Bio

Clinical Focus


  • Thoracic and Cardiovascular Surgery

Academic Appointments


Honors & Awards


  • Co-Principal Investigator, Mechanism of Coronary Microvascular Dysfunction in Metabolic Syndrome (September 2013)
  • Grand Rounds, Krannert Institute of Cardiology (October 2013)
  • Moderator, AHA Coronary Artery Disease (November 2012)
  • Moderator, AHA Thoracic Aortic Disease I (November 2010)
  • Delegate, 2010 STS Legislative Advocacy Workshop (June 2010)
  • Recipient, Young Physician Scholarship (August 2010)
  • Top Doctor, US News & World Report (2013, 2012)
  • Top Doctor, Castle Connolly (2013)
  • Teaching Resident of the Year, Department of General Surgery Indiana University School of Medicine (2006)

Boards, Advisory Committees, Professional Organizations


  • Member, The American Board of Thoracic Surgery (2011 - Present)
  • Member, Society of Thoracic Surgeons (2010 - Present)
  • Member, International Society of Minimally Invasive Of Cardiac Surgeons (2009 - Present)
  • Member, American Heart Association (2009 - Present)
  • Member, The American Board of Surgery (2007 - Present)

Professional Education


  • Board Certification: Thoracic and Cardiovascular Surgery, American Board of Thoracic Surgery (2011)
  • Fellowship:Indiana University School of MedicineIN
  • Residency:Indiana University School of MedicineIN
  • Internship:Indiana University School of MedicineIN
  • Board Certification: General Surgery, American Board of Surgery (2007)
  • Medical Education:Indiana University School of Medicine (2000) IN
  • Fellowship, Good Samaritan Hospital, Robotic Cardiac Surgery (2009)
  • Fellowship, University of Pennsylvania, Minimally Invasive Cardiac Surgery (2009)
  • Resident, Indiana University School of Medicine, Thoracic Surgery (2009)
  • Resident, Indiana University School of Medicine, General Surgery (2006)
  • Faculty of Health Sciences, Moi University, Eldoret, Kenya, Health Care in a Third World Country (2004)
  • Intern, Indiana University School of Medicine, General Surgery (2001)
  • Doctorate, Indiana University School of Medicine, Medicine (2000)
  • Bachelor of Arts, University of Notre Dame, Government (1996)

Publications

All Publications


  • Surgical unroofing of hemodynamically significant myocardial bridges in a pediatric population. The Journal of thoracic and cardiovascular surgery Maeda, K., Schnittger, I., Murphy, D. J., Tremmel, J. A., Boyd, J. H., Peng, L., Okada, K., Pargaonkar, V. S., Hanley, F. L., Mitchell, R. S., Rogers, I. S. 2018

    Abstract

    BACKGROUND: Although myocardial bridges (MBs) are traditionally regarded as incidental findings, it has been reported that adult patients with symptomatic MBs refractory to medical therapy benefit from unroofing. However, there is limited literature in the pediatric population. The aim of our study was to evaluate the indications and outcomes for unroofing in pediatric patients.METHODS: We retrospectively reviewed all pediatric patients with MB in our institution who underwent surgical relief. Clinical characteristics, relevant diagnostic data, intraoperative findings, and postoperative outcomes were evaluated.RESULTS: Between 2012 and 2016, 14 pediatric patients underwent surgical unroofing of left anterior descending artery MBs. Thirteen patients had anginal symptoms refractory to medical therapy, and 1 patient was asymptomatic until experiencing aborted sudden cardiac arrest during exercise. Thirteen patients underwent exercise stress echocardiography, all of which showed mid-septal dys-synergy. Coronary computed tomography imaging confirmed the presence of MBs in all patients. Intravascular ultrasound imaging confirmed the length of MBs: 28.2±16.3mm, halo thickness: 0.59±0.24mm, and compression of left anterior descending artery at resting heart rate: 33.0±11.6%. Invasive hemodynamic assessment with dobutamine confirmed the physiologic significance of the MBs with diastolic fractional flow reserve: 0.59±0.13. Unroofing was performed with the patient under cardiopulmonary bypass (CPB) in the initial 9 cases and without CPB in the subsequent 5 cases. All patients were discharged without complications. The 13 symptomatic patients reported resolution of symptoms on follow-up, and improvement in symptoms and quality of life was documented using the Seattle Angina Questionnaire version 7.CONCLUSIONS: Unroofing of MBs can be safely performed in pediatric patients, with or without use of CPB. In symptomatic patients, unroofing can provide relief of symptoms refractory to medical therapy.

