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Hack M, Wood KL, Bjelic M, Paic F, Vidula H, Cheyne C, Chase K, Tallman M, Bernstein W, Wyrobek JA, Alexis JD, Gosev I. Less Invasive Left Ventricular Assist Device Implantation Is Safe and Feasible in Patients With Smaller Body Surface Area. Innovations (Phila) 2023; 18:445-451. [PMID: 37794726 DOI: 10.1177/15569845231198088] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Smaller body surface area (BSA) frequently precludes patients from left ventricular assist device (LVAD) therapy. We sought to investigate the clinical outcomes in patients with small BSA undergoing less invasive LVAD implantation. METHODS We conducted a retrospective review of 216 patients implanted with HeartMate 3 LVAD (Abbott, Chicago, IL) via less invasive surgery at our institution. Patients were dichotomized based on their preimplant BSA for comparison between small BSA (≤1.8 m2) and normal/large BSA (>1.8 m2). We analyzed patient perioperative characteristics and outcomes. RESULTS In our study, small BSA was found in 32 patients (14.8%), while 184 patients (85.2%) had normal/large BSA. Women were more prevalent in the small BSA group (50.0% vs 13.0%, P < 0.001). Preoperative and intraoperative data showed comparable results. Major complications and hospital length of stay did not differ by BSA group. Patients with smaller BSA had significantly decreased pump parameters at discharge, including LVAD flow (4.11 ± 0.49 vs 4.60 ± 0.54 L/min, P < 0.001) and pump speed (5,200 vs 5,400 rpm, P < 0.001). Survival to discharge and within 6 months after implantation were similar between the groups. CONCLUSIONS Our study results suggest that less invasive HeartMate 3 implantation can be safely performed and demonstrates equivalent outcomes in patients with smaller body habitus. Randomized trials are required to confirm our data.
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Affiliation(s)
- Madelaine Hack
- Division of Cardiac Surgery, University of Rochester, NY, USA
| | | | - Milica Bjelic
- Division of Cardiac Surgery, University of Rochester, NY, USA
| | - Frane Paic
- Division of Cardiac Surgery, University of Rochester, NY, USA
| | | | | | - Karin Chase
- Division of Cardiac Surgery, University of Rochester, NY, USA
| | - Mark Tallman
- Division of Cardiac Surgery, University of Rochester, NY, USA
| | - Wendy Bernstein
- Division of Cardiac Surgery, University of Rochester, NY, USA
| | - Julie A Wyrobek
- Division of Cardiac Surgery, University of Rochester, NY, USA
| | | | - Igor Gosev
- Division of Cardiac Surgery, University of Rochester, NY, USA
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2
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Sherazi S, Alexis JD, McNitt S, Polonsky B, Shah S, Younis A, Kutyifa V, Vidula H, Gosev I, Goldenberg I. Racial differences in clinical characteristics and readmission burden among patients with a left ventricular-assist device. Artif Organs 2023; 47:1242-1249. [PMID: 36820756 DOI: 10.1111/aor.14506] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/13/2023] [Accepted: 01/24/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND There are limited data regarding racial disparities in outcomes after left ventricular assist device (LVAD) implantation. The purpose of this study was to compare clinical characteristics and the burden of readmissions by race among patients with LVAD. METHODS The study population included 461 patients implanted with LVADs at the University of Rochester Medical Center, NY from May 2008 to March 2020. Patients were stratified by race as White patients (N = 396 [86%]) and Black patients (N = 65 [14%]). The Anderson-Gill recurrent regression analysis was used to assess the independent association between race and the total number of admissions after LVAD implant during an average follow-up of 2.45 ± 2.30 years. RESULTS Black patients displayed significant differences in baseline clinical characteristics compared to White patients, including a younger age, a lower frequency of ischemic etiology, and a higher baseline serum creatinine. Black patients had a significantly higher burden of readmissions after LVAD implantation as compared with White patients 10 versus 7 (average number of hospitalizations per patient at 5 years of follow-up, respectively) translated into a significant 39% increased risk of recurrent readmissions after multivariate adjustment (Hazard ratio 1.39, 95% CI; 1.07-1.82, p 0.013). CONCLUSION Black LVAD patients experience an increased burden of readmissions compared with White patients, after adjustment for baseline differences in demographics and clinical characteristics. Future studies should assess the underlying mechanisms for this increased risk including the effect of social determinants of health on the risk of readmissions in LVAD recipients.
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Affiliation(s)
- Saadia Sherazi
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Jeffrey D Alexis
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Scott McNitt
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Bronislava Polonsky
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Suhaib Shah
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Arwa Younis
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Valentina Kutyifa
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Himabindu Vidula
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Igor Gosev
- Division of Cardiothoracic Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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3
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Thohan V, Abraham J, Burdorf A, Sulemanjee N, Jaski B, Guglin M, Pagani FD, Vidula H, Majure DT, Napier R, Heywood TJ, Cogswell R, Dirckx N, Farrar DJ, Drakos SG. Use of a Pulmonary Artery Pressure Sensor to Manage Patients With Left Ventricular Assist Devices. Circ Heart Fail 2023. [PMID: 37079511 DOI: 10.1161/circheartfailure.122.009960] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Background: Hemodynamic-guided management with a pulmonary artery pressure (PAP) sensor (CardioMEMSTM) is effective in reducing heart failure hospitalization (HFH) in patients with chronic heart failure (HF). This study aims to determine the feasibility and clinical utility of the CardioMEMS HF system to manage patients supported with LVADs. Methods: In this multi-center prospective study, we followed patients with HeartMate IITM (n=52) or HeartMate 3TM (n=49) LVADs and with CardioMEMS PA Sensors, and measured PAP, 6-minute walk distance (6MWD), quality of life (EQ-5D-5L scores), and HFH rates through 6 months. Patients were stratified as responders (R) and non-responders (NR) to reductions in PA diastolic pressure (PAD). Results: There were significant reductions in PAD from baseline to 6 months in R (21.5 to 16.5 mmHg, p<0.001), compared to an increase in NR (18.0 to 20.3, p=0.002). and there was a significant increase in 6MWD among R (266 vs 322 meters, p=0.025) compared to no change in NR. Patients who maintained PAD < 20 compared with PAD ≥ 20 mmHg for more than half the time throughout the study (averaging 15.6 vs 23.3 mmHg) had a statistically significant lower rate of HFH (12.0% vs 38.9%, p=0.005). Conclusions: LVAD patients managed with CardioMEMS with a significant reduction in PAD at 6 months showed improvements in 6MWD. Maintaining PAD < 20 mmHg was associated with fewer HF hospitalizations. Hemodynamic-guided management of LVAD patients with CardioMEMS is feasible and may result in functional and clinical benefits. Prospective evaluation of ambulatory hemodynamic management in LVAD patients is warranted. Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT03247829.
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Affiliation(s)
| | - Jacob Abraham
- Center for Cardiovascular Analytics, Research, and Data Science, Providence St. Vincent Medical Center, Portland, OR
| | - Adam Burdorf
- University of Nebraska Medical Center, Omaha, NE
| | - Nasir Sulemanjee
- Advocate Aurora Medical Group, St. Luke's Medical Center, Milwaukee, WI
| | | | - Maya Guglin
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN
| | | | | | - David T Majure
- Weill Cornell Medicine, Division of Cardiology, New York, NY
| | | | | | - Rebecca Cogswell
- University of Minnesota, Department of Medicine, Division of Cardiology, Minneapolis, MN
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4
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Goodman A, Fryer M, Jones A, Wood K, Bjelic M, Paic F, Thomas E, Hack M, Vidula H, Alexis J, Cheyne C, Chase K, Bernstein W, Lindenmuth D, Wyrobek J, Gosev I. Off-Pump Less Invasive HeartMate3 LVAD Implantation is Safe and Feasible Compared to the On-Pump Technique. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.902] [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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5
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Talha KM, Aktas MK, Goldenberg I, Zareba W, Boehm M, Abdin A, Vidula H, Brueckmann M, Zaremba-Pechmann L, Zeller C, Ferreira JP, Pocock SJ, Zannad F, Anker SD, Filippatos GS, Packer M, Butler J. EFFECT OF PRIMARY PREVENTION IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR THERAPY ON MORTALITY AND SUDDEN CARDIAC DEATH IN HEART FAILURE TREATED WITH SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITORS: AN ANALYSIS FROM THE EMPEROR-REDUCED TRIAL. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00813-6] [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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6
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Iyengar A, Cohen W, Han J, Helmers M, Kelly JJ, Patrick W, Moss N, Molina EJ, Sheikh FH, Houston BA, Tedford RJ, Shore S, Vorovich EE, Hsich EM, Bensitel A, Alexander KM, Chaudhry SP, Vidula H, Kilic A, Genuardi MV, Birati EY, Atluri P. Effects of Body Mass Index on Presentation and Outcomes of COVID-19 among Heart Transplant and Left Ventricular Assist Device Patients: A Multi-Institutional Study. ASAIO J 2023; 69:43-49. [PMID: 36583770 PMCID: PMC9797121 DOI: 10.1097/mat.0000000000001801] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic continues to pose a significant threat to patients receiving advanced heart failure therapies. The current study was undertaken to better understand the relationship between obesity and outcomes of SARS-CoV-2 infection in patients with a left ventricular assist device (LVAD) or heart transplant. We performed a retrospective review of patients with a heart transplant or LVAD who presented to one of the participating 11 institutions between April 1 and November 30, 2020. Patients were grouped by body mass index (BMI) into obese (BMI ≥ 30 k/m2) and nonobese cohorts (BMI < 30 kg/m2). Multivariable logistic regression models were used to estimate effects of obesity on outcomes of interest. Across all centers, 162 heart transplant and 81 LVAD patients were identified; 54 (33%) and 38 (47%) were obese, respectively. Obese patients tended to have more symptoms at presentation. No differences in rates of hospitalization or ICU admission were noted. Obese patients with LVADs were more likely to require mechanical ventilation (39% vs. 8%, p < 0.05). No differences in renal failure or secondary infection were noted. Mortality was similar among heart transplant patients (11% [obese] vs. 16% [nonobese], p = 0.628) and LVAD patients (12% vs. 15%, p = 1.0). BMI was not associated with increased adjusted odds of mortality, ICU admission, or mechanical ventilation (all p > 0.10). In summary, acute presentations of SARS-CoV-2 among heart transplant and LVAD recipients carry a significantly higher mortality than the general population, although BMI does not appear to impact this. Further studies on the longer-term effects of COVID-19 on this population are warranted.
