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Malas J, Chen Q, Akhmerov A, Tremblay P, Egorova N, Moriguchi J, Kobashigawa J, Czer L, Cole R, Emerson D, Chikwe J, Arabia F, Esmailian F. Does Extracorporeal Membrane Oxygenation Duration as a Bridge to Total Artificial Heart Affect Outcomes. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.144] [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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Robba T, Desi G, Arabia F, Dotto M, Piana R, Martorano D, Fonio P. Use of Diffusion-weighted Imaging at MRI in Differentiating Enchondroma and Low-grade and High-grade Chondrosarcoma. Semin Musculoskelet Radiol 2022. [DOI: 10.1055/s-0042-1750681] [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: 10/17/2022]
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Musso G, Taliano C, Molinaro F, Fonti C, Veliaj D, Torti D, Paschetta E, Castagna E, Carbone G, Laudari L, Aseglio C, Zocca E, Chioni S, Giannone LC, Arabia F, Deiana C, Benato FM, Druetta M, Campagnola G, Borsari M, Mucci M, Rubatto T, Peyronel M, Tirabassi G. Early prolonged prone position in noninvasively ventilated patients with SARS-CoV-2-related moderate-to-severe hypoxemic respiratory failure: clinical outcomes and mechanisms for treatment response in the PRO-NIV study. Crit Care 2022; 26:118. [PMID: 35488356 PMCID: PMC9052189 DOI: 10.1186/s13054-022-03937-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/02/2022] [Indexed: 12/23/2022] Open
Abstract
Background Whether prone position (PP) improves clinical outcomes in COVID-19 pneumonia treated with noninvasive ventilation (NIV) is unknown. We evaluated the effect of early PP on 28-day NIV failure, intubation and death in noninvasively ventilated patients with moderate-to-severe acute hypoxemic respiratory failure due to COVID-19 pneumonia and explored physiological mechanisms underlying treatment response. Methods In this controlled non-randomized trial, 81 consecutive prospectively enrolled patients with COVID-19 pneumonia and moderate-to-severe (paO2/FiO2 ratio < 200) acute hypoxemic respiratory failure treated with early PP + NIV during Dec 2020–May 2021were compared with 162 consecutive patients with COVID-19 pneumonia matched for age, mortality risk, severity of illness and paO2/FiO2 ratio at admission, treated with conventional (supine) NIV during Apr 2020–Dec 2020 at HUMANITAS Gradenigo Subintensive Care Unit, after propensity score adjustment for multiple baseline and treatment-related variables to limit confounding. Lung ultrasonography (LUS) was performed at baseline and at day 5. Ventilatory parameters, physiological dead space indices (DSIs) and circulating inflammatory and procoagulative biomarkers were monitored during the initial 7 days. Results In the intention-to-treat analysis. NIV failure occurred in 14 (17%) of PP patients versus 70 (43%) of controls [HR = 0.32, 95% CI 0.21–0.50; p < 0.0001]; intubation in 8 (11%) of PP patients versus 44 (30%) of controls [HR = 0.31, 95% CI 0.18–0.55; p = 0.0012], death in 10 (12%) of PP patients versus 59 (36%) of controls [HR = 0.27, 95% CI 0.17–0.44; p < 0.0001]. The effect remained significant within different categories of severity of hypoxemia (paO2/FiO2 < 100 or paO2/FiO2 100–199 at admission). Adverse events were rare and evenly distributed. Compared with controls, PP therapy was associated with improved oxygenation and DSIs, reduced global LUS severity indices largely through enhanced reaeration of dorso-lateral lung regions, and an earlier decline in inflammatory markers and D-dimer. In multivariate analysis, day 1 CO2 response outperformed O2 response as a predictor of LUS changes, NIV failure, intubation and death.
Conclusion Early prolonged PP is safe and is associated with lower NIV failure, intubation and death rates in noninvasively ventilated patients with COVID-19-related moderate-to-severe hypoxemic respiratory failure. Early dead space reduction and reaeration of dorso-lateral lung regions predicted clinical outcomes in our study population.
Clinical trial registration ISRCTN23016116. Retrospectively registered on May 1, 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-03937-x.
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Affiliation(s)
- Giovanni Musso
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy.
