Papers by Penny Houghtaling
The Journal of Thoracic and Cardiovascular Surgery, Apr 1, 2019
Bookmarks Related papers MentionsView impact
The Journal of Thoracic and Cardiovascular Surgery, Sep 1, 2007
Bookmarks Related papers MentionsView impact
The Journal of Thoracic and Cardiovascular Surgery, Sep 1, 2014
Bookmarks Related papers MentionsView impact
Journal of the American College of Cardiology, Apr 1, 2004
Bookmarks Related papers MentionsView impact
The Journal of Thoracic and Cardiovascular Surgery, Feb 1, 2023
Bookmarks Related papers MentionsView impact
The Journal of Thoracic and Cardiovascular Surgery, Dec 1, 2022
OBJECTIVES To evaluate recent practice and outcomes of reoperative cardiac surgery via re-sternot... more OBJECTIVES To evaluate recent practice and outcomes of reoperative cardiac surgery via re-sternotomy. Use of early versus late institution of cardiopulmonary bypass (CPB) before sternal re-entry was of particular interest. METHODS From January 2008 to July 2017, 7640 patients underwent reoperative cardiac surgery at Cleveland Clinic. The study group consisted of 6627 who had a re-sternotomy and preoperative computed tomography scans; 755 and 5872 were in the early and late institution of CPB groups, respectively. Patients were stratified into high (n = 563) or low (n = 6064) anatomic risk of re-entry on the basis of computed tomography criteria. Weighted propensity-balanced operative mortality and morbidity were compared with surgeon as a random effect. RESULTS Reoperative procedures most commonly incorporated aortic valve replacement (n = 3611) and coronary artery bypass grafting (n = 2029), but also aortic root (n = 1061) and arch procedures (n = 527). Unadjusted operative mortality was 3.5% (235/6627), and major sternal re-entry and mediastinal dissection injuries were uncommon (2.8%). In the propensity-weighted analysis, similar mortality (3.1% vs 4.5%; P = .6) and major morbidity, including stroke (1.8% vs 3.2%) and dialysis (0 vs 2.6%), were noted in the high anatomic risk cohort between early and late CPB groups. Similar trends were observed in the low anatomic risk cohort (mortality 3.5% vs 2.1%; P = .2). CONCLUSIONS Reoperative cardiac surgery is associated with low operative morbidity and mortality at an experienced center. Early and late CPB strategies have comparable outcomes in the context of an image-guided, team-based strategy.
Bookmarks Related papers MentionsView impact
The Journal of Thoracic and Cardiovascular Surgery, May 1, 2013
Bookmarks Related papers MentionsView impact
The Journal of Thoracic and Cardiovascular Surgery, Apr 1, 2023
OBJECTIVE Intrinsic risk of infection of cryopreserved allograft aortic root replacements remains... more OBJECTIVE Intrinsic risk of infection of cryopreserved allograft aortic root replacements remains poorly understood despite their long history of use. The objective of this study was to determine this intrinsic risk of allograft infection and its risk factors when allografts are implanted for both nonendocarditis indications and infective endocarditis. METHODS From January 1987 to January 2017, 2042 patients received 2110 allograft aortic valves at a quaternary medical center, 1124 (53%) for nonendocarditis indications and 986 (47%) for endocarditis indications (670 [68%] prosthetic valve endocarditis). Staphylococcus aureus caused 193 of 949 cases of endocarditis (20%), 71 (7.3%) in persons who injected drugs. Periodic surveillance and cross-sectional follow-up achieved 85% of possible follow-up time. The primary end point was allograft infection in patients with nonendocarditis and endocarditis indications. Risk factors were identified by hazard function decomposition and machine learning. RESULTS During follow-up, 30 allografts (26 explanted) became infected in patients in the nonendocarditis group and 49 (41 explanted) in patients with endocarditis. At 20 years, the probability of allograft infection was 5.6% in patients in the nonendocarditis group and 14% in patients with endocarditis. Risk factors for allograft infection in patients in the nonendocarditis group were younger patient age and older donor age. Risk factors for allograft infection in patients with endocarditis were earlier implant year, injection drug use, and younger age. In patients with endocarditis, 18% of allograft infections were caused by the original organism. CONCLUSIONS The low infection rates, both in patients without and with endocarditis, support continued use of allografts in the modern era, in particular for the treatment of invasive endocarditis of the aortic root.
