Cardiac Engineering

About

Welcome to Cardiac Engineering
State of the Art Quantitative Cardiovascular Research and Design

Specializing in cardiac and cardiovascular engineering, research design, analysis, education and clinical trials.

Operating Room Fire Safety by Art Wallace MD PhD: Guidelines for creating and maintaining a fire-safe operating room environment

October 2010 Issue of Anesthesiology: Association of the Pattern of Use of Perioperative [beta]-Blockade and Postoperative Mortality In the news: NPR | HealthCanal | More

Control of Blood Pressure and Vascular Tone: Hemodynamics Made Incredibly Simple

 

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ECOM Endotrachial Cardiac Output Monitor now available. 

 

 

Pacemakers for Anesthesiologists Made Incredibly Simple

Simple, Inexpensive, Instant, JCAHO Compliant Drug Labels for Anesthesia

Beta-Blocker & Clonidine (BBAC) Protocol online course

In the News: Cardiac Engineering in the media

Operating room Fire Safety

Watch the Video! YouTube | Vimeo | at VA Medical Centers (only)

Operating room fires can be devastating to patients and staff. The operating room environment contains the three requirements for fire: fuel, oxygen, and an ignition source. Surgical drapes, prep solutions, sponges,, and disposable plastic equipment can all can ignite in a high oxygen environment with devastating consequences. Over the last two years we have had two operating room fires. In the first, use of electrocautery in the chest cavity in a high oxygen environment caused ignition of a chest tube. In the second case, use of electrocautery in the chest caused ignition of a dry sponge.

It is difficult for staff to recognize when there is a high oxygen environment in some situations because oxygen may leak out of the ventilator circuit or lung. In a high oxygen environment, electrocautery can ignite normally safe materials creating devastatingly rapid fires. We recommend that all cases have an accurate assessment of fire risk. It is SF VAMC policy to complete the fire risk assessment sheet and follow the guidelines. Using carbon dioxide flush during thoracic or cardiac cases may reduce fire risk.

 

Download the Operating Room Pre-Operative Briefing Sheet (doc and pdf) -

 

Image 1 - Note the tube on the left hand side of the screen with carbon dioxide flush. This flush at 5 liters/minute using a filtered tube reduces the risk of a high oxygen environment and the risk of fire.

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Image 2 - Electrocautery used to dissect out the left internal mammary artery prior to coronary artery bypass surgery. Note the tube on the left hand side of the screen with carbon dioxide flush. This flush at 5 liters/minute using a filtered tube reduces the risk of a high oxygen environment and the risk of fire.

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We would like to thank the technical support of SF VAMC Biomedical Engineering and SF VAMC Biomedical Photography. No one was harmed in the production of the photographs or video. However, ignoring the points of the video may lead to harm.

Cardiac Engineering in the News

Cardiac Engineering in the News
State of the Art Quantitative Cardiovascular Research and Design

Specializing in cardiac and cardiovascular engineering, research design, analysis, education and clinical trials.

9/29/10: Cheap Pill May Save Lives When Given Before Surgery by Richard Knox, NPR Science News

9/29/10: Beta blockers reduce risk of death after surgery, study finds HealthCanal.com, InSciences.org, HealthOrbit Canada

9/29/10: Study: Beta Blockers Reduce Post-Operative Mortality Rates by Rachel Fields, Beckers' ASC Review

9/27/10: Perioperative Beta Blockade Reduces Short- and Long-Term Mortality After Surgery in Patients at Risk for Cardiac Events Newswise

9/05: New website teaches doctors how to prevent deaths of at-risk patients (UCSF press release about BBAC site)

2/05: ACC/AHA Beta-Blocker Guidelines Followed Poorly By Physicians in Anesthesiology News (features CardiacEngineering.com website)

8/2/04: Perioperative clonidine lowers CAD mortality in InCirculation.net

7/29/04: Anti-hypertensive drug clonidine before non-cardiac surgery reduces risk of complications due to inadequate blood flow to the heart in Medical Study News

7/28/04: Clonidine reduces post surgical risk of cardiovascular death in non-cardiac surgery ran in Medical News Today (U.K.), and Innovations Report (Germany), 7/29 in Merck Medicus, Medscape

7/27/04: Reuters article Drug Cuts Death Risk for Heart Patients ran in Forbes.com Health, HealthCentral.com, the Atlantic Journal Constitution, HealthDay News, Yahoo! Health

7/27/04: Clonidine helps when given before non-cardiac surgery ran on Dr.Koop.com

7/27/04: Clonidine reduces post-surgical risk of cardiovascular death in non-cardiac surgery UCSF Press Release

4/12/02: New Device Measures Heart’s Pumping Ability from Inside Windpipe from VHA Highlights

1/16/01: Myocardial ischemia reduced with clonidine from The Medical Post

8/95: "Heart-friendly Surgery" in Reader's Digest and Consumers Digest

See Publications for publications by Dr. Wallace.

