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Jacob S, Garg P, Wadiwala I, Yazji JH, Alomari M, Alamouti-fard E, Akram Hussain MW, Pham SM. Strategies for Expanding Donors Pool in Heart Transplantation. Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2308285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Martin AK, Shah SZ, Guru PK, Chaudhary S, Franco PM, Makey I, Fritz AV, Pham SM, Thomas M. Multidisciplinary Approach for Lung Transplantation due to COVID-19. Mayo Clin Proc Innov Qual Outcomes 2022; 6:200-208. [PMID: 35281693 PMCID: PMC8904149 DOI: 10.1016/j.mayocpiqo.2022.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), a novel etiology of end-stage lung disease, has resulted in major disruptions to the process of health care delivery worldwide. These disruptions have led to team-based innovations globally, resulting in a broad range of new processes in cardiopulmonary perioperative management. A key intersection of multidisciplinary teamwork and COVID-19 is found in lung transplantation, in which diverse teams collaborate throughout the perioperative period to achieve optimal outcomes. In this article, we describe the multidisciplinary approach taken by Mayo clinic in Florida to manage patients with COVID-19 presenting for lung transplantation.
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Key Words
- ARDS, acute respiratory distress syndrome
- CAD, coronary artery disease
- COVID-19, coronavirus disease 2019
- ECMO, extracorporeal membrane oxygenation
- ESLD, end-stage lung disease
- ICU, intensive care unit
- MCF, Mayo clinic in Florida
- MDT, multidisciplinary team
- OR, operating room
- PCR, polymerase chain reaction
- POD, postoperative day
- PPE, personal protective equipment
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- VA, veno-arterial
- VV, veno-venous
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Bitargil M, Haddad O, Pham SM, Garg N, Jacob S, El-Sayed Ahmed MM, Landolfo K, Patel PC, Goswami RM, Leoni Moreno JC, Yip DS, Sareyyupoglu B. Packing the donor heart: Is SherpaPak cold preservation technique safer compared to ice cold storage. Clin Transplant 2022; 36:e14707. [PMID: 35543679 DOI: 10.1111/ctr.14707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 04/27/2022] [Accepted: 05/03/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The present study aimed to compare the clinical outcomes of heart transplant patients whose donor hearts were preserved with the SherpaPak controlled cold organ system versus the conventional ice storage technique. METHODS All patients undergoing heart transplantation at our center between January 2019 and April 2021 were divided into two groups according to the technique used during donor heart preservation and transport. The first group consisted of 34 SherpaPak controlled temperature preservation patients, and the second group consisted of 47 patients where the conventional three bags and ice technique was utilized during organ transportation. The two groups were compared based on demographics, operative details, and postoperative outcomes. RESULTS There were no significant differences between the groups regarding Vasoactive Inotropic Score (VIS), Primary Graft Dysfunction (PGD), and the need for a transient pacer. However, the VIS, PGD, and pacing trends were lower in the SherpaPak patients even though the total ischemic and cardiopulmonary bypass times were significantly longer. Furthermore, SherpaPak patients exhibited a shorter stay in the ICU with no severe PGD and mortality. CONCLUSION The SherpaPak donor heart preservation provides safe outcomes in heart transplant patients. Further research is needed to utilize this method for longer durations of ischemic time and expand travel distances for organ transportation. This article is protected by copyright. All rights reserved.
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Jacob S, Garg P, El-Sayed Ahmed MM, Goswami RM, Landolfo KP, Pham SM, Sareyyupoglu B. Biatrial Transplantation of a Donor Heart with a Single Left Superior Vena Cava Draining to Coronary Sinus. JTCVS Tech 2022; 14:127-129. [PMID: 35967201 PMCID: PMC9366616 DOI: 10.1016/j.xjtc.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/10/2022] [Indexed: 11/28/2022] Open
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El-Sayed Ahmed MM, Pham A, Sareyyupoglu B, Pham SM. Bench valvular surgery in donor's hearts before transplantation: Choice versus necessity. J Card Surg 2022; 37:2209-2211. [PMID: 35438821 DOI: 10.1111/jocs.16533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
The severe shortage of donor's hearts has increased the mortality of patients on the transplant waiting list. However, donor hearts with valvular dysfunction are rarely used. Utilizing donor hearts with valvular lesions that can be repaired or replaced at the time of transplant will decrease waitlist mortality and offer many patients a second chance in life.