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Affiliation(s)
- Amit Iyengar
- From the Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - William Cohen
- From the Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason Han
- From the Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark Helmers
- From the Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John J. Kelly
- From the Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - William Patrick
- From the Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Noah Moss
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ezequiel J. Molina
- Department of Surgery, MedStar Washington Hospital Center, Washington, DC
| | - Farooq H. Sheikh
- Department of Surgery, MedStar Washington Hospital Center, Washington, DC
| | - Brian A. Houston
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Ryan J. Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Supriya Shore
- Division of Cardiovascular Disease, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Esther E. Vorovich
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eileen M. Hsich
- Heart and Vascular Institute at the Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Albatoul Bensitel
- Heart and Vascular Institute at the Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Kevin M. Alexander
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Sunit-Preet Chaudhry
- Department of Medicine, Ascension St. Vincent – Indianapolis, Indianapolis, Indiana
| | - Himabindu Vidula
- Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michael V. Genuardi
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Edo Y. Birati
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- Cardiovascular Division, Poriya Medical Center, Bar Ilan University, Israel
| | - Pavan Atluri
- From the Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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7
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Chaudhry S, DeVore AD, Vidula H, Nassif M, Mudy K, Birati EY, Gong T, Atluri P, Pham D, Sun B, Bansal A, Najjar SS. Left Ventricular Assist Devices: A Primer For the General Cardiologist. J Am Heart Assoc 2022; 11:e027251. [PMID: 36515226 PMCID: PMC9798797 DOI: 10.1161/jaha.122.027251] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Durable implantable left ventricular assist devices (LVADs) have been shown to improve survival and quality of life for patients with stage D heart failure. Even though LVADs remain underused overall, the number of patients with heart failure supported with LVADs is steadily increasing. Therefore, general cardiologists will increasingly encounter these patients. In this review, we provide an overview of the field of durable LVADs. We discuss which patients should be referred for consideration of advanced heart failure therapies. We summarize the basic principles of LVAD care, including medical and surgical considerations. We also discuss the common complications associated with LVAD therapy, including bleeding, infections, thrombotic issues, and neurologic events. Our goal is to provide a primer for the general cardiologist in the recognition of patients who could benefit from LVADs and in the principles of managing patients with LVAD. Our hope is to "demystify" LVADs for the general cardiologist.
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Affiliation(s)
- Sunit‐Preet Chaudhry
- Division of CardiologyAscension St. Vincent Heart CenterIndianapolisIN,Ascension St. Vincent Cardiovascular Research InstituteIndianapolisIN
| | - Adam D. DeVore
- Department of Medicine and Duke Clinical Research InstituteDuke University School of MedicineDurhamNC
| | - Himabindu Vidula
- Division of Heart Failure and TransplantUniversity of Rochester School of Medicine and DentistryRochesterNY
| | - Michael Nassif
- Division of Heart failure and TransplantSaint Luke’s Mid America Heart InstituteKansas CityMO
| | - Karol Mudy
- Division of Cardiothoracic SurgeryMinneapolis Heart InstituteMinneapolisMN
| | - Edo Y. Birati
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and SurgeryPadeh‐Poriya Medical Center, Bar Ilan UniversityPoriyaIsrael
| | - Timothy Gong
- Center for Advanced Heart and Lung DiseaseBaylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical CenterDallasTX
| | - Pavan Atluri
- Division of Cardiovascular SurgeryUniversity of PennsylvaniaPhiladelphiaPA
| | - Duc Pham
- Center for Advanced Heart FailureBluhm Cardiovascular Institute, Northwestern University, Feinberg School of MedicineChicagoIL
| | - Benjamin Sun
- Division of Cardiothoracic Surgery, Abbott Northwestern HospitalMinneapolisMN
| | - Aditya Bansal
- Division of Cardiothoracic Surgery, Department of SurgeryOchsner Clinic FoundationNew OrleansLA
| | - Samer S. Najjar
- Division of Cardiology, MedStar Heart and Vascular InstituteMedstar Medical GroupBaltimoreMD
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8
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Bjelic M, Wood KL, Simon BV, Vidula H, Cheyne C, Chase K, Wu IY, Alexis JD, McNitt S, Goldenberg I, Gosev I. Left atrial appendage exclusion with less invasive left ventricular assist device implantation. J Card Surg 2022; 37:4967-4974. [PMID: 36378835 DOI: 10.1111/jocs.17200] [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] [Received: 09/13/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The objective of this single-center, pilot, prospective, and historical control study is to evaluate safety and feasibility outcomes associated with left atrial appendage exclusion (LAAE) concomitant with left ventricular assist device (LVAD) implantation via less invasive surgery (LIS) as a stroke prevention strategy. METHODS A predefined number of 30 eligible subjects scheduled for LIS LVAD with LAAE were enrolled in the prospective arm between January 2020 and February 2021. Eligible retrospective LIS LVAD patients without LAAE were propensity-matched in a 1:1 ratio with the prospective arm subjects. The primary study objectives were to evaluate the safety, feasibility, and efficacy of the LAAE concomitant with LIS LVAD. RESULTS Preoperative characteristics of patients in the Non-LAAE and LAAE groups were similar. LAAE was successfully excluded in all prospective patients (100%). Primary safety endpoints of chest tube output within the first 24 postoperative hours, Reoperation for bleeding within 48 h, and index hospitalization mortality demonstrated comparable safety of LAAE versus Non-LAAE with LIS LVAD. Cox proportional hazard regression demonstrated that LAAE with LIS LVAD was associated with 37% and 49% reduction in the risk of stroke and disabling stroke, respectively (p > .05). CONCLUSION Results from our pilot study demonstrated the safety and feasibility of LAAE concomitant with LIS LVAD as a stroke prevention strategy. This is the first prospective study describing LAAE performed concomitantly to less invasive LVAD implantation. The efficacy of LAAE in long-term stroke prevention needs to be confirmed in future prospective randomized clinical trials.
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Affiliation(s)
- Milica Bjelic
- Department of Surgery, Division of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Katherine L Wood
- Department of Surgery, Division of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Bartholomew V Simon
- Department of Surgery, Division of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Himabindu Vidula
- Department of Medicine, Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Christina Cheyne
- Department of Medicine, Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Karin Chase
- Department of Surgery, Division of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Isaac Y Wu
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Jeffrey D Alexis
- Department of Medicine, Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Scott McNitt
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Igor Gosev
- Department of Surgery, Division of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, New York, USA
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9
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Aktas MK, Zareba W, Butler J, Younis A, McNitt S, Brown MW, Rao N, Rao N, Steinberg J, Chen L, Alexis J, Vidula H, Goldenberg I. Confirm Rx insertable cardiac monitor for primary atrial fibrillation detection in high-risk heart failure patients (Confirm-AF trial). Ann Noninvasive Electrocardiol 2022; 28:e13021. [PMID: 36436199 PMCID: PMC9833354 DOI: 10.1111/anec.13021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/21/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patients with heart failure (HF) represent a large population of patients who are at high risk for complications related to undiagnosed atrial fibrillation (AF). However, currently there are limited modalities available for early AF detection in this high-risk population. An implantable cardiac monitor (ICM) is inserted subcutaneously and can provide long-term arrhythmia information via remote monitoring. METHODS AND RESULTS Confirm-AF is a prospective randomized, nonblinded, two arm, multicenter clinical trial to be performed in the United States, enrolling 477 patients with a history of HF hospitalization and left ventricular ejection fraction >35% from 30 medical sites. Patients will be randomized in a 2:1 fashion to undergo ICM implant with remote monitoring and symptom-triggered mobile app transmissions versus (vs.) Non-ICM management and follow-up. The primary objective of this trial is to compare the time to first detection of AF lasting > 5 min using an Abbott ICM compared to non-ICM monitoring in symptomatic HF patients. This article describes the design and analytic plan for the Confirm-AF trial. CONCLUSIONS The Confirm-AF trial seeks to accurately define the burden of AF in high-risk HF patients with LVEF > 35% using an Abbott ICM. A finding showing significantly higher incidence of AF along with improved clinical outcomes with ICM monitoring is expected to have substantial clinical implications and may change the method of monitoring high-risk HF patients.
