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IN THE ADULT

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CARDIAC SURGERY

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Notice
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Medicine is an ever-changing science. As new research and clinical experi-
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ence broaden our knowledge, changes in treatment and drug therapy are

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required. The authors and the publisher of this work have checked with
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sources believed to be reliable in their efforts to provide information that is
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complete and generally in accord with the standards accepted at the time of
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publication. However, in view of the possibility of human error or changes in
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medical sciences, neither the authors nor the publisher nor any other party
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who has been involved in the preparation or publication of this work war-
rants that the information contained herein is in every respect accurate or
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complete, and they disclaim all responsibility for any errors or omissions or
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for the results obtained from use of the information contained in this work.
Readers are encouraged to confirm the information contained herein with
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rate and that changes have not been made in the recommended dose or in the
contraindications for administration. This recommendation is of particular
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importance in connection with new or infrequently used drugs.
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CARDIAC SURGERY
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IN THE ADULT
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Fifth Edition
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Lawrence H. Cohn, MD
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Virginia and James Hubbard Professor of Cardiac Surgery
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Harvard Medical School
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Division of Cardiac Surgery
Brigham and Women’s Hospital
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Boston, Massachusetts
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David H. Adams, MD
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Cardiac Surgeon-in-Chief, Mount Sinai Health System
Marie-Josée and Henry R. Kravis Professor and Chairman
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Department of Cardiovascular Surgery
Icahn School of Medicine at Mount Sinai and The Mount Sinai Hospital
New York, New York
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New York  Chicago  San Francisco  Athens  London  Madrid  Mexico City

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Milan  New Delhi  Singapore  Sydney  Toronto
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Copyright © 2018 by McGraw-Hill Education. All rights reserved. Except as permitted under the United States Copyright Act of 1976,

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without the prior written permission of the publisher.
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Lawrence H. Cohn, MD
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The 5th edition of Cardiac Surgery in the Adult is dedicated to adult cardiac surgery. During his career Dr. Cohn earned the
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Dr. Lawrence Cohn, Emeritus Chief of the Division of Cardiac highest awards and honors a cardiac surgeon could possibly
Surgery at Brigham and Women’s Hospital and Virginia and achieve, serving as the 79th President of the American Asso-
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James Hubbard Professor of Cardiac Surgery at Harvard ciation for Thoracic Surgery, receiving an honorary Masters
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Medical School, who sadly passed away unexpectedly during of Medicine from Harvard, and receiving the American Heart
the final stages of preparation of this latest edition of “his” Association’s Paul Dudley White Award, among numerous
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reference textbook. Dr. Cohn leaves a legacy of excellence others. He would claim his greatest honor, however, was the
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seldom seen in academic surgery, and he will be sorely missed
by all of us who knew him, and especially those of us lucky
enough to have been mentored by him. Dr. Cohn received his
training in cardiothoracic surgery under the tutelage of
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opportunity to train over 200 residents and fellows from all
over the world, many of whom went on to become Divi-
sion Chiefs, Department Chairs, and leaders in the specialty.
His American Association for Thoracic Surgery presidential

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Dr. Norman Shumway at Stanford University, and after com- address “What the Cardiothoracic Surgeon of the 21st Century
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pleting his fellowship in 1971 he joined the staff of the Peter Ought to Be” personifies the essence of what made him one
Bent Brigham Hospital in Boston. Over the next 45 years of the masters of cardiac surgery who will be remembered
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he was the driving force behind the success of the Harvard by generations to come. Through leadership by example in
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program, and became the Chief of the Division of Cardiac all phases of his career, his unwavering commitment to the fre
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Surgery in 1986. A clinical cardiac surgeon first and foremost, individual patient was the foundation of all of his accomplish-
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Dr. Cohn performed over 11,000 open heart procedures dur- ments, and few surgeons have had such a profound impact on
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ing his career, and was best known for his pioneering and our specialty. Dr. Cohn was my teacher, mentor, and friend,
international leadership in minimally invasive valve surgery. and it was an honor to be asked by his wife of 55 years, Roberta,
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His academic contributions included over 500 peer-reviewed to assume the role of Co-Editor to complete this 5th edition of
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publications, 100 book chapters, and 750 invited lectures on
virtually all topics in cardiac surgery, but perhaps his greatest
academic legacy was his editorship of the 2nd, 3rd, and 4th
editions of Cardiac Surgery in the Adult, which under his vision
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his textbook. Dr. Cohn left footprints too large to fill, but with
the help of the many authors who contributed chapters and
the publisher’s leadership, we now present this peer tribute to
one of the greatest cardiac surgeons of all time.

became the most widely referenced international textbook in

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David H. Adams, MD
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CONTENTS

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Contributors xi PERIOPERATIVE/INTRAOPERATIVE
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II
CARE 221
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10. Preoperative Evaluation for Cardiac
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Surgery 223
I FUNDAMENTALS 1 Christian T. Ruff / Patrick T. O’Gara
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1. History of Cardiac Surgery  3 11. Cardiac Anesthesia  233
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Larry W. Stephenson / Frank A. Baciewicz, Jr.
2. Surgical Anatomy of the Heart  21
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John G. Augoustides / William C. Culp / Wendy Gross /
Annette Mizuguchi / Prakash A. Patel / Kent Rehfeldt /
Pinak Shah / Usha Tedrow / Stanton K. Shernan

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Michael R. Mill / Robert H. Anderson / Lawrence H. Cohn
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12. Echocardiography in Cardiac Surgery  267
3. Cardiac Surgical Physiology  43
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Eliza P. Teo / Michael H. Picard / Hanjo Ko /
Edward B. Savage / Nicolas A. Brozzi Michael N. D’Ambra
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4. Cardiac Surgical Pharmacology  71
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13. Extracorporeal Circulation  299
Jerrold H. Levy / Jacob N. Schroder / James G. Ramsay John W. Hammon / Michael H. Hines
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5. Cardiovascular Pathology  99
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14. Transfusion Therapy and Blood
Frederick J. Schoen / Robert F. Padera Conservation 347
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Andreas R. de Biasi / William J. DeBois /
6. Computed Tomography of the Adult O. Wayne Isom / Arash Salemi
Cardiac Surgery Patient: Principles
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and Applications  157 15. Deep Hypothermic Circulatory Arrest  361
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Andreas A. Giannopoulos / Frank J. Rybicki / Bradley G. Leshnower / Edward P. Chen
Tarang Sheth / Frederick Y. Chen
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16. Myocardial Protection  373
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7. Risk Assessment and Performance

Improvement in Cardiac Surgery  183
M. Salik Jahania / Roberta A. Gottlieb /
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Robert M. Mentzer, Jr.