| | - Claudio Taliano
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy
| | - Federica Molinaro
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy
| | - Caterina Fonti
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy
| | | | - Davide Torti
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy
| | - Elena Paschetta
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy
| | - Elisabetta Castagna
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy
| | - Giorgio Carbone
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy
| | - Luigi Laudari
- Intensive Care Unit, HUMANITAS Gradenigo, Turin, Italy
| | | | - Edoardo Zocca
- Intensive Care Unit, HUMANITAS Gradenigo, Turin, Italy
| | - Sonia Chioni
- Intensive Care Unit, HUMANITAS Gradenigo, Turin, Italy
| | | | | | - Cecilia Deiana
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy
| | | | - Marta Druetta
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy
| | | | | | - Martina Mucci
- Intensive Care Unit, HUMANITAS Gradenigo, Turin, Italy
| | | | - Mara Peyronel
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy
| | - Gloria Tirabassi
- Emergency Medicine Department, HUMANITAS Gradenigo, C.so Regina Margherita 8, 10132, Turin, Italy
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Mitchel H, Patalinghug P, Berthiaume K, Morris M, Kalya A, Arabia F, Gopalan R. Severe Isolated Cardiomyopathy Requiring Heart Transplant Following COVID-19 Infection and Subsequent Vaccination. J Heart Lung Transplant 2022. [PMCID: PMC8988570 DOI: 10.1016/j.healun.2022.01.1700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction Cardiomyopathy is a known complication associated with COVID-19, and 7% of all COVID-19 related deaths are thought to be due to myocarditis. There is also growing evidence for COVID-19 vaccine-related myocarditis. We present the first case of a patient with severe isolated cardiomyopathy requiring heart transplant after both COVID-19 infection and vaccination. Case Report A 58-year-old male with no prior medical history was diagnosed with COVID-19 infection in December 2020 without hospitalization. He experienced declining symptoms over the next 7 months and completed COVID-19 vaccination in July. On 8/10/2021, he presented to the emergency room with worsening exertional dyspnea and orthopnea. Initial labs revealed elevated NT-proBNP (1,701 pg/mL) and high-sensitivity cardiac troponin-T (45 ng/L). Transthoracic echocardiography revealed reduced left ventricular (LV) ejection fraction at 15% and LV end-diastolic diameter at 5.6 cm. Coronaries were clear. Cardiac MRI (cMR) is depicted in Figure 1. He was managed with an Impella device and dobutamine but failed weaning from this cardiac support. He was listed for transplant as UNOS Status 2 and underwent successful OHT on 9/19/2021. Summary Acute myocardial injury is known to be a frequent complication during the COVID-19 course, but it is not known to require advanced therapies. There is only one other case from France that describes a patient bridged with temporary mechanical support to OHT following COVID-19 induced cardiomyopathy. In both cases, cMR revealed similar late gadolinium enhancement (LGE) patterns. The cases differ as our patient experienced Long COVID symptoms over 8 months after diagnosis and was vaccinated while the French report describes a patient who was diagnosed with COVID-19, experienced end-stage heart failure and underwent transplant all within 11 days. This case contributes to the lacunae in data in the era of COVID-19 and its vaccines.
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Lam L, Payne-Cardona M, Fang M, Herra R, Mondragon EC, Runyan C, Moriguchi J, Kobashigawa J, Czer L, Arabia F, Zabner R. Comparing the Incidence of Surgical Site Infections(SSI) Using Narrow versus Broad-Spectrum Perioperative Antibiotic Prophylaxis in Mechanical Circulatory Support (MCS) Patients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.239] [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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Czer L, Lam L, Hays R, Baiesc F, Kuo A, Hariri S, Moriguchi J, Arabia F, Volod O. Correlation of High Molecular Weight Von Willebrand Factor Multimer loss and Rotational Speed During Short Term Mechanical Circulatory Support. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.978] [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: 11/16/2022] Open
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Coleman B, Levine R, Arabia F, Passano E, Dimbil S, Barone H, Runyan C, Huie N, Hajj J, Lindsay M, Kobashigawa J. Is the VAS Quality of Life Assessment Tool Sensitive to Both Male and Female MCSD Patients? J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.761] [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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Esmailian F, Arabia F, Czer L, Kittleson M, Geft D, Cole R, Esmailian G, Rafiei M, Passano E, Barone H, Moriguchi J. Does the Type of Mechanical Circulatory Support as a Bridge to Heart Transplant Affect Outcome after Transplant? J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.729] [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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Reich HJ, Morgan J, Arabia F, Czer L, Moriguchi J, Ramzy D, Esmailian F, Lam L, Dunhill J, Volod O. Comparative analysis of von Willebrand factor profiles after implantation of left ventricular assist device and total artificial heart. J Thromb Haemost 2017; 15:1620-1624. [PMID: 28586149 DOI: 10.1111/jth.13753] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Indexed: 11/30/2022]
Abstract
Essentials Bleeding is a major source of morbidity during mechanical circulatory support. von Willebrand factor (VWF) multimer loss may contribute to bleeding. Different patterns of VWF multimer loss were seen with the two device types. This is the first report of total artificial heart associated VWF multimer loss. SUMMARY Background Bleeding remains a challenge during mechanical circulatory support and underlying mechanisms are incompletely understood. Functional von Willebrand factor (VWF) impairment because of loss of high-molecular-weight multimers (MWMs) produces acquired von Willebrand disease (VWD) after left ventricular assist device (LVAD). Little is known about VWF multimers with total artificial hearts (TAHs). Here, VWF profiles with LVADs and TAHs are compared using a VWD panel. Methods VWD evaluations for patients with LVAD or TAH (2013-14) were retrospectively analyzed and included: VWF activity (ristocetin cofactor, VWF:RCo), VWF antigen (VWF:Ag), ratio of VWF:RCo to VWF:Ag, and quantitative VWF multimeric analysis. Results Twelve patients with LVADs and 12 with TAHs underwent VWD evaluation. All had either normal (47.8%) or elevated (52.2%) VWF:RCo, normal (26.1%) or elevated (73.9%) VWF:Ag and 50.0% were disproportional (ratio ≤ 0.7). Multimeric analysis showed abnormal patterns in all patients with LVADs: seven with high MWM loss; five with highest MWM loss. With TAH, 10/12 patients had abnormal patterns: all with highest MWM loss. High MWM loss correlated with presence of LVAD and highest MWM loss with TAH. Increased low MWMs were detected in 22/24. Conclusion Using VWF multimeric analysis, abnormalities after LVAD or TAH were detected that would be missed with measurements of VWF level alone: loss of high MWM predominantly in LVAD, loss of highest MWM in TAH, and elevated levels of low MWM in both. This is the first study to describe TAH-associated highest MWM loss, which may contribute to bleeding.