 

JCAHO Compliant Drug Labels for Anesthesia

JCAHO Compliant Drug Labels for Anesthesia

by Arthur Wallace, M.D., Ph.D. and Alfred Wallace

Drug substitution errors are common and can lead to significant morbidity and mortality. Improved drug labeling has been identified by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) as a way to reduce drug errors and reduce risk. There is a new JCAHO mandate that all syringes must be labeled with the drug name, concentration, the date and time, and the person preparing the medication. This labeling takes time and it is difficult to write legibly on the label on a syringe. The curved surface of the syringe and the required small print is difficult and time consuming. Compliance with this new mandate is difficult. We developed a simple, inexpensive, rapid, easily customizable system of labeling that fulfils the JCAHO drug labeling requirements.

The system consists of a set of Microsoft Word (Microsoft Corp, Redmond WA) files formatted to print on Avery Laser and Inkjet White Address Labels (Avery No. 5167) (Avery Office Products, Brea, CA) (0.5 inch by 1.75 inch labels in 100 label per sheet). We use the Skilcraft generic equivalent labels to save cost. The labels cost $25.80 per package of 100 sheets (8,000 individual labels). The Avery version costs $43.27 for 100 sheets. Each custom file has the drug name, drug concentration, date, time, and clinician’s name. The current date and time are automatically filled in by Microsoft word on printing. Individual clinicians can modify the sheet to have the set of most commonly used drugs. We have one set that is used most commonly for non-cardiac cases, and one set that is used for cardiac cases, but the sheets can be modified easily by the clinician for the specific drugs they use. One advantage of the system is that all clinicians prepare drugs in the same concentration in the same syringe size because the labeling mandates the concentrations.

The labels are printed in color on a Xerox Phaser 8500/N color laser printer. Anesthesia technicians print the files for the clinicians working each day at 6:30 am. They then put the sheet of labels on the anesthesia cart in the OR for each clinician for the day. The sheets have enough labels for at least four cases per room. At the end of the day the sheets are discarded and a new sheet prepared the next morning. The clinicians prepare drugs using the label when they set up for the day. The system is simple, inexpensive, easily customizable, and fits all JCAHO requirements.

Instructions for use:

1. Download the MS Word file here --> Art Wallace Drug Labels 8167 V5. 

2. Open the file in Microsoft Word, if it does not open automatically.

3. On the EDIT menu select FIND and REPLACE

4. In the 'Find What' box, type <Art Wallace, M.D.> and in the 'Replace With' box type < your name, title>.

5. Click Replace All. It should replace 80 names on the 80 labels.

6. Save the file on your Desktop or somewhere you will easily find it.

7. On the morning of surgery, open the file and print it. We have a work room technician print everyone's labels at once and then place them on the clinician’s cart in the OR. The date and time will be updated automatically to the current date and time on your computer.

Additional Information:

1. We place the files on a network drive that is accessible to all. The clinicians can then customize the files to their needs and preferences. 

2. We try to have all the same colors for classes of drugs. We turned down the color intensity on the FORMAT, BORDERS and SHADING, SHADING, MORE COLORS, CUSTOM using the triangular slider on the right side to cut the cost of the color printing.

3. We try to have all drugs mixed with the standard concentrations and volumes to avoid confusion.

Coming soon! Individual labels and batch printed sheets can be printed using a Visual Basic Program (Microsoft Corp, Redmond WA) that we have developed. It prints the label sheets for the clinicians working on that day from the database. The program also prints single drug labels on the Dymo Labelwriter 400 printer (Dymo Corporation, Stamford, CT) which can be placed in each operating room for printing a single label if it is needed.

People

Staff

Art Wallace, M.D. Ph.D. Professor of Anesthesiology & Perioperative Care, University of California San Francisco (UCSF) Curriculum Vitae

Steven Takemoto, Ph.D. Associate Professor of Anesthesiology & Perioperative Care, University of California San Francisco (UCSF)

Mark Ratcliffe, M.D. Professor in Residence, Vice Chair, UCSF; Chief, Surgical Service, San Francisco VA

Julius Guccione, Ph.D Associate Professor, Co-Director, Cardiac Biomechanics Lab

Art Wallace, M.D., Ph.D.

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Specialties:

Cardiac Physiology & Function: Over the last 30 years I have investigated the etiology and treatment of perioperative cardiac morbidity. I have worked and published on numerous human and animal studies investigating the natural history, therapy, and prevention of cardiac morbidity

Biomedical Engineering: Design, development, and testing of devices for use in anesthesia and cardiac surgery.

Clinical Research: State-of-the-art design, implementation and data analysis for clinical research. Custom algorithm development and implementation.

Recent and On-going Research Projects:

  • ECOM monitor
  • AVx Medical and AVD System
  • L-ARG CABG Study
  • Clonidine Study
  • IMST (In-vivo Myocardial Stiffness Transducer) Study
  • Aneurysm Study
  • Myocardial Mechanics: Epicardial, Myocardial, and Infarct: Diastolic Mechanics
  • Non-Invasive Monitoring
  • Thoracoscopic CABG Study
  • EPI I and II Study
  • Mivazerol Study
  • Cytokine Study
  • Draflazine Study
  • Atenolol Study
  • Warm Cardioplegia Study
  • Acoustic Quantification Study
Research

Research Design

The cardiac engineering group has experience with the development, design, conduct, and analysis of clinical and laboratory research. We are able to produce and care for chronically instrumented large animals. We have a chronic model of left ventricular infarction and left ventricular aneurysm and subsequent repair. We have designed and conducted studies for minimally invasive coronary artery bypass surgery, minimally invasive aneurysm repair, and cardiac monitor development. We have extensive experience with flow probes, vascular occluders, multi-dimensional digital sonomicrometry, intra-vascular and endotracheal impedance measurements, volume conductance catheters, cardiopulmonary bypass, finite element analysis, MRI scanning, cardiovascular monitor development and bi-axial tissue mechanics.

