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Fazzone B, Anderson EM, Krebs J, Ueland W, Viscardi C, Jacobs C, Spratt JR, Scali ST, Jeng E, Upchurch GR, Weaver ML, Cooper MA. Perioperative Cerebrospinal Fluid Drain Placement Does Not Increase Venous Thromboembolism Risk After Thoracic and Fenestrated Endovascular Aortic Repair. Ann Vasc Surg 2024; 99:58-64. [PMID: 37972728 DOI: 10.1016/j.avsg.2023.09.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/04/2023] [Accepted: 09/26/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) incidence after thoracic and fenestrated endovascular aortic repair (TEVAR/FEVAR) is high (up to 6-7%) relative to other vascular procedures; however, the etiology for this discrepancy remains unknown. Notably, patients undergoing TEVAR/FEVAR commonly receive cerebrospinal fluid drains (CSFDs) for neuroprotection, requiring interruption of perioperative anticoagulation and prolonged immobility. We hypothesized that CSFDs are a risk factor for VTE after TEVAR/FEVAR. METHODS Consecutive TEVAR/FEVAR patients at a single center were reviewed (2011-2020). Cerebrospinal fluid drains (CSFDs) were placed based on surgeon preference preoperatively or for spinal cord ischemia (SCI) rescue therapy postoperatively. The primary end-point was VTE occurrence, defined as any new deep venous thrombosis (DVT) or pulmonary embolism (PE) confirmed on imaging within 30 days postoperatively. Routine postoperative VTE screening was not performed. Patients with and without VTE, and subjects with and without CSFDs were compared. Logistic regression was used to explore associations between VTE incidence and CSFD exposure. RESULTS Eight hundred ninety-seven patients underwent TEVAR/FEVAR and 43% (n = 387) received a CSFD at some point during their care (preoperative: 94% [n = 365/387]; postoperative SCI rescue therapy: 6% [n = 22/387]). CSFD patients were more likely to have previous aortic surgery (44% vs. 37%; P = 0.028) and received more postoperative blood products (780 vs. 405 mL; P = 0.005). The overall VTE incidence was 2.2% (n = 20). 70% (14) patients with VTE had DVT, 50% (10) had PE, and 20% (4) had DVT and PE. Among TEVAR/FEVAR patients with VTE, 65% (n = 13) were symptomatic. Most VTEs (90%, n = 18) were identified inhospital and the median time to diagnosis was 12.5 (interquartile range 7.5-18) days postoperatively. Patients with VTE were more likely to have nonelective surgery (95% vs. 41%; P < 0.001), had higher American Society of Anesthesiologists classification (4.1 vs. 3.7; P < 0.001), required longer intensive care unit admission (24 vs. 12 days; P < 0.001), and received more blood products (1,386 vs. 559 mL; P < 0.001). Venous thromboembolism (VTE) incidence was 1.8% in CSFD patients compared to 3.5% in non-CSFD patients (odds ratio 0.70 [95% confidence interval 0.28-1.78, P = 0.300). However, patients receiving CSFDs postoperatively for SCI rescue therapy had significantly greater VTE incidence (9.1% vs. 1.1%; P = 0.044). CONCLUSIONS CSFD placement was not associated with an increased risk of VTE in patients undergoing TEVAR/FEVAR. Venous thromboembolism (VTE) risk was greater in patients undergoing nonelective surgery and those with complicated perioperative courses. Venous thromboembolism (VTE) risk was greater in patients receiving therapeutic CSFDs compared to prophylactic CSFDs, highlighting the importance of careful patient selection for prophylactic CSFD placement.
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Affiliation(s)
- Brian Fazzone
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL
| | - Erik M Anderson
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL
| | - Jonathan Krebs
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL
| | - Walker Ueland
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL
| | - Chelsea Viscardi
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL
| | - Chris Jacobs
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL
| | - John R Spratt
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL
| | - Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL
| | - Eric Jeng
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL
| | - Gilbert R Upchurch
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL
| | - M Libby Weaver
- Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, VA
| | - Michol A Cooper
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL.