    View details for DOI 10.1016/j.jtcvs.2018.01.081

    View details for PubMedID 30005887

  • Impact of load variations on systolic function of failed left ventricle under extracorporeal membrane oxygenation assessed by strain and tissue doppler imaging Ouazani, N., Shudo, Y., Sallam, K., Lee, A., Boyd, J., Teuteberg, J. WILEY. 2018: 114–15
  • How to start a successful robotic mitral surgery program: It's not just about the surgery! JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Wang, H., Boyd, J. H. 2018; 155 (4): 1472–73

    View details for DOI 10.1016/j.jtcvs.2017.12.017

    View details for Web of Science ID 000427633800036

    View details for PubMedID 29317089

  • MYOCARDIAL BRIDGE MUSCLE INDEX (MMI): A MARKER OF DISEASE SEVERITY AND ITS RELATIONSHIP WITH ENDOTHELIAL DYSFUNCTION AND SYMPTOMATIC OUTCOME IN PATIENTS WITH ANGINA AND A HEMODYNAMICALLY SIGNIFICANT MYOCARDIAL BRIDGE Pargaonkar, V., Schnittger, I., Rogers, I., Tanaka, S., Yamada, R., Kimura, T., Boyd, J., Tremmel, J. ELSEVIER SCIENCE INC. 2018: 160
  • Atrial Septal Defect as Unexpected Cause of Pulmonary Artery Hypertension TEXAS HEART INSTITUTE JOURNAL Parikh, R., Boyd, J., Lee, D. P., Witteles, R. 2018; 45 (1): 42–44

    Abstract

    Methamphetamine abuse is an increasingly prevalent cause of pulmonary artery hypertension in the United States. Conversely, an atrial septal defect rarely presents late as pulmonary artery hypertension. We present the case of a 44-year-old methamphetamine abuser who had a 3-month history of worsening fatigue and near-syncope. She had elevated cardiac enzyme levels and right-sided heart strain. Angiographic findings suggested methamphetamine-induced pulmonary artery hypertension; however, we later heard S2 irregularities that raised suspicion of an atrial septal defect. Ultimately, the diagnosis was pulmonary artery hypertension and a large secundum atrial septal defect with left-to-right flow. One year after defect closure, the patient was asymptomatic. In addition to discussing this unexpected case of a secundum atrial septal defect masquerading as methamphetamine-induced pulmonary artery hypertension, we briefly review the natural history of atrial septal defects and emphasize the importance of thorough examination in avoiding diagnostic anchoring bias.

    View details for DOI 10.14503/THIJ-17-6208

    View details for Web of Science ID 000426402700011

    View details for PubMedID 29556152

    View details for PubMedCentralID PMC5832086

  • Second Arterial Versus Venous Conduits for Multivessel Coronary Artery Bypass Surgery in California. Circulation Goldstone, A. B., Chiu, P., Baiocchi, M., Wang, H., Lingala, B., Boyd, J. H., Woo, Y. J. 2018; 137 (16): 1698–1707