We also are able to design and conduct small, medium, and large (multi-centered) clinical perioperative cardiovascular research.

Data Analysis
We have extensive experience with computerized data acquisition, signal processing, and algorithm development.

 

Research & Development
  • Clinical Trials
  • PTSD
  • Smoking Cessation
  • Acadesine 
  • Draflazine
  • Mivazerol
  • Warm Cardioplegia
  • EPI-1
  • EPI-2
  • Atenolol
  • Clonidine
  • L-Arginine
  • ECOM
  • Hearten
  • AVX 

 

Biomedical Engineering
  • Development of Techniques for Minimally Invasive Cardiac Surgery
  • Cardiovascular Monitor Design and Development
  • Quantitative Cardiovascular Physiology
  • Finite Element Analysis
  • Signal Processing and Algorithm Design

 

Device Development

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ECOM is a minimally invasive cardiac output monitor designed and tested in the Cardiac Engineering lab. It has received FDA 510K approval and is marketed by Conmed

Downloads
ECOM Brochure
Abstract of ECOM device in Anesthesia & Analgesia 2008;106
ECOM Transducer Set-Up Guide

Literature: "ECOM: Endotracheal Cardiac Output Monitor" Wallace A, Salahieh A, Lawrence A, Spector K, Alonso D. Anesthesiology 2000;92:1-12. This study represents four years of physics and computer science; electrical, mechanical, and biomedical engineering; as well as chronic animal and human testing for the development of a new clinical device for the measurement of cardiac output. The ECOM device has received FDA 510K approval and is now being marketed.

ECOM Monitor Images

The ECOM device is a minimally invasive cardiac output monitordesigned and tested in the Cardiac Engineering lab. It has received FDA 510K approval and is beginning to be marketed by Conmed.

 

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The ECOM development project required physics, mechanical engineering, electrical engineering, manufacturing engineering, software design, time and frequency domain signal processing, artificial intelligence, adaptive filters, fuzzy logic, algorithm design, applied math, chronic animal experimentation, and clinical trial design and execution. We produced more than 100 chronically instrumented pigs that survived for 30 to 90 days. We designed, manufactured, and tested 33 separate device designs. We have designed, built, and tested five separate versions of the measuring electronics each with high speed computerized data acquisition. We have tested numerous different algorithm designs. The design and the animal work has been published in Anesthesiology. We then conducted a 330 patient multicentered clinical trial in patients undergoing cardiac surgery. The system have several patents and is FDA 510K approved for clinical use. 

 

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AVD system: We have completed a 103 patient clinical trial of the AVD system.

Hearten: The Hearten Project was a radiofrequency device designed to allow treatment of left ventricular aneurysms without use of

cardiopulmonary bypass. We tested the system in an animal model of heart failure and then assisted in clinical testing in patients undergoing CABG surgery.

Protocols

Beta-Blocker & Clonidine (BBAC) Protocol Course Online!
Beta Blocker Protocol
Perioperative Cardiovascular Evaluation for Noncardiac Surgery fromThe National Guideline Clearinghouse

Supporting References

  • The Effect of Bisoprolol on Perioperative Mortality and Myocardial Infarction in High-Risk Patients Undergoing Vascular Surgery. Poldermans et al., NEJM Volume 341:1789-1794, Number 24, December 9, 1999 (NEJM subscribers click here for full .pdf
  • Effect of Atenolol on Mortality and Cardiovascular Morbidity after Noncardiac Surgery.
    Mangano et al., NEJM Volume 335:1713-1721, Number 23, December 5, 1996. (NEJM subscribers click here for full .pdf)
  • Prophylactic Atenolol Reduces Postoperative Myocardial Ischemia.
    Wallace et al., Anesthesiology: Volume 88(1) January 1998 pp 7-17 (Anesthesiology subscribers click here for full article)

 

 

 

 

 

Education

General

Operating Room Fire Safety by Art Wallace MD PhD: Guidelines for creating and maintaining a fire-safe operating room environment (Link to videos and briefing sheets)
Control of Blood Pressure and Vascular Tone: Hemodynamics Made Incredibly Simple (.pdf) by Art Wallace MD PhD
Pacemakers for Anesthesiologists Made Incredibly Simple (.pdf) by Art Wallace MD PhD
Simple, Inexpensive, Instant, JCAHO Compliant Drug Labels for Anesthesia by Art Wallace MD PhD & Alfred Wallace
Management of Wound Hematoma following Neck Surgery 
Cardiopulmonary bypass A color diagram detailing the process. by Art Wallace MD PhD (This document can also be downloaded as a MS Word file (1.1 MB) here.
Beta Blocker and Clonidine Protocol (B.B.A.C.) online course by Art Wallace, MD PhD & Alfia Wallace
The Anesthesia Resident's On-Call Guide by Salim D. Islam, MD: An Introduction to Being On-Call
The 10 Pyxis Commandments by Eric Huczko, MD PhD: Thou shalt not commit Pyxis sins!
GASNet Anesthesia Educational Resources founded by Keith Ruskin MD: Pioneering anesthesia education website which includes tutorials on Anesthesia for the Intoxicated Patient, Hemodynamic Optimization, Transesophageal echocardiography and more.