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Victor A. Ferraris / Fred H. Edwards / Jeremiah T. Martin

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17. Postoperative Care of Cardiac Surgery

8. Simulation in Cardiac Surgery  207 Patients 405
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Jennifer D. Walker / Philip J. Spencer / Toni B. Walzer / Farhang Yazdchi / James D. Rawn
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Jeffrey B. Cooper
18. Temporary Mechanical Circulatory
9. The Integrated Cardiovascular Center  217 Support 429
T. Konrad Rajab / Lawrence Lee / Edwin C. McGee, Jr. / Nader Moazami
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Vakhtang Tchantchaleishvili / Mandeep R. Mehra /

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John G. Byrne
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31. Surgical Treatment of Aortic Valve
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III ISCHEMIC HEART DISEASE  451 Endocarditis 731

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Gösta B. Pettersson / Syed T. Hussain

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19. Myocardial Revascularization with
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Percutaneous Devices  453 32. Minimally Invasive Aortic
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James M. Wilson / James T. Willerson Valve Surgery  743
Prem S. Shekar / Lawrence S. Lee / Lawrence H. Cohn
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20. Myocardial Revascularization with
Cardiopulmonary Bypass  471 33. Percutaneous Treatment of Aortic Valve
Michael H. Kwon / George Tolis, Jr. / Thoralf M. Sundt Disease 751
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21. Myocardial Revascularization Without
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Cardiopulmonary Bypass  519
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Bobby Yanagawa / Michael E. Halkos / John D. Puskas MITRAL VALVE DISEASE  759
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22. Myocardial Revascularization after
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Acute Myocardial Infarction  539 34. Pathophysiology of Mitral Valve
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Disease 761
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Deane E. Smith III / Mathew R. Williams
James I. Fann / Neil B. Ingels, Jr. / D. Craig Miller
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23. Minimally Invasive Myocardial
Revascularization 559 35. Mitral Valve Repair  797
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Piroze M. Davierwala / David M. Holzhey / Dan Loberman / Paul A. Pirundini / John G. Byrne /
Friedrich W. Mohr Lawrence H. Cohn
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24. Coronary Artery Reoperations  575 36. Mitral Valve Repair: Rheumatic  817
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Bruce W. Lytle / George Tolis, Jr. Javier G. Castillo / David H. Adams
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25. Surgical Treatment of Complications 37. Surgery for Functional Mitral
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of Myocardial Infarction, Ventricular Septal Regurgitation 825
Matthew A. Romano / Steven F. Bolling
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Defect, Myocardial Rupture, and Left
Ventricular Aneurysm  595
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38. Surgical Treatment of Mitral Valve
Donald D. Glower
Endocarditis 835
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Gösta B. Pettersson / Syed T. Hussain
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IV AORTIC VALVE DISEASE  631 39. Mitral Valve Repair for Congenital
Mitral Valve Disease in the Adult  847
26. Pathophysiology of Aortic Valve Disease  633
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David P. Bichell / Bret Mettler
Anna Brzezinski / Marijan Koprivanac / A. Marc Gillinov /
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Tomislav Mihaljevic 40. Minimally Invasive and Robotic Mitral
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and Tricuspid Valve Surgery  855
27. Aortic Valve Replacement with a
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Mechanical Cardiac Valve Prosthesis  649

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Robert W. Emery / Rochus K. Voeller / Robert J. Emery
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41. Percutaneous Catheter-based Mitral Valve

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28. Stented Bioprosthetic Aortic Valve Repair 885

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Replacement 665 Mani Arsalan / J. Michael DiMaio / Michael Mack

Bobby Yanagawa / Subodh Verma / George T. Christakis
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42. Mitral Valve Replacement  895

29. Stentless Aortic Valve and Root Tsuyoshi Kaneko / Maroun Yammine /
Replacement 695 Dan Loberman / Sary Aranki
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Paul Stelzer / Robin Varghese

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30. Aortic Valve Repair and Aortic

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Valve-Sparing Operations  717

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Tirone E. David
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VALVULAR HEART DISEASE 54. Surgery for Atrial Fibrillation  1167
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VI
(OTHER) 925 Matthew C. Henn / Spencer J. Melby /

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43. Tricuspid Valve Disease  927
55. Surgical Implantation of Pacemakers
Richard J. Shemin / Peyman Benharash
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and Automatic Defibrillators  1181
44. Multiple Valve Disease  943 Henry M. Spotnitz / Michelle D. Spotnitz
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Hartzell V. Schaff / Rakesh M. Suri

45. Valvular and Ischemic Heart Disease  965 OTHER CARDIAC

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Kevin D. Accola / Clay M. Burnett OPERATIONS 1213
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46. Reoperative Valve Surgery  983 56. Surgery for Adult Congenital Heart
Disease 1215
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Julius I. Ejiofor / John G. Byrne / Marzia Leacche
Redmond P. Burke
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VII SURGERY OF THE GREAT

57. Pericardial Disease  1225
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VESSELS 1001 Eric N. Feins / Jennifer D. Walker
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58. Cardiac Neoplasms  1243
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47. Aortic Dissection  1003
Basel Ramlawi / Michael J. Reardon
Ravi K. Ghanta / Carlos M. Mery / Irving L. Kron

48. Ascending and Arch Aortic Aneurysms  1037

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Chase R. Brown / Joseph E. Bavaria / Nimesh D. Desai X TRANSPLANT AND MECHANICAL
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CIRCULATORY SUPPORT  1277
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49. Descending and Thoracoabdominal
Aortic Aneurysms  1075
fre

fre

fre

fre
59. Immunobiology of Heart and Lung
Joseph S. Coselli / Kim de la Cruz / Ourania Preventza / Transplantation 1279
ks

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ks

ks
Scott A. LeMaire Bartley P. Griffith / Agnes Azimzadeh
oo

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50. Endovascular Therapy for the Treatment 60. Heart Transplantation  1299
eb

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of Thoracic Aortic Disease  1101 Richard J. Shemin / Mario Deng
Susan D. Moffatt-Bruce / R. Scott Mitchell
m

