
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    Commentary: Shunted single-ventricle neonatal ventricular-assist device support: Are we nearing a consensus strategy?
    (The Journal of thoracic and cardiovascular surgery, 2019-08) Andersen, Nicholas D; Kirmani, Sonya; Turek, Joseph W
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    Cultured thymus tissue implementation promotes donor-specific tolerance to allogeneic heart transplants.
    (JCI insight, 2020-04-30) Kwun, Jean; Li, Jie; Rouse, Clay; Park, Jae Berm; Farris, Alton B; Kuchibhatla, Maragatha; Turek, Joseph W; Knechtle, Stuart J; Kirk, Allan D; Markert, M Louise
    Eighty-six infants born without a thymus have been treated with allogeneic cultured thymus tissue implantation (CTTI). These infants, who lack T cells and are profoundly immunodeficient at birth, after CTTI from an unmatched donor develop genetically-recipient T cells that are tolerant to both their own major histocompatibility antigens and those of the donor. We tested use of CTTI with the goal of inducing tolerance to unmatched heart transplants in immunocompetent rats. We thymectomized and T cell depleted Lewis rats. The rats were then given Lewis x Dark Agouti (LWxDA) CTTI under the kidney capsule and vascularized DA heart transplants in the abdomen. Cyclosporine was administered for 4 months. The control group did not receive CTTI. Recipients with CTTI showed repopulation of naïve and recent thymic emigrant CD4 T cells; controls had none. Recipients of CTTI did not reject DA cardiac allografts. Control animals did not reject DA grafts, due to lack of functional T cells. To confirm donor-specific unresponsiveness, MHC-mismatched Brown Norway (BN) hearts were transplanted 6 months after the initial DA heart transplant. LW rats with (LWxDA) CTTI rejected the third-party BN hearts (mean survival time 10d; n=5). Controls did not (n=5). CTTI recipients produced antibody against third party BN donor but not against the DA thymus donor demonstrating humoral donor-specific tolerance. Taken together, F1(LWxDA) CTTI given to Lewis rats resulted in specific tolerance to the allogeneic DA MHC expressed in the donor thymus with resulting long-term survival of DA heart transplants after withdrawal of all immunosuppression.
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    Infant heart transplant following donation after circulatory death using normothermic regional perfusion and distant transport, first reported case in North America
    (JTCVS Techniques, 2023-01-01) Beckerman, Ziv; Overbey, Douglas; Bryner, Benjamin S; Schroder, Jacob N; Andersen, Nicholas D; Carboni, Michael P; Casalinova, Sarah; Turek, Joseph W
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    Left Anterior Mini-Incision for Pulmonary Valve Replacement Following Tetralogy of Fallot Repair.
    (Innovations (Philadelphia, Pa.), 2020-03) Nellis, Joseph R; Vekstein, Andrew M; Meza, James M; Andersen, Nicholas D; Haney, John C; Turek, Joseph W
    Pulmonary insufficiency is a known complication following Tetralogy of Fallot repair. With over 90% of patients now surviving to adulthood, surgeons are once again faced with the question of when, and more importantly, how to reintervene. We developed a novel approach to pulmonary valve replacement in this population through a 5-cm left anterior mini-incision. The incision is optimized for exposing and operating on the right ventricular outflow tract and the main pulmonary artery in patients with a history of median sternotomy. Early outcomes are reassuring, and we believe our approach is a safe and reliable alternative to median sternotomy within this patient population, with the ability to quickly convert intraoperatively when needed.
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    Left Anterior Mini-Incision for Pulmonary Valve Replacement in a 12-Year-Old.
    (Innovations (Philadelphia, Pa.), 2020-03) Vekstein, Andrew M; Nellis, Joseph R; Meza, James M; Andersen, Nicholas D; Haney, John C; Turek, Joseph W
    A 12-year-old, 32 kg male with history of Tetralogy of Fallot status post repair at 8 days of life presented with progressive pulmonary insufficiency and left pulmonary artery stenosis. Surgical options were discussed, and the patient and his family elected to pursue minimally invasive pulmonary valve replacement with left pulmonary artery augmentation through a 5-cm left anterior mini-incision. The procedure was performed without complication, and he was discharged on postoperative day 3. At the time of his last follow-up, the patient was recovering well without evidence of pulmonary stenosis or insufficiency.
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    Minimally Invasive Pulmonary Fibroelastoma Resection.
    (Innovations (Philadelphia, Pa.), 2019-11-19) Nellis, Joseph R; Wojnarski, Charles M; Fitch, Zachary W; Andersen, Nicholas A; Turek, Joseph W
    Pulmonary fibroelastomas are a rare primary cardiac tumor with less than 50 cases reported in the literature to date. We performed a minimally invasive valve-sparing tumor resection through a left anterior mini-incision (LAMI). The procedure was performed without cardiac arrest or aortic cross clamp, expediting postoperative recovery and allowing for an uncomplicated discharge on postoperative day 5. LAMI is a safe and reliable alternative to median sternotomy for patients requiring interventions on the right ventricular outflow tract and main pulmonary artery, including pulmonary fibroelastoma resection and pulmonary valve replacement when needed.