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Affiliation(s)
- H J Reich
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - J Morgan
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - F Arabia
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - L Czer
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - J Moriguchi
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - D Ramzy
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - F Esmailian
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - L Lam
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
- Department of Pharmacy, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - J Dunhill
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
- Department of Hematology and Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - O Volod
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Maglia G, Arabia F, Aspromonte V, Mignano A, Candigliota M, Pirrotta S, D'argento C, Bavila R, Cerroni M, Malacrida M, Cassadonte F. P926Preliminary experience of maximum voltage-guided approach with a novel ultra-high density mapping system for atrial flutter ablation. Europace 2017. [DOI: 10.1093/ehjci/eux151.108] [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: 11/14/2022] Open
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Awad M, Czer LSC, Esmailian F, Jordan S, De Robertis MA, Mirocha J, Patel J, Chang DH, Kittleson M, Ramzy D, Arabia F, Chung JS, Cohen JL, Trento A, Kobashigawa JA. Combined Heart and Kidney Transplantation: A 23-Year Experience. Transplant Proc 2017; 49:348-353. [PMID: 28219597 DOI: 10.1016/j.transproceed.2016.11.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND We report clinical experience with combined heart and kidney transplantation (HKTx) over a 23-year time period. METHODS From June 1992 to August 2015, we performed 83 combined HKTx procedures at our institution. We compared the more recent cohort of 53 HKTx recipients (group 2, March 2009 to August 2015) with the initial 30 previously reported HKTx recipients (group 1, June 1992 to February 2009). Pre-operative patient characteristics, peri-operative factors, and post-operative outcomes including survival were examined. RESULTS The baseline characteristics of the two groups were similar, except for a lower incidence of ethanol use and higher pre-operative left-ventricular ejection fraction, cardiac output, and cardiac index in group 2 when compared with group 1 (P = .007, .046, .037, respectively). The pump time was longer in group 2 compared with group 1 (153.30 ± 38.68 vs 129.60 ± 37.60 minutes; P = .007), whereas the graft ischemic time was not significantly different between the groups, with a trend to a longer graft ischemic time in group 2 versus group 1 (195.17 ± 45.06 vs 178.07 ± 52.77 minutes; P = .056, respectively). The lengths of intensive care unit (ICU) and hospital stay were similar between the groups (P = .083 and .39, respectively). In addition, pre-operative and post-operative creatinine levels at peak, discharge, 1 year, and 5 years and the number of people on post-operative dialysis were similar between the groups (P = .37, .75, .54, .87, .56, and P = .139, respectively). Overall survival was not significantly different between groups 2 and 1 for the first 5 years after transplant, with a trend toward higher survival in group 2 (P = .054). CONCLUSIONS The most recent cohort of combined heart and kidney transplant recipients had similar ICU and hospital lengths of stay and post-operative creatinine levels at peak, discharge, and 1 and 5 years and a similar number of patients on post-operative dialysis when compared with the initial cohort. Overall survival was not significantly different between the later and earlier groups, with a trend toward higher overall survival at 5 years in the more recent cohort of patients. In selected patients with co-existing heart and kidney failure, combined heart and kidney transplantation is safe to perform and has excellent outcomes.
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Affiliation(s)
- M Awad
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - L S C Czer
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California.
| | - F Esmailian
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - S Jordan
- Division of Pediatric Nephrology, Cedars-Sinai Medical Center, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - M A De Robertis
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California
| | - J Mirocha
- Section of Biostatistics and Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - J Patel
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - D H Chang
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - M Kittleson
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - D Ramzy
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - F Arabia
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - J S Chung
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - J L Cohen
- Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - A Trento
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
| | - J A Kobashigawa
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California; Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California
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Ruan V, Czer LSC, Awad M, Kittleson M, Patel J, Arabia F, Esmailian F, Ramzy D, Chung J, De Robertis M, Trento A, Kobashigawa JA. Use of Anti-Thymocyte Globulin for Induction Therapy in Cardiac Transplantation: A Review. Transplant Proc 2017; 49:253-259. [PMID: 28219580 DOI: 10.1016/j.transproceed.2016.11.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 11/01/2016] [Accepted: 11/16/2016] [Indexed: 01/20/2023]
Abstract
The most common causes of death after heart transplantation (HTx) include acute rejection and multi-organ failure in the early period and malignancy and cardiac allograft vasculopathy (CAV) in the late period. Polyclonal antibody preparations such as rabbit anti-thymocyte globulin (ATG) may reduce early acute rejection and the later occurrence of CAV after HTx. ATG therapy depletes T cells, modulates adhesion and cell-signaling molecules, interferes with dendritic cell function, and induces B-cell apoptosis and regulatory and natural killer T-cell expansion. Evidence from animal studies and from retrospective clinical studies in humans indicates that ATG can be used to delay calcineurin inhibitor (CNI) exposure after HTx, thus benefiting renal function, and to reduce the incidence of CAV and ischemia-reperfusion injury in the transplanted heart. ATG may reduce de novo antibody production after HTx. ATG does not appear to increase cytomegalovirus infection rates with longer prophylaxis (6-12 months). In addition, ATG may reduce the risk of lymphoproliferative disease and does not appear to confer an additive effect on acquiring lymphoma after HTx. Randomized, controlled trials may provide stronger evidence of ATG association with patient survival, graft rejection, renal protection through delayed CNI initiation, as well as other benefits. It can also help establish optimal dosing and patient criteria to maximize treatment benefits.
