RUSH Cardiovascular and Thoracic Surgery 2023 Annual Report

RUSH Cardiovascular and Thoracic Surgery

2023 Annual Report

Michael Liptay, MD

Dear Colleagues,

I’m pleased to share with you the RUSH Department of Cardiovascular and Thoracic Surgery’s 2023 annual report.

In it, you’ll see numerous examples of our foundation to excellent care: our use of cutting edge surgical techniques and treatment approaches, combined with a compassionate, personalized touch with every patient we see.

Our cardiac, vascular and thoracic surgeons specialize in treating some of the most complex cases. RUSH has received the highest possible rating from the Society of Thoracic Surgeons for both coronary artery bypass procedures and lung cancer surgeries, which put our outcomes in the top 5% in the country.

Our surgeons are also national and international leaders in the use of minimally invasive techniques, as you’ll see, for instance, with their use of same-day, robotic-assisted bronchoscopy or how they were able to preserve a patient’s ability to eat and speak normally through an esophagectomy and tracheal wall reconstruction.

Our ECMO program to support lung failure grew out of COVID and its excellence is internationally recognized. In fact, our cardiac program has the lowest rate of mortality for heart failure care in the country.

I hope that you enjoy reading this report and are inspired by the work of our team.

Thank you for your interest in RUSH Cardiovascular and Thoracic Surgery and my best wishes to you.

Michael Liptay, MD

Chair, RUSH Department of Cardiovascular and Thoracic Surgery Director, RUSH Lung Center

Antone Tatooles, MD, FACS, FACCP

Use of VA ECMO in the Treatment of an Acute Myocardial Infarction and Cardiac Arrest

By Antone Tatooles, MD, FACS, FACCP

History

A male patient presented to the emergency room with severe dyspnea and chest pain. On examination, the patient had hemodynamic instability, malperfusion and EKG changes consistent with an acute myocardial infarction. He had incessant ventricular tachycardia and subsequent cardiac arrest and required cardiopulmonary resuscitation. The patient had a known history of obesity, hyperlipidemia and poor heart function.

Treatment

With ongoing CPR, the cardiac surgical team assisted in resuscitation and placed the patient on veno arterial extracorporeal membrane oxygenation (ECMO). He underwent cardiac catheterization, revealing critical coronary disease, including left main stenosis.

Subsequently, salvage coronary artery bypass grafting revascularized the patient’s critical disease. The ECMO support system was maintained and reconfigured to facilitate rehabilitation and ambulation. His postoperative course required temporary dialysis for acute kidney injury, prolonged ventilatory support for respiratory failure and endoscopic therapy for gastrointestinal bleeding. With the use of ECMO, his organ function improved. He was liberated from the ventilator and subsequently taken off ECMO support, rehabilitated and recovered cardiac function.

Outcome

The patient benefited from acute rehabilitation. He continues to improve and has now returned to work.

Analysis

ECMO has evolved as an essential resuscitative tool. For patients with cardiopulmonary collapse, the immediate appropriate application has resulted in favorable outcomes in our experience.

This case demonstrates the timely multidisciplinary team that implemented ECMO to stabilize the patient and provide appropriate hemodynamic and pulmonary support during interventions on his heart.

His presentation demonstrates that select patients with catastrophic diseases recover and receive the critical care necessary for optimal outcomes. In general, ECMO demonstrates efficacy in several scenarios, including acute cardiovascular collapse, progressive cardiogenic shock with concomitant pulmonary failure, and post cardiotomy syndrome in those who have failed conventional therapy.

Additional, well-established applications include primary respiratory failure, refractory hypoxemia with PF ratios less than 100, hypercapnic respiratory failure, and as a bridge to transplantation.

ECMO utilization continues to evolve. Appropriate strategies and implementation in the proper patient favor recovery of organ function or utilization as a bridge to transplantation. In addition, RUSH’s survival percentage has exceeded the international average for respiratory and cardiac support for years. 

Antone Tatooles, MD, and RUSH Evaluating Two Potentially Transformative Cardiac Surgical Procedures

APOLLO Trial

RUSH is currently participating in the APOLLO Trial, a global, multicenter trial evaluating the safety and efficacy of the Intrepid transcatheter mitral valve replacement (TMVR) system, and determining if it is as effective as traditional mitral valve surgery in treating patients with severe, symptomatic mitral regurgitation (MR). Hussam Suradi, MD, an interventional cardiologist at RUSH, is the principal investigator on the trial, and Antone Tatooles, MD, FACS, FACCP, cardiac surgeon at RUSH, serves as a co-principal investigator.

The current standard treatment for mitral regurgitation is surgery; the Intrepid system uses a less invasive, catheter-based alternative to treat patients with MR. The APOLLO trial will compare the one-year rates of mortality, stroke, reoperation/reintervention and cardiovascular hospitalization between patients receiving traditional surgery or TMVR.

In essence, TMVR is a modification of transcatheter aortic valve replacement (TAVR), a catheter-based approach that continues in the line of less invasive approaches to treating mitral valve disease.

“TAVR is an established treatment for the aortic valve, and TMVR is the next evolution of catheter-based treatment for patients with challenges with their mitral valves who may not be the best candidates for surgery,” Dr. Tatooles says.