    Abstract

    Whether a second arterial conduit improves outcomes after multivessel coronary artery bypass grafting remains unclear. Consequently, arterial conduits other than the left internal thoracic artery are seldom used in the United States.Using a state-maintained clinical registry including all 126 nonfederal hospitals in California, we compared all-cause mortality and rates of stroke, myocardial infarction, repeat revascularization, and sternal wound infection between propensity score-matched cohorts who underwent primary, isolated multivessel coronary artery bypass grafting with the left internal thoracic artery, and who received a second arterial conduit (right internal thoracic artery or radial artery, n=5866) or a venous conduit (n=53 566) between 2006 and 2011. Propensity score matching using 34 preoperative characteristics yielded 5813 matched sets. A subgroup analysis compared outcomes between propensity score-matched recipients of a right internal thoracic artery (n=1576) or a radial artery (n=4290).Second arterial conduit use decreased from 10.7% in 2006 to 9.1% in 2011 (P<0.0001). However, receipt of a second arterial conduit was associated with significantly lower mortality (13.1% versus 10.6% at 7 years; hazard ratio, 0.79; 95% confidence interval [CI], 0.72-0.87), and lower risks of myocardial infarction (hazard ratio, 0.78; 95% CI, 0.70-0.87) and repeat revascularization (hazard ratio, 0.82; 95% CI, 0.76-0.88). In comparison with radial artery grafts, right internal thoracic artery grafts were associated with similar mortality rates (right internal thoracic artery 10.3% versus radial artery 10.7% at 7 years; hazard ratio, 1.10; 95% CI, 0.89-1.37) and individual risks of cardiovascular events, but the risk of sternal wound infection was increased (risk difference, 1.07%; 95% CI, 0.15-2.07).Second arterial conduit use in California is low and declining, but arterial grafts were associated with significantly lower mortality and fewer cardiovascular events. A right internal thoracic artery graft offered no benefit over that of a radial artery, but did increase risk of sternal wound infection. These findings suggest surgeons should consider lowering their threshold for using arterial grafts, and the radial artery may be the preferred second conduit.

    View details for DOI 10.1161/CIRCULATIONAHA.117.030959

    View details for PubMedID 29242351

  • The tip of the iceberg: Evaluating the mechanism behind dehiscence of mitral annuloplasty rings. The Journal of thoracic and cardiovascular surgery MacArthur, J. W., Boyd, J. 2017

    View details for DOI 10.1016/j.jtcvs.2017.08.099

    View details for PubMedID 28947191

  • Current status of domino heart transplantation. Journal of cardiac surgery Shudo, Y., Ma, M., Boyd, J. H., Woo, Y. J. 2017; 32 (3): 229-232

    Abstract

    Domino heart transplant, wherein the explanted heart from the recipient of an en-bloc heart-lung is utilized for a second recipient, represents a unique surgical strategy for patients with end-stage heart failure. With a better understanding of the potential advantages and disadvantages of this procedure, its selective use in the current era can improve and maximize organ allocation in the United States. In this report, we reviewed the current status of domino heart transplantation.

    View details for DOI 10.1111/jocs.13104

    View details for PubMedID 28219115

  • Successful use of donor lungs after repairing severely injured pulmonary vein of donor lungs. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery Shudo, Y., Miller, S. L., Boyd, J. H., Woo, Y. J. 2017

    View details for DOI 10.1093/ejcts/ezx392

    View details for PubMedID 29186381

  • Surgical Unroofing of Hemodynamically Significant Left Anterior Descending Myocardial Bridges. Annals of thoracic surgery Boyd, J. H., Pargaonkar, V. S., Scoville, D. H., Rogers, I. S., Kimura, T., Tanaka, S., Yamada, R., Fischbein, M. P., Tremmel, J. A., Mitchell, R. S., Schnittger, I. 2016

    Abstract

    Left anterior descending artery myocardial bridges (MBs) range from clinically insignificant incidental angiographic findings to a potential cause of sudden cardiac death. Within this spectrum, a group of patients with isolated, symptomatic, and hemodynamically significant MBs despite maximally tolerated medical therapy exist for whom the optimal treatment is controversial. We evaluated supraarterial myotomy, or surgical unroofing, of the left anterior descending MBs as an isolated procedure in these patients.In 50 adult patients, we prospectively evaluated baseline clinical characteristics, risk factors, and medications for coronary artery disease, relevant diagnostic data (stress echocardiography, computed tomography angiography, stress coronary angiogram with dobutamine challenge for measurement of diastolic fractional flow reserve, and intravascular ultrasonography), and anginal symptoms using the Seattle Angina Questionnaire. These patients then underwent surgical unroofing of their left anterior descending artery MBs followed by readministration of the Seattle Angina Questionnaire at 6.6-month (range, 2 to 13) follow-up after surgery.Dramatic improvements were noted in physical limitation due to angina (52.0 versus 87.1, p < 0.001), anginal stability (29.6 versus 66.4, p < 0.001), anginal frequency (52.1 versus 84.7, p < 0.001), treatment satisfaction (76.1 versus 93.9, p < 0.001), and quality of life (25.0 versus 78.9, p < 0.001), all five dimensions of the Seattle Angina Questionnaire. There were no major complications or deaths.Surgical unroofing of carefully selected patients with MBs can be performed safely as an independent procedure with significant improvement in symptoms postoperatively. It is the optimal treatment for isolated, symptomatic, and hemodynamically significant MBs resistant to maximally tolerated medical therapy.

