1
|
Wadiwala I, Garg P, Alamouti-Fard E, Landolfo K, Sareyyupoglu B, Ahmed MES, Jacob S, Pham S. Absorbable antibiotic beads for treatment of LVAD driveline infections. Artif Organs 2024; 48:559-566. [PMID: 38400624 DOI: 10.1111/aor.14721] [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: 06/20/2023] [Revised: 11/11/2023] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
BACKGOUND Infections of the left ventricular assist device (LVAD) driveline are a dreaded complication that results in high mortality and morbidity. METHOD We retrospectively reviewed five consecutive patients with severe continuous-flow LVAD (HVAD, Heartmate 2, and Heartmate 3) driveline infection. These infections, which developed on an average of 960.4 ± 843.9 days after LVAD placement, were refractory to systemic antibiotics and local wound care. All were treated with extensive surgical debridement, local installation of absorbable antibiotic-loaded calcium sulfate beads (vancomycin and tobramycin), primary wound closure, and 6 weeks of systemic antibiotics after surgery. RESULTS Four patients had resolution of DLI, and one had a recurrent infection at another part of the driveline 7 months after the complete resolution of the previous site. This patient was successfully treated with debridement and bead placements. Three patients still have their LVADs, while two received orthotopic heart transplants. At the time of the transplant, there was no evidence of gross infection of the LVAD drivelines or pumps. At the average follow-up time of 425.8 ± 151 days, no patients have an active infection. CONCLUSION Treatment of LVAD driveline infection with absorbable antibiotic beads with primary wound closure is a viable option and merits further investigation.
Collapse
Affiliation(s)
- Ishaq Wadiwala
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA
| | - Pankaj Garg
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA
| | - Emad Alamouti-Fard
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA
| | - Kevin Landolfo
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA
| | - Basar Sareyyupoglu
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Samuel Jacob
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA
| | - Si Pham
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA
| |
Collapse
|
2
|
Alomari M, El-Sayed Ahmed MM, Ali M, Wadiwala IJ, Pham SM, Sareyyupoglu B. Quadricuspid Aortic Valve: Imaging, Diagnosis, and Prognosis. Tex Heart Inst J 2024; 51:e238256. [PMID: 38686682 DOI: 10.14503/thij-23-8256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Quadricuspid aortic valve is a rare congenital cardiac anomaly with an incidence of 0.008% to 0.043%. Its clinical course varies depending on cusp anatomy, function, and associated cardiac malformations. It frequently progresses to aortic valve regurgitation that may require surgical valve replacement. Detection has shifted from incidental discovery during autopsies or cardiac surgeries in the early 20th century to various cardiac imaging methods in recent decades. In addition to contributing to the literature, this report supports the use of transesophageal echocardiography more liberally to detect aortic valve abnormalities. The case presents a 48-year-old female patient with an incidentally discovered quadricuspid aortic valve.
Collapse
Affiliation(s)
- Mohammad Alomari
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Magdy M El-Sayed Ahmed
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
- Department of Surgery, Zagazig University Faculty of Medicine, Zagazig, Egypt
| | - Mostafa Ali
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Ishaq J Wadiwala
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| |
Collapse
|
3
|
Raavi L, Garg P, Alomari M, Celik NB, Makey IA, Thomas M, Nassar A, Sareyyupoglu B, Jacob S, Pham SM, El-Sayed Ahmed MM. Outcome of lung transplantation in patients with pulmonary alveolar microlithiasis in the era of COVID-19 infection. J Surg Case Rep 2024; 2024:rjae211. [PMID: 38605700 PMCID: PMC11008913 DOI: 10.1093/jscr/rjae211] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/15/2024] [Indexed: 04/13/2024] Open
Abstract
Lung transplant recipients are at higher risk of developing COVID-19 infection compared to other solid organ transplants. The risk further increases in the unvaccinated patients. We present a case of a 43-year-old male who underwent bilateral sequential lung transplantation for pulmonary alveolar microlithiasis (PAM) and had an uneventful recovery. However, two years post-transplantation, the patient developed chronic lung allograft dysfunction (CLAD) with bronchiolitis obliterans syndrome and two episodes of COVID-19 infection. During the second episode of COVID-19 infection, the patient developed sepsis and multi-organ dysfunction ultimately resulting in death. Our case report highlights the increased susceptibility of PAM patients' post-lung transplant to COVID-19 infection. Continuous follow-up of PAM patients' post-lung transplantation is necessary to prevent unfavorable outcomes.
Collapse
Affiliation(s)
- Lekhya Raavi
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville 32224, FL, United States
| | - Pankaj Garg
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville 32224, FL, United States
| | - Mohammad Alomari
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville 32224, FL, United States
| | - Nafiye B Celik
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville 32224, FL, United States
| | - Ian A Makey
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville 32224, FL, United States
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville 32224, FL, United States
| | - Aziza Nassar
- Department of Pathology, Mayo Clinic, 12220 Kinneil Court, Jacksonville, FL 32224, United States
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville 32224, FL, United States
| | - Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville 32224, FL, United States
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville 32224, FL, United States
| | - Magdy M El-Sayed Ahmed
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville 32224, FL, United States
- Department of Surgery, Zagazig University Faculty of Medicine, Koliat Altob st., Zagazig 44519, Egypt
| |
Collapse
|
4
|
Waldron NH, Pandompatam G, Sareyyupoglu B, Kalagara H. Transesophageal echocardiographic acquisition of the venous excess ultrasound exam-a case series and technical description. Can J Anaesth 2024; 71:422-430. [PMID: 38286981 PMCID: PMC10923736 DOI: 10.1007/s12630-023-02688-9] [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] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 01/31/2024] Open
Abstract
PURPOSE Obtaining an objective, reproducible, and accurate assessment of volume status is one of the more difficult tasks in the perioperative arena. Since its advent in 2020, the Venous Excess Ultrasound (VExUS) score has gained popularity in the minimally invasive assessment of venous congestion. The VExUS exam has been well described as an additional series of images (hepatic vein, portal vein, and intrarenal vein) obtained with a phased-array probe during a transthoracic echocardiogram. Nevertheless, there are no descriptions of comprehensive VExUS exams performed using transesophageal echocardiography (TEE)-a modality that is routinely employed in patients undergoing cardiac surgery. CLINICAL FEATURES We describe techniques to acquire and interpret a comprehensive TEE-supported VexUS exam, which may be used to optimize the perioperative care of cardiac surgical patients. CONCLUSION Given the risks of fluid overload in critically ill cardiac surgery patients, TEE-supported VExUS examination may be a way to reduce morbidity in this population.
Collapse
Affiliation(s)
- Nathan H Waldron
- Department of Anesthesiology and Perioperative Pain Medicine, Mayo Clinic, Jacksonville, FL, USA.
- Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Govind Pandompatam
- Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Basar Sareyyupoglu
- Department of Cardiovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Hari Kalagara
- Department of Anesthesiology and Perioperative Pain Medicine, Mayo Clinic, Jacksonville, FL, USA
| |
Collapse
|
5
|
Sinclair De Frías J, Isha S, Olivero L, Raavi L, Narra SA, Paghdar S, Jonna S, Satashia P, Hannon R, Blasavage J, White L, Olanipekun T, Bansal P, Kiley S, Leoni JC, Nativí J, Lyle M, Thomas M, Sareyyupoglu B, Pham S, Smith M, Moreno Franco P, Patel P, Sanghavi D. Association between Impella device support and elevated rates of gout flares: a retrospective propensity-matched study. BMC Rheumatol 2024; 8:9. [PMID: 38424614 PMCID: PMC10902952 DOI: 10.1186/s41927-024-00380-z] [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: 11/03/2023] [Accepted: 02/09/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Impella is an advanced ventricular assist device frequently used as a bridge to heart transplantation. The association of Impella with increased rates of gout flares has not been studied. Our primary aim is to determine the rates of gout flares in patients on Impella support. METHODOLOGY A retrospective study was conducted between January 2017 and September 2022 involving all patients who underwent heart transplantation. The cohort was divided into two groups based on Impella support for statistical analysis. In patients receiving Impella support, outcome measures were compared based on the development of gout flares. 1:1 nearest neighbor propensity match, as well as inverse propensity of treatment weighted analyses, were performed to explore the causal relationship between impella use and gout flare in our study population. RESULTS Our analysis included 213 patients, among which 42 (19.71%) patients were supported by Impella. Impella and non-Impella groups had similar age, race, and BMI, but more males were in the Impella group. Gout and chronic kidney disease were more prevalent in Impella-supported patients, while coronary artery disease was less common. The prevalence of gout flare was significantly higher in Impella patients (30.9% vs. 5.3%). 42 Impella-supported patients were matched with 42 patients from the non-impella group upon performing a 1:1 propensity matching. Impella-supported patients were noted to have a significantly higher risk of gout flare (30.9% vs. 7.1%, SMD = 0.636), despite no significant difference in pre-existing gout history and use of anti-gout medications. Impella use was associated with a significantly increased risk of gout flare in unadjusted (OR 8.07), propensity-matched (OR 5.83), and the inverse propensity of treatment-weighted analysis (OR 4.21). CONCLUSION Our study is the first to identify the potential association between Impella support and increased rates of gout flares in hospitalized patients. Future studies are required to confirm this association and further elucidate the biological pathways. It is imperative to consider introducing appropriate measures to prevent and promptly manage gout flares in Impella-supported patients.
