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Single-pass albumin dialysis and hemoadsorption for bilirubin and bile acids removal for a child with hyperbilirubinemia after ventricular assist device implantation. J Artif Organs 2022; 25:270-273. [PMID: 35038050 DOI: 10.1007/s10047-022-01309-4] [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: 10/24/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
We report the successful management of hyperbilirubinemia using two different modalities of extracorporeal bilirubin removal therapy for a pediatric patient. A 13-year-old boy with dilated cardiomyopathy requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) developed acute kidney injury and was dependent on continuous renal replacement therapy. He developed hyperbilirubinemia with a peak total bilirubin level of 786 μmol/L after implantation of biventricular assist device (BiVAD). Extracorporeal bilirubin and bile acids removal using single-pass albumin dialysis (SPAD) with 4% albumin as dialysate brought down the bilirubin level to 672 μmol/L after 21 h of therapy. Subsequently, he was started on two sessions of hemoadsorption using the Cytosorb® column which further lowered the total bilirubin level to 306 μmol/ in 24 h and 173 μmol/ after the treatment. No complication was encountered. Our case illustrated that both SPAD and hemoadsorption can effectively and safely reduce the serum bilirubin and bile acid levels in pediatric patients with BiVAD implantation. The ease of set-up, faster rate of bilirubin decline and capability of cytokine removal make hemoadsorption a favorable alternative to albumin dialysis.
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Oxidative Stress Markers and Modified Model for End-Stage Liver Disease Are Associated with Outcomes in Patients with Advanced Heart Failure Receiving Bridged Therapy with Continuous-Flow Left Ventricular Assist Devices. Antioxidants (Basel) 2021; 10:antiox10111813. [PMID: 34829684 PMCID: PMC8615232 DOI: 10.3390/antiox10111813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/01/2021] [Accepted: 11/10/2021] [Indexed: 12/28/2022] Open
Abstract
Left ventricular assist device (LVAD) is well established as an alternative treatment for end-stage heart failure (HF) patients. The aim of the study was to determine the prognostic value of oxidative stress markers and the modified Model for End-Stage Liver Disease (modMELD) in patients receiving bridged therapy with continuous-flow LVAD. We prospectively analyzed 36 end-stage HF patients who received LVAD therapy between 2015 and 2018. The total antioxidant capacity (TAC) and total oxidant status (TOS) were measured by the methods described by Erel. The oxidative stress index (OSI) was defined as the ratio of the TOS to TAC levels. The modMELD scores were calculated based on the serum bilirubin, creatinine, and albumin levels. The patients’ median age was 58 (50–63.0) years. During the 1.5-years follow-up, a major adverse cardiac event—MACE (death, stroke, or pump thrombosis) was observed in 17 patients (47.2%). The area under the receiver operating characteristics curves (AUCs) indicated a good prognostic power of TAC (AUC 0.7183 (0.5417–0.8948)), TOS (AUC 0.9149 (0.8205–0.9298)), OSI (AUC 0.9628 (0.9030–0.9821)), and modMELD (AUC 0.87 (0.7494–0.9905)) to predict a MACE. Oxidative stress markers serum concentrations, as well as the modMELD score, allow the identification of patients with a risk of MACE.
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Yalcin YC, Muslem R, Veen KM, Soliman OI, Manintveld OC, Darwish Murad S, Kilic A, Constantinescu AA, Brugts JJ, Alkhunaizi F, Birim O, Tedford RJ, Bogers AJJC, Hsu S, Caliskan K. Impact of preoperative liver dysfunction on outcomes in patients with left ventricular assist devices. Eur J Cardiothorac Surg 2021; 57:920-928. [PMID: 31828334 DOI: 10.1093/ejcts/ezz337] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/29/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES We evaluated the impact of preoperative liver function on early and 1-year postoperative outcomes in patients supported with a left ventricular assist device (LVAD) and subsequent evolution of liver function markers. METHODS A retrospective multicentre cohort study was conducted, including all patients undergoing continuous-flow LVAD implantation. The Model for End-stage Liver Disease (MELD) score was used to define liver dysfunction. RESULTS Overall, 290 patients with an LVAD [78% HeartMate II, 15% HVAD and 7% HeartMate 3, mean age 55 (18), 76% men] were included. Over 40 000 measurements of liver function markers were collected over a 1-year period. A receiver operating characteristic curve analysis for the 1-year mortality rate identified the optimal cut-off value of 12.6 for the MELD score. Therefore, the cohort was dichotomized into patients with an MELD score of less than or greater than 12.6. The early (90-day) survival rates in patients with and without liver dysfunction were 76% and 91% (P = 0.002) and 65% and 90% at 1 year, respectively (P < 0.001). Furthermore, patients with preoperative liver dysfunction had more embolic events and more re-explorations. At the 1-year follow-up, liver function markers showed an overall improvement in the majority of patients, with or without pre-LVAD liver dysfunction. CONCLUSIONS Preoperative liver dysfunction is associated with higher early 90-day and 1-year mortality rates after LVAD implantation. Furthermore, liver function improved in both patient groups. It has become imperative to optimize the selection criteria for possible LVAD candidates, since those who survive the first year show excellent recovery of their liver markers.
