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Florissi IS, Acton M, Kolesnik I, Pasrija C, Patel I, Etchill E, Holmes SD, Quinn R, Gammie JS. Non-resectional cordal repair for Barlow mitral valve disease. J Cardiovasc Surg (Torino) 2024:S0021-9509.24.12899-6. [PMID: 38511306 DOI: 10.23736/s0021-9509.24.12899-6] [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] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND The redundant leaflet tissue and annular pathology of Barlow disease can make surgical repair challenging. We examined perioperative and late outcomes of a large cohort of patients with Barlow disease undergoing surgical repair. METHODS Patients included in this analysis underwent mitral valve repair from 01/2004-11/2021 by a single surgeon. RESULTS Of 2798 patients undergoing mitral valve operations, 46% (N.=1292) had degenerative pathology and 7% (N.=184) had Barlow disease. Of the 179 Barlow patients, median age at surgery was 62 (51-70) years; 64% were male (115/179). Rates of non-resectional cordal repair and resectional repair were 86% (154/179) and 14% (25/179). Among patients undergoing non-resectional repair, the median number of cordal pairs inserted on the anterior and posterior leaflets was 2 (2-3) and 4 (3-4). Incidence of return to bypass for systolic anterior motion of the mitral valve, perioperative death, stroke, and renal failure was 2% (4/179), 1% (2/179), 0% (0/179), and 0% (0/179). Rates of clinical and echocardiographic follow-up were 93% (165/177) and 89% (157/177). Median time to latest postoperative clinical and echocardiographic follow-up was 2.4 (0.8-6.1) and 2.1 (0.6-4.7) years. Mitral regurgitation grade at latest follow-up or time of repair failure was none/trace, mild, mild to moderate, and severe in 63% (98/157), 26% (41/157), 8% (12/157), and 4% (6/157); five of six patients with severe MR underwent reoperation. Since 2011 97% (139/144) of patients underwent cordal repair without resection. CONCLUSIONS Non-resectional artificial cordal repair is safe and feasible in almost all patients with Barlow valves and is associated with excellent mid-term results.
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Affiliation(s)
- Isabella S Florissi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA -
| | - Matthew Acton
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Irina Kolesnik
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Chetan Pasrija
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ishani Patel
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric Etchill
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sari D Holmes
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachael Quinn
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James S Gammie
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Labrada L, Panah L, Johnson J, Brennan K, Pasrija C, Grace M, Menachem J, Rali AS. Rare Etiology of Cardiogenic Shock in Pregnancy. Circ Heart Fail 2024; 17:e011006. [PMID: 38054278 DOI: 10.1161/circheartfailure.123.011006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Affiliation(s)
- Lyana Labrada
- Division of Cardiovascular Diseases (L.L., L.P., J.M., A.S.R.), Vanderbilt University Medical Center, Nashville, TN
| | - Lindsay Panah
- Division of Cardiovascular Diseases (L.L., L.P., J.M., A.S.R.), Vanderbilt University Medical Center, Nashville, TN
| | - Joyce Johnson
- Department of Pathology (J.J.), Vanderbilt University Medical Center, Nashville, TN
| | - Kaitlyn Brennan
- Department of Anesthesiology (K.B.), Vanderbilt University Medical Center, Nashville, TN
| | - Chetan Pasrija
- Department of Cardiac Surgery (C.P.), Vanderbilt University Medical Center, Nashville, TN
| | - Matthew Grace
- Department of Obstetrics and Gynecology (M.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Jonathan Menachem
- Division of Cardiovascular Diseases (L.L., L.P., J.M., A.S.R.), Vanderbilt University Medical Center, Nashville, TN
| | - Aniket S Rali
- Division of Cardiovascular Diseases (L.L., L.P., J.M., A.S.R.), Vanderbilt University Medical Center, Nashville, TN
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Amancherla K, Feurer ID, Rega SA, Cluckey A, Salih M, Davis J, Pedrotty D, Ooi H, Rali AS, Siddiqi HK, Menachem J, Brinkley DM, Punnoose L, Sacks SB, Zalawadiya SK, Wigger M, Balsara K, Trahanas J, McMaster WG, Hoffman J, Pasrija C, Lindenfeld J, Shah AS, Schlendorf KH. Early Assessment of Cardiac Allograft Vasculopathy Risk Among Recipients of Hepatitis C Virus-infected Donors in the Current Era. J Card Fail 2023:S1071-9164(23)00381-0. [PMID: 37907147 PMCID: PMC11056484 DOI: 10.1016/j.cardfail.2023.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Transplantation of hearts from hepatitis C virus (HCV)-positive donors has increased substantially in recent years following development of highly effective direct-acting antiviral therapies for treatment and cure of HCV. Although historical data from the pre-direct-acting antiviral era demonstrated an association between HCV-positive donors and accelerated cardiac allograft vasculopathy (CAV) in recipients, the relationship between the use of HCV nucleic acid test-positive (NAT+) donors and the development of CAV in the direct-acting antiviral era remains unclear. METHODS AND RESULTS We performed a retrospective, single-center observational study comparing coronary angiographic CAV outcomes during the first year after transplant in 84 heart transplant recipients of HCV NAT+ donors and 231 recipients of HCV NAT- donors. Additionally, in a subsample of 149 patients (including 55 in the NAT+ cohort and 94 in the NAT- cohort) who had serial adjunctive intravascular ultrasound examination performed, we compared development of rapidly progressive CAV, defined as an increase in maximal intimal thickening of ≥0.5 mm in matched vessel segments during the first year post-transplant. In an unadjusted analysis, recipients of HCV NAT+ hearts had reduced survival free of CAV ≥1 over the first year after heart transplant compared with recipients of HCV NAT- hearts. After adjustment for known CAV risk factors, however, there was no significant difference between cohorts in the likelihood of the primary outcome, nor was there a difference in development of rapidly progressive CAV. CONCLUSIONS These findings support larger, longer-term follow-up studies to better elucidate CAV outcomes in recipients of HCV NAT+ hearts and to inform post-transplant management strategies.
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Affiliation(s)
- Kaushik Amancherla
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Irene D Feurer
- Departments of Surgery and Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott A Rega
- Vanderbilt Transplant Center, Nashville, Tennessee
| | - Andrew Cluckey
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mohamed Salih
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan Davis
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dawn Pedrotty
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Henry Ooi
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aniket S Rali
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hasan K Siddiqi
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan Menachem
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Douglas M Brinkley
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lynn Punnoose
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Suzanne B Sacks
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sandip K Zalawadiya
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mark Wigger
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Keki Balsara
- Department of Cardiac Surgery, Medstar Washington Hospital Center, Washington, DC
| | - John Trahanas
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William G McMaster
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jordan Hoffman
- Division of Cardiothoracic Surgery, University of Colorado, Aurora, Colorado
| | - Chetan Pasrija
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joann Lindenfeld
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ashish S Shah
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelly H Schlendorf
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
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Siddiqi HK, Trahanas J, Xu M, Wells Q, Farber-Eger E, Pasrija C, Amancherla K, Debose-Scarlett A, Brinkley DM, Lindenfeld J, Menachem JN, Ooi H, Pedrotty D, Punnoose L, Rali AS, Sacks S, Wigger M, Zalawadiya S, McMaster W, Devries S, Shah A, Schlendorf K. Outcomes of Heart Transplant Donation After Circulatory Death. J Am Coll Cardiol 2023; 82:1512-1520. [PMID: 37793748 DOI: 10.1016/j.jacc.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Heart transplantation using donation after circulatory death (DCD) allografts is increasingly common, expanding the donor pool and reducing transplant wait times. However, data remain limited on clinical outcomes. OBJECTIVES We sought to compare 6-month and 1-year clinical outcomes between recipients of DCD hearts, most of them recovered with the use of normothermic regional perfusion (NRP), and recipients of donation after brain death (DBD) hearts. METHODS We conducted a single-center retrospective observational study of all adult heart-only transplants from January 2020 to January 2023. Recipient and donor data were abstracted from medical records and the United Network for Organ Sharing registry, respectively. Survival analysis and Cox regression were used to compare the groups. RESULTS During the study period, 385 adults (median age 57.4 years [IQR: 48.0-63.7 years]) underwent heart-only transplantation, including 122 (32%) from DCD donors, 83% of which were recovered with the use of NRP. DCD donors were younger and had fewer comorbidities than DBD donors. DCD recipients were less often hospitalized before transplantation and less likely to require pretransplantation temporary mechanical circulatory support compared with DBD recipients. There were no significant differences between groups in 1-year survival, incidence of severe primary graft dysfunction, treated rejection during the first year, or likelihood of cardiac allograft vasculopathy at 1 year after transplantation. CONCLUSIONS In the largest single-center comparison of DCD and DBD heart transplantations to date, outcomes among DCD recipients are noninferior to those of DBD recipients. This study adds to the published data supporting DCD donors as a safe means to expand the heart donor pool.