Cardiac Anesthesia

Cardiac Anesthesia Made Ridiculously Simple by Art Wallace, MD PhD: Introduction to Adult Cardiac Anesthesiology for Residents (i.e. Read this document before your VA Rotation.) by Art Wallace 
Anesthesia for Minimally Invasive Cardiac Surgery by Art Wallace, MD PhD: Made Ridiculously Simple Introduction to Minimally Invasive Coronary Artery Bypass Surgery for Residents (i.e. Read this document before your first MID CABG at the VA.)

Cardiac Surgery

Cardiac Surgery Made Ridiculously Simple by Art Wallace, MD PhD: Cardiac surgery is a dangerous and complex field of medicine with significant morbidity and mortality. This document attempts to describe the bare bones sequence for cardiac surgical care for adult CABG and VALVE procedures with specific recommendations. It is not all inclusive or definitive but it is the minimal critical requirements.

Publications

Peer Reviewed Journal Articles

Cavalieri R.R., Gavin L.A, Wallace A., Hammond M.E., and Cruse K.  Serum Thyroxine, Free T4, Triiodothronine, and Reverse-T3 in Diphenylhydantoin-Treated Patients.  Metabolism  28(11): 1160–1165, 1979

Skiolderbrand C.G., Lipton M.L., Redington R.W., Beringer W.H., Wallace A., and Carlsson E. Myocardial Infarction in Dogs, Demonstrated by Nonenhanced Computer Tomography.  Acta Radiol. (Stockh)  22(1): 1–8, 1981.

Brunner M.J., Wallace A., and MacAnespie C.L.  Interaction of Carotid Chemoreceptor and Baroreceptor Reflexes in Anesthetized Dogs.  Am. J. Physiol.  254 (Regulatory Integrative Comp. Physiol. 23): R1–10, 1988.

Wallace A.W., Tunin C.M., and Shoukas A.A.  Effects of Vasopressin on Pulmonary and Systemic Vascular Mechanics.  Am. J. Physiol.  257 (Heart Circ. Physiol. 26): H1228–1234, 1989.

Wallace A.W.  and Shoukas A.A.  Three Neuron Model of Central Baroreceptor Interaction.  IEEE-Biomedical Engineering Symposium, 1987.

Wallace A.  Do Deficiencies of Endothelial Derived Relaxing Factor Contribute to Myocardial Stunning?  J. Card. Surg.  8[Suppl]: 325–328, 1993.

Wallace A., Lam H.W., Nosé P.S., Bellows W., and the Multicenter Study of Perioperative Ischemia (McSPI) Research Group.  Changes in Systolic and Diastolic Ventricular Function with Cold Cardioplegic Arrest in Man.  J. Cardiac Surg.  9[Suppl]: 497–502, 1994.

Wallace A., Lam H.W., Mangano D.T., and the Multicenter Study of Perioperative Ischemia (McSPI) Research Group.  Linearity, Load Dependence, and Hysteresis of Left Ventricular Contractility Indices in Man.  J. Cardiac Surg.  10[Suppl]: 460–467, 1995.

Mangano D.T., Layug E.L., Wallace A., Tateo I., and the Multicenter Study of Perioperative Ischemia (McSPI) Research Group.  Effect of Atenolol on Mortality and Cardiovascular Morbidity after Noncardiac Surgery.  N. Engl. J. Med.  335(23): 1713–1720, 1996.

Wallace A., Mangano D.T., and the Multicenter Study of Perioperative Ischemia (McSPI) Research Group.  Use of Beta-blockade to Prevent Mortality after Non-cardiac Surgery.  West J. Med.  166(3): 203–204, 1997.

Wallace A., Layug B., Tateo I., Li J., Hollenberg M., Browner W., Miller D., Mangano D.T., and the Multicenter Study of Perioperative Ischemia (McSPI) Research Group.  Prophylactic Atenolol Reduces Postoperative Myocardial Ischemia.  Anesthesiology  88(1): 7–17, 1998.

Ratcliffe M., Hong J., Salahieh A., Ruch S., and Wallace A.  The Effect of Ventricular Volume Reduction Surgery in the Dilated Poorly Contractile Left Ventricle: A Simple Finite Element Analysis.  J. Thorac. Cardiovasc. Surg.  116: 4 566–577, 1998.

Wallace A., Ratcliffe M.B., Galindez D., and Kong J.S.  L-Arginine Infusion Dilates Coronary Vasculature in Patients Undergoing Coronary Bypass Surgery.  Anesthesiology  90(6): 1577–1586 , 1999.