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61. Lung Transplantation and Heart-lung
51. Trauma to the Great Vessels  1109 Transplantation 1331
Tom P. Theruvath / Claudio J. Schonholz / Hari R. Mallidi / Jatin Anand / Robert C. Robbins
m

m
John S. Ikonomidis
co

co

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co

co
62. Long-term Mechanical Circulatory
52. Pulmonary Embolism and Pulmonary Support and the Total Artificial Heart  1361
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Thromboendarterectomy 1127 Andrew C. W. Baldwin / Courtney J. Gemmato /
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Stuart W. Jamieson / Michael M. Madani William E. Cohn / O. H. Frazier fre

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63. Tissue Engineering for Cardiac Valve

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VIII SURGERY FOR CARDIAC

Surgery 1391
ARRHYTHMIAS 1145
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Danielle Gottlieb / John E. Mayer

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53. Interventional Therapy for Atrial and Index 1401

Ventricular Arrhythmias  1147
Jason S. Chinitz / Robert E. Eckart / Laurence M. Epstein
m

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CONTRIBUTORS

sf
ks

ks

ks

k
oo

oo

oo

oo
eb

eb

eb

eb
m

m
m

om
co

co

co

co

c
e.

e.

e.

e.
Kevin D. Accola, MD Agnes Azimzadeh, PhD
Director, Valve Center of Excellence Associate Professor
re

fre

re

re
Florida Hospital Cardiovascular Institute Department of Surgery
sf

f
Cardiovascular Surgeons, PA University of Maryland School of Medicine
ks

ks

ks
Orlando, Florida
k

Baltimore, Maryland
oo

oo

oo

oo
David H. Adams, MD Frank A. Baciewicz, Jr., MD
eb

eb

eb

eb
Cardiac Surgeon-in-Chief, Mount Sinai Health System Professor and Chief
Marie-Josée and Henry R. Kravis Professor and Chairman Division of Cardiothoracic Surgery
m

m
Department of Cardiovascular Surgery Wayne State University
Icahn School of Medicine at Mount Sinai and Harper University Hospital/Karmanos Cancer Center
  The Mount Sinai Hospital Detroit, Michigan
New York, New York
m

m
Andrew C. W. Baldwin, MD
co

co

co

co

co
Jatin Anand, MD Clinical Fellow in Cardiothoracic Transplant
Duke University Medical Center Texas Heart Institute
e.

e.

e.

e.
Durham, North Carolina Houston, Texas
fre

fre

fre

fre
Resident in General Surgery
Robert H. Anderson, BSc, MD, FRCPath Yale School of Medicine
ks

ks

ks

ks
Visiting Professorial Fellow New Haven, Connecticut
Institute of Genetic Medicine
oo

oo

oo

oo
Newcastle University Joseph E. Bavaria, MD
eb

eb

eb

eb
Newcastle-upon-Tyne Roberts-Measey Professor and Vice-Chief
United Kingdom Department of Cardiovascular Surgery
m

m
Hospital of the University of Pennsylvania
Sary Aranki, MD Philadelphia, Pennsylvania
Associate Professor of Surgery
Brigham and Women’s Hospital Peyman Benharash, MD
m

m
Harvard Medical School Assistant Professor in-Residence
co

co

co

co

co
Boston, Massachusetts Division of Cardiac Surgery
Department of Surgery
e.

e.

e.

e.
Mani Arsalan, MD David Geffen School of Medicine at UCLA
re

fre

fre

fre
Department Cardiac Surgery Los Angeles, California
Kerckhoff Heart Center
sf

ks

ks

ks
Bad Nauheim, Germany David P. Bichell, MD
k

The Heart Hospital Baylor Plano Cornelius Vanderbilt Chair in Surgery

oo

oo

oo

oo

Plano, Texas Chief, Pediatric Cardiac Surgery

eb

eb

eb

eb

Vanderbilt University
John G. Augoustides, MD, FASE, FAHA Monroe Carell Jr. Children’s Hospital
m

Professor Nashville, Tennessee

Cardiovascular and Thoracic Section
Department of Anesthesiology and Critical Care Steven F. Bolling, MD
Perelman School of Medicine The University of Michigan Hospitals
m

University of Pennsylvania Department of Cardiac Surgery

co

co

co

co

co

Philadelphia, Pennsylvania Cardiovascular Center

Ann Arbor, Michigan
e.

e.

e.

e.
fre

fre

fre

fre

xi
s

ks

ks

ks
ok

oo

oo

oo
o
eb

eb

eb

eb
m

Cohn FM_pi-xx.indd 11 08/05/17 4:55 pm

 e

e
m

m
m

om

m
xii
co

co

co

co
Contributors

c
e.

e.

e.

e.
Chase R. Brown, MD George T. Christakis, MD, FRCS(C)
fre

fre

fre

re
Cardiothoracic Surgery Professor, Department of Surgery

sf
Department of Cardiovascular Surgery Division of Cardiac Surgery, Schulich Heart Centre
ks

ks

ks

k
Hospital of the University of Pennsylvania Sunnybrook Health Sciences Centre
oo

oo

oo

oo
Philadelphia, Pennsylvania Director, Undergraduate Medical Education
University of Toronto
eb

eb

eb

eb
Nicolas A. Brozzi, MD Ontario, Canada
Department of Cardiothoracic Surgery
m

m
Cleveland Clinic Florida William E. Cohn, MD, FACS, FACCP
Weston, Florida Professor of Surgery
Director of Surgical Innovation
Anna Brzezinski, MD
m

om
Baylor College of Medicine
Medical Student (M2) Director of Minimally Invasive Surgical Technology
co

co

co

co
University of Illinois at Chicago Texas Heart Institute

c
Chicago, Illinois
e.

e.

e.

e.
Houston, Texas
re

fre

re

re
Redmond P. Burke, MD Lawrence H. Cohn, MD*
Chief, Division of Cardiovascular and Thoracic Surgery
sf

f
Emeritus Virginia and James Hubbard Professor
ks

ks

ks
Miami Children’s Hospital
k

Harvard Medical School

Miami, Florida
oo

oo

oo

oo
Division of Cardiac Surgery
Brigham and Women’s Hospital
Clay M. Burnett, MD
eb

eb

eb

eb
Boston, Massachusetts
Florida Hospital Cardiovascular Institute *
Deceased
m

m
Orlando, Florida
Jeffrey B. Cooper, PhD
John G. Byrne, MD
Professor of Anesthesia
Hospital Corporation of America
Department of Anesthesia, Critical Care, and Pain Medicine
m

m
Houston, Texas
Harvard Medical School
co

co

co

co

co
Massachusetts General Hospital
Javier G. Castillo, MD
Executive Director Emeritus and Senior Fellow
e.