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Affiliation(s)
- Hasan K Siddiqi
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - John Trahanas
- Department of Cardiothoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Meng Xu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Quinn Wells
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric Farber-Eger
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chetan Pasrija
- Department of Cardiothoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kaushik Amancherla
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alexandra Debose-Scarlett
- Department of Cardiothoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - D Marshall Brinkley
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - JoAnn Lindenfeld
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan N Menachem
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Henry Ooi
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Medicine, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Dawn Pedrotty
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Medicine, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Lynn Punnoose
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aniket S Rali
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Suzanne Sacks
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mark Wigger
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Medicine, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Sandip Zalawadiya
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William McMaster
- Department of Cardiothoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven Devries
- Department of Cardiothoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ashish Shah
- Department of Cardiothoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelly Schlendorf
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Pasrija C, Kon ZN, Shah A, Holmes SD, Rozenberg KS, Joseph S, Griffith BP. Indexed donor cardiac output for improved size matching in heart transplantation: A United Network for Organ Sharing database analysis. JTCVS Open 2023; 15:291-299. [PMID: 37808019 PMCID: PMC10556824 DOI: 10.1016/j.xjon.2023.04.021] [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] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/31/2023] [Accepted: 04/14/2023] [Indexed: 10/10/2023]
Abstract
Objective Implantation of an appropriately sized donor heart is critical for optimal outcomes after heart transplantation. Although predicted heart mass has recently gained consideration, there remains a need for improved granularity in size matching, particularly among small donor hearts. We sought to determine if indexed donor cardiac output is a sensitive metric to assess the adequacy of a donor heart for a given recipient. Methods A retrospective analysis was performed (2003-2021) in isolated orthotopic heart transplant recipients from the United Network for Organ Sharing database. Donor cardiac output was divided by recipient body surface area to compute cardiac index (donor cardiac index). Predicted heart mass ratio was computed as donor/recipient predicted heart mass. The primary outcome was mortality 1 year after transplant. Results Among transplant recipients, median donor cardiac output was 7.3 (5.8-9.0) liters per minute and donor cardiac index was 3.7 (3.0-4.6) liters per minute/m2. Predicted heart mass ratio was 1.01 (0.91-1.13). After multivariable adjustment, higher donor cardiac index was associated with lower 1-year mortality risk (odds ratio, 0.92, P = .042). Recipients with predicted heart mass ratio less than 0.80 (n = 255) had a lower median donor cardiac index than those with a predicted heart mass ratio of 0.80 or greater (3.2 vs 3.7, P < .001). As predicted, heart mass ratio became smaller and the association between donor cardiac index and 1-year mortality became progressively stronger. Conclusions Higher donor cardiac index was associated with a lower probability of 1-year mortality among patients undergoing heart transplantation and served to further quantify mortality risk among those with a small predicted heart mass ratio. Donor cardiac index appears to be an effective tool for size matching and may serve as an adjunctive strategy among small donor hearts with a low predicted heart mass ratio.
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Affiliation(s)
- Chetan Pasrija
- Department of Cardiac Surgery, Vanderbilt University School of Medicine, Nashville, Tenn
| | - Zachary N. Kon
- Department of Cardiac Surgery, Northwell Health, Manhasset, NY
| | - Aakash Shah
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Sari D. Holmes
- Division of Cardiac Surgery, Johns Hopkins School of Medicine, Baltimore, Md
| | - Karina S. Rozenberg
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Susan Joseph
- Division of Cardiology, University of Maryland School of Medicine, Baltimore, Md
| | - Bartley P. Griffith
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
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Cardona S, Downing JV, Witting MD, Haase DJ, Powell EK, Dahi S, Pasrija C, Tran QK. Venoarterial Extracorporeal Membrane Oxygenation With or Without Advanced Intervention for Massive Pulmonary Embolism. Perfusion 2023:2676591231177909. [PMID: 37246150 DOI: 10.1177/02676591231177909] [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] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Massive pulmonary embolism (MPE) is a rare but highly fatal condition. Our study's objective was to evaluate the association between advanced interventions and survival among patients with MPE treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO). METHODS This is a retrospective review of the Extracorporeal Life Support Organization (ELSO) registry data. We included adult patients with MPE who were treated with VA-ECMO during 2010-2020. Our Primary outcome was survival to hospital discharge; secondary outcomes were ECMO duration among survivors and rates of ECMO-related complications. Clinical variables were compared using the Pearson chi-square and Kruskal-Wallis H tests. RESULTS We included 802 patients; 80 (10%) received SPE and 18 (2%) received CDT. Overall, 426 (53%) survived to discharge; survival was not significantly different among those treated with SPE or CDT on VA-ECMO (70%) versus VA-ECMO alone (52%) or SPE or CDT before VA-ECMO (52%). Multivariable regression found a trend towards increased survival among those treated with SPE or CDT while on ECMO (AOR 1.8, 95% CI 0.9-3.6), but no significant correlation. There was no association between advanced interventions and ECMO duration among survivors, or rates of ECMO-related complications. CONCLUSION Our study found no difference in survival in patients with MPE who received advanced interventions prior to ECMO, and a slight non-significant benefit in those who received advanced interventions while on ECMO.
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Affiliation(s)
- Stephanie Cardona
- Department of Critical Care Medicine, The Mount Sinai Hospital, New York, NY, USA
| | - Jessica V Downing
- Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael D Witting
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel J Haase
- Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Elizabeth K Powell
- Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Siamak Dahi
- Department of Surgery, Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Chetan Pasrija
- Department of Cardiac Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Quincy K Tran
- Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Pasrija C, Tipograf Y, Shah AS, Trahanas JM. Normothermic regional perfusion for donation after circulatory death donors. Curr Opin Organ Transplant 2023; 28:71-75. [PMID: 36409266 DOI: 10.1097/mot.0000000000001038] [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: 11/23/2022]
Abstract
PURPOSE OF REVIEW This review is intended to provide an update on the logistics, technique, and outcomes associated with normothermic regional perfusion (NRP), as well as provide a discussion of the associated ethical issues. RECENT FINDINGS There has been renewed interest in utilizing NRP to increase quality and availability of organs from donation after circulatory death (DCD) donors. Our institution has increasing experience with thoraco-abdominal NRP (TA-NRP) in controlled DCD donors (cDCD), whereas abdominal NRP (A-NRP) has been used with success in both cDCD and uncontrolled DCD (uDCD). There is increasing evidence that NRP can be conducted in a practical and cost-efficient manner, and that the organ yield may be of better quality than standard direct procurement and perfusion (DPP). SUMMARY NRP is increasingly successful and will likely prove to be a superior method for cDCD recovery. However, before TA-NRP can be widely accepted the ethical debate surrounding this technique must be settled. VIDEO ABSTRACT http://links.lww.com/COOT/A11.
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Affiliation(s)
- Chetan Pasrija
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Pasrija C, DeBose-Scarlett A, Keck C, Scholl S, Siddiqi H, Amancherla K, Brinkley D, Lindenfeld J, Menachem J, Ooi H, Pedrotty D, Punnoose L, Rali A, Sacks S, Wigger M, Zalawadiya S, McMaster W, Shah A, Schlendorf K, Trahanas J. Prolonged Warm Ischemic Time is Safe for Cardiac Donation after Circulatory Death. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.208] [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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Harris T, Tracy K, Francois S, Tucker W, Ukita R, Johnson C, DeVries S, Cortelli M, Cardwell N, Do N, Pasrija C, Demarest C, Alexopoulos S, Shaver C, Bacchetta M. Autologous Blood Re-Exposure Does Not Invoke Hyperacute Rejection in a Human Lung after Xenogeneic Cross-Circulation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1540] [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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Siddiqi H, DeBose-Scarlett A, Trahanas J, Pasrija C, Amancherla K, Brinkley D, Lindenfeld J, Menachem J, Ooi H, Pedrotty D, Punnoose L, Rali A, Sacks S, Wigger M, Zalawadiya S, McMaster W, Shah A, Schlendorf K. Characteristics and Outcomes Among Recipients of Dcd Versus Dbd Heart Transplantation - The Vanderbilt Experience. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1609] [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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Trahanas J, DeBose-Scarlett A, Siddiqi H, Amancherla K, Brinkley D, Lindenfeld J, Menachem J, Ooi H, Pedrotty D, Punnoose L, Rali A, Sacks S, Wigger M, Zalawadiya S, Hoffman J, McMaster W, Shah A, Schlendorf K, Pasrija C. Normothermic Regional Perfusion Versus Direct Procurement and Preservation: Is There a Difference for DCD Heart Recipients? J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.157] [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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Quinn RW, Pasrija C, Zaheer S, Winicki N, Gammie JS. How To Do It: Mitral Valve Translocation. Innovations (Phila) 2023; 18:120-123. [PMID: 36988265 DOI: 10.1177/15569845231159624] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Mitral valve translocation (MVT) is a novel procedure that was developed to treat patients with severe, symptomatic, secondary mitral regurgitation (MR). MVT enhances leaflet coaptation by insertion of an autologous pericardial patch interposed between the mitral annulus and the native mitral leaflets. The patch substantially increases total leaflet surface area and creates supranormal coaptation. In addition, it relieves leaflet tethering by transposing the native valve deeper into the ventricle and decreases the circumference of the annulus. The enhanced coaptation produced by MVT may protect against recurrent MR in patients with continued adverse left ventricular remodeling. The procedural steps include detachment of the intact native mitral valve at the annulus, placement of interrupted pledgeted sutures around the annulus to secure the proximal aspect of the patch, and attachment of the native valve to the distal aspect of the patch using running suture. Follow-up of patients who have undergoing MVT is ongoing, with satisfactory short-term results, including sustained MR grades of ≤mild and 14 mm coaptation at 12 months.
