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Wadiwala I, Garg P, Alamouti-Fard E, Landolfo K, Sareyyupoglu B, Ahmed MES, Jacob S, Pham S. Absorbable antibiotic beads for treatment of LVAD driveline infections. Artif Organs 2024; 48:559-566. [PMID: 38400624 DOI: 10.1111/aor.14721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/11/2023] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
BACKGOUND Infections of the left ventricular assist device (LVAD) driveline are a dreaded complication that results in high mortality and morbidity. METHOD We retrospectively reviewed five consecutive patients with severe continuous-flow LVAD (HVAD, Heartmate 2, and Heartmate 3) driveline infection. These infections, which developed on an average of 960.4 ± 843.9 days after LVAD placement, were refractory to systemic antibiotics and local wound care. All were treated with extensive surgical debridement, local installation of absorbable antibiotic-loaded calcium sulfate beads (vancomycin and tobramycin), primary wound closure, and 6 weeks of systemic antibiotics after surgery. RESULTS Four patients had resolution of DLI, and one had a recurrent infection at another part of the driveline 7 months after the complete resolution of the previous site. This patient was successfully treated with debridement and bead placements. Three patients still have their LVADs, while two received orthotopic heart transplants. At the time of the transplant, there was no evidence of gross infection of the LVAD drivelines or pumps. At the average follow-up time of 425.8 ± 151 days, no patients have an active infection. CONCLUSION Treatment of LVAD driveline infection with absorbable antibiotic beads with primary wound closure is a viable option and merits further investigation.
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Affiliation(s)
- Ishaq Wadiwala
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA
| | - Pankaj Garg
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA
| | - Emad Alamouti-Fard
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA
| | - Kevin Landolfo
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA
| | - Basar Sareyyupoglu
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Samuel Jacob
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA
| | - Si Pham
- Cardiothoracic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA
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Jang JM, Jarmi T, Sareyyupoglu B, Nativi J, Patel PC, Leoni JC, Landolfo K, Pham S, Yip DS, Goswami RM. Axillary mechanical circulatory support improves renal function prior to heart transplantation in patients with chronic kidney disease. Sci Rep 2023; 13:19671. [PMID: 37952046 PMCID: PMC10640571 DOI: 10.1038/s41598-023-46901-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/07/2023] [Indexed: 11/14/2023] Open
Abstract
Impaired kidney function is often associated with acute decompensation of chronic heart failure and portends a poor prognosis. Unfortunately, current data have demonstrated worse survival in patients with acute kidney injury than in patients with chronic kidney disease during durable LVAD placement as bridge therapy. Furthermore, end-stage heart failure patients undergoing combined heart-kidney transplantation have poorer short- and long-term survival than heart transplants alone. We evaluated the kidney function recovery in our heart failure population awaiting heart transplantation at our institution, supported by temporary Mechanical Circulatory Support (tMCS) with Impella 5.5. The protocol (#22004000) was approved by the Mayo Clinic institutional review board, after which we performed a retrospective review of all patients with acute on chronic heart failure and kidney disease in patients considered for only heart and kidney combined organ transplant and supported by tMCS between January 2020 and February 2021. Hemodynamic and kidney function trends were recorded and analyzed before and after tMCS placement and transplantation. After placement of tMCS, we observed a trend towards improvement in creatinine, Fick cardiac index, mixed venous saturation, and glomerular filtration rate (GFR), which persisted through transplantation and discharge. The average duration of support with tMCS was 16.5 days before organ transplantation. The median pre-tMCS creatinine was 2.1 mg/dL (IQR 1.75-2.3). Median hematocrit at the time of tMCS placement was 32% (IQR 32-34), and the median estimated glomerular filtration rate was 34 mL/min/BSA (34-40). The median GFR improved to 44 mL/min/BSA (IQR 45-51), and serum creatinine improved to 1.5 mg/dL (1.5-1.8) after tMCS. Median discharge creatinine was 1.1 mg/dL (1.19-1.25) with a GFR of 72 (65-74). None of these six patients supported with tMCS required renal replacement therapy after heart transplantation. Early adoption of Impella 5.5 in this patient population resulted in renal recovery without needing renal replacement therapies or dual organ transplantation and should be further evaluated.
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Affiliation(s)
- Ji-Min Jang
- Division of Heart Failure and Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32246, USA
| | - Tambi Jarmi
- Division of Transplant Nephrology, Mayo Clinic Florida, Jacksonville, USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, USA
| | - Jose Nativi
- Division of Heart Failure and Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32246, USA
| | - Parag C Patel
- Division of Heart Failure and Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32246, USA
| | - Juan C Leoni
- Division of Heart Failure and Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32246, USA
| | - Kevin Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, USA
| | - Si Pham
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, USA
| | - Daniel S Yip
- Division of Heart Failure and Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32246, USA
| | - Rohan M Goswami
- Division of Heart Failure and Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32246, USA.
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Paciotti BL, Garg P, Ritchie CA, Landolfo K, Sareyyupoglu B. Aggressive Management of a Bilateral Chylothorax Complicating an Orthotopic Heart-Kidney Transplantation. Braz J Cardiovasc Surg 2023; 38:e20230041. [PMID: 37801652 PMCID: PMC10552658 DOI: 10.21470/1678-9741-2023-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/16/2023] [Indexed: 10/08/2023] Open
Abstract
Chylothorax after an orthotopic heart transplant is a rare but potentially detrimental occurrence. This is the first reported case of bilateral chylothorax complicating a heart-kidney transplant patient. No universally accepted protocol exists for the management of chylothorax in general population, let alone the immunocompromised transplant patient. This case presents unique challenges to the management of postoperative chylothorax given heart-kidney transplant's effect on the patient's volume status and immunocompromised state. We make the argument for aggressive treatment of chylothorax in an immunocompromised heart-kidney transplant patient to limit complications in a patient population predisposed to infection.
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Affiliation(s)
- Breah Lynn Paciotti
- Department of Cardiothoracic Surgery, Mayo Clinic Florida,
Jacksonville, Florida, United States of America
| | - Pankaj Garg
- Department of Cardiothoracic Surgery, Mayo Clinic Florida,
Jacksonville, Florida, United States of America
| | - Charles A. Ritchie
- Department of Radiology, Mayo Clinic Florida, Jacksonville,
Florida, United States of America
| | - Kevin Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic Florida,
Jacksonville, Florida, United States of America
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic Florida,
Jacksonville, Florida, United States of America
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Paghdar S, Desai S, Jang JM, Ruiz J, Malkani S, Patel P, Yip DS, Leoni JC, Nativi J, Sareyyupoglu B, Landolfo K, Pham S, Goswami RM. One-year survival in recipients older than 50 bridged to heart transplant with Impella 5.5 via axillary approach. J Geriatr Cardiol 2023; 20:319-329. [PMID: 37397862 PMCID: PMC10308172 DOI: 10.26599/1671-5411.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Optimizing patients with advanced heart failure before orthotopic heart transplantation (OHT), especially in patients greater than 50 years old, is imperative to achieving successful post-transplant outcomes. Complications are well-described for patients bridged to transplant (BTT) with durable left ventricular assist device (LVAD) support. Given the lack of data available in older recipients after the recent increase in mechanical support use, we felt it crucial to report our center's one-year outcomes in older recipients after heart transplantation with percutaneously placed Impella 5.5 as a BTT. METHODS Forty-nine OHT patients were supported with the Impella 5.5 intended as a bridge between December 2019 and October 2022 at Mayo Clinic in Florida. Data were extracted from the electronic health record at baseline and during their transplant episode of care after Institutional Review Boards approval as exempt for retrospective data collection. RESULTS Thirty-eight patients aged 50 or older were supported with Impella 5.5 as BTT. Ten patients underwent heart and kidney transplantation within this cohort. The median age at OHT was 63 (58-68) years, with 32 male (84%) and six female patients (16%). Etiology was divided into ischemic (63%) and non-ischemic cardiomyopathy (37%). The baseline median ejection fraction was 19% (15-24). Most patients were in blood group O (60%), and 50% were diabetic. The average duration of support was 27 days (range 6-94). The median duration of follow-up is 488 days (185-693). For patients that have reached the 1-year follow-up timeframe (22 of 38, 58%), the 1-year post-transplant survival is 95%. CONCLUSION Our single-center data provides awareness for using the Impella 5.5 percutaneously placed axillary support device in older heart failure patients in cardiogenic shock as a bridge to transplantation. One-year survival outcomes after heart transplantation are excellent despite the older recipient's age and prolonged pre-transplant support.