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Affiliation(s)
- V Ruan
- Division of Cardiology, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California
| | - L S C Czer
- Division of Cardiology, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California.
| | - M Awad
- Division of Cardiology, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California
| | - M Kittleson
- Division of Cardiology, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California
| | - J Patel
- Division of Cardiology, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California
| | - F Arabia
- Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California
| | - F Esmailian
- Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California
| | - D Ramzy
- Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California
| | - J Chung
- Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California
| | - M De Robertis
- Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California
| | - A Trento
- Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California
| | - J A Kobashigawa
- Division of Cardiology, Cedars-Sinai Medical Center, and Cedars-Sinai Heart Institute, Los Angeles, California
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Awad M, Czer LSC, Mirocha J, Ruzza A, de Robertis M, Rafiei M, Reich H, Sasevich M, Rihbany K, Kass R, Kobashigawa J, Arabia F, Trento A, Esmailian F, Ramzy D. Similar Mortality and Morbidity of Orthotopic Heart Transplantation for Patients 70 Years of Age and Older Compared With Younger Patients. Transplant Proc 2017; 48:2782-2791. [PMID: 27788818 DOI: 10.1016/j.transproceed.2016.06.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 06/06/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The upper age limit of heart transplantation remains controversial. The goal of the present study was to investigate the mortality and morbidity of orthotopic heart transplantation (HT) for recipients ≥70 compared with those <70 years of age. METHODS Of 704 adults who underwent HT from December 1988 to June 2012 at our institution, 45 were ≥70 years old (older group) and 659 were <70 years old (younger group). Survival, intraoperative blood product usage, intensive care unit (ICU) and hospital stays, and frequency of reoperation for chest bleeding, dialysis, and >48 hours ventilation were examined after HT. RESULTS The older group had 100% 30-day and 60-day survival compared with 96.8 ± 0.7% 30-day and 95.9 ± 0.8% 60-day survival rates in the younger group. The older and younger groups had similar 1-year (93.0 ± 3.9% vs 92.1 ± 1.1%; P = .79), 5-year (84.2 ± 6.0% vs 73.4 ± 1.9%; P = .18), and 10-year (51.2 ± 10.7% vs 50.2 ± 2.5%; P = .43) survival rates. Recipients in the older group had higher preoperative creatinine levels, frequency of coronary artery disease, and more United Network for Organ Sharing status 2 and fewer status 1 designations than recipients in the younger group (P < .05 for all). Pump time and intraoperative blood usage were similar between the 2 groups (P = NS); however, donor-heart ischemia time was higher in the older group (P = .002). Older recipients had higher postoperative creatinine levels at peak (P = .003) and at discharge (P = .007). Frequency of postoperative complications, including reoperation for chest bleeding, dialysis, >48 hours ventilation, pneumonia, pneumothorax, sepsis, in-hospital and post-discharge infections, were similar between groups (P = NS for all comparisons). ICU and hospital length of stays were similar between groups (P = .35 and P = .87, respectively). In Cox analysis, recipient age ≥70 years was not identified as a predictor of lower long-term survival after HT. CONCLUSIONS HT recipients ≥70 years old had similar 1, 5, and 10-year survival rates compared with younger recipients. Both patient groups had similar intra- and postoperative blood utilization and frequencies of many postoperative complications. Older and younger patients had similar morbidity and mortality rates following HT. Carefully selected older patients (≥70 years) can safely undergo HT and should not be excluded from HT consideration based solely on age.
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Affiliation(s)
- M Awad
- Division of Cardiology, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - L S C Czer
- Division of Cardiology, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
| | - J Mirocha
- Section of Biostatistics, Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - A Ruzza
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - M de Robertis
- Division of Cardiology, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - M Rafiei
- Division of Cardiology, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - H Reich
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - M Sasevich
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - K Rihbany
- Division of Cardiology, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - R Kass
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - J Kobashigawa
- Division of Cardiology, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - F Arabia
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - A Trento
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - F Esmailian
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - D Ramzy
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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Arman D, Kuraitis D, Moriguchi J, Hamilton M, Liou F, Siddiqui S, Luu M, Zakowski P, Arabia F, Kobashigawa J. Do Prior Driveline Infections Increase the Risk of Infection in Heart Transplant Patients Treated With Rabbit Antithymocyte Globulin Induction Therapy? Transplant Proc 2017; 48:3393-3396. [PMID: 27931587 DOI: 10.1016/j.transproceed.2016.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The use of mechanical circulatory support devices (MCSDs) has been increasing over the past several years. Driveline infections (DLIs) are one of the most common complications seen in these patients; reportedly, up to 50% of patients with MCSDs can develop this complication. It is believed that the removal of the driveline results in treatment of the localized infection area. MCSD patients are also known to develop circulating antibodies. These circulating antibodies have been associated with poor outcomes after heart transplantation. The use of rabbit antithymocyte globulin (ATG) as induction therapy reportedly decreases the development of circulating antibodies; it is now commonly used in sensitized patients undergoing heart transplantation. It is unknown whether ATG induction therapy immediate posttransplant will increase the risk of infection of those MCSD patients with DLIs. METHODS Between 2003 and 2013, we evaluated 57 MCSD patients who subsequently underwent heart transplantation and received ATG induction therapy. Patients were divided into those with previous MCSD DLI and those without, and they were assessed for 1-year freedom from infection (specifically, sternal wound infections). One-year survival and freedom from treated rejection, both cellular and antibody mediated, were also assessed. RESULTS MCSD patients with DLIs who received ATG induction did not have a lower freedom from any treated infection and from sternal wound infection posttransplant compared with those MCSD patients without DLIs and not treated with ATG induction. There were also no significant differences between the 2 groups in terms of 1-year posttransplant survival and freedom from treated rejection. CONCLUSIONS The use of ATG induction in patients with prior DLIs did not seem to increase the risk for posttransplant infection (eg, sternal wound infection). ATG induction can therefore be safely used in this population.