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Al-Ani MA, Bai C, Bledsoe M, Ahmed MM, Vilaro JR, Parker AM, Aranda JM, Jeng E, Shickel B, Bihorac A, Peek GJ, Bleiweis MS, Jacobs JP, Mardini MT. Utilization of the percutaneous left ventricular support as bridge to heart transplantation across the United States: In-depth UNOS database analysis. J Heart Lung Transplant 2023; 42:1597-1607. [PMID: 37307906 DOI: 10.1016/j.healun.2023.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/12/2023] [Accepted: 06/06/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Intra-aortic balloon pump (IABP) and Impella device utilization as a bridge to heart transplantation (HTx) have risen exponentially. We aimed to explore the influence of device selection on HTx outcomes, considering regional practice variation. METHODS A retrospective longitudinal study was performed on a United Network for Organ Sharing (UNOS) registry dataset. We included adult patients listed for HTx between October 2018 and April 2022 as status 2, as justified by requiring IABP or Impella support. The primary end-point was successful bridging to HTx as status 2. RESULTS Of 32,806 HTx during the study period, 4178 met inclusion criteria (Impella n = 650, IABP n = 3528). Waitlist mortality increased from a nadir of 16 (in 2019) to a peak of 36 (in 2022) per thousand status 2 listed patients. Impella annual use increased from 8% in 2019 to 19% in 2021. Compared to IABP, Impella patients demonstrated higher medical acuity and lower success rate of transplantation as status 2 (92.1% vs 88.9%, p < 0.001). The IABP:Impella utilization ratio varied widely between regions, ranging from 1.77 to 21.31, with high Impella use in Southern and Western states. However, this difference was not justified by medical acuity, regional transplant volume, or waitlist time and did not correlate with waitlist mortality. CONCLUSIONS The shift in utilizing Impella as opposed to IABP did not improve waitlist outcomes. Our results suggest that clinical practice patterns beyond mere device selection determine successful bridging to HTx. There is a critical need for objective evidence to guide tMCS utilization and a paradigm shift in the UNOS allocation system to achieve equitable HTx practice across the United States.
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Affiliation(s)
- Mohammad A Al-Ani
- From the Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.
| | - Chen Bai
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida
| | - Maisara Bledsoe
- From the Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Mustafa M Ahmed
- From the Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Juan R Vilaro
- From the Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Alex M Parker
- From the Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Juan M Aranda
- From the Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Eric Jeng
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Benjamin Shickel
- Department of Medicine, University of Florida, Gainesville, Florida; and the Intelligent Critical Care Center (IC3), University of Florida, Gainesville, Florida
| | - Azra Bihorac
- Department of Medicine, University of Florida, Gainesville, Florida; and the Intelligent Critical Care Center (IC3), University of Florida, Gainesville, Florida
| | - Giles J Peek
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Mark S Bleiweis
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Mamoun T Mardini
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida
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Donohue C, Wiele L, Terry A, Jeng E, Beaver T, Martin T, Vasilopoulos T, Plowman EK. Preoperative respiratory strength training is feasible and safe and improves pulmonary physiologic capacity in individuals undergoing cardiovascular surgery. JTCVS Open 2023; 15:324-331. [PMID: 37808054 PMCID: PMC10556933 DOI: 10.1016/j.xjon.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/06/2023] [Accepted: 07/13/2023] [Indexed: 10/10/2023]
Abstract
Objective To determine the safety, feasibility, and physiologic impact of a preoperative respiratory strength training (RST) program in individuals undergoing elective cardiac surgery (CS). Methods Twenty-five adults undergoing an elective CS at an academic hospital setting enrolled and completed RST 5 days/week (50 repetitions, 50% training load, ≥3 weeks) at home via telehealth in this open-label prospective cohort study. RST adherence, telehealth attendance, and adverse events were tracked. Pre- and post-RST outcomes of maximum expiratory pressure (MEP), maximum inspiratory pressure (MIP), voluntary cough spirometry, and patient-reported dyspnea were collected. Descriptive analyses and Wilcoxon signed rank-tests were performed. Results Two participants (9%) did not complete the prescribed RST program. No significant RST-related adverse events occurred. Treatment adherence for all enrolled participants was 90%, and telehealth attendance was 99%. Of the CS patients who completed the prescribed program (n = 23; 91%), treatment adherence and telehealth attendance were excellent (98% and 100%, respectively). Significant increases in primary outcomes were observed: MEP mean change, +15.4 (95% confidence interval [CI], +3.4 to +27.3, P < .007); MIP mean change, +14.9 (95% CI, +9.4 to +20.4, P < .0001). No statistically significant differences in voluntary cough or perceived dyspnea outcomes were observed (P > .05). Conclusions These preliminary data demonstrate that a preoperative RST program is safe and feasible and can improve short-term respiratory physiologic capacity (MEP and MIP) in CS patients. Future research is warranted to validate the current findings in a larger cohort of CS patients and to determine whether RST improves postoperative extubation outcomes, airway clearance capacity, and aspiration following cardiac surgery.
