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Bruckheimer E, Rackauskas G, Verheye S, Prihadi E, Flint N, Neužil P, Amir O, Sievert H, Pinney S, Reddy VY. Transcatheter Pulmonary Artery Banding for HFrEF: Initial Results: Exercise Hemodynamics From the Ongoing First-in-Human Trial. JACC Basic Transl Sci 2024; 9:445-447. [PMID: 38680953 PMCID: PMC11055201 DOI: 10.1016/j.jacbts.2024.02.008] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Affiliation(s)
| | | | | | | | - Nir Flint
- Sourasky Medical Center, Tel Aviv, Israel
| | | | - Offer Amir
- Hadassah Medical Center, Jerusalem, Israel
| | | | - Sean Pinney
- Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vivek Y. Reddy
- Helmsley Electrophysiology Center, Mount Sinai Fuster Heart Hospital, New York, New York, USA
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Bapat V, Weiss E, Bajwa T, Thourani VH, Yadav P, Thaden JJ, Lim DS, Reardon M, Pinney S, Adams DH, Yakubov SJ, Modine T, Redwood SR, Walton A, Spargias K, Zhang A, Mack M, Leon MB. 2-Year Clinical and Echocardiography Follow-Up of Transcatheter Mitral Valve Replacement With the Transapical Intrepid System. JACC Cardiovasc Interv 2024:S1936-8798(24)00527-2. [PMID: 38639690 DOI: 10.1016/j.jcin.2024.02.033] [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: 10/30/2023] [Revised: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Thirty-day outcomes with the investigational Intrepid transapical (TA) transcatheter mitral valve replacement (TMVR) system have previously demonstrated good technical success, but longer-term outcomes in larger cohorts need to be evaluated. OBJECTIVES The authors sought to evaluate the 2-year safety and performance of the Intrepid TA-TMVR system in patients with symptomatic, ≥moderate-severe mitral regurgitation (MR) and high surgical risk. METHODS Patient eligibility was determined by local heart teams and approved by a central screening committee. Clinical events were adjudicated by an independent clinical events committee. Echocardiography was evaluated by an independent core laboratory. RESULTS The cohort included 252 patients that were enrolled at 58 international sites before February 2021 as part of the global Pilot Study (n = 95) or APOLLO trial (primary cohort noneligible + TA roll-ins, n = 157). Mean age was 74.2 years, mean STS-PROM was 6.3%, 60.3% were male, and 80.6% were in NYHA functional class III/IV. Most presented with secondary MR (70.1%), and nearly all had ≥moderate-severe MR (98.4%). All-cause mortality was 13.1% (30-day), 27.3% (1-year), and 36.2% (2-year). The 30-day ≥major bleeding event rate was 22.3%. Heart failure rehospitalization was 9.6% (30-day) and 36.2% (2-year). At 2 years, >50% of patients were alive with improvement in NYHA functional class (82.1%, class I/II), and all patients with available echocardiograms had ≤mild MR. CONCLUSIONS This analysis represents the largest reported TA-TMVR experience with the longest follow-up in high-risk ≥moderate-severe MR patients. Early mortality and heart failure rehospitalizations were significant, exacerbated by early TA-related bleeding events; however, meaningful improvements in clinical outcomes and marked reductions in MR severity were observed through 2 years.
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Affiliation(s)
- Vinayak Bapat
- St. Thomas' Hospital, London, United Kingdom; New York Presbyterian/Columbia University Medical Center, New York, New York, USA.
| | - Eric Weiss
- Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA
| | - Tanvir Bajwa
- Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA
| | | | | | | | - D Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | - Michael Reardon
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sean Pinney
- Mount Sinai Medical Center, New York, New York, USA
| | | | | | - Thomas Modine
- Department of Heart Valve Therapy, CHU Bordeaux, Bordeaux, France
| | | | - Antony Walton
- Cardiology Department, The Alfred, Melbourne, Australia
| | | | | | - Michael Mack
- Baylor Scott and White Heart Hospital, Plano, Texas, USA
| | - Martin B Leon
- New York Presbyterian/Columbia University Medical Center, New York, New York, USA
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Bharani A, Mehta A, Hiensch K, Zeng L, Lala A, Pinney S, Goldstein N, Chai E, Gelfman LP. Referral Versus Embedded Palliative Care Consultation Among People Hospitalized With Heart Failure: A Report From a Single Center Pilot Program. J Pain Symptom Manage 2024; 67:241-249. [PMID: 38040389 DOI: 10.1016/j.jpainsymman.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/17/2023] [Accepted: 11/24/2023] [Indexed: 12/03/2023]
Abstract
CONTEXT Despite calls for integration into routine heart failure (HF) care, optimal palliative care delivery for people living with HF remains unclear. OBJECTIVES Describe an innovative model of an embedded palliative care nurse practitioner (NP) within a HF team. Compare demographics and utilization among people hospitalized with HF receiving referral or embedded consultation. METHODS Using an electronic health record-based palliative care registry, we conducted descriptive analyses and t-tests and χ2 tests, as appropriate, to examine bivariate associations between sociodemographic, clinical and utilization data of hospitalized people with HF receiving a traditional, referral-based palliative care consultation generated exclusively by the primary team vs. a novel, embedded-based consultation generated by collaboration between a palliative care NP and the advanced HF team at an urban, quaternary care academic medical center in New York City. RESULTS During the study period from January 1, 2019-December 31, 2021, consultation volume nearly doubled with 363 consults from traditional referrals and an additional 317 consults from the newly embedded NP. People in the embedded group, as compared to referral, were younger (mean age: 60.1 vs. 71.9 years (2019); 59.2 vs. 70.4 (2020); 61.3 vs. 69.6 (2021), p-value < 0.001), more functional (median Karnofsky Performance Status: 40% vs. 30%, p-value = 0.01 (2019); 40% vs 20%, p-value < 0.0001 (2020); 40% vs. 20%, p-value = 0.02 (2021)), more likely had capacity to designate a medical decision maker (56.4% vs. 20.6%, p-value < 0.001 (2020); 76.3% vs. 49.5%, p-value < 0.001 (2021)), received earlier consultation (median days before discharge: 9.5 vs. 4 (2019); 11 vs. 5 (2020); 7 vs. 3 (2021), p-value ≤ 0.001), and more likely to discharge home (60% vs. 26%, p-value ≤ 0.001 (2019); 62.7% vs 20.6%, p-value ≤ 0.001 (2020); 42.3% vs. 28%, p-value = 0.03 (2021)). CONCLUSION Hospitalized people living with advanced HF who received an embedded palliative care consult were younger, had higher functional status and less illness severity compared to those served by a traditional, referral-based consult.
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Affiliation(s)
- Anup Bharani
- Brookdale Department of Geriatrics and Palliative Medicine (A.B., A.M., K.H., L.Z., N.G., E.C., L.P.G.), Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Ankita Mehta
- Brookdale Department of Geriatrics and Palliative Medicine (A.B., A.M., K.H., L.Z., N.G., E.C., L.P.G.), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Karen Hiensch
- Brookdale Department of Geriatrics and Palliative Medicine (A.B., A.M., K.H., L.Z., N.G., E.C., L.P.G.), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Li Zeng
- Brookdale Department of Geriatrics and Palliative Medicine (A.B., A.M., K.H., L.Z., N.G., E.C., L.P.G.), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anuradha Lala
- The Zena and Michael A. Wiener Cardiovascular Institute (A.L., S.P.), Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Population Health Science and Policy (A.L.), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sean Pinney
- The Zena and Michael A. Wiener Cardiovascular Institute (A.L., S.P.), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nathan Goldstein
- Brookdale Department of Geriatrics and Palliative Medicine (A.B., A.M., K.H., L.Z., N.G., E.C., L.P.G.), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emily Chai
- Brookdale Department of Geriatrics and Palliative Medicine (A.B., A.M., K.H., L.Z., N.G., E.C., L.P.G.), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laura P Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine (A.B., A.M., K.H., L.Z., N.G., E.C., L.P.G.), Icahn School of Medicine at Mount Sinai, New York, New York, USA; Geriatric Research Education and Clinical Center (L.P.G.), James J. Peters VA Medical Center, Bronx, New York, USA
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Nishida H, Jeevanandam V, Salerno C, Nemoto A, Song T, Onsager D, Nguyen A, Grinstein J, Chung B, Sarswat N, Kim G, Pinney S, Ota T. Impact of prophylactic donor heart tricuspid valve annuloplasty on outcomes in heart transplantation. J Cardiothorac Surg 2023; 18:288. [PMID: 37828522 PMCID: PMC10571443 DOI: 10.1186/s13019-023-02396-x] [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: 01/10/2023] [Accepted: 09/30/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Tricuspid regurgitation(TR) following heart transplantation could adversely affect clinical outcomes. In an effort to reduce the incidence of TR, prophylactic donor heart tricuspid valve annuloplasty has been performed during heart transplantation in our institution. We assessed early and long-term outcomes. METHODS Between August 2011 and August 2021, 349 patients who underwent prophylactic tricuspid valve annuloplasty were included. Tricuspid valve annuloplasty was performed using the DeVega annuloplasty technique. The clinical outcomes of the interests included complete atrioventricular block requiring pacemaker implantation, the occurrence of significant TR(defined as moderate or greater), and survival. Long-term survival was compared in patients with and without significant TR using the Kaplan-Meier method. The Cox proportional hazards regression with time-dependent covariate analysis was used to see if significant TR affected the long-term survival. RESULTS There was one patient(0.3%) who required pacemaker implantation for complete atrioventricular block. No patients developed tricuspid valve stenosis that required intervention. Significant TR developed in 31 patients(8.9%) during the follow-up period. The survival rate of patients who developed significant TR was significantly lower than that of those who did not(log rank < 0.01). Significant TR was associated with the long-term mortality(HR2.92, 95%CI 1.47-5.82, p < 0.01). CONCLUSIONS Prophylactic donor heart tricuspid valve annuloplasty has the potential to reduce the occurrence of significant TR and can be performed safely. The significant TR that developed in patients with prophylactic annuloplasty negatively affected survival and was an independent predictor of long-term mortality.
