Timothy V Votapka

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This report describes a late, near-fatal rupture of a false aneurysm of the right internal mammary artery subsequent to coronary artery bypass grafting. The patient presented to us in shock due to hemorrhaging, 8 weeks after bypass surgery that had been complicated by sternal fracture, dehiscence, and infection. Emergent thoracotomy and suture ligation(More)
BACKGROUND Approximately 20 percent of all allogeneic blood transfusions are administered in connection with coronary artery bypass graft (CABG) operations. Transfusion practices vary across the country. The whole-body oxygen extraction ratio (O2 ER) reflects the adequacy of the patient's response to acute normovolemic anemia with an O2 ER of approximately(More)
UNLABELLED Hemodilution during cardiopulmonary bypass (CPB) is a primary risk factor for blood transfusion in cardiac surgical patients. Priming of the CPB circuit with the patients' own blood (retrograde autologous priming, RAP) is a technique used to limit hemodilution and reduce transfusion requirements. We designed this study to examine the impact of(More)
BACKGROUND Recent advances in technology as well as refinements of patient selection criteria have improved results of ventricular assistance in patients with end-stage heart disease. With a "normal" cardiac output and the resultant improvement in end-organ perfusion, some patients revert to normal or near normal physiology. Seven patients supported with(More)
OBJECTIVE To investigate the effect of a single, vital capacity breath (vital capacity maneuver [VCM]), administered at the end of cardiopulmonary bypass (CPB), on pulmonary gas exchange in patients undergoing coronary artery bypass graft surgery. DESIGN Prospective, randomized, double-blind study. SETTING University-affiliated hospital. PARTICIPANTS(More)
Atrioventricular valvular regurgitation is a known complication after cardiac transplantation. In this communication, we describe a case of progressively severe tricuspid insufficiency that ultimately necessitated tricuspid valve replacement. The patient has done well clinically since valve replacement, and a postoperative cardiac catheterization(More)
BACKGROUND The current health care environment mandates closer scrutiny of health care dollar allocation. To better understand the distribution of heart transplantation costs, we reviewed hospital and physician billing of patients who underwent orthotopic heart transplantation between August 1988 and September 1993. METHODS This study is a retrospective(More)
Over the past 30 years, there have been significant pharmacological and technological advances in the treatment of cardiogenic shock. Although most patients who develop cardiogenic shock can be effectively treated with conventional therapy, including inotropic and vasodilating drugs and intra-aortic balloon pumps, a significant number of patients have(More)
Saphenous vein coronary artery bypass grafting requires a proximal anastomosis of the vein to the aorta. A variety of techniques have been described to create the aortotomy. We have developed a four-sided knife (Xcision Scalpel; patent pending, Research Medical, Inc, Midvale, UT) that facilitates the creation of a more uniform circular aortotomy. The(More)