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Affiliation(s)
- Mehmet K. Aktas
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Wojciech Zareba
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Javed Butler
- Baylor Scott and White Research InstituteDallasTexasUSA,Department of CardiologyUniversity of MississippiJacksonMississippiUSA
| | - Arwa Younis
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA,Clinical Electrophysiology, Department of CardiologyCleveland ClinicClevelandOhioUSA
| | - Scott McNitt
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Mary W. Brown
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Nikhila Rao
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Nilesh Rao
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Jonathan Steinberg
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA,Summit Medical GroupShort HillsNew JerseyUSA
| | - Leway Chen
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Jeffrey D. Alexis
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Himabindu Vidula
- Division of CardiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Ilan Goldenberg
- Clinical Cardiovascular Research CenterUniversity of Rochester Medical CenterRochesterNew YorkUSA
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10
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Ojo A, Younis A, Saxena S, Kutyifa V, Chen AY, McNitt S, Polonsky B, Aktas MK, Huang DT, Rosero S, Vidula H, Diamond A, Sampath R, Klein H, Steiner H, Zareba W, Goldenberg I. Comparison of Frequency of Ventricular Tachyarrhythmia in Men-Versus-Women in Patients with Implantable Cardioverter-Defibrillator for Primary Prevention. Am J Cardiol 2022; 176:43-50. [PMID: 35606170 DOI: 10.1016/j.amjcard.2022.04.027] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 11/19/2022]
Abstract
Current guidelines do not account for possible sex differences in the risk of ventricular tachyarrhythmia (VTA). We sought to identify specific factors associated with increased risk for VTA in women implanted with a primary prevention implantable cardioverter-defibrillator (ICD). Our study cohort consisted of 4,506 patients with an ICD or cardiac resynchronization therapy-defibrillator who were enrolled in the 4 landmark MADIT studies - MADIT-II, MADIT-RISK, MADIT-CRT and MADIT-RIT (1,075 women [24%]). Fine and Gray regression models were used to identify female-specific risk factors for the primary end point of VTA, defined as ICD-recorded, treated, or monitored, sustained ventricular tachycardia ≥170 beats per minute or ventricular fibrillation. At 3.5 years of follow-up, the cumulative incidence of VTA was significantly lower in women than men (17% vs 26%, respectively; p <0.001 for the entire follow-up). Use of amiodarone at enrollment, Black race, and history of previous myocardial infarction without previous revascularization was found to be independent risk factors of VTA in women. Of these factors, only Black race was associated with a statistically significant risk increase in men. At 3.5 years, the cumulative incidence of VTA in women with one or more of these risk factors was 27% compared with 14% in women with none of the risk factors (hazard ratio [confidence interval] = 2.08 [1.49 to 2.91]). In conclusion, our study, comprising 4 landmark ICD clinical trials, shows that sex and race have the potential to be used for improved risk stratification of patients who are candidates for primary prevention ICD.
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Affiliation(s)
- Amole Ojo
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York.
| | - Arwa Younis
- Department of Cardiovascular Medicine, Cleveland Clinic, Ohio
| | - Shireen Saxena
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - Valentina Kutyifa
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - Anita Y Chen
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York; Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York
| | - Scott McNitt
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - Bronislava Polonsky
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - Mehmet K Aktas
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - David T Huang
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - Spencer Rosero
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - Himabindu Vidula
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - Alexander Diamond
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - Ramya Sampath
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - Helmut Klein
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - Hillel Steiner
- Department of Cardiology, The Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Wojciech Zareba
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, New York
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11
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Bjelic M, Vidula H, Wu IY, McNitt S, Barrus B, Cheyne C, Chase K, Zottola Z, Alexis JD, Goldenberg I, Gosev I. Impact of surgical approach for left ventricular assist device implantation on postoperative invasive hemodynamics and right ventricular failure. J Card Surg 2022; 37:3072-3081. [PMID: 35842802 DOI: 10.1111/jocs.16766] [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] [Received: 01/10/2022] [Revised: 05/06/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Right ventricular failure (RVF) remains one of the major causes of morbidity and mortality after left ventricular assist device (LVAD) implantation. We sought to compare immediate postoperative invasive hemodynamics and the risk of RVF following two different surgical approaches: less invasive surgery (LIS) versus full sternotomy (FS). METHODS The study population comprised all 231 patients who underwent implantation of a HeartMate 3 (Abbott) LVAD at our institution from 2015 to 2020, utilizing an LIS (n = 161; 70%) versus FS (n = 70; 30%) surgical approach. Outcomes included postoperative invasive hemodynamic parameters, vasoactive-inotropic score (VIS), RVF during index hospitalization, and 6-month mortality. RESULTS Baseline clinical characteristics of the two groups were similar. Multivariate analysis showed that LIS, compared with FS, was associated with the improved cardiac index (CI) at the sixth postoperative hour (p = .036) and similar CI at 24 h, maintained by lower VIS at both timepoints (p = .002). The LIS versus FS approach was also associated with a three-fold lower incidence of in-hospital severe RVF (8.7% vs. 28.6%, p < .001) and need for RVAD support (5.0% vs. 17.1%, p = .003), and with 68% reduction in the risk of 6-month mortality after LVAD implantation (Hazard ratio, 0.32; CI, 0.13-0.78; p = .012). CONCLUSION Our findings suggest that LIS, compared with FS, is associated with a more favorable hemodynamic profile, as indicated by similar hemodynamic parameters maintained by lower vasoactive-inotropic support during the acute postoperative period. These findings were followed by a reduction in the risk of severe RVF and 6-month mortality in the LIS group.
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Affiliation(s)
- Milica Bjelic
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, University of Rochester, Rochester, New York, USA
| | - Himabindu Vidula
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, University of Rochester, Rochester, New York, USA
| | - Isaac Y Wu
- Department of Anesthesiology, University of Rochester Medical Center, University of Rochester, Rochester, New York, USA
| | - Scott McNitt
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, University of Rochester, Rochester, New York, USA
| | - Bryan Barrus
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, University of Rochester, Rochester, New York, USA
| | - Christina Cheyne
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, University of Rochester, Rochester, New York, USA
| | - Karin Chase
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, University of Rochester, Rochester, New York, USA
| | - Zachary Zottola
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, University of Rochester, Rochester, New York, USA
| | - Jeffrey D Alexis
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, University of Rochester, Rochester, New York, USA
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, University of Rochester, Rochester, New York, USA
| | - Igor Gosev
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, University of Rochester, Rochester, New York, USA
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Vidula H, Takeda K, Estep JD, Silvestry SC, Milano C, Cleveland JC, Goldstein DJ, Uriel N, Kormos RL, Dirckx N, Mehra MR. Hospitalization Patterns and Impact of a Magnetically-Levitated Left Ventricular Assist Device in the MOMENTUM 3 Trial. JACC Heart Fail 2022; 10:470-481. [PMID: 35772857 DOI: 10.1016/j.jchf.2022.03.007] [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] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/22/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND In the MOMENTUM 3 (Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3) pivotal trial, the HeartMate 3 (HM3) fully magnetically levitated left ventricular assist device (LVAD) demonstrated superiority over the axial-flow HeartMate II (HMII) LVAD. The patterns and predictors of hospitalizations with the HM3 LVAD have not been characterized. OBJECTIVES This study sought to determine causes, predictors, and impact of hospitalizations during LVAD support. METHODS Patients discharged after LVAD implantation were analyzed. In the pivotal trial, 485 recipients of HM3 were compared with 471 recipients of HMII. The pivotal trial HM3 group was also compared to 949 recipients of HM3 in the postapproval phase within the trial portfolio. Predictors of cause-specific rehospitalization were analyzed. RESULTS The rates of rehospitalization were lower with HM3 LVAD than with HMII LVAD in the pivotal trial (225.7 vs 246.4 events per 100 patient-years; P < 0.05). Overall, rehospitalization rates and duration were similar in the HM3 postapproval phase and pivotal trial but prolonged hospitalizations (>7 days) were less frequent (rate ratio: 0.90 [95% CI: 0.80-0.98]; P < 0.05). In HM3 recipients, the most frequent causes of rehospitalization included infection, heart failure (HF)-related events, and bleeding. First rehospitalization caused by HF-related event versus other causes was associated with reduced survival (HR: 2.2 [95% CI: 1.3-3.9]; P = 0.0014). Male sex, non-White race, presence of cardiac resynchronization therapy/implantable cardioverter-defibrillator, obesity, higher right atrial pressure, smaller LV size, longer duration of index hospitalization, and lower estimated glomerular filtration rate at index discharge predicted HF hospitalizations. CONCLUSIONS Contemporary support with the HM3 fully magnetically levitated LVAD is associated with a lower hospitalization burden than with prior pumps; however, rehospitalizations for infection, HF, and bleeding remain important challenges for progress in the patient journey. (MOMENTUM 3 IDE Clinical Study, NCT02224755; MOMENTUM 3 Continued Access Protocol [MOMENTUM 3 CAP], NCT02892955).
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Affiliation(s)
- Himabindu Vidula
- Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Koji Takeda
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University College of Physicians and Surgeons and New York-Presbyterian Hospital, New York, New York, USA
| | - Jerry D Estep
- Kaufman Center for Heart Failure and Recovery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Scott C Silvestry
- Thoracic Transplant, Thoracic, and Cardiovascular Surgery Program, AdventHealth Transplant Institute, Orlando, Florida, USA
| | - Carmelo Milano
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Joseph C Cleveland
- Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Daniel J Goldstein
- Department of Cardiothoracic Surgery, Montefiore Einstein Center for Heart and Vascular Care, New York, New York, USA
| | - Nir Uriel
- Division of Cardiology, Columbia University College of Physicians and Surgeons and New York-Presbyterian Hospital, New York, New York, USA
| | | | | | - Mandeep R Mehra
- Center for Advanced Heart Disease, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, USA.
