Academic Appointments

Honors & Awards

  • Class Honors, Duke University (1982-4)
  • Magna Cum Laude, Duke University (1984)
  • Phi Lambda Upsilon Honor Society, National Chemistry Honor Society (1984)
  • Chicago Surgical Society Research Award, Chicago Surgical (1993)
  • Alpha Omega Alpha, AOA (1994)
  • Golden Apple Teaching Award, University of Chicago (1994)
  • Whos Who in American Healthcare, Strathmore (2003)
  • Pioneer in Healthcare Reform, NRCC (2004)
  • Whos Who in Medicine, Marquis (2007)
  • Americas Top Surgeon, Consumers (2008)
  • Top Doc, NJ Monthly (2008)
  • Patients Choice Award, Patients Choice (2008, 2009.2010, 2011, 2012)
  • Americas Top Doctors, Castle Connolly (2009, 2010, 2011, 2012,2013)
  • Top Doctor, US News and World Report (2010.2011.2012.2013)

Professional Education

  • MD, New York/Cornell, Cardiothoracic Surgery
  • MD, University of Chicago, Surgery
  • MD, Columbia University (1988)
  • BA, Duke University (1984)

Research & Scholarship

Current Research and Scholarly Interests

minimally invasive mitral valve repairs, minimally invasive maze procedures, off-pump cabg, robotic heart surgery


All Publications

  • Preoperative Heparin Therapy Causes Immune-Mediated Hypotension Upon Heparin Administration for Cardiac Surgery JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Casthely, P. A., Defilippi, V., Cornwell, L., Samuel, Z., Yoganathan, T., Komer, C., Cisbarros, S., Acevedo, A. 2010; 24 (1): 69-72


    To evaluate whether patients with positive or negative heparin antibodies who received heparin preoperatively by continuous infusion developed cardiovascular changes upon heparin administration prior to cardiopulmonary bypass.Clinical trial.Single institution, academic hospital.Eighty (80) patients with good ventricular function on low-dose heparin infusion prior to surgery.Patients were divided into 2 equal groups: group A had negative heparin antibodies (% ratio < 0.26), group B had positive heparin antibodies (% ratio > 1.2). All patients received heparin, 400 units/kg, prior to institution of cardiopulmonary bypass. Cardiovascular changes, activated coagulation time (ACT), and histamine levels were measured before and 5 minutes after administration of heparin. Platelets also were counted before and 6 hours after surgery.Significant hypotension and decreased cardiac index occurred in patients with positive heparin antibodies who received heparin prior to cardiac surgery. Histamine levels increased significantly 5 minutes after heparin administration. Significant thrombocytopenia occurred 6 hours after surgery in group B patients. There was a good correlation between heparin antibodies, histamine levels, thrombocytopenia and cardiovascular changes. Group B patients also had heparin resistance as manifested by a lower ACT after the loading doses of heparin.Patients with positive heparin antibodies pretreated with heparin prior to surgery developed a type of immune-mediated cardiovascular changes and postoperative thrombocytopenia.

    View details for DOI 10.1053/j.jvca.2009.10.015

    View details for Web of Science ID 000276965500013

    View details for PubMedID 20123238

  • The effects of intracoronary nicardipine on ventricular dynamics and function in patients undergoing off-pump coronary artery bypass graft surgery JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Casthely, P. A., Defilippi, V., Pakonis, G., Bikkina, M., Yoganathan, T., Komer, C., Cornwell, L. 2008; 22 (2): 192-198


    To evaluate whether intracoronary nicardipine can provide myocardial protection in patients undergoing off-pump coronary artery bypass graft surgery.Clinical trial.Single-institution, academic hospital.Off-pump coronary artery bypass patients with good ejection fraction.Patients were divided into 2 equal groups: group A received 1 mL (0.1 mg) of intracoronary nicardipine before performing the distal anastomosis, and group B patients received 1 mL of NaCl in the coronary artery. Transesophageal echocardiography (PowerVision 6000, 9-mm 6-MHz probe; Toshiba, Elmsford, NY) was used in this study.Left ventricular ejection fraction, cardiac index, tissue Doppler imaging, velocity of the left ventricle and mitral annulus, and troponin levels were measured in both groups. The incidence of diastolic dysfunction as evaluated by superior pulmonary blood flow and pulsed-wave Doppler of the mitral annulus was significantly lower in group A. Tissue Doppler imaging velocity of the left ventricle and mitral annular displacement were significantly higher in the nicardipine group. Group A patients had significantly lower incidences of ST-segment changes, prolonged pharmacologic support in the postoperative period, and lower levels of troponin after surgery.Intracoronary nicardipine improves ventricular function in patients undergoing off-pump coronary artery bypass surgery.