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Jacob S, Nguyen JH, El-Sayed Ahmed MM, Makey IA, Haddad OK, Thomas M, Sareyyupoglu B, Pham SM, Landolfo KP. Combined cardiac surgery procedures and liver transplant: a single-center experience. Gen Thorac Cardiovasc Surg 2022; 70:714-720. [PMID: 35146597 DOI: 10.1007/s11748-022-01783-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/27/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Morbidity and mortality rates associated with liver transplant are high for patients with concomitant heart disease. Traditionally, such cases were considered contraindications for transplant. The objective of our study was to assess the outcome of combined surgical approaches. METHODS A prospectively maintained database was analyzed of patients undergoing cardiac surgery and liver transplant at our institution. Twelve identified patients underwent combined cardiac operation and liver transplant. A control group was created (n = 24) with the same selection criteria. RESULTS Median patient age was 64.94 years in the combined group vs 63.80 in the control, and in both groups, 58% were male. Left ventricular ejection fraction (0.60), body mass index (30.1), and median (range) score of the Model for End-stage Liver Disease (18 [9-33]) were the same in both groups. The cardiac operations combined with liver transplant were coronary artery bypass grafting, valve replacement procedures, and ascending thoracic aortic aneurysm repair. Piggyback liver transplant was performed for all patients. Survival periods of 1, 5, and 10 years for control vs combined cases were 90 vs 62%, 79 vs 55%, and 70 vs 45%, respectively (P = 0.03). CONCLUSION Concomitant cardiac procedure and liver transplant is a valid treatment option and should be considered with risk stratification criteria of the patient with end-stage liver disease and cardiac surgical pathologic characteristics.
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Bitargil M, Sareyupoglu B, Haddad O, Pham SM. Caval Isolation With Balloon Catheters Within Venous Cannulas in Cardiac Surgery. JTCVS Tech 2022; 13:62-64. [PMID: 35711176 PMCID: PMC9195633 DOI: 10.1016/j.xjtc.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/12/2022] [Indexed: 11/04/2022] Open
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Bitargil M, Haddad O, Pham SM, Goswami RM, Patel PC, Jacob S, El‐Sayed Ahmed MM, Leoni Moreno JC, Yip DS, Landolfo K, Sareyyupoglu B. Controlled temperatures in cold preservation provides safe heart transplantation results. J Card Surg 2022; 37:732-738. [DOI: 10.1111/jocs.16243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/01/2021] [Accepted: 11/10/2021] [Indexed: 02/04/2023]
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Pereira ROL, Rodrigues ES, Martin AK, Narula T, Ball CT, Alvarez F, Erasmus DB, Elrefaei M, Pham SM, Salinas JLZ, Thomas M. Outcomes After Lung Retransplantation: A Single-Center Retrospective Cohort Study. J Cardiothorac Vasc Anesth 2021; 36:1366-1372. [PMID: 34544627 DOI: 10.1053/j.jvca.2021.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/01/2021] [Accepted: 08/18/2021] [Indexed: 11/11/2022]
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Haddad O, Jacob S, Ung RL, Goswami RM, Patel PC, Pham SM, Sareyyupoglu B. Impella flow pump reinsertion after axillary graft thrombectomy: Technical points in replacing axillary Impella. SAGE Open Med Case Rep 2021; 9:2050313X211032401. [PMID: 34290874 PMCID: PMC8278451 DOI: 10.1177/2050313x211032401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/24/2021] [Indexed: 11/24/2022] Open
Abstract
Axillary Impella devices are increasingly employed for long-term support of patients with systolic heart failure and shock. Axillary access allows for awake support and ambulation, which carries an inherent risk of disconnection or malposition. We report a series of two cases where device replacement due to dysfunction and malposition can be completed safely through the original axillary graft using axillary graft thrombectomy, given that the clot burden could be a major source of morbidity to the patient.