Although it’s too early in the trial to draw any conclusions about TMVR, Dr. Tatooles believes that once the safety and efficacy of the Intrepid device has been established, it has the potential to be an alternative therapy for patients with mitral valve disease.

“I believe that the future treatment of mitral valve disease will continue to grow as new technology offers innovative minimally invasive approaches to therapy,” he says.

For more information about the trial, or to enroll your patient, visit rush.edu/clinical-trials/apollo-trial-treatment-mitral-regurgitation 

Antone Tatooles, MD, FACS, FACCP

TRILUMINATE Trial

RUSH is also enrolling patients in the Triluminate Trial, which is evaluating the TriClip transcatheter tricuspid valve repair system (TriClip) for transcatheter repair in patients who have symptoms of heart failure related to severe tricuspid regurgitation.

Currently, there are not many effective percutaneous treatment options, including surgery, for patients with severe tricuspid regurgitation. The Triluminate Trial, however, adapts the MitraClip system, a catheter-based technology that reduces regurgitation and improves symptoms of heart failure for the mitral valve, for the tricuspid valve.

“The delivery system for the mitral valve has been developed for an application to the tricuspid valve,” Dr. Tatooles says.

Early results from the Triluminate Trial show encouraging one-year findings where the TriClip system improved patients’ quality of life and reduced their symptoms of tricuspid regurgitation, both of which compare favorably to medical therapy — the use of diuretics.

Patients whose tricuspid regurgitation is left untreated can have a myriad of health issues, such as atrial fibrillation and fatigue, as well as a lower chance of survival. Due to their existing comorbidities, patients are often not ideal candidates for surgery, and the Triclip offers a potentially breakthrough avenue to treat these patients.

For more information about the trial, or to enroll your patient, visit rush.edu/clinical-trials/triluminate-study-treatment-tricuspidregurgitation 

Sungho Lim, MD

Endovascular Aortic Repair Using Thoracic Branch Endoprosthesis for Type B Aortic

Dissection

By Sungho Lim, MD, and Megan Grobelny, BSN, RN, SCRN

History

A male patient in his 60s had a history of hypertension and morbid obesity who presented to RUSH with sudden onset chest pain. He was diagnosed with acute type B aortic dissection, which was initially managed with anti-impulse control. He was discharged to home with several new blood pressure medications.

Presentation and Examination

His computed tomography revealed several high-risk features, including a compressed true lumen with a large fenestration and early aneurysmal degeneration of the descending thoracic aorta.

About Type B Aortic Dissection

An aortic dissection is a tear in the intima and media layers of the aorta. These can cause malperfusion or, in some cases, aortic rupture. Aortic dissections can affect approximately three in 100,000 patients annually in the United States. Initial medical management is critically important for uncomplicated type B aortic dissection. Thoracic endovascular aortic repair (TEVAR) is a mainstay of treatment when an intervention is performed. Procedural planning centers on patient status, extent of the dissection and branch vessel involvement.

About GORE Thoracic Branch Endoprosthesis

From the Food and Drug Administration

Approved by the FDA in 2022, the GORE Thoracic Branch Endoprosthesis (GORE TBE) is designed to repair the damage to the descending thoracic aorta. It consists of three implantable stent grafts with their own catheter-based delivery system. The GORE TBE is implanted in the descending thoracic aorta and into the left subclavian artery to allow blood to keep flowing past the aorta’s damaged or diseased parts.

Treatment

I performed a TEVAR with a subclavian branch device. I began the procedure by exposing the left brachial artery; a 5 Fr 70 cm sheath was inserted, and the tip was placed at the left subclavian artery (SCA) origin.

I then obtained percutaneous access to both common femoral arteries.

I accessed the ascending thoracic by a double curved Lunderquist wire. An IVUS was run over the Lunderquist wire, which confirmed wire location within the true lumen.

Then, the left femoral access was upsized to a 26 Fr Dryseal sheath. A 450 cm Jag wire was advanced from the left brachial artery and the wire was advanced to the descending thoracic aorta. An Indy OTW snare was used to externalize it through the left femoral artery access. 

I advanced a GORE TBE device to the distal aortic arch without a wire wrap. Once the supra-aortic trunk vessels were visualized, the GORE TBE device was deployed at the intended location. Then, the side branch component was delivered with the guide of the 5 Fr sheath from the brachial access. The side branch endoprosthesis was deployed and the patency of the left vertebral artery was confirmed.

I performed a series of angiograms and aortograms to evaluate the success of the procedure. I found no type 1 or 3 endoleak and excellent flow to the supra-aortic trunk vessels. There was demonstrated persistent false lumen flow and compressed true lumen in the infrarenal aorta. Therefore, a Cook Zenith dissection endovascular stent was placed.

Outcome

I saw the patient one month following the procedure and he is doing well. A CTA showed excellent results with decreased false lumen diameter, stable aortic size and well-perfused supra-aortic trunk and visceral circulation. I asked him to come back for a surveillance CTA one year later.

Analysis

Thoracic branch endoprosthesis is a novel treatment that can provide great benefit to patients with aortic dissection. In this case, I utilized it to avoid possible complications, such as wound dehiscence or lymphatic leak, in a high-risk surgical patient.