Wallace A., Salahieh A., Lawrence A., Spector K., and Alonso D.  Endotracheal Cardiac Output Monitor.  Anesthesiology  92(1): 178–189, 2000.

Ratcliffe M., Wallace A., Salahieh A., Hong J., Ruch S., and Hall T.  Ventricular Volume, Chamber Stiffness, and Function after Anteroapical Aneurysm Plication in the Sheep.  J. Thorac. Cardiovasc. Surg.  199: 115–124, 2000.

Ratcliffe M.B., Hong J., Salahieh A., and Wallace A.W.  The Effect Of Diastolic Stiffness On Ventricular Function After Partial Ventriculectomy: A Finite Element Simulation.  Journal of the American Society of Artificial Internal Organs (ASAIO J) 46: 111–116, 2000.

Wallace A.W. and Tom W.  L-Arginine and PDE Inhibitors in Vasodilation of the Porcine Internal Mammary Artery.  Anesth. Analg.  90: 840–846, 2000.

Wallace A.W., Ratcliffe M.B., Nosé P., Bellows W., Moores W., Flachsbart K., McEnany M.T., and Mangano D.T.  The Effect of Induction and Reperfusion with Warm Substrate Enriched Cardioplegia on Ventricular Function.  Ann. Thorac. Surg.  70: 1301–1307, 2000.

Ratcliffe M.B., Wallace A.W., Teerlink J. R., Hong J., Salahieh A., and Sung S.H.  Radio Frequency Heating of Chronic Ovine Infarct Leads to Sustained Infarct Area and Ventricular Volume Reduction.  J. Thorac. Cardiovasc. Surg.  119(6): 1194–1204, 2000.

Quarterman R.L., Wallace A., and Ratcliffe M.B. Cardiopulmonary Complications Following Cardiac Surgery.  Current Treatment Options in Cardiovascular Medicine.  3(2): 125–137, 2001.

Guccione J.M., Moonly S.M., Wallace A.W., and Ratcliffe M.B. Residual stress produced by ventricular volume reduction surgery has little effect on ventricular function and mechanics: a finite element model study.  J. Thorac. Cardiovasc. Surg.  122(3): 592–599, 2001.

Victal O.A., Teerlink J.R., Gaxiola E., Wallace A.W., Najar S., Camacho D.H., Gutierrez A., Herrera G., Zuniga G., Mercado-Rios F., Ratcliffe M.B. Left Ventricular Volume Reduction by Radiofrequency Heating of Chronic Myocardial Infarction in Patients with Congestive Heart Failure.  Circulation  105(11): 1317–1322, 2002.

Quarterman R.L., Moonly S., Wallace A.W., Guccione J., and Ratcliffe M.B. A finite element model of left ventricular cellular transplantation in dilated cardiomyopathy.  Journal of the American Society of Artificial Internal Organs (ASAIO J)  48(5): 508–513, 2002.

Wallace A. Editorial View: Is it Time to Get on the Fast Track or Stay on the Slow Track? Anesthesiology  99(774): 001, 2003.

Guccione J., Salahieh A., Moonly S., Kortsmit J., Wallace A.W., and Ratcliffe M. B.  Myosplint(R) Decreases Wall Stress Without Depressing Function in the Failing Heart:  A Finite Element Model Study. Ann Thorac Surg. 2003 Oct;76(4):1171-80.

Wallace A.W., Galindez D., Salahieh A., Layug B., Felipe EL., Haratonik K., Boisvert D. and Kardatzke D.  Effect of Clonidine on Cardiovascular Morbidity and Mortality after Non-Cardiac Surgery.  (In press Anesthesiology, 2004.)

Dang A.B.C, Guccione J.M., Zhang P., Wallace A.W., Gorman R.C., Gorman J.H., and Ratcliffe M.B. Akinetic myocardial infarcts must contain contracting myocytes: finite-element model study. Am J Physiol Heart Circ Physiol. 2005 Apr;288(4):H1844-50. Epub 2004 Dec 16.

Walker JC, Ratcliffe MB, Zhang P, Wallace AW, Fata B, Hsu EW, Saloner DA, Guccione JM. MRI-based finite element analysis of left ventricular aneurysm. Am J Physiol Heart Circ Physiol. 2005 Mar 18.

Walker JC, Guccione JM, Jiang Y, Zhang P, Wallace AW, Hsu EW, Ratcliffe MB. Helical myofiber orientation after myocardial infarction and left ventricular surgical restoration in sheep. J Thorac Cardiovasc Surg. 2005 Feb;129(2):382-90.

Dang AB, Guccione JM, Zhang P, Wallace AW, Gorman RC, Gorman JH 3rd, Ratcliffe MB. Effect of ventricular size and patch stiffness in surgical anterior ventricular restoration: a finite element model study. Ann Thorac Surg. 2005 Jan;79(1):185-93.

Chen JC, Rollins SA, Shernan SK, Boyce S, Allen K, Wallace A, Malloy KJ, Eng JS, Colman RW, Fitch JC; Pexelizumab Study Investigators. Pharmacologic C5-complement suppression reduces blood loss during on-pump cardiac surgery. J Card Surg. 2005 Jan-Feb;20(1):35-41.