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Shoukry M, Jorgensen MS, Solak S, Pham SM, Martin AK, Farres H. Utilization of ECMO in vascular surgery: A presentation of two cases. Int J Surg Case Rep 2021; 85:106141. [PMID: 34330069 PMCID: PMC8329508 DOI: 10.1016/j.ijscr.2021.106141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/17/2021] [Accepted: 06/24/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a form of temporary mechanical circulatory support commonly used during cardiothoracic interventions. Malperfusion during complex vascular procedures remains a significant risk that may potentially lead to multiple complications. Here, we report two cases highlighting the efficacy of VA-ECMO in both planned and emergent vascular interventions. Presentation of case In our first case, VA-ECMO was used to support an 82-year-old male during a high-risk thoracoabdominal aortic aneurysm repair. Our second case details an emergent pulmonary embolectomy in which VA-ECMO was used as a bridge to cardiopulmonary bypass. In both cases, the procedures were well-tolerated, and the patients were discharged 17 days postoperatively. Discussion VA-ECMO has been increasingly used as a form of post-operative circulatory support following cardiothoracic and vascular interventions. However, only few instances of perioperative VA-ECMO use have been reported in the field of vascular surgery. Conclusion The presented cases highlight that the perioperative use of VA-ECMO may be a viable modality for required perfusion during complex planned or emergent vascular procedures. Perioperative use of VA-ECMO in vascular surgery has not been sufficiently explored. VA-ECMO can be used to maintain perfusion during high-risk vascular interventions. VA-ECMO can serve as a bridge to cardiopulmonary bypass in emergent scenarios.
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Jacob S, Pham AN, Sareyyupoglu B, Pham SM. Bilateral lung transplantation for pulmonary artery aneurysm with severe pulmonary hypertension: An evolution or a revolution? J Card Surg 2021; 36:3000-3002. [PMID: 33993532 DOI: 10.1111/jocs.15654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022]
Abstract
The surgical treatment of pulmonary hypertension (PH), with or without pulmonary artery aneurysm, has evolved during the last 40 years from heart-lung transplants to bilateral lung transplants as the treatment of choice for PH patients with preserved right and left ventricular function and without complex cardiac abnomalies.
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Thomas M, Martin AK, Allen WL, Makey IA, Renew JR, Rodrigues ES, Mordecai MM, Brown TE, Foeks JJ, Johnson JL, Landolfo KL, Pham SM. Lung Transplantation Using a Hybrid Extracorporeal Membrane Oxygenation Circuit. ASAIO J 2021; 66:e123-e125. [PMID: 33136605 DOI: 10.1097/mat.0000000000001157] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Extracorporeal circulation (ECC) support using intraoperative extracorporeal membrane oxygenation (ECMO) during lung transplantation (LTx) is now a routine practice for many high volume centers. Circuits that are dedicated to ECMO alone can be expensive and do not allow full cardiopulmonary bypass (CPB) to be performed. We describe our technique of instituting venoarterial ECMO during LTx using a less-expensive hybrid circuit that facilitates easy and immediate conversion to full CPB if needed, without interruption of ECC.
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El-Sayed Ahmed MM, Thomas M, Makey IA, Martin AK, Erasmus DB, Sareyyupoglu B, Landolfo KP, Pham SM. Heart-lung transplant in congenitally corrected transposition of the great arteries and dextrocardia patient. SAGE Open Med Case Rep 2021; 9:2050313X20987449. [PMID: 33633862 PMCID: PMC7887666 DOI: 10.1177/2050313x20987449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/18/2020] [Indexed: 11/23/2022] Open
Abstract
A 53-year-old male patient was presented to our institution with the clinical picture of biventricular failure. The echocardiogram revealed congenitally corrected transposition of the great arteries, dextrocardia with situs solitus, atrioventricular discordance and ventriculoatrial discordance, severe systemic and mitral valves regurgitation, and severe pulmonary hypertension (mean pulmonary artery pressure: 51 mm Hg). He underwent heart–lung transplant. He was discharged on postoperative day 25 with left ventricular ejection fraction of 60%–65%, and with oxygen independency.