e.

e.

e.
Assistant Professor
Center for Medical Simulation
Department of Cardiovascular Surgery
fre

fre

fre

fre
Boston, Massachusetts
The Mount Sinai Medical Center
ks

ks

ks

ks
New York, New York
Joseph S. Coselli, MD
oo

oo

oo

oo
Edward P. Chen, MD Professor and Chief of the Division of Cardiothoracic Surgery
Director of Thoracic Aortic Surgery Vice Chair, Michael E. DeBakey Department of Surgery
eb

eb

eb

eb
Associate Professor Baylor College of Medicine
Division of Cardiothoracic Surgery Chief of the Section of Adult Cardiac Surgery
m

m
Emory University School of Medicine Texas Heart Institute
Atlanta, Georgia Houston, Texas

Kim I. de la Cruz, MD, FACS

m

m
Frederick Y. Chen, MD, PhD
Associate Surgeon Assistant Professor
co

co

co

co

co
Director, Cardiac Surgery Research Laboratory Division of Cardiothoracic Surgery
Division of Cardiac Surgery Michael E. DeBakey Department of Surgery
e.

e.

e.

e.
Brigham and Women’s Hospital Baylor College of Medicine, and Clinical Staff
re

fre

fre

Associate Professor of Surgery Texas Heart Institute

Houston, Texas fre
sf

Harvard Medical School

ks

ks

ks
Boston, Massachusetts
k

William C. Culp, Jr., MD

oo

oo

oo

oo

Jason S. Chinitz, MD, FACC, FHRS Professor

eb

eb

eb

eb

Director, Cardiac Electrophysiology Scott & White Hospital

Assistant Professor, Hofstra Northwell School of Medicine Department of Anesthesiology
m

Southside Hospital The Texas A&M University System Health Science

Bayshore, New York   Center College of Medicine
Bryan, Texas
W. Randolph Chitwood, Jr, MD, FACS, FRCS (Eng)
m

Emeritus Professor and Chairman Michael D’Ambra, MD

co

co

co

co

co

Department of Surgery Associate Professor of Anesthesia

Founder—East Carolina Heart Institute Harvard Medical School
e.

e.

e.

e.

Brody School of Medicine Boston, Massachusetts

fre

fre

fre

fre

East Carolina University

Greenville, North Carolina
s

ks

ks

ks
ok

oo

oo

oo
o
eb

eb

eb

eb
m

Cohn FM_pi-xx.indd 12 08/05/17 4:55 pm

 e

e
m

m
m

om

m
xiii
co

co

co

co
Contributors

c
e.

e.

e.

e.
Ralph J. Damiano, Jr., MD Robert J. Emery, BS, MMS
fre

fre

fre

re
Evarts A. Graham Professor of Surgery Medical University Medical School

sf
Chief, Division of Cardiothoracic Surgery Philadelphia, Pennsylvania
ks

ks

ks

k
Co-Chair, Heart & Vascular Center
oo

oo

oo

oo
Washington University School of Medicine Robert W. Emery, MD
St. Louis, Missouri Director Emeritus, Cardiovascular and Thoracic Surgery
eb

eb

eb

eb
HealthEast Care System
Tirone E. David, MD St Joseph’s Hospital
m

m
Professor of Surgery St Paul, Minnesota
University of Toronto
Toronto, Ontario, Canada Laurence M. Epstein, MD
m

om
Professor of Medicine
Piroze M. Davierwala, MD Harvard Medical School
co

co

co

co
Department of Cardiac Surgery Chief, Arrhythmia Service

c
e.

e.

e.

e.
Heart Center Leipzig Brigham and Women’s Hospital
Leipzig, Germany Boston, Massachusetts
re

fre

re

re
sf

f
Andreas R. de Biasi, MD James I. Fann, MD
ks

ks

ks
Research Fellow
k

Professor
oo

oo

oo

oo
Department of Cardiothoracic Surgery Department of Cardiothoracic Surgery
Weill Cornell Medical College Stanford University
eb

eb

eb

eb
New York-Presbyterian Hospital Stanford, California
New York, New York
m

m
Eric N. Feins, MD
William J. DeBois, CCP, MBA Division of Cardiac Surgery
Chief Perfusionist and Director Department of Surgery
Department of Perioperative Services Massachusetts General Hospital
m

m
New York-Presbyterian Hospital Boston, Massachusetts
co

co

co

co

co
Weill Cornell Medical Center
New York, New York Victor A. Ferraris, MD, PhD
e.

e.

e.

e.
Tyler Gill Professor of Surgery
fre

fre

fre

fre
Mario Deng, MD, FACC, FESC Division of Cardiothoracic Surgery
Professor of Medicine University of Kentucky Chandler Medical Center
ks

ks

ks

ks
Advanced Heart Failure/Mechanical Support/Heart Transplant Lexington, Kentucky
David Geffen School of Medicine at UCLA
oo

oo

oo

oo
Ronald Reagan UCLA Medical Center O.H. Frazier, MD
eb

eb

eb

eb
Los Angeles, California Professor of Surgery
Michael E. DeBakey Department of Surgery
m

m
Nimesh D. Desai, MD, PhD, FRCSC, FAHA Baylor College of Medicine
Co-Director, Aortic and Vascular Center of Excellence Chief of the Center for Cardiac Support
Director, Thoracic Aortic Surgery Research Program Texas Heart Institute
Assistant Professor, Division of Cardiovascular Surgery Houston, Texas
m

m
Hospital of the University of Pennsylvania
co

co

co

co

co
Philadelphia, Pennsylvania Courtney J. Gemmato, MD
Resident in Cardiothoracic Surgery
e.

e.

e.

e.
J. Michael DiMaio, MD Texas Heart Institute
re

fre

fre

The Heart Hospital Baylor Plano

Plano, Texas
Baylor College of Medicine
Houston, Texas fre
sf

ks

ks

ks
k

Robert E. Eckart, DO Ravi K. Ghanta, MD

oo

oo

oo

oo

Heart Specialists of Sarasota Assistant Professor of Surgery

Sarasota, Florida
eb

eb

eb

eb

Department of Surgery
University of Virginia
m

Fred H. Edwards, MD Charlottesville, Virginia

Emeritus Professor of Surgery
University of Florida Andreas A. Giannopoulos, MD
Jacksonville, Florida Research Fellow
m

Applied Imaging Science Laboratory

Julius I. Ejiofor, MD
co

co

co

co

co

Brigham and Women’s Hospital

Division of Cardiac Surgery Harvard Medical School
e.

e.

e.

e.