    View details for DOI 10.1016/j.athoracsur.2016.08.035

    View details for PubMedID 27745841

  • Successful Operative Repair of Delayed Left Ventricle Rupture From Blunt Trauma. Annals of thoracic surgery Greene, C. L., Boyd, J. H. 2016; 102 (2): e101-3

    Abstract

    A 21-year-old female was found to have an enlarging pericardial effusion 10 days after a 40-foot fall. Initial cardiac evaluation was negative. Ten days after presentation she developed hemodynamic compromise and chest computed tomography was concerning for cardiac rupture. The patient was taken to the operating room where the ruptured posterior ventricle was repaired, perforation in the P1 leaflet was identified and the mitral valve was replaced. The patient survived. To our knowledge, this is the first report of survival after delayed presentation of atrioventricular rupture at the level of the mitral valve.

    View details for DOI 10.1016/j.athoracsur.2016.01.031

    View details for PubMedID 27449439

  • Salvage Extracorporeal Membrane Oxygenation Prior to "Bridge" Transcatheter Aortic Valve Replacement. Journal of cardiac surgery Chiu, P., Fearon, W. F., Raleigh, L. A., Burdon, G., Rao, V., Boyd, J. H., Yeung, A. C., Miller, D. C., Fischbein, M. P. 2016; 31 (6): 403-405

    Abstract

    We describe a patient who presented in profound cardiogenic shock due to bioprosthetic aortic valve stenosis requiring salvage Extracorporeal Membrane Oxygenation followed by a "bridge" valve-in-valve transcatheter aortic valve replacement. doi: 10.1111/jocs.12750 (J Card Surg 2016;31:403-405).

    View details for DOI 10.1111/jocs.12750

    View details for PubMedID 27109017

    View details for PubMedCentralID PMC4951207

  • Bilateral Giant Coronary Artery Aneurysms Complicated by Acute Coronary Syndrome and Cardiogenic Shock. Annals of thoracic surgery Chiu, P., Lynch, D., Jahanayar, J., Rogers, I. S., Tremmel, J., Boyd, J. 2016; 101 (4): e95-7

    Abstract

    Giant coronary aneurysms are rare. We present a 25-year-old woman with a known history of non-Kawasaki/nonatherosclerotic bilateral coronary aneurysms. She was transferred to our facility with acute coronary syndrome complicated by cardiogenic shock. Angiography demonstrated giant bilateral coronary aneurysms and complete occlusion of the left anterior descending (LAD) artery. Emergent coronary artery bypass grafting was performed. Coronary artery bypass grafting is the preferred approach for addressing giant coronary aneurysms. Intervention on the aneurysm varies in the literature. Aggressive revascularization is recommended in the non-Kawasaki/nonatherosclerotic aneurysm patient, and ligation should be performed in patients with thromboembolic phenomena.

