Papers by YIH-SHARNG CHEN
European Journal of Cardio-Thoracic Surgery, 2005
Anesthesia & Analgesia, 1992
xtracorporeal membrane oxygenation (ECMO) is routinely used for cardiopulmonary support E in a wi... more xtracorporeal membrane oxygenation (ECMO) is routinely used for cardiopulmonary support E in a wide variety of neonatal diseases, such as meconium aspiration syndrome, respiratory distress syndrome, persistent pulmonary hypertension, sepsis syndrome, and severe pneumonia. Extracorporeal membrane oxygenation is also potentially useful as a component of preoperative care for infants with profound respiratory failure and surgical lesions such as congenital diaphragmatic hernia (1). We recently used ECMO intraoperatively to support a baby with congenital tracheal stenosis (CTS) and continued using ECMO during the postoperative period to avoid trauma to the tracheal anastomosis. Extracorporeal membrane oxygenation was continued for 7 days, after which the patient was safely returned to mechanical ventilation. This hybrid approach is similar to that used in patients with unrepaired congenital diaphragmatic hernia (2). Neonatal CTS, which presents with severe symptoms in the first days of life, has a high mortality (44%-79%), and sudden death is common (3,4). If the lesion is near or includes the carina or involves >50% of the trachea, repair is both difficult and dangerous. A variety of surgical approaches have been used. The surgical repair of choice is primary tracheal resection and anastomosis (5). Most surgeons believe that up to 50% of the length of the infant trachea can be primarily resected (1). Where the lesion involves >50% of the trachea, tracheal reconstruction has been performed using a variety of materials to fill the defect, including costochondral grafts (3,6), pericardium (9, and esophagus (4). Regardless of the method of repair, providing ventilation and oxygenation during surgical correction of the trachea is one of the anesthesiologist’s greatest challenges. If an endotracheal tube can be
Intensive care medicine, Jan 3, 2017
This study aimed to concisely describe the current standards of care, major recent advances, comm... more This study aimed to concisely describe the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to extracorporeal membrane oxygenation (ECMO). Narrative review based on a systematic analysis of the medical literature, national and international guidelines, and expert opinion. The use of venovenous ECMO (VV-ECMO) is increasing in the most severe forms of acute lung injury. In patients with cardiogenic shock, short-term veno-arterial ECMO (VA-ECMO) provides both pulmonary and circulatory support. Technological improvements and recently published studies suggest that ECMO is able to improve patients' outcomes. There are, however, many uncertainties regarding the real benefits of this technique both in hemodynamic and respiratory failure, the territorial organization to deliver ECMO, the indication...
American Journal of Respiratory and Critical Care Medicine, 2013
with it through other confounders. However, these data do help us better understand the effect of... more with it through other confounders. However, these data do help us better understand the effect of nutrition, and especially early parenteral nutrition, on critically ill patients. It does provide one explanation as to why patients given early parenteral nutrition in the EPaNIC study experienced worse outcomes. These data do not inform as to whether some nutrition is better than starvation, nor do they inform us how to treat patients who are already malnourished at ICU admission. Given the available data, it appears that in most critically ill patients, nutrition may be another treatment in the ICU where less is more.
American Heart Journal, 1994
ABSTRACT
Journal of Critical Care, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
The Annals of thoracic surgery, Jan 16, 2018
A patient with double inlet left ventricle with transposition of great arteries, and severe coarc... more A patient with double inlet left ventricle with transposition of great arteries, and severe coarctation of the aorta received aortoplasty and pulmonary artery banding, followed by bidirectional Glenn shunt and extracardiac total cavopulmonary connection(TCPC). Severe subaortic stenosis and increased atrio-ventricular valve regurgitation were noted 4 years after TCPC.
The Annals of thoracic surgery, 2017
Ebstein's anomaly in combination with tetralogy of Fallot (TOF) is rare. We report a male inf... more Ebstein's anomaly in combination with tetralogy of Fallot (TOF) is rare. We report a male infant with these combined anomalies who presented with severe cyanosis, heart failure, and respiratory distress after birth. Biventricular repair was successfully performed with 1-stage correction of his ventricular septal defect (VSD), right ventricular outflow tract (RVOT) obstruction, and tricuspid regurgitation. The downward displaced tricuspid valve was also restored to the normal annulus position. The infant recovered well. The surgical technique for this rare and severe anomaly is reported here.
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 15, 2015
We report our surgical experience in congenitally corrected transposition of great arteries (CCTG... more We report our surgical experience in congenitally corrected transposition of great arteries (CCTGAs) and the long-term follow-up result. From January 1995 to February 2012, 56 patients with CCTGA received definite surgical repair; 15 patients received conventional repair (Group I), 18 patients received anatomical repair (Group II) and 23 patients received single ventricular palliation (Group III). They were followed for early and late mortality, long-term survival, postoperative morbidity and reintervention or reoperation. The overall survival rate was 80% at 16 years in Group I, 53% at 13 years in Group II and 100% at 13 years in Group III. After excluding the early surgical mortality, the long-term survival rate was 92% at 16 years in Group I, 64% at 13 years in Group II and 100% at 13 years in Group III. Patients with significant tricuspid valve regurgitation showed the worst outcome after surgery. Our series showed good results with single ventricular palliation (SVP) in CCTGA w...