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Affiliation(s)
- Smit Paghdar
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, USA
| | - Smruti Desai
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, USA
| | - Ji-Min Jang
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, USA
| | - Jose Ruiz
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, USA
| | - Sharan Malkani
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, USA
| | - Parag Patel
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, USA
| | - Daniel S Yip
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, USA
| | - Juan C Leoni
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, USA
| | - Jose Nativi
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, USA
| | | | - Kevin Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic in Florida, USA
| | - Si Pham
- Department of Cardiothoracic Surgery, Mayo Clinic in Florida, USA
| | - Rohan M Goswami
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, USA
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Haddad O, Sareyyupoglu B, Goswami RM, Bitargil M, Patel PC, Jacob S, El-Sayed Ahmed MM, Leoni Moreno JC, Yip DS, Landolfo K, Pham SM. Short-term outcomes of heart transplant patients bridged with Impella 5.5 ventricular assist device. ESC Heart Fail 2023. [PMID: 37137732 PMCID: PMC10375168 DOI: 10.1002/ehf2.14391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 01/15/2023] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
AIMS We sought to investigate the outcomes of heart transplant patients supported with Impella 5.5 temporary mechanical circulatory support. METHODS AND RESULTS Patient demographics, perioperative data, hospital timeline, and haemodynamic parameters were followed during initial admission, Impella support, and post-transplant period. Vasoactive-inotropic score, primary graft failure, and complications were recorded. Between March 2020 and March 2021, 16 advanced heart failure patients underwent Impella 5.5 temporary left ventricular assist device support through axillary approach. Subsequently, all these patients had heart transplantation. All patients were either ambulatory or chair bound during their temporary mechanical circulatory support until heart transplantation. Patients were kept on Impella support median of 19 days (3-31) with the median lactate dehydrogenase level of 220 (149-430). All Impella devices were removed during heart transplantation. During Impella support, patients had improved renal function with median creatinine serum level of 1.55 mg/dL decreased to 1.25 (P = 0.007), pulmonary artery pulsatility index scores increased from 2.56 (0.86-10) to 4.2 (1.3-10) (P = 0.048), and right ventricular function improved (P = 0.003). Patients maintained improved renal function and favourable haemodynamics after their heart transplantation as well. All patients survived without any significant morbidity after their heart transplantation. CONCLUSIONS Impella 5.5 temporary left ventricular assist device optimizes care of heart transplant recipients providing superior haemodynamic support, mobility, improved renal function, pulmonary haemodynamics, and right ventricular function. Utilizing Impella 5.5 as a direct bridging strategy to heart transplantation resulted in excellent outcomes.
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Affiliation(s)
- Osama Haddad
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Rohan M Goswami
- Department of Transplantation, Mayo Clinic Hospital, Jacksonville, FL, USA
| | - Macit Bitargil
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Parag C Patel
- Department of Transplantation, Mayo Clinic Hospital, Jacksonville, FL, USA
| | - Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Magdy M El-Sayed Ahmed
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | | | - Daniel S Yip
- Department of Transplantation, Mayo Clinic Hospital, Jacksonville, FL, USA
| | - Kevin Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
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Wadiwala I, Garg P, Nativi J, Lyle M, Leoni J, Yip D, Goswami R, Patel P, Sareyyupoglu B, MM E, Jacob S, Landolfo K, Pham S. The Role of Impella 5.5 to Reduce Pulmonary Artery Pressures in Patients with Cardiac Amyloidosis with Small Ventricular Cavity as a Bridge to Heart Transplant. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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7
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Balasubramanian P, Thomas M, Makey I, Alvarez F, Narula T, Pham S, Landolfo K, Ahmed MES, Jacob S, Shah S, Mallea J. Remote vs Local Ex-Vivo Lung Perfusion, a Single Center Experience. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1441] [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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8
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Jang J, Ruiz J, Desai S, Sareyyupoglu B, Paghdar S, Malkani S, Landolfo K, Patel P, Nativi J, Yip D, Lyle M, Leoni J, Pham S, Goswami R. Mid-Term Survival in Patients with Advanced Heart Failure Receiving an Impella Device Intended as Bridge to Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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9
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Jacob S, Ahmed MMES, Haddad OK, Orlando D, Landolfo C, Thomas M, Makey IA, Sareyyupoglu B, Landolfo K, Pham SM. Regression of Tricuspid Valve Regurgitation After Lung Transplant: A Single-Center Experience. Transplant Proc 2022; 54:2325-2328. [PMID: 36058747 DOI: 10.1016/j.transproceed.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/07/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although tricuspid regurgitation (TR) is common in candidates for lung transplant, no data or established guidelines exist regarding the need for surgical repair at the time of transplant. We aimed to evaluate the natural course of TR by assessing the incidence and extent of TR regression among patients who did not undergo tricuspid valve repair (TVR) concomitantly with lung transplant. METHODS We retrospectively identified adult patients who underwent lung transplant without TVR at our institution from 2001 through 2017. Pretransplant and posttransplant echocardiograms were reviewed to assess severity of TR, tricuspid annular plane systolic excursion, central venous pressure, mean pulmonary arterial pressure, and right ventricular size and function. RESULTS Among 553 included patients, 324 (58.7%) were men, the mean (SD) age was 61.9 years (12.7), and 417 (75.4%) had a double lung transplant. TR before transplant was reported as trivial in 265 patients (47.9%), mild in 235 (42.5%), moderate in 40 (7.2%), and severe in 13 (2.4%). After transplant, TR improved significantly overall (P < .001). TR improved in 193 patients: 158 patients (81.9%) by 1 grade and 35 patients (18.1%) by 2 or more grades. Additionally, of 53 patients with pretransplant moderate or severe TR, 44 (83%) had improvement to mild, trivial, or no TR. After transplant, 12 patients (2.2%) had no remaining TR. CONCLUSION The severity of TR improved or showed no change in most patients after lung transplant, which obviates the need for TVR among most lung transplant recipients.
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Affiliation(s)
- Samuel Jacob
- Department of Cardiothoracic Surgery Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida.
| | - Magdy M El-Sayed Ahmed
- Department of Cardiothoracic Surgery Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - Osama K Haddad
- Department of Cardiothoracic Surgery, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - David Orlando
- Clinical Research Internship Study Program, Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - Carolyn Landolfo
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | - Mathew Thomas
- Department of Cardiothoracic Surgery Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - Ian A Makey
- Department of Cardiothoracic Surgery Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - Kevin Landolfo
- Department of Cardiothoracic Surgery Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
| | - Si M Pham
- Department of Cardiothoracic Surgery Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida
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Ghannam A, Gharacholou SM, Ball CT, Pollak PM, Parikh PP, Landolfo C, Ali MT, Landolfo K. Characteristics and Outcomes After Transcatheter Aortic Valve Implantation in Immunocompromised Patients. Am J Cardiol 2022; 173:100-105. [PMID: 35367046 DOI: 10.1016/j.amjcard.2022.02.049] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/10/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022]
Abstract
Immunocompromised (IC) patients are at greater risk of adverse outcomes from cardiac surgery, and less invasive options for treating severe aortic stenosis among IC patients are often sought. However, despite greater preference for transcatheter aortic valve implantation (TAVI) in this population, there are limited data on outcomes in IC patients. Between January 2015 and December 2019, we studied patients with severe aortic stenosis who underwent TAVI. We defined IC status by the presence of active malignancy and receipt of oncologic treatment, post-organ transplantation-associated immunosuppression, human immunodeficiency virus, chronic steroid use (>5 mg/day), or active autoimmune disorder, and compared characteristics and outcomes of IC patients with those of non-IC patients. Of 173 patients who underwent TAVI, 56 (32%) were IC, 30 (54%) had active malignancy and underwent active treatment, 19 (34%) were IC without malignancy, and 7 (13%) were both IC and had active malignancy. IC patients, compared with non-IC patients, had similar baseline demographics, Society of Thoracic Surgeons risk scores (median 4.3% vs 4.4%), and overall complications (29% vs 26%). There were 37 deaths (16 IC and 21 non-IC) over a median follow-up of 17 months (95% confidence interval [CI] 14 to 20 months), and 1-year survival after TAVI was 84.0% for IC patients and 89.0% for non-IC patients (p = 0.51 by log-rank). After adjusting for Society of Thoracic Surgeons risk scores, IC patients had a nonsignificant trend toward greater risk of death compared with non-IC patients (adjusted hazard ratio 1.48, 95% CI 0.77 to 2.84). IC patients had a significantly smaller risk of cardiac-related death (adjusted hazard ratio 0.21, 95% CI 0.05 to 0.98) but a greater risk of noncardiac-related death (adjusted hazard ratio 4.14, 95% CI 1.71 to 10.0) than non-IC patients. In conclusion, IC patients who underwent TAVI have similar complication rates as non-IC patients, with a nonsignificant trend toward greater mortality, specifically related to noncardiac causes.