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Affiliation(s)
- D Arman
- Cedars-Sinai Heart Institute, Los Angeles, California
| | - D Kuraitis
- Cedars-Sinai Heart Institute, Los Angeles, California
| | - J Moriguchi
- Cedars-Sinai Heart Institute, Los Angeles, California
| | - M Hamilton
- Cedars-Sinai Heart Institute, Los Angeles, California
| | - F Liou
- Cedars-Sinai Heart Institute, Los Angeles, California
| | - S Siddiqui
- Cedars-Sinai Heart Institute, Los Angeles, California
| | - M Luu
- Cedars-Sinai Heart Institute, Los Angeles, California
| | - P Zakowski
- Division of Infectious Diseases, Cedars-Sinai Medical Center, Los Angeles, California
| | - F Arabia
- Cedars-Sinai Heart Institute, Los Angeles, California
| | - J Kobashigawa
- Cedars-Sinai Heart Institute, Los Angeles, California.
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Volod O, Lam L, Barglowski M, Mirocha J, Runyan C, Moriguchi J, Czer L, Arabia F. Comparison of Activated Partial Thromboplastin Time (aPTT) and Anti-Factor Xa for Low Intensity Unfractionated Heparin Monitoring in Patients with Mechanical Circulatory Support Devices (MCSD). J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1268] [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: 11/17/2022] Open
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16
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Barone H, Coleman B, Aronow H, Runyan C, Hajj J, Huie N, Passano E, Czer L, Kobashigawa J, Moriguchi J, Arabia F. Implementing Practices to Improve Self-Care Among Caregivers of Patients with Mechanical Circulatory Support. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1012] [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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17
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Cohn W, Arabia F, Timms D, Greatrex N, Kleinheyer M, Nestler F, Diab S, Frazier O. Pulsatile Outflow in Cows Supported Long-Term with the BiVACOR Rotary TAH. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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18
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Reich H, Ramzy D, Mirocha J, De Robertis M, Chung J, Esmailian F, Chang D, Moriguchi J, Czer L, Trento A, Arabia F. Not All INTERMACS Level 1’s Are the Same: Survival After Total Artificial Heart Implantation with or without Temporary Circulatory Support. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.977] [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: 10/19/2022] Open
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19
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Zhang X, Mirocha J, Aintablian T, Moriguchi J, Arabia F, Kobashigawa J, Reinsmoen N. Revealing a New Mode of Sensitization Induced by Mechanical Circulatory Support Devices (MCS): Impact of Anti-AT1R Antibodies. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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20
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Coleman B, Barone H, Aronow H, Runyan C, Hajj J, Huie N, Passano E, Czer L, Kobashigawa J, Moriguchi J, Arabia F. Mechanical Circulatory Support Caregiver Gender Burden and Benefit: Is There a Difference? J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1008] [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: 10/19/2022] Open
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21
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Moriguchi J, Kittleson M, Patel J, Aintablian T, Kwan J, Kransdorf E, Geft D, Chang D, Czer L, Kobashigawa J, Arabia F. Combined Heart-Kidney Transplant vs Heart Alone Transplant in Patients with Total Artificial Heart: Are they Viable? J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.922] [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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22
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Mohan R, Neyer J, Patel J, Kittleson M, Aintablian T, Levine R, Chang D, Czer L, Moriguchi J, Kobashigawa J, Arabia F. Pre-Implant Moderate-Severe Fibrosis on Liver Biopsy Predicts Adverse Outcomes After Mechanical Circulatory Support. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.322] [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: 10/19/2022] Open
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23
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Conte A, Hajj J, Yang S, Passano E, Barone H, Chang D, Esmailian F, Czer L, Kobashigawa J, Moriguchi J, Arabia F. Utilization of Transverse Abdominis Plexus Block for Treatment of Left Ventricular Assist Device Associated Driveline Pain / Abdominal Pain Refractory to Conventional Multi-Modal Therapy: A Case Series. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1006] [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: 10/19/2022] Open
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24
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Barone H, Hajj J, Runyan C, Huie N, Jocson R, Geft D, Passano E, Czer L, Moriguchi J, Kobashigawa J, Arabia F. Managing Driveline Repairs in Total Artificial Heart Patients: A Single Center Experience. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1199] [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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25
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Esmailian F, Perry P, Luu M, Patel J, Kittleson M, Czer L, Aintablian T, Zarrini P, Velleca A, Rush J, Arabia F, Kobashigawa J. Vasoplegia After Heart Transplantation: Unraveling the Enigma. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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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26
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Arabia F, Milano C, Mahr C, McGee E, Maltais S, Boyce S, Pretorius V, Civitello A, Mallidi H, Mokadam N, Rame J, Naftel D, Myers S, Kirklin J. Early Results of Biventricular Support with Durable, Intracorporeal Continuous Flow Centrifugal Ventricular Assist Devices: Analysis from INTERMACS. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.261] [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: 10/22/2022] Open