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Affiliation(s)
- Yunus C Yalcin
- Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands.,Department of Cardio-thoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Rahatullah Muslem
- Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands.,Department of Cardio-thoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Kevin M Veen
- Department of Cardio-thoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Osama I Soliman
- Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Sarwa Darwish Murad
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Ahmet Kilic
- Department of Cardiology, Johns Hopkins Heart and Vascular Institute, Baltimore, MD, USA
| | - Alina A Constantinescu
- Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Fatimah Alkhunaizi
- Department of Cardiology, Johns Hopkins Heart and Vascular Institute, Baltimore, MD, USA
| | - Ozcan Birim
- Department of Cardio-thoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Ryan J Tedford
- Department of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Ad J J C Bogers
- Department of Cardio-thoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Steven Hsu
- Department of Cardiology, Johns Hopkins Heart and Vascular Institute, Baltimore, MD, USA
| | - Kadir Caliskan
- Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands
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Nakajima Doi S, Seguchi O, Yamamoto M, Fujita T, Fukushima S, Mochizuki H, Iwasaki K, Kimura Y, Toda K, Kumai Y, Kuroda K, Watanabe T, Yanase M, Kobayashi J, Kimura T, Fukushima N. Impact of bridge-to-bridge strategies from paracorporeal to implantable left ventricular assist devices on the pre-heart transplant outcome: A single-center analysis of 134 cases. J Cardiol 2020; 77:408-416. [PMID: 33243529 DOI: 10.1016/j.jjcc.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/12/2020] [Accepted: 10/18/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND In Japan, patients with heart failure who have a paracorporeal left ventricular assist device (pLVAD) and cannot be weaned from the VAD may undergo conversion to implantable continuous-flow LVAD (iLVAD) via a bridge-to-bridge (BTB) strategy for bridge-to-transplantation (BTT). This study aimed to evaluate the real-world clinical status of BTB strategies. METHODS Among 134 patients who underwent iLVAD implantation for BTT, 34 patients underwent conversion from pLVAD to iLVAD (BTB group) and 100 patients underwent iLVAD implantation primarily (primary iLVAD group). The clinical characteristics and outcomes were compared between the two groups. RESULTS No significant difference was found in the overall survival between the two groups (p = 0.26; log-rank test). However, the 1-year survival rate and the 1-year freedom from the composite events of death, stroke, systemic infection, and bleeding rate were lower in the BTB group than in the primary iLVAD group (survival rate, 88.2% vs. 99.0%, p = 0.0040; composite event-free survival rate, 26.1% vs. 49.8%, p = 0.030; log-rank test). Multivariate analysis indicated that the BTB strategy [hazard ratio (HR) 1.70, 95% confidence intervals (CI) 1.03-2.72; p=0.036] and serum total bilirubin levels at iLVAD implantation [HR 1.31, 95% CI 1.00-1.65; p=0.043] were independent predictors of 1-year composite events. CONCLUSIONS The BTB strategy is useful in providing long-term survival in patients with acute critical diseases. However, the early mortality rate after conversion is higher in patients who underwent the BTB strategy.