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Affiliation(s)
- Rachael W Quinn
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chetan Pasrija
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Salman Zaheer
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nolan Winicki
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - James S Gammie
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Gammie JS, Pasrija C, Quinn RW. Mitral Valve Translocation: A Novel Approach to Repair Secondary Mitral Regurgitation. Innovations (Phila) 2023; 18:118-119. [PMID: 36988277 DOI: 10.1177/15569845231159619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Affiliation(s)
- James S Gammie
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chetan Pasrija
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rachael W Quinn
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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14
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Pasrija C, Kon ZN, Mazzeffi MA, Zhang J, Wu ZJ, Tran D, Bittle GJ, Ghoreishi M, Miller TR, Alkhatib H, Tobin N, Taylor BS, Deatrick KB, Rector R, Herr DL, Griffith BP. Spinal Cord Infarction With Prolonged Femoral Venoarterial Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2023; 37:758-766. [PMID: 36842938 DOI: 10.1053/j.jvca.2022.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 12/06/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES There have been sporadic reports of ischemic spinal cord injury (SCI) during venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. The authors observed a troubling pattern of this catastrophic complication and evaluated the potential mechanisms of SCI related to ECMO. DESIGN This study was a case series. SETTING This study was performed at a single institution in a University setting. PARTICIPANTS Patients requiring prolonged VA-ECMO were included. INTERVENTIONS No interventions were done. This was an observational study. MEASUREMENTS AND MAIN RESULTS Four hypotheses of etiology were considered: (1) hypercoagulable state/thromboembolism, (2) regional hypoxia/hypocarbia, (3) hyperperfusion and spinal cord edema, and (4) mechanical coverage of spinal arteries. The SCI involved the lower thoracic (T7-T12 level) spinal cord to the cauda equina in all patients. Seven out of 132 (5.3%) patients with prolonged VA-ECMO support developed SCI. The median time from ECMO cannulation to SCI was 7 (range: 6-17) days.There was no evidence of embolic SCI or extended regional hypoxia or hypocarbia. A unilateral, internal iliac artery was covered by the arterial cannula in 6/7 86%) patients, but flow into the internal iliac was demonstrated on imaging in all available patients. The median total flow (ECMO + intrinsic cardiac output) was 8.5 L/min (LPM), and indexed flow was 4.1 LPM/m2. The median central venous oxygen saturation was 88%, and intracranial pressure was measured at 30 mmHg in one patient, suggestive of hyperperfusion and spinal cord edema. CONCLUSIONS An SCI is a serious complication of extended peripheral VA-ECMO support. Its etiology remains uncertain, but the authors' preliminary data suggested that spinal cord edema from hyperperfusion or venous congestion could contribute.
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Affiliation(s)
- Chetan Pasrija
- Division of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, MD.
| | - Zachary N Kon
- Department of Cardiothoracic Surgery, Northwell Health, New York, NY
| | - Michael A Mazzeffi
- Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine, Washington, DC
| | - Jiafeng Zhang
- Division of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, MD
| | - Zhongjun J Wu
- Division of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, MD
| | - Douglas Tran
- Division of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, MD
| | - Gregory J Bittle
- Division of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, MD
| | - Mehrdad Ghoreishi
- Division of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, MD
| | - Timothy R Miller
- Department of Radiology, Division of Neuroradiology, University of Maryland, School of Medicine, Baltimore, MD
| | - Hani Alkhatib
- Department of Medicine, University of Maryland, School of Medicine, Baltimore, MD
| | - Nicole Tobin
- Division of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, MD
| | - Bradley S Taylor
- Division of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, MD
| | - Kristopher B Deatrick
- Division of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, MD
| | - Raymond Rector
- Perfusion Services, University of Maryland Medical Center, Baltimore, MD
| | - Daniel L Herr
- Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Bartley P Griffith
- Division of Cardiac Surgery, University of Maryland, School of Medicine, Baltimore, MD
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15
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Shah A, Goerlich CE, Pasrija C, Hirsch J, Fisher S, Odonkor P, Strauss E, Ayares D, Mohiuddin MM, Griffith BP. Anatomical Differences Between Human and Pig Hearts and Their Relevance for Cardiac Xenotransplantation Surgical Technique. JACC Case Rep 2022; 4:1049-1052. [PMID: 36062051 PMCID: PMC9434648 DOI: 10.1016/j.jaccas.2022.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 05/22/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Abstract
Cardiac xenotransplantation has been proposed to bridge the gap between supply and demand for patients with end-stage heart failure requiring transplantation. However, differences in pig anatomy compared with human anatomy require modification of the surgical approach. In addition, careful consideration should be given to size matching before transplantation. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Aakash Shah
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Corbin E. Goerlich
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Chetan Pasrija
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jeffrey Hirsch
- Department of Radiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Stacy Fisher
- Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Patrick Odonkor
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Erik Strauss
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Muhammad M. Mohiuddin
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Bartley P. Griffith
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Address for correspondence: Dr. Bartley P. Griffith, Program in Cardiac Xenotransplantation, 110 S. Paca Street, 7th Floor, Baltimore, Maryland 21201, USA.
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16
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Shah A, Pasrija C, Kronfli A, Essien EO, Zhou Y, Brigante F, Bittle G, Menaker J, Herr D, Mazzeffi MA, Deatrick KB, Kon ZN. A Comparison of Anticoagulation Strategies in Veno-venous Extracorporeal Membrane Oxygenation. ASAIO J 2022; 68:738-743. [PMID: 34437329 DOI: 10.1097/mat.0000000000001560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/26/2022] Open
Abstract
Bleeding remains a major source of morbidity associated with veno-venous extracorporeal membrane oxygenation (VV-ECMO). Moreover, there remains significant controversy, and a paucity of data regarding the ideal anticoagulation strategy for VV-ECMO patients. All patients undergoing isolated, peripheral VV-ECMO between January 2009 and December 2014 at our institution were retrospectively reviewed. Patients (n = 123) were stratified into one of three sequential eras of anticoagulation strategies: activated clotting time (ACT: 160-180 seconds, n = 53), high-partial thromboplastin time (H-PTT: 60-80 seconds, n = 25), and low-PTT (L-PTT: 45-55 seconds, n = 25) with high-flow (>4 L/min). Pre-ECMO APACHE II scores, SOFA scores, and Murray scores were not significantly different between the groups. Patients in the L-PTT group required less red blood cell units on ECMO than the ACT or H-PTT group (2.1 vs. 1.3 vs. 0.9; p < 0.001) and patients in the H-PTT and L-PTT group required less fresh frozen plasma than the ACT group (0.33 vs. 0 vs. 0; p = 0.006). Overall, major bleeding events were significantly lower in the L-PTT group than in the ACT and H-PTT groups. There was no difference in thrombotic events. In this single-institution experience, a L-PTT, high-flow strategy on VV-ECMO was associated with fewer bleeding and no difference in thrombotic events than an ACT or H-PTT strategy.
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Affiliation(s)
- Aakash Shah
- From the Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Chetan Pasrija
- From the Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Anthony Kronfli
- From the Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Eno-Obong Essien
- From the Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Ya Zhou
- From the Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Francis Brigante
- From the Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Gregory Bittle
- From the Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Jay Menaker
- Shock Trauma Critical Care, University of Maryland School of Medicine, Baltimore, MD
| | - Daniel Herr
- Shock Trauma Critical Care, University of Maryland School of Medicine, Baltimore, MD
| | - Michael A Mazzeffi
- Division of Cardiothoracic Anesthesiology, University of Maryland School of Medicine, Baltimore, MD
| | - Kristopher B Deatrick
- From the Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Zachary N Kon
- Department of Cardiothoracic Surgery, New York University Medical Center, New York, NY
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Pasrija C, Kon Z, Shah A, Holmes S, Rozenberg K, Feller E, Joseph S, Griffith B. Indexed Donor Cardiac Output for Improved Size Matching in Heart Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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18
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Pasrija C, Shah A, Holmes S, Bittle G, Reed R, Patel V, Lau C, Krupnick A. Safety of Single Lung Transplantation Post Donation Service Area-Specific Organ Distribution. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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19
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Gammie JS, Quinn RW, Pasrija C. Adding mitral valve translocation to the tool kit for treatment of secondary mitral regurgitation. Ann Thorac Surg 2022; 114:2401. [PMID: 35339446 DOI: 10.1016/j.athoracsur.2022.02.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 02/20/2022] [Indexed: 11/01/2022]
Affiliation(s)
- James S Gammie
- Division of Cardiac Surgery Department of Surgery Johns Hopkins University School of Medicine 1800 Orleans St, Zayed 7107 Baltimore, MD 21287
| | - Rachael W Quinn
- Division of Cardiac Surgery Department of Surgery Johns Hopkins University School of Medicine 1800 Orleans St, Zayed 7107 Baltimore, MD 21287
| | - Chetan Pasrija
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
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20
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Pasrija C, Quinn RW, Bernstein D, Tran D, Alkhatib H, Rice M, Morales D, Shah A, Ghoreishi M, Strauss ER, Henderson R, D'Ambra MN, Gammie JS. Mitral Valve Translocation: A Novel Operation for the Treatment of Secondary Mitral Regurgitation. Ann Thorac Surg 2021; 112:1954-1961. [PMID: 34419436 DOI: 10.1016/j.athoracsur.2021.07.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/05/2021] [Revised: 05/04/2021] [Accepted: 07/12/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Conventional annuloplasty repair of secondary (functional) ischemic mitral regurgitation (IMR) is associated with a 60% recurrence of moderate or greater mitral regurgitation at 2 years. We developed a novel repair technique for IMR that addresses the underlying geometric alterations of the mitral valve apparatus and compared outcomes with those of conventional repair in a swine model. METHODS Chronic IMR was induced by percutaneous embolization of the circumflex artery. Swine with severe IMR (median 9 weeks after infarction) underwent undersized rigid annuloplasty (n = 5) or translocation repair (n = 6). Translocation repair consisted of detaching the mitral valve en bloc at the annulus, creating a 1 cm wide frustum-shaped pericardial patch, and suturing the outer circumference of the patch to the annulus and inner circumference to the mitral valve. RESULTS Operative survival was 92% (11 of 12). All animals had none/trace residual central mitral regurgitation, and mean inflow gradients were similar (1 mm Hg [interquartile range, 1 to 2] vs 2 mm Hg [interquartile range, 1 to 2]; P = .75) in the annuloplasty and translocation groups, respectively. Median coaptation length marginally improved in conventional swine (3 to 4 mm, P = .05), but dramatically improved in translocation swine (3 to 8 mm, P = .003). Posterior leaflet angle increased from 39 to 80 degrees (P = .05) in annuloplasty swine but decreased from 50 to 31 degrees (P = .03) in translocation swine. The posterior leaflet was immobile after annuloplasty but had preserved motion after translocation (excursion, 1 degree vs 24 degrees; P = .045). CONCLUSIONS Mitral valve translocation effectively treats mitral regurgitation by relieving leaflet tethering. Compared with annuloplasty, mitral valve translocation creates a larger surface of coaptation and preserves leaflet mobility without compromising diastolic function.