    View details for DOI 10.1053/j.jvca.2007.11.002

    View details for Web of Science ID 000254902300004

    View details for PubMedID 18375319

  • Left Ventricular function in Patients undergoing Off-pump Coronary Artery Bypass (OPCAB) Using the Tissue Stabilizer Octopus R3: A comparative Study using the Deep pericardial Sutures of the Starfish Stabilizer Anesth Analg Princesa GR, DeFilippi V, Yoganathan T, Komer C, Upadya P 2003; 96 (sca1): 141
  • Internal mammary artery harvesting using the harmonic scalpel ASAIO JOURNAL Orejola, W. C., Villacin, A. B., Defilippi, V. J., Mekhjian, H. A. 2000; 46 (1): 99-102


    Internal mammary artery (IMA) harvesting using the harmonic scalpel (HS) was recently introduced. We studied 541 IMAs harvested by the same surgeon through a standard median sternotomy in 472 coronary bypass patients; 252 (47%) with the HS, while 289 (53%) were with electrocautery (EC). Patient demographics included mean ages: 67 years HS vs. 65 years EC (p = NS); male:female ratio: 3:1; and insulin dependent diabetes mellitus (IDDM): 11% HS vs. 12.5% EC (NS). Mean ultrasonic IMA flow at a mean SBP of 70 mm Hg in 10 consecutive patients of each group were: preharvest, HS 11.9 +/- 2.3 ml/min vs. EC 8.5 +/- 1.6 ml/min (p = 0.256); postharvest, HS 35.7 +/- 10.7 ml/min vs. EC 22 +/- 2.9 ml/min (0.235); and postcardiopulmonary bypass (post-CPB), HS 47.8 +/- 6.2 ml/min vs. EC 41.7 +/- 2.5 ml/min (0.381). Histologic samples of 50 consecutive IMAs showed no evidence of vessel injury in either group. Clinical results revealed postoperative bleeding in 6/217 (2.7%) HS vs. 7/255 (2.7%) EC (p = 0.783), none attributed to bleeding from the IMA; phrenic paresis: 0/217 in HS but 1/255 (0.4%) in EC (p = 0.960); sternal wound infection: 5/217 (2.3%) HS vs. 6/255 (2.4%) EC (p = 0.787); postoperative IABP: 6/217 (2.7%) HS vs. 5/255 (2%) EC (p = 0.859); mortality: 2/217 (0.9%) HS vs. 2/255 (0.8%) EC (p = 0.710). Hemodynamic, histologic, and clinical results were comparable in both groups. The authors believe the HS is safe and effective for IMA harvesting.

    View details for Web of Science ID 000166430800023

    View details for PubMedID 10667725

  • Characterization of the effects of histamine on porcine tracheobronchial lymph vessels AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY REEDER, L. B., Defilippi, V. J., Ferguson, M. K. 1996; 271 (6): H2501-H2507


    We characterized the responses of lymphatic vascular smooth muscle to histaminergic-receptor stimulation and blockade and explored the mechanisms underlying the histamine-stimulated release of endothelium-derived relaxing factor (EDRF). Fresh porcine tracheobronchial lymph vessel rings mounted in organ baths were stimulated by the cumulative addition of histamine or H1, H2, and H3 receptor-specific agonists in the presence or absence of receptor-specific antagonists. Histamine had a contractile effect on lymphatic vascular smooth muscle that was H1 receptor mediated. No important effects were elicited by H2- or H3-receptor stimulation. Histamine also caused the release of EDRF as demonstrated by an increase in smooth muscle tone in the absence of endothelium and after inhibition of nitric oxide synthase. This effect was strong at high concentrations of histamine and was mediated by H1-receptor stimulation. The results suggest that histamine may contribute to the regulation of lymphatic vascular smooth muscle tone under pathological conditions, an effect that may be controlled through modification of H1-receptor activity.

    View details for Web of Science ID A1996WB84000036

    View details for PubMedID 8997310

  • Retroperitoneal placement of an ICD generator: A solution for a difficult problem PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY Defilippi, V. J., Gottlieb, L., Bump, T., Ferguson, M. K. 1996; 19 (1): 130-131


    A woman experienced multiple episodes of pocket erosion after placement of an implantable cardioverter defibrillator culminating in a pocket infection. The device was placed in a retroperitoneal location, and the patient has not developed further episodes of pocket erosion or infection. Interrogation of the device in this position and its subsequent replacement have been straightforward.

