Cardiothoracic Division: Research & Recent Publications

Please select a doctor below to view research interests and recent publications.

Dr. Ittleman has served as an investigator on several recent clinical trials. His work on clinical trials includes a study on the detection of cancer cells in bone marrow samples, sedation for mechanical ventilation in post-CABG patients, and a double-blind multicenter study of Paracoxib followed by Valdecoxib in patients who have CABG surgery.

In terms of teaching, Dr. Ittleman supervises students and residents in preoperative, intraoperative and postoperative management of thoracic and cardiac surgical patients.  This includes daily rounds, review of cardiac catheterizations and appropriate x-ray studies, and formal teaching sessions on selected topics.  For the past several years, Dr. Ittleman has instituted a Friday morning teaching session with the available house staff and students.

Recent Publications:

Schmoker JD, McPartland KJ, Fellinger EK, Boyum J, Trombley L, Ittleman FP, Terrien C 3rd, Stanley A, Howard A.  Matrix metalloproteinase and tissue inhibitor expression in atherosclerotic and nonatherosclerotic thoracic aortic aneurysms.  J Thoracic Cardiovasc Surg.  2007  Jan;133(1):155-61.

Kusminsky R, Manna E, Ambaye A, Weaver DL, Harlow SP, Covelli M, Stanley MA, McCahill L, Ittleman FP, Leavitt BJ, Krag M: The Detection of Isolated Tumor Cells in Bone Marrow Comparing Brightfield Immunocytochemistry and Multi-color Immunofluorescence.  Annals of Surgical Oncology 2005; 12(9):1-8. DOI: 10.1245/ASO.2005.12.004.

Dr. Leavitt is a member of the Northern New England Cardiovascular Disease Study Group (NNE), the largest validated regional cardiac surgical database in the county that serves as a benchmark for quality improvement processes in cardiac surgery.

At FAHC, Dr. Leavitt has taken an interest in the internal mammary artery (IMA) graft as a conduit for bypass surgery. Two papers have been published on the use of the IMA in over 27,000 patients in this region documenting that a lower mortality rate exists when the IMA graft is used. The studies also showed that there was a significant difference in IMA usage among surgeons across Northern New England. Increasing surgeon use of the IMA has the potential for significant short and long-term improvements in bypass surgery.

Fletcher Allen Health Care plays an integral role in the Northern New England Group and are involved in all of the various research projects that the NNE has going at any one time. A major facet has been the improvement of low output heart failure from patients undergoing cardiac surgery. Some of the future directions include reducing the incidence of stroke after cardiac surgical revascularization.

Recent Publications:

Likosky DS, Sorensen MJ, Dacey LJ, Baribeay YR, Leavitt BJ, DiScipio AW, Hernandez Jr F, Cochran RP, Quinn R, Helm RE, Charlesworth DC, Clough RA, Malenka DJ, Sisto DA, Sardella G, Olmstead EM, Ross CS, O’Connor GT, Northern New England Cardiovascular Disease Study Group. Long-Term Survival of the Very Elderly Undergoing Aortic Valve Surgery. Circulation 2009;120[suppl 1]:S127-S133.

Leavitt BJ, Baribeau YR, Ross CS, DiScipio AW, Quinn RD, Olmstead EM, Sisto D, Likosky DS, Cochran RP, Clough RA, Boss RA, Kramer RS, O'Connor GT. Outcomes of Patients Undergoing Concomitant Aortic and Mitral Valve Surgery in Northern New England. Circulation 2009;120:S155-S162.

Brown JR, Cochran RP, Leavitt BJ, Dacey LJ, Ross CS, MacKenzie TA, Kunzelman KS, Kramer RS, Hernandez Jr F, Helm RE, Westbrook BM, Dunton RF, Malenka DJ, O’Connor GT, and for the Northern New England Cardiovascular Disease Study Group. Multivariable Prediction of Renal Insufficiency Developing After Cardiac Surgery. Circulation 2007;116;I-139-I-143.

Likosky DS, Dacey LJ, Baribeau YR, Leavitt BJ, Clough R, Cochran RP, Quinn R, Sisto DA, Charlesworth DC, Malenka DJ, MacKenzie TA, Olmstead EM, Ross CS, O’Connor GT. Long-Term Survival of the Very Elderly Undergoing Coronary Artery Bypass Grafting. Ann Thorac Surg 2008;85:1233-8.

Leavitt BJ. The Effects of Diabetes Mellitus on Coronary Artery Bypass Graft Surgery. Current Diabetes Reports, 2007 Feb;7(1):20-4.

Dacey LJ, Likosky DS, Ryan TJ Jr, Robb JF, Quinn RD, DeVries JT, Hearne MJ, Leavitt BJ, Dunton RF, Clough RA, Sisto D, Ross CS, Olmstead EM, O'Connor GT, Malenka DJ; Northern New England Cardiovascular Disease Study Group. Long-term survival after surgery versus percutaneous intervention in octogenarians with multivessel coronary disease. Ann Thorac Surg. 2007 Dec;84(6):1904-11; discussion 1904-11.

Brown JR, Cochran RP, Leavitt BJ, Dacey LJ, Ross CS, MacKenzie TA, Kunzelman KS, Kramer RS, Hernandez Jr F, Helm RE, Westbrook BM, Dunton RF, Malenka DJ, O’Connor GT, and the Northern New England Cardiovascular Disease Study Group. Multivariable Prediction of Renal Insufficiency Developing After Cardiac Surgery. Circulation 2007;116;I-139-I-143.

Leavitt BJ. The Effects of Diabetes Mellitus on Coronary Artery Bypass Graft Surgery. Current Diabetes Reports, 2007 Feb;7(1):20-4.