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27
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Runyan C, Henry H, Huie N, Moriguchi J, Kittleson M, Czer L, Chang D, Passano E, Aintablian T, Kobashigawa J, Esmailian F, Arabia F. Can Patients with Restrictive Physiology Be Successfully Bridged to Transplant with Left Ventricular Support Alone Versus Biventricular Support? J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.1106] [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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28
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Awad M, Czer L, De Robertis M, Mirocha J, Ruzza A, Rafiei M, Reich H, Trento A, Moriguchi J, Kobashigawa J, Esmailian F, Arabia F, Ramzy D. Adult Heart Transplantation Following Ventricular Assist Device Implantation: Early and Late Outcomes. Transplant Proc 2016; 48:158-66. [DOI: 10.1016/j.transproceed.2015.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
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Ruzza A, Czer L, De Robertis M, Luthringer D, Moriguchi J, Kobashigawa J, Trento A, Arabia F. Total Artificial Heart as Bridge to Heart Transplantation in Chagas Cardiomyopathy: Case Report. Transplant Proc 2016; 48:279-81. [DOI: 10.1016/j.transproceed.2015.12.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
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Reich H, Czer L, Bannykh S, De Robertis M, Wolin E, Amersi F, Moriguchi J, Kobashigawa J, Arabia F. Total Artificial Heart Bridge to Transplantation for a Patient With Occult Intracardiac Malignancy: Case Report. Transplant Proc 2015; 47:2291-4. [DOI: 10.1016/j.transproceed.2015.04.083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 04/28/2015] [Indexed: 10/23/2022]
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31
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Ghafourian K, Moriguchi J, Kittleson M, Czer L, Passano E, Liou F, Huie N, Chang D, Trento A, Arabia F, Kobashigawa J. Does Time on Ventricular Assist Device Compromise Post-Transplant Outcome? J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.488] [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: 11/16/2022] Open
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32
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McMenamy M, Arabia F, Czer L, Kittleson M, Passano E, Liou F, Yabuno J, Chang D, Esmailian F, Kobashigawa J, Moriguchi J. Breaking the Myth of Obesity as a Contraindication to Continuous Flow Left Ventricular Assist Devices. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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33
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Runyan C, Moriguchi J, Kittleson M, Czer L, Passano E, Liou F, Chang D, Ramzy D, Esmailian F, Kobashigawa J, Arabia F. Reliability of the Freedom Driver After Total Artificial Heart Implantation. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.569] [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: 10/23/2022] Open
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34
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Arabia F, Kittleson M, Czer L, Hajj J, Passano E, Liou F, Siddiqui S, Chang D, Kobashigawa J, Moriguchi J, Heart Institute CS, Los Angeles CA. The Risk of Hospital Readmissions Following Mechanical Circulatory Support Placement. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.335] [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: 11/16/2022] Open
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35
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Kansara P, Czer L, Awad M, Arabia F, Mirocha J, De Robertis M, Moriguchi J, Ramzy D, Kass RM, Esmailian F, Trento A, Kobashigawa J. Heart transplantation with and without prior sternotomy: analysis of the United Network for Organ Sharing database. Transplant Proc 2015; 46:249-55. [PMID: 24507061 DOI: 10.1016/j.transproceed.2013.09.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 09/26/2013] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Patients with history of prior sternotomy may have poorer outcomes after heart transplantation. Quantitation of risk from prior sternotomy has not been well established. The United Network for Organ Sharing (UNOS) database was analyzed to assess early and late survival and predictors of outcome in adult heart transplant recipients with and without prior sternotomy. METHODS Of 11,266 adults with first heart-only transplantation from 1997 to 2011, recipients were divided into 2 groups: those without prior sternotomy (first sternotomy group; n = 6006 or 53.3%) and those with at least 1 prior sternotomy (redo sternotomy group; n = 5260 or 46.7%). A multivariable Cox model was used to identify predictors of mortality. RESULTS Survival was lower in the redo group at 60 days (92.6% vs 95.9%; hazard ratio [HR] 1.83, 95% confidence interval [CI]: 1.56-2.15; P < .001). Conditional 5-year survival in 60-day survivors was similar in the 2 groups (HR = 1.01, 95% CI 0.90-1.12, P = .90). During the first 60 days post-transplant, the redo group had more cardiac reoperations (12.3% vs 8.8%, P = .0008), a higher frequency of dialysis (8.9% vs 5.2%, P < .0001), a greater percentage of drug-treated infections (23.2% vs 19%, P = .003), and a higher percentage of strokes (2.5% vs 1.4%, P = .0001). A multivariable Cox proportional hazards model identified prior sternotomy as a significant independent predictor of mortality, in addition to age, female gender, congenital cardiomyopathy, need for ventilation, mechanical circulatory support, dialysis prior to transplant, pretransplant serum bilirubin (≥ 3 mg/dL), and preoperative serum creatinine (≥ 2 mg/dL). CONCLUSIONS Prior sternotomy is associated with an excess 3.3% mortality and higher morbidity within the first 60 days after heart transplantation, as measured by frequency of dialysis, drug-treated infections, and strokes. Conditional 5-year survival after 60 days is unaffected by prior sternotomy. These findings should be taken into account for risk assessment of patients undergoing heart transplantation.