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Affiliation(s)
- Alexander Ghannam
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | | | - Colleen T Ball
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - Peter M Pollak
- Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, FL
| | | | - Carolyn Landolfo
- Department of Cardiovascular Disease, Mayo Clinic, Jacksonville, FL
| | - Mays T Ali
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Kevin Landolfo
- Department of Cardiac Surgery, Mayo Clinic, Jacksonville, Florida
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11
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Bitargil M, Haddad O, Pham SM, Garg N, Jacob S, El-Sayed Ahmed MM, Landolfo K, Patel PC, Goswami RM, Leoni Moreno JC, Yip DS, Sareyyupoglu B. Packing the donor heart: Is SherpaPak cold preservation technique safer compared to ice cold storage. Clin Transplant 2022; 36:e14707. [PMID: 35543679 DOI: 10.1111/ctr.14707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 04/27/2022] [Accepted: 05/03/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The present study aimed to compare the clinical outcomes of heart transplant patients whose donor hearts were preserved with the SherpaPak controlled cold organ system versus the conventional ice storage technique. METHODS All patients undergoing heart transplantation at our center between January 2019 and April 2021 were divided into two groups according to the technique used during donor heart preservation and transport. The first group consisted of 34 SherpaPak controlled temperature preservation patients, and the second group consisted of 47 patients where the conventional three bags and ice technique was utilized during organ transportation. The two groups were compared based on demographics, operative details, and postoperative outcomes. RESULTS There were no significant differences between the groups regarding Vasoactive Inotropic Score (VIS), Primary Graft Dysfunction (PGD), and the need for a transient pacer. However, the VIS, PGD, and pacing trends were lower in the SherpaPak patients even though the total ischemic and cardiopulmonary bypass times were significantly longer. Furthermore, SherpaPak patients exhibited a shorter stay in the ICU with no severe PGD and mortality. CONCLUSION The SherpaPak donor heart preservation provides safe outcomes in heart transplant patients. Further research is needed to utilize this method for longer durations of ischemic time and expand travel distances for organ transportation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Macit Bitargil
- Mayo Clinic Hospital, Department of Cardiothoracic Surgery, Jacksonville, Florida, USA
| | - Osama Haddad
- Mayo Clinic Hospital, Department of Cardiothoracic Surgery, Jacksonville, Florida, USA
| | - Si M Pham
- Mayo Clinic Hospital, Department of Cardiothoracic Surgery, Jacksonville, Florida, USA
| | - Neha Garg
- Mayo Clinic Hospital, Department of Cardiothoracic Surgery, Jacksonville, Florida, USA
| | - Samuel Jacob
- Mayo Clinic Hospital, Department of Cardiothoracic Surgery, Jacksonville, Florida, USA
| | | | - Kevin Landolfo
- Mayo Clinic Hospital, Department of Cardiothoracic Surgery, Jacksonville, Florida, USA
| | - Parag C Patel
- Mayo Clinic Hospital, Department of Transplantation, Jacksonville, Florida, USA
| | - Rohan M Goswami
- Mayo Clinic Hospital, Department of Transplantation, Jacksonville, Florida, USA
| | | | - Daniel S Yip
- Mayo Clinic Hospital, Department of Transplantation, Jacksonville, Florida, USA
| | - Basar Sareyyupoglu
- Mayo Clinic Hospital, Department of Cardiothoracic Surgery, Jacksonville, Florida, USA
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12
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Bitargil M, Haddad O, Pham SM, Goswami RM, Patel PC, Jacob S, El‐Sayed Ahmed MM, Leoni Moreno JC, Yip DS, Landolfo K, Sareyyupoglu B. Controlled temperatures in cold preservation provides safe heart transplantation results. J Card Surg 2022; 37:732-738. [DOI: 10.1111/jocs.16243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/01/2021] [Accepted: 11/10/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Macit Bitargil
- Department of Cardiothoracic Surgery Mayo Clinic Hospital Jacksonville Florida USA
| | - Osama Haddad
- Department of Cardiothoracic Surgery Mayo Clinic Hospital Jacksonville Florida USA
| | - Si M. Pham
- Department of Cardiothoracic Surgery Mayo Clinic Hospital Jacksonville Florida USA
| | - Rohan M. Goswami
- Department of Transplantation Mayo Clinic Hospital Jacksonville Florida USA
| | - Parag C. Patel
- Department of Transplantation Mayo Clinic Hospital Jacksonville Florida USA
| | - Samuel Jacob
- Department of Cardiothoracic Surgery Mayo Clinic Hospital Jacksonville Florida USA
| | | | | | - Daniel S. Yip
- Department of Transplantation Mayo Clinic Hospital Jacksonville Florida USA
| | - Kevin Landolfo
- Department of Cardiothoracic Surgery Mayo Clinic Hospital Jacksonville Florida USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery Mayo Clinic Hospital Jacksonville Florida USA
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Melody M, Butts E, Menke D, Landolfo K, Oken K, Sher T, Khurana S. Use of Tocilizumab in Management of Post-Operative Myelomonocytic Leukemoid Reaction. Leuk Res Rep 2020; 14:100228. [PMID: 33240789 PMCID: PMC7672312 DOI: 10.1016/j.lrr.2020.100228] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 11/26/2022] Open
Abstract
Interleukin 6 receptor (IL6R) inhibitor, tocilizumab, has been effectively used in the treatment of cytokine release syndrome in patients receiving chimeric antigen receptor T-cell therapy. Here we present a patient with chronic myelomonocytic leukemia (CMML) who developed a steroid refractory, post-operative myelomonocytic leukemoid reaction (PO-MMLR), effectively treated with tocilizumab. Although, further studies are needed to validate the effectiveness of tocilizumab in management of PO-MMLR, this case serves to provide a new management approach in treatment of this rare but lethal syndrome with no standardized treatment options.
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Affiliation(s)
- Megan Melody
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Emily Butts
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - David Menke
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, United States
| | - Kevin Landolfo
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Keith Oken
- Department of Cardiology, Mayo Clinic, Jacksonville, FL, United States
| | - Taimur Sher
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL, United States
| | - Sharad Khurana
- Division of Hematology-Oncology, University of Arizona Cancer Center, Tucson, AZ, United States
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14
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Haddad O, Landolfo K. Commentary: Is 80 really the new 60? J Thorac Cardiovasc Surg 2020; 162:1533-1534. [PMID: 32417068 DOI: 10.1016/j.jtcvs.2020.04.022] [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: 04/02/2020] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Osama Haddad
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Fla
| | - Kevin Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Fla.