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Affiliation(s)
- Chetan Pasrija
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rachael W Quinn
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Douglas Tran
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Hani Alkhatib
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - MaryJoe Rice
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - David Morales
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Aakash Shah
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mehrdad Ghoreishi
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Erik R Strauss
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Reney Henderson
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael N D'Ambra
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - James S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
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21
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Pasrija C, Quinn R, Ghoreishi M, Eperjesi T, Lai E, Gorman RC, Gorman JH, Gorman RC, Pouch A, Cortez FV, D'Ambra MN, Gammie JS. A Novel Quantitative Ex Vivo Model of Functional Mitral Regurgitation. Innovations (Phila) 2021; 15:329-337. [PMID: 32830572 DOI: 10.1177/1556984520930336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/29/2022]
Abstract
OBJECTIVE Durability of mitral valve (MV) repair for functional mitral regurgitation (FMR) remains suboptimal. We sought to create a highly reproducible, quantitative ex vivo model of FMR that functions as a platform to test novel repair techniques. METHODS Fresh swine hearts (n = 10) were pressurized with air to a left ventricular pressure of 120 mmHg. The left atrium was excised and the altered geometry of FMR was created by radially dilating the annulus and displacing the papillary muscle tips apically and radially in a calibrated fashion. This was continued in a graduated fashion until coaptation was exhausted. Imaging of the MV was performed with a 3-dimensional (3D) structured-light scanner, which records 3D structure, texture, and color. The model was validated using transesophageal echocardiography in patients with normal MVs and severe FMR. RESULTS Compared to controls, the anteroposterior diameter in the FMR state increased 32% and the annular area increased 35% (P < 0.001). While the anterior annular circumference remained fixed, the posterior circumference increased by 20% (P = 0.026). The annulus became more planar and the tenting height increased 56% (9 to 14 mm, P < 0.001). The median coaptation depth significantly decreased (anterior leaflet: 5 vs 2 mm; posterior leaflet: 7 vs 3 mm, P < 0.001). The ex vivo normal and FMR models had similar characteristics as clinical controls and patients with severe FMR. CONCLUSIONS This novel quantitative ex vivo model provides a simple, reproducible, and inexpensive benchtop representation of FMR that mimics the systolic valvular changes of patients with FMR.
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Affiliation(s)
- Chetan Pasrija
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rachael Quinn
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mehrdad Ghoreishi
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Thomas Eperjesi
- 6572 Department of Surgery, University of Pennsylvania, PA, USA
| | - Eric Lai
- 6572 Department of Surgery, University of Pennsylvania, PA, USA
| | - Robert C Gorman
- 6572 Department of Surgery, University of Pennsylvania, PA, USA
| | - Joseph H Gorman
- 6572 Department of Surgery, University of Pennsylvania, PA, USA
| | - Robert C Gorman
- 6572 Department of Surgery, University of Pennsylvania, PA, USA
| | - Alison Pouch
- 6572 Department of Surgery, University of Pennsylvania, PA, USA
| | - Felino V Cortez
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael N D'Ambra
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James S Gammie
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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22
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Pasrija C, Quinn RW, Gammie JS. Reproducibility and Survival in Swine Structural Heart Research. Ann Thorac Surg 2021; 113:701-702. [PMID: 34022211 DOI: 10.1016/j.athoracsur.2021.04.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Chetan Pasrija
- Division of Cardiac Surgery, University of Maryland School of Medicine, 110 S Paca St, 7th Flr, Baltimore, MD 21201.
| | - Rachael W Quinn
- Division of Cardiac Surgery, University of Maryland School of Medicine, 110 S Paca St, 7th Flr, Baltimore, MD 21201
| | - James S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, 110 S Paca St, 7th Flr, Baltimore, MD 21201
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23
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Levy LE, Kaczorowski DJ, Pasrija C, Boyajian G, Mazzeffi M, Krause E, Shah A, Madathil R, Deatrick KB, Herr D, Griffith BP, Gammie JS, Taylor BS, Ghoreishi M. Peripheral cannulation for extracorporeal membrane oxygenation yields superior neurologic outcomes in adult patients who experienced cardiac arrest following cardiac surgery. Perfusion 2021; 37:745-751. [PMID: 33998349 DOI: 10.1177/02676591211018129] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest has improved mortality in post-cardiac surgery patients; however, loss of neurologic function remains one of the main and devastating complications. We reviewed our experience with ECPR and investigated the effect of cannulation strategy on neurologic outcome in adult patients who experienced cardiac arrest following cardiac surgery that was managed with ECPR. METHODS Patients were categorized by central versus percutaneous peripheral VA-extracorporeal membrane oxygenation (ECMO) cannulation strategy. We reviewed patient records and evaluated in-hospital mortality, cause of death, and neurologic status 72 hours after cannulation. RESULTS From January 2010 to September 2019, 44 patients underwent post-cardiac surgery ECPR for cardiac arrest. Twenty-six patients received central cannulation; 18 patients received peripheral cannulation. Mean post-operative day of the cardiac arrest was 3 and 9 days (p = 0.006), and mean time between initiation of CPR and ECMO was 40 ± 24 and 28 ± 22 minutes for central and peripheral cannulation, respectively. After 72 hours of VA-ECMO support, 30% of centrally cannulated patients versus 72% of peripherally cannulated patients attained cerebral performance status 1-2 (p = 0.01). Anoxic brain injury was the cause of death in 26.9% of centrally cannulated and 11.1% of peripherally cannulated patients. Survival to discharge was 31% and 39% for central and peripheral cannulation, respectively. CONCLUSIONS Peripheral VA-ECMO allows for continuous CPR and systemic perfusion while obtaining vascular access. Compared to central cannulation, a peripheral cannulation strategy is associated with improved neurologic outcomes and decreased likelihood of anoxic brain death.
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Affiliation(s)
- Lauren E Levy
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David J Kaczorowski
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Chetan Pasrija
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Gregory Boyajian
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael Mazzeffi
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eric Krause
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Aakash Shah
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ronson Madathil
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kristopher B Deatrick
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel Herr
- Department of Shock Trauma Critical Care, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bartley P Griffith
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James S Gammie
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bradley S Taylor
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mehrdad Ghoreishi
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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Tran D, Hays N, Shah A, Pasrija C, Cires-Drouet RS, Toursavadkohi SA, Mazzeffi MA, Herr DL, Madathil RJ, Gammie JS, Griffith BP, Deatrick KB, Kaczorowski DJ. Ultrasound-assisted catheter directed thrombolysis for pulmonary embolus during extracorporeal membrane oxygenation. J Card Surg 2021; 36:2685-2691. [PMID: 33982349 DOI: 10.1111/jocs.15622] [Citation(s) in RCA: 3] [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: 01/26/2021] [Revised: 03/29/2021] [Accepted: 04/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute pulmonary embolism (PE) is the third most common cause of cardiovascular death. For patients who are hemodynamically unstable, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support has been shown to provide hemodynamic stability, and allow time for definitive treatment and recovery. Ultrasound-assisted catheter directed thrombolysis (USAT) has the potential to be a safe adjunct and expedite right ventricular (RV) recovery for patients requiring VA-ECMO for PE. METHODS A review of all VA-ECMO patients from January 2017 to September 2019 was performed. A total of 49 of these patients were cannulated due to a PE. USAT therapy was used as an adjunct in 6 (12%) of these patients. These 6 patients were given standardized USAT therapy with EKOs catheters at 1 mg/h of tissue plasminogen activator with an unfractionated heparin infusion for additional systemic anticoagulation. Outcomes, including in-hospital death, 90-day survival, RV recovery, and complications, were examined in the cohort of patients that received USAT as an adjunct to ECMO. RESULTS Median age was 54 years old. Five of the six patients presented with a massive PE and had a PE severity score of Class V. One patient presented with a submassive PE with a Bova score of 2, but was cannulated to VA-ECMO in the setting of worsening RV function. All patients demonstrated recovery of RV function, were free from in-hospital death, and were alive at 90-day follow-up. CONCLUSION Ekosonic endovascular system therapy may be a safe and feasible adjunct for patients on VA-ECMO for PE, and allow for survival with RV recovery with minimal complications.