Sungho

Fenestrated Endovascular Aneurysm Repair Using Physician Modified Endograft

By Sungho Lim, MD, and Megan Grobelny, BSN, RN, SCRN

History

A male patient in his 50s had an incidental finding of a large abdominal aortic aneurysm demonstrated on an abdominal duplex ultrasound.

Presentation and Examination

The patient had a 7-cm supra renal abdominal aortic aneurysm. He had heart failure with decreased left ventricular function. He was evaluated by cardiac surgery and underwent a 5-vessel coronary artery bypass grafting. His post-CABG ejection fraction was largely unchanged, and he then underwent implantable cardioverter defibrillator (ICD) placement. He was determined to be a high-risk candidate for open aneurysm repair due to his reduced cardiac function. He was also not a candidate for regular endovascular aneurysm repair as his aneurysm extended above the renal artery.

About abdominal aortic aneurysms

An abdominal aortic aneurysm is caused by a weakening in the wall of the aorta that results in a dilation of the vessel. About 200,000 people are diagnosed with an abdominal aortic aneurysm (AAA) every year in the United States. Ruptured abdominal aortic aneurysm is the 15th leading cause of death in men over the age of 55. Abdominal aortic aneurysm is often diagnosed as an incidental finding noted on ultrasound or computed tomography.

Treatment

The patient underwent a 3-vessel fenestrated endovascular aneurysm repair using a physician-modified endograft. His celiac artery was chronically occluded. Therefore, the superior mesenteric artery (SMA) and bilateral renal arteries required fenestration and target vessel stenting. The graft was opened on the back table and the SMA and bilateral renal artery fenestrations were designed based on the patient’s most recent CT angiography.

I began the procedure by obtaining percutaneous access in both femoral arteries. Then, I advanced a modified Cook Alpha device to the aneurysm site. Through the contralateral femoral artery, a 7 Fr steerable sheath was telescoped into an 18 Fr Dryseal sheath. The 7 Fr sheath was shaped toward the SMA fenestration.

The SMA was selected and a Rosen wire was positioned into the SMA, then both renal arteries were individually selected and wired in the same fashion.

The modified Cook Alpha device was fully deployed, and diameter-reducing ties were removed. I deployed the target vessel stent serially. A 7 x 29 VBX stent graft was placed to the SMA and flared up to 10 mm at the seal.

Right renal fenestration was stented using a 6 x 19 VBX, which was flared to 8 mm. A 5 x 29 VBX was deployed to the left renal fenestration and flared to 8 mm. None of the target vessel stents had a type 3 endoleak on digital subtraction angiography. 

I removed the suprarenal fixation of a Cook Zenith Flex stent graft on the back table. This device was deployed and there was more than a two-stent overlap between the devices. The contralateral gate was selected, then the iliac limbs were deployed to the iliac bifurcation.

I performed a completion angiogram, which demonstrated patent SMA and renal arteries. There was no type 1 or 3 endoleak.

Outcome

The patient was seen six months following the procedure and is doing well. He will return in one year for surveillance imaging.

Analysis

Endovascular approach for AAA

Vascular surgeons employing an endovascular approach provide their patients with several benefits. Chiefly, there is less morbidity using an endovascular approach as compared to open surgery. However, patients with aneurysms involving mesenteric or renal arteries are not eligible for commercially available endografts.

Physician-modified fenestrated grafts are an excellent alternative for juxta-renal or higher-level aortic aneurysm with significant comorbidity. I have been using this approach to extend the applicability of endovascular techniques to more patents who would be deemed ineligible for standard endovascular therapy or open aortic repair.

As it was with this case, I believe physician-modified endografts used in the endovascular aortic repair of complex aortic anatomy can be performed with acceptable peri- and post-procedural morbidity and mortality in high-risk patients. 

Michael Liptay, MD

Same-day Robotic-Assisted Bronchoscopy and Treatment of Lung Adenocarcinoma

By Michael Liptay, MD, and James Katsis, MD

History

A male patient in his 60s with a prior history of smoking had been undergoing surveillance, low- dose CT lung cancer screenings. In May 2023, he was found to have new lung nodules concerning for lung cancer.

The patient’s CT showed enlarging and progressively solid ground-glass opacities (GGO) that were concerning for possible malignancy. Most notable was an enlarging 2.8 x 2.0 cm right upper lobe, sub-solid nodule with a new 4-mm component, along with an additional right upper lobe 1.3 x 1.0 cm sub-solid nodule, which has increased from 1.1 x 1.9 cm.

Presentation and Examination

Given the character and location of the nodules, a lobectomy was deemed necessary for resection. The patient was referred to James Katsis, MD, an interventional pulmonologist, for a robotassisted bronchoscopy for diagnostic purposes of the suspected cancerous tissue.

After the bronchoscopy was performed via the Ion endoluminal system, it was confirmed that the patient had an invasive T1aN0 lung adenocarcinoma.

Once the diagnosis was confirmed, Michael Liptay, MD, a thoracic surgeon, performed a thoracoscopic right upper lobe lobectomy and mediastinal lymph node dissection under the same anesthetic. The margins were negative for tumor, and there was no evidence of lymphovascular invasion. The visceral pleura was uninvolved, and all lymph nodes were negative for neoplasm. The pathologic stage of the tumor was pT1a N0.