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15
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Stinson G, Patel P, Yip D, Leoni-Moreno J, Ung R, Landolfo K, Pham S, Sareyyupoglu B, Goswami R. Assessment of Aortic Root Size in Donor Heart Predicts Short and Long Term Recipient Outcomes after Orthotopic Heart Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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16
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Landolfo K, Haddad O. Commentary: How Should We Build The Wall? The Importance of Sternal Closure. Semin Thorac Cardiovasc Surg 2020; 32:253-254. [PMID: 32114111 DOI: 10.1053/j.semtcvs.2020.02.027] [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] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/21/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Kevin Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, Florida.
| | - Osama Haddad
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, Florida
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17
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Pham AN, Patel PC, Landolfo K, Burns JM, Yip DS, Leoni Moreno JC, Goswami RM, Jacob S, El‐Sayed Ahmed MM, Makey IA, Thomas M, Mai ML, Taner CB, Pham SM. Kidney transplantation on extracorporeal life support for primary cardiac allograft dysfunction. J Card Surg 2020; 35:725-728. [DOI: 10.1111/jocs.14451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Anthony N. Pham
- Department of Cardiothoracic SurgeryMayo ClinicJacksonville Florida
| | - Parag C. Patel
- Department of TransplantationMayo ClinicJacksonville Florida
| | - Kevin Landolfo
- Department of Cardiothoracic SurgeryMayo ClinicJacksonville Florida
| | - Justin M. Burns
- Department of TransplantationMayo ClinicJacksonville Florida
| | - Daniel S. Yip
- Department of TransplantationMayo ClinicJacksonville Florida
| | | | | | - Samuel Jacob
- Department of Cardiothoracic SurgeryMayo ClinicJacksonville Florida
| | | | - Ian A. Makey
- Department of Cardiothoracic SurgeryMayo ClinicJacksonville Florida
| | - Mathew Thomas
- Department of Cardiothoracic SurgeryMayo ClinicJacksonville Florida
| | - Martin L. Mai
- Department of TransplantationMayo ClinicJacksonville Florida
| | - C. Burcin Taner
- Department of TransplantationMayo ClinicJacksonville Florida
| | - Si M. Pham
- Department of Cardiothoracic SurgeryMayo ClinicJacksonville Florida
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18
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Makey IA, Jacob S, El-Sayed Ahmed MM, Pham S, Landolfo K, Thomas M. Latissimus muscle sparing approach to subscapular rib fracture plating. Trauma Case Rep 2019; 24:100247. [PMID: 31872020 PMCID: PMC6911933 DOI: 10.1016/j.tcr.2019.100247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/28/2019] [Accepted: 09/19/2019] [Indexed: 11/25/2022] Open
Abstract
Surgical stabilization of fractured ribs has been shown to improve trauma related outcomes, however the procedure itself can be a source of morbidity. This report details two cases of latissimus dorsi muscle sparing sub-scapular multi-rib fracture plating. We combined several techniques to make this possible. The first technique was use of a vertical skin incision along the anterior border of the latissimus muscle. The second was the use of a mammary retractor to provide adequate and sustained retraction of the latissimus and scapula. The third was utilization of a right angle screwdriver to allow placement of the posterior screws. Sparing the latissimus muscle for sub-scapular fractures is possible but requires planning and extra equipment to perform. Minimizing rib fixation related morbidity makes it a more appealing treatment.
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Affiliation(s)
- Ian A Makey
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | | | - Si Pham
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Kevin Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
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19
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Jacob S, Meneses A, Landolfo K, El-Sayed Ahmed M, Makey IA, Pham SM, Thomas M. Incidence, Management, and Outcomes of Chylothorax after Lung Transplantation: A Single-center Experience. Cureus 2019; 11:e5190. [PMID: 31341753 PMCID: PMC6649881 DOI: 10.7759/cureus.5190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background The objective of this study was to determine the incidence and outcomes of chylothorax after lung transplantation. Methods We conducted a retrospective review of our institutional lung transplant registry of 504 adult transplantations done from 2001 to 2015 and identified seven patients (1.38%) with chylothorax. Electronic health records were then analyzed to determine demographics, indications for surgery, management, and outcomes. Survival curves were plotted using the Kaplan-Meier method. Results Chylothorax presented in the first week in four (62.5%) patients, and approximately one month later in the remaining three. Nonsurgical management was initially attempted in all patients and succeeded in three (42.9%). Elective surgical ligation of the thoracic duct (LTD) was successful in two (66.7%) out of three patients in whom it was performed. One patient required emergent reoperation for clamshell thoracotomy dehiscence from severe chylothorax. Thoracic duct embolization was attempted but unsuccessful in two patients. Subsequently, one of these patients received a peritoneal-venous shunt and the other underwent LTD. Chylothorax permanently resolved in six patients (85.7%). There were no mortalities directly related to chylothorax. The median time to resolution was 11 days (range: 7-60). The mean survival in months for chylothorax patients was 29.2 (SE 3.1) and 78.2 (SE 2.9) for the remaining patients (p = 0.37). The median survival was not reached for the chylothorax group and was 71.8 months (95% CI: 58.0-83.9) for the rest. Conclusion Chylothorax is rare after lung transplantation but can lead to major comorbidities and prolonged hospital stay. In our experience, nonsurgical management was successful in up to 40% of patients. LTD should be considered in those who fail conservative management.
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Affiliation(s)
- Samuel Jacob
- Cardiothoracic Surgery, Mayo Clinic, Jacksonville, USA
| | - Axel Meneses
- Cardiothoacic Surgery, Mayo Clinic, Jacksonville, USA
| | | | | | - Ian A Makey
- Cardiothoraic Surgery, Mayo Clinic, Jacksonville, USA
| | - Si M Pham
- Cardiothoracic Surgery, Mayo Clinic, Jacksonville, USA
| | - Mathew Thomas
- Cardiothoracic Surgery, Mayo Clinic, Jacksonville, USA
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Jacob S, Lima B, Gonzalez‐Stawinski GV, El‐Sayed Ahmed MM, Patel PC, Belli EV, Makey IA, Thomas M, Landolfo K, Landolfo C, Leoni Moreno JC, Yip DS, Pham SM. Extracorporeal membrane oxygenation as a salvage therapy for patients with severe primary graft dysfunction after heart transplant. Clin Transplant 2019; 33:e13538. [DOI: 10.1111/ctr.13538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/27/2019] [Accepted: 03/09/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Samuel Jacob
- Department of Cardiothoracic Surgery Mayo Clinic Jacksonville Florida
| | - Brian Lima
- Department of Cardiothoracic Surgery Baylor University Medical Center Dallas Texas
| | | | - Magdy M. El‐Sayed Ahmed
- Department of Cardiothoracic Surgery Mayo Clinic Jacksonville Florida
- Department of Surgery, Faculty of Medicine Zagazig University Zagazig Egypt
| | - Parag C. Patel
- Division of Transplant Medicine Mayo Clinic Jacksonville Florida
| | - Erol V. Belli
- Department of Cardiothoracic Surgery Mayo Clinic Jacksonville Florida
| | - Ian A. Makey
- Department of Cardiothoracic Surgery Mayo Clinic Jacksonville Florida
| | - Mathew Thomas
- Department of Cardiothoracic Surgery Mayo Clinic Jacksonville Florida
| | - Kevin Landolfo
- Department of Cardiothoracic Surgery Mayo Clinic Jacksonville Florida
| | - Carolyn Landolfo
- Department of Cardiovascular Medicine Mayo Clinic Jacksonville Florida
| | | | - Daniel S. Yip
- Division of Transplant Medicine Mayo Clinic Jacksonville Florida
| | - Si M. Pham
- Department of Cardiothoracic Surgery Mayo Clinic Jacksonville Florida
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21
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Allen KB, Icke KJ, Thourani VH, Naka Y, Grubb KJ, Grehan J, Patel N, Guy TS, Landolfo K, Gerdisch M, Bonnell M. Sternotomy closure using rigid plate fixation: a paradigm shift from wire cerclage. Ann Cardiothorac Surg 2018; 7:611-620. [PMID: 30505745 DOI: 10.21037/acs.2018.06.01] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Rigid plate fixation (RPF) is the cornerstone in managing fractures and osteotomies except for sternotomy, where most cardiac surgeons continue to use wire cerclage (WC). Results of a multicenter randomized trial evaluating sternal healing, sternal complications, patient reported outcome measures (PROMs), and costs after sternotomy closure with RPF or WC are summarized here. Methods Twelve US centers randomized 236 patients to either RPF (n=116) or WC (n=120). The primary endpoint, sternal healing at 6 months, was evaluated by a core laboratory using computed tomography and a validated 6-point scale (greater scores represent greater healing). Secondary endpoints assessed through 6 months included sternal complications and PROMs. Costs from the time of sternal closure through 90 days and 6 months were analyzed by a health economic core laboratory. Results RPF compared to WC resulted in better sternal healing scores at 3 (2.6±1.1 vs. 1.8±1.0; P<0.0001) and 6 months (3.8±1.0 vs. 3.3±1.1; P=0.0007) and higher sternal union rates at 3 [41% (42/103) vs. 16% (16/102); P<0.0001] and 6 months [80% (81/101) vs. 67% (67/100); P=0.03]. There were fewer sternal complications with RPF through 6 months [0% (0/116) vs. 5% (6/120); P=0.03] and a trend towards fewer sternal wound infections [0% (0/116) vs. 4.2% (5/120); P=0.06]. All PROMs including sternal pain, upper extremity function (UEF), and quality-of-life scores were numerically better in RPF patients compared to WC patients at all follow-up time points. Although RPF was associated with a trend toward higher index hospitalization costs, a trend towards lower follow-up costs resulted in total costs that were $1,888 less at 90 days in RPF patients compared to WC patients (95% CI: -$8,889 to $4,273; P=0.52) and $1,646 less at 6 months (95% CI: -$9,127 to $4,706; P=0.61). Conclusions Sternotomy closure with RPF resulted in significantly better sternal healing, fewer sternal complications, improved PROMs and was cost neutral through 90 days and 6 months compared to WC.
