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McGiffin DC, Kure CE, Macdonald PS, Jansz PC, Emmanuel S, Marasco SF, Doi A, Merry C, Larbalestier R, Shah A, Geldenhuys A, Sibal AK, Wasywich CA, Mathew J, Paul E, Cheshire C, Leet A, Hare JL, Graham S, Fraser JF, Kaye DM. Hypothermic oxygenated perfusion (HOPE) safely and effectively extends acceptable donor heart preservation times: Results of the Australian and New Zealand trial. J Heart Lung Transplant 2024; 43:485-495. [PMID: 37918701 DOI: 10.1016/j.healun.2023.10.020] [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: 08/10/2023] [Revised: 10/08/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Cold static storage preservation of donor hearts for periods longer than 4 hours increases the risk of primary graft dysfunction (PGD). The aim of the study was to determine if hypothermic oxygenated perfusion (HOPE) could safely prolong the preservation time of donor hearts. METHODS We conducted a nonrandomized, single arm, multicenter investigation of the effect of HOPE using the XVIVO Heart Preservation System on donor hearts with a projected preservation time of 6 to 8 hours on 30-day recipient survival and allograft function post-transplant. Each center completed 1 or 2 short preservation time followed by long preservation time cases. PGD was classified as occurring in the first 24 hours after transplantation or secondary graft dysfunction (SGD) occurring at any time with a clearly defined cause. Trial survival was compared with a comparator group based on data from the International Society of Heart and Lung Transplantation (ISHLT) Registry. RESULTS We performed heart transplants using 7 short and 29 long preservation time donor hearts placed on the HOPE system. The mean preservation time for the long preservation time cases was 414 minutes, the longest being 8 hours and 47 minutes. There was 100% survival at 30 days. One long preservation time recipient developed PGD, and 1 developed SGD. One short preservation time patient developed SGD. Thirty day survival was superior to the ISHLT comparator group despite substantially longer preservation times in the trial patients. CONCLUSIONS HOPE provides effective preservation out to preservation times of nearly 9 hours allowing retrieval from remote geographic locations.
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Affiliation(s)
- David C McGiffin
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Australia; Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Critical Care Research Group, Adult Intensive Care Unit, The Prince Charles Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia.
| | - Christina E Kure
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Australia; Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | | | - Paul C Jansz
- Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, Australia
| | - Sam Emmanuel
- Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, Australia
| | - Silvana F Marasco
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Australia; Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Atsuo Doi
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Australia
| | - Chris Merry
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Australia
| | - Robert Larbalestier
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Australia
| | - Amit Shah
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
| | - Agneta Geldenhuys
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Australia
| | - Amul K Sibal
- Department of Cardiothoracic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Cara A Wasywich
- Department of Cardiology, Auckland City Hospital, Auckland, New Zealand
| | - Jacob Mathew
- Department of Cardiology, Royal Children's Hospital, Melbourne, Australia
| | - Eldho Paul
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Angeline Leet
- Department of Cardiology, The Alfred, Melbourne, Australia
| | - James L Hare
- Department of Cardiology, The Alfred, Melbourne, Australia
| | - Sandra Graham
- Department of Cardiology, The Alfred, Melbourne, Australia
| | - John F Fraser
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Critical Care Research Group, Adult Intensive Care Unit, The Prince Charles Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; St Andrews War Memorial Hospital, Brisbane, Australia
| | - David M Kaye
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Australia
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2
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Cheshire C, Messer S, Martinez L, Vokshi I, Ali J, Cernic S, Page A, Andal R, Berman M, Kaul P, Osman M, Rafiq M, Goddard M, Tweed K, Jenkins D, Tsui S, Large S, Kydd A, Lewis C, Parameshwar J, Pettit S, Bhagra S. Graft function and incidence of cardiac allograft vasculopathy in donation after circulatory-determined death heart transplant recipients. Am J Transplant 2023; 23:1570-1579. [PMID: 37442277 DOI: 10.1016/j.ajt.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/02/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023]
Abstract
Experience in donation after circulatory-determined death (DCD) heart transplantation (HTx) is expanding. There is limited information on the functional outcomes of DCD HTx recipients. We sought to evaluate functional outcomes in our cohort of DCD recipients. We performed a single-center, retrospective, observational cohort study comparing outcomes in consecutive DCD and donation after brain death (DBD) HTx recipients between 2015 and 2019. Primary outcome was allograft function by echocardiography at 12 and 24 months. Secondary outcomes included incidence of cardiac allograft vasculopathy, treated rejection, renal function, and survival. Seventy-seven DCD and 153 DBD recipients were included. There was no difference in left ventricular ejection fraction at 12 months (59% vs 59%, P = .57) and 24 months (58% vs 58%, P = .87). There was no significant difference in right ventricular function at 12 and 24 months. Unadjusted survival between DCD and DBD recipients at 5 years (85.7% DCD and 81% DBD recipients; P = .45) was similar. There were no significant differences in incidence of cardiac allograft vasculopathy (odds ratio 1.59, P = .21, 95% confidence interval 0.77-3.3) or treated rejection (odds ratio 0.60, P = .12, 95% confidence interval 0.32-1.15) between DBD and DCD recipients. Post-transplant renal function was similar at 1 and 2 years. In conclusion, cardiac allografts from DCD donors perform similarly to a contemporary population of DBD allografts in the medium term.