Collapse
Affiliation(s)
- Jorge Sinclair De Frías
- Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road S, 32224, Jacksonville, FL, USA
| | - Shahin Isha
- Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road S, 32224, Jacksonville, FL, USA
| | - Lorenzo Olivero
- Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road S, 32224, Jacksonville, FL, USA
| | - Lekhya Raavi
- Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road S, 32224, Jacksonville, FL, USA
| | - Sai Abhishek Narra
- Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road S, 32224, Jacksonville, FL, USA
| | - Smit Paghdar
- Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road S, 32224, Jacksonville, FL, USA
| | - Sadhana Jonna
- Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road S, 32224, Jacksonville, FL, USA
| | - Parthkumar Satashia
- Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road S, 32224, Jacksonville, FL, USA
| | - Rachel Hannon
- Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road S, 32224, Jacksonville, FL, USA
| | - Jessica Blasavage
- Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road S, 32224, Jacksonville, FL, USA
- Associate Clinical Consultant, Abiomed, Jacksonville, FL, USA
| | - Layton White
- Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road S, 32224, Jacksonville, FL, USA
| | - Titilope Olanipekun
- Department of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pankaj Bansal
- Department of Rheumatology, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Sean Kiley
- Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road S, 32224, Jacksonville, FL, USA
| | - Juan Carlos Leoni
- Division of Advanced Heart Failure and Transplantation, Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Jose Nativí
- Division of Advanced Heart Failure and Transplantation, Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Melissa Lyle
- Division of Advanced Heart Failure and Transplantation, Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Mathew Thomas
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Basar Sareyyupoglu
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Si Pham
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Michael Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Pablo Moreno Franco
- Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road S, 32224, Jacksonville, FL, USA
| | - Parag Patel
- Division of Advanced Heart Failure and Transplantation, Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Devang Sanghavi
- Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road S, 32224, Jacksonville, FL, USA.
| |
Collapse
|
6
|
Garg P, Lykins A, Alomari M, Reynolds JP, Johnson E, Sareyyupoglu B. PlasmaBlade-assisted surgical septal myectomy: technique and our experience. Front Cardiovasc Med 2024; 11:1345540. [PMID: 38357514 PMCID: PMC10864591 DOI: 10.3389/fcvm.2024.1345540] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024] Open
Abstract
Background The pulsed-electron avalanche knife (PEAK) PlasmaBlade provides an atraumatic, scalpel-like cutting precision and electrocautery-like hemostasis. PlasmaBlade operates near body temperature, and its long, thin, and malleable tip can overcome the limitations of a surgical knife. In this study, we aimed to evaluate our clinical experience and histopathological outcomes of septal myectomy using PlasmaBlade. Methods Electronic medical records were reviewed for preoperative, operative, and follow-up data of the patients who underwent septal myectomy using PEAK PlasmaBlade at our institute between January 2019 and December 2022. Histopathology of the myectomy specimens was reviewed for the depth of muscle necrosis and compared with the left atrial appendage (LAA) specimen. Results Twenty-nine patients underwent septal myectomy using the PEAK PlasmaBlade. No mortality was reported. The mean age was 60.6 ± 12.5 years, and 58.6% of patients were male. Peak left ventricular outflow tract (LVOT) gradients were 40.5 ± 34.9 mmHg at rest and 56.5 ± 34.9 mmHg after provocation. Concomitant procedures performed were LAA ligation in 20 (69.0%), aortic valve replacement in 5 (17.2%), and coronary artery bypass grafting in 3 (10.3%) patients. Postoperative complications were complete heart block in one (3.4%) and ventricular septal defect in two (6.9%) patients. Both the ventricular septal defects were identified intraoperatively and repaired. Histopathology of myectomy specimens demonstrated cautery artifact limited to <50 µm depth compared to >1,000 µm with conventional electrocautery. At a mean follow-up of 8.4 ± 10.3 months, the mean LVOT gradient was 4.4 ± 5.8 mmHg at rest and 9.5 ± 3.3 mmHg after provocation. All patients were alive and in New York Heart Association class I/II. No patient developed complications or required reintervention or reoperation. Conclusion Adequate septal myectomy can be precisely and safely performed using the PEAK PlasmaBlade with minimal collateral damage.
Collapse
Affiliation(s)
- Pankaj Garg
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Amy Lykins
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Mohammad Alomari
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Jordan P. Reynolds
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, United States
| | - Elizabeth Johnson
- Department of Radiology, Mayo Clinic, Jacksonville, FL, United States
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, United States
| |
Collapse
|
7
|
Alomari M, Garg P, Wadiwala I, Pham SM, Sareyyupoglu B. Septal myectomy for hypertrophic obstructive cardiomyopathy using a pulsed radiofrequency energy soft tissue dissection instrument. JTCVS Tech 2023; 22:220-222. [PMID: 38152217 PMCID: PMC10750430 DOI: 10.1016/j.xjtc.2023.07.015] [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] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Mohammad Alomari
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Fla
| | - Pankaj Garg
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Fla
| | - Ishaq Wadiwala
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Fla
| | - Si M. Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Fla
| | | |
Collapse
|
8
|
Martin AK, Fritz AV, Pham SM, Landolfo KP, Sareyyupoglu B, Brown TE, Logvinov I, Li Z, Narula T, Makey IA, Thomas M. Initial experience and outcomes with a hybrid extracorporeal membrane oxygenation and cardiopulmonary bypass circuit for lung transplantation. JTCVS Open 2023; 16:1029-1037. [PMID: 38204698 PMCID: PMC10775128 DOI: 10.1016/j.xjon.2023.09.033] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/24/2023] [Accepted: 09/21/2023] [Indexed: 01/12/2024]
Abstract
Background The utilization of extracorporeal life support (ECLS) for intraoperative support during lung transplantation has increased over the past decade. Although veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has recently emerged as the preferred modality over cardiopulmonary bypass (CPB), many centers continue to use both forms of ECLS during lung transplantation. Our novel hybrid VA-ECMO/CPB circuit allows for seamless transition from VA-ECMO to CPB at a significant cost savings compared to a standalone VA-ECMO circuit. This study describes our initial experience and outcomes in the first 100 bilateral lung transplantations using this novel hybrid VA-ECMO/CPB circuit. Methods Medical records from September 2017 to May 2021 of the first 100 consecutive patients undergoing bilateral lung transplantation with intraoperative hybrid VA-ECMO support were examined retrospectively. We excluded patients with single lung transplants, retransplantations, preoperative ECLS bridging, and veno-venous (VV) ECMO and those supported with CPB only. Perioperative recipient, anesthetic, perfusion variables, and outcomes were assessed. Results Of the 100 patients supported with VA-ECMO, 19 were converted intraoperatively to CPB. Right ventricular dysfunction was seen in 37% of patients, and the median mean pulmonary artery pressure was 28 mm Hg. No oxygenator clotting was observed with a median heparin dose of 13,000 units in the VA-ECMO group. Primary graft dysfunction grade 3 at 72 hours was observed in 10.1% of all patients and observed 1-year mortality was 4%. Conclusions The use of a hybrid VA-ECMO/CPB circuit in our institution allows for rapid conversion to CPB with acceptable outcomes across a diverse recipient group at a significantly reduced cost compared to standalone VA-ECMO circuits.