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Affiliation(s)
- Cara Donohue
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville, Fla
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Fla
- Breathing Research and Therapeutics Center, University of Florida, Gainesville, Fla
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, Tenn
| | - Lauren Wiele
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville, Fla
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Fla
| | - Alyssa Terry
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville, Fla
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Fla
| | - Eric Jeng
- Department of Surgery, University of Florida, Gainesville, Fla
| | - Thomas Beaver
- Department of Surgery, University of Florida, Gainesville, Fla
| | - Tomas Martin
- Department of Surgery, University of Florida, Gainesville, Fla
| | | | - Emily K. Plowman
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville, Fla
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Fla
- Breathing Research and Therapeutics Center, University of Florida, Gainesville, Fla
- Department of Surgery, University of Florida, Gainesville, Fla
- Department of Neurology, University of Florida, Gainesville, Fla
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Croft K, Dallal-York J, Miller S, Anderson A, Donohue C, Jeng E, Plowman EK. Provision of Oral Care in the Cardiothoracic Intensive Care Unit: Survey of Nursing Staff Training, Confidence, Methods, Attitudes, and Perceived Barriers. J Contin Educ Nurs 2023; 54:313-321. [PMID: 37390307 DOI: 10.3928/00220124-20230620-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
BACKGROUND Poor oral health is associated with adverse outcomes in critical care settings. Although provision of oral care is a fundamental aspect of nursing practice, both formal training and practice among nursing staff remain unclear. METHOD Cardiothoracic intensive care unit nurses were recruited to complete a 16-item survey regarding training, confidence, methods, prioritization, and barriers to provision of oral care. RESULTS A total of 108 nurses participated (70% response rate). Formal training in oral care was reported by 38%, most frequently reported as less than 1 hour (53%) in duration. Of the respondents, 70% reported confidence in providing oral care. Nine methods and 16 products were identified, with variability in the frequency of provision. Prioritization of oral care was rated most frequently as moderate (53%), with 28% reporting barriers. CONCLUSION Despite limited formal training, surveyed nurses reported confidence in providing oral care. Methods, frequency, and prioritization were variable. Both development of formal curricula and evaluation of adherence to standardized protocols for oral care are warranted. [J Contin Educ Nurs. 2023;54(7):313-321.].
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Mankowski RT, Wohlgemuth SE, Bresciani G, Martin AD, Arnaoutakis G, Martin T, Jeng E, Ferreira L, Machuca T, Rackauskas M, Smuder AJ, Beaver T, Leeuwenburgh C, Smith BK. Intraoperative Hemi-Diaphragm Electrical Stimulation Demonstrates Attenuated Mitochondrial Function without Change in Oxidative Stress in Cardiothoracic Surgery Patients. Antioxidants (Basel) 2023; 12:antiox12051009. [PMID: 37237876 DOI: 10.3390/antiox12051009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Mechanical ventilation during cardiothoracic surgery is life-saving but can lead to ventilator-induced diaphragm dysfunction (VIDD) and prolong ventilator weaning and hospital length of stay. Intraoperative phrenic nerve stimulation may preserve diaphragm force production to offset VIDD; we also investigated changes in mitochondrial function after stimulation. During cardiothoracic surgeries (n = 21), supramaximal, unilateral phrenic nerve stimulation was performed every 30 min for 1 min. Diaphragm biopsies were collected after the last stimulation and analyzed for mitochondrial respiration in permeabilized fibers and protein expression and enzymatic activity of biomarkers of oxidative stress and mitophagy. Patients received, on average, 6.2 ± 1.9 stimulation bouts. Stimulated hemidiaphragms showed lower leak respiration, maximum electron transport system (ETS) capacities, oxidative phosphorylation (OXPHOS), and spare capacity compared with unstimulated sides. There were no significant differences between mitochondrial enzyme activities and oxidative stress and mitophagy protein expression levels. Intraoperative phrenic nerve electrical stimulation led to an acute decrease of mitochondrial respiration in the stimulated hemidiaphragm, without differences in biomarkers of mitophagy or oxidative stress. Future studies warrant investigating optimal stimulation doses and testing post-operative chronic stimulation effects on weaning from the ventilator and rehabilitation outcomes.