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Affiliation(s)
- Caitlin Cheshire
- Department of Cardiology, Alfred Health, Melbourne, Australia; Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
| | - Simon Messer
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
| | - Luis Martinez
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
| | - Ismail Vokshi
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
| | - Jason Ali
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
| | - Sendi Cernic
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
| | - Aravinda Page
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
| | - Ryan Andal
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
| | - Marius Berman
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
| | - Pradeep Kaul
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
| | - Mohamed Osman
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
| | - Muhammad Rafiq
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
| | - Martin Goddard
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
| | - Katharine Tweed
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
| | - David Jenkins
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
| | - Steven Tsui
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
| | - Stephen Large
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
| | - Anna Kydd
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
| | - Clive Lewis
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
| | - Jayan Parameshwar
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
| | - Stephen Pettit
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
| | - Sai Bhagra
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
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3
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Kaye D, Fraser J, Jansz P, MacDonald P, Marasco S, Doi A, Merry C, Emmanuel S, Leet A, Hare J, Cheshire C, Larbalestier R, Shah A, Wasywich C, Mathew J, Sibal A, Kure C, McGiffin D. Influence of Hypothermic Machine Perfusion (HMP) on Donor Heart Function Following an Ischemic Time of 6-8 Hours. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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4
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Burrage MK, Cheshire C, Hey CY, Azam S, Watson WD, Bhagra S, Berman M, D'Errico L, Jenkins DP, Kaul P, Large S, Lewis C, Martinez L, Messer S, Page A, Parameshwar J, Pettit S, Rafiq M, Tsui S, Tweed K, Weir-McCall JR, Kydd A. Comparing Cardiac Mechanics and Myocardial Fibrosis in DBD and DCD Heart Transplant Recipients. J Card Fail 2022; 29:834-840. [PMID: 36521726 DOI: 10.1016/j.cardfail.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/11/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Heart transplantation (HTx) after donation after circulatory death (DCD) is an expanding practice but is associated with increased warm ischemic time. The impact of DCD HTx on cardiac mechanics and myocardial fibrosis has not been reported. We aimed to compare cardiac mechanics and myocardial fibrosis using cardiovascular magnetic resonance (CMR) imaging in donation after brain death (DBD) and DCD HTx recipients and healthy controls. METHODS AND RESULTS Consecutive HTx recipients between March 2015 and March 2021 who underwent routine surveillance CMR imaging were included. Cardiac mechanics were assessed using CMR feature tracking to compute global longitudinal strain, global circumferential strain, and right ventricular free-wall longitudinal myocardial strain. Fibrosis was assessed using late gadolinium enhancement imaging and estimation of extracellular volume. There were 82 (DBD n = 42, DCD n = 40) HTx recipients (aged 53 years, interquartile range 41-59 years, 24% female) who underwent CMR imaging at median of 9 months (interquartile range 6-14 months) after transplantation. HTx recipients had increased extracellular volume (29.7 ± 3.6%) compared with normal ranges (25.9%, interquartile range 25.4-26.5). Myocardial strain was impaired after transplantation compared with controls (global longitudinal strain -12.6 ± 3.1% vs -17.2 ± 1.8%, P < .0001; global circumferential strain -16.9 ± 3.1% vs -19.2 ± 2.0%, P = .002; right ventricular free-wall longitudinal strain -15.7 ± 4.5% vs -21.6 ± 4.7%, P < .0001). There were no differences in fibrosis burden (extracellular volume 30.6 ± 4.4% vs 29.2 ± 3.2%; P = .39) or cardiac mechanics (global longitudinal strain -13.1 ± 3.0% vs -12.1 ± 3.1%, P = .14; global circumferential strain -17.3 ± 2.9% vs -16.6 ± 3.1%, P = .27; right ventricular free-wall longitudinal strain -15.9 ± 4.9% vs -15.5 ± 4.1%, P = .71) between DCD and DBD HTx. CONCLUSIONS HTx recipients have impaired cardiac mechanics compared with controls, with increased myocardial fibrosis. There were no differences in early CMR imaging characteristics between DBD and DCD heart transplants, providing further evidence that DCD and DBD HTx outcomes are comparable.