Outcome

The patient did well postoperatively and will not require additional treatment. He will return in six months to initiate surveillance imaging and monitor additional known lung nodules and GGOs.

Analysis

Shortened treatment time through multidisciplinary approach

In 2020, 2.2 million patients were diagnosed with lung cancer worldwide, and 1.8 million patients died. According to the American Cancer Society, 238,340 new cases of lung cancer and 127,070 lung cancer deaths are expected in 2023 in the U.S. alone. Per current National Comprehensive Cancer Network guidelines, a typical lung cancer patient should go from diagnosis to treatment within eight weeks. Delayed time to treatment can adversely affect progression of the disease.

The ability to minimize upstaging and the need for adjuvant therapy is greatly enhanced with a timely diagnosis combined with a quick treatment turnaround. If clinicians can shorten the time from diagnosis to treatment from weeks to minutes, we are likely to cure more cancer.

This approach is contingent on utilizing a coordinated, multidisciplinary approach between the anesthesia, pathology, pulmonology and thoracic surgery teams. Effective communication is critical between these groups to facilitate both the bronchoscopy and lobectomy under the same anesthetic.

Move to more minimally invasive surgery

Treatment plans utilizing the same anesthesia for multiple procedures streamline the experience for our patients. In addition, robot-assisted procedures, such as the use of the Ion endoluminal platform in this case, give pulmonologists access to all 18 segments of the lung and enhance their precision and stability to target specific nodes for biopsy. 

Christopher Seder, MD

Esophagectomy and Tracheal Wall Reconstruction for Treatment of Adenoid Cystic Cancer

By Christopher Seder, MD, and Kerstin Stenson, MD, FACS

History

A female patient in her 40s reported progressive dysphagia. She was diagnosed with esophageal adenoid cystic carcinoma at an outside hospital, where her medical team recommended an esophagectomy with laryngectomy for treatment. She came to RUSH for a second opinion.

Presentation and Examination

The patient had a large bulky tumor encasing the cervical esophagus, positive for low grade adenoid cystic cancer, which invaded the posterior tracheal wall over the length of 6 cm. The tumor was located 2 cm below the vocal cords and 3 cm above the carina.

We decided an esophagectomy with a gastric pull-up and an en bloc posterior tracheal wall resection with tracheoplasty would be the best course of treatment for this patient.

About Adenoid Cystic Carcinoma

Adenoid cystic carcinoma (ACC) is a rare tumor of the head and neck. It most commonly occurs in the salivary glands and is rarely identified in the esophagus. ACC often has an insidious onset with vague symptoms and is characterized by perineural invasion and local recurrences. Approximately 200,000 people worldwide have this disease, 60% of whom are women. About 1,300 people are diagnosed with this type of cancer every year in the United States. 

CT scan of the tumor

Treatment

The patient underwent a laparoscopic trans-hiatal esophagectomy, en bloc resection of the posterior tracheal wall with lymphadenectomy and a tracheoplasty. The trachea was transected below the first ring, and the posterior wall was resected along with the involved portion of the cervical esophagus down to the sixth ring. Given the location of the tumor, femoral veno-venous ECMO was used during the tracheal wall resection and reconstruction.

During the cervical dissection, we discovered that the tumor was involving both recurrent laryngeal nerves and thus were included in the en bloc resection. Once the specimen was removed, the left ansa hypoglossi was anastomosed to the remnant left recurrent laryngeal nerve. The remnant right recurrent laryngeal nerve was not amenable to anastomosis, so two branches of the right ansa hypoglossi were sutured to the posterior cricoid and thyroid arytenoid muscles.

The gastric conduit was anastomosed to the cervical esophagus using a single-layer, hand-sewn technique.

The final portion of the operation involved reconstructing the posterior tracheal wall. A Doppler was used to identify the supraclavicular artery along the right neck and deltoid. A supraclavicular pedicled fascial flap was then created, de-epithelialized, rotated 90 degrees and used to reconstruct the back wall of the trachea. The remaining anterior tracheal rings were advanced superiorly and sutured to the newly reconstructed posterior wall. A split-thickness skin graft was harvested to cover the supraclavicular defect.

A tracheostomy was then performed between the new 3rd and 4th tracheal rings. The patient did well postoperatively. She underwent bilateral vocal fold injection laryngoplasty. Her final pathology revealed

a T4N0M0 adenoid cystic carcinoma with microscopically positive margins; she then completed adjuvant radiation therapy.

Outcome

The patient was recently seen and is doing well, with no evidence of recurrence two years after surgery. She was eventually decannulated after two subglottic dilations. She must pay a little closer attention to swallowing carefully but otherwise has normal function.

Anterior wall of trachea after tumor was resected

Creation of the supraclavicular pedicled fascial flap

Analysis

Preserving the patient’s quality of life

To treat this patient’s tumor, an esophagectomy and laryngectomy was one option, but this would have left her without the ability to speak naturally and with a permanent stoma. The RUSH multidisciplinary team of cardiothoracic surgeons, ENT/head and neck surgeons, and medical and radiation oncologists worked together to allow her to keep her voice and swallow normally.

Three key factors enabled us to do this specialized reconstruction:

• The patient’s tumor was just low enough (2 cm) beneath her vocal cords to allow us to save her larynx and perform the posterior tracheal wall reconstruction.