Brigham and Women’s Hospital Boston, Massachusetts

Harvard Medical School
fre

fre

fre

fre

Boston, Massachusetts
s

ks

ks

ks
ok

oo

oo

oo
o
eb

eb

eb

eb
m

Cohn FM_pi-xx.indd 13 08/05/17 4:55 pm

 e

e
m

m
m

om

m
xiv
co

co

co

co
Contributors

c
e.

e.

e.

e.
A. Marc Gillinov, MD Syed T. Hussain, MD
fre

fre

fre

re
The Judith Dion Pyle Chair in Heart Valve Research Assistant Professor of Surgery

sf
Department of Thoracic and Cardiovascular Surgery Department of Thoracic & Cardiovascular Surgery
ks

ks

ks

k
Cleveland Clinic Cleveland Clinic
oo

oo

oo

oo
Cleveland, Ohio Cleveland, Ohio
eb

eb

eb

eb
Donald D. Glower, MD John S. Ikonomidis, MD, PhD
Professor of Surgery Professor of Surgery
m

m
Duke University Medical Center Chief, Division of Cardiothoracic Surgery
Durham, North Carolina University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
m

om
Danielle Gottlieb Sen, MS, MD, MPH
Assistant Professor of Surgery Neil B. Ingels, Jr., PhD
co

co

co

co
Pediatric Cardiovascular Surgery Consulting Professor

c
e.

e.

e.

e.
Children’s Hospital of New Orleans/LSU Health Science Center Department of Cardiothoracic Surgery
New Orleans, Louisiana Stanford University School of Medicine
re

fre

re

re
Stanford, California
sf

f
Roberta A. Gottlieb, MD
ks

ks

ks
Director, Molecular Cardiobiology O. Wayne Isom, MD
k
oo

oo

oo

oo
Dorothy and E. Phillip Lyon Chair in Molecular Cardiology in The Terry Allen Kramer Professor of Cardiothoracic Surgery
  honor of Clarence M. Agress MD Chairman, Department of Cardiothoracic Surgery
eb

eb

eb

eb
Research Scientist, Heart Institute Cardiothoracic Surgeon-in-Chief
Los Angeles, California Weill Cornell Medical College
m

m
New York-Presbyterian Hospital
Bartley P. Griffith, MD New York, New York
The Thomas E. and Alice Marie Hales
Distinguished Professor in Transplantation M. Salik Jahania, MD
m

m
Executive Director, Program in Lung Healing Associate Professor of Surgery
co

co

co

co

co
University of Maryland School of Medicine Cardiothoracic Surgery
Baltimore, Maryland Wayne State University
e.

e.

e.

e.
Detroit, Michigan
fre

fre

fre

fre
Wendy Gross, MD
Assistant Professor of Anesthesia Stuart W. Jamieson, MD, FRCS, FACS
ks

ks

ks

ks
Department of Anesthesiology, Perioperative and Pain Medicine Endowed Chair and Distinguished Professor
oo

oo

oo

oo
Brigham and Women’s Hospital Dean, Cardiovascular Affairs
Harvard Medical School University of California
eb

eb

eb

eb
Boston, Massachusetts San Diego, California
m

m
Michael E. Halkos, MD, MSc, FACS, FACC Tsuyoshi Kaneko, MD
Associate Professor of Surgery Division of Cardiac Surgery
Division of Cardiothoracic Surgery Brigham and Women’s Hospital
Scientific Director, Cardiothoracic Center for Clinical Research Boston, Massachusetts
m

m
Associate Program Director
co

co

co

co

co
Thoracic Surgery Residency Program Hanjo Ko, MD
Atlanta, Georgia Assistant Professor
e.

e.

e.

e.
Department of Anesthesiology and Critical Care
re

fre

fre

John W. Hammon, MD
Professor of Surgery, Emeritus
University of Pennsylvania Health System
Philadelphia, Pennsylvania fre
sf

ks

ks

ks
Department of Cardiothoracic Surgery
k

Wake Forest University School of Medicine Marijan Koprivanac, MD, MS

oo

oo

oo

oo

Winston-Salem, North Carolina Resident, Department of General surgery

eb

eb

eb

eb

Cleveland Clinic
Matthew C. Henn, MS, MD Research Fellow
m

Cardiac Surgery Research Fellow Department of Cardiothoracic Surgery, Cleveland Clinic

Washington University School of Medicine Clinical Instructor, Case Western University
St. Louis, Missouri Cleveland, Ohio
m

David M. Holzhey, MD Irving L. Kron, MD

co

co

co

co

co

Department of Cardiac Surgery S. Hurt Watts Professor and Chair

Heart Center Leipzig Department of Surgery
e.

e.

e.

e.

Leipzig, Germany University of Virginia

fre

fre

fre

fre

Charlottesville, Virginia
s

ks

ks

ks
ok

oo

oo

oo
o
eb

eb

eb

eb
m

Cohn FM_pi-xx.indd 14 08/05/17 4:55 pm

 e

e
m

m
m

om

m
xv
co

co

co

co
Contributors

c
e.

e.

e.

e.
Michael H. Kwon, MD Hari R. Mallidi, MD
fre

fre

fre

re
Research Fellow, Brigham and Women’s Hospital BWH Thoracic and Cardiac Surgery

sf
Clinical Fellow in Surgery (EXT), Harvard Medical School Co-Director, Program in Heart and Lung Transplant and MCS
ks

ks

ks

k
Boston, Massachusetts Surgical Director of Lung Transplant and Pulmonary
oo

oo

oo

oo
  Vascular Disease
Marzia Leacche, MD Senior Surgeon, Collaborative Center for Advanced Heart Failure
eb

eb

eb

eb
Spectrum Health Executive Director, BWH ECMO Program
Meijer Heart Center Boston, Massachusetts
m

m
Grand Rapids, Michigan
Jeremiah T. Martin, MBBCh, FRCSI
Lawrence Lee, MD Assistant Professor of Surgery
Clinical Fellow in Surgery
m

om
University of Kentucky Chandler Medical Center
Harvard Medical School Lexington, Kentucky
co

co

co

co
Resident in Cardiothoracic Surgery

c
Brigham and Women’s Hospital
e.

e.

e.