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Tankut S, Gosev I, Yoruk A, Younis A, McNitt S, Bjelic M, Vidula H, Wu I, Aktas MK, Goldenberg I, Huang DT. Intraoperative Ventricular Tachycardia Ablation During Left Ventricular Assist Device Implantation in High-Risk Heart Failure Patients. Circ Arrhythm Electrophysiol 2022; 15:e010660. [PMID: 35617273 DOI: 10.1161/circep.121.010660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sinan Tankut
- Department of Cardiology (S.T., H.V., M.K.A., D.T.H.), University of Rochester, NY
| | - Igor Gosev
- Clinical Cardiovascular Research Center (I.Goldenberg, S.M., M.B., I.G.), University of Rochester, NY.,Department of Cardiac Surgery (I.Gosev), University of Rochester, NY
| | - Ayhan Yoruk
- Department of Electrophysiology, University of California San Francisco (A.Y.)
| | - Arwa Younis
- Department of Electrophysiology, University of California San Francisco (A.Y.)
| | - Scott McNitt
- Clinical Cardiovascular Research Center (I.Goldenberg, S.M., M.B., I.G.), University of Rochester, NY
| | - Milica Bjelic
- Clinical Cardiovascular Research Center (I.Goldenberg, S.M., M.B., I.G.), University of Rochester, NY
| | - Himabindu Vidula
- Department of Cardiology (S.T., H.V., M.K.A., D.T.H.), University of Rochester, NY
| | - Isaac Wu
- Department of Cardiac Anesthesia (I.W.), University of Rochester, NY
| | - Mehmet K Aktas
- Department of Cardiology (S.T., H.V., M.K.A., D.T.H.), University of Rochester, NY
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center (I.Goldenberg, S.M., M.B., I.G.), University of Rochester, NY
| | - David T Huang
- Department of Cardiology (S.T., H.V., M.K.A., D.T.H.), University of Rochester, NY
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Aktas MK, Goldenberg I, Zareba W, Vidula H, Brueckmann M, Zeller C, Ferreira JP, Pocock S, ZANNAD F, Anker S, Filippatos G, Packer M, Butler J. HF-567-01 THE BENEFIT OF AN IMPLANTABLE CARDIOVERTER DEFIBRILLATOR IN HEART FAILURE PATIENTS TREATED WITH EMPAGLIFLOZIN: AN ANALYSIS FROM THE EMPEROR-REDUCED TRIAL. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.723] [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: 11/04/2022]
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15
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Vidula H, Altintas O, McNitt S, DeVore AD, Birati EY, Genuardi MV, Sheikh FH, Polonsky B, Alexis JD, Gosev I, Bisognano JD, Kutyifa V, Seidmann A, Goldenberg I. Low Blood Pressure Threshold for Adverse Outcomes During Left Ventricular Assist Device Support. Am J Cardiol 2022; 169:78-85. [PMID: 35063265 DOI: 10.1016/j.amjcard.2021.12.045] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 11/01/2022]
Abstract
It has been suggested that maintaining low mean arterial pressure (MAP) in left ventricular assist device (LVAD) recipients is associated with a reduced risk of stroke/death. However, the lower limit of the optimal MAP range has not been established. We aimed to identify this lower limit in a contemporary cohort of LVAD recipients with frequent longitudinal MAP measurements. We analyzed 86,651 MAP measurements in 309 patients with an LVAD (32% LVADs with full magnetic levitation of the impeller) at a tertiary medical center during a mean follow-up of 1.7 ± 1.1 years. Cox proportional hazards regression modeling was used to study the association of serial MAP measurements with stroke/death within 3 years after index discharge. Multivariate analysis identified MAP ≤75 mm Hg, compared with MAP >75 mm Hg, as the low MAP threshold associated with increased risk of death (hazard ratio [HR] 4.74, 95% confidence interval [CI] 2.85 to 7.87, p <0.001), stroke (HR 2.72;, 95% CI 1.39 to 5.33, p = 0.01), and stroke/death (HR 4.45, 95% CI 2.83 to 6.99, p <0.001). The risk associated with MAP ≤75 mm Hg was consistent in subgroups categorized by age, gender, race, device type, renal function, right-sided heart failure, and blood pressure medications. In conclusion, our findings suggest that maintaining MAP ≤75 mm Hg during long-term follow-up in LVAD recipients is associated with increased risk of stroke/death regardless of risk factors or medical management.
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Vidula H, McNitt S, Dennison C, Sampath R, Bjelic M, Sziveri Z, Alexis J, Gosev I, Caufield L, Goldenberg I. Safety and Efficacy of Home-Based Exercise Rehabilitation Using Remote Monitoring in New Left Ventricular Assist Device Recipients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.151] [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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Bjelic M, Wood K, Paic F, Louis C, Cheyne C, Goodman A, Gu Y, Chase K, Vidula H, Gosev I. Bridging INTERMACS Profile 1 Patients to Left Ventricular Assist Device: The Right Device, the Right Time, and the Best Surgical Approach. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1191] [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: 10/18/2022] Open
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18
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Bjelic M, Wood K, Vidula H, McNitt S, Cheyne C, Chase K, Bernstein W, Wyrobek J, Wu I, Alexis J, Goldenberg I, Gosev I. Comparison of Early and Late Postoperative Outcomes Between INTERMACS 1/2 vs. 3/4. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1445] [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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Wood K, Bjelic M, Paic F, Vidula H, Cheyne C, Chase K, Bernstein W, Wyrobek J, Alexis J, Gosev I. Less Invasive Left Ventricular Assist Device Implantation is Safe and Feasible in Patients with Smaller Body Surface Area. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.317] [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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20
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Vidula H, Dennison C, Sziveri Z, Alexis J, Gosev I, Caufield L, Goldenberg I. Home-based Exercise Rehabilitation Using Remote Monitoring In Left Ventricular Assist Device Recipients: Pilot Data From The Prospective Move-lvad Study. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.303] [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: 10/18/2022]
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21
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Vidula H, Cowger JA. Getting to the Heart of the Muscle: Sarcopenia in Advanced Heart Failure. J Heart Lung Transplant 2022; 41:763-764. [DOI: 10.1016/j.healun.2022.02.017] [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] [Received: 02/08/2022] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 11/24/2022] Open
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22
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Saeed O, Moss N, Barrus B, Vidula H, Shah S, Feitell S, Masser KS, Kilic A, Moin D, Atluri P, Barati E. Preventing Driveline Infection during Left Ventricular Assist Device Support by the HeartMate 3: A Survey-Based Study. Artif Organs 2022; 46:1409-1414. [PMID: 35083754 DOI: 10.1111/aor.14187] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 10/26/2021] [Revised: 11/30/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Driveline infection (DLI) is a significant source of morbidity and mortality during left ventricular assist device (LVAD) support yet limited studies are available to describe center-level prevalence, preventive practices and their potential effectiveness. METHODS We surveyed LVAD centers in the United States to determine program burden and preventive practices for DLI during HeartMate (HM) 3 support. An online, anonymous, question-based survey was sent to expert providers at implanting centers. Only a single respondent completed the survey for each center. As an exploratory analysis, we compared specific DLI preventive practices between centers with low (≤10%) and high (>10%) reported prevalence of DLI. RESULTS Seventy-eight centers responded to the survey (response rate: 50%). Respondent were comprised of 37 (47%) heart failure cardiologists, 27 (35%) LVAD coordinators and 14 (18%) cardiothoracic surgeons. The prevalence of DLI during HM3 was reported as ≤10% by 27 (35%), 11-25% by 36 (46%) and >25% by 16 (19%) of centers. Thirteen (17%) centers had a body mass index threshold for device placement, 29 (37%) utilized a counter incision, 66 (81%) placed an anchor stitch and 69 (88%) used an external device to stabilize the DL. Proportionally more centers with a low DLI prevalence used a wound vacuum 6(22%) vs. 3(6%, p=0.03) than those with high DLI. CONCLUSION Variation exists in reported prevalence and practices of preventing and managing driveline infections across centers during HM3 support. Further studies are warranted to develop and assess the effectiveness of standardized preventive strategies.
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Affiliation(s)
- Omar Saeed
- Department of Medicine (Cardiology), Montefiore Medical Center, Bronx, NY, USA
| | - Noah Moss
- Department of Medicine (Cardiology), Mount Sinai Medical Center, New York, NY, USA
| | - Bryan Barrus
- Department of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Himabindu Vidula
- Department of Medicine (Cardiology), University of Rochester Medical Center, Rochester, NY, USA
| | - Samit Shah
- Department of Medicine (Cardiology), NorthWell Health, Manhasset, NY, USA
| | - Scott Feitell
- Department of Medicine (Cardiology), Rochester Regional Medical Center, Bronx, NY, USA
| | | | - Arman Kilic
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Danyaal Moin
- Department of Medicine (Cardiology), Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Pavan Atluri
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Edo Barati
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Sherazi S, Goldenberg I, McNitt S, Kutyifa V, Gosev I, Wood K, Chen L, Polonsky B, Vidula H, Alexis JD. Smoking and the Risk of Stroke in Patients with a Left Ventricular Assist device. ASAIO J 2021; 67:1217-1221. [PMID: 34049312 DOI: 10.1097/mat.0000000000001458] [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] [Indexed: 11/26/2022] Open
Abstract
There are limited data on the association of smoking with the risk of stroke following left ventricular assist device (LVAD) implantation. We designed this study to analyze the impact of smoking status at the time of LVAD implantation on stroke. We hypothesized that current smokers are at increased risk of stroke when compared with patients who were former or never smokers. The study population comprised of 369 patients in the University of Rochester Medical Center LVAD database, implanted with an LVAD between 2008 and 2018. Patients were stratified as current smoker (smoking within 30 days before LVAD implantation), former smoker, and never smoker. Stroke was defined as a transient ischemic attack or cerebrovascular accident (hemorrhagic or ischemic). There were 45 current smokers, 198 former smokers, and 125 never smokers. Current smokers were younger (mean age 50 ± 11 years), as compared with former (58 ± 12 years) and never smokers (56 ± 13 years) p < 0.001. At 2 years following LVAD implantation, the cumulative incidence of stroke was significantly higher among current smokers (39%) as compared with former and never smokers (16% and 15%, respectively; p = 0.022 for the overall difference during follow-up). In a multivariate model adjusted for significant clinical variables, current smoking was associated with a significant 88% (p = 0.018) higher risk of stroke when compared with all noncurrent smokers. In conclusion, our data suggest that LVAD candidates who are current smokers experience a significantly higher risk of stroke following device implantation.