Collapse
Affiliation(s)
- Archer Kilbourne Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic Florida, Jacksonville, Fla
| | - Ashley Virginia Fritz
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic Florida, Jacksonville, Fla
| | - Si M. Pham
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, Fla
| | - Kevin P. Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, Fla
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, Fla
| | - Thomas E. Brown
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, Fla
| | - Ilana Logvinov
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic Florida, Jacksonville, Fla
| | - Zhuo Li
- Department of Clinical Trials and Biostatistics, Mayo Clinic Florida, Jacksonville, Fla
| | - Tathagat Narula
- Division of Lung Failure and Transplant, Mayo Clinic Florida, Jacksonville, Fla
| | - Ian A. Makey
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, Fla
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, Fla
| |
Collapse
|
9
|
Jang JM, Jarmi T, Sareyyupoglu B, Nativi J, Patel PC, Leoni JC, Landolfo K, Pham S, Yip DS, Goswami RM. Axillary mechanical circulatory support improves renal function prior to heart transplantation in patients with chronic kidney disease. Sci Rep 2023; 13:19671. [PMID: 37952046 PMCID: PMC10640571 DOI: 10.1038/s41598-023-46901-7] [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: 07/19/2022] [Accepted: 11/07/2023] [Indexed: 11/14/2023] Open
Abstract
Impaired kidney function is often associated with acute decompensation of chronic heart failure and portends a poor prognosis. Unfortunately, current data have demonstrated worse survival in patients with acute kidney injury than in patients with chronic kidney disease during durable LVAD placement as bridge therapy. Furthermore, end-stage heart failure patients undergoing combined heart-kidney transplantation have poorer short- and long-term survival than heart transplants alone. We evaluated the kidney function recovery in our heart failure population awaiting heart transplantation at our institution, supported by temporary Mechanical Circulatory Support (tMCS) with Impella 5.5. The protocol (#22004000) was approved by the Mayo Clinic institutional review board, after which we performed a retrospective review of all patients with acute on chronic heart failure and kidney disease in patients considered for only heart and kidney combined organ transplant and supported by tMCS between January 2020 and February 2021. Hemodynamic and kidney function trends were recorded and analyzed before and after tMCS placement and transplantation. After placement of tMCS, we observed a trend towards improvement in creatinine, Fick cardiac index, mixed venous saturation, and glomerular filtration rate (GFR), which persisted through transplantation and discharge. The average duration of support with tMCS was 16.5 days before organ transplantation. The median pre-tMCS creatinine was 2.1 mg/dL (IQR 1.75-2.3). Median hematocrit at the time of tMCS placement was 32% (IQR 32-34), and the median estimated glomerular filtration rate was 34 mL/min/BSA (34-40). The median GFR improved to 44 mL/min/BSA (IQR 45-51), and serum creatinine improved to 1.5 mg/dL (1.5-1.8) after tMCS. Median discharge creatinine was 1.1 mg/dL (1.19-1.25) with a GFR of 72 (65-74). None of these six patients supported with tMCS required renal replacement therapy after heart transplantation. Early adoption of Impella 5.5 in this patient population resulted in renal recovery without needing renal replacement therapies or dual organ transplantation and should be further evaluated.
Collapse
Affiliation(s)
- Ji-Min Jang
- Division of Heart Failure and Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32246, USA
| | - Tambi Jarmi
- Division of Transplant Nephrology, Mayo Clinic Florida, Jacksonville, USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, USA
| | - Jose Nativi
- Division of Heart Failure and Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32246, USA
| | - Parag C Patel
- Division of Heart Failure and Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32246, USA
| | - Juan C Leoni
- Division of Heart Failure and Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32246, USA
| | - Kevin Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, USA
| | - Si Pham
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, USA
| | - Daniel S Yip
- Division of Heart Failure and Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32246, USA
| | - Rohan M Goswami
- Division of Heart Failure and Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32246, USA.
| |
Collapse
|
10
|
Satashia PH, Franco PM, Rivas AL, Isha S, Hanson A, Narra SA, Singh K, Jenkins A, Bhattacharyya A, Guru P, Chaudhary S, Kiley S, Shapiro A, Martin A, Thomas M, Sareyyupoglu B, Libertin CR, Sanghavi DK. From numbers to medical knowledge: harnessing combinatorial data patterns to predict COVID-19 resource needs and distinguish patient subsets. Front Med (Lausanne) 2023; 10:1240426. [PMID: 38020180 PMCID: PMC10664024 DOI: 10.3389/fmed.2023.1240426] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background The COVID-19 pandemic intensified the use of scarce resources, including extracorporeal membrane oxygenation (ECMO) and mechanical ventilation (MV). The combinatorial features of the immune system may be considered to estimate such needs and facilitate continuous open-ended knowledge discovery. Materials and methods Computer-generated distinct data patterns derived from 283 white blood cell counts collected within five days after hospitalization from 97 COVID-19 patients were used to predict patient's use of hospital resources. Results Alone, data on separate cell types-such as neutrophils-did not identify patients that required MV/ECMO. However, when structured as multicellular indicators, distinct data patterns displayed by such markers separated patients later needing or not needing MV/ECMO. Patients that eventually required MV/ECMO also revealed increased percentages of neutrophils and decreased percentages of lymphocytes on admission. Discussion/conclusion Future use of limited hospital resources may be predicted when combinations of available blood leukocyte-related data are analyzed. New methods could also identify, upon admission, a subset of COVID-19 patients that reveal inflammation. Presented by individuals not previously exposed to MV/ECMO, this inflammation differs from the well-described inflammation induced after exposure to such resources. If shown to be reproducible in other clinical syndromes and populations, it is suggested that the analysis of immunological combinations may inform more and/or uncover novel information even in the absence of pre-established questions.
Collapse
Affiliation(s)
| | - Pablo Moreno Franco
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Ariel L. Rivas
- Center for Global Health-Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Shahin Isha
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Abby Hanson
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Sai Abhishek Narra
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Kawaljeet Singh
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Anna Jenkins
- Mayo Clinic Alix School of Medicine, Jacksonville, FL, United States
| | | | - Pramod Guru
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Sanjay Chaudhary
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Sean Kiley
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Anna Shapiro
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Archer Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Claudia R. Libertin
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL, United States
| | - Devang K. Sanghavi
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, United States
| |
Collapse
|
11
|
Olanipekun T, Sanghavi D, Moreno Franco P, Robinson MT, Thomas M, Kiley S, Paghdar S, Sareyyupoglu B, Diaz Milian R. Translating Policy to Practice: An Association Between Medicare Access and Children's Health Insurance Program Reauthorization Act Implementation and Palliative Care Consultations and Perioperative Mortality in Critical Care. Crit Care Med 2023; 51:1461-1468. [PMID: 37378470 DOI: 10.1097/ccm.0000000000005982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
OBJECTIVES To evaluate the 30-day postoperative mortality and palliative care consultations in patients that underwent surgical procedures in the United States before and after Medicare Access and Children's Health Insurance Program Reauthorization Act (MACRA) implementation. DESIGN Retrospective, Observational cohort study. SETTING Secondary data were collected from the U.S. National Inpatient Sample, the largest hospital database in the country. The time span was from 2011 to 2019. PATIENTS Adult patients that electively underwent 1 of 19 major procedures. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was cumulative postoperative mortality in two study cohorts. The secondary outcome was palliative care use. We identified 4,900,451 patients and categorized them into two study cohorts: PreM: 2011-2014 ( n = 2,103,836) and PostM: 2016-2019 ( n = 2,796,615). Regression discontinuity estimates and multivariate analysis were used. Across all procedures, 149,372 patients (7.1%) and 156,610 patients (5%) died within 30 days of their index procedures in the PreM and PostM cohorts, respectively. There was no statistically significant increase in mortality rates around postoperative day (POD) 30 (POD 26-30 vs 31-35) for both cohorts. More patients had inpatient palliative consultations during POD 31-60 compared with POD 1-30 in PreM (8,533 of 2,081,207 patients [0.4%] vs 1,118 of 22,629 patients [4.9%]) and PostM (18,915 of 2,791,712 patients [0.7%] vs 417 of 4,903 patients [8.5%]). Patients were more likely to receive palliative care consultations during POD 31-60 compared with POD 1-30 in both the PreM (odds ratio [OR] 5.31; 95% CI, 2.22-8.68; p < 0.001) and the PostM (OR 7.84; 95% CI, 4.83-9.10; p < 0.001) cohorts. CONCLUSIONS We did not observe an increase in postoperative mortality after POD 30 before or after MACRA implementation. However, palliative care use markedly increased after POD 30. These findings should be considered hypothesis-generating because of several confounders.
Collapse
Affiliation(s)
- Titilope Olanipekun
- Safety, Quality, Informatics and Leadership Program, Department of Postgraduate Medical Education, Harvard Medical School, Boston, MA
- Department of Hospital Medicine, Covenant Health System, Knoxville, TN
| | - Devang Sanghavi
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL
| | | | - Maisha T Robinson
- Department of Neurology, Family Medicine, Palliative Medicine, Mayo Clinic, Jacksonville, FL
| | - Mathew Thomas
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Jacksonville, FL
| | - Sean Kiley
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Smit Paghdar
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL
| | - Basar Sareyyupoglu
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Jacksonville, FL
| | - Ricardo Diaz Milian
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| |
Collapse
|
12
|
El-Sayed Ahmed MM, Shah SZ, Zhang N, Jarmi T, Jacob S, Makey IA, Thomas M, Sareyyupoglu B, Landolfo KP, Erasmus DB, Pham SM. Survival Outcomes of Lung Transplant Recipients From Donors With Abnormal Kidney Function. Ann Thorac Surg 2023; 116:1071-1078. [PMID: 36404446 DOI: 10.1016/j.athoracsur.2022.10.016] [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] [Received: 06/08/2022] [Revised: 09/19/2022] [Accepted: 10/17/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Recovering lungs with pulmonary edema due to abnormal kidney function is considered one of the expanded selection criteria for lung transplant. The aim of this study is to assess lung transplant recipients' survival from donors with abnormal kidney function and to determine differences in lung recovery rates from donors with and donors without abnormal kidney function. METHODS We reviewed the United Network for Organ Sharing registry for first-time adult lung transplant donors and recipients from June 2005 to March 2017. Donor kidney function was categorized into three groups based on estimated glomerular filtration rate: group I, greater than 60 mL/min; group II, 15 to 59 mL/min; and group III, less than 15 mL/min. Recipient survival was stratified based on estimated glomerular filtration rate using Kaplan-Meier. A multivariate Cox Regression model with known risk factors that affect survival was used to compare survival among groups. Comparison of lung recovery among the three groups was also performed. RESULTS Lung recovery rates were 29.7% (15,670 of 52,747), 19.4% (3879 of 20,040), and 18.1% (704 of 3898) for groups I, II, and III, respectively. The 1-, 3-, and 5-year recipient survival rates were 86.2%, 69.2%, and 55.7% for group I; 84.9%, 66.9%, and 53.8% for group II; and 85.5%, 65.3%, and 50.3% for group III, respectively (adjusted P = .25; multivariate Cox regression method). When group I was used as reference, the adjusted hazard ratio for group II was 1.04 (95% CI, 0.98-1.10) and for group III, it was 1.08 (95% CI, 0.96-1.23), after adjusting with the multivariate Cox regression model. CONCLUSIONS There was no significant difference in lung recipient survival. The lung recovery rate from donors with abnormal kidney function was lower compared with that of donors with normal kidney function.