Bookmarks Related papers MentionsView impact
The Annals of Thoracic Surgery, Jun 1, 2021
BACKGROUND The value of allografts for aortic root replacement is controversial, with recent conc... more BACKGROUND The value of allografts for aortic root replacement is controversial, with recent concern about limited durability. Currently, we prefer allografts for invasive infective endocarditis. Purposes of this study were to assess allograft performance and durability in our cumulative experience with aortic allografts. METHODS From 1/1987-1/2017, 2,042 adults received 2,110 aortic allograft root replacements at our institution, 986 (47%) for infective endocarditis (669 [68%] for prosthetic valve endocarditis) and 1,124 (53%) for other indications. Mean recipient age was 54±15 years and mean allograft donor age 35±13 years. Follow-up was 85% complete and comprised 17,253 patient-years of data. Longitudinal allograft performance was extracted from 6,339 available echocardiographic studies. Durability was assessed by explant for allograft structural failure. RESULTS Allograft mean gradient at hospital discharge was 6 mmHg and 9, 13, and 15 mmHg at 5, 10, and 15 years post-implant. Severe aortic regurgitation was 0% at hospital discharge, but 14%, 25%, and 35% at 5, 10 and 15 years. 405 allografts were explanted for structural failure, actuarially 2%, 14%, 34%, and 51% at 5, 10, 15, and 20 years. Risk factors for structural failure were younger recipient age, larger body surface area, hypertension, and thoracic aorta disease; donor factors were older age and larger allograft size. Implant for infective endocarditis was not associated with accelerated structural failure. CONCLUSIONS This study affirms allografts' long-term acceptable hemodynamic performance and durability. Concern about structural failure should not limit allograft use. Recipient hypertension, allograft size, and donor age are modifiable risk factors.
Bookmarks Related papers MentionsView impact
The Journal of Thoracic and Cardiovascular Surgery, May 1, 2019
Bookmarks Related papers MentionsView impact
Journal of the American College of Cardiology, 2020
Bookmarks Related papers MentionsView impact
Journal of Heart and Lung Transplantation, Apr 1, 2016
Bookmarks Related papers MentionsView impact
European Journal of Heart Failure Supplements, Jun 1, 2008
Bookmarks Related papers MentionsView impact
The Annals of Thoracic Surgery, 2021
BACKGROUND Although coronary artery bypass grafting using bilateral internal thoracic arteries (B... more BACKGROUND Although coronary artery bypass grafting using bilateral internal thoracic arteries (BITA) maximizes long-term survival, knowledge of the effect of different right ITA (RITA) inflow configurations on graft patency is limited. We have compared RITA occlusion among these configurations and identified its risk factors while adjusting for outflow coronary target location. METHODS From 1/1972-1/2016, of 7,092 patients undergoing BITA grafting at a single center, 1,331 received 1 ITA to the left anterior descending coronary artery (LAD) and had ≥1 evaluable postoperative coronary angiograms: 835 (63%) in-situ, 496 free-RITA grafts (311 [63%] originating from aorta, 98 [20%] left internal thoracic artery (LITA), 76 [15%] saphenous vein graft [SVG], 11 [2%] radial graft). RITA occlusion reported on 1,983 angiograms performed a median of 5.8 years later was estimated using nonlinear mixed-effects longitudinal modeling. RESULTS RITA patency was 90% at 1 year, 87% at 5 years, and 86% at 10 and 15 years. At 15 years, in-situ RITA patency was 91% and free RITA patency from aorta 91%, LITA 89%, and SVG 77%. After adjusting for coronary target location and degree of stenosis, occlusion was similar in free RITAs from aorta (P=.15), LITA (P=.4), SVG (P=.13), and in-situ RITAs. However, RITAs grafted to the LAD had fewer occlusions (P<.001), with patency similar to LITAs. CONCLUSIONS Among patients with BITA grafting requiring interval coronary angiography, long-term RITA patency was high and independent of its inflow configuration. Therefore, priority should be a RITA configuration optimizing its reach to important coronary targets, including the LAD.