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Affiliation(s)
- Saadia Sherazi
- From the Division of Cardiology, Clinical Cardiovascular Research Center and
| | - Ilan Goldenberg
- From the Division of Cardiology, Clinical Cardiovascular Research Center and
| | - Scott McNitt
- From the Division of Cardiology, Clinical Cardiovascular Research Center and
| | - Valentina Kutyifa
- From the Division of Cardiology, Clinical Cardiovascular Research Center and
| | - Igor Gosev
- Division of Cardiothoracic Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Katherine Wood
- Division of Cardiothoracic Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Leway Chen
- From the Division of Cardiology, Clinical Cardiovascular Research Center and
| | - Bronislava Polonsky
- From the Division of Cardiology, Clinical Cardiovascular Research Center and
| | - Himabindu Vidula
- From the Division of Cardiology, Clinical Cardiovascular Research Center and
| | - Jeffrey D Alexis
- From the Division of Cardiology, Clinical Cardiovascular Research Center and
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Schwartz RG, Vidula H. 2020 vision: New insights on hypoxia imaging to assess cardiac and extra-cardiac active inflammatory sarcoidosis. J Nucl Cardiol 2021; 28:2149-2150. [PMID: 32034664 DOI: 10.1007/s12350-020-02032-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/04/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Ronald G Schwartz
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, AC-G, Rochester, NY, 14642-8679, USA.
- Division of Nuclear Medicine, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA.
| | - Himabindu Vidula
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, AC-G, Rochester, NY, 14642-8679, USA
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Tankut S, Yoruk A, Younis A, McNitt S, Bjelic M, Vidula H, Gosev I, Aktas MK, Goldenberg I, Huang DT. B-PO04-129 INTRAOPERATIVE VENTRICULAR TACHYCARDIA ABLATION DURING LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION IN HIGH-RISK HEART FAILURE PATIENTS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.823] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Al Jebaje Z, Wu M, McNitt S, Vidula H, Chen L, Alexis J, Goldenberg I, Kutyifa V. B-AB23-05 OUTCOMES AND COMPLICATIONS OF CARDIAC RESYNCHRONIZATION THERAPY IN PATIENTS WITH CONTINUOUS-FLOW LEFT VENTRICULAR ASSIST DEVICES. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.132] [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: 11/29/2022]
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27
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Bjelic M, Ayers B, Paic F, Bernstein W, Barrus B, Chase K, Gu Y, Alexis JD, Vidula H, Cheyne C, Prasad S, Gosev I. Study results suggest less invasive HeartMate 3 implantation is a safe and effective approach for obese patients. J Heart Lung Transplant 2021; 40:990-997. [PMID: 34229916 DOI: 10.1016/j.healun.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/15/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Historically, obesity was considered a relative contraindication to left ventricular assist device (LVAD) implantation with less invasive surgery (LIS). The present study aimed to compare the outcomes of obese patients who underwent LVAD implantation through LIS with those who received full sternotomy (FS) implantation. METHODS We retrospectively reviewed all patients implanted with HeartMate 3 LVAD in our institution between September 2015 and June 2020. Obese patients (BMI ≥ 30 kg/m2) were included and dichotomized based on surgical approach into the FS or LIS cohort. RESULTS Of 231 implanted patients, 107 (46%) were obese and included in the study. FS was performed in 26 (24%) patients and LIS approach in 81 (76%) patients. Preoperative patient characteristics were similar between the cohorts. Postoperatively, patients in LIS cohort had less bleeding (p = 0.029), fewer transfusions (p = 0.042), shorter duration of inotropic support (p = 0.049), and decreased incidence of severe RV failure (11.1% vs 30.8%, p = 0.028). Survival to discharge for the obese population was 87.5% overall and did not differ based on an approach (91.4% LIS vs 76.9% FS, p = 0.079). More LIS patients were discharged home (60.0% vs 82.4%, p = 0.041) rather than to rehabilitation center. CONCLUSION Our results showed that the LIS approach in obese patients is associated with fewer postoperative complications and a trend towards better short-term survival. These results suggest that less invasive LVAD implantation is a safe and effective approach for obese patients. Future prospective randomized trials are required to substantiate these results.
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Affiliation(s)
- Milica Bjelic
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Brian Ayers
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Frane Paic
- Department of Medical Biology and Genetics, University of Zagreb Medical School, Zagreb, Croatia
| | - Wendy Bernstein
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York
| | - Bryan Barrus
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Karin Chase
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Yang Gu
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York
| | - Jeffrey D Alexis
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Himabindu Vidula
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Christina Cheyne
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Sunil Prasad
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Igor Gosev
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York.
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Lindenmuth DM, Chase K, Cheyne C, Wyrobek J, Bjelic M, Ayers B, Barrus B, Vanvoorhis T, Mckinley E, Falvey J, Barney B, Fingerut L, Sitler B, Kumar N, Akwaa F, Paic F, Vidula H, Alexis JD, Gosev I. Enhanced Recovery After Surgery in Patients Implanted with Left Ventricular Assist Device. J Card Fail 2021; 27:1195-1202. [PMID: 34048920 DOI: 10.1016/j.cardfail.2021.05.006] [Citation(s) in RCA: 3] [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: 02/26/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION We sought to develop and implement a comprehensive enhanced recovery after surgery (ERAS) protocol for patients implanted with a left ventricular assist device (LVAD). METHODS AND RESULTS In this article, we describe our approach to the development and phased implementation of the protocol. Additionally, we reviewed prospectively collected data for patients who underwent LVAD implantation at our institution from February 2019 to August 2020. To compare early outcomes in our patients before and after protocol implementation, we dichotomized patients into two 6-month cohorts (the pre-ERAS and ERAS cohorts) separated from each other by 6 months to allow for staff adoption of the protocol. Of the 115 LVAD implants, 38 patients were implanted in the pre-ERAS period and 46 patients in the ERAS period. Preoperatively, the patients` characteristics were similar between the cohorts. Postoperatively, we observed a decrease in bleeding (chest tube output of 1006 vs 647.5 mL, P < .001) and blood transfusions (fresh frozen plasma 31.6% vs 6.7%, P = .04; platelets 42.1% vs 8.7%, P = .001). Opioid prescription at discharge were 5-fold lower with the ERAS approach (P < .01). Furthermore, the number of patients discharged to a rehabilitation facility decreased significantly (20.0% vs 2.4%, P = .02). The index hospitalization length of stay and survival were similar between the groups. CONCLUSIONS ERAS for patients undergoing LVAD implantation is a novel, evidence-based, interdisciplinary approach to care with multiple potential benefits. In this article, we describe the details of the protocol and early positive changes in clinical outcomes. Further studies are needed to evaluate benefits of an ERAS protocol in an LVAD population.Lay Summary: Enhanced recovery after surgery (ERAS) is the implementation of standardized clinical pathways that ensures the use of best practices and decreased variation in perioperative care. Multidisciplinary teams work together on ERAS, thereby enhancing communication among health care silos. ERAS has been used for more than 30 years by other surgical services and has been shown to lead to a decreased length of stay, fewer complications, lower mortality, fewer readmissions, greater job satisfaction, and lower costs. Our goal was to translate these benefits to the perioperative care of complex patients with a left ventricular assist device. Early results suggest that this goal is possible; we have observed a decrease in transfusions, discharge on opioids, and discharge to a rehabilitation facility.
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Affiliation(s)
- Danielle M Lindenmuth
- Division of Regional Anesthesia and Acute Pain, Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York
| | - Karin Chase
- Division of Cardiothoracic Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Christina Cheyne
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Julie Wyrobek
- Division of Cardiac Anesthesiology, Department of Anesthesiology and Perioperative Medicine University of Rochester Medical Center, Rochester, New York
| | - Milica Bjelic
- Division of Cardiothoracic Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Brian Ayers
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Bryan Barrus
- Division of Cardiothoracic Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Timothy Vanvoorhis
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Elizabeth Mckinley
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Jennifer Falvey
- Department of Pharmacy, University of Rochester Medical Center; Rochester, New York
| | - Bethany Barney
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Liubov Fingerut
- Department of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Brianna Sitler
- Department of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Neil Kumar
- Division of Cardiothoracic Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Frank Akwaa
- Division of Hematology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Frane Paic
- Department of Medical Biology and Genetics, University of Zagreb Medical School, Zagreb, Croatia
| | - Himabindu Vidula
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Jeffrey D Alexis
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Igor Gosev
- Division of Cardiothoracic Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York.
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Genuardi MV, Moss N, Najjar SS, Houston BA, Shore S, Vorovich E, Atluri P, Molina M, Chambers S, Sharkoski T, Hsich E, Estep JD, Owens AT, Alexander KM, Chaudhry SP, Garcia-Cortes R, Molina E, Rodrigo M, Wald MDJ, Margulies KB, Hanff TC, Zimmer R, Kilic A, Mclean R, Vidula H, Dodd K, Blumberg EA, Mazurek JA, Goldberg LR, Alvarez-Garcia J, Mancini D, Teuteberg JJ, Tedford RJ, Birati EY. Coronavirus disease 2019 in heart transplant recipients: Risk factors, immunosuppression, and outcomes. J Heart Lung Transplant 2021; 40:926-935. [PMID: 34140222 PMCID: PMC8131557 DOI: 10.1016/j.healun.2021.05.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 12/21/2020] [Revised: 04/28/2021] [Accepted: 05/11/2021] [Indexed: 12/14/2022] Open
Abstract
Background COVID-19 continues to inflict significant morbidity and mortality, particularly on patients with preexisting health conditions. The clinical course, outcomes, and significance of immunosuppression regimen in heart transplant recipients with COVID-19 remains unclear. Methods We included the first 99 heart transplant recipients at participating centers with COVID-19 and followed patients until resolution. We collected baseline information, symptoms, laboratory studies, vital signs, and outcomes for included patients. The association of immunosuppression regimens at baseline with severe disease were compared using logistic regression, adjusting for age and time since transplant. Results The median age was 60 years, 25% were female, and 44% were white. The median time post-transplant to infection was 5.6 years. Overall, 15% died, 64% required hospital admission, and 7% remained asymptomatic. During the course of illness, only 57% of patients had a fever, and gastrointestinal symptoms were common. Tachypnea, oxygen requirement, elevated creatinine and inflammatory markers were predictive of severe course. Age ≥ 60 was associated with higher risk of death and the use of the combination of calcineurin inhibitor, antimetabolite, and prednisone was associated with more severe disease compared to the combination of calcineurin inhibitor and antimetabolite alone (adjusted OR = 7.3, 95% CI 1.8-36.2). Among hospitalized patients, 30% were treated for secondary infection, acute kidney injury was common and 17% required new renal replacement therapy. Conclusions We present the largest study to date of heart transplant patients with COVID-19 showing common atypical presentations and a high case fatality rate of 24% among hospitalized patients and 16% among symptomatic patients.