e.
John E. Mayer, Jr., MD
Boston, Massachusetts Senior Associate in Cardiac Surgery
re

fre

re

re
Childrens Hospital, Boston
sf

f
Lawrence S. Lee, MD Professor of Surgery
ks

ks

ks
Assistant Professor of Surgery Harvard Medical School
k
oo

oo

oo

oo
Division of Cardiothoracic Surgery Department of Cardiac Surgery
University of Tennessee Graduate School of Medicine Children’s Hospital
eb

eb

eb

eb
Knoxville, Tennessee Boston, Massachusetts
m

m
Scott A. LeMaire, MD Edwin C. McGee, Jr., MD
Professor and Director of Research Thoracic and Cardiovascular Surgery
Division of Cardiothoracic Surgery Professor
Michael E. DeBakey Department of Surgery Director, Heart Transplant & Ventricular Assist Device Program
m

m
Baylor College of Medicine, and Cardiovascular Surgery Staff Loyola Medicine
co

co

co

co

co
Texas Heart Institute Maywood, Illinois
Houston, Texas
e.

e.

e.

e.
Mandeep R. Mehra, MD
fre

fre

fre

fre
Bradley G. Leshnower, MD Professor of Medicine
Assistant Professor of Surgery Harvard Medical School
ks

ks

ks

ks
Division of Cardiothoracic Surgery Medical Director
Emory University School of Medicine
oo

oo

oo

oo
Heart and Vascular Center
Atlanta, Georgia Brigham and Women’s Hospital
eb

eb

eb

eb
Boston, Massachusetts
Jerrold H. Levy, MD, FAHA, FCCM
m

m
Professor of Anesthesiology Spencer J. Melby, MD
Associate Professor of Surgery Associate Professor of Surgery
Co-Director Cardiothoracic Intensive Care Unit Department of Surgery
Duke University School of Medicine Division of Cardiothoracic Surgery
m

m
Durham, North Carolina Washington University in St. Louis and Barnes Jewish Hospital
co

co

co

co

co
St. Louis, Missouri
Dan Loberman, MD
e.

e.

e.

e.
Division of Cardiac Surgery Robert M. Mentzer, Jr., MD
re

fre

fre

fre
Brigham and Women’s Hospital Professor of Medicine and Surgery
Harvard Medical school Cedars-Sinai Heart Institute
sf

ks

ks

ks
Boston, Massachusetts Cedars-Sinai Medical Center
k

Los Angeles, California

oo

oo

oo

oo

Bruce W. Lytle, MD
Director of Strategic Operations
eb

eb

eb

eb

Carlos M. Mery, MD, MPH

The Heart Hospital Baylor-Plano Assistant Professor of Surgery and Pediatrics
Dallas, Texas
m

Department of Surgery
Texas Children’s Hospital/Baylor College of Medicine
Michael Mack, MD Houston, Texas
The Heart Hospital Baylor Plano
m

Plano, Texas Bret A. Mettler, MD

co

co

co

co

co

Assistant Professor in Surgery

Michael M. Madani, MD
Vanderbilt University
e.

e.

e.

e.

Professor and Chief

Monroe Carell Jr. Children’s Hospital
Division of Cardiovascular and Thoracic Surgery
fre

fre

fre

fre

Nashville, Tennessee
University of California, San Diego
La Jolla, California
s

ks

ks

ks
ok

oo

oo

oo
o
eb

eb

eb

eb
m

Cohn FM_pi-xx.indd 15 08/05/17 4:55 pm

 e

e
m

m
m

om

m
xvi
co

co

co

co
Contributors

c
e.

e.

e.

e.
Stephanie L. Mick, MD Friedrich-Wilhelm Mohr, MD, PhD
fre

fre

fre

re
Cardiac Surgery, Surgical Director of Transcatheter Valve Insertion Professor of Cardiac Surgery

sf
Program University of Leipzig
ks

ks

ks

k
Department of Thoracic and Cardiovascular Surgery, Medical Director Heart Center Leipzig
oo

oo

oo

oo
Heart and Vascular Institute Director Department of Cardiac Surgery
Cleveland Clinic Heart Center Leipzig
eb

eb

eb

eb
Cleveland, Ohio Leipzig, Germany
m

m
Tomislav Mihaljevic, MD L. Wiley Nifong, MD
Professor of Surgery Division of Cardiothoracic Surgery
Cleveland Clinic Lerner College of Medicine Department of Cardiovascular Sciences
m

om
Cleveland, Ohio East Carolina Heart Institute
Chief Executive Officer Brody School of Medicine at East Carolina University
co

co

co

co
Cleveland Clinic Abu Dhabi Greenville, North Carolina

c
e.

e.

e.

e.
Abu Dhabi, United Arab Emirates
Patrick T. O’Gara, MD
re

fre

re

re
Michael R. Mill, MD Watkins Family Distinguished Chair in Cardiology
sf

f
Professor Brigham and Women’s Hospital
ks

ks

ks
Departments of Surgery and Pediatrics
k

Professor of Medicine
oo

oo

oo

oo
University of North Carolina Harvard Medical School
Chapel Hill, North Carolina Boston, Massachusetts
eb

eb

eb

eb
D. Craig Miller, MD Robert F. Padera, MD, PhD
m

m
Thelma and Henry Doelger Professor of Cardiovascular Surgery Associate Pathologist
Dept. of Cardiothoracic Surgery Department of Pathology
Stanford University School of Medicine Brigham and Women’s Hospital
Falk CV Research Building Assistant Professor of Pathology
m

m
Stanford, California Harvard Medical School
co

co

co

co

co
Boston, Massachusetts
R. Scott Mitchell, MD
e.

e.

e.

e.
Professor Emeritus Prakash A. Patel, MD
fre

fre

fre

fre
Department of Cardiothoracic Surgery Assistant Professor
Stanford University School of Medicine Cardiovascular and Thoracic Section
ks

ks

ks

ks
Falk Cardiovascular Research Building Department of Anesthesiology and Critical Care
oo

oo

oo

oo
Stanford, California Perelman School of Medicine
Attending Surgeon University of Pennsylvania
eb

eb

eb

eb
Division of Cardiac Surgery Philadelphia, Pennsylvania
V.A. Hospital Palo Alto
m

m
Palo Alto, California Gösta B. Pettersson, MD, PhD
Professor of Surgery
Annette Mizuguchi, MD Vice Chairman
Assistant Professor of Anesthesia Department of Thoracic and Cardiovascular Surgery
m

m
Department of Anesthesiology, Perioperative and Pain Medicine Cleveland Clinic
co

co

co

co

co
Brigham and Women’s Hospital Cleveland, Ohio
Harvard Medical School
e.

e.

e.

