Research Departments & Organizations
Cardiac surgery involves use of cardiopulmonary bypass machine, which can be associated with an inflammatory response that may lead to injury to different organs after surgery. My research interest in this area has been to explore the relationship between different markers of inflammation and outcomes such as stroke, kidney injury, death, and heart injury.
I also have research interest in high blood pressure and its influence on surgical outcomes. Specifically, I have been exploring the relationship between pre-exsiting subtypes of hypertension such as systolic vs diastolic vs pulse pressure (difference between systolic and diastolic pressures) and complications after surgery involving the brain, the heart, and the kidneys.
Additional research interest include the anticoagulation during and after surgery
Specialized Terms: Perioperative Outcomes Research in Cardiac Surgery with Bypass; Atrial Fibrillation; Thrombocytopenia; Perioperative Hypertension; Pulse Pressure Hypertension; Acute Kidney Injury Hypercoagulability and surgical outcomes
Extensive Research Description
My recent research interest has greatly focused on hematology/inflammation and ischemic outcomes in the environment of open-heart surgery. As a junior faculty at Yale, I participated in a number of research pursuits addressing inflammatory responses during and after cardiopulmonary bypass that led to several publications. Specifically we addressed both humoral as well as cellular inflammatory responses in the context of cardiopulmonary bypass (CPB)- demonstrating significant associations between platelet activation and cardiac and cerebral events; monocyte activation and new-onset atrial fibrillation after surgery; and neutrophil activation and renal ischemia. In 1999, I joined the Department of Anesthesiology at Cornell, NY and continued pursuing my research interests in this area and in clinical outcomes after cardiac surgery. Examples include multicenter studies investigating the effects of complement inhibition and clinical outcomes; C-reactive protein and atrial fibrillation; leukocytosis and atrial fibrillation. I was a member of the notable Multicenter Study on Perioperative Ischemia (McSPI) research group for nearly 20 years. We have published several landmark works on epidemiology and outcomes in cardiac surgery that have led to significant changes in clinical practice. I am particularly interested in investigating thrombotic events and factors that exacerbate morbidity and mortality in the setting of cardiopulmonary bypass procedures. My other research interest is in the area of hypertension and perioperative outcomes. We were the first to publish on the importance of pulse pressure on ischemic outcomes such as acute kidney injury, mortality and on stroke. I continue to pursue research in this area in other perioperative settings such as in non-cardiac surgery. lastly, I've been involved in research on postoperative thrombocytopenia- demonstrating its relation to acute kidney injury and mortality.
Pulse Pressure and non cardiac surgery
Postoperative Thrombocytopenia and Acute Kidney Injury and Mortality after Heart Surgery in Adults
Postoperative Thrombocytopenia and Acute Kidney Injury after Heart Surgery in Pediatric Cardiac Surgery
Antithrombin III deficiency and Thrombotic events in patients undergoing cardiac surgery
Postoperative hypercoagulable state and thrombotic events in the setting of left ventricular device implantation
|Diseases of the Kidney & Urinary Tract||The NGAL Test™ As An Aid in the Risk Assessment for AKI Stage II and III in an Intensive Care Population|
|Diseases of the Cardiovascular System||Sugammadex and Decreased Time to Extubation|
|Diseases of the Cardiovascular System||Safety and Efficacy of Preoperative Antithrombin Supplementation in Patients Undergoing High-Risk Cardiopulmonary Bypass|
|Diseases of the Cardiovascular System||Transfusion Requirements in Cardiac Surgery III (TRICS-III)|
- Patterns of Perioperative ACEI Therapy in Cardiac Surgery and Associated Morbidity and Mortality Drenger B, Fontes ML, Miao Y, Gozal Y, Aronson S, Dietzel C, Mangano DT, for the Multicenter Study of Perioperative Ischemia (McSPI) Research Group and the Ischemia Research and Education Foundation (IREF) Investigators. Patterns of Perioperative ACEI Therapy in Cardiac Surgery and Associated Morbidity and Mortality. Circulation. 2012 Jul;126(3):261-269
- Arterial Hyperoxia During Cardiopulmonary Bypass and Postoperative Cognitive Dysfunction Fontes MT, McDonagh DL, Phillips-Bute B, Welsby IJ, Podgoreanu MV, Fontes ML, Stafford-Smith M, Newman MF, Mathew JP; for the Neurologic Outcome Research Group (NORG) of the Duke Heart Center. Arterial Hyperoxia During Cardiopulmonary Bypass and Postoperative Cognitive Dysfunction. J Cardiothorac Vasc Anesth. 2013 Aug 22. pii: S1053-0770(13)00178-X.
- Pulse pressure and long-term survival following CABG surgery Nikolov NM, Fontes ML, White WD, Aronson S, Bar-Yosef S, Gaca JG, Podgoreanu MV, Stafford-Smith M, Newman MF, Mathew JP. Pulse pressure and long-term survival following CABG surgery. Anesth Analg 2010; 110:335-340
- Pulse pressure and risk of adverse outcome in coronary bypass surgery Fontes ML, Aronson S, Mathew JP, Miao Y, Drenger B, Barash PG, Mangano, DT, Multicenter Study of Perioperative Ischemia (McSPI) Research Group, and Ischemia Research and Education Foundation (IREF) Investigators. Pulse pressure and risk of adverse outcome in coronary bypass surgery. Anesth Analg 2008; 107:1122-1129
- Risk Index for Perioperative Renal Dysfunction/Failure: Critical Dependence on Pulse Pressure Hypertension Aronson S, Fontes ML, Miao Y, Mangano DT, for the Investigators of the Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation. Risk Index for Perioperative Renal Dysfunction/Failure: Critical Dependence on Pulse Pressure Hypertension. Circulation, 2007;115:733-742