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Affiliation(s)
- Hidefumi Nishida
- Department of Surgery, Section of Cardiac Surgery, The University of Chicago Medicine, 5841S Maryland Avenue, MC5040, Chicago, IL, 60637, USA.
| | - Valluvan Jeevanandam
- Department of Surgery, Section of Cardiac Surgery, The University of Chicago Medicine, 5841S Maryland Avenue, MC5040, Chicago, IL, 60637, USA
| | - Christopher Salerno
- Department of Surgery, Section of Cardiac Surgery, The University of Chicago Medicine, 5841S Maryland Avenue, MC5040, Chicago, IL, 60637, USA
| | - Atsushi Nemoto
- Department of Surgery, Section of Cardiac Surgery, The University of Chicago Medicine, 5841S Maryland Avenue, MC5040, Chicago, IL, 60637, USA
| | - Tae Song
- Department of Surgery, Section of Cardiac Surgery, The University of Chicago Medicine, 5841S Maryland Avenue, MC5040, Chicago, IL, 60637, USA
| | - David Onsager
- Department of Surgery, Section of Cardiac Surgery, The University of Chicago Medicine, 5841S Maryland Avenue, MC5040, Chicago, IL, 60637, USA
| | - Ann Nguyen
- Department of Medicine, Section of Cardiology, The University of Chicago Medicine, Chicago, IL, USA
| | - Jonathan Grinstein
- Department of Medicine, Section of Cardiology, The University of Chicago Medicine, Chicago, IL, USA
| | - Bow Chung
- Department of Medicine, Section of Cardiology, The University of Chicago Medicine, Chicago, IL, USA
| | - Nitasha Sarswat
- Department of Medicine, Section of Cardiology, The University of Chicago Medicine, Chicago, IL, USA
| | - Gene Kim
- Department of Medicine, Section of Cardiology, The University of Chicago Medicine, Chicago, IL, USA
| | - Sean Pinney
- Department of Medicine, Section of Cardiology, The University of Chicago Medicine, Chicago, IL, USA
| | - Takeyoshi Ota
- Department of Surgery, Section of Cardiac Surgery, The University of Chicago Medicine, 5841S Maryland Avenue, MC5040, Chicago, IL, 60637, USA
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Cooper L, DeVore A, Cowger J, Pinney S, Baran D, DeWald TA, Burt T, Pietzsch JB, Walton A, Aaronson K, Shah P. Patients hospitalized with acute heart failure, worsening renal function, and persistent congestion are at high risk for adverse outcomes despite current medical therapy. Clin Cardiol 2023; 46:1163-1172. [PMID: 37464579 PMCID: PMC10577559 DOI: 10.1002/clc.24080] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Approximately 1/3 of patients with acute decompensated heart failure (ADHF) are discharged with persistent congestion. Worsening renal function (WRF) occurs in approximately 50% of patients hospitalized for ADHF and the combination of WRF and persistent congestion are associated with higher risk of mortality and HF readmissions. METHODS We designed a multicenter, prospective registry to describe current treatments and outcomes for patients hospitalized with ADHF complicated by WRF (defined as a creatinine increase ≥0.3 mg/dL) and persistent congestion at 96 h. Study participants were followed during the hospitalization and through 90-day post-discharge. Hospitalization costs were analyzed in an economic substudy. RESULTS We enrolled 237 patients hospitalized with ADHF, who also had WRF and persistent congestion. Among these, the average age was 66 ± 13 years and 61% had a left ventricular ejection fraction (LVEF) ≤ 40%. Mean baseline creatinine was 1.7 ± 0.7 mg/dL. Patients with persistent congestion had a high burden of clinical events during the index hospitalization (7.6% intensive care unit transfer, 2.1% intubation, 1.7% left ventricular assist device implantation, and 0.8% dialysis). At 90-day follow-up, 33% of patients were readmitted for ADHF or died. Outcomes and costs were similar between patients with reduced and preserved LVEF. CONCLUSIONS Many patients admitted with ADHF have WRF and persistent congestion despite diuresis and are at high risk for adverse events during hospitalization and early follow-up. Novel treatment strategies are urgently needed for this high-risk population.
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Affiliation(s)
- Lauren Cooper
- Department of CardiologyNorth Shore University HospitalManhassetNew YorkUSA
- Inova Heart & Vascular InstituteInova Fairfax HospitalFalls ChurchVirginiaUSA
| | - Adam DeVore
- Department of MedicineDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Jennifer Cowger
- Division of Cardiovascular MedicineHenry Ford HospitalsDetroitMichiganUSA
| | - Sean Pinney
- Heart & Vascular CenterUniversity of Chicago MedicineChicagoIllinoisUSA
| | | | - Tracy A. DeWald
- Department of MedicineDuke University School of MedicineDurhamNorth CarolinaUSA
| | | | | | | | - Keith Aaronson
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Palak Shah
- Inova Heart & Vascular InstituteInova Fairfax HospitalFalls ChurchVirginiaUSA
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Hahn RT, Brener MI, Cox ZL, Pinney S, Lindenfeld J. Tricuspid Regurgitation Management for Heart Failure. JACC Heart Fail 2023; 11:1084-1102. [PMID: 37611990 DOI: 10.1016/j.jchf.2023.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/25/2023]
Abstract
There is growing evidence that severe tricuspid regurgitation (TR) impacts clinical outcomes in a variety of cardiovascular disease states. The late presentation of patients with advanced TR highlights the underappreciation of the disease, as well as the pitfalls of current guideline-directed medical management. Given the high in-hospital mortality associated with isolated tricuspid valve surgery, transcatheter options continue to be explored with the hope of improved survival and reduced heart failure hospitalizations. In this review, we explore the physiology of TR, discuss the etiologic classes of TR, and explore the transcatheter options for treatment and who might benefit from device therapy.
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Affiliation(s)
- Rebecca T Hahn
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.
| | - Michael I Brener
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Zachary L Cox
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Lipscomb University College of Pharmacy, Nashville, Tennessee, USA
| | - Sean Pinney
- Department of Medicine, Icahn School of Medicine, Mount Sinai Morningside, New York, New York, USA
| | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Nishida H, Jeevanandam V, Salerno C, Nemoto A, Song T, Onsager D, Nguyen A, Grinstein J, Chung B, Sarswat N, Kim G, Pinney S, Ota T. Concomitant left atrial appendage closure during left ventricular assist device surgery can reduce ischaemic cerebrovascular accidents. Interdiscip Cardiovasc Thorac Surg 2023:ivad112. [PMID: 37421402 PMCID: PMC10338136 DOI: 10.1093/icvts/ivad112] [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: 04/06/2023] [Revised: 05/23/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND It remains unknown if the left atrial appendage closure at the time of left ventricular assist device surgery can reduce ischaemic cerebrovascular accidents. METHODS Consecutive 310 patients who underwent left ventricular assist device surgery with HeartMate II or 3 between January 2012 and November 2021 were included in this study. The cohort was divided into two groups: patients with left atrial appendage closure (Group A) and without left atrial appendage closure (Group B). We compared the clinical outcomes including the incidence of cerebrovascular accident between two groups. RESULTS Ninety-eight patients were included in Group A, and 212 patients in Group B. There were no significant differences between two groups in age, preoperative CHADS2 score and history of atrial fibrillation. In-hospital mortality did not differ significantly between the two groups (Group A: 7.1%, Group B: 12.3%, p = 0.16). Thirty-seven patients (11.9%) experienced ischaemic cerebrovascular accident (five patients in Group A and 32 patients in Group B). The cumulative incidence from ischaemic cerebrovascular accidents in Group A (5.3% at 12 months and 5.3% at 36 months) was significantly lower than that in Group B (8.2% at 12 months and 16.8% at 36 months; p = 0.017). In a multivariable competing risk analysis, left atrial appendage closure was associated with reducing ischaemic cerebrovascular accidents (hazard ratio 0.38, 95% confidence interval 0.15-0.97, p = 0.043). CONCLUSIONS Concomitant left atrial appendage closure in left ventricular assist device surgery can reduce ischaemic cerebrovascular accidents without increasing perioperative mortality and complications.