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Affiliation(s)
- Matthew K Burrage
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK; Faculty of Medicine, University of Queensland, Brisbane, Australia.
| | | | - Cong Ying Hey
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Saima Azam
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | | | - Sai Bhagra
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Marius Berman
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | | | | | - Pradeep Kaul
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Stephen Large
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Clive Lewis
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Luis Martinez
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | | | - Aravinda Page
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | | | | | | | - Steven Tsui
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | | | - Jonathan R Weir-McCall
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK; School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Anna Kydd
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK.
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5
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Warren J, Cheshire C, Gutman S, Hare J, Taylor A, Patel H, Bergin P, Zimmet A, Marasco S, Kaye D, Leet A. Spontaneous Coronary Artery Dissection in an Orthotopic Heart Transplant Recipient. JACC Case Rep 2022; 4:977-981. [PMID: 35935148 PMCID: PMC9350898 DOI: 10.1016/j.jaccas.2022.05.018] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 11/18/2022]
Abstract
We present the case of acute myocardial infarction secondary to spontaneous coronary artery dissection in a patient 2 weeks post orthotopic heart transplantation. (Level of Difficulty: Advanced.)
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Affiliation(s)
| | | | - Sarah Gutman
- Department of Cardiology Alfred Hospital, Melbourne, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - James Hare
- Department of Cardiology Alfred Hospital, Melbourne, Australia
| | - Andrew Taylor
- Department of Cardiology Alfred Hospital, Melbourne, Australia
| | - Hitesh Patel
- Department of Cardiology Alfred Hospital, Melbourne, Australia
| | - Peter Bergin
- Department of Cardiology Alfred Hospital, Melbourne, Australia
| | - Adam Zimmet
- Department of Cardiothoracic Surgery Alfred Hospital, Melbourne, Australia
| | - Silvana Marasco
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Department of Cardiothoracic Surgery Alfred Hospital, Melbourne, Australia
| | - David Kaye
- Department of Cardiology Alfred Hospital, Melbourne, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Angeline Leet
- Department of Cardiology Alfred Hospital, Melbourne, Australia
- Address for correspondence: Dr Angeline Leet, Heart Centre, Alfred Hospital, Melbourne, Victoria 3004, Australia. @drjosiewarren
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6
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Cheshire C, Quigley R, Claydon S, Von Joel S, Osman M, Kaul P, Rafiq M, Tsui S, Jenkins DP, Berman M, Pettit S. Validation of predicted heart mass equations by measurement of donor heart mass at time of heart transplantation. Clin Transplant 2022; 36:e14773. [PMID: 35833312 DOI: 10.1111/ctr.14773] [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: 02/20/2022] [Revised: 06/23/2022] [Accepted: 07/09/2022] [Indexed: 11/27/2022]
Abstract
Predicted Heart Mass (PHM) equations may be used in donor-recipient size matching in heart transplantation. We compared PHM and actual heart mass in 25 consecutive DBD heart transplants. There was a moderate positive correlation between actual heart mass and PHM. There was a similar moderate correlation between actual heart mass and donor weight or donor body surface area but not donor height. PHM was lower than actual heart mass for all donor hearts. Bland-Altman analysis showed a systematic bias between PHM and actual heart mass, with a mean difference of 190.9 ± 66.4 g. The utility of PHM equations is likely to be part of a multi-parametric assessment of the relative differences between donor and recipient, so the absolute difference is likely to be unimportant. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Caitlin Cheshire
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.,Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Richard Quigley
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Sarah Claydon
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Sadie Von Joel
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Mohamed Osman
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Pradeep Kaul
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Muhammad Rafiq
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Steven Tsui
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - David P Jenkins
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Marius Berman
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Stephen Pettit
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
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7