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Gharacholou SM, Del-Carpio Munoz F, Motiei A, Sandhu GS, Barsness GW, Gulati R, Wright RS, Pellikka PA, Lewis B, Johnson MP, Lane GE, Pollak PM, Pillai DP, Sabbagh AE, Paul TK, Pham SM, Singh M. Characteristics and Long-Term Outcomes of Patients With Prior Coronary Artery Bypass Grafting Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2020; 135:1-8. [PMID: 32866446 DOI: 10.1016/j.amjcard.2020.08.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 11/19/2022]
Abstract
Limited data are available on characteristics and long-term outcomes of patients with coronary artery bypass grafts (CABG) undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI). Between January 2000 to December 2014, we identified STEMI patients with prior CABG undergoing primary percutaneous coronary intervention from 3 sites. Kaplan-Meier methods to estimate survival and major adverse cardiac events (MACE) were employed and compared to a propensity matched cohort of non-CABG STEMI patients. Independent predictors of outcomes were analyzed with Cox modeling. Of the 3,212 STEMI patients identified, there were 296 (9.2%) CABG STEMI patients, having nearly similar frequencies of culprit graft (47.6%) versus culprit native (52.4%) as the infarct-related artery (IRA). At 10 years, the adjusted survival was 44% in CABG STEMI versus 55% in non-CABG STEMI (HR 1.26; 95%CI 0.86 to 1.87; p = 0.72). Survival free of MACE was lower for CABG STEMI (graft IRA, 37%; native IRA, 46%) as compared to non-CABG STEMI controls (63%) (p = 0.02). Neither CABG history nor IRA (native vs graft) was independently associated with death or MACE in multivariable analysis. Temporal trends showed no significant change in death or MACE rates of CABG STEMI patients over time. In conclusion, long term survival of CABG STEMI patients is not significantly different than matched STEMI patients without prior CABG; however, CABG STEMI patients were at significantly higher risk for MACE events.
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El-Sayed Ahmed MM, Makey IA, Landolfo KP, Jacob S, Pham SM, Sareyyupoglu B, Thomas M. Safe Lung Flush Technique During Recovery From Donors After Circulatory Death. Ann Thorac Surg 2020; 111:e297-e299. [PMID: 33159868 DOI: 10.1016/j.athoracsur.2020.08.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022]
Abstract
Donation after circulatory death is defined as donation after cardiac arrest and circulatory cessation. The number of circulatory death donors is growing and significantly increases the organ donor pool. Shortening the warm ischemia time is pivotal in the outcomes and survival after transplant. We describe simplified and safe technique for lung flush during lung recovery from donors after circulatory death.
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Patel PC, Sareyyupoglu B, Pham SM. Left ventricular assist devices in the elderly: Marching forward with cautions. J Card Surg 2020; 35:3409-3411. [PMID: 32985721 DOI: 10.1111/jocs.15079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022]
Abstract
Congestive heart failure is highly prevalent in the elderly population and left ventricular assist device (LVAD) has been increasingly used in this population. LVAD therapy is more costly than medical treatment but it increases the survival and quality of life of the elderly patients with low disease acuity. Therefore careful selection of candidates and implementation of LVAD therapy earlier in the course of the disease is crucial to improve outcomes. With the technical advances and improvement in clinical management, the financial burden of LVAD therapy in the elderly will become less, making this therapy more economically feasible.
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Martin AK, Harrison BA, Fritz AV, Landolfo KP, Makey IA, Sareyyupoglu B, Brown TE, Johnson JL, Pham SM, Thomas M. Intraoperative management of a hybrid extracorporeal membrane oxygenation circuit for lung transplantation. J Card Surg 2020; 35:3560-3563. [PMID: 32939826 DOI: 10.1111/jocs.15029] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 08/26/2020] [Accepted: 09/04/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND The use of extracorporeal circulation (ECC) for intraoperative cardiopulmonary support during lung transplantation has been increasing in the recent years. Our group previously described a novel hybrid extracorporeal membrane oxygenation (ECMO) circuit for use in lung transplantation. TECHNIQUE Our approach for intraoperative management of our novel hybrid ECMO circuit for lung transplantation is driven by two main goals: The first is to deliver management that ensures an appropriate balance between the native and ECMO cardiac outputs in order to provide a stable environment that promotes attenuation of ischemic-reperfusion injury during implantation. The second is to provide a stable hemodynamic environment that results in an appropriate global perfusion guided by multiple monitors and an organ systems-based approach during implantation. COMMENTS Our novel technique for intraoperative management of this circuit during lung transplantation is described.