During the surgery, nerves to both of the patient’s vocal cords had to be cut. When that happens, patients are typically unable to breathe normally and become tracheostomy dependent. We were able to do bilateral nerve grafting from her ansa hypoglossi nerves, which maintained the paramedian position and muscle bulk of the vocal cords. Thus, we were able to preserve natural voice and eventually eliminate the stoma.

• The use of ECMO is uncommon during a procedure to reconstruct the posterior tracheal wall. Since we didn’t need to worry about operating around an endotracheal tube, we had enough time to rebuild her trachea.

• This patient’s overall excellent health allowed us to treat her in an aggressive and novel fashion. Patient selection is critical. 

Kerstin Stenson, MD, FACS

RUSH Thoracic Surgery Advancing Patient Care by Leading Two Multi-Institutional Clinical Trials

The Division of Thoracic Surgery at RUSH provides patients the opportunity to participate in a number of innovative clinical trials, ensuring that they receive the most state-of-the-art care. Patients have access to national cooperative groups trials, industry-sponsored trials and international investigator-initiated trials. Two trials being led by RUSH, the Prolonged Air Leak Autologous Blood Patch Trial and the Acute to Chronic Pain Signatures (A2CPS) study, offer promise to significantly improve quality of life for patients.

The Prolonged Air Leak Autologous Blood Patch Trial

Opened in February 2023, the Prolonged Air Leak Autologous Blood Patch Trial is an international, multi-institutional trial that examines the safety and efficacy of using an autologous blood patch for air leaks in patients who have undergone anatomic lung resection. RUSH is the international study center for this trial.

Prolonged air leak (PAL), or air leak that lasts for more than five days after lung surgery, is one of the most common complications after lung resection and often determines length of hospital stay for patients postoperatively. PAL occurs in approximately 10% of all lung resections. Male patients with a body mass index ≤ 25 kg/m2 with poor preoperative lung function who undergo right-sided lobectomy or bilobectomy are most at risk for developing a prolonged air leak.

While many air leaks seal on their own, clinicians currently do not have an agreed-upon strategy to treat the condition when it doesn’t seal on its own. The options available to clinicians include prolonged chest tube drainage, reoperation or the use of an autologous blood patch. The chief concern with tube-based treatments is that the risk of infection of the pleural space increases the longer a tube is in place.

“The use of an autologous blood patch has been around since the 1950s, but there was never really any agreement on which method was best to treat patients,” says Christopher Seder, MD, a thoracic surgeon at RUSH who serves as the PI on this trial. “Our goal with this study is to show that the autologous blood patch works well and is safe for patients.”

Application of an autologous blood patch is simple: A small amount of the patient’s blood is drawn off and injected into the chest tube. The blood causes clotting and an inflammatory reaction that helps to seal the leaking lung tissue.

“Patients are uncomfortable with a tube sticking out of their chest or worry about their risk of infection from it,” Dr. Seder says. “With an autologous blood patch, we can hopefully reduce those concerns.”

To learn more about the trial or to enroll your patient, visit rush.edu/clinical-trials/prolonged-air-leak-pal-autologous-blood-patchintervention-trial

The Acute to Chronic Pain Signatures (A2CPS) study

Patients undergoing thoracic surgery at RUSH can also participate in the multi-institutional Acute to Chronic Pain Signatures (A2CPS) study. Conducted by a nationwide consortium of researchers, this project aims to develop individualized treatment plans for patients with postoperative pain and to better understand the biological processes underlying chronic pain.

Patients who undergo thoracic surgery have a 30% to 47% chance of developing new chronic pain within six months of surgery. Researchers will focus on identifying the biomarkers responsible for the development of chronic pain after surgery. The ultimate goal for the study is that once the biological pathways that lead to chronic pain are identified, clinicians could offer their patients treatment algorithms that would modulate the biological pathways and prevent the development of chronic pain after surgery. Over time, RUSH researchers believe that treatments for chronic pain could be developed based on biomarkers.

To learn more about the study or to enroll your patient, visit a2cps.org.

To learn about RUSH’s role advancing this study, visit rush.edu/news/ acute-chronic-pain-signatures-a2cps-study 

Department Leadership

Michael J. Liptay, MD

The Mary and John Bent Professor and Chair, Department of Cardiovascular and Thoracic Surgery Director, RUSH Lung Center

