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Biomedical subjects

Jeffrey H Shuhaiber

Publications and source records attributed to Jeffrey H Shuhaiber.

15 recordsLinked to original sources
PubMed2005

Meta-analysis of clinical outcomes of maze-related surgical procedures for medically refractory atrial fibrillation.

OBJECTIVE: Although maze-related surgical procedures have shown success at eliminating atrial fibrillation, published controlled studies have generally been too small to detect clinically significant differences in morbidity and mortality. We pooled available studies to determine whether a simultaneous maze procedure reduces the risk of stroke or death in patients with chronic or paroxysmal atrial fibrillation who receive mitral valve surgery. Secondary outcomes included post-operative bleeding and need for pacemaker. METHODS: Our systematic review identified four randomized controlled trials and six retrospective comparative studies that met minimum quality criteria. We conducted meta-analyses of clinical outcomes using Cohen's h, a statistic appropriate for analysis of infrequent events. RESULTS: The findings suggest that maze may reduce stroke risk but also increase the need for pacemaker implantation, as well as increase the risk of post-operative bleeding unless radiofrequency ablation is used. However, the statistically significant findings for stroke, need for pacemaker, and post-operative bleeding were overturned by sensitivity analysis, indicating that the findings are not robust. CONCLUSION: The literature evaluating maze clinical outcomes suffers from several shortcomings, particularly small sample sizes and selection bias. However, weak evidence supports a reduction in stroke rates and an increase in need for pacemakers among patients receiving the maze procedure. Radiofrequency maze may avoid an excess risk of post-operative bleeding associated with maze incisions. Larger, well-designed RCTs are needed to confirm these findings and evaluate outcomes such as survival and quality of life.

Atrial Fibrillation↗
PubMed2004

Augmented reality in surgery.

OBJECTIVE: To evaluate the history and current knowledge of computer-augmented reality in the field of surgery and its potential goals in education, surgeon training, and patient treatment. DATA SOURCES: National Library of Medicine's database and additional library searches. STUDY SELECTION: Only articles suited to surgical sciences with a well-defined aim of study, methodology, and precise description of outcome were included. DATA SYNTHESIS: Augmented reality is an effective tool in executing surgical procedures requiring low-performance surgical dexterity; it remains a science determined mainly by stereotactic registration and ergonomics. Strong evidence was found that it is an effective teaching tool for training residents. Weaker evidence was found to suggest a significant influence on surgical outcome, both morbidity and mortality. No evidence of cost-effectiveness was found. CONCLUSIONS: Augmented reality is a new approach in executing detailed surgical operations. Although its application is in a preliminary stage, further research is needed to evaluate its long-term clinical impact on patients, surgeons, and hospital administrators. Its widespread use and the universal transfer of such technology remains limited until there is a better understanding of registration and ergonomics.

Forecasting↗
PubMed2004

The role of palmaris muscle tendon in mitral valve annulus reconstruction: a novel technique for mitral valve repair.

BACKGROUND: Autogenous tissue for heart valve repair is limited to pericardium and fascia lata. Prosthetic annuloplasty rings have limitations and are expensive. No previous cadaveric study has documented autotransplantation of forearm tendons for mitral valve repair. The purposes of this anatomical study were (1) to determine the feasibility of using tendons for annular reconstruction during mitral valve repair (band or ring shape) and (2) to compare the metric dimensions and gross morphology with those of prosthetic rings. METHODS: The palmaris tendon (PM) (n = 7) was harvested from forearms of human cadavers and prepared in the dissecting room. The tendon was incorporated along the valve annulus. Surgery consisted of mitral valve annuloplasty performed with an undersized and a complete tendon. RESULTS: On gross handling PM tissue was morphologically resilient. Preparation and use of PM for annuloplasty were feasible. Anatomical reconstruction of the annulus with autogenous tissue using this tendon also was feasible. The annulus behaved as a flexible ring that allowed for improved atrioventricular continuity. Complete (n = 7) and partial (n = 7) annuloplasty rings were constructed. Metric dimensions were similar to those of prosthetic rings. CONCLUSION: PM is a suitable novel autogenous tissue that can be harvested together with the radial artery and has direct relevance in ischemic mitral valve regurgitation. These tendons can be easily utilized to achieve results similar to those of pericardial reconstruction and prosthetic annuloplasty rings. The tissue is readily available from the patient, and no extra cost is incurred. Further chemical studies in the human subjects are warranted.

Cadaver↗
PubMed2003

The impact of introducing an autologous intraoperative transfusion device to a community hospital.

The purpose of this study was to determine the benefits and disadvantages of transfusing autologous blood during abdominal aortic aneurysm (AAA) surgery at a district general hospital with an intraoperative autologous transfusion device (Haemoccel ABT 350). In this retrospective study, 128 patients underwent abdominal aortic aneurysm repair between 1992 and 1999 by a single vascular surgeon. Ninety-three patients (60 autologous and 33 allogeneic) had elective AAA repair (group A) and 25 patients (4 autologous and 21 allogeneic) had emergency AAA repair (group B). Nine group A patients (7.6%) received their own salvaged blood and no other allogeneic blood. Although the mean estimated blood loss was higher in the autologous group of patients (NS), the intraoperative autologous transfusion device did not significantly reduce allogeneic blood usage in patients who had autologous transfusion in both elective and emergency groups. There was no difference in postoperative hemoglobin and hematocrit, ICU stay or hospital stay. In this study, red cell salvage was significantly more expensive than blood bank usage (p < 0.0001), yet it did not significantly reduce the needs of allogeneic blood. We concluded that the intraoperative autologous transfusion device is underused, not cost-effective and requires formulation of local guidelines.

Aged↗
PubMed2003

Plantaris tendon graft for atrioventricular valve repair: a novel hypothetical technique.

Heart valve repair is a biomaterial-dependent procedure, yet autogenous tissue for valvular reconstruction has to date been obtained mostly from the pericardium and fascia lata. Most clinical studies recommend valve repair as an alternative to replacement. We now put forward a hypothesis, extrapolated from hand surgery, for use of the plantaris tendon in heart valve repair. This proposal, if implemented, would increase the supply of autogenous donor tissue for valve repair, thereby enhancing the surgeon's armamentarium. The report describes a novel technique that in our judgment warrants future clinical development.

Cardiac Surgical Procedures↗
PubMed2002

Mechanisms and future directions for prevention of vein graft failure in coronary bypass surgery.

Coronary artery bypass grafting has been utilized as a beneficial treatment for myocardial ischemic disease for over three decades. Failure of coronary artery venous grafts occurs at a substantial rate and has a large impact on two main endpoints, survival and quality of life. An exhaustive amount of basic research has been generated to delineate possible mechanisms responsible for graft failure and modalities to prevent its occurrence. Although pharmacotherapy exists, insufficient translation has emerged from the bench to the operating room. In this article, we review the literature regarding the current mechanisms and mediators including growth factors, nitric oxide and genetics leading to saphenous vein graft occlusion. The review addresses the current state of affairs and modes for prevention of vein graft failure perioperatively and newer technologies that may help ameliorate this problem in the future.

Arteriosclerosis↗