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Affiliation(s)
- Douglas Tran
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Nicole Hays
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Aakash Shah
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Chetan Pasrija
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Rafael S Cires-Drouet
- Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Shahab A Toursavadkohi
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Michael A Mazzeffi
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Daniel L Herr
- Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Ronson J Madathil
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - James S Gammie
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Bartley P Griffith
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Kristopher B Deatrick
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - David J Kaczorowski
- Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
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Pasrija C, Quinn RW, Gammie JS. Developing and Evaluating a Chronic Ischemic Mitral Regurgitation Animal Model. Ann Thorac Surg 2021; 113:1753-1754. [PMID: 33971172 DOI: 10.1016/j.athoracsur.2021.04.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Chetan Pasrija
- Division of Cardiac Surgery, University of Maryland School of Medicine, 110 S Paca St, 7th Flr, Baltimore, MD 21201.
| | - Rachael W Quinn
- Division of Cardiac Surgery, University of Maryland School of Medicine, 110 S Paca St, 7th Flr, Baltimore, MD 21201
| | - James S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, 110 S Paca St, 7th Flr, Baltimore, MD 21201
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Cires-Drouet RS, Nagarsheth K, Kaczorowski DJ, Toursavadkohi S, Deatrick K, Madathil RJ, Jones KM, Liskov S, Fitch J, Sayad M, Pasrija C, Mayorga-Carlin M, Herr D, Sorkin JD, Griffith B, Lal BK, Gammie JS. Catheter-based interventions versus medical and surgical approaches in acute pulmonary embolism. J Vasc Surg Venous Lymphat Disord 2021; 9:1382-1390. [PMID: 33965609 DOI: 10.1016/j.jvsv.2021.02.015] [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: 11/17/2020] [Accepted: 02/21/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Catheter-based intervention (CBI) has become an increasingly popular option for treating pulmonary embolism (PE); however, the real benefits are unknown. The purpose of the present study was to compare the outcomes of patients treated with CBI with the outcomes of those treated with medical or surgical approaches. METHODS We performed a retrospective analysis of patients admitted from October 2015 to December 2017 with a diagnosis of acute PE. We compared patients aged ≥18 years with a diagnosis of acute PE treated with CBI against a control group identified by propensity score matching. The control group was divided into those who had undergone surgical pulmonary embolectomy (SPE) as the surgical group and those who had not undergone SPE as the medical group. The primary outcome was mortality (in-hospital and overall mortality). The secondary outcomes were major bleeding, length of hospital stay, thrombus resolution, right ventricle improvement in systolic function and dilatation, and recurrent PE. RESULTS Of the 108 patients, 30 were in the CBI group and 78 were in the control group (62 in the medical group and 16 in the surgical group). The patient characteristics on admission were similar, except for the body mass index, which was greater in the CBI group (P = .03). No difference was found in clinical severity, clot burden, right ventricle function, or biomarkers. Recurrent PE was less frequent in the CBI group than in the medical group (0% vs 6.4%). Otherwise, no significant differences were found in the outcomes between the CBI and medical groups. When CBI was compared with the surgical group, SPE was associated with improved mortality (0% vs 16.6%) but a longer median length of hospital stay (median, 7 days; interquartile range, 3-12 days; vs median, 8 days; interquartile range, 6.5-17 days). CONCLUSIONS The use of CBI reduced the number of recurrent PE events compared with the medically treated patients; however, the mortality was higher than that in the surgical group.
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Affiliation(s)
- Rafael S Cires-Drouet
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Md; Department of Medicine, University of Maryland School of Medicine, Baltimore, Md.
| | - Khanjan Nagarsheth
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - David J Kaczorowski
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Shahab Toursavadkohi
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Baltimore Veterans Affairs Medical Center, Baltimore, Md
| | - Kristopher Deatrick
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Ronson J Madathil
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Kevin M Jones
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Md
| | - Steven Liskov
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Md
| | - Jeffrey Fitch
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Md
| | - Michelle Sayad
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Md
| | - Chetan Pasrija
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | | | - Daniel Herr
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - John D Sorkin
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Md; Baltimore Veterans Affairs Geriatrics Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center, Baltimore, Md
| | - Bartley Griffith
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Brajesh K Lal
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Baltimore Veterans Affairs Medical Center, Baltimore, Md
| | - James S Gammie
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
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Abstract
There is a severe shortage in the availability of donor organs for lung transplantation. Novel strategies are needed to optimize usage of available organs to address the growing global needs. Ex vivo lung perfusion has emerged as a powerful tool for the assessment, rehabilitation, and optimization of donor lungs before transplantation. In this review, we discuss the history of ex vivo lung perfusion, current evidence on its use for standard and extended criteria donors, and consider the exciting future opportunities that this technology provides for lung transplantation.
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Affiliation(s)
- Nikhil K. Prasad
- Department of Surgery, University of Maryland School of Medicine
| | - Chetan Pasrija
- Department of Surgery, University of Maryland School of Medicine
| | - Tara Talaie
- Department of Surgery, University of Maryland School of Medicine
| | | | - Yunge Zhao
- Department of Surgery, University of Maryland School of Medicine
| | - Christine L. Lau
- Department of Surgery, University of Maryland School of Medicine
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Powell E, Pasrija C, Menne A, Haase D, Ghoreishi M, Griffith B. Bedside VA-ECMO Cannulation for a Patient with CTEPH and RV Failure. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.2128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Ghoreishi M, Thourani VH, Badhwar V, Massad M, Svensson L, Taylor BS, Pasrija C, Gammie JS, Jacobs JP, Cox M, Grau-Sepulveda M, Brennan M, Griffith BP, Milliken JC, Abdelhady K, Kon Z. Less-Invasive Aortic Valve Replacement: Trends and Outcomes From The Society of Thoracic Surgeons Database. Ann Thorac Surg 2021; 111:1216-1223. [DOI: 10.1016/j.athoracsur.2020.06.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/01/2020] [Accepted: 06/08/2020] [Indexed: 10/23/2022]
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Shah A, Arons D, Pasrija C, Kon ZN, Ghoreishi M. Bedside angiography of distal perfusion catheter for veno-arterial extracorporeal membrane oxygenation. Perfusion 2021; 37:499-504. [PMID: 33781131 DOI: 10.1177/02676591211007017] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the ipsilateral lower extremity (ILE) outcomes of patients who underwent bedside angiography via the distal perfusion catheter while on femoral veno-arterial extracorporeal membrane oxygenation (VA ECMO). METHODS This is a retrospective analysis of all patients placed on VA ECMO at a single center from January 2017 to December 2019 who underwent bedside angiography via the distal perfusion catheter. RESULTS Twenty-four patients underwent bedside angiography via the distal perfusion catheter after being placed on VA ECMO. A vasodilator was directly administered in three patients for suspected spasm. One patient had distal thrombus and underwent thrombectomy and fasciotomy. One patient had a dislodged catheter and underwent thrombectomy, fasciotomy, and replacement of the catheter. One patient had severe ILE ischemia, however was not intervened upon due to critical acuity. Finally, one patient had inadvertent placement in the saphenous vein and had a new catheter placed in the SFA. No patients underwent amputation. Ultimately, 21 patients (87.5%) had no ILE compromise at the end their ECMO course. Survival to decannulation was 66.7% (n = 16). CONCLUSIONS Bedside angiography of the distal perfusion catheter is feasible and can be a useful adjunct in informing the need for further intervention to the ILE. CLASSIFICATIONS extracorporeal membrane oxygenation, ischemia.
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Affiliation(s)
- Aakash Shah
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Danielle Arons
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Chetan Pasrija
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Zachary N Kon
- Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, NY, USA
| | - Mehrdad Ghoreishi
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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Ghoreishi M, Pasrija C, Kon Z. Which one you rather have if you are fifty: TAVR vs. small - incision AVR vs. full sternotomy AVR. Ann Thorac Surg 2021; 113:2109-2110. [PMID: 33631149 DOI: 10.1016/j.athoracsur.2020.12.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/01/2022]
Affiliation(s)
- Mehrdad Ghoreishi
- University of Maryland School of Medicine, Cardiac Surgery, 2335 Unit 3, Boston Street Baltimore, MD 21224.
| | - Chetan Pasrija
- University of Maryland School of Medicine, Cardiac Surgery, 2335 Unit 3, Boston Street Baltimore, MD 21224
| | - Zachary Kon
- University of Maryland School of Medicine, Cardiac Surgery, 2335 Unit 3, Boston Street Baltimore, MD 21224
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Affiliation(s)
- Mehrdad Ghoreishi
- Department of Surgery, Division of Cardiac Surgery, University of Maryland School of Medicine, 110 S Paca St, 7th Floor, Baltimore, MD 21201.
| | - Chetan Pasrija
- Department of Surgery, Division of Cardiac Surgery, University of Maryland School of Medicine, 110 S Paca St, 7th Floor, Baltimore, MD 21201
| | - Zachary Kon
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY
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Pasrija C, Parchment N, Tran D, Mackowick K, Boulos F, Iacono A, Kim J, Griffith BP, Sanchez PG, Pham SM, Kon ZN. Strategic application of modular risk components to safely increase lung transplantation volume. J Card Surg 2020; 35:2177-2184. [PMID: 33448475 DOI: 10.1111/jocs.14874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/22/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Considerable growth of individual lung transplant programs remains challenging. We hypothesized that the systematic implementation of modular risk components to a lung transplantation program would allow for expeditious growth without increasing mortality. METHODS All consecutive patients placed on the lung transplantation waitlist were reviewed. Patients were stratified by an 18-month period surrounding the systematic implementation of the modular risk components Era 1 (1/2014-6/2015) and Era 2 (7/2015-12/2016). Modular risk components were separately evaluated for donors, recipients, and perioperative features. RESULTS One hundred and thirty-two waitlist patients (Era 1: 48 and Era 2: 84) and 100 transplants (Era 1: 32 and Era 2: 68) were identified. There was a trend toward decreased waitlist mortality (P = .07). In Era 2, the use of ex vivo lung perfusion (P = .05) and donor-recipient over-sizing (P = .005) significantly increased. Moreover, transplantation with a lung allocation score greater than 70 (P = .05), extracorporeal support (P = .06), and desensitization (P = .008) were more common. Transplant rate significantly improved from Era 1 to Era 2 (325 vs 535 transplants per 100 patient years, P = .02). While primary graft dysfunction (PGD) grade 3 at 72 hours (P = .05) was significantly higher in Era 2, 1-year freedom from rejection was similar (86% vs 90%, P = .69) and survival (81% vs 95%, P = .02) was significantly greater in Era 2. CONCLUSIONS The systematic implementation of a modular risk components to a lung transplantation program can result in a significant increase in center volume. However, measures to mitigate an expected increase in the incidence of PGD must be undertaken to maintain excellent short and midterm outcomes.