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Vokshi I, Ali J, Ansaripour A, Woolcock E, Cheshire C, Parameshwar J, Kydd A, Lewis C, Jenkins D, Tsui S, Kaul P, Large S, Berman M, Pettit S, Bhagra S. Surgical Palpation to Exclude Donor Transmitted Coronary Disease: A Single Centre Experience. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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8
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Cheshire C, Kydd A, Nerlekar N, Catarino P, Brown A, Parameshwar J, Pettit S. Size matching in heart transplantation: Is predicted heart mass the optimal method in a United Kingdom cohort? Clin Transplant 2020; 35:e14192. [PMID: 33336378 DOI: 10.1111/ctr.14192] [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] [Received: 10/15/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
Predicted heart mass (PHM) equations have been proposed as an alternative method for size matching in heart transplantation. We assessed association between donor-recipient size mismatch, defined using PHM equations, and survival post-heart transplant in the United Kingdom. Data from all adult patients who received a heart transplant between 1995 and 2017 were obtained from the United Kingdom Transplant Registry. PHM was calculated using published equations. Primary outcome was 1-year survival post-heart transplantation. Recipients of undersized organs had reduced 1-year survival (HR 1.31, 95% CI 1.03-1.67, p = .03). Oversizing had no impact on survival (HR 0.99, 95% CI 0.78-1.26, p = .96). Gender mismatching had no impact on survival in the cohort matched by PHM (HR 1.12, 95% CI 0.86-1.47, p = .4). In recipients without pulmonary hypertension, undersizing by PHM had no impact on 1-year survival (HR 0.95, 95% CI 0.61-1.49, p = .83). In recipients with pulmonary hypertension, oversizing donor RV by using PHM RV equation (PHMRV ) results in improved survival at 1 year (HR 0.65, 95% CI 0.5-0.83, p = .001). In conclusion, receiving an organ undersized by PHM was associated with decreased 1-year survival. Subgroup analyses demonstrated that undersizing only impacted survival in recipients with pulmonary hypertension and that these recipients had improved outcomes if they received an organ with an RV oversized by >10% by PHMRV .
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Affiliation(s)
- Caitlin Cheshire
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.,Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia
| | - Anna Kydd
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia
| | - Pedro Catarino
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Adam Brown
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia
| | - Jayan Parameshwar
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Stephen Pettit
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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9
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Messer S, Cernic S, Page A, Berman M, Kaul P, Colah S, Ali J, Pavlushkov E, Baxter J, Quigley R, Osman M, Nachum E, Parameshwar J, Abu-Omar Y, Dunning J, Goddard M, Bhagra S, Pettit S, Cheshire C, Lewis C, Kydd A, Ali A, Sudarshan C, Jenkins D, Tsui S, Hall R, Catarino P, Large SR. A 5-year single-center early experience of heart transplantation from donation after circulatory-determined death donors. J Heart Lung Transplant 2020; 39:1463-1475. [PMID: 33248525 DOI: 10.1016/j.healun.2020.10.001] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [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: 06/03/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND In an effort to address the increasing demand for heart transplantation within the United Kingdom (UK), we established a clinical program of heart transplantation from donation after circulatory-determined death (DCD) donors in 2015. After 5 years, we report the clinical early outcomes and impact of the program. METHODS This is a single-center, retrospective, matched, observational cohort study comparing outcomes of hearts transplanted from DCD donors from March 1, 2015 to February 29, 2020 with those from matched donation after brain death (DBD) donors at Royal Papworth Hospital (RPH) (Cambridge, UK). DCD hearts were either retrieved using thoracoabdominal normothermic regional perfusion or the direct procurement and perfusion technique. All DBD hearts were procured using standard cold static storage. The primary outcomes were recipient 30-day and 1-year survival. RESULTS During the 5-year study, DCD heart donation increased overall heart transplant activity by 48% (79 for DCD and 164 for DBD). There was no difference in survival at 30 days (97% for DCD vs 99% for DBD, p = 1.00) or 1 year (91% for DCD vs 89% for DBD, p = 0.72). There was no difference in the length of stay in the intensive care unit (7 for DCD vs 6 for DBD days, p = 0.24) or in the hospital (24 for DCD vs 25 for DBD days, p = 0.84). CONCLUSIONS DCD heart donation increased overall heart transplant activity at RPH by 48%, with no difference in 30-day or 1-year survival in comparison with conventional DBD heart transplantations. DCD heart donation is set to make a dramatic difference in the number of patients who can benefit from heart transplantation.