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Affiliation(s)
- Seiko Nakajima Doi
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Osamu Seguchi
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masahiro Yamamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomoyuki Fujita
- Department of Adult Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satsuki Fukushima
- Department of Adult Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroki Mochizuki
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Keiichiro Iwasaki
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuki Kimura
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koichi Toda
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuto Kumai
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kensuke Kuroda
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takuya Watanabe
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masanobu Yanase
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Junjiro Kobayashi
- Department of Adult Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Norihide Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
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Rosenbaum AN, Ternus BW, Pahwa S, Stulak JM, Clavell AL, Schettle SD, Behfar A, Jentzer JC. Risk of Liver Dysfunction After Left Ventricular Assist Device Implantation. Ann Thorac Surg 2020; 111:1961-1967. [PMID: 33058819 DOI: 10.1016/j.athoracsur.2020.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/21/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Incident liver dysfunction after left ventricular assist device implantation has been previously associated with adverse outcomes, yet data on perioperative risk markers are sparse. METHODS We retrospectively reviewed consecutive patients undergoing continuous-flow left ventricular assist device implant between 2007 and 2017 at a single institution. Perioperative variables were evaluated by univariate modeling and adjusted for false discovery rate. Variables most significantly associated with incident Interagency Registry for Mechanically Assisted Circulatory Support-defined liver dysfunction (INT-LD) were evaluated using logistic regression and optimal cutpoints were defined. One-year survival was evaluated using Kaplan-Meier analysis. RESULTS We included 359 patients (79% male; mean age 59 ± 13 years; 46% ischemic; 64% destination therapy). Lower right ventricular stroke work index at the time of right heart catheterization, higher right atrial pressure 6 hours after right heart catheterization, higher preoperative total bilirubin, longer cardiopulmonary bypass time, and greater volume of intraoperative ultrafiltration were most strongly associated with incident INT-LD (adjusted P < .01 for each). Initial right ventricular stroke work index less than 460 mm Hg∗mL/m2 (odds ratio [OR] 4.6; 95% confidence interval [CI], 2.3 to 9.4), 6-hour right heart catheterization 14 mm Hg or greater (OR 4.3; 95% CI, 2.1 to 8.8), cardiopulmonary bypass time longer than 137 minutes (OR 3.3; 95% CI, 1.8 to 6.2; P < .01 for all), ultrafiltration more than 2.95 L (OR 3.7; 95% CI, 2 to 6.8), and total bilirubin greater than 1.4 mg/dL (OR 2.7; 95% CI, 1.4 to 5) were each strongly associated with risk of INT-LD, which was associated with decreased unadjusted 1-year survival (P < .001). CONCLUSIONS Right ventricular stroke work index, right heart catheterization, cardiopulmonary bypass time, and ultrafiltration were each more strongly associated with elevated risk of INT-LD after left ventricular assist device implant than total bilirubin. Therefore, optimization of right ventricular hemodynamics and minimizing cardiopulmonary bypass time and ultrafiltration could potentially reduce the risk of liver dysfunction, but these observations require prospective validation.
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Affiliation(s)
- Andrew N Rosenbaum
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison, Wisconsin.
| | - Bradley W Ternus
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison, Wisconsin
| | - Siddharth Pahwa
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Alfredo L Clavell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota
| | - Sarah D Schettle
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Atta Behfar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota; VanCleve Cardiac Regenerative Medicine Program, Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Majumder K, Spratt JR, Holley CT, Roy SS, Cogswell RJ, Liao K, John R. Impact of Postoperative Liver Dysfunction on Survival After Left Ventricular Assist Device Implantation. Ann Thorac Surg 2017; 104:1556-1562. [DOI: 10.1016/j.athoracsur.2017.04.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/17/2017] [Accepted: 04/18/2017] [Indexed: 12/25/2022]
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7
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Prometheus' predicament: How to address contemporary left ventricular assist devices in patients with liver dysfunction. J Thorac Cardiovasc Surg 2015; 151:236-7. [PMID: 26478237 DOI: 10.1016/j.jtcvs.2015.09.048] [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: 09/03/2015] [Accepted: 09/05/2015] [Indexed: 11/21/2022]
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8
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Potthoff A, Schettler A, Attia D, Schlue J, Schmitto JD, Fegbeutel C, Strüber M, Haverich A, Manns MP, Wedemeyer H, Gebel M, Schneider A. Liver stiffness measurements and short-term survival after left ventricular assist device implantation: A pilot study. J Heart Lung Transplant 2015; 34:1586-94. [PMID: 26169664 DOI: 10.1016/j.healun.2015.05.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 04/12/2015] [Accepted: 05/28/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hepatic dysfunction can contribute to the clinical outcome of patients with end-stage chronic heart failure (HF). This pilot study evaluated the importance of liver stiffness (LS) measurements by acoustic radiation force impulse (ARFI) imaging elastography in patients with end-stage chronic HF who underwent left ventricular assist device (LVAD) implantation. METHODS The study enrolled 28 patients (23 men), mean age of 54 ± 11 years, with end-stage chronic HF selected for LVAD implantation. At baseline, all patients received LS measurements using ARFI elastography. Hepatic venous pressure gradient measurements and transjugular liver biopsies were performed in 16 patients. Liver stiffness was measured 21 days (Follow-up 1, n = 23) and 485 ± 136 days (Follow-up 2, n = 13) after LVAD implantation. Patients were classified according to their baseline LS into Group I (low baseline LS [no significant fibrosis = Metavir F < 2]) or Group II (high baseline LS [significant fibrosis = Metavir F ≥ 2]). RESULTS LS at baseline was higher in Group II than in Group I (p < 0.001) and decreased significantly after LVAD implantation (Follow-up 1, p = 0.002; Follow-up 2, p = 0.002). Baseline LS correlated with liver fibrosis (p = 0.049) and central venous pressure (p = 0.001). Non-survivors showed higher LS (p = 0.019), bilirubin (p = 0.018), Model for End-Stage Liver Disease score (p = 0.001), and liver fibrosis (p = 0.004) compared with the survivors. In the univariate analysis, LS was a significant factor (p = 0.017) in predicting survival after LVAD implantation. CONCLUSIONS ARFI elastography shows that LS is influenced by central venous congestion and histologic changes of the liver in patients with end-stage chronic HF. LS may predict the outcome in patients after LVAD implantation.