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Affiliation(s)
- Keith B Allen
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | | | | | | | | | | | | | | | | | - Marc Gerdisch
- Franciscan St. Francis Health, Indianapolis, IN, USA
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22
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Austin CO, Landolfo K, Parikh PP, Patel PC, Venkatachalam KL, Kusumoto FM. Retained cardiac implantable electronic device fragments are not associated with magnetic resonance imaging safety issues, morbidity, or mortality after orthotopic heart transplant. Am Heart J 2017; 190:46-53. [PMID: 28760213 DOI: 10.1016/j.ahj.2017.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 12/24/2016] [Accepted: 04/25/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cardiac implantable electronic device therapy (CIED) has revolutionized treatment for advanced heart failure. Most patients considered for orthotopic heart transplantation (OHT) are treated with implantable cardioverter defibrillators, cardiac resynchronization therapy, or both. These CIEDs are surgically extracted at the time of transplant. Occasionally, CIEDs are incompletely removed. Little is known about the outcomes of post-OHT patients with retained CIED fragments. METHODS We identified 200 consecutive patients that underwent OHT at our institution between April 2006 and December 2014 and performed a retrospective analysis of available radiographic images and clinical records. Chest radiographs prior to and following OHT were reviewed for the presence of CIED or retained CIED fragments. The outcomes of patients with retained CIED fragments that had subsequent magnetic resonance imaging (MRI) studies performed were further investigated. RESULTS One hundred eighty of 200 patients were identified as having CIED prior to OHT, of which 29 had retained CIED fragments after OHT. Most retained CIED fragments originated from superior vena cava defibrillator coils. There were no adverse events in the retained CIED fragment cohort, and survival was unaffected. Ten patients with retained CIED fragments safely underwent a total of 28 MRIs after OHT, all of diagnostic quality. CONCLUSION Retained CIED fragments are not associated with adverse events or increased mortality after OHT. Diagnostic MRI has been safely performed in patients with retained CIED fragments after incomplete device extraction. Retrieval of these fragments prior to MRI does not appear warranted given the demonstrated safety and preserved image quality in this population.
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Affiliation(s)
| | - Kevin Landolfo
- Division of Cardiovascular Surgery, Mayo Clinic Florida, Jacksonville, FL
| | - Pragnesh P Parikh
- Division of Cardiovascular Disease, Mayo Clinic Florida, Jacksonville, FL
| | - Parag C Patel
- Division of Transplant Medicine, Mayo Clinic Florida, Jacksonville, FL
| | - K L Venkatachalam
- Division of Cardiovascular Disease, Mayo Clinic Florida, Jacksonville, FL
| | - Fred M Kusumoto
- Division of Cardiovascular Disease, Mayo Clinic Florida, Jacksonville, FL
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23
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Landolfo K, Belli E. Secondary sclerosing cholangitis following cardiac surgery: An uncommon but deadly gastrointestinal complication. J Thorac Cardiovasc Surg 2017. [PMID: 28625770 DOI: 10.1016/j.jtcvs.2017.05.019] [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] [Indexed: 10/19/2022]
Affiliation(s)
- Kevin Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, Fla.
| | - Erol Belli
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, Fla
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24
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Allen KB, Thourani VH, Naka Y, Grubb KJ, Grehan J, Patel N, Guy TS, Landolfo K, Gerdisch M, Bonnell M, Cohen DJ. Randomized, multicenter trial comparing sternotomy closure with rigid plate fixation to wire cerclage. J Thorac Cardiovasc Surg 2017; 153:888-896.e1. [DOI: 10.1016/j.jtcvs.2016.10.093] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/11/2016] [Accepted: 10/12/2016] [Indexed: 11/26/2022]
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25
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Landolfo K, Belli E. An evolving paradigm for adult extracorporeal membrane oxygenation: Should the indications include patients with sepsis? J Thorac Cardiovasc Surg 2016; 152:1479-1480. [PMID: 27842680 DOI: 10.1016/j.jtcvs.2016.09.025] [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: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Kevin Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, Fla.
| | - Erol Belli
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, Fla
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26
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Blackshear JL, Kusumoto H, Safford RE, Wysokinska E, Thomas CS, Waldo OA, Stark ME, Shapiro BP, Ung S, Moussa I, Agnew RC, Landolfo K, Chen D. Usefulness of Von Willebrand Factor Activity Indexes to Predict Therapeutic Response in Hypertrophic Cardiomyopathy. Am J Cardiol 2016; 117:436-42. [PMID: 26705879 DOI: 10.1016/j.amjcard.2015.11.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/03/2015] [Accepted: 11/03/2015] [Indexed: 11/18/2022]
Abstract
Degraded by shear stress, loss of high-molecular-weight multimers of von Willebrand factor (VWF) correlates strongly with pressure gradient in aortic stenosis (AS) and obstructive hypertrophic cardiomyopathy (HC). We assessed VWF tests before and after interventions in HC and contrasted the severity of abnormalities in HC to patients with AS, mitral regurgitation, and left ventricular assist devices. Ninety patients with median (interquartile range) age 66 (53 to 72) years, 51% men, with HC had assessments of 3 VWF parameters and B-type natriuretic peptide before and after 26 discreet medical/pacing interventions, 22 alcohol septal ablations, and 28 ventricular septal myectomies. VWF multimers were abnormal in 87% of patients with obstructive HC versus 48% of patients with latent obstruction (p = 0.0001). VWF measurements correlated with peak instantaneous left ventricular outflow tract gradient, Spearman ρ 0.51 to 0.61, p <0.0001. For B-type natriuretic peptide, correlation with left ventricular outflow tract gradient was weaker, ρ = 0.37, p = 0.0005, but stronger with septal thickness or mitral E/e'. In pre-/post-medical treatment of HC, VWF multimers were abnormal in 73%/68% of patients, p = 0.74; pre-/post-septal ablation 74%/26%, p = 0.0035; and pre-/post-septal myectomy 75%/0%, p <0.0001. In obstructive HC, the degree VWF multimer loss was greater than in severe AS or severe mitral regurgitation and overlapped that seen in left ventricular assist devices. In conclusion, VWF activity indexes were predictably abnormal in patients with HC with resting obstruction to a degree where bleeding could be anticipated, accurately reflected gradient changes after intervention, and demonstrated complete normalization after septal myectomy.
