Physicians

Division Chief, Cardiovascular and Thoracic Surgery

Department / Division
Surgery / Cardiovascular & Thoracic

Address
DUMC 3442
Durham, NC 27710

Appointment Telephone
919-684-2890

Office Telephone
919-684-2890

Fax Telephone
919-681-7905

Training

• MD, Duke University School of Medicine, 1977

Residency

• Cardiovascular Research, Duke University Medical Center, 1987
• Teaching Scholar, AHA Clinician Scientist Awardee, Duke University Medical Center, 1980-1983

Clinical Interests
Adult cardiac surgery with emphasis on coronary artery disease and valvular heart surgery

Research Interests
Our primary interests are in the areas of right ventricular function, pulmonary vascular intergetics, and coronary perfusion.  The first two relate to our laboratory's long standing interest in the efficiency of transpulmonary blood flow.  Using Fourier analysis we have developed an animal model wherein the energy dissipated in pulmonary vascular transport can be completely described in both meaning and oscillatory terms.  This description is relatively unimportant in the systemic circulation, where oscillatory energy represents less the 5% of energy dissipated.  In the pulmonary circuit, this can represent up to 50% of the energy requirements of the right ventricle and thus represents a large fraction that is susceptible to afterload reduction therapy.  Oscillatory energy is that energy required to create oscillations about the mean and does not result in net forward blood flow.  Minimizing oscillatory work improves the efficiency of transpulmonary blood flow.  Our laboratory has demonstrated a variety of deleterious effects on transpulmonary blood flow efficiency, including positive end-expiratory pressure, a variety of drugs, elevation in left atrial pressure and heart failure models, acute and chronic high-flow states, and following lung transplantation.  We have studied a model of acute lung injury to study both adult respiratory distress syndrome and the consequences of lung preservation prior to transplantation.  With the advent of the selective pulmonary vasodilatory, nitric oxide, we now have a selective tool to modify the pulmonary circulation.  A more complete understanding of the adrenergic receptor system in smooth muscle cells has permitted more selective drug modification to be studied.  This is naturally led us to the study of right ventricular function given our complete understanding of right ventricular afterload.  We have created a swine model wherein the right ventricular is modeled as a bullet ellipsoid and have documented our ability to analyze the function of both the normal and feeling right ventricle.  

Our laboratory has a long-standing interest in coronary perfusion and have studied the coronary circulation extensively using radioactive tracer microspheres and using contrast echocardiography.  We have extensively researched the use of echocardiographic contrast agents to permit noninvasive assessment of coronary blood flow and have participated in numerous human trials documenting the safety, efficacy, and accuracy of this technique.

Industry Relationships and Collaborations (What's this?)

This physician (or a member of their immediate family) has a working relationship (i.e. consulting, research, and/or educational services) with the companies listed below. These relations have been reported to the health system leadership and, when appropriate, management plans are in place to address potential conflicts.

• Baxter Healthcare
• Bayer

Representative Publications
Albahrani MJ, Swaminathan M, Phillips-Bute B, Smith PK, Newman MF, Mathew JP, Stafford-Smith M. Postcardiac surgery complications: association of acute renal dysfunction and atrial fibrillation. Anesth Analg. 2003 Mar;96(3):637-43. (2003) Abstract

Amory DW, Grigore A, Amory JK, Gerhardt MA, White WD, Smith PK, Schwinn DA, Reves JG, Newman MF. Neuroprotection is associated with beta-adrenergic receptor antagonists during cardiac surgery: evidence from 2,575 patients. J Cardiothorac Vasc Anesth. 2002 Jun;16(3):270-7. (2002) Abstract

Grocott HP, Mackensen GB, Grigore AM, Mathew J, Reves JG, Phillips-Bute B, Smith PK, Newman MF, , . Postoperative hyperthermia is associated with cognitive dysfunction after coronary artery bypass graft surgery. Stroke. 2002 Feb;33(2):537-41. (2002) Abstract

Milano CA, Patel VS, Smith PK, Smith MS. Risk of anaphylaxis from aprotinin re-exposure during LVAD removal and heart transplantation. J Heart Lung Transplant. 2002 Oct;21(10):1127-30. (2002) Abstract

O'Connor CM, Velazquez EJ, Gardner LH, Smith PK, Newman MF, Landolfo KP, Lee KL, Califf RM, Jones RH. Comparison of coronary artery bypass grafting versus medical therapy on long-term outcome in patients with ischemic cardiomyopathy (a 25-year experience from the Duke Cardiovascular Disease Databank). Am J Cardiol. 2002 Jul 15;90(2):101-7. (2002) Abstract

Scarborough JE, Smith ML, Domkowski PW, Diodato LH, Pippen AM, Smith PK, Annex BH, Landolfo KP. Basic fibroblast growth factor is upregulated in hibernating myocardium. J Surg Res. 2002 Sep;107(1):119-23. (2002) Abstract

Sharma AD, Slaughter TF, Clements FM, Sreeram G, Newman MF, Phillips-Bute B, Bredehoeft SJ, Smith PK, Stafford-Smith M. Association of leukocyte-depleted blood transfusions with infectious complications after cardiac surgery. Surg Infect (Larchmt). 2002 Summer;3(2):127-33. (2002) Abstract

Smith PK, Cowie H, Olafsson RF, Liefooghe AP, Almeida A, Araki H, del Barrio C, Costabile A, Dekleva B, Houndoumadi A, Kim K, Olafsson RP, Ortega R, Pain J, Pateraki L, Schafer M, Singer M, Smorti A, Toda Y, Tomasson H, Wenxin Z. Definitions of bullying: a comparison of terms used, and age and gender differences, in a fourteen-country international comparison. Child Dev. 2002 Jul-Aug;73(4):1119-33. (2002) Abstract

Swaminathan M, McCreath BJ, Phillips-Bute BG, Newman MF, Mathew JP, Smith PK, Blumenthal JA, Stafford-Smith M, . Serum creatinine patterns in coronary bypass surgery patients with and without postoperative cognitive dysfunction. Anesth Analg. 2002 Jul;95(1):1-8, table of contents. (2002) Abstract

Welsby IJ, Bennett-Guerrero E, Atwell D, White WD, Newman MF, Smith PK, Mythen MG. The association of complication type with mortality and prolonged stay after cardiac surgery with cardiopulmonary bypass. Anesth Analg. 2002 May;94(5):1072-8, table of contents. (2002) Abstract

Grigore AM, Mathew J, Grocott HP, Reves JG, Blumenthal JA, White WD, Smith PK, Jones RH, Kirchner JL, Mark DB, Newman MF, , . Prospective randomized trial of normothermic versus hypothermic cardiopulmonary bypass on cognitive function after coronary artery bypass graft surgery. Anesthesiology. 2001 Nov;95(5):1110-9. (2001) Abstract

Sapirstein JS, Smith PK. The "ideal" replacement heart valve. Am Heart J. 2001 May;141(5):856-60. (2001) Abstract

Saur CD, Granger BB, Muhlbaier LH, Forman LM, McKenzie RJ, Taylor MC, Smith PK. Depressive symptoms and outcome of coronary artery bypass grafting. Am J Crit Care. 2001 Jan;10(1):4-10. (2001) Abstract

Swaminathan M, East C, Phillips-Bute B, Newman MF, Reves JG, Smith PK, Stafford-Smith M. Report of a substudy on warm versus cold cardiopulmonary bypass: changes in creatinine clearance. Ann Thorac Surg. 2001 Nov;72(5):1603-9. (2001) Abstract