Collapse
Affiliation(s)
- Magdy M El-Sayed Ahmed
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida; Department of Surgery, Zagazig University Faculty of Medicine, Zagazig, Egypt.
| | - Sadia Z Shah
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida
| | - Nan Zhang
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, Arizona
| | - Tambi Jarmi
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida
| | - Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Ian A Makey
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Kevin P Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - David B Erasmus
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| |
Collapse
|
13
|
Paciotti BL, Garg P, Ritchie CA, Landolfo K, Sareyyupoglu B. Aggressive Management of a Bilateral Chylothorax Complicating an Orthotopic Heart-Kidney Transplantation. Braz J Cardiovasc Surg 2023; 38:e20230041. [PMID: 37801652 PMCID: PMC10552658 DOI: 10.21470/1678-9741-2023-0041] [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: 02/03/2023] [Accepted: 03/16/2023] [Indexed: 10/08/2023] Open
Abstract
Chylothorax after an orthotopic heart transplant is a rare but potentially detrimental occurrence. This is the first reported case of bilateral chylothorax complicating a heart-kidney transplant patient. No universally accepted protocol exists for the management of chylothorax in general population, let alone the immunocompromised transplant patient. This case presents unique challenges to the management of postoperative chylothorax given heart-kidney transplant's effect on the patient's volume status and immunocompromised state. We make the argument for aggressive treatment of chylothorax in an immunocompromised heart-kidney transplant patient to limit complications in a patient population predisposed to infection.
Collapse
Affiliation(s)
- Breah Lynn Paciotti
- Department of Cardiothoracic Surgery, Mayo Clinic Florida,
Jacksonville, Florida, United States of America
| | - Pankaj Garg
- Department of Cardiothoracic Surgery, Mayo Clinic Florida,
Jacksonville, Florida, United States of America
| | - Charles A. Ritchie
- Department of Radiology, Mayo Clinic Florida, Jacksonville,
Florida, United States of America
| | - Kevin Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic Florida,
Jacksonville, Florida, United States of America
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic Florida,
Jacksonville, Florida, United States of America
| |
Collapse
|
14
|
Garg P, Lykins A, Alomari M, Pollak P, Patel P, Sareyyupoglu B. Case report: Heart transplant for persistent right heart failure after complete surgical repair and percutaneous closure of post-myocardial infarction ventricular septal rupture. Front Cardiovasc Med 2023; 10:1237772. [PMID: 37790593 PMCID: PMC10543756 DOI: 10.3389/fcvm.2023.1237772] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023] Open
Abstract
The incidence of post-acute myocardial infarction ventricular septal rupture (post-AMI VSR) has decreased; however, mortality after surgical repair of post-AMI VSR remains high. Patients who are not surgical candidates can be managed by heart transplant with a good outcome. A heart transplant in a patient after successful repair of VSR has never been reported. We report a patient who had persistent right heart failure after the successful repair of VSR and underwent a heart transplant with a good outcome.
Collapse
Affiliation(s)
- Pankaj Garg
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Amy Lykins
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Mohammad Alomari
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Peter Pollak
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida
| | - Parag Patel
- Department of Transplant, Division of Advanced Heart Failure and Cardiac Transplant, Mayo Clinic, Jacksonville, Florida
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| |
Collapse
|
15
|
Garg P, Hussain MWA, Sareyyupoglu B. Role of acute mechanical circulatory support devices in cardiogenic shock. Indian J Thorac Cardiovasc Surg 2023; 39:25-46. [PMID: 37525710 PMCID: PMC10387030 DOI: 10.1007/s12055-023-01484-w] [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: 07/29/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 03/30/2023] Open
Abstract
Cardiogenic shock is a state of low cardiac output that is associated with significant morbidity and mortality. A considerable proportion of patients with cardiogenic shock respond poorly to medical management and require acute mechanical circulatory support (AMCS) devices to improve tissue perfusion as well as to support the heart. In the last two decades, many new AMCS devices have been introduced to support the right, left, and both ventricles. All these devices vary in terms of the support they provide to the body and heart, mechanism of functioning, method of insertion, and adverse events. In this review, we compare and contrast the available percutaneous and surgically placed AMCS devices used in cardiogenic shock and discuss the associated clinical and hemodynamic data to make a conscious decision about choosing a device.
Collapse
Affiliation(s)
- Pankaj Garg
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Md Walid Akram Hussain
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA
- Cardiothoracic Surgery, Heart and Lung Transplant Program, Mayo Clinic, 4500 San Pablo Road, FL 32224 Jacksonville, USA
| |
Collapse
|
16
|
Paghdar S, Desai S, Jang JM, Ruiz J, Malkani S, Patel P, Yip DS, Leoni JC, Nativi J, Sareyyupoglu B, Landolfo K, Pham S, Goswami RM. One-year survival in recipients older than 50 bridged to heart transplant with Impella 5.5 via axillary approach. J Geriatr Cardiol 2023; 20:319-329. [PMID: 37397862 PMCID: PMC10308172 DOI: 10.26599/1671-5411.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Optimizing patients with advanced heart failure before orthotopic heart transplantation (OHT), especially in patients greater than 50 years old, is imperative to achieving successful post-transplant outcomes. Complications are well-described for patients bridged to transplant (BTT) with durable left ventricular assist device (LVAD) support. Given the lack of data available in older recipients after the recent increase in mechanical support use, we felt it crucial to report our center's one-year outcomes in older recipients after heart transplantation with percutaneously placed Impella 5.5 as a BTT. METHODS Forty-nine OHT patients were supported with the Impella 5.5 intended as a bridge between December 2019 and October 2022 at Mayo Clinic in Florida. Data were extracted from the electronic health record at baseline and during their transplant episode of care after Institutional Review Boards approval as exempt for retrospective data collection. RESULTS Thirty-eight patients aged 50 or older were supported with Impella 5.5 as BTT. Ten patients underwent heart and kidney transplantation within this cohort. The median age at OHT was 63 (58-68) years, with 32 male (84%) and six female patients (16%). Etiology was divided into ischemic (63%) and non-ischemic cardiomyopathy (37%). The baseline median ejection fraction was 19% (15-24). Most patients were in blood group O (60%), and 50% were diabetic. The average duration of support was 27 days (range 6-94). The median duration of follow-up is 488 days (185-693). For patients that have reached the 1-year follow-up timeframe (22 of 38, 58%), the 1-year post-transplant survival is 95%. CONCLUSION Our single-center data provides awareness for using the Impella 5.5 percutaneously placed axillary support device in older heart failure patients in cardiogenic shock as a bridge to transplantation. One-year survival outcomes after heart transplantation are excellent despite the older recipient's age and prolonged pre-transplant support.
Collapse
Affiliation(s)
- Smit Paghdar
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, USA
| | - Smruti Desai
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, USA
| | - Ji-Min Jang
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, USA
| | - Jose Ruiz
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, USA
| | - Sharan Malkani
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, USA
| | - Parag Patel
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, USA
| | - Daniel S Yip
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, USA
| | - Juan C Leoni
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, USA
| | - Jose Nativi
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, USA
| | | | - Kevin Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic in Florida, USA
| | - Si Pham
- Department of Cardiothoracic Surgery, Mayo Clinic in Florida, USA
| | - Rohan M Goswami
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, USA
| |
Collapse
|
17
|
Haddad O, Sareyyupoglu B, Goswami RM, Bitargil M, Patel PC, Jacob S, El-Sayed Ahmed MM, Leoni Moreno JC, Yip DS, Landolfo K, Pham SM. Short-term outcomes of heart transplant patients bridged with Impella 5.5 ventricular assist device. ESC Heart Fail 2023. [PMID: 37137732 PMCID: PMC10375168 DOI: 10.1002/ehf2.14391] [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: 05/03/2022] [Revised: 01/15/2023] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
AIMS We sought to investigate the outcomes of heart transplant patients supported with Impella 5.5 temporary mechanical circulatory support. METHODS AND RESULTS Patient demographics, perioperative data, hospital timeline, and haemodynamic parameters were followed during initial admission, Impella support, and post-transplant period. Vasoactive-inotropic score, primary graft failure, and complications were recorded. Between March 2020 and March 2021, 16 advanced heart failure patients underwent Impella 5.5 temporary left ventricular assist device support through axillary approach. Subsequently, all these patients had heart transplantation. All patients were either ambulatory or chair bound during their temporary mechanical circulatory support until heart transplantation. Patients were kept on Impella support median of 19 days (3-31) with the median lactate dehydrogenase level of 220 (149-430). All Impella devices were removed during heart transplantation. During Impella support, patients had improved renal function with median creatinine serum level of 1.55 mg/dL decreased to 1.25 (P = 0.007), pulmonary artery pulsatility index scores increased from 2.56 (0.86-10) to 4.2 (1.3-10) (P = 0.048), and right ventricular function improved (P = 0.003). Patients maintained improved renal function and favourable haemodynamics after their heart transplantation as well. All patients survived without any significant morbidity after their heart transplantation. CONCLUSIONS Impella 5.5 temporary left ventricular assist device optimizes care of heart transplant recipients providing superior haemodynamic support, mobility, improved renal function, pulmonary haemodynamics, and right ventricular function. Utilizing Impella 5.5 as a direct bridging strategy to heart transplantation resulted in excellent outcomes.