Surgenor SD, DeFoe GR, Leavitt BJ, Likosky DS, Groom RC, Clark C, Fillinger MP, Helm RE, Kramer RS, Klemperer JD, Krumholz CF, Westrbook BM, Galatis DJ, Frumiento C, Ross CS, Olmstead EM, O’Connor GT. Intraoperative red blood cell transfusion during CABG surgery increases the risk of post-operative low output heart failure. Circulation. 2006 Jul 4;114(1 Suppl):I409-13.

Leavitt BJ, Ross CS, O’Connor GT. Long-term Survival of Patients With Chronic Obstructive Pulmonary Disease Undergoing Coronary Artery Bypass Surgery. Circulation. 2006 Jul 4;114(1 Suppl):I430-4.

Brown JR, Cochran RP, Dacey LJ, Ross CS, Kunzelman KS, Dunton RF, Braxton JH, Charlesworth DC, Clough RA, Helm RE, Leavitt BJ, MacKenzie TA, O'Connor GT. Perioperative Increases in Serum Creatinine Are Predictive of Increased 90-Day Mortality After Coronary Artery Bypass Graft Surgery. Circulation 2006;114 I-409-I-413

Malenka DJ, Leavitt BJ, Hearne MJ, Robb JF, Baribeau YR, Ryan TJ, Helm RE, Kellett MA, Dauerman HL, Dacey LJ, Silver MT, VerLee PN, Weldner PW, Hettleman BD, Olmstead EM, Piper WD, O'Connor GT; Northern New England Cardiovascular Disease Study Group. Comparing long-term survival of patients with multivessel coronary disease after CABG or PCI: analysis of BARI-like patients in northern New England. Circulation. 2005 Aug 30;112(9 Suppl):I371-6.

Mallow LA, Tischler MD, Martin BJ, Leavitt BJ. Dexmedetomidine does not improve patient satisfaction when compared to propofol during mechanical ventilation. Crit Care Med, 2005; 32(593).

Ander S, MacLennan M, Bentil S, Leavitt BJ, Chesler N: Pressure-induced vector transport in human saphenous vein. Ann Biomed Eng. February 2005;33(2):202-8.

Dacey LJ, Likosky DS, Leavitt BJ, Lahey SJ, Quinn RD, Hernandez F, Quinton HB, DeSimone JP, Ross CS, O’Connor GT: Perioperative stroke and long-term survival after coronary bypass surgery. Ann Thorac Surg. February 2005;79(2):532-6; discussion 537.

Mulieri LA, Tischler D, Martin BJ, Leavitt BJ, Ittleman FP, Alpert NR, LeWinter MM. Regional differences in the force-frequency relation of human left ventricular myocardium in mitral regurgitation: Implication for ventricular shape. Am J Physiol Heart Circ Physiol May 2005;288(5):H2185-91. Epub Jan 6, 2005.

As an associate professor of surgery at the University of Vermont, Dr. Norotsky has taken part in over a dozen research projects in the field of cardiothoracic surgery. His most recent projects include a study regarding the survival of octogenarians in coronary artery bypass surgery which took place in 2006 and an examination of the perforation of the right atrium during radiofrequency catheter ablation that was accepted for print by the Journal of Cardiovascular Anesthesia in 2007. Dr. Norotsky has several ongoing investigations, including two studies regarding coronary artery bypass graft surgery.

Recent Publications:

Tsai M, Fisher JM, Norotsky M, Keating F, Anderson L, Howe P, Marcus S. Perforation of the right atrium during radiofrequency catheter ablation. J Cardiothorac Vasc Anesth. 2008 Jun;22(3):426-7. Epub 2007 Nov 26.

Dr. Schmoker's research interests are focused on the biology of the vascular wall. Research is conducted on the various cells of the blood vessel wall, and on certain proteins that are found in the matrix between cells.

Efforts are directed towards the study of the changes that occur within the walls of blood vessels that are used as bypass conduits for the treatment of coronary artery disease. The saphenous vein, radial artery, and the internal mammary artery are studied under simulated pathophysiologic pressure to gain insight into the machanisms contributing to morphologic change within the grafted vessel.

Research efforts are also directed at understaning the role of the matrix metalloproteinases, reactive oxygen species, and second messenger systems in the development of thoracic aortic aneurysms. The effect of pressure on the induction of these systems has been studied in human aorta using novel organ culture models.

The lab has developed a porcine model of traumatic aortic injury that lends itself to the study of cellular changes that occur within the aortic wall exposed to traumatic surgery, and the cellular response to healing.

Work has also focused on a porcine model created to study the phenotypic changes that occur within the cerebral arterioles during cardiopulmonary bypass and profound hypothermic circulatory arrest.

Recent Publications:

Schmoker JD, Terrien III C, McPartland KJ, Boyum J, Wellman G, Trombley L, Kinne J. Cerebrovascular response to continuous cold cerebral perfusion and hypothermic circulatory arrest. The Journal of Thoracic and Cardiovascular Surgery 137:459-464, 2009.

Schmoker JD, Lee CH, Taylor R, Chung A, Trombley L, Hardin N, Russell SR, Howard A. A novel model of blunt thoracic aortic injury: a mechanism confirmed? The Journal of Trauma 64:923-931, 2008.

Schmoker JD, McPartland KJ, Fellinger E, Boyum J, Trombly L, Ittleman FP, Terrien III C, Stanley A. Matrix metalloproteinase and tissue inhibitor expression in atherosclerotic and nonatherosclerotic thoracic aortic aneurysms. Journal of  Thoracic and Cardiovascular Surgery 133:155-161, 2007.

Chung A, Trombley L, Stanley A, Schmoker JD. Pathophysiologic pressure induces the expression of matrix metalloproteinase-2 in thoracic aortic aneurysms. Journal of the American College of Surgeons 201(3S):S27, 2005.