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Affiliation(s)
- Andrej Potthoff
- Department of Gastroenterology, Hepatology and Endocrinology.
| | - Anika Schettler
- Department of Gastroenterology, Hepatology and Endocrinology
| | - Dina Attia
- Department of Gastroenterology, Hepatology and Endocrinology; Departement of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
| | | | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christine Fegbeutel
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Martin Strüber
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany; Heart Center Leipzig, Department of Cardiac Surgery, University of Leipzig, Leipzig, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology
| | | | - Michael Gebel
- Department of Gastroenterology, Hepatology and Endocrinology
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Duncker D, Friedel K, König T, Schreyer H, Lüsebrink U, Duncker M, Oswald H, Klein G, Gardiwal A. Cardiac resynchronization therapy improves psycho-cognitive performance in patients with heart failure. Europace 2015; 17:1415-21. [DOI: 10.1093/europace/euv005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 12/19/2014] [Indexed: 11/14/2022] Open
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10
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Mujib M, Khanna N, Mazumder NK, Aronow WS, Kolte D, Khera S, Palaniswamy C, Jain D, Lanier GM, Sule S, Ahmed A, Levy WC, Prabhu SD, Cooper HA, Panza JA, Gass AL, Fonarow GC. Pretransplant coagulopathy and in-hospital outcomes among heart transplant recipients: a propensity-matched nationwide inpatient sample study. Clin Cardiol 2015; 38:300-8. [PMID: 25684174 DOI: 10.1002/clc.22391] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/05/2015] [Accepted: 01/07/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The prevalence and contemporary trends of pre-heart transplantation (HT) coagulopathy and associated clinical outcomes have not been studied from a national database. HYPOTHESIS Pre-HT coagulopathy is associated with increased in-hospital mortality. METHODS Among 2454 adult HT recipients from the 2003 to 2010 Nationwide Inpatient Sample databases, 707 (29%) had pre-HT coagulopathy (defined as a comorbidity variable, based on International Classification of Diseases, Ninthe Revision, Clinical Modification and Diagnosis Related Group codes). We used propensity scores for coagulopathy to assemble a matched cohort of 664 pairs of patients with and without coagulopathy balanced in 54 baseline characteristics. RESULTS The prevalence of pre-HT coagulopathy increased from 17% in 2003 to 44% in 2010 (P for trend <0.001). In-hospital mortality occurred in 8.6% and 4.7% of matched HT recipients with and without coagulopathy, respectively (hazard ratio: 1.81; 95% confidence interval [CI]: 1.17-2.80; P = 0.008). Coagulopathy was not significantly associated with post-HT graft complications (odds ratio [OR]: 1.20; 95% CI: 0.95-1.52; P = 0.131) but was associated with increased blood transfusions (OR: 1.92; 95% CI, 1.54-2.41; P < 0.001). Coagulopathy and no-coagulopathy groups had no difference in median length of stay (22 days in each group, P = 0.746), but median total hospital charges were higher among patients with coagulopathy compared to those without (US$425 643 vs US$389 656; P = 0.008). CONCLUSIONS In this national study of HT recipients, pretransplant coagulopathy was common, increased over time, and was not significantly associated with post-HT graft complications or increased hospital stay. However, it was associated with increased bleeding risk, in-hospital mortality, and total hospital charges. These findings may have implications for the selection of patients for HT.