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Affiliation(s)
- Chetan Pasrija
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nathaniel Parchment
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Douglas Tran
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kristen Mackowick
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Francesca Boulos
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Aldo Iacono
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - June Kim
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Bartley P Griffith
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Pablo G Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, Florida
| | - Zachary N Kon
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
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Mazzeffi M, Bathula A, Tabatabai A, Menaker J, Kaczorowski D, Madathil R, Galvagno S, Pasrija C, Rector R, Tanaka K, Herr D. Von Willebrand Factor Concentrate Administration for Acquired Von Willebrand Syndrome- Related Bleeding During Adult Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2020; 35:882-887. [PMID: 32758410 DOI: 10.1053/j.jvca.2020.06.083] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To review the use of Von Willebrand Factor (VWF) concentrate for treatment of acquired Von Willebrand syndrome (VWS)-related bleeding in adult extracorporeal membrane oxygenation (ECMO) patients and determine if it was associated with improved VWF laboratory parameters. DESIGN Retrospective observational cohort study. SETTING Tertiary care academic medical center. PARTICIPANTS Adult ECMO patients who received VWF concentrate for treatment of acquired VWS- related bleeding. INTERVENTIONS None, observational study. MEASUREMENTS AND MAIN RESULTS Ten adult ECMO patients received VWF concentrate for treatment of bleeding with evidence of acquired VWS over a 15-month period. Six patients were on veno-arterial ECMO and 4 were on veno-venous ECMO. The most common site of bleeding was airway or tracheal bleeding. The mean dose of VWF concentrate was 41 IU/kg. Mean VWF antigen was 263 ± 93 IU/dL before treatment and 394 ± 54 after treatment. Mean ristocetin cofactor activity was 127 ± 47 IU/dL before treatment and 240 ± 33 after treatment. The mean VWF ristocetin cofactor activity antigen ratio increased from 0.52 ± 0.14 before treatment to 0.62 ± 0.04 after treatment. Four of 10 patients had complete resolution of their bleeding within 24 hours, and 6 of 10 had complete resolution of their bleeding within 2- to- 4 days. There were 3 patients who had thrombotic events potentially related to VWF concentrate administration. No patient had an arterial thrombosis, stroke, or myocardial infarction. CONCLUSIONS VWF concentrate administration increases VWF function in adult ECMO patients, but also may be associated with increased thrombotic risk. Larger studies are needed to determine VWF concentrate's safety, efficacy, and optimal dosing in adult ECMO patients.
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Affiliation(s)
- Michael Mazzeffi
- University of Maryland School of Medicine, Department of Anesthesiology, Baltimore, MD.
| | - Allison Bathula
- University of Maryland Medical Center, Department of Pharmacy, Baltimore, MD
| | - Ali Tabatabai
- University of Maryland School of Medicine, Department of Medicine, Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, MD
| | - Jay Menaker
- University of Maryland School of Medicine, Department of Surgery, Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, MD
| | - David Kaczorowski
- University of Maryland School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Baltimore, MD
| | - Ronson Madathil
- University of Maryland School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Baltimore, MD
| | - Samuel Galvagno
- University of Maryland School of Medicine, Department of Anesthesiology, Baltimore, MD
| | - Chetan Pasrija
- University of Maryland School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Baltimore, MD
| | - Raymond Rector
- University of Maryland School of Medicine, Department of Surgery, Division of Cardiothoracic Surgery, Baltimore, MD
| | - Kenichi Tanaka
- University of Maryland School of Medicine, Department of Anesthesiology, Baltimore, MD
| | - Daniel Herr
- University of Maryland School of Medicine, Department of Medicine, Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, MD
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Affiliation(s)
- Chetan Pasrija
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Aakash Shah
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David J. Kaczorowski
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christine L. Lau
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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Pasrija C, Sawan MA, Sorensen E, Voorhees HJ, Shah A, Wang L, Ton VK, DiChiacchio L, Kaczorowski DJ, Griffith BP, Pham SM, Kon ZN. Less Invasive Approach to Left Ventricular Assist Device Implantation May Improve Survival in High-Risk Patients. Innovations (Phila) 2020; 15:243-250. [PMID: 32379514 DOI: 10.1177/1556984520918959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 01/11/2023]
Abstract
OBJECTIVE Despite improvement in outcomes after left ventricular assist device (LVAD) implantation over the past 2 decades, high-risk recipients continue to have a prohibitive rate of morbidity and mortality. We hypothesized that a less invasive approach to LVAD implantation would be associated with improved survival compared to a conventional approach in this high-risk cohort. METHODS All consecutive LVAD recipients (2013 to 2017) that underwent centrifugal LVAD implantation were retrospectively reviewed. Patients were classified as high-risk if INTERMACS 1 or required temporary VAD/venoarterial extracorporeal membrane oxygenation prior to durable VAD implantation. Patients were stratified into 3 groups: left thoracotomy with hemi-sternotomy (LTHS) high-risk, conventional sternotomy (CS) high-risk, and non-high-risk. The primary outcome was 1-year survival. RESULTS A total of 57 patients (LTHS high-risk: 11, CS high-risk: 12, non-high-risk: 34) were identified. Preoperative right ventricular failure scores, HeartMate-II mortality scores, and end-organ dysfunction were similar between the 2 high-risk groups. While operative time was similar between the 3 groups, cardiopulmonary bypass time was significantly shorter in the LTHS high-risk group compared to other groups. There was a trend toward decreased intensive care unit length of stay and ventilator time in LTHS high-risk compared to CS high-risk patients. Moreover, between these 2 groups, there was a significant decrease in temporary right VAD support (50% vs 0%, P = 0.014), and 1-year survival was significantly higher in the LTHS group (42% vs 91%, P = 0.025). CONCLUSIONS Less invasive LVAD implantation appears to be associated with improved survival compared to conventional LVAD implantation in high-risk patients.
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Affiliation(s)
- Chetan Pasrija
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mariem A Sawan
- Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Erik Sorensen
- 21668 Division of Clinical Engineering, University of Maryland Medical Center, Baltimore, MD, USA
| | - Hannah Joy Voorhees
- 21668 Division of Clinical Engineering, University of Maryland Medical Center, Baltimore, MD, USA
| | - Aakash Shah
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Libin Wang
- Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Van-Khue Ton
- Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Laura DiChiacchio
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David J Kaczorowski
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bartley P Griffith
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Si M Pham
- 23389 Department of Cardiothoracic Surgery, Mayo Medical Center, Jacksonville, FL, USA
| | - Zachary N Kon
- 12297 Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
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Leibowitz JL, Pasrija C, Toursavadkohi SA, Kaczorowski DJ. Massive atrial thrombus 30 years after Adams-DeWeese IVC clip placement. J Card Surg 2020; 35:1335-1336. [PMID: 32333416 DOI: 10.1111/jocs.14553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Joshua L Leibowitz
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Chetan Pasrija
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Shahab A Toursavadkohi
- Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - David J Kaczorowski
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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Pasrija C, Tran D, George P, Sorensen E, Kaczorowski DJ, Ton VK, Kon ZN, Vorhees H, Sawan M, Griffith BP. Left ventricular assist device implantation may be feasible in appropriately selected patients with severe renal insufficiency. J Thorac Cardiovasc Surg 2020; 159:1307-1319.e2. [DOI: 10.1016/j.jtcvs.2019.03.098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 02/27/2019] [Accepted: 03/16/2019] [Indexed: 11/30/2022]
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Shah A, Pasrija C, Madathil RJ, Lau CL. Commentary: Does an expeditious evaluation for high-acuity lung transplant recipients make a difference? J Thorac Cardiovasc Surg 2020; 161:S0022-5223(20)30594-8. [PMID: 32622561 DOI: 10.1016/j.jtcvs.2020.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Aakash Shah
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Chetan Pasrija
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Ronson J Madathil
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Christine L Lau
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
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Ghoreishi M, Shah A, Jeudy J, Pasrija C, Lebowitz J, Kaczorowski D, Gupta A, Toursavadkohi S, Taylor BS. Endovascular Repair of Ascending Aortic Disease in High-Risk Patients Yields Favorable Outcome. Ann Thorac Surg 2020; 109:678-685. [DOI: 10.1016/j.athoracsur.2019.07.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/05/2019] [Accepted: 07/01/2019] [Indexed: 11/29/2022]
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Pasrija C, Bernstein DA, Rice M, Tran D, Morales D, Grintz T, Deatrick KB, Gammie JS, Madathil R, Kaczorowski DJ. Sutureless Closure of Arterial Cannulation Sites. Innovations (Phila) 2020; 15:138-141. [PMID: 32107959 DOI: 10.1177/1556984519899940] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Percutaneous femoral cannulation for venoarterial extracorporeal membrane oxygenation (ECMO) is commonly performed but percutaneous removal of arterial cannulas has not been broadly accepted. We hypothesized that a system that allows endovascular access to ECMO circuits along with the MANTA® large-bore vascular closure device could be used to successfully close arterial ECMO cannulation sites in a large animal model. METHODS Yorkshire swine (40 to 60 kg, n = 2) were used for this study. In the first swine, the infrarenal abdominal aorta was exposed. The aorta was cannulated once using a 15 Fr cannula and twice with a 19 Fr arterial cannula. A novel adaptor system that facilitates endovascular access to ECMO circuits was connected, and a 0.035″ Benston wire was placed through the adaptor and guided into the aorta. The cannula was removed over the wire and manual pressure was applied. The MANTA® sheath was inserted over the wire followed by the closure unit and was deployed. The process was repeated at 2 separate sites. A similar experiment was performed in a second swine, but through a median sternotomy to cannulate the ascending aorta. RESULTS Good hemostasis was achieved at all cannulation sites. Angiography demonstrated unobstructed flow across all closure sites with no evidence of extravasation. CONCLUSIONS The data presented here support the use of the MANTA® vascular closure device for the closure of arterial cannulation sites following ECMO decannulation and demonstrates utility of a novel adaptor system for establishing endovascular access in this context.