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Affiliation(s)
- Simon Messer
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Sendi Cernic
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Aravinda Page
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Marius Berman
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Pradeep Kaul
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Simon Colah
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Jason Ali
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Evgeny Pavlushkov
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Jen Baxter
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Richard Quigley
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Mohamed Osman
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Eyal Nachum
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Jayan Parameshwar
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Yasir Abu-Omar
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - John Dunning
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Martin Goddard
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Sai Bhagra
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Stephen Pettit
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Caitlin Cheshire
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Clive Lewis
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Anna Kydd
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Ayyaz Ali
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Catherine Sudarshan
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - David Jenkins
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Steven Tsui
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Roger Hall
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Pedro Catarino
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Stephen R Large
- Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.
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10
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Abstract
Despite progress in the medical and device therapy for heart failure (HF), the prognosis for those with advanced HF remains poor. Acute heart failure (AcHF) is the rapid development of, or worsening of symptoms and signs of HF typically leading to hospitalization. Whilst many HF decompensations are managed at a ward-based level, a proportion of patients require higher acuity care in the intensive care unit (ICU). Admission to ICU is associated with a higher risk of in-hospital mortality, and in those who fail to respond to standard supportive and medical therapy, a proportion maybe suitable for mechanical circulatory support (MCS). The optimal pre-operative management of advanced HF patients awaiting durable MCS or cardiac transplantation (CTx) is vital in improving both short and longer-term outcomes. This review will summarize the clinical assessment, hemodynamic profiling and management of the patient with AcHF in the ICU. The general principles of pre-surgical optimization encompassing individual systems (the kidneys, the liver, blood and glycemic control) will be discussed. Other factors impacting upon post-operative outcomes including nutrition and sarcopenia and pre-surgical skin decolonization have been included. Issues specific to durable MCS including the assessment of the right ventricle and strategies for optimization will also be discussed.
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Affiliation(s)
- Caitlin Cheshire
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Catriona Jane Bhagra
- Department of Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sai Kiran Bhagra
- Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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11
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Messer S, Page A, Kaul P, Berman M, Patterson C, Cheshire C, Thomas D, Quigley R, Abu-Omar Y, Jasvir P, Large S, Catarino P. Successful Combined Heart-Lung Transplant from a Donation after Circulatory Determined Death (DCD) Donor. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1149] [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: 11/15/2022] Open
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12
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Fung K, Cheshire C, Cooper JA, Catarino P, Piechnik SK, Neubauer S, Bhagra S, Pettit S, Petersen SE. Validation of Cardiovascular Magnetic Resonance-Derived Equation for Predicted Left Ventricular Mass Using the UK Biobank Imaging Cohort: Tool for Donor-Recipient Size Matching. Circ Heart Fail 2019; 12:e006362. [PMID: 31805784 PMCID: PMC6922072 DOI: 10.1161/circheartfailure.119.006362] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Current guidance from International Society for Heart and Lung Transplantation recommends using body weight for donor-recipient size matching for heart transplantation. However, recent studies have shown that predicted heart mass, using body weight, height, age, and sex, may represent a better method of size matching. We aim to validate a cardiovascular magnetic resonance (CMR)-derived equation for predicted left ventricular mass (LVM) in a cohort of normal individuals in the United Kingdom. METHODS This observational study was conducted in 5065 middle-aged (44-77 years old) UK Biobank participants who underwent CMR imaging in 2014 to 2015. Individuals with cancer diagnosis in the previous 12 months or history of cardiovascular disease were excluded. Predicted LVM was calculated based on participants' sex, height, and weight recorded at the time of imaging. Correlation analyses were performed between the predicted LVM and the LVM obtained from manual contouring of CMR cine images. The analysis included 3398 participants (age 61.5±7.5 years, 47.8% males). RESULTS Predicted LVM was considerably higher than CMR-derived LVM (mean±SD of 138.8±28.9 g versus 86.3±20.9 g). However, there was a strong correlation between the 2 measurements (Spearman correlation coefficient 0.802, P<0.0001). CONCLUSIONS Predicted LVM calculated using a CMR-derived equation that incorporates height, weight, and sex has a strong correlation with CMR LVM in large cohort of normal individuals in the United Kingdom. Our findings suggest that predicted heart mass equations may be a valid tool for donor-recipient size matching for heart transplantation in the United Kingdom.