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Affiliation(s)
- Marjan Mujib
- Department of Medicine, New York Medical College, Valhalla, New York
| | - Neel Khanna
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Nabila K Mazumder
- Department of Medicine, Flushing Hospital Medical Center, Flushing, New York
| | - Wilbert S Aronow
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Dhaval Kolte
- Department of Medicine, New York Medical College, Valhalla, New York
| | - Sahil Khera
- Division of Cardiology, New York Medical College, Valhalla, New York
| | | | - Diwakar Jain
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Gregg M Lanier
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Sachin Sule
- Department of Medicine, New York Medical College, Valhalla, New York
| | - Ali Ahmed
- Department of Medicine, Washington DC VA Medical Center, Washington, DC
| | - Wayne C Levy
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Sumanth D Prabhu
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Howard A Cooper
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Julio A Panza
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Alan L Gass
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Gregg C Fonarow
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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11
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Roefe D, Schulz U. „Ventricular-assist-device“-Koordination. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2014. [DOI: 10.1007/s00398-013-1051-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Demirozu ZT, Hernandez R, Mallidi HR, Singh SK, Radovancevic R, Segura AM, Etheridge WB, Cohn WE, Frazier O. HeartMate II Left Ventricular Assist Device Implantation in Patients with Advanced Hepatic Dysfunction. J Card Surg 2014; 29:419-23. [DOI: 10.1111/jocs.12318] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Zumrut T. Demirozu
- Department of Cardiopulmonary Transplantation; Texas Heart Institute; Houston Texas
- Center for Cardiac Support; Texas Heart Institute; Houston Texas
| | - Ruben Hernandez
- Department of Cardiopulmonary Transplantation; Texas Heart Institute; Houston Texas
- Center for Cardiac Support; Texas Heart Institute; Houston Texas
| | - Hari R. Mallidi
- Department of Cardiopulmonary Transplantation; Texas Heart Institute; Houston Texas
- Center for Cardiac Support; Texas Heart Institute; Houston Texas
| | - Steve K. Singh
- Department of Cardiopulmonary Transplantation; Texas Heart Institute; Houston Texas
- Center for Cardiac Support; Texas Heart Institute; Houston Texas
| | - Rajko Radovancevic
- Department of Cardiopulmonary Transplantation; Texas Heart Institute; Houston Texas
- Center for Cardiac Support; Texas Heart Institute; Houston Texas
| | - Ana Maria Segura
- Department of Cardiovascular Pathology; Texas Heart Institute; Houston Texas
| | | | - William E. Cohn
- Department of Cardiopulmonary Transplantation; Texas Heart Institute; Houston Texas
- Center for Cardiac Support; Texas Heart Institute; Houston Texas
| | - O.H. Frazier
- Department of Cardiopulmonary Transplantation; Texas Heart Institute; Houston Texas
- Center for Cardiac Support; Texas Heart Institute; Houston Texas
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13
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Deo SV, Sharma V, Altarabsheh SE, Hasin T, Dillon J, Shah IK, Durham LA, Stulak JM, Daly RC, Joyce LD, Park SJ. Hepatic and renal function with successful long-term support on a continuous flow left ventricular assist device. Heart Lung Circ 2014; 23:229-33. [PMID: 23992754 DOI: 10.1016/j.hlc.2013.07.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 07/17/2013] [Accepted: 07/24/2013] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Data regarding the long-term clinical effects of a continuous flow left ventricular assist device (CF-LVAD) on hepato-renal function is limited. Hence our aim was to assess changes in hepato-renal function over a one-year period in patients supported on a CF-LVAD. METHODS During the study period 126 patients underwent CF-LVAD implant. Changes in hepato-renal laboratory parameters were studied in 61/126 patients successfully supported on a CF-LVAD for period of one year. A separate cohort of a high-risk group (HCrB) of patients (56/126) with a serum creat>1.9 mg/dL (168 μmol/L) (75th percentile) or a serum bil>1.5 mg/dL (25.65 μmol/L) (75th percentile) was created. Changes in serum creatinine and bilirubin were analysed at regular intervals for this group along with the need for renal replacement therapy. RESULTS Baseline creatinine and blood urea nitrogen (BUN) for the entire cohort was 1.4[1.2,1.9 mg/dL] [123.7(106,168) μmol/L) and 27[20,39.5 mg/dL] [9.6(7.1,14.1) mmol/L] respectively. After an initial reduction at the end of one month [1(0.8,1.2) mg/dL; 88(70,105) μmol/L] (p<0.0001), a gradual increase was noted over the study period to reach (1.25[1.1,1.5] mg/dL; 106(97.2,132.6) μmol/L] (p=0.0003). The serum bilirubin normalised from a [1(0.7,1.55) mg/dL] [17(18.8,25.7) μmol/L) to 0.9(0.6,1.2)mg/dL [15.4(10.2,20.5) μmol/L] (p=0.0005) and continued to decline over one year. Improvement in the synthetic function of the liver was demonstrated by a rise in the serum albumin levels to reach 4.3[4.1,4.5] [43(41,45) gm/L] at the end of one year (p<0.0001). The baseline serum creatinine and bilirubin for the high-risk cohort (HCrB) was 1.9(1.3,2.4) mg/dL [168(115,212) μmol/L] and 1.7(1.00,2.4) mg/dL [29(17.1,68.4) μmol/L] respectively. The high-risk cohort (HCrB) demonstrated a trend towards higher 30-day mortality (p=0.06). While the need for temporary renal replacement therapy was higher in this cohort (16% vs. 4%; p=0.03), only 3% need it permanently. A significant reduction in creatinine was apparent at the end of one month [1.1(0.8,1.4) mg/dL; 97(70.7,123.7) μmol/L] (p<0.0001) and then remained stable at [1.3(1.1,1.5) mg/dL; 115(97,132.6) μmol/L]. Bilirubin demonstrated a 30% decline over one month and then remained low at [0.7(0.5,0.8) mg/dL; 62(44,70) μmol/L] p=0.0005 compared to the pre-operative baseline. CONCLUSION Hepato-renal function demonstrates early improvement and then remains stable in the majority of patients on continuous flow left ventricular assist device support for one year. High-risk patients demonstrate a higher 30-day mortality and temporary need for renal replacement therapy. Yet even in this cohort, improvement is present over a period of one year on the device, with a minimal need for permanent haemodialysis.