Collapse
Affiliation(s)
- Osama Haddad
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Rohan M Goswami
- Department of Transplantation, Mayo Clinic Hospital, Jacksonville, FL, USA
| | - Macit Bitargil
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Parag C Patel
- Department of Transplantation, Mayo Clinic Hospital, Jacksonville, FL, USA
| | - Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Magdy M El-Sayed Ahmed
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | | | - Daniel S Yip
- Department of Transplantation, Mayo Clinic Hospital, Jacksonville, FL, USA
| | - Kevin Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| |
Collapse
|
18
|
Wadiwala I, Garg P, Nativi J, Lyle M, Leoni J, Yip D, Goswami R, Patel P, Sareyyupoglu B, MM E, Jacob S, Landolfo K, Pham S. The Role of Impella 5.5 to Reduce Pulmonary Artery Pressures in Patients with Cardiac Amyloidosis with Small Ventricular Cavity as a Bridge to Heart Transplant. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1062] [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
|
19
|
Shah SZ, Alvarez FG, Sanghavi DK, Moreno Franco P, Isha S, Marquez CP, Libertin C, Guru PK, Sareyyupoglu B, Pham SM. Coronavirus Disease 2019 Causing Infection of Transplanted Lung Allograft: A Pitfall of Prolonged Shedding of Severe Acute Respiratory Syndrome Coronavirus-2 Pretransplant. Mayo Clin Proc Innov Qual Outcomes 2023; 7:93-98. [PMID: 36644594 PMCID: PMC9829600 DOI: 10.1016/j.mayocpiqo.2023.01.001] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/25/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) pandemic has led to considerable morbidity and mortality across the world. Lung transplant is a viable option for a few with COVID-19-related lung disease. Whom and when to transplant has been the major question impacting the transplant community given the novelty of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We describe a pitfall of presumed prolonged shedding of SARS-CoV-2 in a patient with COVID-19 associated acute respiratory distress syndrome leading to COVID-19 pneumonia after lung transplant. This raises concerns that replication-competent SARS-CoV-2 virus can persist for months post-infection and can lead to re-infection of grafts in the future.
Collapse
Key Words
- BAL, bronchoalveolar lavage
- BSL-3, Biosafety level-3
- COVID-19, coronavirus disease 2019
- CP, convalescent plasma
- CT, computed tomography
- LT, lung transplant
- NPS, nasopharyngeal swab
- RT-PCR, reverse transcriptase–polymerase chain reaction
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- VV-ECMO, veno-venous extracorporeal membrane oxygenation
Collapse
Affiliation(s)
- Sadia Z. Shah
- Department of Transplantation, Mayo Clinic, Jacksonville, FL,Correspondence: Address to Sadia Z. Shah, Department of Transplantation, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224
| | | | | | | | - Shahin Isha
- Department of Critical Care, Mayo Clinic, Jacksonville, FL
| | | | - Claudia Libertin
- Division of Infectious Disease, Department of Medicine, and Mayo Clinic, Jacksonville, FL
| | - Pramod K. Guru
- Department of Critical Care, Mayo Clinic, Jacksonville, FL
| | | | - Si M. Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL
| |
Collapse
|
20
|
Jang J, Ruiz J, Desai S, Sareyyupoglu B, Paghdar S, Malkani S, Landolfo K, Patel P, Nativi J, Yip D, Lyle M, Leoni J, Pham S, Goswami R. Mid-Term Survival in Patients with Advanced Heart Failure Receiving an Impella Device Intended as Bridge to Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.047] [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
|
21
|
El-Sayed Ahmed MM, Landolfo KP, Jacob S, Sareyyupoglu B, Thomas M, Pham SM, Makey IA. Safe heart flush technique during recovery from donors after circulatory death. J Card Surg 2022; 37:5646-5648. [PMID: 36229938 PMCID: PMC10092136 DOI: 10.1111/jocs.17023] [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: 06/28/2022] [Accepted: 08/24/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Donation after circulatory death is the donation after cardiac arrest. This technique has been employed and adopted by clinicians to overcome the shortage of available hearts for transplant. Warm ischemia time plays a pivotal role in the survival outcome of the heart recipients. AIM OF THE STUDY To assess the efficacy of using the Foley catheter to flush the heart during procurement from donation after circulatory death donors. METHODS We utilized a 2-WAY Foley catheter to flush the heart during procurement. The catheter was prepared and modified on the back table. RESULTS We were successfully able to flush the heart within 3 minutes from skin incision with a good recipient outcome. CONCLUSIONS Using the Foley catheter to flush the heart during recovery from donation after circulatory death donors was both efficient and fast.
Collapse
Affiliation(s)
- Magdy M El-Sayed Ahmed
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA.,Department of Surgery, Zagazig University Faculty of Medicine, Zagazig, Egypt
| | - Kevin P Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Ian A Makey
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| |
Collapse
|
22
|
Lykins AJ, Garg P, Fleissner ZJ, Sareyyupoglu B. Successful management of complex haemorrhagic pericardial cyst with cirrhosis of liver: a case report. Interact Cardiovasc Thorac Surg 2022; 35:6835423. [PMID: 36409034 PMCID: PMC9707403 DOI: 10.1093/icvts/ivac278] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
Haemorrhagic pericardial cysts are rare and may be complicated by encasement of the heart, right heart failure and, rarely, cardiac cirrhosis. Surgical management of complicated cysts is challenging and has poor outcomes. We report a case of successful surgical management of a complicated pericardial cyst presenting with cardiac cirrhosis and the challenges associated with this condition.
Collapse
Affiliation(s)
- Amy J Lykins
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Pankaj Garg
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Basar Sareyyupoglu
- Corresponding author. Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA. Tel: +1-904-956-3212; fax: +1-904-953-7368; e-mail: (B. Sareyyupoglu)
| |
Collapse
|
23
|
Jacob S, Ahmed MMES, Haddad OK, Orlando D, Landolfo C, Thomas M, Makey IA, Sareyyupoglu B, Landolfo K, Pham SM. Regression of Tricuspid Valve Regurgitation After Lung Transplant: A Single-Center Experience. Transplant Proc 2022; 54:2325-2328. [PMID: 36058747 DOI: 10.1016/j.transproceed.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/07/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although tricuspid regurgitation (TR) is common in candidates for lung transplant, no data or established guidelines exist regarding the need for surgical repair at the time of transplant. We aimed to evaluate the natural course of TR by assessing the incidence and extent of TR regression among patients who did not undergo tricuspid valve repair (TVR) concomitantly with lung transplant. METHODS We retrospectively identified adult patients who underwent lung transplant without TVR at our institution from 2001 through 2017. Pretransplant and posttransplant echocardiograms were reviewed to assess severity of TR, tricuspid annular plane systolic excursion, central venous pressure, mean pulmonary arterial pressure, and right ventricular size and function. RESULTS Among 553 included patients, 324 (58.7%) were men, the mean (SD) age was 61.9 years (12.7), and 417 (75.4%) had a double lung transplant. TR before transplant was reported as trivial in 265 patients (47.9%), mild in 235 (42.5%), moderate in 40 (7.2%), and severe in 13 (2.4%). After transplant, TR improved significantly overall (P < .001). TR improved in 193 patients: 158 patients (81.9%) by 1 grade and 35 patients (18.1%) by 2 or more grades. Additionally, of 53 patients with pretransplant moderate or severe TR, 44 (83%) had improvement to mild, trivial, or no TR. After transplant, 12 patients (2.2%) had no remaining TR. CONCLUSION The severity of TR improved or showed no change in most patients after lung transplant, which obviates the need for TVR among most lung transplant recipients.