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Affiliation(s)
- Michael V Genuardi
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Noah Moss
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Supriya Shore
- Cardiovascular Division, University of Michigan, Ann Arbor, MI
| | - Esther Vorovich
- Division of Cardiology, Northwestern University, Chicago, IL
| | - Pavan Atluri
- Department of Cardiothoracic Surgery, University of Pennsylvania, Pennsylvania
| | - Maria Molina
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan Chambers
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tiffany Sharkoski
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eileen Hsich
- Heart and Vascular Institute at the Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jerry D Estep
- Heart and Vascular Institute at the Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH
| | - Anjali T Owens
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin M Alexander
- Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | | | | | | | | | - MDc Joyce Wald
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth B Margulies
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas C Hanff
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ross Zimmer
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rhondalyn Mclean
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Himabindu Vidula
- Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Katherine Dodd
- Division of Cardiology, Northwestern University, Chicago, IL
| | - Emily A Blumberg
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy A Mazurek
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lee R Goldberg
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jesus Alvarez-Garcia
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Donna Mancini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeffrey J Teuteberg
- Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | | | - Edo Y Birati
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular division, Poriya Medical Center, Bar Ilan University, Israel
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Birati EY, Najjar SS, Tedford RJ, Houston BA, Shore S, Vorovich E, Atluri P, Urgo K, Molina M, Chambers S, Escobar N, Hsich E, Estep JD, Alexander KM, Teuteberg JJ, Chaudhry SP, Ravichandran A, DeVore AD, Margulies KB, Hanff TC, Zimmer R, Kilic A, Wald JW, Vidula H, Martens J, Blumberg EA, Mazurek JA, Owens AT, Goldberg LR, Alvarez-Garcia J, Mancini DM, Moss N, Genuardi MV. Characteristics and Outcomes of COVID-19 in Patients on Left Ventricular Assist Device Support. Circ Heart Fail 2021; 14:e007957. [PMID: 33813838 PMCID: PMC8059761 DOI: 10.1161/circheartfailure.120.007957] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Supplemental Digital Content is available in the text. Background: The coronavirus disease 2019 (COVID-19) pandemic continues to afflict millions of people worldwide. Patients with end-stage heart failure and left ventricular assist devices (LVADs) may be at risk for severe COVID-19 given a high prevalence of complex comorbidities and functional impaired immunity. The objective of this study is to describe the clinical characteristics and outcomes of COVID-19 in patients with end-stage heart failure and durable LVADs. Methods: The Trans-CoV-VAD registry is a multi-center registry of LVAD and cardiac transplant patients in the United States with confirmed COVID-19. Patient characteristics, exposure history, presentation, laboratory data, course, and clinical outcomes were collected by participating institutions and reviewed by a central data repository. This report represents the participation of the first 9 centers to report LVAD data into the registry. Results: A total of 40 patients were included in this cohort. The median age was 56 years (interquartile range, 46–68), 14 (35%) were women, and 21 (52%) were Black. Among the most common presenting symptoms were cough (41%), fever, and fatigue (both 38%). A total of 18% were asymptomatic at diagnosis. Only 43% of the patients reported either subjective or measured fever during the entire course of illness. Over half (60%) required hospitalization, and 8 patients (20%) died, often after lengthy hospitalizations. Conclusions: We present the largest case series of LVAD patients with COVID-19 to date. Understanding these characteristics is essential in an effort to improve the outcome of this complex patient population.
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Affiliation(s)
- Edo Y Birati
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia.,Perelman School of Medicine and Cardiovascular Outcomes, Quality, and Evaluative Research Center (E.Y.B.), University of Pennsylvania, Philadelphia.,Cardiovascular Division, Poriya Medical Center, Bar-Ilan University, Israel. (E.Y.B.)
| | - Samer S Najjar
- MedStar Washington Hospital Center, Washington, DC (S.S.N.)
| | - Ryan J Tedford
- Medical University of South Carolina, Charleston, SC (R.J.T., B.A.H.)
| | - Brian A Houston
- Medical University of South Carolina, Charleston, SC (R.J.T., B.A.H.)
| | - Supriya Shore
- Cardiovascular Division, University of Michigan, Ann Arbor (S.S.)
| | - Esther Vorovich
- Division of Cardiology, Northwestern University, Chicago, IL (E.V.)
| | - Pavan Atluri
- Department of Cardiothoracic Surgery (P.A.), University of Pennsylvania, Philadelphia
| | - Kimberly Urgo
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Maria Molina
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Susan Chambers
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Nicole Escobar
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Eileen Hsich
- Heart and Vascular Institute at the Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, OH (E.H., J.D.E.)
| | - Jerry D Estep
- Heart and Vascular Institute at the Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, OH (E.H., J.D.E.)
| | - Kevin M Alexander
- Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine, CA (K.M.A., J.J.T.)
| | - Jeffrey J Teuteberg
- Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine, CA (K.M.A., J.J.T.)
| | - Sunit-Preet Chaudhry
- St Vincent Medical Group, St Vincent Heart Center, Indianapolis, IN (S.-P.C., A.R.)
| | - Ashwin Ravichandran
- St Vincent Medical Group, St Vincent Heart Center, Indianapolis, IN (S.-P.C., A.R.)
| | - Adam D DeVore
- Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine, Durham, NC (A.D.D.)
| | - Kenneth B Margulies
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Thomas C Hanff
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Ross Zimmer
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, PA (A.K.)
| | - Joyce W Wald
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Himabindu Vidula
- Division of Cardiology, University of Rochester School of Medicine and Dentistry, NY (H.V., J.M.)
| | - John Martens
- Division of Cardiology, University of Rochester School of Medicine and Dentistry, NY (H.V., J.M.)
| | - Emily A Blumberg
- Division of Infectious Diseases (E.A.B.), University of Pennsylvania, Philadelphia
| | - Jeremy A Mazurek
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Anjali T Owens
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Lee R Goldberg
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
| | - Jesus Alvarez-Garcia
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (J.A.-G., D.M.M., N.M.)
| | - Donna M Mancini
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (J.A.-G., D.M.M., N.M.)
| | - Noah Moss
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (J.A.-G., D.M.M., N.M.)