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Affiliation(s)
- Joseph L Blackshear
- Department of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, Florida.
| | | | - Robert E Safford
- Department of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, Florida
| | | | - Colleen S Thomas
- Department of Health Sciences Research, Mayo Clinic Florida, Jacksonville, Florida
| | - Oral A Waldo
- Cardiovascular Diseases Fellowship Program, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Mark E Stark
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida
| | - Brian P Shapiro
- Department of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, Florida
| | - Steven Ung
- Department of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, Florida
| | - Issam Moussa
- First Coast Cardiovascular, Jacksonville, Florida
| | - Richard C Agnew
- Division of Thoracic and Cardiovascular Surgery, Mayo Clinic Florida, Jacksonville, Florida
| | - Kevin Landolfo
- Division of Thoracic and Cardiovascular Surgery, Mayo Clinic Florida, Jacksonville, Florida
| | - Dong Chen
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota
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27
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Affiliation(s)
- Erol Belli
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Kevin Landolfo
- Department of Cardiothoracic Surgery and Transplantation, Mayo Clinic Florida, Jacksonville, FL, USA
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28
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Belli E, Leoni Moreno JC, Hosenpud J, Rawal B, Landolfo K. Preoperative risk factors predict survival following cardiac retransplantation: analysis of the United Network for Organ Sharing database. J Thorac Cardiovasc Surg 2014; 147:1972-7, 1977.e1. [PMID: 24636155 DOI: 10.1016/j.jtcvs.2014.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 10/22/2013] [Revised: 01/20/2014] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of our study was to identify preoperative risk factors affecting overall survival after cardiac retransplantation (ReTX) in a contemporary era. METHODS The United Network for Organ Sharing database was used to identify patients undergoing ReTX between 1995 and 2012. Of the total 28,464 primary transplants performed, 987 (3.5%) were retransplants. The primary outcome investigated was overall survival. The influence of preoperative donor and recipient characteristics on survival were then tested with univariate logistic regression and multivariate Cox regression models. RESULTS Of 987 patients who underwent ReTX, median survival was 9 years. Estimated survival at 1, 3, 5, 10, and 15 years following retransplant was 80% (95% confidence interval [CI], 78%-83%), 70% (95% CI, 67%-73%), 64% (95% CI, 61%-67%), 47% (95% CI, 43%-51%), and 30% (95% CI, 25%-37%), respectively. Clinical predictors of survival using multivariable analysis included donor age (relative risk [RR], 1.14; P = .004), ischemic time > 4 hours (RR, 1.48; P = .004); preoperative support with extracorporeal membrane oxygenator (RR, 3.91; P < .001), and the time between previous and current transplant (P = .004). Patients with ReTX have 1.27 times higher relative risk of death compared with patients undergoing primary transplant only (RR, 1.27; 95% CI, 1.13-1.42; P < .001). CONCLUSIONS Patients who undergo cardiac ReTX can expect to have a 1-year survival less than a patient undergoing primary transplant with an acceptable median overall survival. Both donor and recipient preoperative factors contribute to overall survival following cardiac ReTx. Donor characteristics include age of the donor and ischemic time. Recipient factors include the need for extracorporeal membrane oxygenator and the number of days between the first and second transplant. Optimal survival following cardiac ReTX can best be predicted by choosing patients who are farther out from their initial transplant, not dependent upon preoperative extracorporeal support, and by choosing donor hearts younger in age and those likely to have shorter ischemic times.
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Affiliation(s)
- Erol Belli
- Department of Surgery, Mayo Clinic Florida, Jacksonville, Fla
| | | | - Jeffrey Hosenpud
- Department of Cardiology, Mayo Clinic Florida, Jacksonville, Fla
| | - Bhupendra Rawal
- Department of Biostatistics and Bioinformatics, Mayo Clinic Florida, Jacksonville, Fla
| | - Kevin Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, Fla
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Conlon PJ, Stafford-Smith M, Neary JJ, Crowley J, Stack R, White WD, Newman MF, Landolfo K. Renal Artery Stenosis is Not Associated with the Development of Acute Renal Failure Following Coronary Artery Bypass Grafting. Ren Fail 2009. [DOI: 10.1081/jdi-42779] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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30
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Clark JA, Bar-Yosef S, Anderson A, Newman MF, Landolfo K, Grocott HP. Postoperative Hyperthermia Following Off-Pump Versus On-Pump Coronary Artery Bypass Surgery. J Cardiothorac Vasc Anesth 2005; 19:426-9. [PMID: 16085244 DOI: 10.1053/j.jvca.2005.01.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2004] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Hyperthermia is common in the first 24 hours following coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CPB). An inflammatory response to CPB is often implicated in the pathophysiology of this fever. Unlike CABG with CPB, the temperature pattern after off-pump CABG (OPCAB), where CPB is avoided, has not yet been described. The purpose of this study was to describe the postoperative temperature pattern following OPCAB and to compare it with that following on-pump cardiac surgery. DESIGN Retrospective, observational study. SETTING Tertiary care university hospital. PARTICIPANTS Consenting patients undergoing CABG or OPCAB procedures. INTERVENTIONS Observational. MEASUREMENTS AND MAIN RESULTS Of the CABG patients, 89% had temperature elevations above 38 degrees C, versus 44% of the OPCAB patients (P = 0.04). Peak body temperature was higher in the on-pump patients (CABG 38.5 degrees C +/- 0.4 degrees C versus OPCAB 37.9 degrees C +/- 0.5 degrees C; P = 0.002), as was the area under the curve for temperatures greater than 38 degrees C (CABG 1.6 +/- 1.7 degrees C/hr versus OPCAB 0.4 +/- 1.2 degrees C/hr; P = 0.02). CONCLUSIONS Off-pump CABG surgery patients experience less hyperthermia compared with on-pump CABG patients. The reasons for a lower incidence and severity of hyperthermia after OPCAB surgery are not known, but may be related to a reduced inflammatory response.
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Affiliation(s)
- Jeffrey A Clark
- Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA
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Conlon PJ, Crowley J, Stack R, Neary JJ, Stafford-Smith M, White WD, Newman MF, Landolfo K. Renal artery stenosis is not associated with the development of acute renal failure following coronary artery bypass grafting. Ren Fail 2005; 27:81-6. [PMID: 15717639] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Acute renal failure (ARF) is a frequent complication of coronary artery bypass grafting (CABG) surgery and is strongly associated with perioperative morbidity and mortality. We hypothesized that renal artery stenosis (RAS), causing occult renal ischemia, may be an important factor contributing to development of ARF after CABG surgery. METHODS Preoperative and intraoperative data on 798 consecutive adult patients undergoing CABG surgery with cardiopulmonary bypass from February 1, 1995 to February 1, 1997 (who had also undergone an abdominal aortogram for the evaluation of RAS) were recorded and entered into a computerized database. The development of ARF was defined as a rise in serum creatinine of 1 mg/dL (88.4 micromol/L) above baseline postoperatively. The association between the presence of renal artery stenosis together with preoperative and intraoperative variables and the development of ARF was assessed by multivariate logistic regression. RESULTS A total of 798 patients underwent isolated coronary bypass grafting, of which 18.7% demonstrated 50% or more RAS. ARF developed in 82 patients (10.2%), of which three (0.3%) required dialysis support. The mortality for patients who developed ARF was 14% (OR 15, P=0.0001) compared to 0.2% among those who did not develop ARF. The presence of renal artery stenosis of any severity ranging from unilateral 50% RAS to bilateral 95% RAS was not associated with the subsequent development of ARF. CONCLUSIONS The development of ARF following CABG surgery is associated with high mortality. The presence of RAS does not appear to increase the risk for developing ARF.
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Affiliation(s)
- Peter J Conlon
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
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Conlon P, Stafford-Smith M, Neary J, Crowley J, Stack R, White W, Newman M, Landolfo K. Renal Artery Stenosis is Not Associated with the Development of Acute Renal Failure Following Coronary Artery Bypass Grafting. Ren Fail 2005. [DOI: 10.1081/jdi-200042779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Phillips Bute B, Mathew J, Blumenthal JA, Welsh-Bohmer K, White WD, Mark D, Landolfo K, Newman MF. Female gender is associated with impaired quality of life 1 year after coronary artery bypass surgery. Psychosom Med 2003; 65:944-51. [PMID: 14645771 DOI: 10.1097/01.psy.0000097342.24933.a2] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate gender-related differences in quality of life (QOL) and cognitive function 1 year after coronary artery bypass surgery (CABG) after adjusting for known baseline differences. MATERIALS AND METHODS Two hundred eighty patients (96 women and 184 men) underwent neurocognitive and QOL evaluation at baseline (preoperatively) and at 1 year after CABG. Multivariable linear regression was used to assess the relationship of gender to follow-up QOL and cognitive function. Measures used to evaluate QOL were IADL, DASI, work activities (SF-36), social activities, social support, general health perception (SF-36), CESD, STAI, and symptom limitations. Cognitive function was measured with a battery of performance-based neuropsychological tests, reduced to a four-cognitive domain scores with factor analysis, and a self-report measure of cognitive difficulties. Covariates in multiple regression models included age, years of education, marital status, Charlson Comorbidity Index, hypertension, diabetes, race, and baseline QOL/cognitive status. RESULTS Female patients showed significantly worse outcome than male patients at 1 year follow-up in several key areas of QOL. After adjusting for baseline differences, women are at greater risk for increased cognitive difficulties (p= 0.04) and anxiety (p= 0.03), as well as impaired DASI (p= 0.02), IADL (p= 0.03), and work activities (p= 0.02). Cognitive sequelae attributable to bypass surgery were similar between men and women. CONCLUSIONS Even after adjusting for known risk factors for compromised QOL and cognitive functioning, women do not show the same long-term quality benefits of CABG surgery that men do.