Collapse
Affiliation(s)
- Samuel Jacob
- Department of Cardiothoracic Surgery Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida.
| | - Magdy M El-Sayed Ahmed
- Department of Cardiothoracic Surgery Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - Osama K Haddad
- Department of Cardiothoracic Surgery, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - David Orlando
- Clinical Research Internship Study Program, Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - Carolyn Landolfo
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | - Mathew Thomas
- Department of Cardiothoracic Surgery Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - Ian A Makey
- Department of Cardiothoracic Surgery Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - Kevin Landolfo
- Department of Cardiothoracic Surgery Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - Si M Pham
- Department of Cardiothoracic Surgery Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| |
Collapse
|
24
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- Macit Bitargil
- Mayo Clinic Hospital, Department of Cardiothoracic Surgery, Jacksonville, Florida, USA
| | - Osama Haddad
- Mayo Clinic Hospital, Department of Cardiothoracic Surgery, Jacksonville, Florida, USA
| | - Si M Pham
- Mayo Clinic Hospital, Department of Cardiothoracic Surgery, Jacksonville, Florida, USA
| | - Neha Garg
- Mayo Clinic Hospital, Department of Cardiothoracic Surgery, Jacksonville, Florida, USA
| | - Samuel Jacob
- Mayo Clinic Hospital, Department of Cardiothoracic Surgery, Jacksonville, Florida, USA
| | | | - Kevin Landolfo
- Mayo Clinic Hospital, Department of Cardiothoracic Surgery, Jacksonville, Florida, USA
| | - Parag C Patel
- Mayo Clinic Hospital, Department of Transplantation, Jacksonville, Florida, USA
| | - Rohan M Goswami
- Mayo Clinic Hospital, Department of Transplantation, Jacksonville, Florida, USA
| | | | - Daniel S Yip
- Mayo Clinic Hospital, Department of Transplantation, Jacksonville, Florida, USA
| | - Basar Sareyyupoglu
- Mayo Clinic Hospital, Department of Cardiothoracic Surgery, Jacksonville, Florida, USA
| |
Collapse
|
25
|
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] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/10/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Fla
| | - Pankaj Garg
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Fla
| | | | | | - Kevin P. Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Fla
| | - Si M. Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Fla
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Fla
- Address for reprints: Basar Sareyyupoglu, MD, Cardiothoracic Surgery, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL 32224.
| |
Collapse
|
26
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- Magdy M El-Sayed Ahmed
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA.,Department of Surgery, Zagazig University Faculty of Medicine, Zagazig, Egypt
| | - Anthony Pham
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| |
Collapse
|
27
|
Bitargil M, Pham S, Haddad O, Sareyyupoglu B. Single arterial access for Ecpella and jugular venous cannulation provides full mobility on a status 1 heart transplant recipient. ESC Heart Fail 2022; 9:2003-2006. [PMID: 35194962 PMCID: PMC9065810 DOI: 10.1002/ehf2.13862] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 01/19/2022] [Accepted: 02/13/2022] [Indexed: 11/17/2022] Open
Abstract
Concomitant treatment with veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) and Impella may improve outcomes in patients with cardiogenic shock compared with VA‐ECMO alone. Here, we explain a new method to introduce Impella and ECMO through the same arterial access site and jugular venous cannulation to accomplish a mobile patient concept.
Collapse
Affiliation(s)
- Macit Bitargil
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Si Pham
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Osama Haddad
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| |
Collapse
|
28
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, Florida, 32224, USA.
| | - Justin H Nguyen
- Division of Transplant Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Magdy M El-Sayed Ahmed
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, Florida, 32224, USA
| | - Ian A Makey
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, Florida, 32224, USA
| | - Osama K Haddad
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, Florida, 32224, USA.,Division of Transplant Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, Florida, 32224, USA
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, Florida, 32224, USA
| | - Kevin P Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, Florida, 32224, USA.,Division of Transplant Surgery, Mayo Clinic, Jacksonville, Florida, USA
| |
Collapse
|
29
|
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] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/01/2021] [Accepted: 11/10/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Macit Bitargil
- Department of Cardiothoracic Surgery Mayo Clinic Hospital Jacksonville Florida USA
| | - Osama Haddad
- Department of Cardiothoracic Surgery Mayo Clinic Hospital Jacksonville Florida USA
| | - Si M. Pham
- Department of Cardiothoracic Surgery Mayo Clinic Hospital Jacksonville Florida USA
| | - Rohan M. Goswami
- Department of Transplantation Mayo Clinic Hospital Jacksonville Florida USA
| | - Parag C. Patel
- Department of Transplantation Mayo Clinic Hospital Jacksonville Florida USA
| | - Samuel Jacob
- Department of Cardiothoracic Surgery Mayo Clinic Hospital Jacksonville Florida USA
| | | | | | - Daniel S. Yip
- Department of Transplantation Mayo Clinic Hospital Jacksonville Florida USA
| | - Kevin Landolfo
- Department of Cardiothoracic Surgery Mayo Clinic Hospital Jacksonville Florida USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery Mayo Clinic Hospital Jacksonville Florida USA
| |
Collapse
|
30
|
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] [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: 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.
Collapse
Affiliation(s)
- Osama Haddad
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Ryan L Ung
- Departments of Transplantation, Advanced Heart Failure and Transplant Cardiology, Mayo Clinic, Jacksonville, FL, USA
| | - Rohan M Goswami
- Departments of Transplantation, Advanced Heart Failure and Transplant Cardiology, Mayo Clinic, Jacksonville, FL, USA
| | - Parag C Patel
- Departments of Transplantation, Advanced Heart Failure and Transplant Cardiology, Mayo Clinic, Jacksonville, FL, USA
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| |
Collapse
|
31
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Anthony N Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| |
Collapse
|
32
|
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] [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: 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.
Collapse
Affiliation(s)
- Magdy M El-Sayed Ahmed
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA.,Department of Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Ian A Makey
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Archer K Martin
- Department of Anesthesiology, Mayo Clinic, Jacksonville, FL, USA
| | - David B Erasmus
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Kevin P Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| |
Collapse
|
33
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- Magdy M El-Sayed Ahmed
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida; Department of Surgery, Zagazig University Faculty of Medicine, Zagazig, Egypt.
| | - Ian A Makey
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Kevin P Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| |
Collapse
|
34
|
Haddad O, Jacob S, Pham A, Sareyyupoglu B, Dye K, Pham SM. Harvesting left internal thoracic artery via clamshell incision for coronary bypass and lung transplant. J Surg Case Rep 2020; 2020:rjaa363. [PMID: 33133499 PMCID: PMC7588304 DOI: 10.1093/jscr/rjaa363] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/21/2020] [Indexed: 11/14/2022] Open
Abstract
Concomitant lung transplantation and coronary artery bypass grafting operation became more prevalent over the last decade due to the advanced age of recipients. Median sternotomy approach is traditionally used when internal thoracic artery is utilized. Here we report a technique of harvesting the left internal thoracic artery via a clamshell incision for a combined coronary artery bypass and bilateral lung transplant operation in a 71-year-old male with terminal respiratory failure and coronary artery disease.
Collapse
Affiliation(s)
- Osama Haddad
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Anthony Pham
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Kenneth Dye
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Si Mai Pham
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| |
Collapse
|
35
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- Parag C Patel
- Departments of Transplantation, Mayo Clinic, Jacksonville, Florida, USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| |
Collapse
|
36
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- Archer Kilbourne Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Barry A Harrison
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Ashley Virginia Fritz
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Kevin P Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Ian A Makey
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Thomas E Brown
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - James L Johnson
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| |
Collapse
|
37
|
Ansari-Gilani K, Sareyyupoglu B. Multimodality imaging of left ventricular apical pseudoaneurysm after apical approach transcatheter aortic valve replacement. Echocardiography 2020; 37:1509-1511. [PMID: 32856338 DOI: 10.1111/echo.14831] [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: 06/22/2020] [Accepted: 07/31/2020] [Indexed: 12/01/2022] Open
Abstract
Left ventricular pseudoaneurysm formation is a rare complication of transapical approach transcatheter aortic valve replacement. It can cause chest pain and shortness of breath or remain asymptomatic. Mortality rate is high, and therefore, timely diagnosis and management are essential. Different imaging modalities can provide anatomic or functional information and are essential for the primary diagnosis or during follow-up.