| | - Michael V Genuardi
- Cardiovascular Division, Department of Medicine (E.Y.B., K.U., M.M., S.C., N.E., K.B.M., T.C.H., R.Z., J.W.W., J.A.M., A.T.O., L.R.G., M.V.G.), University of Pennsylvania, Philadelphia
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Vidula H, Barrus B, Feitell S, Kilic A, Moin D, Moss N, Saeed O, Shah S, Atluri P, Birati E. Telehealth for Left Ventricular Assist Device Patients: Current Perceptions and Practices in the United States. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1132] [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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Sherazi S, Goldenberg I, McNitt S, Polonsky B, Gosev I, Vidula H, Alexis J. Gastrointestinal Bleeding, International Normalized Ratio, and Subsequent Risk of Recurrent Thromboembolic Events among Left Ventricular Assist Device Patients. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.526] [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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Iyengar A, Han J, Helmers M, Smood B, Patrick W, Kelly J, Moss N, Najjar S, Houston B, Tedford R, Shore S, Vorovich E, Hsich E, Alexander K, Chaudhry S, Vidula H, Kilic A, Genuardi M, Birati E, Atluri P. The Effect of Body Mass Index on Presentation of COVID-19 amongst Heart Transplant Recipients: A Multi-Institutional Study. J Heart Lung Transplant 2021. [PMCID: PMC7979420 DOI: 10.1016/j.healun.2021.01.1792] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Characteristics and outcomes of heart transplant (HT) recipients who contract coronavirus (SARS-CoV-2) have been poorly described. The current study was undertaken to better understand the risk obesity may pose in this patient population Methods A prospectively-maintained Trans-CoV-VAD Registry containing HT recipients at 11 participating institutions who presented with SARS-CoV-2 were reviewed. Presenting characteristics, hospitalization rates, ventilator & intensive care unit usage, and mortality were queried. Patients were grouped by body mass index (BMI) into obese (BMI≥30 k/m2) and non-obese cohorts (BMI<30 kg/m2). Comparisons between groups were made utilizing chi-squared, Fisher's exact, and Mann-Whitney U-tests. Multivariable logistic regression models were utilized Results Across all centers, 85 HT recipients who tested positive for SARS-CoV-2 were identified, of whom 26 (31%) were obese. Median time from HT to diagnosis was 4.6 (1.8-13.8) years. No differences in age (57 vs 60 p 0.85) or female gender (31% vs 24% p 0.5) were noted between obese and non-obese patients. On presentation, obese patients were more symptomatic with higher rates of cough (76% vs 48% p 0.02), dyspnea (62% vs 41% p 0.09), diarrhea (60% vs 35% p 0.03), and headache (35% vs 14% p 0.03). No differences in rates of admission (62% vs 64% p 0.8), ICU presentation (44% vs 35% p 0.6) or need for mechanical ventilation were noted (38% vs 22% p 0.2). More secondary infections were noted amongst obese patients (32% vs 13% p 0.04). On follow-up, mortality was similar between groups (12% vs 9% p 0.7). On multivariable modeling, BMI was not associated with increased adjusted odds of hospital/ICU admission or mechanical ventilation (p>0.10) Conclusion Acute presentations of SARS-CoV-2 amongst HT recipients carry significantly higher mortality over the general population. Obesity appears to impact presenting symptoms and secondary infections, but does not strongly impact ICU requirements or mortality
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Saeed O, Moss N, Barrus B, Vidula H, Shah S, Feitell S, Kilic A, Moin D, Atluri P, Barati E. Primary Prevention Strategies for Driveline Infection during Left Ventricular Assist Device Support: A Survey of 55 Centers within the United States. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1157] [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: 10/21/2022] Open
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Younis A, Aktas MK, Lee D, Zareba W, McNitt S, Polonsky B, Kutyifa V, Rosero S, Huang D, Vidula H, Goldenberg I. Hospitalization for Heart Failure and Subsequent Ventricular Tachyarrhythmias in Patients With Left Ventricular Dysfunction. JACC Clin Electrophysiol 2021; 7:1099-1107. [PMID: 33812828 DOI: 10.1016/j.jacep.2021.01.021] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/15/2021] [Accepted: 01/17/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study aimed to evaluate the risk of sustained life-threatening ventricular tachyarrhythmias (VTAs) after hospitalization for heart failure (HHF). BACKGROUND HHF is common among patients with an implantable cardioverter-defibrillator (ICD). METHODS We analyzed all 5,511 ICD patients enrolled in the landmark MADIT and RAID trials. Multivariate Cox regression was used to evaluate the association of in-trial HHF occurrence with the risk of subsequent VTA and the composite end point of VTA or cardiac death. RESULTS Mean age was 64 ± 11 years, 23% were women, 62% were ischemic, and 40% had cardiac resynchronization therapy with defibrillators. The 3-year cumulative rate of VTA subsequent to HHF was significantly higher than the corresponding rate without HHF (44% vs. 24%, respectively; p < 0.001). After multivariable adjustment, time-dependent HHF was shown to be associated with a 79% increased risk for VTA and a 2.9-fold increased risk for VTA/cardiac death (p < 0.001 for both). In-trial development of atrial tachyarrhythmia (ATA) was also identified as an independent risk factor for the VTA and VTA/cardiac death end points (hazard ratios [HRs]: 1.59 and 1.43, respectively; p ≤ 0.001 for both) but did not affect the association of HHF with VTA. Subgroup analysis demonstrated that the association of HHF with the risk of subsequent VTA was maintained among risk subsets categorized by age, sex, history of ATA, and implantation indication, but was significantly more pronounced among patients with nonischemic versus ischemic cardiomyopathy (HRs: 2.54 and 1.43, respectively; p value for interaction: 0.017). CONCLUSIONS HHF is a powerful risk factor for subsequent VTA in patients implanted with an ICD. These data may be used for improved risk stratification in this population.
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Affiliation(s)
- Arwa Younis
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Mehmet K Aktas
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Daniel Lee
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Wojciech Zareba
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Scott McNitt
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Bronislava Polonsky
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Valentina Kutyifa
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Spencer Rosero
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York, USA
| | - David Huang
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Himabindu Vidula
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York, USA.
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Lee EC, Goldenberg I, Vidula H. Response to "How to consider optimal therapeutic strategy for bridge to heart transplantation". Int J Cardiol 2020; 320:126. [PMID: 32663483 DOI: 10.1016/j.ijcard.2020.07.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Elizabeth C Lee
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
| | - Ilan Goldenberg
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Himabindu Vidula
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Ayers B, Lee E, Wood K, Bruckel J, Alexis J, Vidula H, Barrus B, Prasad S, Gosev I. Patient-Reported Outcomes Measurement Information System (PROMIS) in Left Ventricular Assist Devices. Ann Thorac Surg 2020; 113:859-865. [PMID: 33275931 DOI: 10.1016/j.athoracsur.2020.11.011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/27/2020] [Accepted: 11/12/2020] [Indexed: 11/01/2022]
Abstract
BACKGROUND Appropriate collection of quality of life (QOL) measurements for left ventricular assist device (LVAD) patients is challenging. Patient-Reported Outcomes Measurement Information System (PROMIS) is a popular tool that has been validated across multiple disciplines, but its applicability to the LVAD population remains unknown. METHODS This single-center, retrospective review included LVAD patients that completed a PROMIS assessment and Kansas City Cardiomyopathy Questionnaire (KCCQ-12) survey at clinical encounters postoperatively. Patients completed computer adaptive PROMIS assessments for physical function, pain interference and depression. All PROMIS domains are designed to follow a normal distribution (mean T-score 50, standard deviation 10) in the general population. Assessments were aggregated over time and correlation between the KCCQ-12 summary score and each PROMIS domain was assessed individually. RESULTS A total of 178 LVAD patients were included in the study. The median time between LVAD implantation and PRO collection was 16.5 [interquartile range, 7.9-37.8] months. Patients typically had worse physical function (T-score 38.8 [33.6-44.2]) but comparable pain (51.1 [38.7-59.2]) and depression (49.9 [41.7-57.5]) as the general population. The KCCQ-12 was more strongly correlated to PROMIS physical function (Spearman's ρ = 0.746) than pain (ρ = -0.539) or depression (ρ = -0.591). CONCLUSIONS PROMIS provides a robust QOL data collection system that can be implemented in a clinical setting without imposing a significant burden. Using this more holistic system may allow for better patient-centered care in order to address QOL limitations imposed by LVAD support that are not directly related to heart failure symptoms.
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Vidula H, Cheyne C, Martens J, Gosev I, Zareba W, Goldenberg I. Telehealth for the Management of Left Ventricular Assist Device Patients: The University of Rochester TeleLVAD Study. J Card Fail 2020; 27:112-113. [PMID: 33035684 PMCID: PMC7537648 DOI: 10.1016/j.cardfail.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 09/28/2020] [Accepted: 10/02/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Himabindu Vidula
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.
| | - Christina Cheyne
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - John Martens
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Igor Gosev
- Division of Cardiothoracic Surgery, Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Wojciech Zareba
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Ilan Goldenberg
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Thomas S, McNitt S, Polonsky S, Alexis J, Bisognano J, Vidula H, Gosev I, Goldenberg I, Kutyifa V. The Effects of Cardiac Resynchronization Therapy on Cardiovascular and Non-cardiovascular Hospitalization: A Long-term Follow-up MADIT-CRT Sub-study. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.034] [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]
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Lee EC, McNitt S, Martens J, Bruckel JT, Chen L, Alexis JD, Storozynsky E, Thomas S, Gosev I, Barrus B, Goldenberg I, Vidula H. Long-term milrinone therapy as a bridge to heart transplantation: Safety, efficacy, and predictors of failure. Int J Cardiol 2020; 313:83-88. [PMID: 32320777 DOI: 10.1016/j.ijcard.2020.04.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/09/2020] [Accepted: 04/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Studies of long-term inotrope use in advanced HF have previously provided limited and conflicting results. This study aimed to evaluate the safety and efficacy of long-term milrinone use and identify predictors of failure to bridge to orthotropic heart transplant (OHT) in a cohort of end-stage heart failure (HF) patients listed for heart transplantation and receiving inotrope therapy. METHODS The study included 150 adults listed for OHT at a single center from 2001 to 2017 who received milrinone therapy for ≥30 days. Multivariate Cox proportional hazards models were used to identify factors associated with "failure" (left ventricular assist device, intra-aortic balloon pump, status downgrade due to instability, death) vs. "success" (OHT, recovery) during bridging to OHT. RESULTS "Failure" occurred in 33 (22%) patients. Factors independently associated with failure included male sex (HR = 7.6; p = 0.004), no implantable cardioverter-defibrillator (HR = 3.8; p = 0.009), and lack of guideline-directed medical therapy (GDMT) with a beta-blocker (HR = 7.8; p = 0.002) or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (HR = 6.3; p < 0.001). Patients who received fewer guideline-directed medications had a higher cumulative probability of failure. Adverse events included central line-associated bloodstream infection (2.55 per 1000 line-days) and arrhythmia (1.59 per 1000 treatment-days). CONCLUSIONS Our findings suggest that long-term milrinone therapy in selected patients is associated with a high rate of successful bridging to OHT and a low rate of adverse events. Patients intolerant of GDMT are more likely to fail to bridge to OHT without mechanical support. Sex differences in outcomes associated with milrinone therapy should be explored.