    View details for DOI 10.1016/j.athoracsur.2015.06.104

    View details for PubMedID 27000621

  • A novel approach to ischemic mitral regurgitation (IMR). Annals of cardiothoracic surgery Scoville, D. H., Boyd, J. B. 2015; 4 (5): 443-448

    Abstract

    Ischemic mitral regurgitation (IMR) is a complicated medical condition with varying degrees of coronary artery disease and mitral regurgitation (MR). The traditional surgical treatment option for those with indications for intervention is coronary artery bypass grafting (CABG) plus or minus mitral valve repair or replacement (MVR). Percutaneous coronary intervention, hybrid coronary revascularization (HCR), and conventional CABG are three techniques available to address coronary artery disease (CAD). Percutaneous edge-to-edge repair, minimally invasive, and traditional sternotomy are accepted approaches for the treatment of MR. When taken in combination, there are nine methods available to revascularize the myocardium and restore competency to the mitral valve. While most of these treatment options have not been studied in detail, they may offer novel solutions to a widely variable and complex IMR patient population. Thus, a comparative analysis including an examination of potential benefits and risks will be helpful and potentially allow for more patient-specific treatment strategies.

    View details for DOI 10.3978/j.issn.2225-319X.2015.08.06

    View details for PubMedID 26539349

    View details for PubMedCentralID PMC4598475

  • Ventricular assist device implantation in the elderly. Annals of cardiothoracic surgery Hiesinger, W., Boyd, J. H., Woo, Y. J. 2014; 3 (6): 570-572

    Abstract

    Dramatic advances in ventricular assist device (VAD) design and patient management have made mechanical circulatory support an attractive therapeutic option for the growing pool of elderly heart failure patients.A literature review of all relevant studies was performed. No time or language restrictions were imposed, and references of the selected studies were checked for additional relevant citations.In concordance with the universal trend in mechanical circulatory support, continuous flow devices appear to have particular benefits in the elderly. In addition, the literature suggests that early intervention before the development of cardiogenic shock, important in all patients, is particularly paramount in older patients.The ongoing refinement of patient selection, surgical technique, and post-operative care will continue to improve surgical outcomes, and absolute age may become a less pivotal criterion for mechanical circulatory support. However, clear guidelines for the use of mechanical circulatory support in the elderly remain undefined.

    View details for DOI 10.3978/j.issn.2225-319X.2014.09.07

    View details for PubMedID 25512896

  • Human aortic allograft: an excellent conduit choice for superior vena cava reconstruction JOURNAL OF CARDIOTHORACIC SURGERY Spera, K., Kesler, K. A., Syed, A., Boyd, J. H. 2014; 9

    Abstract

    Superior vena cava (SVC) reconstruction is occasionally required in the treatment of benign and malignant conditions. We report a patient with symptomatic SVC obstruction secondary to mediastinal fibrosis successfully reconstructed with an aortic allograft.

    View details for DOI 10.1186/1749-8090-9-16

    View details for Web of Science ID 000331888700001

    View details for PubMedID 24428914

  • Epicardial adipose excision slows the progression of porcine coronary atherosclerosis JOURNAL OF CARDIOTHORACIC SURGERY Mckenney, M. L., Schultz, K. A., Boyd, J. H., Byrd, J. P., Alloosh, M., Teague, S. D., Arce-Esquivel, A. A., Fain, J. N., Laughlin, M. H., Sacks, H. S., Sturek, M. 2014; 9

    Abstract

    In humans there is a positive association between epicardial adipose tissue (EAT) volume and coronary atherosclerosis (CAD) burden. We tested the hypothesis that EAT contributes locally to CAD in a pig model.Ossabaw miniature swine (n=9) were fed an atherogenic diet for 6 months to produce CAD. A 15 mm length by 3-5 mm width coronary EAT (cEAT) resection was performed over the middle segment of the left anterior descending artery (LAD) 15 mm distal to the left main bifurcation. Pigs recovered for 3 months on atherogenic diet. Intravascular ultrasound (IVUS) was performed in the LAD to quantify atheroma immediately after adipectomy and was repeated after recovery before sacrifice. Coronary wall biopsies were stained immunohistochemically for atherosclerosis markers and cytokines and cEAT was assayed for atherosclerosis-related genes by RT-PCR. Total EAT volume was measured by non-contrast CT before each IVUS.Circumferential plaque length increased (p<0.05) in the proximal and distal LAD segments from baseline until sacrifice whereas plaque length in the middle LAD segment underneath the adipectomy site did not increase. T-cadherin, scavenger receptor A and adiponectin were reduced in the intramural middle LAD. Relative to control pigs without CAD, 11β-hydroxysteroid dehydrogenase (11βHSD-1), CCL19, CCL21, prostaglandin D2 synthase, gp91phox [NADPH oxidase], VEGF, VEGFGR1, and angiotensinogen mRNAs were up-regulated in cEAT. EAT volume increased over 3 months.In pigs used as their own controls, resection of cEAT decreased the progression of CAD, suggesting that cEAT may exacerbate coronary atherosclerosis.