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Affiliation(s)
- Salil V Deo
- Division of Cardiovascular Surgery, Mayo Clinic, United States
| | - Vikas Sharma
- Division of Cardiovascular Surgery, Mayo Clinic, United States
| | | | - Tal Hasin
- Department of Cardiovascular Diseases, Mayo Clinic, United States
| | - John Dillon
- Division of Nephrology and Hypertension, Mayo Clinic, United States
| | - Ishan K Shah
- Division of Cardiovascular Surgery, Mayo Clinic, United States
| | - Lucian A Durham
- Division of Cardiovascular Surgery, Mayo Clinic, United States
| | - John M Stulak
- Division of Cardiovascular Surgery, Mayo Clinic, United States
| | - Richard C Daly
- Division of Cardiovascular Surgery, Mayo Clinic, United States
| | - Lyle D Joyce
- Division of Cardiovascular Surgery, Mayo Clinic, United States
| | - Soon J Park
- Division of Cardiovascular Surgery, Mayo Clinic, United States.
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14
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Abstract
Understanding the mutual relationship between the liver and the heart is important for both hepatologists and cardiologists. Hepato-cardiac diseases can be classified into heart diseases affecting the liver, liver diseases affecting the heart, and conditions affecting the heart and the liver at the same time. Differential diagnoses of liver injury are extremely important in a cardiologist’s clinical practice calling for collaboration between cardiologists and hepatologists due to the many other diseases that can affect the liver and mimic haemodynamic injury. Acute and chronic heart failure may lead to acute ischemic hepatitis or chronic congestive hepatopathy. Treatment in these cases should be directed to the primary heart disease. In patients with advanced liver disease, cirrhotic cardiomyopathy may develop including hemodynamic changes, diastolic and systolic dysfunctions, reduced cardiac performance and electrophysiological abnormalities. Cardiac evaluation is important for patients with liver diseases especially before and after liver transplantation. Liver transplantation may lead to the improvement of all cardiac changes and the reversal of cirrhotic cardiomyopathy. There are systemic diseases that may affect both the liver and the heart concomitantly including congenital, metabolic and inflammatory diseases as well as alcoholism. This review highlights these hepatocardiac diseases
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15
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Nishi H, Toda K, Miyagawa S, Yoshikawa Y, Fukushima S, Yoshioka D, Saito T, Saito S, Sakaguchi T, Ueno T, Kuratani T, Sawa Y. Prediction of outcome in patients with liver dysfunction after left ventricular assist device implantation. J Artif Organs 2013; 16:404-10. [PMID: 23989898 DOI: 10.1007/s10047-013-0724-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 07/30/2013] [Indexed: 11/27/2022]
Abstract
Although postoperative liver dysfunction (LD) following left ventricular assist device (LVAD) implantation is associated with high mortality, outcome is difficult to predict in patients with liver dysfunction. We aimed to clarify factors affecting recovery from LD after VAD implantation. A total of 167 patients underwent LVAD implantation, of whom 101 developed early postoperative LD, defined as maximum total bilirubin (max T-bil) greater than 5.0 mg/dl within 2 weeks. We set two different end-points, unremitting LD, and 90-day mortality. The rates of early mortality (90 days) and recovery from LD were 36 % (36/101) and 72 % (73/101), respectively. Univariate analysis showed that preoperative body weight, preoperative mechanical support, preoperative T-bil and creatinine, left ventricular diastolic dimension, right VAD (RVAD) insertion, cardiopulmonary bypass time, postoperative cardiac index, and postoperative T-bil and central venous pressure (CVP) on postoperative day (POD) 3 (non-recovered vs recovered, 12.4 ± 4.5 vs 9.5 ± 3.6 mmHg) were higher in patients with unremitting LD. Preoperative T-bil, RVAD insertion, and T-bil and CVP on POD 3 (non-survivor vs survivor, 12.4 ± 4.4 vs 9.4 ± 3.6 mmHg) were also higher in non-survivors. Multivariate analysis demonstrated that CVP on POD 3 was predictive of recovery from postoperative LD (OR 0.730, P < 0.05) and 90-day mortality (OR 0.730, P < 0.05). A key outcome factor in patients who developed early postoperative LD after LVAD implantation was postoperative liver congestion with high CVP. To overcome postoperative LD, appropriate management of postoperative CVP level is important.