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Affiliation(s)
- Robert T Mankowski
- Department of Physiology and Aging, University of Florida, Gainesville, FL 32611, USA
| | | | - Guilherme Bresciani
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL 32611, USA
| | - A Daniel Martin
- Department of Physical Therapy, University of Florida, Gainesville, FL 32611, USA
- Department of Surgery, University of Florida, Gainesville, FL 32611, USA
| | - George Arnaoutakis
- Department of Surgery, University of Florida, Gainesville, FL 32611, USA
| | - Tomas Martin
- Department of Surgery, University of Florida, Gainesville, FL 32611, USA
| | - Eric Jeng
- Department of Surgery, University of Florida, Gainesville, FL 32611, USA
| | - Leonardo Ferreira
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL 32611, USA
| | - Tiago Machuca
- Department of Surgery, University of Florida, Gainesville, FL 32611, USA
| | | | - Ashley J Smuder
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL 32611, USA
| | - Thomas Beaver
- Department of Surgery, University of Florida, Gainesville, FL 32611, USA
| | | | - Barbara K Smith
- Department of Physical Therapy, University of Florida, Gainesville, FL 32611, USA
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Slaughter M, Ahmed M, Allen S, Answini G, Bartoli C, Dhingra R, Dowling R, Egnaczyk G, Griffith B, Gulati S, Hall S, Jeng E, Joseph S, Kiernan M, Lozonschi L, Mahr C, Meyer D, Ono M, Ravichandran A, Shafii A, Soleimani B, Toyoda Y, Yarboro L. Initial Safety Cohort Analysis: Prospective Multi-Center Randomized Study for Evaluating The EVAHEART®2 Left Ventricular Assist System (The COMPETENCE Trial). J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Njoroge L, Malyala R, Meece L, Jeng E, Ahmed M, Birks E. Dual VADs to Dual Organs: Successful Bridge to Heart and Kidney Transplantation with 2 HeartMate 3 LVADs in Biventricular Failure. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Sharaf O, Falasa M, Liu H, Ahmed M, Vilaro J, Parker A, Al-Ani M, Aranda J, Demos D, Neal D, Beaver T, Jeng E. Intra-Aortic Balloon Pump Optimization Before Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Al-Ani M, Bai C, Shickel B, Bledsoe M, Ahmed M, Vilaro J, Parker A, Aranda J, Jeng E, Bleiweis M, Jacobs J, Bihorac A, Mardini M. Determinants of Successful Bridging to Heart Transplantation on Temporary Percutaneous Left Ventricular Support - An Insight Using Artificial Intelligence. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Elzeneini M, Osman A, Bright K, Yang S, Guo Y, Jeng E, Shah K. CAREGIVER STRESS IS IMPROVED AND SUSTAINED FOLLOWING TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02695-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Elzeneini M, Osman A, Bright K, Yang S, Guo Y, Jeng E, Shah KB. Caregiver Stress Is Improved and Sustained Following Transcatheter Aortic Valve Replacement. Palliat Med Rep 2023; 4:56-58. [PMID: 36910451 PMCID: PMC9994443 DOI: 10.1089/pmr.2022.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 02/26/2023] Open
Abstract
Background Little is known about the impact of symptomatic aortic stenosis and subsequent transcatheter aortic valve replacement (TAVR) on stress and health for the caregiver. In this prospective cohort study, we measured caregiver stress before and after TAVR. Methods We interviewed 34 primary caregivers for patients undergoing outpatient TAVR at an academic institution. Caregiver stress was measured using the Kingston Caregiver Stress Scale (KCSS) and the Caregiver Self-Assessment Questionnaire (CSAQ) before TAVR and at one and six months after. Mean scores were compared pre- and post-TAVR using the Wilcoxon signed-rank test. Results There was significant improvement in KCSS caregiver stress at one month that was sustained at six months post-TAVR (mean change -1.91 ± 2.50 for six months, p-value 0.01). This was primarily driven by improvement in caregiving issues rather than family or financial issues. There was also significant improvement in CSAQ self-assessed health/illness at one and six months (mean change -2.78 ± 4.01 for six months, p-value 0.016). Conclusions Our findings support further investigation of caregiver outcomes in shared decision making before TAVR.