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Affiliation(s)
- Hidefumi Nishida
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | | | | | - Atsushi Nemoto
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Tae Song
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - David Onsager
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Ann Nguyen
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Jonathan Grinstein
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Bow Chung
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Nitasha Sarswat
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Gene Kim
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Sean Pinney
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Takeyoshi Ota
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
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Grinstein J, Belkin MN, Kalantari S, Bourque K, Salerno C, Pinney S. Adverse Hemodynamic Consequences of Continuous Left Ventricular Mechanical Support: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 82:70-81. [PMID: 37380306 DOI: 10.1016/j.jacc.2023.04.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 01/11/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 06/30/2023]
Abstract
Left ventricular assist devices (LVADs) provide lifesaving therapy for patients with advanced heart failure. The recognition of pump thrombosis, stroke, and nonsurgical bleeding as hemocompatibility-related adverse events (HRAEs) led to pump design improvements and reduced adverse event rates. However, continuous flow can predispose patients to right-sided heart failure (RHF) and aortic insufficiency (AI), especially as patients live longer with their device. Given the hemodynamic contributions to AI and RHF, these comorbidities can be classified as hemodynamic-related events (HDREs). Hemodynamic-driven events are time dependent and often manifest later than HRAEs. This review examines the emerging strategies to mitigate HDREs, with a focus on defining best practices for AI and RHF. As we head into the next generation of LVAD technology, it is important to differentiate HDREs from HRAEs so that we can continue to advance the field and improve the true durability of the pump-patient continuum.
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Affiliation(s)
- Jonathan Grinstein
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA.
| | - Mark N Belkin
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Sara Kalantari
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Kevin Bourque
- Heart Failure Division, Abbott, Burlington, Massachusetts, USA
| | - Christopher Salerno
- Section of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Sean Pinney
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
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Hamid N, Jorde UP, Reisman M, Latib A, Lim DS, Joseph SM, Kurlianskaya A, Polonetsky O, Neuzil P, Reddy V, Foerst J, Gada H, Grubb KJ, Silva G, Kereiakes D, Shreenivas S, Pinney S, Davidavicius G, Sorajja P, Boehmer JP, Kleber FX, Perier P, VAN Mieghem NM, Dumonteil N, Leon MB, Burkhoff D. Transcatheter Left Ventricular Restoration in Patients With Heart Failure. J Card Fail 2023; 29:1046-1055. [PMID: 36958391 DOI: 10.1016/j.cardfail.2023.03.003] [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: 02/28/2023] [Revised: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Left ventricular (LV) volume reshaping reduces myocardial wall stress and may induce reverse remodeling in patients with heart failure with reduced ejection fraction. The AccuCinch Transcatheter Left Ventricular Restoration system consists of a series of anchors connected by a cable implanted along the LV base that is cinched to the basal free wall radius. We evaluated the echocardiographic and clinical outcomes following transcatheter left ventricular restoration. METHODS AND RESULTS We analyzed 51 heart failure patients with a left ventricular ejection fraction between 20% and 40%, with no more than 2+ mitral regurgitation treated with optimal medical therapy, who subsequently underwent transcatheter left ventricular restoration. Serial echocardiograms, Kansas City Cardiomyopathy Questionnaire scores, and 6-minute walk test distances were measured at baseline through 12 months. Primary analysis end point was change in end-diastolic volume at 12 months compared with baseline. Patients (n = 51) were predominantly male (86%) with a mean age of 56.3 ± 13.1 years. Fluoroscopy showed LV free wall radius decreased by a median of 9.2 mm amounting to a 29.6% decrease in the free wall arc length. At 12 months, the LV end-diastolic volume decreased by 33.6 ± 34.8 mL (P < .01), with comparable decreases in the LV end-systolic volume. These decreases were associated with significant improvements in the overall Kansas City Cardiomyopathy Questionnaire score (16.4 ± 18.7 points; P < .01) and 6-minute hall walk test distance (45.9 ± 83.9 m; P < .01). There were no periprocedural deaths; through the 1-year follow-up, 1 patient died (day 280) and 1 patient received a left ventricular assist device (day 13). CONCLUSIONS In patients with heart failure with reduced ejection fraction without significant mitral regurgitation receiving optimal medical therapy, the AccuCinch System resulted in decreases of LV volume, as well as improved quality of life and exercise endurance. A randomized trial is ongoing (NCT04331769).
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Affiliation(s)
- Nadira Hamid
- Columbia University Medical Center/ NY Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Ulrich P Jorde
- Montefiore Medical Center, New York, New York; Albert Einstein College of Medicine, Bronx, New York
| | | | - Azeem Latib
- Montefiore Medical Center, New York, New York; Albert Einstein College of Medicine, Bronx, New York
| | - D Scott Lim
- University of Virginia, Charlottesville, Virginia
| | - Susan M Joseph
- University of Maryland Medical Center, Baltimore, Maryland
| | | | - Oleg Polonetsky
- Republican Scientific and Practical Center Cardiology, Minsk, Belarus
| | | | - Vivek Reddy
- Icahn School of Medicine Mount Sinai, New York, New York
| | - Jason Foerst
- Carilion Roanoke Memorial Hospital, Roanoke, Virginia
| | - Hemal Gada
- UPMC Heart and Vascular Institute, Pinnacle Health, Harrisburg, Pennsylvania
| | | | | | | | | | - Sean Pinney
- University of Chicago, Division of Cardiology, Chicago, Illinois
| | - Giedrius Davidavicius
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, and Cardiology and Angiology Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Paul Sorajja
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | - Franz X Kleber
- Martin Luther Universität Halle-Wittenberg, PGS Wittenberg, Germany
| | - Patrick Perier
- Campus Bad Neustadt, Herzchirurgie, Bad Neustadt/Saale, Germany
| | - Nicolas M VAN Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Martin B Leon
- Columbia University Medical Center/ NY Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
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10
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Saeed D, Feldman D, Banayosy AE, Birks E, Blume E, Cowger J, Hayward C, Jorde U, Kremer J, MacGowan G, Maltais S, Maybaum S, Mehra M, Shah KB, Mohacsi P, Schweiger M, Schroeder SE, Shah P, Slepian M, Tops LF, Alvarez P, Arabia F, Aslam S, Benson-Louis L, Birati E, Buchholz HW, Cedars A, Christensen D, Ciarka A, Coglianese E, Cogswell R, Cook J, Copeland J, Costello JG, Drakos SG, Eghtesady P, Elliot T, Estep JD, Eulert-Grehn JJ, Fabrizio DR, Garbade J, Gelow J, Guglin M, Hernandez-Montfort J, Horstmanshof D, John R, Kanwar M, Khaliel F, Kim G, Kumar S, Lavee J, Leache M, Leprince P, Lim S, Loforte A, Maly J, Najjar S, Netuka I, Pamboukian SV, Patel SR, Pinney S, Pluym CV, Potapov E, Robson D, Rochlani Y, Russell S, Sandau K, Sandoval E, Sayer G, Schettle S, Schibilsky D, Schlöglhofer T, Schmitto J, Siddique A, Silvestry S, Slaughter MS, Sun B, Takayama H, Tedford R, Teuteberg JJ, Ton VK, Uriel N, Vierecke J, Zimpfer D, D'Alessandro D. The 2023 International Society for Heart and Lung Transplantation Guidelines for Mechanical Circulatory Support: A 10- Year Update. J Heart Lung Transplant 2023; 42:e1-e222. [PMID: 37245143 DOI: 10.1016/j.healun.2022.12.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/05/2022] [Indexed: 05/29/2023] Open
Affiliation(s)
- Diyar Saeed
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany..
| | - David Feldman
- University of Cincinnati & Cincinnati Childrens Hosptial, Cincinnati, Ohio, USA.