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Affiliation(s)
- Kenneth Fung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, United Kingdom (K.F., J.A.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (K.F., S.E.P.)
| | - Caitlin Cheshire
- Advanced Heart Failure and Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (C.C., P.C., S.B., S.P.)
| | - Jackie A. Cooper
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, United Kingdom (K.F., J.A.C., S.E.P.)
| | - Pedro Catarino
- Advanced Heart Failure and Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (C.C., P.C., S.B., S.P.)
| | - Stefan K. Piechnik
- NIHR Oxford Biomedical Research Centre, Division of Cardiovascular Medicine, University of Oxford, United Kingdom (S.K.P., S.N.)
| | - Stefan Neubauer
- NIHR Oxford Biomedical Research Centre, Division of Cardiovascular Medicine, University of Oxford, United Kingdom (S.K.P., S.N.)
| | - Sai Bhagra
- Advanced Heart Failure and Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (C.C., P.C., S.B., S.P.)
| | - Stephen Pettit
- Advanced Heart Failure and Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (C.C., P.C., S.B., S.P.)
| | - Steffen E. Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, United Kingdom (K.F., J.A.C., S.E.P.)
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (K.F., S.E.P.)
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13
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Zentner D, Cheshire C, Grigg L. Extracardiac Conduit Fontan – Outcome Data in Early Adulthood. Heart Lung Circ 2018; 27:254-259. [DOI: 10.1016/j.hlc.2017.03.162] [Citation(s) in RCA: 2] [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] [Received: 11/14/2016] [Accepted: 03/20/2017] [Indexed: 12/01/2022]
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14
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Nerlekar N, Ha FJ, Cheshire C, Rashid H, Cameron JD, Wong DT, Seneviratne S, Brown AJ. Computed Tomographic Coronary Angiography–Derived Plaque Characteristics Predict Major Adverse Cardiovascular Events. Circ Cardiovasc Imaging 2018; 11:e006973. [DOI: 10.1161/circimaging.117.006973] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [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: 07/26/2017] [Accepted: 11/01/2017] [Indexed: 12/26/2022]
Abstract
Background—
Computed tomographic coronary angiography is a noninvasive imaging modality that permits identification and characterization of coronary plaques. Despite consensus statements supporting routine reporting of computed tomographic coronary angiography plaque characteristics, there remains uncertainty whether these data convey prognostic information. We performed a systematic review and meta-analysis assessing the strength of association between computed tomographic coronary angiography–derived plaque characterization and major adverse cardiovascular events (MACE).
Methods and Results—
Electronic databases were searched for studies reporting computed tomographic coronary angiography plaque characterization and MACE. Data were gathered on plaque morphology (noncalcified, partially calcified, and calcified) and high-risk plaque (HRP) features, including low-attenuation plaque, napkin-ring sign, spotty calcification, and positive remodeling. Of 5496 citations, 13 studies met inclusion criteria. Five hundred fifty-two (3.9%) MACE occurred in 13 977 patients with mean follow-up ranging between 1.3 and 8.2 years. In terms of plaque morphology, the strongest association was observed for noncalcified plaque (hazard ratio [HR], 1.45; 95% confidence interval [CI], 1.24–1.70;
P
<0.001), with weaker associations found for partially calcified (HR, 1.37; 95% CI, 1.18–1.60;
P
<0.001) and calcified plaques (HR, 1.23; 95% CI, 1.16–1.30;
P
<0.001). All HRP features were strongly associated with MACE, including napkin-ring sign (HR, 5.06; 95% CI, 3.23–7.94;
P
<0.001), low-attenuation plaque (HR, 2.95; 95% CI, 2.03–4.29;
P
<0.001), positive remodeling (HR, 2.58; 95% CI, 1.84–3.61;
P
<0.001), and spotty calcification (HR, 2.25; 95% CI, 1.26–4.04;
P
=0.006). The presence of ≥2 HRP features had highest risk of MACE (HR, 9.17; 95% CI, 4.10–20.50;
P
<0.001).