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Affiliation(s)
- Mohammed Elzeneini
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Alfaroug Osman
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Khadija Bright
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Shuang Yang
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Eric Jeng
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
| | - Khanjan B Shah
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
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Spratt J, Scali S, Patterson S, Martin T, Jeng E, Back M, Huber T, Upchurch G, Beaver T. Outcomes of Endovascular Repair of Thoracic and Thoracoabdominal Aortic Pathology in Connective Tissue Disease Patients at a Tertiary Aortic Center. Ann Vasc Surg 2022. [DOI: 10.1016/j.avsg.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Budweg J, Joseph R, Perry C, Shah K, Choi C, Jeng E. TAVR in the tricuspid domain: valve-in-valve transcatheter tricuspid valve replacement for bioprosthetic valve degeneration. BMJ Case Rep 2022; 15:15/9/e251333. [DOI: 10.1136/bcr-2022-251333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a novel use of transcatheter aortic valve replacement (TAVR) for valve-in-valve tricuspid valve replacement. A man in his 50s with prohibitive risks for surgical intervention underwent this procedure to improve severe, symptomatic tricuspid stenosis. Though current literature is limited to case reports, the Valve-in-Valve International Database (VIVID) reports similar mortality rates between surgical and transcutaneous replacement. As a novel, off-label procedure, there is limited operator experience. Nonetheless, in non-operative or high-risk patients, similar outcomes are noted in between transcatheter tricuspid valve replacement and surgical replacement. This registry sets the framework for further studies with the possibility of observing outcomes as operator experience increases, while highlighting the feasibility of the procedure.
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Ashraf H, Massoomi M, Mustafa A, Vilaro J, Parker A, Aranda J, Jeng E, Bleiweis M, Kerensky R, Al-Ani M. Acute Left Subclavian Artery - Aortic Arch Approach Angle Increases the Risk of Axillary Intra-Aortic Balloon Pump Complication: A Word of Caution. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Patel PA, Rao S, Goswami RM, Snipelisky D, Cyrille-Superville NB, Jeng E, Sinha SS, Feliberti JP, DeVore A, Najjar SS, Grinstein J. DIFFERENCES IN HEMODYNAMIC MEASUREMENT AND INTERPRETATION BETWEEN HEART FAILURE AND INTERVENTIONAL CARDIOLOGISTS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01222-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Freeman KA, Pipkin M, Machuca TN, Jeng E, Oduntan O, Moore FA, Peng YG, Philip J, Machado D, Beaver TM. Post-Traumatic Pneumonectomy and Management of Severely Contaminated Pleural Space. JTCVS Tech 2022; 13:275-279. [PMID: 35711215 PMCID: PMC9196252 DOI: 10.1016/j.xjtc.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 02/01/2022] [Indexed: 11/26/2022] Open
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Antoine SM, Canha C, Andersen-Davis D, Vilaro J, Ahmed M, Jeng E, Aranda J, Al-Ani M. ACUTE HEMODYNAMIC EFFECT OF INTRINSIC ATRIOVENTRICULAR CONDUCTION IN A LVAD PATIENT WITH ACUTE RIGHT VENTRICULAR FAILURE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03645-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Jeng E, Esseghir F, Ahmed M, Parker A, Al-Ani M, Vilaro J, Aranda J, Peek G, Bleiweis M. Single Center Experience with Venoarterial Extracorporeal Membrane Oxygenation as a Bridge to Heart Transplant under the Contemporary UNOS Heart Allocation System. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Liu H, Jones TE, Jeng E, Peng KL, Peng YG. Risk Stratification and Optimization to Prevent Right Heart Failure During Left Ventricular Assist Device Implantation. J Cardiothorac Vasc Anesth 2020; 35:3385-3393. [DOI: 10.1053/j.jvca.2020.09.130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/08/2020] [Accepted: 09/27/2020] [Indexed: 01/20/2023]
