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Publications & Research

Dr. Spoor has contributed to 4 publications.
Title Vancomycin Use During Left Ventricular Assist Device Support.
Date July 2009
Journal Infection Control and Hospital Epidemiology : the Official Journal of the Society of Hospital Epidemiologists of America

We reviewed the frequency and duration of vancomycin use during 93 left ventricular assist device placements. Vancomycin prophylaxis was administered for a mean duration (+/- standard deviation) of 10.5 +/- 11 days. Empirical vancomycin use was frequent, with a mean duration (+/- standard deviation) of therapy of 9.8 +/- 9 days (median, 8 days) given during 81 (87%) of the implantations. The most common indications for empirical vancomycin treatment were isolated leukocytosis or driveline drainage. Strategies to improve vancomycin use during left ventricular assist device support should be considered.

Title Valve Pathology in Heart Failure: Which Valves Can Be Fixed?
Date September 2007
Journal Heart Failure Clinics

Heart transplantation has evolved to become the gold standard treatment for patients who have symptoms of severe congestive heart failure associated with end-stage heart disease. From an epidemiologic perspective, this treatment is "trivial" because less than 2800 patients in the United States are offered transplantation because of limitations of age, comorbid conditions, and donor availability. New surgical strategies to manage patients who have severe end-stage heart disease have therefore evolved to cope with the donor shortage in heart transplantation and have included high-risk coronary artery revascularization, cardiomyoplasty, and high-risk valvular repair or replacement.

Title Flexible Versus Nonflexible Mitral Valve Rings for Congestive Heart Failure: Differential Durability of Repair.
Date August 2006
Journal Circulation

BACKGROUND: Surgical intervention is playing an increasingly important therapeutic role in congestive heart failure (CHF) patients with ischemia and dilated cardiomyopathy. Their mitral regurgitation (MR) is a result of left ventricular (LV) geometrical distortion. The optimal type of ring for CHF patients with geometric ventricular-based MR is unknown. This study reviewed the results of flexible versus nonflexible complete mitral valve rings in CHF patients with geometric mitral regurgitation. METHODS AND RESULTS: Using a prospectively maintained database, patients undergoing mitral valve reconstruction (MVR) with either a flexible or nonflexible complete ring were identified on the basis of preoperative ejection fraction (EF) < or = 30% and no primary mitral pathology. These 2 groups of CHF patients with severe geometric MR were then compared in terms of recurrent MR requiring reoperation. Between 1992 and 2004, 289 patients with EF < or = 30%, received an undersized complete mitral annuloplasty ring as their MVR procedure. Of these, 170 patients had a flexible complete ring. In follow-up, 16 "flexible" patients (9.4%) required a repeat procedure for significant recurrent geometric MR and CHF (10 replacements, 3 re-repairs, 3 transplants). The average time to reoperation was 2.4 years. In contrast, 119 patients with an EF < or = 30% received a MVR using an undersized nonflexible complete ring. Only 3 "non-flexible" patients required a repeat operation, MVR (1), and 2 patients required a transplant. The time to reoperation was 4.0 years. A significant difference in reoperation rates, for recurrent MR, between the 2 groups (P=0.012). There were no differences between groups, in terms of age, ring size used, preoperative EF, LV size, MR grade, or New York Heart Association class. CONCLUSIONS: Patients with CHF having a flexible ring have a higher likelihood of developing recurrent MR requiring reoperation. The use of a nonflexible ring appears to significantly reduce the need for repeat surgical procedures. Further refinement and development of nonflexible ring systems, aimed at LV restoration, deserve ongoing investigation.

Title The Evolution of the Concept of Brain Death.
Date January 2005
Journal Annals (royal College of Physicians and Surgeons of Canada)

The definition of death has taken many forms throughout history. Because of advances in critical care and developments in transplantation, a new definition of death has evolved over the past 30 years. The first accounts of brain death were published in 1959, in relative obscurity. They were only considered to be of academic interest. In the mid-1960s, advances in transplantation and the need for viable organs started debate about the use of "brain-dead" patients as organ donors. Conceptual advances by the ad hoc committee of the Harvard medical school and the use of angiography and the electroencephalogram both advanced and confused the issue. Acceptance by the medical community remained divided. During the 1970s, brain-stem death was proposed as the true definition of death by pioneers in the United States and Britain. In the 1980s, the clinical diagnosis of brain-stem death was officially accepted and many of the controversies subsided.

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