The Journal of pharmacology and experimental therapeutics, 2014
Some patients with nonsmall-cell lung cancer (NSCLC) without epidermal growth factor receptor (EG... more Some patients with nonsmall-cell lung cancer (NSCLC) without epidermal growth factor receptor (EGFR) mutations still respond to gefitinib and erlotinib, suggesting that there may be a mechanism(s) other than the EGFR pathway that mediates the tumoricidal effects. In the current study, we tested the efficacy of TD-19, a novel compound chemically modified from erlotinib, which has more potent apoptotic effects than erlotinib in EGFR wild-type NSCLC cell lines. TD-19 induced significant cell death and apoptosis in H358, H441, H460, and A549 cells, as evidenced by increased caspase-3 activity and cleavage of procaspase-9 and poly (ADP-ribose) polymerase. The apoptotic effect of TD-19 in H460 cells, which were resistant to erlotinib, was associated with downregulation of cancerous inhibitor of protein phosphatase 2A (CIP2A), increased protein phosphatase 2A (PP2A) activity, and decreased AKT phosphorylation, but minimal effects on EGFR phosphorylation. Overexpression of CIP2A partially p...
Backgroud: Robotic mitral surgery is the most common robotic cardiac procedures. However, in mitr... more Backgroud: Robotic mitral surgery is the most common robotic cardiac procedures. However, in mitral endocarditis the repair become more challenging especially in minimally approach. We applied robotic surgery in mitral endocarditis repair and reviewed our surgical methods and results. Patients: From January 2012 to December 2013, 12 patients with mitral endocarditis in National Taiwan University Hospital were operated via robotic assisted repair. Age of them was among 21 to 65 years old, mean 43. Results: The vegetation involves anterior leaflet in 3, posterior leaflet in 8 and commissural leaflet in 4. Mean cardiopulmonary bypass time is 124 minutes and cross clamp time is 89 minutes. There was no stroke and no operation death. Mitral valve repair technique including anterior leaflet patch augmentation in 2, direct closure of rupture hole on anterior leaflet in one, plication commissural leaflet in 2, and artificial chordae in 10. There was no mitral regurgitation detected immediately after weaning of cardiopulmonary bypass. All of them got free-from-regurgitation or-stenosis rate was 100% at one-year follow. Conclusions: Although mitral infective endocarditis is complex and difficult to repair, robotic mitral repair in infective endocarditis is feasible. Even in the complex repair group, the cardiopulmonary bypass time is not prolonged and the result is good.
PLoS ONE, 2014
Background: Although much attention has been focused on the association between chronic hyperglyc... more Background: Although much attention has been focused on the association between chronic hyperglycemia and cerebrovascular diseases in type 2 diabetes mellitus (DM) patients, there is no data regarding the risk of ischemic stroke after a hyperosmolar hyperglycemic state (HHS) attack. The objective of this study was to investigate the risk of ischemic stroke in type 2 DM patients after an HHS attack. Methods: From 2004 to 2008, this retrospective observational study was conducted on a large cohort of Taiwanese using Taiwan's National Health Insurance Research Database (NHIRD). We identified 19,031 type 2 DM patients who were discharged with a diagnosis of HHS and 521,229 type 2 DM patients without an HHS diagnosis. Using the propensity score generated from logistic regression models, conditional on baseline covariates, we matched 19,031 type 2 DM patients with an HHS diagnosis with the same number from the comparison cohort. The one-year cumulative rate for ischemic stroke was estimated using the Kaplan-Meier method. After adjusting covariates, Cox proportional hazard regression was used to compute the adjusted one-year rate of ischemic stroke. Results: Of the patients sampled, 1,810 (9.5%) of the type 2 DM patients with HHS and 996 (5.2%) of the comparison cohort developed ischemic stroke during the one-year follow-up period. After adjusting for covariates, the adjusted HR for developing ischemic stroke during the one-year follow-up period was 1.8 (95% C.I., 1.67 to 1.95, P,0.001) for type 2 DM patients with HHS compared with those without HHS. Conclusion: Although DM is a well-recognized risk factor for atherosclerosis, type 2 DM patients that have suffered a HHS attacks are at an increased risk of developing ischemic stroke compared with those without HHS.
Pediatric Research, 2011
Pulmonary regurgitation and prolonged QRS duration of right bundle branch (RBB) block are common ... more Pulmonary regurgitation and prolonged QRS duration of right bundle branch (RBB) block are common in repaired tetralogy of Fallot (TOF) and increase the risk of sudden death. We sought to establish an animal model to reflect both abnormalities. Twenty-one canines: group I (n ϭ 7) received a surgical right ventricular outflow tract (RVOT) transannular patch plus pulmonary valve destruction; group II (n ϭ 5) received RBB ablation and sham operation; and group III (n ϭ 9) received combined interventions. Serial electrophysiological data were obtained up to 1 y. Procedure mortality was 27.6%. At 1 y, although severe pulmonary regurgitation was documented in most dogs in groups I (71%) and III (100%), progressive RVOT dilatation was noted in group III. RBB block was present in all dogs in groups II and III. However, the increments of QRS duration, QTc, JTc, and QT dispersion progression between 1 mo and 1 y were all greatest in group III. Ventricular arrhythmia events were frequent in group III (median 3.3/mo) but uncommon in groups I and II (median 1/mo). We have created a novel animal model that adequately reflects both the hemodynamic and electrophysiological characteristics of repaired TOF patients and can be applied to examine the risk of ventricular arrhythmias.