e.
Boston, Massachusetts Michael H. Picard, MD
re

fre

fre

Nader Moazami, MD
Professor of Medicine
Harvard Medical School fre
sf

ks

ks

ks
Thoracic and Cardiovascular Surgery Director, Echocardiography
k

Cleveland Clinic Massachusetts General Hospital

oo

oo

oo

oo

Cleveland, Ohio Boston, Massachusetts

eb

eb

eb

eb

Susan D. Moffatt-Bruce, MD, PhD Paul A. Pirundini, MD

Chief, Cardiac Surgery
m

Associate Professor, Division of Thoracic Surgery

Department of Surgery Cape Cod Hospital
Ohio State University Hyannis, Massachusetts
Wexner Medical Center Associate Surgeon
m

Columbus, Ohio Brigham and Women’s Hospital

co

co

co

Boston, Massachusetts
co

co
e.

e.

e.

e.
fre

fre

fre

fre
s

ks

ks

ks
ok

oo

oo

oo
o
eb

eb

eb

eb
m

Cohn FM_pi-xx.indd 16 08/05/17 4:55 pm

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e
m

m
m

om

m
xvii
co

co

co

co
Contributors

c
e.

e.

e.

e.
Ourania Preventza, MD Matthew A. Romano, MD
fre

fre

fre

re
Associate Professor of Surgery Assistant Professor

sf
Division of Cardiothoracic Surgery Department of Cardiac Surgery
ks

ks

ks

k
Michael E DeBakey Department of Surgery University of Michigan
oo

oo

oo

oo
Baylor College of Surgery Ann Arbor, Michigan
Attending Cardiac and Endovascular Surgeon
eb

eb

eb

eb
Texas Heart Institute Christian T. Ruff, MD, MPH
Baylor St Luke’s Medical Center Assistant Professor of Medicine
m

m
Houston, Texas Cardiovascular Medicine Division
Brigham and Women’s Hospital
John D. Puskas, MD Harvard Medical School
m

om
Chair, Cardiovascular Surgery Boston, Massachusetts
Mount Sinai St. Luke’s, Mount Sinai Beth Israel, and
co

co

co

co
  Mount Sinai West Frank J. Rybicki, MD, PhD

c
e.

e.

e.

e.
New York, New York Professor, Chair and Chief, Department of Radiology
The University of Ottawa
re

fre

re

re
T. Konrad Rajab, MD Faculty of Medicine and The Ottawa Hospital
sf

f
Clinical Fellow in Surgery Ottawa, Ontario, Canada
ks

ks

ks
Harvard Medical School
k
oo

oo

oo

oo
Resident in Cardiothoracic Surgery Arash Salemi, MD
Brigham and Women’s Hospital Associate Professor of Cardiothoracic Surgery
eb

eb

eb

eb
Boston, Massachusetts Department of Cardiothoracic Surgery
Weill Cornell Medical College
m

m
Basel Ramlawi, MD, FACC, FACS New York-Presbyterian Hospital
Chairman, Heart & Vascular Center New York, New York
Director, Advanced Valve & Aortic Center Valley Health System
Winchester, Virginia Edward B. Savage, MD
m

m
Clinical Professor
co

co

co

co

co
James G. Ramsay, MD Cleveland Clinic Lerner College of Medicine
Professor Anesthesiology Chairman
e.

e.

e.

e.
Director of Cardiothoracic Intensive Care Unit Department of Cardiothoracic Surgery
fre

fre

fre

fre
University of California Director
San Francisco, California Heart and Vascular Institute
ks

ks

ks

ks
Cleveland Clinic Florida
oo

oo

oo

oo
James D. Rawn, MD Weston, Florida
Director, Cardiac Surgery Intensive Care Unit
eb

eb

eb

eb
Instructor in Surgery, Harvard Medical School Hartzell Schaff, MD
Cardiac Surgery Professor of Surgery, College of Medicine
m

m
Boston, Massachusetts Department of Cardiovascular Surgery
Mayo Clinic
Michael J. Reardon, MD, FACS, FACC Rochester, Minnesota
Professor of Cardiothoracic Surgery
m

m
Allison Family Distinguished Chair of Cardiovascular Research Frederick J. Schoen, MD, PhD
co

co

co

co

co
Department of Cardiovascular Surgery Executive Vice Chairman
Houston Methodist DeBakey Heart & Vascular center Department of Pathology
e.

e.

e.

e.
Houston, Texas Brigham and Women’s Hospital
re

fre

fre

Kent Rehfeldt, MD, FASE

Professor of Pathology and Health Sciences and Technology (HST),
fre
sf

Harvard Medical School

ks

ks

ks
Associate Professor of Anesthesiology Boston, Massachusetts
k

Mayo Clinic
oo

oo

oo

oo

Rochester, Minnesota Claudio J. Schonholz, MD

eb

eb

eb

eb

Department of Surgery, Division of Cardiothoracic Surgery

Robert C. Robbins, MD Department of Radiology, Division of Interventional Radiology
m

President and CEO Medical University of South Carolina

Texas Medical Center Charleston, South Carolina
Houston, Texas
Jacob N. Schroder, MD
m

Barbara Robinson, MD, MS, FACS, FAHA, FACC Assistant Professor of Surgery
co

co

co

co

co

Division of Cardiothoracic Surgery Co-Director, Cardiothoracic Intensive Care Unit

Department of Cardiovascular Sciences Duke University School of Medicine
e.

e.

e.

e.

East Carolina Heart Institute Durham, North Carolina

fre

fre

fre

fre

Brody School of Medicine at East Carolina University

Greenville, North Carolina
s

ks

ks

ks
ok

oo

oo

oo
o
eb

eb

eb

eb
m

Cohn FM_pi-xx.indd 17 08/05/17 4:55 pm

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e
m

m
m

om

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co

co

co

co
Contributors

c
e.

e.

e.

e.
Pinak Shah, MD Larry W. Stephenson, MD
fre

fre

fre

re
Associate Professor of Medicine Professor Emeritus

sf
Division of Cardiology Ford Webber Professor of Surgery
ks

ks

ks

k
Department of Medicine Department of Surgery
oo

oo

oo

oo
Brigham and Women’s Hospital Wayne State University
Harvard Medical School Detroit, Michigan
eb

eb

eb

eb
Boston, Massachusetts
Thoralf M. Sundt, MD
m

m
Prem S. Shekar, MD Edward D. Churchill Professor of Surgery
Assistant Professor of Surgery Harvard Medical School
Harvard Medical School Chief, Division of Cardiac Surgery
m

om
Chief, Division of Cardiac Surgery Massachusetts General Hospital
Brigham and Women’s Hospital Boston, Massachusetts
co

co

co

co
Boston, Massachusetts

c
e.