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Affiliation(s)
- Chetan Pasrija
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel A Bernstein
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Maryjoe Rice
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Douglas Tran
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David Morales
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Kristopher B Deatrick
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James S Gammie
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ronson Madathil
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David J Kaczorowski
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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DiChiacchio L, Boulos FM, Brigante F, Raithel M, Shah A, Pasrija C, Mackowick K, Menaker J, Mazzeffi M, Herr D, Kon ZN, Deatrick KB. Early tracheostomy after initiation of venovenous extracorporeal membrane oxygenation is associated with decreased duration of extracorporeal membrane oxygenation support. Perfusion 2020; 35:509-514. [PMID: 32020840 DOI: 10.1177/0267659119898327] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Timing of tracheostomy placement for patients with respiratory failure requiring venovenous extracorporeal membrane oxygenation support is variable and continues to depend on surgeon preference. We retrospectively reviewed all consecutive adult patients supported with peripheral venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome at a single institution with the hypothesis that early tracheostomy (within 7 days of extracorporeal membrane oxygenation initiation) decreases the duration of extracorporeal membrane oxygenation support. The primary endpoint was duration of extracorporeal membrane oxygenation support. Secondary endpoints included mortality, overall and intensive care unit length of stay, duration of mechanical ventilation, and time from extracorporeal membrane oxygenation initiation to liberation from ventilator, intensive care unit discharge, and hospital discharge. Overall and extracorporeal membrane oxygenation-associated hospital costs were compared. A total of 50 patients were identified for inclusion (early n = 21; late n = 29). Baseline characteristics including indices of disease severity were similar between groups. Duration of extracorporeal membrane oxygenation support was significantly shorter in the early tracheostomy group (12 vs. 21 days; p = 0.005). Median extracorporeal membrane oxygenation-related costs were significantly decreased in the early tracheostomy group ($3,624 vs. $5,603, p = 0.03). Early tracheostomy placement is associated with decreased time on extracorporeal membrane oxygenation support and reduced extracorporeal membrane oxygenation-related costs in this cohort. Validation in a prospective cohort or a clinical trial is indicated.
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Affiliation(s)
- Laura DiChiacchio
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Francesca M Boulos
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Francis Brigante
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Maxwell Raithel
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Aakash Shah
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Chetan Pasrija
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kristen Mackowick
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jay Menaker
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.,Lung Rescue Unit, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Michael Mazzeffi
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel Herr
- Department of Critical Care, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Zachary N Kon
- Department of Cardiothoracic Surgery, New York University-Langone Health, New York, NY, USA
| | - Kristopher B Deatrick
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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Mazzeffi M, Holmes SD, Alejo D, Fonner CE, Ghoreishi M, Pasrija C, Schena S, Metkus T, Salenger R, Whitman G, Ad N, Higgins RSD, Taylor B. Racial Disparity in Cardiac Surgery Risk and Outcome: Report From a Statewide Quality Initiative. Ann Thorac Surg 2020; 110:531-536. [PMID: 31962111 DOI: 10.1016/j.athoracsur.2019.11.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 06/08/2019] [Revised: 10/02/2019] [Accepted: 11/15/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Racial disparities persist in health care. Our study objective was to evaluate racial disparity in cardiac surgery in Maryland. METHODS A statewide database was used to identify patients. Demographics, comorbidities, and predicted risk of death were compared between races. Crude mortality and incidence of complications were compared between groups, as were risk-adjusted odds for mortality and major morbidity or mortality. RESULTS The study included 23,094 patients. Most patients were white (75.8%), followed by African American (16.3%), Asian (3.8%), and other races (4.1%). African Americans had a higher preoperative risk for mortality based on The Society of Thoracic Surgeons predictive models compared with white patients (3.0% vs 2.3%, P < .001). African Americans also had higher prevalence of diabetes mellitus, hypertension, peripheral vascular disease, and cerebral vascular disease than white patients. After adjustment for preoperative risk, there was no difference in 30-day mortality between African Americans (odds ratio [OR], 1.26; 95% confidence interval [CI], 0.99-1.59), Asians (OR, 1.22; 95% CI, 0.75-1.97), and other races (OR, 1.18; 95% CI, 0.74-1.89) compared with whites. African Americans had lower risk-adjusted odds of major morbidity or mortality compared with whites (OR, 0.83; 95% CI, 0.75-0.93). CONCLUSIONS African American cardiac surgical patients have the highest preoperative risk in Maryland. Patients appeared to receive excellent cardiac surgical care, regardless of race, as risk-adjusted mortality did not differ between groups, and African American patients had lower risk-adjusted odds of major morbidity or mortality than white patients. Future interventions in Maryland should be aimed at reducing preoperative risk disparity in cardiac surgical patients.
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Affiliation(s)
- Michael Mazzeffi
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Sari D Holmes
- Division of Cardiothoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Diane Alejo
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Clifford E Fonner
- Maryland Cardiac Surgery Quality Initiative, Inc, Baltimore, Maryland
| | - Mehrdad Ghoreishi
- Division of Cardiothoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Chetan Pasrija
- Division of Cardiothoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Stefano Schena
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas Metkus
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rawn Salenger
- Department of Cardiothoracic Surgery, St. Joseph Medical Center, University of Maryland, Towson, Maryland
| | - Glenn Whitman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Niv Ad
- Division of Cardiothoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland; Department of Cardiothoracic Surgery, Washington Adventist Hospital, Takoma Park, Maryland
| | - Robert S D Higgins
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bradley Taylor
- Division of Cardiothoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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Pasrija C, Tran D, Ghoreishi M, Kotloff E, Yim D, Finkel J, Holmes SD, Na D, Devlin S, Koenigsberg F, Dawood M, Quinn R, Griffith BP, Gammie JS. Degenerative Mitral Valve Repair Simplified: An Evolution to Universal Artificial Cordal Repair. Ann Thorac Surg 2019; 110:464-473. [PMID: 31863753 DOI: 10.1016/j.athoracsur.2019.10.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 03/08/2019] [Revised: 10/17/2019] [Accepted: 10/21/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Resectional and artificial cordal repair techniques are effective strategies for degenerative mitral valve (MV) repair. However, resectional repair requires a tailored approach using various techniques, whereas cordal repair offers a simpler, easily reproducible repair. The approach described in this study approach has evolved from resectional to cordal over time, and outcomes are compared between the eras. METHODS Clinical and echocardiographic outcomes of all patients undergoing MV repair for degenerative mitral regurgitation (MR) from January 2004 to September 2017 were reviewed. Patients were stratified by era: from January 2004 to June 2011 (era 1; n = 405), resectional techniques were used in 62% and artificial cordal techniques were used in 38%. From July 2011 to September 2017 (era 2; n = 438), artificial cordal repair was used in 98% of patients. The primary outcome was repair failure, defined as greater than moderate MR or MV reoperation. RESULTS Of 847 patients with degenerative MR, successful repair was achieved in 843 patients (99.5% repair rate). Leaflet prolapse was posterior in 66%, anterior in 8%, and bileaflet in 26%. Cardiopulmonary bypass time and cross-clamp times were shorter in era 2 (CPB: 109 [IQR, 92-128] minutes vs 97 [IQR, 76-121] minutes; P < .001; cross-clamp: 88 [IQR, 73-106] minutes vs. 79 [IQR, 61-99] minutes; P < .001). Predismissal echocardiography demonstrated no MR or trace MR in 95%, mild MR in 4.7%, and moderate MR in 0.3% of patients. Operative mortality was similar in the eras (0.5% vs 0.5%; P > .999). The rates of 5-year freedom from repair failure (95.1% vs 95.5%; P = .707), stroke (96.8% vs 95.3%; P = .538), and endocarditis (99.3% vs 99.7%; P = .604) were similar between the eras. CONCLUSIONS Artificial cordal repair for all patients with degenerative MR simplifies MV repair and yields equivalent, excellent outcomes compared with a tailored resectional approach.