| | - Aly El Banayosy
- Integris Nazih Zuhdi Transplant Institute, Oklahoma City, OK, USA
| | - Emma Birks
- University of Louisville, Louisville, KY, USA
| | | | - Jennifer Cowger
- Department of Cardiology, Henry Ford Hospital, Detroit, MI, USA
| | - Christopher Hayward
- Faculty of Medicine, St Vincent's Hospital, University of New South Wales, Sydney, Australia
| | | | - Jamila Kremer
- Department of Cardiothoracic Surgery, Heidelberg University, Heidelberg, Germany
| | - Guy MacGowan
- Newcastle Upon Tyne Hospitals, and Newcastle University, Newcastle upon Tyne, UK
| | - Simon Maltais
- Department of cardiac Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Keyur B Shah
- Department of Cardiology, Virginia Commonwealth University, Virginia
| | - Paul Mohacsi
- CardioVascular Center Im Park, Seestrasse 247, CH-8038 Zürich
| | | | | | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church VA, USA
| | | | - Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Paulino Alvarez
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Francisco Arabia
- Advanced Heart Program, Banner University Medical Group, Phoenix, AZ, USA
| | - Saima Aslam
- University of California, San Diego, San Diego, CA, USA
| | | | - Edo Birati
- Cardiovascular Division, Padeh-Poriya Medical Center, Bar Ilan University, Israel
| | | | - Ari Cedars
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | - Erin Coglianese
- Department of Medicine/Cardiology, Mass General Hospital, Harvard School of Medicine, Boston Massachusetts USA
| | | | - Jennifer Cook
- University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Jack Copeland
- Department of Surgery, Division of Cardiothoracic Surgery, University of Arizona, Tucson, AZ, USA
| | | | - Stavros G Drakos
- University of Utah Health and School of Medicine and Salt Lake VA Medical Center, Salt Lake City, Utah, USA
| | - Pirooz Eghtesady
- Department of Pediatrics, Washington University in St. Louis, USA
| | | | - Jerry D Estep
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | | | - De Rita Fabrizio
- Consultant in Congenital Heart Surgery, Adult and Paediatric Congenital Heart Unit Freeman Hospital, Newcastle Upon Tyne, UK
| | - Jens Garbade
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzg, Germany
| | - Jill Gelow
- Department of Pediatrics, Providence Heart Institute, Portland, Oregon, USA
| | | | | | | | - Ranjit John
- University of Minnesota, Minneapolis, MN, USA
| | | | - Feras Khaliel
- King Faisal Specialist Hospital & Research Center, Riyadh
| | - Gene Kim
- Department of Cardiology, University of Chicago, Illinois, USA
| | - Sachin Kumar
- Division of Cardiovascular Surgery, Advanced Heart Failure Program, University of Texas Medical Center, Houston, Texas, USA
| | - Jacob Lavee
- Department of Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Marzia Leache
- Department of Cardiac Surgery, New Yok University Medical Center, New York, NY, USA
| | - Pascal Leprince
- Department of Thoracic and Cardiovascular Surgery, Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Sern Lim
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Antonio Loforte
- Bologna University, Cardiothorac, Transplant and Vasc Surg Dept, Bologna, Italy
| | - Jiri Maly
- Department of Cardiac Surgery, Institute for Clinical and Experimental Medicine, Prague, Czeck Republic
| | - Samer Najjar
- Department of Medicine, MedStar Washington Hospital Center, Georgetown University, Wahington DC USA
| | - Ivan Netuka
- Dept. of Cardiac Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Snehal R Patel
- Cardiology Division, Montefiore Medical Center, Bronx, NY, USA
| | - Sean Pinney
- Mount Sinai Medical Center, New York, NY, USA
| | - Christina Vander Pluym
- Division of Cardiology, Boston Children's Hospital/Harvard School of Medicine, Boston, Massachusetts, USA
| | | | - Desiree Robson
- Department of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | | | | | | | | | - Gabriel Sayer
- University of Chicago Medical Center, Chicago, IL, USA
| | | | - David Schibilsky
- Department of Surgery, Universitats- Herzzentrum, Freiburg Germany
| | | | - Jan Schmitto
- Dept. of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Aleem Siddique
- Department of Surgery, University of Nebraska Medical Center, Omha, Nebraska, USA
| | - Scott Silvestry
- Department of Cardiac Surgery, Florida Hospital, Orlando, FL, USA
| | - Mark S Slaughter
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Kentucky, USA
| | - Benjamin Sun
- Cardiac Surgery department, Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Hiroo Takayama
- Department of Cardiac Surgery, Columbia University Medical Center, New York, NY, USA
| | - Ryan Tedford
- Department of Medicine/Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Van-Khue Ton
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nir Uriel
- Department of Cardiology, Columbia University, New York, NY, USA
| | - Juliane Vierecke
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - David D'Alessandro
- Massachusetts General Hospital, Boston, Harvard School of Medicine, Boston, MA, USA.
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11
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Hahn RT, Lerakis S, Delgado V, Addetia K, Burkhoff D, Muraru D, Pinney S, Friedberg MK. Multimodality Imaging of Right Heart Function: JACC Scientific Statement. J Am Coll Cardiol 2023; 81:1954-1973. [PMID: 37164529 DOI: 10.1016/j.jacc.2023.03.392] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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: 02/07/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 05/12/2023]
Abstract
Right ventricular (RV) size and function assessed by multimodality imaging are associated with outcomes in a variety of cardiovascular diseases. Understanding RV anatomy and physiology is essential in appreciating the strengths and weaknesses of current imaging methods and gives these measurements greater context. The adaptation of the right ventricle to different types and severity of stress, particularly over time, is specific to the cardiovascular disease process. Multimodality imaging parameters, which determine outcomes, reflect the ability to image the initial and longitudinal RV response to stress. This paper will review the standard and novel imaging methods for assessing RV function and the impact of these parameters on outcomes in specific disease states.
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Affiliation(s)
- Rebecca T Hahn
- Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA.
| | | | - Victoria Delgado
- Hospital University Germans Trias i Pujol Hospital, Badalona, Barcelona, Spain
| | - Karima Addetia
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | | | - Denisa Muraru
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Sean Pinney
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
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12
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Bangaru S, Uppalapati S, Palluri S, Ram K, Sudheendra K, Jain S, Johnson K, Hynes D, Madhushankar A, Grinstein J, Pinney S, Onsager D, Rodgers D, Jeevanandam V. A Less Restrictive Approach to Procuring Organs is Not an Indicator of Prognostic Survival in Heart Transplantation: A Retrospective Analysis of 118 Adult Heart Transplant Centers from 2020 to 2022. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.103] [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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13
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Loethen A, Lavelle R, Sadzak M, Bucio J, Sarswat N, Chung B, Smith B, Kalantari S, Grinstein J, Nguyen A, Belkin M, Murks C, Riley T, Powers J, Jones A, Kim G, Pinney S. Use of Complement-Fixing Assays to Expand the Donor Pool for Highly Sensitized Heart Transplant Recipients - The Role of C1q Testing. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1659] [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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14
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Patel S, Uriel N, Nguyen A, Silvia B, Wolf-Doty T, Tian W, Qu K, Pinney S. Relationship Between Absolute Quantification of Donor-Derived Cell-Free DNA and Donor-Derived Cell-Free DNA Fraction for Detection of Allograft Rejection in Heart Transplant Patients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1107] [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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15
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Lavelle R, Loethen A, Murks C, Riley T, Powers J, Jones A, Belkin M, Nguyen A, Grinstein J, Chung B, Kalantari S, Smith B, Sarswat N, Kim G, Pinney S. Impact of Early Belatacept Use on 1-Year CAV Progression in Heart Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1358] [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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16
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Watanabe T, Nemoto A, Nguyen A, Grinstein J, Chung B, Smith B, Kalantari S, Sarswat N, Kim G, Pinney S, Onsager D, Song T, Salerno C, Jeevanandam V, Ota T. Impact on Non-Cardiac Surgery for Patients with Lvad Support. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1585] [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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17
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Teuteberg J, Pinney S, Khush K, Fei M, Yue J, Shen L, Patel S, Kanwar M, Shah P, Uriel N. A “Negative” Endomyocardial Biopsy after an Elevated Donor-Derived Cell Free DNA is Associated with Worse Survival after Heart Transplant. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1522] [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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18
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Lowes B, DePasquale E, Pinney S, Hsueh M, Fu Y, Shen L, Baran D, Kobashigawa J, Teuteberg J, Raval N. Higher Utilization of Non-Invasive Rejection Surveillance in Year Two after Heart Transplant is Associated with Higher Rates of Detection Of Rejection, Graft Dysfunction, and Vasculopathy. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.561] [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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19
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Loethen A, Lavelle R, Sarswat N, Chung B, Smith B, Kalantari S, Grinstein J, Nguyen A, Belkin M, Murks C, Riley T, Powers J, Jones A, Kim G, Pinney S. Efficacy and Tolerability of Belatacept in Heart Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.179] [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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20
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Stehlik J, Schroder J, Pinney S, Patel C, D'Alessandro D, Goldstein D, Jorde U, Patel S, Mani D, Esmailian F, Kobashigawa J, Takeda K, Uriel N, Pham S, Patel P, Kai M, Sun B, Shah A, Ono M, Couper G, DeNofrio D, Vest A, Joyce D, DeVore A, Mallidi H, Itoh A, Mehra M, Givertz M, Milano C, Farr M. First Report of the Transmedics Organ Care System Heart Perfusion Registry. A Multi-Institutional Outcomes Analysis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.634] [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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21
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Loethen A, Lavelle R, Sarswat N, Chung B, Smith B, Kalantari S, Grinstein J, Nguyen A, Belkin M, Kim G, Pinney S. Successful Use of Carfilzomib and Belatacept to Lower Alloantibodies Prior to Heart Transplant: A Case Series. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1359] [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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22
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Nemoto A, Belkin M, Sarswat N, Chung B, Nguyen A, Smith B, Kalantari S, Kim G, Grinstein J, Pinney S, Onsager D, Song T, Salerno C, Jeevanandam V, Ota T. Impact of Surgical Techniques on Survival and Hemodynamics after Orthotopic Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1535] [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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23
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Milano C, Schroder J, Farr M, DeVore A, D'Alessandro D, Goldstein D, Jorde U, Patel S, Daneshmand M, Pinney S, Esmailian F, Kobashigawa J, Takeda K, Uriel N, Pham S, Patel P, Kai M, Sun B, Shah A, Ono M, Couper G, DeNofrio D, Vest A, Joyce D, Mallidi H, Itoh A, Mehra M, Givertz M, Patel C, Stehlik J. Demographics and Outcomes of Clinical Trial vs Initial Post-Approval Use of Transmedics Organ Care System Heart. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.135] [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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24
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Siddiki M, Han J, Belkin M, Plana A, Gupta N, Pinney S, Kalantari S, Grinstein J. Response in Kidney Function in Heart Failure after Milrinone Loading. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.441] [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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25
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Bhardwaj A, Fedson S, Munagala M, Pinney S, Rajapreyar I, Mancini D. Pregnancy in Patients With Advanced Heart Failure: Impact of Overturn of Roe v Wade Ruling. JACC Heart Fail 2023; 11:362-364. [PMID: 36889883 DOI: 10.1016/j.jchf.2022.12.013] [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] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/29/2022] [Accepted: 12/20/2022] [Indexed: 03/08/2023]
Affiliation(s)
- Anju Bhardwaj
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas-Houston, Houston, Texas, USA.