    View details for DOI 10.1186/1749-8090-9-2

    View details for Web of Science ID 000331886200002

    View details for PubMedID 24387639

  • Ischemic Mitral Regurgitation - Where Do We Stand? CIRCULATION JOURNAL Boyd, J. H. 2013; 77 (8): 1952-1956

    Abstract

    Chronic ischemic mitral regurgitation (IMR) is still a significant clinical problem. It is present in 10-20% of patients with coronary artery disease and is associated with a worse prognosis after myocardial infarction and subsequent revascularization. Currently, coronary artery bypass grafting combined with restrictive annuloplasty is the most commonly performed surgical procedure, although novel approaches have been used in limited numbers with varying degrees of success. The purpose of this review is to clarify the rationale for the surgical techniques applicable to IMR. In order to do so, the condition will be defined and the evolution of classic or traditional surgical approaches to repairing or replacing the mitral valve in the setting of IMR will be described. Finally, novel approaches to the repair of the ischemic mitral valve will be considered. 

    View details for DOI 10.1253/circj.CJ-13-0743

    View details for Web of Science ID 000322752000004

    View details for PubMedID 23877709

  • Neonatal cavopulmonary assist: Pulsatile versus steady-flow pulmonary perfusion ANNALS OF THORACIC SURGERY Myers, C. D., Boyd, J. H., Presson, R. G., Vijay, P., COATS, A. C., Brown, J. W., Rodefeld, M. D. 2006; 81 (1): 257-263

    Abstract

    Morbidity and mortality associated with single-ventricle physiology decrease substantially once a systemic venous, rather than systemic arterial, source of pulmonary blood flow is established. Cavopulmonary assist has potential to eliminate critical dependence on the problematic systemic-to-pulmonary shunt as a source of pulmonary blood flow in neonates. We have previously demonstrated feasibility of neonatal cavopulmonary assist under steady-flow conditions. We hypothesized that pulsatile pulmonary perfusion would further improve pulmonary hemodynamics.Lambs (weight 7.2 +/- 1.1 kg, age 7.9 +/- 1.5 days) underwent total cavopulmonary diversion using bicaval venous-to-main pulmonary artery cannulation. A miniature centrifugal pump was used to augment cavopulmonary flow. Pulsatility was created with an intermittently compressed compliance chamber in the circuit. Hemodynamic and gas exchange data were measured for 8 hours. Pulsatile (n = 6), steady-flow (n = 13), and control (n = 6) groups were compared using two-way analysis of variance with repeated measures.All animals remained physiologically stable with normal gas exchange function. Mean pulmonary arterial pressure was elevated in pulsatile and steady-flow groups compared with the control group and within-group baseline values. Pulmonary vascular resistance was elevated initially in both assist groups but decreased significantly over the last 4 hours of the study and normalized after hour 4 in the pulsatile perfusion group. Pulmonary vascular resistance also normalized to control in the steady-flow group after hour 7.Both steady-flow and pulsatile pulmonary perfusion demonstrated normalization of pulmonary vascular resistance to control in a neonatal model of univentricular Fontan circulation. These results suggest that there is no benefit to pulsatile flow in this model.