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Affiliation(s)
- Hiroyuki Nishi
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan,
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16
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Abstract
There is a mutual interaction between the function of the heart and the liver and a broad spectrum of acute and chronic entities that affect both the heart and the liver. These can be classified into heart diseases affecting the liver, liver diseases affecting the heart, and conditions affecting the heart and the liver at the same time. In chronic and acute cardiac hepatopathy, owing to cardiac failure, a combination of reduced arterial perfusion and passive congestion leads to cardiac cirrhosis and cardiogenic hypoxic hepatitis. These conditions may impair the liver function and treatment should be directed towards the primary heart disease and seek to secure perfusion of vital organs. In patients with advanced cirrhosis, physical and/or pharmacological stress may reveal a reduced cardiac performance with systolic and diastolic dysfunction and electrophysical abnormalities termed cirrhotic cardiomyopathy. Electrophysiological abnormalities include prolonged QT interval, chronotropic incompetance, and electromechanical uncoupling. No specific therapy can be recommended, but it should be supportive and directed against the heart failure. Numerous conditions affect both the heart and the liver such as infections, inflammatory and systemic diseases, and chronic alcoholism. The risk and prevalence of coronary artery disease are increasing in cirrhotic patients and since the perioperative mortality is high, a careful cardiac evaluation of such patients is required prior to orthotopic liver transplantation.
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Affiliation(s)
- Søren Møller
- Centre of Functional and Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, The Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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17
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Feldman D, Pamboukian SV, Teuteberg JJ, Birks E, Lietz K, Moore SA, Morgan JA, Arabia F, Bauman ME, Buchholz HW, Deng M, Dickstein ML, El-Banayosy A, Elliot T, Goldstein DJ, Grady KL, Jones K, Hryniewicz K, John R, Kaan A, Kusne S, Loebe M, Massicotte MP, Moazami N, Mohacsi P, Mooney M, Nelson T, Pagani F, Perry W, Potapov EV, Eduardo Rame J, Russell SD, Sorensen EN, Sun B, Strueber M, Mangi AA, Petty MG, Rogers J. The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: Executive summary. J Heart Lung Transplant 2013; 32:157-87. [DOI: 10.1016/j.healun.2012.09.013] [Citation(s) in RCA: 850] [Impact Index Per Article: 77.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 09/14/2012] [Indexed: 02/08/2023] Open
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18
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Russo CF, Cannata A, Lanfranconi M, Bruschi G, Milazzo F, Paino R, Martinelli L. Veno-arterial extracorporeal membrane oxygenation using Levitronix centrifugal pump as bridge to decision for refractory cardiogenic shock. J Thorac Cardiovasc Surg 2010; 140:1416-21. [DOI: 10.1016/j.jtcvs.2010.07.083] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2009] [Revised: 07/01/2010] [Accepted: 07/30/2010] [Indexed: 11/30/2022]
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19
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Bhama JK, Rayappa S, Zaldonis D, Adusumilli PS, Bansal A, Genovese EA, Teuteberg JJ, Toyoda Y, Siegenthaler MP, Bermudez CA, McCurry KR, Kormos RL. Impact of abdominal complications on outcome after mechanical circulatory support. Ann Thorac Surg 2010; 89:522-8; discussion 528-9. [PMID: 20103336 DOI: 10.1016/j.athoracsur.2009.11.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 11/01/2009] [Accepted: 11/03/2009] [Indexed: 01/24/2023]
Abstract
BACKGROUND Mechanical circulatory support (MCS) is life sustaining for patients with end-stage heart failure. Most devices require abdominal wall transgression, creating a potential for abdominal complications. The incidence and impact of these relatively underreported complications are unknown. METHODS A retrospective review was performed on 179 patients who received MCS therapy from 1999 to 2008. Abdominal complications were grouped as abdominal wall, gastrointestinal tract, and solid organ. RESULTS Ninety-eight patients (55%) experienced 157 abdominal complications. These involved the abdominal wall in 69 (44%), the gastrointestinal tract in 52 (33%), and the solid organs in 36 (23%). Surgical intervention was required in 36% of patients with abdominal wall complications, 19% of patients with gastrointestinal tract complications, and 14% of patients with solid organ complications. Multivariate analysis identified diabetes mellitus (p < 0.001), emergent device placement (p = 0.019), and preimplant mechanical ventilation (p = 0.045) as independent risk factors for developing an abdominal complication. Kaplan-Meier survival while receiving MCS was significantly reduced for patients with abdominal complications versus those without (p = 0.0142). Multivariate analysis identified only solid organ abdominal complications (p = 0.001) as an independent risk factor for death while receiving device support. CONCLUSIONS Abdominal complications are common in patients supported with MCS devices and significantly reduce survival. Surgical intervention is more frequently required for complications related to the abdominal wall compared with other complications. Patients with significant comorbidities (diabetes mellitus, respiratory failure) requiring urgent or emergent device placement are at higher risk for the development of abdominal complications with an attendant reduction in device-related survival.