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Affiliation(s)
- P Kansara
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - L Czer
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA.
| | - M Awad
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - F Arabia
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - J Mirocha
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - M De Robertis
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - J Moriguchi
- Section of Biostatistics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - D Ramzy
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - R M Kass
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - F Esmailian
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - A Trento
- Division of Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - J Kobashigawa
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA
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Ruzza A, Czer LSC, Ihnken KA, Sasevich M, Trento A, Ramzy D, Esmailian F, Moriguchi J, Kobashigawa J, Arabia F. Combined heart-kidney transplantation after total artificial heart insertion. Transplant Proc 2015; 47:210-2. [PMID: 25596961 DOI: 10.1016/j.transproceed.2014.09.106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/17/2014] [Indexed: 11/25/2022]
Abstract
We present the first single-center report of 2 consecutive cases of combined heart and kidney transplantation after insertion of a total artificial heart (TAH). Both patients had advanced heart failure and developed dialysis-dependent renal failure after implantation of the TAH. The 2 patients underwent successful heart and kidney transplantation, with restoration of normal heart and kidney function. On the basis of this limited experience, we consider TAH a safe and feasible option for bridging carefully selected patients with heart and kidney failure to combined heart and kidney transplantation. Recent FDA approval of the Freedom driver may allow outpatient management at substantial cost savings. The TAH, by virtue of its capability of providing pulsatile flow at 6 to 10 L/min, may be the mechanical circulatory support device most likely to recover patients with marginal renal function and advanced heart failure.
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Affiliation(s)
- A Ruzza
- Cedars-Sinai Heart Institute, Division of Cardiothoracic Surgery, Cedars Sinai Medical Center, Los Angeles, California, United States
| | - L S C Czer
- Cedars-Sinai Heart Institute, Division of Cardiology, Cedars Sinai Medical Center, Los Angeles, California, United States.
| | - K A Ihnken
- Cedars-Sinai Heart Institute, Division of Cardiothoracic Surgery, Cedars Sinai Medical Center, Los Angeles, California, United States
| | - M Sasevich
- Cedars-Sinai Heart Institute, Division of Cardiothoracic Surgery, Cedars Sinai Medical Center, Los Angeles, California, United States
| | - A Trento
- Cedars-Sinai Heart Institute, Division of Cardiothoracic Surgery, Cedars Sinai Medical Center, Los Angeles, California, United States
| | - D Ramzy
- Cedars-Sinai Heart Institute, Division of Cardiothoracic Surgery, Cedars Sinai Medical Center, Los Angeles, California, United States
| | - F Esmailian
- Cedars-Sinai Heart Institute, Division of Cardiothoracic Surgery, Cedars Sinai Medical Center, Los Angeles, California, United States
| | - J Moriguchi
- Cedars-Sinai Heart Institute, Division of Cardiology, Cedars Sinai Medical Center, Los Angeles, California, United States
| | - J Kobashigawa
- Cedars-Sinai Heart Institute, Division of Cardiology, Cedars Sinai Medical Center, Los Angeles, California, United States
| | - F Arabia
- Cedars-Sinai Heart Institute, Division of Cardiothoracic Surgery, Cedars Sinai Medical Center, Los Angeles, California, United States
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Kobashigawa J, Moriguchi J, Reinsmoen N, Kittleson M, Yu Z, Liou F, Ngan A, Runyan C, Henry H, Chang D, Czer L, Arabia F. Sensitized VADs vs. Sensitized Non-VADs: Is There an Immunological Difference? J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.823] [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: 10/25/2022] Open
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Moriguchi J, Arabia F, Jocson R, Patel J, Kittleson M, Liou F, Yu Z, Ernst W, Hamilton M, Chang D, Czer L, Kobashigawa J. Extracorporeal Membrane Oxygenation as a Bridge to Decision for INTERMACS 1 Patients. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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39
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Awad M, Czer L, Rihbany K, Sasevich M, Ruzza A, Rafiei M, Mirocha J, De Robertis M, Kass R, Arabia F, Trento A, Esmailian F, Ramzy D. Comparable Mortality and Morbidity of Orthotopic Heart Transplantation for Patients Younger and Older Than 70 Years. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.205] [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: 11/30/2022] Open
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40
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Coleman B, Phillips A, Mirocha J, Patel J, Arabia F, Kobashigawa J. Antithymocyte Globulin But Not Basiliximab Is Beneficial After Infant Heart Transplantation - Analysis of the UNOS Database. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.048] [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: 10/25/2022] Open
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41
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Torregrossa G, Gerosa G, Tarzia V, Vida V, Duveau D, Arabia F, Leprince P, Kasirajan V, Beyersdof F, Loforte A, Musumeci F, Hetzer R, Krabatsch T, Gummert J, Morshuis M, Copeland J. Long Term Results with Total Artificial Heart: Is It Prime Time for Destination Therapy? J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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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Haddad D, Staley L, Wu Q, Gallegos-Orozco J, Arabia F, Naidu S. Single center interventional radiology experience in the management of gastrointestinal bleeding in patients with ventricular assist devices. J Vasc Interv Radiol 2013. [DOI: 10.1016/j.jvir.2013.01.276] [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: 10/27/2022] Open