Conclusions—
These data demonstrate that HRP is most likely an independent predictor of MACE, which supports the inclusion of HRP reporting in clinical practice. However, at this point, it remains unclear whether HRP reporting has clinical implications.
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Affiliation(s)
- Nitesh Nerlekar
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Francis J. Ha
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Caitlin Cheshire
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Hashrul Rashid
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - James D. Cameron
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Dennis T. Wong
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Sujith Seneviratne
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Adam J. Brown
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia
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15
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Nerlekar N, Cheshire C, Rashid H, Muthalaly R, Cameron J, Meredith I, Seneviratne S, Wong D, Brown A. COMPUTED TOMOGRAPHY CORONARY ANGIOGRAPHY DERIVED PLAQUE MORPHOLOGY PREDICTS MAJOR ADVERSE CARDIOVASCULAR EVENTS: INSIGHTS FROM A 19,943 PATIENT META-ANALYSIS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Cheshire C, Alison J, Healy S, Lockwood S, Kotschet E. Endocardial Left Ventricle Lead Implantation for Cardiac Resynchronisation Therapy. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.314] [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: 10/19/2022]
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17
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Verma K, Cheshire C, Nerlekar N, Brown A, Cameron J. Outcomes with First and Second-Generation Drug-Eluting Stents in Intravascular Ultrasound-Guided Stent Implantation: A Meta-Analysis. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.408] [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: 10/19/2022]
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18
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Cheshire C, Nerlekar N, Nasis A, Moir S. Focal Takotsubo Cardiomyopathy- Insights from Cardiac MRI Imaging. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.503] [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: 10/19/2022]
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19
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Cheshire C, Alison J, Lockwood S, Healy S, Kotschet E. Cardiac Contractility Modulator Insertion for Heart Failure: A Single Centre Australian Experience. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.305] [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: 10/19/2022]
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20
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Nerlekar N, Cheshire C, Verma K, Ihdayhid AR, McCormick L, Cameron J, Bennett M, Malaiapan Y, Meredith I, Brown A. Intravascular ultrasound guidance improves clinical outcomes during implantation of both first- and second-generation drug-eluting stents: a meta-analysis. EUROINTERVENTION 2017; 12:1632-1642. [DOI: 10.4244/eij-d-16-00769] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Nerlekar N, Cheshire C, Rashid H, Muthalaly R, Cameron J, Seneviratne S, Wong D, Harper R, Brown A. Computed Tomography Coronary Angiography (CTCA) Derived Plaque Morphology Predicts Major Adverse Cardiovascular Events (MACE): Insights from a 19,943 Patient Meta-Analysis. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.483] [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: 10/19/2022]
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22
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Verma K, Cheshire C, Nasis .A. Pericardiocentesis for Pericardial Tamponade: A Tertiary Centre Experience. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Cheshire C, Zentner D, Grigg L. Extra cardiac conduit Fontan circulation - outcomes in the first adult cohort. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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24
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Cheshire C, Martin J, Lovibond S, Hengel C. Unilateral cardiogenic pulmonary oedema secondary to severe mitral regurgitation. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.264] [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: 10/23/2022]
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25
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Yudi M, Phan K, Lewis N, Teo E, Brooks M, Cheshire C, Wong J, Joshi S, Ogden V, Gurvitch R. PM116 First Utilization of the Paieon’s C-THV Guiding System for Transcatheter Aortic Valve Implantation (TAVI) in an Australian Setting. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.1514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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26
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Yudi M, Phan K, Cheshire C, Wong J, Joshi S, Warren R, Ogden V, Larobina M, Goldblatt J, Gurvitch R. PT108 Thrombocytopenia Post Transcatheter Aortic Valve Implantation – Incidence and Impact on Clinical Outcomes. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.1895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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27
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Yudi M, Andrianopoulos N, Freeman M, Hiew C, Yan B, Tsang D, Yeoh J, Prabhu S, Cheshire C, Ajani A. PM197 Clinical Characteristics, Trends and Outcomes in Elderly Patients with Acute Coronary Syndromes Undergoing PCI. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.1583] [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: 11/16/2022] Open
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28
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Engles MP, Holloway SR, Nanez JE, Cheshire C. The relationship between macular pigment optical density and hyperacuity training. J Vis 2005. [DOI: 10.1167/5.12.59] [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
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