| | - Savitri Fedson
- Department of Medicine and Clinical Ethics, Michael E. DeBakey VA Medical Center, Center for Medical Ethics, Baylor College of Medicine, Houston, Texas, USA
| | - Mrudula Munagala
- Division of Cardiology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Sean Pinney
- Division of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Indranee Rajapreyar
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Donna Mancini
- Cardiology Department, Cardiovascular Institute, Mount Sinai Hospital, New York, New York, USA
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26
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Kanelidis AJ, Siddiqi U, Miller T, Belkin M, Li G, Smith B, Kalantari S, Nguyen A, Chung BB, Sarswat N, Kim G, Salerno C, Jeevanandam V, Pinney S, Grinstein J. The prognostic role of advanced hemodynamic variables in patients with left ventricular assist devices. Artif Organs 2023; 47:574-581. [PMID: 36305735 PMCID: PMC10023393 DOI: 10.1111/aor.14441] [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: 06/29/2022] [Revised: 09/21/2022] [Accepted: 10/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Invasive hemodynamic variables obtained from right heart catheterization have been used for risk-stratifying patients with advanced heart failure (HF). However, there is a paucity of data on the prognostic value of invasive hemodynamic variables in patients with left ventricular assist devices (LVAD). We hypothesized that cardiac power output (CPO), cardiac power efficiency (CPE), and left ventricular stroke work index (LVSWI) can serve as prognostic markers in patients with LVADs. METHODS Baseline hemodynamic data from patients who had LVAD ramp studies at our institution from 4/2014 to 7/2018 were prospectively collected, from which advanced hemodynamic variables (CPO, CPE, and LVSWI) were retrospectively analyzed. Univariate and multivariable analyses were performed for hemocompatibility-related adverse events (HRAE), HF admissions, and mortality. RESULTS Ninety-one participants (age 61 ± 11 years, 34% women, 40% Black or African American, and 38% ischemic cardiomyopathy) were analyzed. Low CPE was significantly associated with mortality (HR 2.42, 95% CI 1.02-5.74, p = 0.045) in univariate analysis and Kaplan-Meier analysis (p = 0.04). Low LVSWI was significantly associated with mortality (HR 2.13, 95% CI 1.09-4.17, p = 0.03) in univariate analysis and Kaplan-Meier analysis (p = 0.02). CPO was not associated with mortality. CPO, CPE, and LVSWI were not associated with HRAE or HF admissions. CONCLUSIONS Advanced hemodynamic variables can serve as prognostic indicators for patients with LVADs. Low CPE and LVSWI are prognostic for higher mortality, but no variables were associated with HF admissions or HRAEs.
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Affiliation(s)
- Anthony J Kanelidis
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Umar Siddiqi
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Tamari Miller
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Mark Belkin
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - George Li
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Bryan Smith
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Sara Kalantari
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Ann Nguyen
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Ben B Chung
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Nitasha Sarswat
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Gene Kim
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Christopher Salerno
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Valluvan Jeevanandam
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Sean Pinney
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Jonathan Grinstein
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
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27
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Sawinski D, Lai JC, Pinney S, Gray AL, Jackson AM, Stewart D, Levine DJ, Locke JE, Pomposelli JJ, Hartwig MG, Hall SA, Dadhania DM, Cogswell R, Perez RV, Schold JD, Turgeon NA, Kobashigawa J, Kukreja J, Magee JC, Friedewald J, Gill JS, Loor G, Heimbach JK, Verna EC, Walsh MN, Terrault N, Testa G, Diamond JM, Reese PP, Brown K, Orloff S, Farr MA, Olthoff KM, Siegler M, Ascher N, Feng S, Kaplan B, Pomfret E. Addressing sex-based disparities in solid organ transplantation in the United States - a conference report. Am J Transplant 2023; 23:316-325. [PMID: 36906294 DOI: 10.1016/j.ajt.2022.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 05/02/2022] [Revised: 10/17/2022] [Accepted: 11/04/2022] [Indexed: 01/15/2023]
Abstract
Solid organ transplantation provides the best treatment for end-stage organ failure, but significant sex-based disparities in transplant access exist. On June 25, 2021, a virtual multidisciplinary conference was convened to address sex-based disparities in transplantation. Common themes contributing to sex-based disparities were noted across kidney, liver, heart, and lung transplantation, specifically the existence of barriers to referral and wait listing for women, the pitfalls of using serum creatinine, the issue of donor/recipient size mismatch, approaches to frailty and a higher prevalence of allosensitization among women. In addition, actionable solutions to improve access to transplantation were identified, including alterations to the current allocation system, surgical interventions on donor organs, and the incorporation of objective frailty metrics into the evaluation process. Key knowledge gaps and high-priority areas for future investigation were also discussed.
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Affiliation(s)
- Deirdre Sawinski
- Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA.
| | - Jennifer C Lai
- Division of Gastroenterology and Hepatology, University of California, San Francisco, California, USA
| | - Sean Pinney
- University of Chicago Medicine, Chicago, Illinois, USA
| | - Alice L Gray
- University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Annette M Jackson
- Department of Surgery, Duke University, Department of Surgery, Durham, Carolina, USA
| | - Darren Stewart
- United Network for Organ Sharing, Richmond, Virginia, USA
| | | | - Jayme E Locke
- University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, Alabama, USA
| | - James J Pomposelli
- Department of Surgery University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA; Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado, USA
| | | | | | - Darshana M Dadhania
- Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA
| | - Rebecca Cogswell
- University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Richard V Perez
- Department of Surgery, University of California, Davis, School of Medicine, Sacramento, California, USA
| | - Jesse D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Jon Kobashigawa
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Jasleen Kukreja
- Department of Surgery, University of California, San Francisco, California, USA
| | - John C Magee
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - John Friedewald
- Northwestern University Feinberg School of Medicine, Chicago, Illinois USA
| | - John S Gill
- Division of Nephrology, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Gabriel Loor
- Baylor College of Medicine Lung Institute, Houston, Texas, USA
| | | | - Elizabeth C Verna
- Center for Liver Disease and Transplantation, Columbia University, Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Mary Norine Walsh
- Ascension St Vincent Heart Center, Indianapolis, Indianapolis, Indiana, USA
| | - Norah Terrault
- Keck Medicine of University of Southern California, Los Angeles, California, USA
| | - Guiliano Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Joshua M Diamond
- Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter P Reese
- Division of Renal, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Susan Orloff
- Division of Abdominal Organ Transplantation and Hepatobiliary Surgery, Department of Surgery, Portland, Oregon, USA
| | - Maryjane A Farr
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kim M Olthoff
- Department of Surgery, Penn Transplant Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark Siegler
- University of Chicago Medicine, Chicago, Illinois, USA; MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA
| | - Nancy Ascher
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Sandy Feng
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Bruce Kaplan
- Department of Surgery University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA; Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado, USA
| | - Elizabeth Pomfret
- Department of Surgery University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA; Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado, USA
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Copeland H, Knezevic I, Baran DA, Rao V, Pham M, Gustafsson F, Pinney S, Lima B, Masetti M, Ciarka A, Rajagopalan N, Torres A, Hsich E, Patel JK, Goldraich LA, Colvin M, Segovia J, Ross H, Ginwalla M, Sharif-Kashani B, Farr MA, Potena L, Kobashigawa J, Crespo-Leiro MG, Altman N, Wagner F, Cook J, Stosor V, Grossi PA, Khush K, Yagdi T, Restaino S, Tsui S, Absi D, Sokos G, Zuckermann A, Wayda B, Felius J, Hall SA. Donor heart selection: Evidence-based guidelines for providers. J Heart Lung Transplant 2023; 42:7-29. [PMID: 36357275 PMCID: PMC10284152 DOI: 10.1016/j.healun.2022.08.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 01/31/2023] Open
Abstract
The proposed donor heart selection guidelines provide evidence-based and expert-consensus recommendations for the selection of donor hearts following brain death. These recommendations were compiled by an international panel of experts based on an extensive literature review.