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Martínez MDP, Alvarez FG, Mallea JM, Shah SZ, Pham SM, El-Sayed Ahmed MM, Jacob S, Janik AB, Haddad T, Erasmus DB, Narula T. Negative pressure ventilation as a bridge to lung transplant. Oxf Med Case Reports 2020; 2020:omaa056. [PMID: 32793360 PMCID: PMC7416820 DOI: 10.1093/omcr/omaa056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/12/2020] [Indexed: 11/23/2022] Open
Abstract
Recent years have witnessed evolution of lung allocation strategies to prioritize sicker recipients. In the pre-transplant period, this has translated into increased utilization of invasive extracorporeal or mechanical ventilatory support as a bridge to lung transplantation. The morbidity associated with these strategies warrants consideration to less invasive respiratory support modalities. Herein, we present a case highlighting successful bridge to lung transplantation with a relatively non-invasive negative pressure ventilator.
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Pasrija C, Parchment N, Tran D, Mackowick K, Boulos F, Iacono A, Kim J, Griffith BP, Sanchez PG, Pham SM, Kon ZN. Strategic application of modular risk components to safely increase lung transplantation volume. J Card Surg 2020; 35:2177-2184. [PMID: 33448475 DOI: 10.1111/jocs.14874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/22/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Considerable growth of individual lung transplant programs remains challenging. We hypothesized that the systematic implementation of modular risk components to a lung transplantation program would allow for expeditious growth without increasing mortality. METHODS All consecutive patients placed on the lung transplantation waitlist were reviewed. Patients were stratified by an 18-month period surrounding the systematic implementation of the modular risk components Era 1 (1/2014-6/2015) and Era 2 (7/2015-12/2016). Modular risk components were separately evaluated for donors, recipients, and perioperative features. RESULTS One hundred and thirty-two waitlist patients (Era 1: 48 and Era 2: 84) and 100 transplants (Era 1: 32 and Era 2: 68) were identified. There was a trend toward decreased waitlist mortality (P = .07). In Era 2, the use of ex vivo lung perfusion (P = .05) and donor-recipient over-sizing (P = .005) significantly increased. Moreover, transplantation with a lung allocation score greater than 70 (P = .05), extracorporeal support (P = .06), and desensitization (P = .008) were more common. Transplant rate significantly improved from Era 1 to Era 2 (325 vs 535 transplants per 100 patient years, P = .02). While primary graft dysfunction (PGD) grade 3 at 72 hours (P = .05) was significantly higher in Era 2, 1-year freedom from rejection was similar (86% vs 90%, P = .69) and survival (81% vs 95%, P = .02) was significantly greater in Era 2. CONCLUSIONS The systematic implementation of a modular risk components to a lung transplantation program can result in a significant increase in center volume. However, measures to mitigate an expected increase in the incidence of PGD must be undertaken to maintain excellent short and midterm outcomes.
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Ali M, Pham AN, Pooley RA, Rojas CA, Mergo PJ, Pham SM. Three-dimensional printing facilitates surgical planning for resection of an atypical cardiac myxoma. J Card Surg 2020; 35:2863-2865. [PMID: 32720392 DOI: 10.1111/jocs.14896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac myxomas are common and account for 50% of primary intracardiac tumors. Atypical locations of cardiac myxoma increase the risk of intraoperative iatrogenic injuries. Herein, we report a case of using three-dimensional printing (3D) to facilitate the removal of an atypical cardiac myxoma in a 63-year-old woman. METHODS AND RESULTS Mass in the high posterior atrial septum was confirmed through imaging. Due to the potential involvement of the mass to surrounding vital structures, 3D printing of the cardiac mass was performed. The tumor was completely resected via median sternotomy and the resulting defect was repaired with the bovine pericardium. The patient had an uncomplicated postoperative course except for the development of sick sinus syndrome. One-year follow-up showed no tumor recurrent. CONCLUSION 3D printing technology in patients with atypical cardiac tumors enhances our understanding of the extent of the tumor invasion and facilitates planning the operation to avoid intraoperative complications.