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Kasirajan V, Arabia F, Tang D, Jarowszeki D, Hoopes C, Esmailian F, Joyce L, McGrath M, David M, Smith C, Jennifer G, Bowdish M, Mokadam N, Long J. Artificial Heart Patients Discharged Home with a Portable Pneumatic Driver – The Pivotal US Clinical Trial Experience. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Kalya A, Boyle K, Goel R, Arabia F, Pajaro O, Scott R, Gopalan R, Jaroszewski D, Kasper D, Wu Q, Staley L, Pierce C. 567 Renal Dysfunction Following Syncardia Total Artificial Heart Implantation Does Not Affect Survival Following Heart Transplantation. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Larson DF, Elkund DK, Arabia F, Copeland JG. Plasmapheresis during cardiopulmonary bypass: a proposed treatment for presensitized cardiac transplantation patients. J Extra Corpor Technol 1999; 31:177-83. [PMID: 10915474] [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] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Potential thoracic organ transplantation recipients who have positive cytotoxic antibody screens as quantified panel reactive antibodies (PRA) are at risk for immediate or long-term immunologic events that may affect the donor organ. The patient population at risk includes those who are supported with cardiac assist devices, multiparous women, and individuals receiving numerous homologous blood products. We treated three highly positive PRA patients with intraoperative plasmapheresis coupled to the cardiopulmonary bypass system to remove sufficient cytotoxic antibody. Upon the availability of donor hearts of an unknown HLA type, intraoperative plasmapheresis was performed using a Cobe Spectra Plasmapheresis system coupled to a Terumo CXSX18 oxygenator system. Three plasma volume exchanges of fresh frozen plasma (FFP) were performed while the patients were on cardiopulmonary bypass. One to one and one-half plasma volume exchange plasmaphereses were performed with a declining schedule for the next 30 days post-transplantation in combination with aggressive B-cell specific immunosuppressive therapy. The three patients are NYHA functional class I and free of rejection at 6 months post-transplantation. In conclusion, intraoperative plasmapheresis is effective and safe for the patient who would not be otherwise transplanted because of markedly elevated PRAs.
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Affiliation(s)
- D F Larson
- Sarver University Heart Center, Circulatory Sciences Graduate Perfusion Program, University of Arizona, Tucson
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Hubbard RC, Casolaro MA, Mitchell M, Sellers SE, Arabia F, Matthay MA, Crystal RG. Fate of aerosolized recombinant DNA-produced alpha 1-antitrypsin: use of the epithelial surface of the lower respiratory tract to administer proteins of therapeutic importance. Proc Natl Acad Sci U S A 1989; 86:680-4. [PMID: 2783491 PMCID: PMC286537 DOI: 10.1073/pnas.86.2.680] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
To evaluate the possibility of administering therapeutic proteins via the respiratory route, we administered an aerosol of recombinant DNA-produced human alpha 1-antitrypsin (rAAT) to anesthetized sheep and measured levels of the protein in epithelial lining fluid (ELF), lung lymph, blood, and urine. Using a nebulizer that generated aerosol droplets with a mass median aerodynamic diameter of 2.7 micron (55% of droplets were less than 3 micron, a particle size optimal for deposition on the alveolar epithelium), in vitro studies demonstrated that the aerosolized rAAT remained intact and fully functional as an inhibitor of neutrophil elastase. When aerosolized to sheep, the 45-kDa rAAT molecule diffused across the alveolar epithelium, as evidenced by its presence in lung lymph and in blood. Comparison of ELF, lymph, blood, and urine rAAT levels demonstrated that the process was concentration dependent, with highest levels in ELF and in descending concentrations with approximately 10-fold concentration differences in each consecutive compartment, respectively. Importantly, evaluation with aerosolized 125I-labeled rAAT demonstrated that the rAAT molecules that reached the lung lymph and the systemic circulation remained intact as a 45-kDa protein. These results demonstrate the feasibility of using aerosolization to the pulmonary epithelial surface to administer sizeable proteins of therapeutic interest, thus circumventing the necessity of the traditional parenteral modes of administration of such molecules.
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Affiliation(s)
- R C Hubbard
- Pulmonary Branch, National Heart, Lung, and Blood Institute, Bethesda, MD 20892
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Bonaduce D, Petretta M, Gallo C, Conforti G, Breglio R, Arrichiello P, Arabia F. [Prognostic evaluation of patients surviving acute myocardial infarct: univariate and multivariate analysis]. G Ital Cardiol 1986; 16:465-74. [PMID: 3758580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The relationship between 31 variables and survival after acute myocardial infarction was evaluated in 432 patients discharged from our Coronary Care Unit from 1975 to 1984. The patients were followed for 1 to 105 months and either univariate and multivariate analysis were performed. For end-point death the significant variables (p less than 0.05) selected by the univariate analysis were: age, diabetes, smoke, heart rate at recovery, supraventricular arrhythmias, cardiac failure and complex ventricular arrhythmias either during recovery, either after discharge and finally spontaneous angina after hospital discharge. Meanwhile, for the end-point cardiac death age, smoke and supraventricular arrhythmias were not yet significant while arterial pressure at recovery and effort angina after hospital discharge were. Multivariate analysis identified cardiac failure during recovery, diabetes, complex ventricular arrhythmias before and spontaneous angina after discharge as independent variables contributing to total mortality: effort angina was a further significant one relatively to cardiac death. Thus, our study points out the importance of multivariate survival analysis when evaluating the relationship between survival after discharge for the effect of other prognostic factors. Moreover, providing identification of high risk cohorts permits appropriate interventions designed to lessen risk.
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Bonaduce D, Morgano G, Leosco D, Longobardi G, Arabia F, Breglio R, Vitagliano G, D'Ascia C. [Different prognostic significance of ventricular tachycardia in patients with acute or previous myocardial infarction]. Cardiologia 1984; 29:195-201. [PMID: 6541938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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