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Affiliation(s)
- Hannah Copeland
- Department of Cardiovascular and Thoracic Surgery Lutheran Hospital, Fort Wayne, Indiana; Indiana University School of Medicine-Fort Wayne, Fort Wayne, Indiana.
| | - Ivan Knezevic
- Transplantation Centre, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - David A Baran
- Department of Medicine, Division of Cardiology, Sentara Heart Hospital, Norfolk, Virginia
| | - Vivek Rao
- Peter Munk Cardiac Centre Toronto General Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Michael Pham
- Sutter Health California Pacific Medical Center, San Francisco, California
| | - Finn Gustafsson
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sean Pinney
- University of Chicago Medicine, Chicago, Illinois
| | - Brian Lima
- Medical City Heart Hospital, Dallas, Texas
| | - Marco Masetti
- Heart Failure and Heart Transplant Unit IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Agnieszka Ciarka
- Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Institute of Civilisation Diseases and Regenerative Medicine, University of Information Technology and Management, Rzeszow, Poland
| | | | - Adriana Torres
- Los Cobos Medical Center, Universidad El Bosque, Bogota, Colombia
| | | | | | | | | | - Javier Segovia
- Cardiology Department, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain
| | - Heather Ross
- University of Toronto, Toronto, Ontario, Canada; Sutter Health California Pacific Medical Center, San Francisco, California
| | - Mahazarin Ginwalla
- Cardiovascular Division, Palo Alto Medical Foundation/Sutter Health, Burlingame, California
| | - Babak Sharif-Kashani
- Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - MaryJane A Farr
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Luciano Potena
- Heart Failure and Heart Transplant Unit IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | | | | | | | | | | | - Valentina Stosor
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Kiran Khush
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Tahir Yagdi
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Susan Restaino
- Division of Cardiology Columbia University, New York, New York; New York Presbyterian Hospital, New York, New York
| | - Steven Tsui
- Department of Cardiothoracic Surgery Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Daniel Absi
- Department of Cardiothoracic and Transplant Surgery, University Hospital Favaloro Foundation, Buenos Aires, Argentina
| | - George Sokos
- Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Brian Wayda
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Joost Felius
- Baylor Scott & White Research Institute, Dallas, Texas; Texas A&M University Health Science Center, Dallas, Texas
| | - Shelley A Hall
- Texas A&M University Health Science Center, Dallas, Texas; Division of Transplant Cardiology, Mechanical Circulatory Support and Advanced Heart Failure, Baylor University Medical Center, Dallas, Texas
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Abstract
This JAMA Clinical Guidelines Synopsis summarizes the 2022 ACC/AHA/HFSA guidelines for management of heart failure in adults with a diagnosis of or at risk for heart failure.
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Nishida H, Jeevanandam V, Salerno C, Song T, Onsager D, Nguyen A, Grinstein J, Chung B, Smith B, Kalantari S, Sarswat N, Kim G, Pinney S, Ota T. Concomitant left atrial appendage closure with left ventricular assist device surgery can reduce ischemic cerebrovascular accidents. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
It remains unknown if concomitant left atrial appendage closure (LAAC) at the time of left ventricular assist device (LVAD) surgery can reduce ischemic cerebrovascular accidents.
Purpose
The purpose of this study is to assess the impact of LAAC at LVAD surgery on the incidence of ischemic cerebrovascular accidents.
Methods
Between January 2012 and November 2021, 310 patients underwent LVAD surgery with HeartMate II or III. Out of 310 patients, 98 patients (31.6%) underwent concomitant LAAC. The cohort was divided into two groups: patients with LAAC (Group A, n=98) and without LAAC (Group B, n=212). To minimize device bias, LVAD surgery with HeartWare HVAD device was excluded. The ischemic cerebrovascular accident was defined as ischemic stroke, hemorrhagic stroke or transient ischemic attack. We reviewed early and long-term clinical outcomes. The incidence of ischemic cerebrovascular accidents was compared between two groups using the Kaplan-Meier method. We also investigated if LAAC was associated with ischemic cerebrovascular accidents by Cox proportional hazards analysis.
Results
There were no significant differences in baseline characteristics between two groups including age (Group A: 55.0±12.3 years old, Group B: 56.9±14.1 years old, p=0.26), preoperative CHADS2 score (Group A: 2.40±1.1, Group B: 2.58±1.1, p=0.19) and history of atrial fibrillation (Group A: 42.9%, Group B: 42.5%, p=0.95). In-hospital mortality was not significantly different between the two groups (Group A: 7.1%, Group B: 12.3%, p=0.16). In terms of postoperative complications, there were no significant differences between two groups in requiring extracorporeal membrane oxygenation, re-exploration for bleeding and newly required hemodialysis. Median follow up period was 474 days. Thirty-five patients (11.2%) developed ischemic cerebrovascular accidents (5 patients in Group A and 30 patients in Group B). The rate of freedom from ischemic cerebrovascular accidents in Group A (94.1% at 500 days and 94.1% at 1500 days) was significantly higher than that in Group B (88.2% at 500 days and 77.4% at 1500 days; log rank=0.024). In a Cox proportional hazards regression analysis including LAAC, age, history of atrial fibrillation, diabetes mellitus and Heartmate 3 device implantation, LAAC was associated with reducing the incidence of ischemic cerebrovascular accidents (hazard ratio 0.37, 95% CI 0.13–0.89, p=0.02).
Conclusion
Concomitant LAAC at the time of LVAD surgery can reduce ischemic cerebrovascular accidents without increasing perioperative mortality and complications.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- H Nishida
- University of Chicago Medicine , Chicago , United States of America
| | - V Jeevanandam
- University of Chicago Medicine , Chicago , United States of America
| | - C Salerno
- University of Chicago Medicine , Chicago , United States of America
| | - T Song
- University of Chicago Medicine , Chicago , United States of America
| | - D Onsager
- University of Chicago Medicine , Chicago , United States of America
| | - A Nguyen
- University of Chicago Medicine , Chicago , United States of America
| | - J Grinstein
- University of Chicago Medicine , Chicago , United States of America
| | - B Chung
- University of Chicago Medicine , Chicago , United States of America
| | - B Smith
- University of Chicago Medicine , Chicago , United States of America
| | - S Kalantari
- University of Chicago Medicine , Chicago , United States of America
| | - N Sarswat
- University of Chicago Medicine , Chicago , United States of America
| | - G Kim
- University of Chicago Medicine , Chicago , United States of America
| | - S Pinney
- University of Chicago Medicine , Chicago , United States of America
| | - T Ota
- University of Chicago Medicine , Chicago , United States of America
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Kobashigawa JA, Hall S, Farr M, Blumberg E, Michael Borkon A, Colvin M, Copeland H, Eisen H, Johnson M, Jorde U, Khush K, Kirklin JK, Patel J, Pinney S, Saadaeijahromi H, Schold JD, Stehlik J. Proceedings from the metrics forum in heart transplantation for performance monitoring. Am J Transplant 2022; 22:1299-1306. [PMID: 34866328 DOI: 10.1111/ajt.16901] [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: 09/17/2021] [Revised: 11/09/2021] [Accepted: 11/19/2021] [Indexed: 01/25/2023]
Abstract
Regulatory oversight for heart transplant programs is currently under review by the United Network for Organ Sharing (UNOS). There is concern whether 1-year patient and graft survival truly represent heart transplant center performance. Thus, a forum was organized by the Thoracic and Critical Care Community of Practice (TCC COP) of the American Society of Transplantation (AST) for the heart transplant community to voice their opinions on matters involving program performance monitoring by UNOS. A TCC COP work group was formed to review outcome metrics for adult heart transplantation and culminated in a virtual community forum (72 participants representing 61 heart transplant programs) on November 12-13, 2020. One-year posttransplant survival is still considered an appropriate and important measure to assess program performance. Waitlist mortality and offer acceptance rate as pretransplant metrics could also be useful measures of program performance, recognizing that outside factors may influence these metrics. In depth discussion of these metrics and other issues including auditing thresholds, innovations to reduce risk-averse behavior and personally designed program scorecards are included in this meeting proceedings.