    View details for DOI 10.1016/j.athoracsur.2005.07.003

    View details for Web of Science ID 000234585400037

    View details for PubMedID 16368377

  • Cavopulmonary assist in the neonate: An alternative strategy for single-ventricle palliation 29th Annual Meeting of the Western-Thoracic-Surgical-Association Rodefeld, M. D., Boyd, J. H., Myers, C. D., Presson, R. G., Wagner, W. W., Brown, J. W. MOSBY-ELSEVIER. 2004: 705–11

    Abstract

    Cavopulmonary blood flow, rather than a systemic arterial source of pulmonary blood flow, stabilizes Norwood physiology. We hypothesized that pump-assisted cavopulmonary diversion would yield stable pulmonary and systemic hemodynamics in the neonate. This was tested in a newborn animal model of total cavopulmonary diversion and univentricular Fontan circulation.Lambs (n = 13; mean weight, 5.6 +/- 1.5 kg; mean age, 6.8 +/- 4.0 days) were anesthetized and mechanically ventilated. Baseline hemodynamic parameters were measured. Total cavopulmonary diversion was performed with bicaval venous-to-main pulmonary artery cannulation. A miniature centrifugal pump was used to assist cavopulmonary flow. Support was titrated to normal physiologic parameters. Hemodynamic data, arterial blood gases, and lactate values were measured for 8 hours. Baseline, 1-hour, and 8-hour time points were compared by using analysis of variance.All animals remained stable without the use of volume loading, inotropic support, or pulmonary vasodilator therapy. Cardiac index, systemic arterial pressure, left atrial pressure, and lactate values were similar to baseline values 8 hours after surgery. Mean pulmonary arterial pressure and pulmonary vascular resistance were modestly increased 8 hours after surgery. Mean arterial pH, Po(2), and Pco(2) values remained stable throughout the study.Cavopulmonary assist is feasible in a neonatal animal model of total cavopulmonary diversion and univentricular Fontan circulation with acceptable pulmonary arterial pressures and without altering regional volume distribution or cardiac output. Pump-assisted cavopulmonary diversion, in combination with Norwood aortic arch reconstruction, could solve several major problems associated with a systemic shunt-dependent univentricular circulation, including hypoxemia, impaired diastolic coronary perfusion, and ventricular volume overload.

    View details for DOI 10.1016/j.jtcvs.2003.11.007

    View details for Web of Science ID 000220115400017

    View details for PubMedID 15001898

  • Cavopulmonary assist: Circulatory support for the univentricular Fontan circulation 39th Annual Meeting of the Society-of-Thoracic-Surgeons Rodefeld, M. D., Boyd, J. H., Myers, C. D., LaLone, B. J., Bezruczko, A. J., Potter, A. W., Brown, J. W. ELSEVIER SCIENCE INC. 2003: 1911–16

    Abstract

    Following Fontan palliation, the univentricular circulation is notable for coexisting systemic venous hypertension and pulmonary arterial hypotension. Assisted cavopulmonary blood flow to overcome this pressure gradient would restore the circulation to one more closely resembling normal two-ventricle physiology. We hypothesized that mechanical augmentation of cavopulmonary blood flow would provide physiologic stability in a model of cavopulmonary diversion and univentricular circulation.Yearling sheep (n = 13, mean weight 56.5 kg) underwent total cavopulmonary diversion on cardiopulmonary bypass. The superior and inferior vena cavae were anastomosed directly to the right pulmonary artery. Axial flow pumps were positioned within both vena cavae to assist blood flow from the systemic venous circulation into the pulmonary vasculature. Baseline ventilation was resumed, cardiopulmonary bypass was weaned, and pump support was titrated to obtain normal physiologic measurement. Cardiopulmonary data were collected for 6 hours.All animals demonstrated hemodynamic stability without need for volume loading, inotropic support, or pulmonary vasodilator therapy. Cardiac output, pulmonary vascular resistance, pulmonary arterial pressure, inferior vena caval pressure, and arterial pCO(2) and pO(2) values 6 hours after intervention were similar to baseline values. Arterial lactate levels steadily decreased throughout the cavopulmonary assist period.Cavopulmonary assist with a percutaneous pump provides physiologic stability in a model of total cavopulmonary diversion and univentricular Fontan circulation without altering regional volume distribution or cardiac output. This mode of circulatory support may have potential to benefit patients with marginal Fontan hemodynamics in both the early and late time periods.

    View details for DOI 10.1016/S0003-4975(03)01014-2

    View details for Web of Science ID 000186986500028

    View details for PubMedID 14667610