Antone J. Tatooles, MD

Chief of Cardiovascular Surgery

VAD Program Medical Director

Co-Director of Cardiac Service Line

Pat S. Pappas, MD Co-Director of Cardiac Service Line

Christopher W. Seder, MD

Professor

Arthur E. Diggs, MD, and L. Penfield Faber, MD, Chair of Surgical Sciences

Chief, Division of Thoracic Surgery

Alexandre d’Audiffret, MD

Chief of Vascular Surgery

Vascular Surgery Program Director

Division of Thoracic Surgery

Gillian Alex – Assistant Professor

Nicole M. Geissen – Assistant Professor

Justin M. Karush – Assistant Professor

Michael J. Liptay – Professor

Christopher W. Seder – Professor

Division of Vascular Surgery

Alexandre d’Audiffret – Professor

Farah Hashemi – Assistant Professor

Daniel Katz – Associate Professor

Sungho Lim – Assistant Professor

Michele Richard – Assistant Professor

Nikita Y. Tihonov – Assistant Professor

Division of Cardiovascular Surgery

Philip Alexander – Assistant Professor

Allison Becket – Assistant Professor

Keith Bowersox – Assistant Professor

Chadrick A. Cross – Assistant Professor

Michael Frank – Assistant Professor

George Hodakowski – Assistant Professor

Devang Joshi – Assistant Professor

Abraham Katz – Assistant Professor

Robert Kummerer – Assistant Professor

Asif Mustafa – Assistant Professor

Patroklos S. Pappas – Assistant Professor

William Polito – Assistant Professor

William Stansfield – Assistant Professor

David Stern – Assistant Professor

Henry J. Sullivan – Assistant Professor

Antone J. Tatooles – Associate Professor

Timothy Votapka – Assistant Professor

Research

Jeff Borgia – Associate Professor

Annual Surgical Volumes

Residents and Fellows

Cardiovascular & Thoracic Surgery

Michael Bishop – PGY-7

Michael O’Connor – PGY-7

John Aversa – PGY-6

Kashif Malik – PGY-6 Vascular

Surgery

Mauricio Perez Martinez – PGY-7

Ashtin Wilhelmstoetter – PGY-6

Research Publications

Cardiac Publications

Al Saadi T, Andrade A, Chickerillo K, Joshi A, Sciamanna C, Pauwaa S, Macaluso G, Dia M, Cotts W, Tatooles AJ, Pappas P. A Case Series of Patients with Left Ventricular Assist Devices and Concomitant Mechanical Heart Valves. Artif Organs. 2020 Apr 12; doi: 10.1111/aor.13702. [Epub ahead of print] PubMed PMID: 32279355.

Al Saadi T, Sciamanna C, Andrade A, Pauwaa S, Macaluso G, Joshi A, Dia M, Cotts W, Pappas P, Bresticker M, Tatooles AJ. Venoarterial Extracorporeal Membrane Oxygenation Use in Staged Combined Heart-Kidney Transplant. J Surg Case Rep. 2020 Jan;2020(1):rjz408. doi: 10.1093/jscr/rjz408. eCollection 2020 Jan. PubMed PMID: 31976068; PubMed Central PMCID: PMC6970342.

Coyle L, Graney N, Gallagher C, Paliga R, Yost G, Pappas P, Macaluso G, Tatooles AJ. Treatment of HeartMate II Short-to-Shield Patients With an Ungrounded Cable: Indications and Long-Term Outcomes. ASAIO J. 2020 Apr;66(4):381-387. doi: 10.1097/ MAT.0000000000001012. PubMed PMID: 31045924.

Saeed, O, Tatooles, AJ, Farooq, M, Schwartz, G, Pham, DT, Mustafa, AK, D’Alessandro, D, Arbol, S, Jorde, UP, Gregoric, ID, Radovancevic, R, Lima, B, Bryner, BS, Ravichandran, A, Salerno, CT, Spencer, P, Friedmann, P, Silvestry, S, Saunders, P. Characteristics and Outcomes of Patients with COVID-19 Supported by Extracorporeal Membrane Oxygenation: A Retrospective Multicenter Study. The Journal of Thoracic and Cardiovascular Surgery. May 18, 2021. https://www.sciencedirect.com/science/article/pii/ S0022522321008011.

Sanders DJ, Sutter JS, Tatooles AJ, Suboc TM, Rao AK. Endocarditis Complicated by Severe Aortic Insufficiency in a Patient with COVID-19: Diagnostic and Management Implications. Case Rep Cardiol. 2020 Sep 29;2020:8844255. doi: 10.1155/2020/8844255. PMID: 33014475; PMCID: PMC7525298.

Tatooles AJ, Mustafa AK, Alexander PJ, Joshi DJ, Tabachnick, Deborah, Cross, Chadrick, Pappas, Patroklos, Extracorporeal Membrane Oxygenation for Patients With COVID-19 in Severe Respiratory Failure. JAMA Surg. Published online August 11, 2020. doi:10.1001/ jamasurg.2020.3950.

Tatooles, AJ, Mustafa, AK, Joshi, DJ, Pappas, PS. Extracorporeal Membrane Oxygenation with Right Ventricular Support in COVID-19 Patients with Severe Acute Respiratory Distress Syndrome. JTCVS Open. 2021, November 1. https://doi. org/10.1016.j.xjon.2021.10.054

Tatooles, AJ, Yost, Gardner MS, Coyle, L, Gallagher, C, Cotts, W, Pappas, P. Outcomes Following Left Ventricular Assist Device Exchange, ASAIO Journal: October 15, 2020Volume Online First - Issue - doi: 10.1097/MAT.0000000000001287

Zakrzewski, J, Coyle, L, Aicher, T, Chickerillo, K, Gallagher, C, Kuper, K, Sciamanna, C, Chau, VQ, Tatooles, AJ. Impact of COVID-19 on Patients Supported with a Left Ventricular Assist Device, ASAIO Journal: September 1, 2021 - Volume - Issue - doi: 10.1097/MAT.0000000000001578

Zakrzewski, J, Coyle, L, Aicher, T, Gallagher, C, Kuper, K, Sciamanna, C, Chau, VQ, Tatooles, A J. Response to Muller et al. Regarding “Impact of COVID-19 on Patients Supported with a Left Ventricular Assist Device”. ASAIO Journal: September 2022Volume 68 - Issue 9 - p e157 doi: 10.1097/MAT.0000000000001718

Vascular Publications

Ayalew D, Richard M, Newton DH, Albuquerque FC, Levy MM, Larson RA. Analysis of a Novel Inpatient Acute Limb Ischemia Alert System. Ann Vasc Surg. 2021 Nov;77:146-152. doi: 10.1016/j.avsg.2021.05.055. Epub 2021 Aug 23.