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Affiliation(s)
| | - Shelley Hall
- Baylor University Medical Center, Dallas, Texas, USA
| | | | - Emily Blumberg
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Hannah Copeland
- Lutheran Hospital, Indiana University Fort Wayne, Fort Wayne, Indiana, USA
| | - Howard Eisen
- Pennsylvania State University, State College, Pennsylvania, USA
| | | | - Ulrich Jorde
- Montefiore Medical Center, New York, New York, USA
| | - Kiran Khush
- Stanford University, Palo Alto, California, USA
| | - James K Kirklin
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jignesh Patel
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Sean Pinney
- University of Chicago, Chicago, Illinois, USA
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Leven EA, Kurdi AT, Govindarajulu U, Schiano T, Pinney S, Crismale JF. Child-Turcotte-Pugh versus MELD-XI identify distinct high-risk populations for heart transplantation following ventricular assist device placement. Clin Transplant 2022; 36:e14617. [PMID: 35191097 DOI: 10.1111/ctr.14617] [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: 10/05/2021] [Revised: 01/05/2022] [Accepted: 02/11/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patients with end-stage heart failure frequently have significant congestive hepatopathy requiring hepatology assessment prior to heart transplantation listing. An elevated Model for End-stage Liver Disease score with modification to exclude INR (MELD-XI) has been associated with increased mortality following heart transplantation (HT). This study's primary aim was to examine whether Child-Turcotte-Pugh (CTP) classification is associated with post-transplant mortality in patients bridged to transplant with left ventricular assist devices. METHODS AND RESULTS We conducted a retrospective analysis of 134 patients from our center. Age, CTP class, and MELD-XI at HT were included in the multivariate model for the primary outcome, which demonstrated a significant association between 1-year mortality and CTP class (CTP-A HR: .08, CI .01-.46, P < .01; CTP-B HR: .25, CI .05-1.2, P = .08; reference group CTP-C), and MELD-XI (HR: 1.15; CI: 1.03-1.28; P = .01), but no significant difference for age (HR: .97; CI: .93-1.01; P = .15). Only 13/33 patients with CTP improvement after assist device also had improvement in MELD-XI. CONCLUSIONS Patients with relatively low MELD-XI scores with discordantly high CTP classification may be a distinct subset for whom MELD-XI underestimates the risk of mortality after heart transplantation compared to CTP.
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Affiliation(s)
- Emily A Leven
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ahmed T Kurdi
- Department of Medicine, Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | - Usha Govindarajulu
- Center for Biostatistics, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas Schiano
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sean Pinney
- Department of Medicine, Division of Cardiology, University of Chicago, Chicago, Illinois, USA
| | - James F Crismale
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Nishida H, Salerno C, Onsager D, Song T, Nguyen A, Grinstein J, Chung B, Smith B, Kalantari S, Sarswat N, Kim G, Pinney S, Jeevanandam V, Ota T. Comparing short-term/long-term outcomes of heart transplants that occur inside and outside of normal working hours. ESC Heart Fail 2022; 9:2484-2490. [PMID: 35460200 PMCID: PMC9288785 DOI: 10.1002/ehf2.13947] [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: 01/07/2022] [Revised: 03/10/2022] [Accepted: 04/06/2022] [Indexed: 11/06/2022] Open
Abstract
Aims Heart transplantation involves many factors such as donor selection, recipient management, multidisciplinary assessment, coordination with other organ teams, and transportation. Because of some unpredictable factors, heart transplantation can be conducted at any time of day. The purpose of this study is to investigate if outcomes differ between heart transplants taking place inside or outside of normal working hours. Methods and results We reviewed patients who underwent heart transplantation at our institution from January 2010 to July 2020 (n = 329). Based on the documented start time of the recipient surgeries, the cohort was divided into two groups: working hours (Group A: 7:30 to 17:00; n = 92) and after hours (Group B: 17:00 to 7:30; n = 237). We compared these groups using propensity score matching analysis. After propensity score matching, 78 pairs of patients were successfully matched. We reviewed early and late clinical outcomes including survival. Long‐term survival was compared using the Kaplan–Meier method. In the propensity‐score matched patients, there were no significant differences in the baseline characteristics between two groups. In‐hospital mortality was not significantly different between the two groups (Group A: 6.4% vs. Group B: 2.6%, P = 0.44). Ischaemic time and cross‐clamp time did not differ between the groups. In terms of postoperative complications, there were no significant differences between two groups in stroke (6.4% vs. 3.9%, P = 0.72), primary graft dysfunction requiring extracorporeal membrane oxygenation (5.1% vs. 7.7%, P = 0.75), re‐exploration for bleeding (9.0% vs. 12.8%, P = 0.44), and newly required haemodialysis (7.7% vs. 6.4%, P = 0.75). The survival rate in Group A (88.1% at 1 year, 81.3% at 3 years) was not significantly different from Group B (90.5% at 1 year, 82.3% at 3 years, log rank = 0.96). Conclusion There was no significant difference in clinical outcomes between heart transplants taking place inside or outside of working hours. A high quality of care can be provided for heart transplant patients even during after hours.
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Affiliation(s)
- Hidefumi Nishida
- Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | | | - David Onsager
- Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Tae Song
- Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Ann Nguyen
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Jonathan Grinstein
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Bow Chung
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Bryan Smith
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Sara Kalantari
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Nitasha Sarswat
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Gene Kim
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Sean Pinney
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | | | - Takeyoshi Ota
- Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
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Siddiqi U, Belkin M, Li G, Hoang R, Hu K, Jeevanandam V, Pinney S. Panel-Reactive Antibody Associated with Acute Rejection Episodes After Heart Transplantation: An Analysis of the UNOS Database. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.303] [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] Open
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35
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Teuteberg J, Pinney S, Khush K, Fei M, Zhou M, Patel S, Kanwar M, Shah K, Shah P, Uriel N. Should We Be Comforted by a “Negative” Endomyocardial Biopsy? Risk of Future Events with Donor Derived Cell Free DNA in the Setting of Histologic Quiescence. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.268] [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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36
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DePasquale E, Stribling K, Shah K, Zeng J, Tian W, Qu K, Raval N, Shah P, Pinney S. Is Absolute Change in AlloMap More Informative Than Absolute Value? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1118] [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: 11/28/2022] Open
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37
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Plana A, Kanelidis A, Cochran M, Parker W, Jeevanandam V, Salerno C, Kalantari S, Smith B, Pinney S, Grinstein J. Status Exception Use in the New Heart Allocation System: Identifying Inequalities in Allocation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1625] [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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38
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Dela Cruz M, Lin H, Adler E, Khalid M, Boissiere J, Kim G, Pinney S, Pamer E, Nguyen A. The Gut Microbiome as a Marker of Early Cardiac Allograft Injury. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.285] [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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39
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Belkin MN, Kalantari S, Kanelidis AJ, Miller T, Besser S, Nguyen A, Chung B, Smith B, Sarswat N, Kim G, Pinney S, Grinstein J. Calculation Of Cardiac Power Output With Right Atrial Pressure. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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40
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Pinney S, Farr M, Milano C, Shah A, Stehlik J. Organ Care System Heart Perfusion Registry (OHP Registry) - Overview of a National Data Repository of Ex-Vivo Perfusion in DBD and DCD Heart Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1470] [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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41
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Alam A, Uriel N, Shah K, Shah P, Zeng J, Dhingra R, Bellumkonda L, Pinney S, DePasquale E, Hall S. Impact of Donor Characteristics on AlloSure Scores. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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42
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McCarthy S, Molina E, Nemeh H, Chaudhry S, Pinney S, Srivastava A, Grinstein J, Hackett I, Cowger J. Characterizing Outflow Graft Narrowing over Time. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.325] [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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43
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Prabhu N, Wali E, Stock W, Pinney S, DeCara JM. PULMONARY VASCULAR TOXICITY WITH TYROSINE KINASE INHIBITOR THERAPY: A RARE CASE IN A CHRONIC MYELOID LEUKEMIA PATIENT. JACC CardioOncol 2022. [DOI: 10.1016/j.jaccao.2022.01.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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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44
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Henry M, Abutaleb A, Jeevanandam V, Smith H, Belkin M, Husain A, Pinney S, Ota T, Mor-Avi V, Lang RM, Addetia K. Intracardiac device associated interference with tricuspid valve apparatus on echocardiography: What can we learn from pathology? Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
New or worsening tricuspid regurgitation (TR) is associated with right-sided heart failure and worsened outcomes. Cardiac Implantable Electronic Devices (CIEDs), which are being implanted at growing rates worldwide, are increasingly being recognized as associated with TR occurrence related to interference with the tricuspid valve (TV) apparatus. Purpose: We sought to identify echocardiographic features in the right ventricle and TV that differentiate patients who have anatomically demonstrated interference with the TV on direct pathology inspection.
Methods
Explanted hearts from 44 consecutive patients undergoing orthotopic heart transplant (55 ±13 yrs, 68% men) with known implanted CIEDs were dissected to assess the presence (n = 18) or absence (n = 26) of CIED interference with the TV (Figure). Echocardiographic measurements performed prior to transplantation, including left and right ventricular (LV, RV) size and performance metrics as well as TR severity, were compared between both groups using non-parametric testing.
Results
Echocardiographic features of patients with and without anatomically demonstrated TV interference are shown in the Table. Although overall LV dimensions and volumes were not different between the two groups and LV ejection fraction was severely reduced in both groups, patients demonstrating CIED interference trended towards larger right atrial volumes (Table) and also larger RV and tricuspid annular sizes. Importantly, however, they were more than 4 times likely to have abnormal right ventricular function. Lastly, patients with tricuspid apparatus interference tended to have more significant TR, although these differences have not reached statistical significance (Table).