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Haddad O, Pham AN, Thomas M, Ali M, Sareyyupoglu B, El-Sayed Ahmed MM, Pham SM. Absorbable antibiotic beads as an adjuvant therapy in treating ventricular assist devices driveline infection: A case report. J Card Surg 2020; 35:2073-2076. [PMID: 32652630 DOI: 10.1111/jocs.14778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ventricular assist devices driveline infections are common, recalcitrant, and carry high morbidity and mortality. Herein, we reported a patient with driveline infection that was successfully treated with a combination of systemic antibiotics, surgical debridement, and instillation of absorbable antibiotic beads to the wound bed. METHODS AND RESULTS A 39-year-old man with nonischemic cardiomyopathy underwent insertion of a continuous flow left ventricular assist device. Four years postoperatively, the patient presented with clinical, laboratory, and radiologic signs of driveline tract infection. He underwent extensive surgical debridement, installation of absorbable antibiotic beads that consisted of calcium sulfate, vancomycin, and tobramycin, into the wound bed, and systemic antibiotics. The patient was free of infection 9 month postoperatively. CONCLUSION Absorbable calcium sulfate antibiotic beads may serve as a beneficial adjunct to surgical debridement and systemic antibiotics for the treatment of ventricular assist device driveline infection, and merit further investigation.
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Erasmus DB, Pham SM, Landolfo KP. Commentary: Rage against the machine (ventilator that is). J Thorac Cardiovasc Surg 2020; 160:1397-1398. [PMID: 32381334 DOI: 10.1016/j.jtcvs.2020.03.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
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Pasrija C, Sawan MA, Sorensen E, Voorhees HJ, Shah A, Wang L, Ton VK, DiChiacchio L, Kaczorowski DJ, Griffith BP, Pham SM, Kon ZN. Less Invasive Approach to Left Ventricular Assist Device Implantation May Improve Survival in High-Risk Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:243-250. [PMID: 32379514 DOI: 10.1177/1556984520918959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Despite improvement in outcomes after left ventricular assist device (LVAD) implantation over the past 2 decades, high-risk recipients continue to have a prohibitive rate of morbidity and mortality. We hypothesized that a less invasive approach to LVAD implantation would be associated with improved survival compared to a conventional approach in this high-risk cohort. METHODS All consecutive LVAD recipients (2013 to 2017) that underwent centrifugal LVAD implantation were retrospectively reviewed. Patients were classified as high-risk if INTERMACS 1 or required temporary VAD/venoarterial extracorporeal membrane oxygenation prior to durable VAD implantation. Patients were stratified into 3 groups: left thoracotomy with hemi-sternotomy (LTHS) high-risk, conventional sternotomy (CS) high-risk, and non-high-risk. The primary outcome was 1-year survival. RESULTS A total of 57 patients (LTHS high-risk: 11, CS high-risk: 12, non-high-risk: 34) were identified. Preoperative right ventricular failure scores, HeartMate-II mortality scores, and end-organ dysfunction were similar between the 2 high-risk groups. While operative time was similar between the 3 groups, cardiopulmonary bypass time was significantly shorter in the LTHS high-risk group compared to other groups. There was a trend toward decreased intensive care unit length of stay and ventilator time in LTHS high-risk compared to CS high-risk patients. Moreover, between these 2 groups, there was a significant decrease in temporary right VAD support (50% vs 0%, P = 0.014), and 1-year survival was significantly higher in the LTHS group (42% vs 91%, P = 0.025). CONCLUSIONS Less invasive LVAD implantation appears to be associated with improved survival compared to conventional LVAD implantation in high-risk patients.
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Pham AN, Patel PC, Landolfo K, Burns JM, Yip DS, Leoni Moreno JC, Goswami RM, Jacob S, El‐Sayed Ahmed MM, Makey IA, Thomas M, Mai ML, Taner CB, Pham SM. Kidney transplantation on extracorporeal life support for primary cardiac allograft dysfunction. J Card Surg 2020; 35:725-728. [DOI: 10.1111/jocs.14451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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