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Affiliation(s)
- Jay K Bhama
- Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
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20
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Mohedano-Gómez A, Pérez-Vela JL, Renes-Carreño E, De-Andrés CI, Corres-Peiretti MA, Arribas-López P, Gutierrez-Rodriguez J, Perales-Rodríguez-De-Viguri N. Ductular Cholestasis, an Unusual Form of Intrahepatic Cholestasis, Associated With Cardiogenic Shock and Ventricular Assist Device. Artif Organs 2010; 34:149-52. [DOI: 10.1111/j.1525-1594.2009.00760.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Gelow JM, Desai AS, Hochberg CP, Glickman JN, Givertz MM, Fang JC. Clinical Predictors of Hepatic Fibrosis in Chronic Advanced Heart Failure. Circ Heart Fail 2010; 3:59-64. [DOI: 10.1161/circheartfailure.109.872556] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jill M. Gelow
- From the Cardiovascular Division (J.M.G., A.S.D., C.P.H., J.N.G., M.M.G., J.C.F.), Brigham and Women’s Hospital, Boston, Mass; Cardiovascular Division (J.M.G.), Oregon Health and Science University, Portland, Ore; Cardiovascular Division (C.P.H.), Beth Israel Deaconess Medical Center, Boston, Mass; and Cardiovascular Division (J.C.F.), University Hospital-Case Medical Center, Cleveland, Ohio
| | - Akshay S. Desai
- From the Cardiovascular Division (J.M.G., A.S.D., C.P.H., J.N.G., M.M.G., J.C.F.), Brigham and Women’s Hospital, Boston, Mass; Cardiovascular Division (J.M.G.), Oregon Health and Science University, Portland, Ore; Cardiovascular Division (C.P.H.), Beth Israel Deaconess Medical Center, Boston, Mass; and Cardiovascular Division (J.C.F.), University Hospital-Case Medical Center, Cleveland, Ohio
| | - Claudia P. Hochberg
- From the Cardiovascular Division (J.M.G., A.S.D., C.P.H., J.N.G., M.M.G., J.C.F.), Brigham and Women’s Hospital, Boston, Mass; Cardiovascular Division (J.M.G.), Oregon Health and Science University, Portland, Ore; Cardiovascular Division (C.P.H.), Beth Israel Deaconess Medical Center, Boston, Mass; and Cardiovascular Division (J.C.F.), University Hospital-Case Medical Center, Cleveland, Ohio
| | - Jonathan N. Glickman
- From the Cardiovascular Division (J.M.G., A.S.D., C.P.H., J.N.G., M.M.G., J.C.F.), Brigham and Women’s Hospital, Boston, Mass; Cardiovascular Division (J.M.G.), Oregon Health and Science University, Portland, Ore; Cardiovascular Division (C.P.H.), Beth Israel Deaconess Medical Center, Boston, Mass; and Cardiovascular Division (J.C.F.), University Hospital-Case Medical Center, Cleveland, Ohio
| | - Michael M. Givertz
- From the Cardiovascular Division (J.M.G., A.S.D., C.P.H., J.N.G., M.M.G., J.C.F.), Brigham and Women’s Hospital, Boston, Mass; Cardiovascular Division (J.M.G.), Oregon Health and Science University, Portland, Ore; Cardiovascular Division (C.P.H.), Beth Israel Deaconess Medical Center, Boston, Mass; and Cardiovascular Division (J.C.F.), University Hospital-Case Medical Center, Cleveland, Ohio
| | - James C. Fang
- From the Cardiovascular Division (J.M.G., A.S.D., C.P.H., J.N.G., M.M.G., J.C.F.), Brigham and Women’s Hospital, Boston, Mass; Cardiovascular Division (J.M.G.), Oregon Health and Science University, Portland, Ore; Cardiovascular Division (C.P.H.), Beth Israel Deaconess Medical Center, Boston, Mass; and Cardiovascular Division (J.C.F.), University Hospital-Case Medical Center, Cleveland, Ohio
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