Collapse
Affiliation(s)
- Kianoush Ansari-Gilani
- Radiology Department, University Hospital Cleveland Medical Center, Cleveland, Ohio, USA
| | - Basar Sareyyupoglu
- Department of Cardiac Surgery, Mayo Clinic in Jacksonville, Jacksonville, Florida, USA
| |
Collapse
|
38
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- Osama Haddad
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Anthony N Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Mojahid Ali
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | | | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| |
Collapse
|
39
|
Lipinski J, Patel SM, Patel TR, Kobe D, Saric P, Panhwar M, Nadeem F, Li J, Clevenger JR, Ichibori Y, Fares A, Lang K, Bezerra HG, Sareyyupoglu B, Medalion B, Deo S, Elgudin Y, Markowitz A, Simon DI, Costa MA, Kalra A, Attizzani GF. Transcatheter Valve Implantation for Failed Surgical Aortic and Mitral Bioprostheses: A Single-Center Experience. J Invasive Cardiol 2020; 32:186-193. [PMID: 32160153] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We share our center's experience with the use of transcatheter valvular therapies in the setting of failed bioprostheses. BACKGROUND As medicine continues to advance, the lifespan of individuals continues to increase, and current surgical valvular therapies begin to degrade prior to a person's end of life. It is important to evaluate the efficacy and durability of transcatheter valves within failed surgical bioprostheses. METHODS Baseline characteristics, periprocedural complications, and long-term outcomes were collected and assessed in patients who received transcatheter valves for failing surgical aortic valve bioprostheses and mitral valve and ring bioprostheses from March 2011 to July 2018. RESULTS From our cohort of 1048 patients, we identified 45 individuals (4.3%) who underwent transcatheter replacement of a failed bioprosthetic valve or ring. Mean age at presentation was 80.8 ± 10.7 years and 75.5 ± 9.3 years, mean STS score was 9.3 ± 5.1 and 13.3 ± 8.7, and mean time to failure was 12.0 ± 5.2 years and 7.3 ± 4.5 years for aortic and mitral positions, respectively. At 1 year, time to event analysis suggested a 16.4% mortality rate for aortic replacement and 12.8% mortality rate for mitral replacement. CONCLUSIONS We demonstrate outcomes from one of the largest single-center United States based cohorts of transcatheter replacements of failed surgical bioprostheses. Our center has demonstrated that it is feasible to pursue the replacement of failed surgical bioprostheses in the aortic and mitral positions with transcatheter valves given appropriate patient selection.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Guilherme F Attizzani
- Department of Cardiovascular Medicine, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106 USA.
| |
Collapse
|
40
|
Stinson G, Patel P, Yip D, Leoni-Moreno J, Ung R, Landolfo K, Pham S, Sareyyupoglu B, Goswami R. Assessment of Aortic Root Size in Donor Heart Predicts Short and Long Term Recipient Outcomes after Orthotopic Heart Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
41
|
Ahmed MS, Shah S, Zhang N, Jarmi T, Jacob S, Makey I, Thomas M, Sareyyupoglu B, Landolfo K, Erasmus D, Pham S. Survival Outcomes of Lung Transplant Recipients from Donors with Abnormal Kidney Function. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
42
|
Ansari-Gilani K, Sareyyupoglu B, Gilkeson RC. Multi-modality Imaging of Cocaine-induced Rupture of Sinus of Valsalva Aneurysm Communicating with Tricuspid Valve Annulus. J Cardiovasc Imaging 2020; 28:219-221. [PMID: 32052603 PMCID: PMC7316562 DOI: 10.4250/jcvi.2019.0117] [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] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Kianoush Ansari-Gilani
- Department of Radiology, University Hospital Cleveland Medical Center, Cleveland, OH, USA.
| | | | - Robert C Gilkeson
- Department of Radiology, University Hospital Cleveland Medical Center, Cleveland, OH, USA
| |
Collapse
|
43
|
Ichibori Y, Li J, Davis A, Patel TM, Lipinski J, Panhwar M, Saric P, Qureshi G, Patel SM, Sareyyupoglu B, Markowitz AH, Bezerra HG, Costa MA, Zidar DA, Kalra A, Attizzani GF. Feasibility and Safety of Adopting Next-Day Discharge as First-Line Option After Transfemoral Transcatheter Aortic Valve Replacement. J Invasive Cardiol 2019; 31:64-72. [PMID: 30819977] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Data on next-day discharge (NDD) after transcatheter aortic valve replacement (TAVR) are limited. This study investigated the feasibility and safety of NDD as a first-line option (the very-early discharge [VED] strategy) compared with the early-discharge (ED) strategy (2-3 days as a first-line option) after TAVR. METHODS We reviewed 611 consecutive patients who had minimalist TAVR (transfemoral approach under conscious sedation) and no in-hospital mortality; a total of 418 patients underwent ED strategy (since December 2013) and 193 patients underwent VED strategy (as part of a hospital initiative to reduce length of stay, since August 2016). NDD in the VED strategy was performed with heart team consensus in patients without significant complications. The primary outcome was a composite of 30-day all-cause mortality/rehospitalization. RESULTS Sixty-five patients (33.7%) in the VED strategy and 10 patients (2.4%) in the ED strategy were discharged the next day (P<.001). NDD patients had received balloon-expandable (n = 30) or self-expanding valves (n = 45) and showed a similar primary outcome rate compared with non-NDD patients. After adjustment using propensity score matching (172 pairs), post-TAVR length of stay was significantly shorter in the VED group (3.2 ± 3.1 days) than in the ED group (3.5 ± 2.7 days; P<.01). The primary outcome did not differ between the two groups (7.0% vs 11.6%; P=.14), with comparable 30-day mortality rate (1.2% vs 2.3%; P=.68) and rehospitalization rate (5.8% vs 11.1%; P=.08). CONCLUSIONS Utilization of NDD as a first-line option after minimalist TAVR is feasible and safe, and leads to further reduction in length of stay compared with an ED strategy.
Collapse
Affiliation(s)
- Yasuhiro Ichibori
- Division of Cardiovascular Medicine University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106 USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Khayata M, ElAmm CA, Sareyyupoglu B, Zacharias M, Oliveira GH, Medalion B. HeartMate II pump exchange with HeartMate III implantation to the descending aorta. J Card Surg 2019; 34:47-49. [PMID: 30597627 DOI: 10.1111/jocs.13969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Removal of the HeartMate II left ventricular assist device (LVAD) usually requires a sternotomy. We report a case of HeartMate III LVAD implantation to the descending aorta via a left thoracotomy while leaving most of the HeartMate II device in place to avoid redo-sternotomy.
Collapse
Affiliation(s)
- Mohamed Khayata
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Department of Medicine, Division of Cardiology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Chantal A ElAmm
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Department of Medicine, Division of Cardiology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Basar Sareyyupoglu
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Michael Zacharias
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Department of Medicine, Division of Cardiology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Guilherme H Oliveira
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Department of Medicine, Division of Cardiology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Benjamin Medalion
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| |
Collapse
|
45
|
Mitchell SC, Vinnakota A, Deo SV, Markowitz AH, Sareyyupoglu B, Elgudin Y, Medalion B, Tzagournis A, Sabik J, Park SJ. Relationship between intraoperative serum lactate and hemoglobin levels on postoperative renal function in patients undergoing elective cardiac surgery. J Card Surg 2018; 33:316-321. [PMID: 29726039 DOI: 10.1111/jocs.13713] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM We examined the relationship between serum lactate and hemoglobin levels on renal function and postoperative outcome in low-risk elective coronary artery bypass graft (CABG) patients. METHODS Intraoperative hemoglobin and lactate levels were measured in elective isolated CABG patients. Patients with renal dysfunction (baseline creatinine>2 mg/dL) were excluded. Multivariate logistic regression was used to determine associations between lactate, hemoglobin, and acute kidney injury (AKI). RESULTS A total of 375 patients met study requirements, and 56/375 (15%) developed AKI. Of the patients who developed AKI, 43/278 (15.5%) were males, 13/97 (13.4%) females, and 11/44 (25%) African-Americans. Bivariate analysis between AKI and non-AKI subgroups found significant differences in age, race, baseline estimated glomerular filtration rate, preoperative hemoglobin, peak serum lactate, initial hemoglobin, and nadir hemoglobin. A high peak Lactate level (odds ratio [OR] 1.44[1.15-1.82]), low hemoglobin (OR 0.69[0.49-0.96]), and African American race (OR 2.26[0.96-5.05]) were independently associated with acute kidney injury. A significant relationship between decreasing intraoperative hemoglobin and increasing intraoperative serum lactate levels was observed exclusively in patients who developed postoperative AKI. Serum creatinine levels peaked, on average, 48 h postoperatively in the AKI subset of patients. CONCLUSION In this series, 15% of patients who underwent elective cardiopulmonary bypass developed transient acute renal dysfunction. High lactate levels and low hemoglobin levels during cardiopulmonary bypass were associated with an increased risk of kidney injury.