    View details for Web of Science ID A1996TR15200022

    View details for PubMedID 8848371



    Prior reviews of esophageal perforation with delayed recognition have reported mortality rates as high as 66%. We performed a retrospective review of patients with nonmalignant esophageal perforation to assess the outcome of current management techniques.Charts were reviewed of all patients who were treated for nonmalignant esophageal perforation between 1980 and 1993. They were 23 men and 10 women, mean age 49 +/- 3 years, 19 of whom were diagnosed early (< or = 24 hours) and 14 of whom were diagnosed late (> 24 hours).Perforations were due to instrumentation (16), operative injury (7), spontaneous rupture (4), trauma (4), and other causes (2). Pre-existing esophageal disease was identified in 23 patients (70%), including achalasia (9), stricture (7), varices (5), and other (2). Treatment included closure and fundoplication or muscle wrap (10), closure with or without pleural flap (7), resection only (7), resection and reconstruction (3), drainage only (4), and observation (2). Nonfatal complications included empyema (4), arrhythmia (3), persistent leak following attempted closure (2), and other (5). They occurred in 50% of both the early and late diagnosis groups and were of comparable severity in both. The overall mortality was 9% (3/33). Causes of death were sepsis (1) and multisystem organ failure (2). Mortality was 5% (1/19) in patients diagnosed early and 14% (2/14) of those diagnosed late.Current mortality rates in nonmalignant esophageal perforation are improved compared to previously published rates of 19% for all patients with the condition, 9% following early and 29% following late diagnosis (47 patients overall). We conclude that, despite a high incidence of associated complications, the survival rate following nonmalignant esophageal perforation is improving and the impact of delayed recognition is decreasing.

    View details for Web of Science ID A1995RB02500014

    View details for PubMedID 7771627



    We performed morphometric and length-tension analyses comparing mesenteric and tracheobronchial lymph vessel segments to determine the potential of the latter tissue to regulate pulmonary and mediastinal lymph flow via alterations in smooth muscle tone. Fresh porcine lymph vessel rings were prepared for 1) in vitro assessment of length-tension relationships and 2) histologic preparation and measurement of smooth muscle cross-sectional area (SMA). Mesenteric and tracheobronchial optimal vessel ring lengths were 3.1 +/- 0.2 and 3.5 +/- 0.2 mm, and maximum active tensions were 1518 +/- 25 and 1703 +/- 162 mg. Smooth muscle formed indistinct layers in each tissue, and only 30% of the smooth muscle was oriented circumferentially. Stress generated by the circular smooth muscle was similar to that generated by other types of vascular smooth muscle. In 75% of mesenteric vessel rings spontaneous contractions were observed that had a mean contraction frequency of 1.7 +/- 0.2 min-1 and a mean contraction amplitude of 349 +/- 35 mg, while only 40% of tracheobronchial vessels exhibited spontaneous contractions (p < 0.001) that had a mean frequency of 0.6 +/- 0.2 min-1 (p = 0.0021) and a mean contraction amplitude of 118 +/- 10 mg (p < 0.0001). We conclude that tracheobronchial lymphatic vascular smooth muscle is capable of developing stress similar to that generated by mesenteric lymph vessels, and that spontaneous rhythmic contractile activity is qualitatively and quantitatively different in tracheobronchial than in mesenteric porcine lymph vessels. The data suggest that tracheobronchial lymph vessels are capable of regulating pulmonary and mediastinal lymph flow through intrinsic mechanisms. Such regulation may occur by alterations in vascular resistance rather than via spontaneous pumping activity.

    View details for Web of Science ID A1994NT98500002

    View details for PubMedID 8078363



    Lymphatic smooth muscle tone and contractility are important determinants of lymph flow. Because we have shown previously that lymph vessels exhibit endothelium-dependent relaxation similar to that identified in blood vessels, we assessed the possible role of nitric oxide as an endothelium-dependent relaxant factor in lymph vessels using porcine tracheobronchial lymph vessel rings mounted in organ baths. Isometric active tension was measured and normalized as a percentage of response to 65 mM KCl-substituted perfusate. Histamine and NE elicited contraction in all vessel rings at a concentration of 10(-5) M, and we were unable to demonstrate relaxant responses to these substances even at low concentrations. In histamine- and NE-contracted vessel rings an increase in active tension was produced by NMMA (33.9 +/- 5.4 and 26.1 +/- 5%, respectively, P < 0.0001 for each), an effect that was reversed by addition of L-arginine but not by D-arginine. Endothelial disruption reversed the effects of NMMA in histamine-contracted (16.2 +/- 4.0% increase in active tension; P = N.S. vs initial histamine response) and in NE-contracted vessel rings (11.5 +/- 1.2% increase in active tension; P = N.S. vs initial NE response). The data provide evidence that nitric oxide is an endothelium-dependent relaxant factor that regulates tracheobronchial lymphatic smooth muscle tone and is released in response to administration of contractile agonists.

