Bio

Clinical Focus


  • Anesthesia
  • Cardiovascular Anesthesia

Academic Appointments


Professional Education


  • Fellowship:Mount Sinai Medical Center (1985) NY
  • Residency:Mount Sinai Medical Center (1984) NY
  • Internship:Lenox Hill Hospital (1981) NY
  • Medical Education:Robert Wood Johnson Med School (1979) NJ

Teaching

2013-14 Courses


Publications

Journal Articles


  • Case report: a thrombus in the venous reservoir while using bivalirudin in a patient with heparin-induced thrombocytopenia undergoing heart transplantation. Anesthesia and analgesia Wong, J. K., Tian, Y., Shuttleworth, P., Caffarelli, A. D., Reitz, B. A., Mora-Mangano, C. T. 2010; 111 (3): 609-612

    Abstract

    Direct thrombin inhibitors are heparin alternatives for anticoagulation during cardiopulmonary bypass in patients with heparin-induced thrombocytopenia. We report a case of a large thrombus forming in the venous reservoir while using bivalirudin. We suggest that blood stasis associated with the full venous reservoir maintained in this case led to formation of a large thrombus at the top of the venous canister. Furthermore, activated clotting times may not accurately reflect the magnitude of anticoagulation when using direct thrombin inhibitors.

    View details for DOI 10.1213/ANE.0b013e3181e9ead3

    View details for PubMedID 20686010

  • Aprotinin, blood loss, and renal dysfunction in deep hypothermic circulatory arrest CIRCULATION Mangano, C. T., Neville, M. J., Hsu, P. H., Mignea, I., KING, J., Miller, D. C. 2001; 104 (12): I276-I281

    Abstract

    The technique of deep hypothermic circulatory arrest (DHCA) for cardiothoracic surgery is associated with increased risk for perioperative blood loss and renal dysfunction. Although aprotinin, a serine protease inhibitor, reduces blood loss in patients undergoing cardiopulmonary bypass, its use has been limited in the setting of DHCA because of concerns regarding aprotinin-induced renal dysfunction. Therefore, we assessed the affect of aprotinin on both blood transfusion requirements and renal function in patients undergoing cardiovascular surgery and DHCA.We reviewed the records of 853 patients who underwent aortic or thoracoabdominal surgery at Stanford University Medical Center between January 1992 and March 2000. Two hundred three of these patients were treated with DHCA, and 90% (183) survived for more than 24 hours. Preoperative patient characteristics and intraoperative and postoperative clinical and surgical variables were recorded, and creatinine clearance (CRCl) was calculated for the preoperative and postoperative periods; renal dysfunction was prospectively defined as a 25% reduction in CRCl. The association between perioperative variables, including aprotinin use, and renal dysfunction was assessed by ANOVA techniques. Total urine output was 1294+/-1024 mL and 3492+/-1613 mL during and after surgery, respectively. CRCl decreased significantly after DHCA from 86+/-8 mL/min (before surgery) to 67+/-4 mL/min (in the intensive care unit) (P<0.01). Thirty-eight percent of patients (70 of 183) had postoperative renal dysfunction. Multivariate regression analyses identified 5 factors independently associated with a >25% reduction in CRCl: requirement for >/=5 U of packed red blood cells(P=0.0002; OR=2.1),

    View details for Web of Science ID 000171201500050

    View details for PubMedID 11568069

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