Zeng, P. Guccione, J.M. Wallace, A.W. Ratcliffe, M.B, Left ventricular volume and function after endoventricular patch plasty for dyskinetic anteroapical left ventricular aneurysm in sheep Journal of Thoracic and Cardiovascular Surgery (in press).

Guccione JM, Zeng, P., Wallace A.W., Ratcliffe, M.B. The Effect Of Anteroapical Aneurysm Plication On End-Systolic Three-Dimensional Strain In The Sheep: An MRI Tagging Study (V), Journal of Thoracic and Cardiovascular Surgery (in Press)

Wallace A, Implementation of a Program for Perioperative Cardiac Risk Reduction Therapy (PCRRT) Using Beta Blockers and Clonidine (BBAC). CSA Bulletin Vol. 54 No. 3 July-September 2005.

Schecter, W.P., Farmer, D. Horn, J.K., Peitrocola, D.M., Wallace, A.W. Peri-Operative Pain Management – Special Considerations: Audiovisual Distraction, Geriatrics, Pediatrics, and Pregnancy. Journal of the American College of Surgeons. Journal American College of Surgeons 201:4 612-618, 2005.

Julius M. Guccione, Joseph C. Walker, Jeremy R. Beitler, Scott M. Moonly, Peng Zhang, Michael A. Guttman, Cengizhan Ozturk, Elliot R. McVeigh, Arthur W. Wallace, David A. Saloner and Mark B. Ratcliffe. The effect of anteroapical aneurysm plication on end-systolic three-dimensional strain in the sheep: A magnetic resonance imaging tagging study The Journal of Thoracic and Cardiovascular Surgery, Volume 131, Issue 3, March 2006, Page 579

Arthur Wallace. Clonidine and modification of perioperative outcome. Current Opinion in Anesthesiology. 2006 Aug;19(4):411-7

Zhang P, Guccione JM, Nicholas SI, Walker JC, Crawford PC, Shamal A, Acevedo-Bolton G, Guttman MA, Ozturk C, McVeigh ER, Saloner DA, Wallace AW, Ratcliffe MB Endoventricular patch plasty for dyskinetic anteroapical left ventricular aneurysm increases systolic circumferential shortening in sheep. 2007 Oct;134(4):1017-24

Walker JC, Ratcliffe MB, Zhang P, Wallace AW, Hsu EW, Saloner DA, Guccione JM. Magnetic resonance imaging-based finite element stress analysis after linear repair of left ventricular aneurysm. J Thorac Cardiovasc Surg. 2008 May;135(5):1094-102, 1102.e1-2.

Sun K, Stander N, Jhun CS, Zhang Z, Suzuki T, Wang GY, Saeed M, Wallace AW, Tseng EE, Baker AJ, Saloner D, Einstein DR, Ratcliffe MB, Guccione JM. A Computationally Efficient Formal Optimization of Regional Myocardial Contractility in a Sheep with Left Ventricular Aneurysm. J Biomech Eng. 2009 Nov 1;131(11):111001.

Abstracts

Wallace A.W. and Greene A.S.  Physiological Data Acquisition and Analysis System for the IBM-XT.  Scientific Computing and Automation Conference and Exposition; May 1985.

Wallace A.W. and Shoukas A.  Interaction of Pulmonary Artery, Pulmonary Vein, and Carotid Sinus Baroreceptors in the Open Loop Steady State Control of Resistance in the Dog. American Physiological Society; October 1985.

Brunner M.J., Hatem S.F., Wallace A.W., and Greene A.S.  The Effect of PEEP on Cardiovascular and Respiratory Baroreflex Response. American Physiological Society; October 1985.

Brunner M.J., Wallace A., and Hatem S.  Carotid Sinus Baroreflex Gain in Hypertension. American Physiological Society; April 1986.

Nosé P., Wallace A., Bellows W., Moores W., McEnany T., Flashbart K., Mangano D., and Leung J. The Effects of Warm Blood Cardioplegia During Induction and Termination of Cardiopulmonary Bypass.  Society of Cardiovascular Anesthesiologists;  March 1993.

Wallace A., Bellows W., Moores W., Flashbart K., Nosé P., Mangano D., and the Multicenter Study of Perioperative Ischemia (McSPI) Research Group.  Left Ventricular-Pressure Dimension Relationships Derived from Invasive and Non-Invasive Methods in Man. Anesth. Analg.  78(2S): S462, 1994.

Wallace A., Nosé P., Bellows W., Moores W., Flachsbart K., McEnany M.T., Mangano D., and the Multicenter Study of Perioperative Ischemia (McSPI) Research Group.  Substrate Enriched, Warm Induction, Warm Reperfusion Cardioplegia Improves Left Ventricular Systolic Function Post Bypass in Man. Anesth. Analg.  78(2S): S463, 1994.

Wallace A., Layug E., Browner W., Hollenberg M., Jain U., Tateo I., Mangano D., and the Multicenter Study of Perioperative Ischemia (McSPI) Research Group.  Randomized, Double Blinded, Placebo Controlled Trial of Atenolol for the Prevention of Perioperative Myocardial Ischemia in High Risk Patients Scheduled for Non Cardiac Surgery.  Anesthesiology  81(3A): A99, 1994.