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Liu H, Jeng E, Demos D, Vilaro J, Ahmed MM, Parker A, Pinzon J, Aranda J, Beaver TM, Arnaoutakis GJ. Early versus standard renal replacement therapy after left ventricular assist device implantation. J Card Surg 2020; 35:2529-2538. [PMID: 32741013 DOI: 10.1111/jocs.14873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Renal function may improve after left ventricular assist device (LVAD) implant, however, some patients develop postoperative acute kidney injury (AKI). Randomized trials showed benefit for early renal replacement therapy (RRT) in critically ill patients with AKI, but this practice has not been studied in LVAD patients. METHODS We performed a single-center, retrospective cohort study of all adults (>18 years) who underwent LVAD placement from 1/2010 to 12/2018. We collected preoperative, hemodynamic, echocardiographic, intraoperative, and postoperative data. AKI was defined according to Kidney Disease: Improving Global Outcomes definition. Early (E) RRT was considered treatment at AKI stage II or below. Standard (S) RRT was considered treatment at AKI stage III. Outcomes and Kaplan-Meier analysis were compared between groups. RESULTS A total of 184 patients were included (mean age 56.10 years, 81% males, 30.4% African-American race). A total of 71 (38.6%) developed AKI and 17 (9.24%) needed RRT (11 E vs 6 S). A total of 11 remained hemodialysis-dependent at discharge (5 [45.5%] in E vs 6 [100%] in S, P = .043). There was a trend toward shorter intensive care unit stay and ventilation time in E group, and overall hospital stay was significantly less in the E group (48.18 ± 25.95 vs 94.00 ± 53.07 days, P = .028). Thirty-day mortality was similar between groups (E 18% vs S 16%, P = .9), but there was a trend toward improved overall survival in the E group. CONCLUSION This is the first study to examine early initiation of RRT after LVAD implant. Early RRT was associated with shorter hospital stay, lower need for permanent RRT, and a trend toward improved survival. This practice may provide significant cost savings and should be examined further.
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Affiliation(s)
- Hua Liu
- Department of Intensive Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Eric Jeng
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, College of Medicine, University of Florida, Gainesville, Florida
| | - Daniel Demos
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, College of Medicine, University of Florida, Gainesville, Florida
| | - Juan Vilaro
- Division of Cardiology, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Mustafa M Ahmed
- Division of Cardiology, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Alex Parker
- Division of Cardiology, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - James Pinzon
- Division of Cardiology, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Juan Aranda
- Division of Cardiology, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Thomas M Beaver
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, College of Medicine, University of Florida, Gainesville, Florida
| | - George J Arnaoutakis
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, College of Medicine, University of Florida, Gainesville, Florida
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Cooper J, Ashraf H, Vilaro J, Aranda J, Parker A, Wever-Pinzon J, Jeng E, Arnaoutakis G, Ahmed M. Too Well for an LVAD? J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Parker A, Vilaro J, Wever-Pinzon J, Aranda J, Jeng E, Arnaoutakis G, Ahmed M. VAD Patients' Perceptions of Care. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Kostyrko K, Han K, Kelly M, Jeng E, Morgens D, Bassik M, Jackson P, Sweet-Cordero A. SPOT-007 Identifying novel combinatorial synthetic lethal vulnerabilities in KRAS-driven lung cancer. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Al-Ani M, Gul S, Allen B, Beaver T, Arnaoutakis G, Jeng E, Vilaro J, Aranda J, Ahmed M. Patterns of ED Utilization for LVAD Patients Compared to non-LVAD Patients. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Bjurlin M, Jeng E, Goble S, Doherty J, Merlotti G. 1231 COMPARISON OF NONOPERATIVE MANAGEMENT WITH RENORRAPHY AND NEPHRECTOMY IN PENETRATING RENAL INJURIES. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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