Collapse
Affiliation(s)
- Steven C Mitchell
- Division of Clinical Research, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Anirudh Vinnakota
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Salil V Deo
- Division of Cardiovascular Surgery, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Alan H Markowitz
- Division of Cardiovascular Surgery, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Basar Sareyyupoglu
- Division of Cardiovascular Surgery, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Yakov Elgudin
- Division of Cardiovascular Surgery, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Benjamin Medalion
- Division of Cardiovascular Surgery, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Adam Tzagournis
- Division of Cardiovascular Surgery, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Joseph Sabik
- Division of Cardiovascular Surgery, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Soon J Park
- Division of Cardiovascular Surgery, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| |
Collapse
|
46
|
Al-Kindi S, Dhakal B, Elamm C, Sareyyupoglu B, Oliveira G, Ginwalla M. Induction with Basilixumab or Thymoglobulin for Adult Heart Transplantation Transplantation. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.221] [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
|
47
|
Al-Kindi S, Dhakal B, Ginwalla M, ElAmm C, Sareyyupoglu B, Oliveira G. Pulmonary Vascular Resistance Does Not Impact Wait-List Mortality in Patients Bridged with Continuous Flow Left Ventricular Assist Devices. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
48
|
Deo S, Zacharias M, Benatti R, Robinson M, Elamm C, Sareyyupoglu B, Medalion B, Elgudin Y, Oliveira G, Park S, Ginwalla M. Results of Adult Heart Transplant While Supported on Extra-Corporeal Membrane Oxygenator Support: Evidence from a National Registry. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.594] [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
|
49
|
Orasanu G, Al-Kindi SG, Robinson MR, Oliveira GH, Ginwalla M, Elamm C, Zacharias M, Farhoud M, Medalion B, Deo SV, Park SJ, Attizzani GF, Sareyyupoglu B. First-in-Human Experience With Transcatheter Mitral Valve-in-Valve Implantation During Left Ventricular Assist Device Placement. Circ Heart Fail 2016; 9:CIRCHEARTFAILURE.116.003458. [DOI: 10.1161/circheartfailure.116.003458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 10/05/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Gabriela Orasanu
- From the Advanced Heart Failure and Transplantation (G.O., S.A.-K., M.R.R., G.H.O., M.G., C.E., M.Z., M.F.), Interventional Cardiology (G.F.A.), and Cardiothoracic Surgery (B.M., S.V.D., S.J.P., B.S.), Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH
| | - Sadeer G. Al-Kindi
- From the Advanced Heart Failure and Transplantation (G.O., S.A.-K., M.R.R., G.H.O., M.G., C.E., M.Z., M.F.), Interventional Cardiology (G.F.A.), and Cardiothoracic Surgery (B.M., S.V.D., S.J.P., B.S.), Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH
| | - Monique R. Robinson
- From the Advanced Heart Failure and Transplantation (G.O., S.A.-K., M.R.R., G.H.O., M.G., C.E., M.Z., M.F.), Interventional Cardiology (G.F.A.), and Cardiothoracic Surgery (B.M., S.V.D., S.J.P., B.S.), Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH
| | - Guilherme H. Oliveira
- From the Advanced Heart Failure and Transplantation (G.O., S.A.-K., M.R.R., G.H.O., M.G., C.E., M.Z., M.F.), Interventional Cardiology (G.F.A.), and Cardiothoracic Surgery (B.M., S.V.D., S.J.P., B.S.), Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH
| | - Mahazarin Ginwalla
- From the Advanced Heart Failure and Transplantation (G.O., S.A.-K., M.R.R., G.H.O., M.G., C.E., M.Z., M.F.), Interventional Cardiology (G.F.A.), and Cardiothoracic Surgery (B.M., S.V.D., S.J.P., B.S.), Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH
| | - Chantal Elamm
- From the Advanced Heart Failure and Transplantation (G.O., S.A.-K., M.R.R., G.H.O., M.G., C.E., M.Z., M.F.), Interventional Cardiology (G.F.A.), and Cardiothoracic Surgery (B.M., S.V.D., S.J.P., B.S.), Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH
| | - Michael Zacharias
- From the Advanced Heart Failure and Transplantation (G.O., S.A.-K., M.R.R., G.H.O., M.G., C.E., M.Z., M.F.), Interventional Cardiology (G.F.A.), and Cardiothoracic Surgery (B.M., S.V.D., S.J.P., B.S.), Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH
| | - Mahmoud Farhoud
- From the Advanced Heart Failure and Transplantation (G.O., S.A.-K., M.R.R., G.H.O., M.G., C.E., M.Z., M.F.), Interventional Cardiology (G.F.A.), and Cardiothoracic Surgery (B.M., S.V.D., S.J.P., B.S.), Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH
| | - Benjamin Medalion
- From the Advanced Heart Failure and Transplantation (G.O., S.A.-K., M.R.R., G.H.O., M.G., C.E., M.Z., M.F.), Interventional Cardiology (G.F.A.), and Cardiothoracic Surgery (B.M., S.V.D., S.J.P., B.S.), Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH
| | - Salil V. Deo
- From the Advanced Heart Failure and Transplantation (G.O., S.A.-K., M.R.R., G.H.O., M.G., C.E., M.Z., M.F.), Interventional Cardiology (G.F.A.), and Cardiothoracic Surgery (B.M., S.V.D., S.J.P., B.S.), Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH
| | - Soon J. Park
- From the Advanced Heart Failure and Transplantation (G.O., S.A.-K., M.R.R., G.H.O., M.G., C.E., M.Z., M.F.), Interventional Cardiology (G.F.A.), and Cardiothoracic Surgery (B.M., S.V.D., S.J.P., B.S.), Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH
| | - Guilherme F. Attizzani
- From the Advanced Heart Failure and Transplantation (G.O., S.A.-K., M.R.R., G.H.O., M.G., C.E., M.Z., M.F.), Interventional Cardiology (G.F.A.), and Cardiothoracic Surgery (B.M., S.V.D., S.J.P., B.S.), Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH
| | - Basar Sareyyupoglu
- From the Advanced Heart Failure and Transplantation (G.O., S.A.-K., M.R.R., G.H.O., M.G., C.E., M.Z., M.F.), Interventional Cardiology (G.F.A.), and Cardiothoracic Surgery (B.M., S.V.D., S.J.P., B.S.), Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH
| |
Collapse
|
50
|
Kumar S, Deo SV, Altarabsheh SE, Dunlay SM, Sarabu N, Sareyyupoglu B, Elgudin Y, Medalion B, ElAmm C, Ginwalla M, Zacharias M, Benatti R, Oliveira GH, Kilic A, Fonarow GC, Park SJ. Effect of Hepatitis C Positivity on Survival in Adult Patients Undergoing Heart Transplantation (from the United Network for Organ Sharing Database). Am J Cardiol 2016; 118:132-7. [PMID: 27189814 DOI: 10.1016/j.amjcard.2016.04.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/13/2016] [Accepted: 04/13/2016] [Indexed: 02/07/2023]
Abstract
Concerns exist regarding orthotropic heart transplantation in hepatitis C virus (HCV) seropositive recipients. Thus, a national registry was accessed to evaluate early and late outcome in HCV seropositive recipients undergoing heart transplant. Retrospective analysis of the United Network for Organ Sharing registry (1991 to 2014) was performed to evaluate recipient profile and clinical outcome of patients with HCV seropositive (HCV +ve) and seronegative (HCV -ve). Adjusted results of early mortality and late survival were compared between cohorts. From 23,507 patients (mean age 52 years; 75% men), 481 (2%) were HCV +ve (mean age 52 years; 77% men). Annual proportion of HCV +ve recipients was comparable over the study period (range 1.3% to 2.7%; p = 0.2). The HCV +ve cohort had more African-American (22% vs 17%; p = 0.01), previous left ventricular assist device utilization (21% vs 14%; p <0.01) and more hepatitis B core Ag+ve recipients (17% vs 5%; p <0.01). However, both cohorts were comparable in terms of extracorporeal membrane oxygenator usage (p = 0.7), inotropic support (p = 0.2), intraaortic balloon pump (p = 0.7) support, serum creatinine (p = 0.7), and serum bilirubin (p = 0.7). Proportion of status 1A patients was similar (24% HCV + vs 21% HCV -); however, wait time for HCV +ve recipients were longer (mean 23 vs 19 days; p <0.01). Among donor variables, age (p = 0.8), hepatitis B status (p = 0.4), and Center for Diseases Control high-risk status (p = 0.9) were comparable in both cohorts. At a median follow-up of 4 years, 67% patients were alive, 28% died, and 1.1% were retransplanted (3.4% missing). Overall survival was worse in the HCV+ cohort (64.3% vs 72.9% and 43.2% vs 55% at 5 and 10 years; p <0.01), respectively. Late renal (odds ratio [OR] 1.2 [1 to 1.6]; p = 0.02) and liver dysfunction (odds ratio 4.5 [1.2 to 15.7]; p = 0.01) occurs more frequently in HCV +ve recipients. On adjusted analysis, HCV seropositivity is associated with poorer survival (hazard ratio for mortality 1.4 [1.1 to 1.6]; p <0.001). In conclusion, a small proportion of patients receiving a heart transplant in the United States have hepatitis C. Despite comparable preoperative hepatic function, hepatitis C seropositive recipients demonstrate poorer long-term survival.
Collapse
Affiliation(s)
- Sachin Kumar
- Division of Cardiovascular Surgery, Advanced Heart Failure Program, University of Texas Medical Center, Houston, Texas
| | - Salil V Deo
- Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio.
| | - Salah E Altarabsheh
- Department of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan
| | | | - Nagaraju Sarabu
- Division of Nephrology and Renal Transplantation, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Basar Sareyyupoglu
- Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Yakov Elgudin
- Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Benjamin Medalion
- Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Chantal ElAmm
- Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Mahazarin Ginwalla
- Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Michael Zacharias
- Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Rodolpho Benatti
- Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Guilherme H Oliveira
- Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Ahmet Kilic
- Division of Cardiothoracic Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Gregg C Fonarow
- Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, Los Angeles, California
| | - Soon J Park
- Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|