e.

e.

e.
Rakesh Mark Suri, MD, D.Phil
Richard J. Shemin, MD Cleveland Clinic Foundation
re

fre

re

re
Robert and Kelly Day Professor and Chief Department of Thoracic and Cardiovascular Surgery
sf

f
Division of Cardiac Surgery Cleveland, Ohio
ks

ks

ks
Vice Chairman, Department of Surgery
k
oo

oo

oo

oo
Co-director, Cardiovascular Center at UCLA Lars G. Svensson, MD, PhD
David Geffen School of Medicine at UCLA Chairman, Heart and Vascular Institute
eb

eb

eb

eb
Los Angeles, California Cleveland Clinic
Cleveland, Ohio
m

m
Stanton K. Shernan, MD, FAHA, FASE
Professor of Anesthesia Vakhtang Tchantchaleishvili, MD
Department of Anesthesiology, Perioperative and Pain Medicine Cardiothoracic Surgery
Brigham and Women’s Hospital University of Rochester Medical Center
m

m
Harvard Medical School Rochester, New York
co

co

co

co

co
Boston, Massachusetts
Usha Tedrow, MD
e.

e.

e.

e.
Tarang Sheth, MD, FRCPC Assistant Professor of Medicine
fre

fre

fre

fre
Cardiovascular Radiologist Division of Cardiology
Director of Cardiac CT and MR Department of Medicine
ks

ks

ks

ks
Department of Diagnostic Imaging Brigham and Women’s Hospital
oo

oo

oo

oo
Trillium Health Partners Harvard Medical School
Mississauga, Ontario, Canada Boston, Massachusetts
eb

eb

eb

eb
Deane E. Smith III, MD Eliza P. Teo, MBBS
m

m
Assistant Professor of Cardiothoracic Surgery Clinical and Research Fellow in Medicine
NYU School of Medicine Massachusetts General Hospital
New York, New York Research Fellow
Harvard Medical School
m

m
Philip J. Spencer, MD Boston, Massachusetts
co

co

co

co

co
Department of Surgery
Massachusetts General Hospital Tom P. Theruvath, MD, PhD
e.

e.

e.

e.
Boston, Massachusetts Department of Surgery, Division of Cardiothoracic Surgery
re

fre

fre

Michelle D. Spotnitz, MD
Department of Radiology, Division of Interventional Radiology
Medical University of South Carolina fre
sf

ks

ks

ks
Cardiologist Charleston, South Carolina
k

EHE International
oo

oo

oo

oo

New York, New York George Tolis, Jr., MD

eb

eb

eb

eb

Assistant Professor of Surgery

Henry M. Spotnitz, MD Harvard Medical School
m

George H. Humphreys, II, Professor of Surgery Boston, Massachusetts

Department of Surgery
Columbia University Robin Varghese, MD, MS, FRCSC
New York, New York Associate Professor
m

Department of Cardiovascular Surgery

co

co

co

co

co

Paul Stelzer, MD Icahn School of Medicine at Mount Sinai

Professor New York, New York
e.

e.

e.

e.

Department of Cardiovascular Surgery

fre

fre

fre

fre

Icahn School of Medicine at Mount Sinai

New York, New York
s

ks

ks

ks
ok

oo

oo

oo
o
eb

eb

eb

eb
m

Cohn FM_pi-xx.indd 18 08/05/17 4:55 pm

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e
m

m
m

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co

co

co

co
Contributors

c
e.

e.

e.

e.
Subodh Verma, MD, PhD, FRCSC Mathew R. Williams, MD
fre

fre

fre

re
Cardiac Surgeon Associate Professor of Cardiothoracic Surgery & Medicine

sf
St Michael’s Hospital Chief, Division of Adult Cardiac Surgery
ks

ks

ks

k
Professor of Surgery & Pharmacology and Toxicology Director, CVI Structural Heart Program
oo

oo

oo

oo
University of Toronto Director, Interventional Cardiology
Canada Research Chair in Atherosclerosis NYU School of Medicine
eb

eb

eb

eb
Toronto, Ontario New York, New York
m

m
Rochus K. Voeller, MD James M. Wilson, MD
Cardiovascular Surgeon Director, Cardiology Education
Fairview Health System Texas Heart Institute
m

om
Fairview Southdale Hospital Houston, Texas
Edina, Minnesota
co

co

co

co
Maroun Yammine, MD

c
e.

e.

e.

e.
Jennifer D. Walker, MD Division of Cardiac Surgery
Professor and Chief Brigham and Women’s Hospital
re

fre

re

re
Division of Cardiac Surgery Boston, Massachusetts
sf

f
Surgical Director
ks

ks

ks
Heart & Vascular Center of Excellence Bobby Yanagawa, MD, PhD, FRCSC
k
oo

oo

oo

oo
UMass Memorial Medical Center Assistant Professor
Worcester, Massachusetts Division of Cardiac Surgery
eb

eb

eb

eb
St Michael’s Hospital
Toni B. Walzer, MD, FACOG Toronto, Canada
m

m
Assistant Professor, Part-Time, of Obstetrics, Gynecology, and
Reproductive Biology Farhang Yazdchi, MD, MS
Harvard Medical School Clinical Fellow in Surgery (EXT)
Department of Obstetrics and Gynecology Brigham and Women’s Hospital Surgery
m

m
Brigham and Women’s Hospital Brigham and Women’s Hospital
co

co

co

co

co
Assistant in Healthcare Education Cardiac Surgery
Department of Anesthesia, Critical Care, and Pain Medicine Boston, Massachusetts
e.

e.

e.

e.
Massachusetts General Hospital
fre

fre

fre

fre
Director, Labor and Delivery Program
Center for Medical Simulation
ks

ks

ks

ks
Boston, Massachusetts
oo

oo

oo

oo
James T. Willerson, MD, FACC
eb

eb

eb

eb
President and Medical Director
Texas Heart Institute
m

m
Houston, Texas
m

m
co

co

co

co

co
e.

e.

e.

e.
re

fre

fre

fre
sf

ks

ks

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oo

oo

oo

oo
eb

eb

eb

eb
m

m
m

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e.

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e.

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fre

fre

fre

fre
s

ks

ks

ks
ok

oo

oo

oo
o
eb

eb

eb

eb
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