The Journal of Thoracic and Cardiovascular Surgery, 2009
Objective: Clinical improvement after a surgical ventricular restoration for ischemic cardiomyopa... more Objective: Clinical improvement after a surgical ventricular restoration for ischemic cardiomyopathy is increasingly accepted by clinicians, but the mechanism is not completely understood. Methods: Ten patients with ischemic cardiomyopathy underwent detailed magnetic resonance imaging for ventricular function before and 6 weeks after surgical ventricular restoration. Surgical procedures included combinations of coronary artery bypass grafting, restrictive mitral annuloplasty, and endoventricular patch plasty. Magnetic resonance imaging analysis included quantification of global and regional systolic function. Anterior and posterior left ventricular regions were divided by an imaginary plane (C-plane) determined from anterior mitral point and both papillary roots. Results: Global stroke volume index increased from 28.8 AE 4.9 mL/m 2 to 36.5 AE 8.6 mL/m 2 after surgical ventricular restoration (P ¼ .010) and seemed more related to increased posterior stroke volume index (15.9 AE 4.3 mL/m 2 preoperatively, 21.8 AE 3.9 mL/m 2 postoperatively, P ¼ .001) than to changed anterior stroke volume index (15.9 AE 4.4 mL/m 2 preoperatively, 18.2 AE 6.9 mL/m 2 postoperatively, P ¼ .369). C-plane area decreased only a little in diastole (37.7 AE 8.3 cm 2 preoperatively, 32.9 AE 5.9 cm 2 postoperatively, P ¼ .119) but significantly in systole (31.5 AE 9.4 cm 2 preoperatively, 23.7 AE 7.6 cm 2 postoperatively, P ¼ .023). This indicates functional recovery of border zone by restrictive endoventricular patch plasty. Conclusion: Rebuilding geometric normality by surgical ventricular restoration improves contractility of myocardium in border-zone and remote regions, resulting in increased stroke volume index from the posterior left ventricle. Operative Procedure The surgical procedure was performed through a full median sternotomy. Cardiopulmonary bypass was instituted as routine. Whether the operative procedure was performed with a beating heart 10 or with cardiac arrest depended on preoperative myocardial function. For those who underwent cardiac arrest, myocardial protection was achieved with intermittent antegrade Video clip is available online.
The Journal of Thoracic and Cardiovascular Surgery, 2004
The Journal of Thoracic and Cardiovascular Surgery, 2006
The Journal of Thoracic and Cardiovascular Surgery, 2010
The Journal of Thoracic and Cardiovascular Surgery, 2002
Figure 1. a, Extremely dilated heart before operation with cardiothoracic ratio of approximately ... more Figure 1. a, Extremely dilated heart before operation with cardiothoracic ratio of approximately 1.0. b, Reduced heart size after operation. Brief Communications
Journal of the American College of Cardiology, 2003
We conducted this study to determine the result of prolonged cardiopulmonary resuscitation (CPR) ... more We conducted this study to determine the result of prolonged cardiopulmonary resuscitation (CPR) with extracorporeal membrane oxygenation (ECMO) and the predictive factors for hospital discharge and ECMO weaning. BACKGROUND Prolonged CPR carries considerable associated mortality and morbidity. As yet, ECMO for prolonged CPR has no definite results. Only small groups of patients and no detailed analysis have been reported. METHODS Candidates for ECMO resuscitation were patients in cardiac arrest receiving CPR Ͼ10 min without return of spontaneous circulation and no absolute contraindication. Venoarterial ECMO was set up during CPR. We reviewed the data of 57 prolonged CPR patients who received ECMO during CPR over a six-year period. RESULTS The mean duration of CPR was 47.6 Ϯ 13.4 min and that of ECMO was 96.1 Ϯ 87.9 h. The rate of weaning was 66.7%, and the survival rate was 31.6%. Multiple-organ failure was the major reason for mortality, despite successful weaning. Among survivors, long-term follow-up revealed 88.9% survival, and only 5.6% had a severe neurologic deficit. The results indicate that a shorter CPR duration, postcardiotomy arrest, myocardial indicators, a hepatic indicator, and lactic acid are significantly correlated with both weaning and survival, whereas late damage (level on the third or seventh day of reperfusion) rather than initial damage (level on the first day) was more predictive of the results. CONCLUSIONS Prolonged CPR rescue by ECMO provides an acceptable survival rate and outcome in survivors. Our results of the selected cases encourage further investigations of the wider application of ECMO in CPR.
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Papers by YIH-SHARNG CHEN