Bookmarks Related papers MentionsView impact
The Annals of Thoracic Surgery, 2021
BACKGROUND Reoperative cardiac surgery in patients with patent bilateral internal thoracic arteri... more BACKGROUND Reoperative cardiac surgery in patients with patent bilateral internal thoracic arteries (ITA) grafts is technically challenging. METHODS From 2008-2017, of 7,640 patients undergoing reoperative cardiac surgery, 116 (1.5%) had patent bilateral ITA grafts, including 28 with a right ITA crossing the midline. Mean age was 70±9.6 years, and 111 patients (96%) were male. Reoperations included isolated coronary artery bypass grafting (CABG; n=11), isolated valve (n=55), valve+CABG (n=26), and other procedures (n=24). Clinical details, intraoperative management, and perioperative outcomes were analyzed. RESULTS Aortic cannulation was central in 64 patients (56%) and via femoral or axillary artery in 50 (44%). Four patients (3.4%) had planned transection and reattachment of ITAs crossing the midline, and 4 (3.4%) had ITA injuries, all right ITAs, 3 crossing the midline; 3 were repaired with an interposition vein graft, and 1 was managed by translocating the right ITA as a Y-graft off another graft. Patent ITAs were managed by atraumatic occlusion during aortic clamping in 90 patients (78%) and by systemic cooling without ITA occlusion in 19. There were 6 operative deaths, all due to low cardiac output syndrome (5.2%), 4 strokes (3.4%), and 5 cases of new postoperative dialysis (4.3%). CONCLUSIONS Risk of injury to bilateral ITA grafts during reoperation is high, and right ITAs crossing the midline present a particular risk of injury and should inform planning for primary CABG. Risk of low cardiac output syndrome underscores the challenge of ensuring adequate myocardial protection.
Bookmarks Related papers MentionsView impact
Journal of Surgical Research, 2020
Bookmarks Related papers MentionsView impact
IEEE Journal of Translational Engineering in Health and Medicine, 2019
Bookmarks Related papers MentionsView impact
Cardiovascular Diagnosis and Therapy, 2019
Bookmarks Related papers MentionsView impact
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Jan 12, 2016
The incidence, indications, and risk factors for cardiac implantable electronic device (CIED) imp... more The incidence, indications, and risk factors for cardiac implantable electronic device (CIED) implantation after cardiac surgery in an era with an aging population are not well described. There are limited data about the survival of these patients compared with a non-device group. We aimed to evaluate the incidence, indications, and risk factors for postoperative CIED implantation. We also assessed survival of these patients compared with a non-device group. We included all patients without prior CIED implantation who underwent cardiac surgery at our institution from 1996 to 2008. Characteristics associated with CIED implantation were identified by multivariable logistic regression. A propensity model was constructed to compare survival. A total of 39 546 patients were included in the study of which 1608 patients (4.1%) underwent postoperative CIED implantation. Conduction disease accounted for most devices, but 371 patients underwent CIED implantation for secondary prevention of ve...
Bookmarks Related papers MentionsView impact
Nutrition & diabetes, 2012
Obesity is a major public health epidemic and is associated with increased risk of heart failure ... more Obesity is a major public health epidemic and is associated with increased risk of heart failure and mortality. We evaluated the impact of body mass index (BMI) on the prevalence of diastolic dysfunction (DD). We reviewed clinical records and echocardiogram of patients with baseline echocardiogram between 1996 and 2005 that showed normal left ventricular ejection fraction (LVEF). Diastolic function was labeled as normal, stage 1, stage 2 or stage 3/4 dysfunction. Patients were categorized as normal weight (BMI <25 kg m(-2)), overweight (25-29.9 kg m(-2)), obese (30-39.9 kg m(-2)) and morbidly obese (40 kg m(-2)). Multivariable ordinal and ordinary logistic regression were performed to identify factors associated with DD, and evaluate the independent relationship of BMI with DD. The cohort included 21 666 patients (mean (s.d.) age, 57.1 (15.1); 55.5% female). There were 7352 (33.9%) overweight, 5995 (27.6%) obese and 1616 (7.4%) morbidly obese patients. Abnormal diastolic functio...
Bookmarks Related papers MentionsView impact
Uploads
Papers by Penny Houghtaling