Wallace A., Bellows W., Smith M., Mangano D., and the Multicenter Study of Perioperative Ischemia (McSPI) Research Group.  Comparison of Clinical and Invasive Measures of Left Ventricular Contractility in Man.  Anesth. Analg.  80(2S): S535, 1995.

Mangano D.T., Wallace A., Layug E., Tateo I., Browner W., and the Multicenter Study of Perioperative Ischemia (McSPI) Research Group.  Effects of Perioperative Beta Blockade on Long-term Outcomes in High Risk Patients Undergoing Noncardiac Surgery.  Anesthesiology  85(3A): A113, 1996.

Effron H., Zecca A.C., Cason B.A., and Wallace A.  Identification of Abnormal Clinical Findings in an Anesthesia Preoperative Clinic.  American Association of Nurse Anesthetists; 1997.

Wallace A.W., Kong J.S., Galindez D., Ratcliffe M.B., and Mangano D.T.  L-Arginine Infusion Selectively Vasodilates Coronary Vasculature in Patients Undergoing Cardiac Bypass Surgery.  Anesth. Analg.  86(2S): S114, 1998.

Wallace A., Salahieh A., Lawrence A., and Spector K.  ECOM: Endotracheal Cardiac Output Monitor.  Anesthesiology  89(3A): A908, 1998.

Ratcliffe M.B., Hong J., Wallace A.W., and Salahieh A.  The Effect of Diastolic Stiffness on Ventricular Function after Partial Ventriculectomy: A Finite Element Simulation.  Journal of American Society of Artificial Internal Organs  45: 196, 1999.

Waclhwani S., Ratcliffe M.B., Wallace A.W., Salahieh A., Hong J., Sung S., and Teerlink J.  A New Radiofrequency Heating Device Shrinks Chronic Left Ventricular Myocardial Infarct Area.  Journal of American Society of Artificial Internal Organs  45: 209, 1999.

Ratcliffe M.B., Wallace A.W., Teerlink J.R., Hong J., Salahieh A., and Sung S.  Intraoperative Radiofrequency Heating of Chronic Ovine Myocardial Infarct Causes Infarct Shrinkage and Left Ventricular Volume Reduction.  Western Thoracic Surgery Association; 1999.

Ratcliffe M.B., Wallace A.W., Teerlink J.R., Hong J., Salahieh A., and Sung S-H.  Radiofrequency Heating of Chronic Ovine Myocardial Infarction Leads to Sustained Reductions in Infarct Size and Left Ventricular Volume.  Circulation  100 (18, Suppl I): I‑514 (No. 2710), 1999.

Victal-Adame O., Sedano G.Z., Gaxiola E., Zamora A.G., Teerlink J.R, Wallace A.W., and Ratcliffe M.B.  Left Ventricular Volume Reduction by Radiofrequency Heating of Chronic Myocardial Infarction in Patients with Congestive Heart Failure: Results of a Pilot Safety Trial. Presentation at the annual meeting of the Heart Failure Society, September 2000.

Victal O., Najar S., Teerlink J.R., Camacho D.H., Gutierrez A., Herrera G., Zuñiga G., Mercado-Rios F., Wallace A.W., and Ratcliffe M.B.  Radiofrequency Heating of Chronic Myocardial Infarction in Patients with Congestive Heart Failure Results in Sustained Left Ventricular Volume Reduction.  Circulation  102 (18, Suppl II): II-503 (No. 2444), 2000.

Wallace A.W., Galindez D., Layug B., Boisvert D., Mangano D., and the Multicenter Study of Perioperative Ischemia (McSPI) Research Group. Prophylactic Clonidine Reduces the Incidence of Perioperative Myocardial Ischemia. Poster presentation at the annual conference of the American Society of Anesthesiologists, October 2000, and published in Anesthesiology  93: A257, 2000.

Wallace A.W. and Salahieh A.  Conductivity Dilution Algorithm Provides a Method of Calculating Cardiac Output from Endotracheal Cardiac Output Monitor (ECOM). American Society of Anesthesiology; 2000.

Tom W.L., Salahieh A., and Wallace A.W.  Hemodynamic Effects of Co-administration of L‑arginine and Sildenafil (Viagra) in Awake Volunteers. Poster presentation at the annual conference of the American Society of Anesthesiologists, October 2001, and published in Anesthesiology  95: A157, 2001.

Wallace A.W., Salahieh A., and Shamal A.  Comparison of Endotracheal Cardiac Output Monitor (ECOM) and Transit Time Flow Probe Measurement of Cardiac Output in Patients Undergoing Cardiac Surgery. Poster presentation at the annual conference of the American Society of Anesthesiologists, October 2001, and published in Anesthesiology  95: A540, 2001.

Quarterman R.L., Moonly S., Wallace A.W., Guccione J., Ratcliffe M.B. A Finite Element Model of Left Ventricular Cellular Transplantation in Dilated Cardiomyopathy. Presentation at the annual conference of the American Society for Artificial Internal Organs, June 2002.