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Affiliation(s)
- Elizabeth C Lee
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Scott McNitt
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - John Martens
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Jeffrey T Bruckel
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Leway Chen
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Jeffrey D Alexis
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Eugene Storozynsky
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Sabu Thomas
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Igor Gosev
- Division of Cardiac Surgery, Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Bryan Barrus
- Division of Cardiac Surgery, Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Ilan Goldenberg
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Himabindu Vidula
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Vidula H, Lee E, McNitt S, Polonsky B, Aktas M, Rosero S, Younis A, Solomon SD, Zareba W, Kutyifa V, Goldenberg I. Cardiac Resynchronization Therapy and Risk of Recurrent Hospitalizations in Patients Without Left Bundle Branch Block: The Long-Term Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy. Circ Heart Fail 2020; 13:e006925. [PMID: 32605387 DOI: 10.1161/circheartfailure.120.006925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mild heart failure (HF) patients without left bundle branch block (LBBB) did not derive a significant reduction in risk of a HF event/death in the MADIT-CRT trial (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy). However, the efficacy of CRT with a defibrillator (CRT-D) may be modified after the development of the first hospitalization for HF (HHF). We aimed to study the effect of CRT-D on long-term risk of recurrent HHF in patients without LBBB in MADIT-CRT. METHODS Data on recurring HHF were collected for 1818 subjects. The CRT-D versus implantable cardioverter-defibrillator-only risk for first and subsequent HHF was assessed by QRS morphology in on-treatment analysis using Cox proportional hazards regression modeling. RESULTS During long-term follow-up, 412 patients had ≥1 HHF and 333 had ≥2 HHF. Multivariate analysis revealed that in LBBB patients, CRT-D, compared with implantable cardioverter-defibrillator, was associated with a significant reduction in risk of first and subsequent HHF (first: hazard ratio, 0.41 [95% CI, 0.31-0.54], P<0.001; subsequent: hazard ratio, 0.45 [95% CI, 0.29-0.70], P<0.001). Among patients without LBBB, the benefit of CRT-D was nonsignificant for the first HHF (hazard ratio, 0.96; P=0.808). However, after occurrence of a first HHF, CRT-D therapy was associated with a pronounced 44% reduction in risk of subsequent HHF (hazard ratio, 0.56 [95% CI, 0.32-0.97], P=0.039). Patients without LBBB with ≥1 HHF during the first year of follow-up demonstrated increasing dyssynchrony at 1 year compared with those who had no HHF (P=0.016). CONCLUSIONS In MADIT-CRT, we show a beneficial effect of CRT-D in patients without LBBB subsequent to development of a first HHF, possibly due to increased dyssynchrony associated with HF progression. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00180271, NCT01294449, and NCT02060110.
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Affiliation(s)
- Himabindu Vidula
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY (H.V., E.L., S.M., B.P., M.A., S.R., A.Y., W.Z., V.K., I.G.)
| | - Elizabeth Lee
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY (H.V., E.L., S.M., B.P., M.A., S.R., A.Y., W.Z., V.K., I.G.)
| | - Scott McNitt
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY (H.V., E.L., S.M., B.P., M.A., S.R., A.Y., W.Z., V.K., I.G.)
| | - Bronislava Polonsky
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY (H.V., E.L., S.M., B.P., M.A., S.R., A.Y., W.Z., V.K., I.G.)
| | - Mehmet Aktas
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY (H.V., E.L., S.M., B.P., M.A., S.R., A.Y., W.Z., V.K., I.G.)
| | - Spencer Rosero
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY (H.V., E.L., S.M., B.P., M.A., S.R., A.Y., W.Z., V.K., I.G.)
| | - Arwa Younis
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY (H.V., E.L., S.M., B.P., M.A., S.R., A.Y., W.Z., V.K., I.G.)
| | - Scott D Solomon
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.D.S.)
| | - Wojciech Zareba
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY (H.V., E.L., S.M., B.P., M.A., S.R., A.Y., W.Z., V.K., I.G.)
| | - Valentina Kutyifa
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY (H.V., E.L., S.M., B.P., M.A., S.R., A.Y., W.Z., V.K., I.G.)
| | - Ilan Goldenberg
- Division of Cardiology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY (H.V., E.L., S.M., B.P., M.A., S.R., A.Y., W.Z., V.K., I.G.)
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Ayers BC, Wood K, McNitt S, Goldenberg I, Chen L, Alexis J, Vidula H, Thomas S, Storozynsky E, Barrus B, Prasad S, Gosev I. Association of previous cardiac surgery with outcomes in left ventricular assist device patients. Interact Cardiovasc Thorac Surg 2020; 31:1-8. [PMID: 32248242 DOI: 10.1093/icvts/ivaa055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/14/2019] [Revised: 02/05/2020] [Accepted: 02/21/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES History of prior cardiac surgery has traditionally been considered a risk factor for subsequent cardiac procedures. The aim of this study was to investigate the outcomes of patients implanted with a left ventricular assist device via redo sternotomy. METHODS Prospectively collected data were reviewed for all patients implanted with a continuous-flow left ventricular assist device at a single institution from December 2006 through June 2018. Patients were separated into 2 cohorts: those with a history of prior cardiac surgery (redo sternotomy) and those undergoing primary sternotomy at the time of left ventricular assist device implantation. The primary outcome was overall survival. RESULTS Of the 321 patients included in the study, 77 (24%) were implanted via redo sternotomy and 244 (76%) via primary sternotomy. The redo sternotomy cohort was generally older (59 ± 10 vs 57 ± 12 years, P = 0.050) and had a higher incidence of ischaemic disease (70% vs 49%, P = 0.002). The Kaplan-Meier survival analysis demonstrated that overall survival was not significantly different between the redo sternotomy and primary sternotomy groups (6-month survival: 86% vs 92%; 5-year survival: 53% vs 51%; log-rank P = 0.590 for overall difference during follow-up). The propensity score analysis consistently showed that redo sternotomy was not significantly associated with mortality risk (hazard ratio 1.19, 95% confidence interval 0.73-1.93; P = 0.488). Redo sternotomy patients were more likely to require rehospitalization during their first year postoperatively (P = 0.020) and spent less time out of the hospital during the first year (P = 0.046). CONCLUSIONS The redo sternotomy cohort represents a more technically challenging patient population, but overall survival similar to that of primary sternotomy patients can be achieved.
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Affiliation(s)
- Brian C Ayers
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Katherine Wood
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Scott McNitt
- Division of Cardiology, Cardiovascular Research Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Ilan Goldenberg
- Division of Cardiology, Cardiovascular Research Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Leway Chen
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Jeffrey Alexis
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Himabindu Vidula
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Sabu Thomas
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Eugene Storozynsky
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Bryan Barrus
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Sunil Prasad
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Igor Gosev
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
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Wood K, Ayers B, Bernstein W, Vidula H, Chen L, Barrus B, Prasad S, Gosev I. Sternal-Sparing LVAD Implantation Reduces the Incidence of Severe Right Heart Failure. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1008] [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: 11/17/2022] Open
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Cheyne C, Russell H, Martens J, Vidula H, Gosev I. Feasibility of Using an LVAD App to Engage Patients in Recovery Post Implant Discharge. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1204] [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: 10/24/2022] Open
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Vidula H, Wang M, Antaki J, Polonsky B, Sherazi S, Alexis J, Gosev I, Kutyifa V, McNitt S, Goldenberg I. Risk Score for Mortality Prediction after One-Year on Left Ventricular Assist Device Support. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.761] [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: 10/24/2022] Open
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Sherazi S, Ayers B, Polonsky B, McNitt S, Kutyifa V, Alexis J, Gosev I, Goldenberg I, Vidula H. Association of Cardiac Rehabilitation with Improved Healthcare Utilization and Long-Term Survival after Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.976] [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: 10/24/2022] Open
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Sherazi S, Shah S, Younis A, McNitt S, Polonsky B, Kutyifa V, Alexis J, Gosev I, Vidula H, Goldenberg I. Racial Differences in Clinical Characteristics and Risk of Readmissions among Left Ventricular Assist Device Patients. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.358] [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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Ayers B, Cheyne C, Wood K, Quinlan A, Dick S, Vidula H, Alexis J, Barrus B, Prasad S, Gosev I. Long-term ungrounded cable support for short-to-shield syndrome. Clin Case Rep 2020; 8:512-515. [PMID: 32185047 PMCID: PMC7069869 DOI: 10.1002/ccr3.2583] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 10/21/2019] [Accepted: 10/28/2019] [Indexed: 11/11/2022] Open
Abstract
Short-to-shield (STS) is a potential complication for left ventricular assist device (LVAD) patients supported by the HeartMate II (HMII) pump. This phenomenon occurs when a damaged internal wire within the driveline makes contact with the surrounding sheath, resulting in insufficient power delivery to the motor when connected to a grounded power base unit (PBU). An ungrounded cable can be used to negate these effects, but the long-term safety of this treatment strategy is unknown. In this case series, we present our institutional experience treating 17 STS patients with an ungrounded cable. In total, we present 4922 patient-days (13.4 patient-years) of ungrounded cable support after primary STS treatment. There were no deaths or complications related to STS. These data suggest that the long-term use of an ungrounded cable is a reasonable treatment option for patients who cannot or do not wish to undergo pump exchange or splice repair.
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Affiliation(s)
- Brian Ayers
- University of Rochester Medical CenterRochesterNYUSA
| | | | | | - Amy Quinlan
- University of Rochester Medical CenterRochesterNYUSA
| | - Sara Dick
- University of Rochester Medical CenterRochesterNYUSA
| | | | | | - Bryan Barrus
- University of Rochester Medical CenterRochesterNYUSA
| | - Sunil Prasad
- University of Rochester Medical CenterRochesterNYUSA
| | - Igor Gosev
- University of Rochester Medical CenterRochesterNYUSA
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Vidula H, Altintas O, McNitt S, Polonsky B, Alexis JD, Chen L, Gosev I, Bisognano JD, Seidmann A, Goldenberg I. LOW BLOOD PRESSURE AND THE RISK OF DEATH AND STROKE IN CONTEMPORARY LEFT VENTRICULAR ASSIST DEVICE RECIPIENTS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31488-1] [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: 10/24/2022]
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Gosev I, Wood K, Ayers B, Barrus B, Knight P, Alexis JD, Vidula H, Lander H, Wyrobek J, Cheyne C, Goldenberg I, McNitt S, Prasad S. Implantation of a fully magnetically levitated left ventricular assist device using a sternal-sparing surgical technique. J Heart Lung Transplant 2020; 39:37-44. [DOI: 10.1016/j.healun.2019.09.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022] Open
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