Conclusion
CIED interreference with tricuspid valve apparatus occurs frequently (41%) among patients with CIEDs, who undergo orthotopic heart transplantation. This may be associated with worsening TV function with subsequent changes in right atrial and ventricular geometry and function. In light of prior data showing poor outcomes with CIED associated TR, this study emphasizes the importance of non-invasive assessment of CIED interference with the tricuspid valve, in order to improve device placement and patient outcomes. Abstract Figure Abstract Table
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Affiliation(s)
- M Henry
- The University of Chicago Medical Center, Chicago, United States of America
| | - A Abutaleb
- The University of Chicago Medical Center, Chicago, United States of America
| | - V Jeevanandam
- The University of Chicago Medical Center, Chicago, United States of America
| | - H Smith
- The University of Chicago Medical Center, Chicago, United States of America
| | - M Belkin
- The University of Chicago Medical Center, Chicago, United States of America
| | - A Husain
- The University of Chicago Medical Center, Chicago, United States of America
| | - S Pinney
- The University of Chicago Medical Center, Chicago, United States of America
| | - T Ota
- The University of Chicago Medical Center, Chicago, United States of America
| | - V Mor-Avi
- The University of Chicago Medical Center, Chicago, United States of America
| | - RM Lang
- The University of Chicago Medical Center, Chicago, United States of America
| | - K Addetia
- The University of Chicago Medical Center, Chicago, United States of America
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Imamura T, Kinugawa K, Narang N, Nishida H, Pinney S, Jeevanandam V, Ota T. Implications of Heart Rate in Patients with Left Ventricular Assist Devices. Int Heart J 2022; 63:56-61. [DOI: 10.1536/ihj.21-468] [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] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | | | - Sean Pinney
- Department of Medicine, University of Chicago Medical Center
| | | | - Takeyoshi Ota
- Department of Surgery, University of Chicago Medical Center
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Nishida H, Song T, Onsager D, Nguyen A, Grinstein J, Chung B, Smith B, Kalantari S, Sarswat N, Kim G, Pinney S, Jeevanandam V, Milner R, Ota T. Significant vascular complications in percutaneous axillary intra-aortic balloon pump. Ann Vasc Surg 2022; 83:42-52. [DOI: 10.1016/j.avsg.2021.12.078] [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: 11/19/2021] [Revised: 12/13/2021] [Accepted: 12/22/2021] [Indexed: 11/15/2022]
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Nishida H, Song T, Onsager D, Nguyen A, Grinstein J, Chung B, Smith B, Kalantari S, Sarswat N, Kim G, Pinney S, Jeevanandam V, Ota T. Proximal ascending aorta size is associated with the incidence of de novo aortic insufficiency with left ventricular assist device. Heart Vessels 2021; 37:647-653. [PMID: 34585275 DOI: 10.1007/s00380-021-01946-4] [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] [Received: 07/15/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
We sought to assess the impact of the aortic root geometry on developing de novo aortic insufficiency (AI) in patients undergoing left ventricular assist device (LVAD). In total, 114 patients underwent LVAD implantation between February 2016 and January 2020 were included in this study (HeartMate3 N = 68, HeartWare N = 46). Significant aortic insufficiency was defined as mild-to-moderate or greater in echocardiography. The cohort was divided into two groups; those who developed significant AI (Group AI: n = 13) and did not (Group non-AI: n = 101). The primary outcomes of interest included late survival and predictors for significant AI. The patients in Group AI were older than Group non-AI (62.6 ± 11.9 vs 51.3 ± 14.0 years, p < 0.01). The diameter of proximal ascending aorta in Group AI was larger than Group non-AI (31.0 ± 5.0 vs 27.4 ± 4.3 mm, p < 0.01). Aortic valve remained closed in 53.8% in Group AI and 36.6% in Group non-AI (p = 0.24). The late survival was not significantly different between the groups (67.1% vs 76.0% at 3 years, log rank = 0.97). The Cox hazard model showed that larger proximal ascending aortic diameter/BSA (HR 1.55, CI 1.19-2.04, p < 0.01) and not-opening aortic valve (HR 4.73, CI 1.43-16.9, p = 0.01) were independent risk factors for significant AI. The cutoff value of proximal ascending aortic diameter/BSA was 15.5 (area under curve: 0.770, sensitivity: 0.69, specificity: 0.79). Dilated proximal ascending aorta at the time of LVAD surgery and not-opening aortic valve during follow-up were associated with the incidence of de novo significant AI.
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Affiliation(s)
- Hidefumi Nishida
- Department of Surgery, Section of Cardiac Surgery, The University of Chicago Medicine, 5841S Maryland Avenue, MC5040, Chicago, IL, 60637, USA
| | - Tae Song
- Department of Surgery, Section of Cardiac Surgery, The University of Chicago Medicine, 5841S Maryland Avenue, MC5040, Chicago, IL, 60637, USA
| | - David Onsager
- Department of Surgery, Section of Cardiac Surgery, The University of Chicago Medicine, 5841S Maryland Avenue, MC5040, Chicago, IL, 60637, USA
| | - Ann Nguyen
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Jonathan Grinstein
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Bow Chung
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Bryan Smith
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Sara Kalantari
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Nitasha Sarswat
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Gene Kim
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Sean Pinney
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Valluvan Jeevanandam
- Department of Surgery, Section of Cardiac Surgery, The University of Chicago Medicine, 5841S Maryland Avenue, MC5040, Chicago, IL, 60637, USA
| | - Takeyoshi Ota
- Department of Surgery, Section of Cardiac Surgery, The University of Chicago Medicine, 5841S Maryland Avenue, MC5040, Chicago, IL, 60637, USA.
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Nishida H, Song T, Onsager D, Nguyen A, Grinstein J, Chung B, Smith B, Kalantari S, Sarswat N, Kim G, Pinney S, Jeevanandam V, Milner R, Ota T. VASCULAR COMPLICATIONS OF PERCUTANEOUS AXILLARY INTRA-AORTIC BALLOON PUMP THERAPY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02001-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Symalla T, Peev MP, Song T, Naftel D, Myers S, Koehl D, Cantor RS, Pinney S, Jeevanandam V. STS INTERMACS Database: The Key to Conduct Single-arm Trials in Advanced Heart Failure Patients. Ann Thorac Surg 2021; 113:808-815. [PMID: 33930360 DOI: 10.1016/j.athoracsur.2021.04.045] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/21/2021] [Accepted: 04/13/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Safe introduction of novel mechanical circulatory support (MCS) devices into clinical practice is a challenging process. Single-arm trials using a control arm from existing database is an effective alternative that could be applied for regulatory approval. This study analyzes the capability of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database to establish objective performance criteria and select patient population that could be used for future single-arm MCS trials. METHODS Patients with INTERMACS profiles IM1-2 and IM3-5, who underwent implant of isolated Left Ventricular Assist Devises between 2014-2017 were included. Both cohorts were further stratified into Shock and Non-Shock groups using surrogate markers of shock (ECMO, temporary VAD, vasopressor infusions). Survival, transplant rates, adverse events, 6 min walk test and quality of life measures were obtained for all 4 groups at 6 and 12 months. RESULTS Total of 7,907 patients were divided into IM1-2(n=3,909), IM3-5(n=3,998), Shock(n=3,469) and Non-Shock(n=3,040). Re-categorization occurred in 11% of patients from the IM3-5 group into the Shock group. Overall, patients in the Shock group had similar outcomes to the IM 1-2 group (1-year survival: 86% vs 85%, p=0.74). Patients in the Non-Shock group also had similar outcomes to the IM 3-5 (1-year survival: 90% vs 90%, p=0.43). CONCLUSIONS INTERMACS database can successfully establish objective performance criteria and concurrent control group for single-arm trials that could be used to support regulatory approval of new, less invasive MCS. INTERMACS data allows reliable comparisons of outcomes and adverse events.
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Affiliation(s)
- Trever Symalla
- Section of Cardiac Surgery, Department of Surgery, The University of Chicago Medical Center, Chicago IL, USA
| | - Miroslav P Peev
- Section of Cardiac Surgery, Department of Surgery, The University of Chicago Medical Center, Chicago IL, USA.
| | - Tae Song
- Section of Cardiac Surgery, Department of Surgery, The University of Chicago Medical Center, Chicago IL, USA
| | - David Naftel
- Kirklin Institute for Research in Surgical Outcomes (KIRSO), The University of Alabama at Birmingham, Birmingham AL
| | - Susan Myers
- Kirklin Institute for Research in Surgical Outcomes (KIRSO), The University of Alabama at Birmingham, Birmingham AL
| | - Devin Koehl
- Kirklin Institute for Research in Surgical Outcomes (KIRSO), The University of Alabama at Birmingham, Birmingham AL
| | - Ryan S Cantor
- Kirklin Institute for Research in Surgical Outcomes (KIRSO), The University of Alabama at Birmingham, Birmingham AL
| | - Sean Pinney
- Department of Medicine, The University of Chicago Medical Center, Chicago IL, USA
| | - Valluvan Jeevanandam
- Section of Cardiac Surgery, Department of Surgery, The University of Chicago Medical Center, Chicago IL, USA
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Bole I, Rodgers D, Smith B, Nguyen A, Chung B, Kalantari S, Sarswat N, Kim G, Song T, Ota T, Jeevanandam V, Kruse E, Kordeck C, Kramer C, Pinney S, Grinstein J. Simultaneous Multi-Vascular Bed Imaging in a Patient Supported by a Continuous-Flow LVAD. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.2115] [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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