    View details for Web of Science ID A1994NN83500003

    View details for PubMedID 8084297

  • TRANSCERVICAL THYMECTOMY FOR MYASTHENIA-GRAVIS ANNALS OF THORACIC SURGERY Defilippi, V. J., Richman, D. P., Ferguson, M. K. 1994; 57 (1): 194-197


    The use of transcervical thymectomy in the treatment of myasthenia gravis remains controversial. We retrospectively reviewed our experience with this procedure to determine its usefulness in the management of myasthenia gravis. Fifty-three selected myasthenic patients without thymoma underwent transcervical thymectomy between 1977 and 1991. The mean age (27.5 +/- 1.5 years), duration of symptoms (2 +/- 1.0 years), and preoperative Osserman classification (13% class I, 53% class IIA, 28% class IIB, 6% class III) were consistent with previous reports. The average hospitalization was 3.0 +/- 0.3 days, but has been 1.6 +/- 0.2 days since 1987 (n = 14). There were no deaths, and no patients required mechanical ventilation for more than 24 hours. Average follow-up was 4.3 +/- 0.4 years with a range of 0 to 13 years. Eighty-one percent of patients are symptom free, and 9 of 21 (43%) are in complete remission at least 5 years postoperatively. One patient required a transsternal exploration for worsening symptoms. Clinical improvement continued over an extended period of time, and a statistically significant decrease in symptoms was evident comparing the first and sixth postoperative years. Patients were more likely to be improved or in remission if thymectomy was performed within the first year of the onset of symptoms (p < 0.05). Osserman classification, thymus histology, and patient age were not prognostic indicators. Transcervical thymectomy is effective surgical therapy for myasthenia gravis in selected patients without thymoma.

    View details for Web of Science ID A1994MR31800035

    View details for PubMedID 8279889

  • MID-INFRARED LASERS FOR ENDOSCOPIC SURGERY - A NEW CLASS OF SURGICAL LASERS AMERICAN SURGEON Treat, M. R., Trokel, S. L., Defilippi, V. J., Andrew, J., Cohen, M. G. 1989; 55 (2): 81-84


    Unlike the Nd:YAG, the CO2 laser produces well circumscribed tissue removal with little unwanted damage because of its high absorption coefficient relative to tissue water. Unfortunately, conventional quartz fibers cannot transmit wavelengths greater than three microns, well below the ten micron wavelength of the CO2 laser. Thus, fiberoptic transmission of CO2 laser requires use of exotic materials that lack the excellent properties of quartz fibers and that, in some cases, are toxic or chemically unstable. However, there are large peaks in the infrared absorption curve of water in the two to three micron region. Lasers that operate in this mid-infrared region should permit CO2-like precision of cutting, along with excellent transmission through quartz fiberoptics. Two mid-infrared lasers with a fiberoptic delivery system, the Er:YAG (2.94 micron) and the Tm-Ho-Cr:YAG (2.15 micron) have been evaluated with human colon tissue in vitro and with rabbit gastric tissue in vivo. Histologic sections reveal excellently well localized lesions with minimal underlying thermal damage. Depth of penetration is controllable and occurs in very small increments. There is little spreading of the lesions at the 24 hour mark resulting from secondary thermal damage. Based on these facts, the authors think that these lasers will be of benefit to endoscopic surgeons.

    View details for Web of Science ID A1989T131100002

    View details for PubMedID 2916803



    There is a need for lasers that are compatible with fiberoptic endoscopes and that provide greater cutting precision than currently can be produced by the widely used Nd:YAG (1.06 micron) laser. Recently available lasers that operate in the 2-micron region fill this need. This laser light energy can be transmitted by low OH- silica fibers and has much less tissue penetration than radiation at 1.06 micron. We have been evaluating a prototype solid state laser system that produces pulses of 2.15 microns light that is delivered by a silica based fiberoptic delivery system with negligible transmission losses. This system is based on a thulium-holmium-chromium doped YAG (Tm-Ho-Cr: YAG) rod that lases at 2.15 micron. The laser does not require cryogenic cooling, toxic gases, or custom utilities and should be practical in a clinical environment. In vivo animal testing of this laser confirms that it provides greater ablating precision than does the Nd:YAG laser at 1.06 micron.

    View details for Web of Science ID A1988N760200015

    View details for PubMedID 2839746

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