Wallace A.W., Galindez D., Salahieh A., Layug B., and Felipe E.L. Prophylactic Clonidine Reduces Mortality After Non-cardiac Surgery. Poster presentation at the annual conference of the American Society of Anesthesiologists, October 2002, and published in Anesthesiology  96: A247, 2002.

Wallace A.W., Ramsey J.G, Schmid E.R., Salahieh A., and Lawrence A. Comparison of Endotracheal Cardiac Output Monitor (ECOM) to Thermodilution Cardiac Output Monitor in Patients Undergoing Cardiac Surgery. Poster presentation at the annual conference of the American Society of Anesthesiologists, October 2002, and published in Anesthesiology  96: A490, 2002.

Wallace A.W., Schmid E.R., Ramsey J.G., Fontes M., Kummer H.B., Nussmeier N., Schmidlin D., Salahieh A., and Lawrence A. Safety and Efficacy of the Endotracheal Cardiac Output Monitor (ECOM) in Patients Undergoing Cardiac Surgery.  Society of Critical Care Medicine, Jan 31: 23515, 2003.

Wallace A.W., Fontes M., Mathew J., Sonntag H., and Scholz J.  Association of Different Patterns of Use of Anti-ischemic Agents on Mortality and Morbidity After Coronary Artery Bypass Surgery. Poster presentation at the annual conference of the American Society of Anesthesiologists, October 2003, and published in Anesthesiology  99: A255, 2003.

Kalra R and Wallace A. Effect of Clonidine on Heart Rate Variability, Serum Catecholamine Levels, and Survival in a Long-term Prospective Trial. Poster presentation at the annual conference of the American Society of Anesthesiologists, October 2003, and published in Anesthesiology  99: A115, 2003.

Guccione J., Wallace A., Ratcliffe M. The Effect Of Aneurysm Plication On End-Systolic Strain In The Sheep: A 3-D Mr Tagging Study. Presentation at the annual conference of the Biomedical Engineering Society, October 2003.

Books and Monographs

Wallace A.W. and Mangano D.T.  Perioperative Evaluation of the Patient with Ventricular Function.  In: Warltier D.C., ed. Ventricular Function.  Baltimore: Williams & Wilkins; 1995:279–325

Wallace A.W.  Venus Omatic: A Completely Reasonable Plan to Create a New World Out of a Worthless Rock. DPI Publishing; 1998. (A 300-page science fiction comedy and social satire published electronically and accessible at www.plumsite.com/venus/ on the Internet.

Patents

Shmulewitz, Ascher (Tel Aviv, Israel) and Wallace, Arthur W. (San Rafael, California), inventors; Apparatus and methods of bioelectrical impedance analysis of blood flow. United States patent 6,095,987. Issued August 1, 2000. 23 pages. Intern’l Class A61B 005/05.

Wallace, Arthur W. (San Rafael, California) and Shmulewitz, Ascher (Tel Aviv, Israel), inventors; Apparatus and methods of bioelectrical impedance analysis of blood flow. United States patent 6,292,689.  Issued September 18, 2001. 25 pages. Intern’l Class A61B 005/05.

Wallace, Arthur W. L-arginine and phosphodiesterase (PDE) inhibitor synergism. United States patent 6476037. Issued November 5, 2002.

Wallace, Arthur W. Internal Cardiac Output Monitor. United States patent 6496732. Issued December 17, 2002.

Approved FDA 510K Applications

ECOM:  Endotracheal Cardiac Output Computer.

Letters to the Editor

Wallace A. [In reply to letter to the editor].  Beta blockade in non-cardiac surgical patients. Anesthesiology  89(3): 796–797, 1998.

Wallace A. [In reply to letter to the editor].  Diabetes and Not Lack of Treatment with Atenolol Predicts Decreased Survival after Noncardiac Surgery.  Anesthesiology  90(4): 1226–1227, 1999.

Electronic Publications

Cardiac Anesthesia Made Ridiculously Simple by Art Wallace, MD PhD: Introduction to Adult Cardiac Anesthesiology for Residents (i.e. Read this document before your VA Rotation.) by Art Wallace

Anesthesia for Minimally Invasive Cardiac Surgery by Art Wallace, MD PhD: Made Ridiculously Simple Introduction to Minimally Invasive Coronary Artery Bypass Surgery for Residents (i.e. Read this document before your first MID CABG at the VA.)

Cardiac Surgery Made Ridiculously Simple by Art Wallace, MD PhD: Cardiac surgery is a dangerous and complex field of medicine with significant morbidity and mortality. This document attempts to describe the bare bones sequence for cardiac surgical care for adult CABG and VALVE procedures with specific recommendations. It is not all inclusive or definitive but it is the minimal critical requirements.

Beta Blocker Protocol by Art Wallace MD, PhD - General Guidelines for the Adoption of Perioperative Anti-Ischemic Prophylaxis. Download as: Webpage or MS Word Document

Pacemakers for Anesthesiologists Made Incredibly Simple by Art Wallace MD PhD

Venusomatic: A Completely Reasonable Plan to Create a New World Out of a Worthless Rock. DPI Publishing; 1998. (A 300-page science fiction comedy and social satire published electronically on the Internet.)