Halvorson BD, Menon NJ, Goldman D, Frisbee SJ, Goodwill AG, Butcher JT, Stapleton PA, Brooks SD, d’Audiffret AC, Wiseman RW, Lombard JH, Brock RW, Olfert IM, Chantler PD, Frisbee JC. The Development of Peripheral Microvasculopathy with Chronic Metabolic Disease in Obese Zucker Rats: A Retrograde Emergence? Am J Physiol Heart Circ Physiol. 2022 Sep 1;323(3):H475-H489. doi: 10.1152/ajpheart.00264.2022. Epub 2022 Jul 29

Kang S, Park J, Kim K, Lim SH, Kim S, Choi JH, Rah JC, Choi JW. ICoRD: Iterative Correlation-based ROI Detection Method for the Extraction of Neural Signals in Calcium Imaging. J Neural Eng. 2022 Aug 11;19(4). doi: 10.1088/1741-2552/ac84aa.

Lim, S, Kwan, S, Colvard, B, d’Audiffret AC, Kashyap, Vikram S, Cho, Jae S. Impact of Interfacility Transfer of Ruptured Abdominal Aortic Aneurysm Patients. J Vasc Surg. 2022 Dec;76(6):1548-1554.e1. doi: 10.1016/j.jvs.2022.05.020. Epub 2022 Jun 22.

Lim S, Alarhayem AQ, Rowse JW, Caputo FJ, Smolock CJ, Lyden SP, Kirksey L, Hardy DM. Thoracic Outlet Decompression for Subclavian Venous Stenosis After Ipsilateral Hemodialysis Access Creation. J Vasc Surg Venous Lymphat Disord. 2021 Nov;9(6):1473-1478. doi: 10.1016/j.jvsv.2021.02.010. Epub 2021 Mar 3

Nagi, M, d’Audiffret AC, Katz, D. External Carotid Artery Pseudoaneurysm Rupture in a Patient with Polycystic Kidney Disease: Case report and review of literature. Vascular 2022 Sep 1;17085381221124707.doi: 10.1177/17085381221124707. Online ahead of print.

Richard MN, Stroever S, Dowling C, Burton T, Butler A, Plummer D, Dietzek AM. Repeated Endovascular Interventions Are Worthwhile, Even After Thrombosis, to Maintain Long-Term Use of Autogenous Dialysis Fistulas. Vasc Endovascular Surg. 2021 Nov;55(8):823-830. doi: 10.1177/15385744211026452. Epub 2021 Jul 1.

Thoracic Publications

Auger C, Moudgalya H, Neely MR, Stephan JT, Tarhoni I, Gerard D, Basu S, Fhied CL, Abdelkader A, Vargas M, Hu S, Hulett T, Liptay MJ, Shah P, Seder CW, Borgia

JA. Cancers (Basel). Development of a Novel Circulating Autoantibody Biomarker Panel for the Identification of Patients with ‘Actionable’ Pulmonary Nodules. 2023 Apr 12;15(8):2259. doi: 10.3390/cancers15082259.PMID: 37190187 Free PMC article.

Aversa JG, Seder CW. Commentary: Know Your Nodes. J Thorac Cardiovasc Surg 2023 [Online ahead of print].

Bunch CM, Berquist M, Ansari A, McCoy ML, Langford JH, Brenner TJ, Aboukhaled M, Thomas SJ, Peck E, Patel S, Cancel E, Al-Fadhl MD, Zackariya N, Thomas AV, Aversa JG, Greene RB, Seder CW, Speybroeck J, Miller JB, Kwaan HC, Walsh MM. The Choice between Plasma-Based Common Coagulation Tests and Cell-Based Viscoelastic Tests in Monitoring Hemostatic Competence: Not an either-or Proposition. Semin Thromb Hemost. 2022 Oct;48(7):769-784. doi: 10.1055/s-0042-1756302. Epub 2022 Sep 29.PMID: 36174601 Review.

Chaudhry T, Krishnan V, Donaldson AE, Palmisano ZM, Basu S, Geissen NM, Karush JM, Alex GC, Borgia JA, Liptay MJ, Seder CW. Conditional Survival Analysis of Patients with Resected Non-Small Cell Lung Cancer. JVCVS Open 2023; 16:948-959.

Golemi L, Sharma A, Sarau A, Varandani R, Seder CW, Okwuosa TM. Baseline Electrocardiographic Abnormalities in Pre-Treatment Cancer Compared With NonCancer Patients: A Propensity Score Analysis. Cardiol Res. 2023 Jun;14(3):237-239. doi: 10.14740/cr1466. Epub 2023 Apr 18.PMID: 37304916 Free PMC article.