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Affiliation(s)
- Barbara Phillips Bute
- Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
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Newman MF, Grocott HP, Mathew JP, White WD, Landolfo K, Reves JG, Laskowitz DT, Mark DB, Blumenthal JA. Report of the substudy assessing the impact of neurocognitive function on quality of life 5 years after cardiac surgery. Stroke 2001; 32:2874-81. [PMID: 11739990 DOI: 10.1161/hs1201.099803] [Citation(s) in RCA: 244] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The importance of perioperative cognitive decline has long been debated. We recently demonstrated a significant correlation between perioperative cognitive decline and long-term cognitive dysfunction. Despite this association, some still question the importance of these changes in cognitive function to the quality of life of patients and their families. The purpose of our investigation was to determine the association between cognitive dysfunction and long-term quality of life after cardiac surgery. METHODS After institutional review board approval and patient informed consent, 261 patients undergoing cardiac surgery with cardiopulmonary bypass were enrolled and followed for 5 years. Cognitive function was measured with a battery of tests at baseline, discharge, and 6 weeks and 5 years postoperatively. Quality of life was assessed with well-validated, standardized assessments at the 5-year end point. RESULTS Our results demonstrate significant correlations between cognitive function and quality of life in patients after cardiac surgery. Lower 5-year overall cognitive function scores were associated with lower general health and a less productive working status. Multivariable logistic and linear regression controlling for age, sex, education, and diabetes confirmed this strong association in the majority of areas of quality of life. CONCLUSIONS Five years after cardiac surgery, there is a strong relationship between neurocognitive functioning and quality of life. This has important social and financial implications for preoperative evaluation and postoperative care of patients undergoing cardiac surgery.
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Affiliation(s)
- M F Newman
- Department of Anesthesiology, Division of Neurology, Duke University Medical Center, Durham, NC, USA.
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Abstract
OBJECTIVE To measure the changes in systolic and diastolic left ventricular function that occur during off-pump coronary artery bypass grafting (OPCAB) as a consequence of positioning the heart and interrupting coronary flow. METHODS 2-D Transoesophageal echocardiography was used to derive systolic wall motion indices and pulsed Doppler parameters of diastolic function including the E/A ratio, PVS/PVD ratio, and deceleration time. A continuous cardiac output thermodilution pulmonary artery catheter was used to provide hemodynamic measures of left ventricular function. Data was obtained prior to, during and following coronary grafting. RESULTS Thirty-four consecutive anastomoses were evaluated, including eight circumflex (LCX), 17 left anterior descending artery (LAD) and nine right coronary artery (RCA) anastamoses. Significant changes in diastolic and systolic cardiac function were identified in those patients who underwent LCX grafting. Specifically during LCX grafting, both wall motion score index (2.4+/-1.4 vs 1.5+/-0.63 and 1.9+/-0.91) and the E/A ratio were significantly increased (3.5+/-1.4 vs 1.1+/-0.33 and 1.2+/-0.44) when compared to RCA and LAD grafting, respectively. The PVS/PVD ratio was significantly decreased during left circumflex grafting (0.7+/-0.45 vs 1.1+/-0.19 and 1.0+/-0.58) when compared to RCA and LAD grafting, respectively. All functional parameters returned to baseline by the end of surgery. CONCLUSIONS Multivessel OPCAB can be achieved with mild impairment of left ventricular function that returns to baseline by the end of the procedure. Impairment of diastolic function is most marked during circumflex grafting as demonstrated by a restrictive filling pattern. Measures of diastolic function may be helpful in developing better strategies for exposure of the circumflex graft site.
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Affiliation(s)
- S Biswas
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
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Cen YY, Glower DD, Landolfo K, Lowe JE, Davis RD, Wolfe WG, Pieper C, Peterson B. Comparison of survival after mitral valve replacement with biologic and mechanical valves in 1139 patients. J Thorac Cardiovasc Surg 2001; 122:569-77. [PMID: 11547311 DOI: 10.1067/mtc.2001.115418] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [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] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to compare 10-year survival in patients after mitral valve replacement with biologic or mechanical valve prostheses. METHODS Retrospective survival analysis was performed on data from 1139 consecutive patients older than 18 years of age undergoing mitral valve replacement with Carpentier-Edwards (n = 495; Baxter Healthcare Corp, Irvine, Calif) or St Jude Medical (n = 644; St Jude Medical, Inc, St Paul, Minn) prostheses. RESULTS The 10-year survival was not statistically different between the patients receiving Carpentier-Edwards valves and those receiving St Jude Medical valves (P =.16). Adjusted survival estimates at 2, 5, and 10 years were 82% +/- 2% (95% confidence intervals, 79%-85%), 69% +/- 2% (95% confidence intervals, 64%-73%), and 42% +/- 3% (95% confidence intervals, 37%-48%), respectively, for the Carpentier-Edwards group and 83% +/- 2% (95% confidence intervals, 80%-86%), 72% +/- 2% (95% confidence intervals, 69%-76%), and 51% +/- 3% (95% confidence intervals, 45%-58%), respectively, for the St Jude Medical group. Predictors of worse survival after mitral valve replacement are older age, lower ejection fraction, presence of class IV congestive heart failure, coronary artery disease, renal disease, smoking history, hypertension, concurrent other valve surgery, and redo heart surgery. CONCLUSION Choice of biologic or mechanical prosthesis does not significantly affect long-term patient survival after mitral valve replacement.
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Affiliation(s)
- Y Y Cen
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
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Chew ST, Newman MF, White WD, Conlon PJ, Saunders AM, Strittmatter WJ, Landolfo K, Grocott HP, Stafford-Smith M. Preliminary report on the association of apolipoprotein E polymorphisms, with postoperative peak serum creatinine concentrations in cardiac surgical patients. Anesthesiology 2000; 93:325-31. [PMID: 10910477 DOI: 10.1097/00000542-200008000-00008] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Renal dysfunction after cardiac surgery occurs in up to 8% of patients and is associated with major increases in morbidity, mortality, and cost. Genetic polymorphisms have been implicated as a factor in the progression of chronic renal disease, but a genetic basis for the development of acute renal impairment has not been investigated. The authors therefore tested the hypothesis that apolipoprotein E alleles are associated with different postoperative changes in serum creatinine after cardiac surgery. METHODS The authors performed a prospective observational study with use of data from 564 coronary bypass surgical patients who were enrolled in an ongoing investigation of apolipoprotein E genotypes and organ dysfunction at a university hospital between 1989-1999. Renal function was assessed among apolipoprotein E genotype groups by comparisons of preoperative (CrPre), peak in-hospital postoperative (CrMax) and perioperative change (DCr) in serum creatinine values. RESULTS The epsilon4 allele grouping (E2 = 2/2,2/3,2/4; E3 = 3/3; E4 = 3/4,4/4) was associated with a smaller increase in postoperative serum creatinine (perioperative change: E4, +0.17; E3, +0.26; E4, +0.27 mg/dl) and a lower peak postoperative creatinine than the epsilon2 and epsilon3 in univariate and multivariate analysis (peak in-hospital postoperative serum creatinine multivariate P = 0.015 vs. epsilon3, P = 0.038 vs. epsilon2). There was no difference in baseline creatinine among allele groups. CONCLUSIONS Inheritance of the apolipoprotein epsilon4 allele is associated with reduced postoperative increase in serum creatinine after cardiac surgery, compared with the epsilon3 or epsilon2 allele. This is the first report of a possible genetic basis for acute renal impairment. These data may contribute to renal risk stratification for cardiac surgery and raise questions regarding apolipoprotein E and the pathophysiology of acute renal injury.