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Affiliation(s)
- Chetan Pasrija
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Douglas Tran
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mehrdad Ghoreishi
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ethan Kotloff
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - David Yim
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Joshua Finkel
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sari D Holmes
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - David Na
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Stephen Devlin
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Filomena Koenigsberg
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Murtaza Dawood
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rachael Quinn
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bartley P Griffith
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - James S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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Voorhees HJ, Sorensen EN, Pasrija C, Kaczorowski D, Griffith BP, Kon ZN. Outcomes of obese patients undergoing less invasive LVAD implantation. J Card Surg 2019; 34:1465-1469. [DOI: 10.1111/jocs.14307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hannah J. Voorhees
- Department of Clinical Engineering University of Maryland Medical Center Baltimore Maryland
| | - Erik N. Sorensen
- Department of Clinical Engineering University of Maryland Medical Center Baltimore Maryland
| | - Chetan Pasrija
- Division of Cardiac Surgery University of Maryland School of Medicine Baltimore Maryland
| | - David Kaczorowski
- Division of Cardiac Surgery University of Maryland School of Medicine Baltimore Maryland
| | - Bartley P. Griffith
- Division of Cardiac Surgery University of Maryland School of Medicine Baltimore Maryland
| | - Zachary N. Kon
- Department of Cardiothoracic Surgery New York University Langone Health New York New York
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Pasrija C, Bittle GJ, Zhang J, Morales D, Tran D, Deatrick KB, Gammie JS, Wu Z, Griffith BP, Kon ZN, Kaczorowski DJ. A novel adaptor system enables endovascular access through extracorporeal life support circuits. J Thorac Cardiovasc Surg 2019; 158:1359-1366. [DOI: 10.1016/j.jtcvs.2019.02.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/25/2019] [Accepted: 02/09/2019] [Indexed: 12/28/2022]
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DiChiacchio L, Singh AK, Lewis B, Zhang T, Hardy N, Pasrija C, Morales D, Odonkor P, Strauss E, Williams B, Deatrick KB, Kaczorowski DJ, Ayares D, Griffith BP, Bartlett ST, Mohiuddin MM. Early Experience With Preclinical Perioperative Cardiac Xenograft Dysfunction in a Single Program. Ann Thorac Surg 2019; 109:1357-1361. [PMID: 31589847 DOI: 10.1016/j.athoracsur.2019.08.090] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 02/11/2019] [Revised: 07/16/2019] [Accepted: 08/28/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Perioperative cardiac xenograft dysfunction (PCXD) was described by McGregor and colleagues as a major barrier to the translation of heterotopic cardiac xenotransplantation into the orthotopic position. It is characterized by graft dysfunction in the absence of rejection within 24 to 48 hours of transplantation. We describe our experience with PCXD at a single program. METHODS Orthotopic transplantation of genetically engineered pig hearts was performed in 6 healthy baboons. The immunosuppression regimen included induction by anti-CD20 monoclonal antibodies (mAb), thymoglobulin, cobra venom factor, and anti-CD40 mAb, and maintenance with anti-CD40 mAb, mycophenolate mofetil, and tapering doses of steroids. Telemetry was used to assess graft function. Extracorporeal membrane oxygenation was used to support 1 recipient. A full human clinical transplantation team was involved in these experiments and the procedure was performed by skilled transplantation surgeons. RESULTS A maximal survival of 40 hours was achieved in these experiments. The surgical procedures were uneventful, and all hearts were weaned from cardiopulmonary bypass without issue. Support with inotropes and vasopressors was generally required after separation from cardiopulmonary bypass. The cardiac xenografts performed well immediately, but within the first several hours they required increasing support and ultimately resulted in arrest despite maximal interventions. All hearts were explanted immediately; histology showed no signs of rejection. CONCLUSIONS Despite excellent surgical technique, uneventful weaning from cardiopulmonary bypass, and adequate initial function, orthotopic cardiac xenografts slowly fail within 24 to 48 hours without evidence of rejection. Modification of preservation techniques and minimizing donor organ ischemic time may be able to ameliorate PCXD.
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Affiliation(s)
- Laura DiChiacchio
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Avneesh K Singh
- Department of Surgery, University of Maryland Baltimore, School of Medicine, Baltimore, Maryland
| | - Billeta Lewis
- Department of Surgery, University of Maryland Baltimore, School of Medicine, Baltimore, Maryland
| | - Tianshu Zhang
- Department of Surgery, University of Maryland Baltimore, School of Medicine, Baltimore, Maryland
| | - Naomi Hardy
- Department of Pathology, University of Maryland Medical Center, Baltimore, Maryland
| | - Chetan Pasrija
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - David Morales
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Patrick Odonkor
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Erik Strauss
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Brittney Williams
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | | | - David J Kaczorowski
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | | | - Bartley P Griffith
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Stephen T Bartlett
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Muhammad M Mohiuddin
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland.
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Pasrija C, Sawan MA, Sorensen E, Voorhees H, Shah A, Strauss E, Ton VK, DiChiacchio L, Kaczorowski DJ, Griffith BP, Pham SM, Kon ZN. Less invasive left ventricular assist device implantation may reduce right ventricular failure. Interact Cardiovasc Thorac Surg 2019; 29:592-598. [DOI: 10.1093/icvts/ivz143] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 05/08/2019] [Accepted: 05/13/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
OBJECTIVES
Right ventricular (RV) failure after left ventricular assist device (LVAD) implantation continues to be a morbid complication. In this study, we hypothesized that a less invasive approach to implantation would preserve RV function relative to a conventional sternotomy (CS) approach.
METHODS
All patients (2013–2017) who underwent LVAD implantation were reviewed. Patients were stratified by surgical approach: less invasive left thoracotomy with hemi-sternotomy (LTHS) and CS. The primary outcome was severe RV failure.
RESULTS
Eighty-three patients (LTHS: 37, CS: 46) were identified. The median Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) score was significantly worse in the LTHS compared to the CS cohort, and there was a trend towards higher RV failure scores and HeartMate II mortality scores. Preoperative RV dysfunction, in pulmonary artery pulsatility index and RV stroke work index were similar between the 2 groups. Though operative time did not significantly differ between the 2 groups, cardiopulmonary bypass time was significantly shorter in the LTHS group (61 vs 95 min, P < 0.001). The incidence of postoperative severe RV failure was significantly reduced in the LTHS group (16% vs 39%, P = 0.030), along with the need for temporary right ventricular assist device (3% vs 26%, P = 0.005). Improvement in RV function, along with a change in pulmonary artery pulsatility index, was significantly greater in the LTHS cohort. There was a trend towards improved Kaplan–Meier 1-year survival in the LTHS cohort (91% vs 56%, P = 0.056).
CONCLUSIONS
In this cohort, less invasive LVAD implantation appears to be associated with reduced postoperative RV failure, and equivalent or improved survival compared to conventional LVAD implantation.
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Affiliation(s)
- Chetan Pasrija
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mariem A Sawan
- Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Erik Sorensen
- Division of Clinical Engineering, University of Maryland Medical Center, Baltimore, MD, USA
| | - Hannah Voorhees
- Division of Clinical Engineering, University of Maryland Medical Center, Baltimore, MD, USA
| | - Aakash Shah
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Erik Strauss
- Department of Anaesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Van-Khue Ton
- Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Laura DiChiacchio
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David J Kaczorowski
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bartley P Griffith
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Medical Center, Jacksonville, FL, USA
| | - Zachary N Kon
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
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Ghoreishi M, Sundt TM, Cameron DE, Holmes SD, Roselli EE, Pasrija C, Gammie JS, Patel HJ, Bavaria JE, Svensson LG, Taylor BS. Factors associated with acute stroke after type A aortic dissection repair: An analysis of the Society of Thoracic Surgeons National Adult Cardiac Surgery Database. J Thorac Cardiovasc Surg 2019; 159:2143-2154.e3. [PMID: 31351776 DOI: 10.1016/j.jtcvs.2019.06.016] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 05/18/2019] [Accepted: 06/03/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Data from the Society of Thoracic Surgeons Adult Cardiac Surgery Database was used to examine the incidence and factors associated with acute stroke following type A repair. METHODS Acute type A aortic dissection repairs performed from 2014 to 2017 were identified from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. The effect of cannulation strategy (eg, axillary, femoral, direct, or innominate), lowest temperature, cerebral protection techniques (antegrade cerebral profusion, retrograde cerebral perfusion, both, or none), repair technique, and institutional volume on postoperative stroke was investigated. RESULTS Acute type A repair was performed on 8937 patients at 772 centers, of which 7353 met inclusion criteria. Operative mortality was 17% and incidence of postoperative stroke was 13%. Axillary cannulation was associated with lower risk of stroke versus femoral (odds ratio, 0.60; P < .001). Retrograde cerebral perfusion was associated with reduced risk for stroke compared with no cerebral perfusion (odds ratio, 0.75; P = .008) or antegrade cerebral perfusion (odds ratio, 0.75; P = .007). Total arch replacement was associated with greater risk for stroke versus hemiarch technique (odds ratio, 1.30; P = .013). Longer circulatory arrest time, cerebral perfusion time, and cardiopulmonary bypass time were all related to higher risk of postoperative stroke. CONCLUSIONS Stroke is a common complication after type A repair. Axillary cannulation was associated with lower incidence of stroke, whereas femoral cannulation significantly increased the risk of stroke regardless of the cerebral perfusion strategy or the degree of hypothermia. Retrograde cerebral profusion was found to have reduced risk for postoperative stroke. Degree of hypothermia and center volume were not related to stroke incidence.
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Affiliation(s)
- Mehrdad Ghoreishi
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md.
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Duke E Cameron
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Sari D Holmes
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Eric E Roselli
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Chetan Pasrija
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - James S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md
| | | | - Joseph E Bavaria
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Lars G Svensson
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bradley S Taylor
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md
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Pasrija C, Bedeir K, Jeudy J, Kon ZN. Harlequin Syndrome during Venoarterial Extracorporeal Membrane Oxygenation. Radiol Cardiothorac Imaging 2019; 1:e190031. [PMID: 33778505 PMCID: PMC7970096 DOI: 10.1148/ryct.2019190031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/05/2019] [Accepted: 04/18/2019] [Indexed: 05/21/2023]
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