Karush JM, Alex G, Geissen N, Wakefield C, Basu S, Liptay MJ, Seder CW. Predicting Non-home Discharge After Lung Surgery: Analysis of the General Thoracic Surgery Database. Ann Thorac Surg. 2023 Mar;115(3):687-692. doi: 10.1016/j. athoracsur.2022.07.020. Epub 2022 Jul 31.PMID: 35921862

Marsh PL, Moore EE, Moore HB, Bunch CM, Aboukhaled M, Condon SM, et al. Iatrogenic Air Embolism: Pathoanatomy, Thromboinflammation, Endotheliopathy and Therapies. Front Immunol 2023;14:1230049.

O’Connor MC, Seder CW. Commentary: Tumor Biology Remains the Star of the Show. J Thorac Cardiovasc Surg. 2022 Sep 3: S0022-5223(22)00914-X. doi: 10.1016/j. jtcvs.2022.08.022. Online ahead of print.PMID: 36175200 No abstract available. Servais EL, Blasberg JD, Brown LM, Towe CW, Seder CW, Onaitis MW, Block MI, David EA. Research. Ann Thorac Surg. 2023 Jan;115(1):43-49. doi: 10.1016/j. athoracsur.2022.10.025. Epub 2022 Oct 29.PMID: 36404445

Stephan JT, Mehta P, Zepeda DL, Uppal M, Basu S, Shah P, Borgia JA, Karush J, Geissen NM, Alex G, Liptay MJ, Seder CW. Low-Dose CT Scan Features are Associated with Annual Risk of Hospitalization. Ann Thoracic Short Reports 2023;1:558-561.

Towe CW, Servais EL, Brown LM, Blasberg JD, Mitchell JD, Worrell SG, Seder CW, David EA. The Society of Thoracic Surgeons General Thoracic Surgery Database: 2023 Update on Outcomes and Research. Ann Thorac Surg 2023:S0003-4975(23)01225-0.

Wakefield CJ, Lund N, Coughlin J, Karush JM, Geissen N, Alex G, Liptay MJ, Borgia JA, Shah P, Seder CW. The Association Between Thoracic Sarcopenia and Survival is Gender Specific in Early-stage Lung Cancer. J Thorac Dis. 2022 Nov;14(11):4256-4265. doi: 10.21037/jtd-22-273.PMID: 36524067 Free PMC article.

Presentations

“Complex Airway Management in a Patient with a Rapidly Enlarging Merkel Cell Metastasis and Bilateral Vocal Cord Paresis” CHEST 2023 Annual Meeting, October 8-11, Honolulu, HI. (Katsis)

“Conditional Survival Analysis of Patients with Resected Non-Small Cell Lung Cancer” 103rd Annual Meeting of the American Association for Thoracic Surgery, May 6-9, 2023, Los Angeles, CA. (Seder)

“Esophageal Ultrasound with Bronchoscopic Fine Needle Aspiration (EUS-B-FNA) in the Staging and Diagnosis of Thoracic Malignancies: A Case Series” CHEST 2023, October 8-11, Honolulu, HI. (Katsis)

“Firefighting Is Associated with Lung-RADS 4 Nodules on Low-Dose CT Scan” Oral presentation at the Southern Thoracic Surgical Association 70th Annual Meeting, November 2-5, 2023, Orlando, FL. (Geisen)

“Low-Dose CT Scan Features are Associated with Annual Risk of Hospitalization” Oral presentation at the 35nd Annual Meeting of the General Thoracic Surgery Club. March 9-12, 2023, Duck Key, FL. (Seder)

“Neutrophil-to-Lymphocyte Ratio is Associated with Mortality in Patients Undergoing Treatment for Hemato-Oncologic Malignancies and Admitted for COVID-19.” 2023 Annual American Thoracic Society International Conference, Washington, D.C. (Seder)

“Novel Application of Pectoralis Muscle Index as Predictor of Outcomes in Patients with Blunt Chest Wall Injury.” Oral presentation at the 2023 Annual Chest Wall Injury Summit. Charlotte, NC. (Seder)

“Number of Lymph Nodes Examined is Associated with Survival in Pulmonary Sarcoma” 35th Annual Meeting of the General Thoracic Surgery Club. March 9-12, 2023, Duck Key, FL. (Alex)

“Performance Feedback Platforms: The STS General Thoracic Surgery Database.” Oral presentation at the American Cancer Society National Lung Cancer Roundtable, March 2, 2023, Chicago, IL. (Seder)

“Single vs. Multi-slice Thoracic Body Composition Analysis in Low-Dose Computed Tomography” Oral presentation at the 2024 American Roentgen Ray Society Annual Meeting, May 5-9, Boston, MA. (Seder)

“The State of Cardiothoracic Surgery: Data and Practice Trends from the GTSD” Oral presentation at the STS 59th Annual Meeting, January 21-23, 2023, San Diego, CA. (Seder)

“Tracheal and Esophageal Resections” Oral presentation at STS Advances in Quality & Outcomes Meeting (Virtual), October 27, 2023. (Seder)

“Women are Underrepresented in Non-Small Cell Lung Cancer Randomized Trials –A Systematic Review” 103rd Annual Meeting of the American Association for Thoracic Surgery, May 6-9, 2023, Los Angeles, CA. (Alex)

Gillian Alex, MD