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Affiliation(s)
- S T Chew
- Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA
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Abstract
BACKGROUND Acute renal failure requiring dialysis (ARF-D) occurs in 1.5% of patients following cardiac surgery, and remains a cause of major morbidity and mortality. While some preoperative risk factors have been characterized, the influence of preoperative and intraoperative factors on the occurrence of ARF following cardiac surgery is less well understood. METHODS Preoperative and intraoperative data on 2843 consecutive adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) from February 1, 1995 to February 1, 1997 were recorded and entered into a computerized database. Two definitions of renal failure were employed: (i) ARF defined as a rise in serum creatinine (Cr) of 1 mg/dl above baseline; and (ii) ARF-D defined as the development of ARF for which some form of dialytic therapy was required. The association between preoperative and intraoperative variables and the development of ARF was assessed by multivariate logistic regression. RESULTS A total of 2672 of the 2844 patients underwent isolated coronary artery bypass grafting (CABG) surgery, the remaining 172 underwent valve surgery with or without bypass grafting. Of the CABG patients 7.9% developed ARF and 0.7% developed ARF-D. The mortality for patients who developed ARF was 14% (OR 15, P = 0.0001) compared with 1% among those who did not develop ARF. The mortality for CABG patients who developed ARF-D was 28% (OR 20, P = 0.0001) compared with 1.8% among those who did not require dialysis. Variables that were significantly associated with the development of ARF by multivariate analysis included: increased age, elevated preoperative serum Cr, duration of CPB, presence of a carotid artery bruit, presence of diabetes, reduced cardiac ejection fraction and increased body weight. Variables independently associated with ARF-D included serum Cr, duration of CPB, carotid artery bruit and presence of diabetes. The utility of these models for predicting the development of ARF and ARF-D was confirmed by bootstrapping techniques. Because of the small number of patients who underwent valve surgery, none of these variables were significantly associated with the development of ARF or ARF-D in this group of patients. CONCLUSION The development of ARF or ARF-D is associated with a high mortality following CABG surgery. We have identified perioperative variables, which may be useful in stratifying risk for the development of ARF.
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Affiliation(s)
- P J Conlon
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
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Peterseim DS, Cen YY, Cheruvu S, Landolfo K, Bashore TM, Lowe JE, Wolfe WG, Glower DD. Long-term outcome after biologic versus mechanical aortic valve replacement in 841 patients. J Thorac Cardiovasc Surg 1999; 117:890-7. [PMID: 10220680 DOI: 10.1016/s0022-5223(99)70368-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.0] [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] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to optimize selection criteria of biologic versus mechanical valve prostheses for aortic valve replacement. METHODS Retrospective analysis was performed for 841 patients undergoing isolated, first-time aortic valve replacement with Carpentier-Edwards (n = 429) or St Jude Medical (n = 412) prostheses. RESULTS Patients with Carpentier-Edwards and St Jude Medical valves had similar characteristics. Ten-year survival was similar in each group (Carpentier-Edwards 54% 3% versus St Jude Medical 50% 6%; P =.4). Independent predictors of worse survival were older age, renal or lung disease, ejection fraction less than 40%, diabetes, and coronary disease. Carpentier-Edwards versus St Jude Medical prostheses did not affect survival (P =.4). Independent predictors of aortic valve reoperation were younger age and Carpentier-Edwards prosthesis. The linearized rates of thromboembolism were similar, but the linearized rate of hemorrhage was lower with Carpentier-Edwards prostheses (P <.01). Perivalvular leak within 6 months of operation was more likely with St Jude Medical than with Carpentier-Edwards prostheses (P =.02). Estimated 10-year survival free from valve-related morbidity was better for the St Jude Medical valve in patients aged less than 65 years and was better for the Carpentier-Edwards valve in patients aged more than 65 years. Patients with renal disease, lung disease (in patients more than age 60 years), ejection fraction less than 40%, or coronary disease had a life expectancy of less than 10 years. CONCLUSIONS For first-time, isolated aortic valve replacement, mechanical prostheses should be considered in patients under age 65 years with a life expectancy of at least 10 years. Bioprostheses should be considered in patients over age 65 years or with lung disease (in patients over age 60 years), renal disease, coronary disease, ejection fraction less than 40%, or a life expectancy less than 10 years.
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Affiliation(s)
- D S Peterseim
- Departments of Surgery and Medicine, Duke University Medical Center, Durham NC, USA
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Chew STH, Tardiff BE, Conlon PJ, White WD, Newman MF, Landolfo K, Grocott HP, Smith MS. APOLIPOPROTEIN E PHENOTYPE DOES NOT PREDICT RISK OF RENAL IMPAIRMENT AFTER CABG SURGERY. Anesth Analg 1998. [DOI: 10.1213/00000539-199804001-00057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Landolfo K. Intermediate-term Results From Carpentier-Edwards Tricuspid Valve Repair. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(97)85126-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Grocott HP, Root J, Berkowitz SD, deBruijn N, Landolfo K. Coagulation complicating cardiopulmonary bypass in a patient with heparin-induced thrombocytopenia receiving the heparinoid, danaparoid sodium. J Cardiothorac Vasc Anesth 1997; 11:875-7. [PMID: 9412888 DOI: 10.1016/s1053-0770(97)90124-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [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] [Indexed: 02/05/2023]
Affiliation(s)
- H P Grocott
- Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA
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Affiliation(s)
- H P Grocott
- Department of Anesthesiology, Duke UNiversity Medical Center, Durham, NC 27710, USA
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Roberts D, Landolfo K, Dobson K, Light RB. The effects of methoxamine and epinephrine on survival and regional distribution of cardiac output in dogs with prolonged ventricular fibrillation. Chest 1990; 98:999-1005. [PMID: 2209164 DOI: 10.1378/chest.98.4.999] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [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: 12/30/2022] Open
Abstract
This study compares the effects of methoxamine, a pure alpha 1-agonist, and epinephrine on cerebral and myocardial blood flow, central hemodynamics, and survival in a randomized placebo-controlled fashion during prolonged ventricular fibrillation (VF) in a canine model. Twenty-four anesthetized and ventilated adult mongrel dogs were instrumented for regional blood flow determinations using radio-labeled microspheres. The dogs were randomized to receive either 20 mg of methoxamine as a single intravenous bolus or repeated boluses of 0.02 mg/kg of epinephrine, 0.2 mg/kg of epinephrine, or normal saline solution placebo beginning at three minutes following induction of VF and initiation of closed chest cardiac massage (CCCM). Organ blood flow measurements were determined during normal sinus rhythm and after five and 20 minutes of VF. All six dogs receiving methoxamine were successfully resuscitated in contrast to only one in each of the epinephrine-treated groups and none of the dogs receiving placebo (p less than .01). Although epinephrine was associated with significantly higher blood pressures than placebo during cardiopulmonary resuscitation (CPR), blood pressures achieved with methoxamine were significantly higher than those observed in the other three treatment groups (p less than .001). Cerebral blood flow was significantly higher with both methoxamine and high-dose epinephrine (p less than .05). Mean left and right ventricular myocardial flows were highest with methoxamine but this did not achieve statistical significance. In contrast, organ flows measured in the animals receiving the lowest dose of epinephrine were not significantly higher than those associated with placebo. Cardiac output after 20 minutes of CPR was significantly lower with high-dose epinephrine than with methoxamine or placebo (p less than .05). Our results suggest that methoxamine significantly improves regional cerebral blood flow and survival during CPR and although high-dose epinephrine is associated with comparable improvements in regional cerebral blood flow, this treatment is associated with deterioration in central hemodynamics during prolonged VF and does not enhance survival.
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Affiliation(s)
- D Roberts
- Section of Critical Care Medicine, University of Manitoba, Winnipeg, Canada
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Abstract
Few if any prearrest or intraarrest variables have been identified as highly predictive of inhospital mortality following cardiopulmonary arrest. A total of 310 consecutive patients requiring advanced cardiac life support during the calendar years 1985 and 1986 were reviewed with respect to eight specific variables. These included age, diagnosis, location, mechanism of the event, duration of resuscitation, whether the event was witnessed or unwitnessed, the initial observed rhythm and medications administered. A total of 37.1 percent of the patients were successfully resuscitated, but only 9.7 percent survived until discharge. Factors strongly associated with inhospital mortality included unwitnessed events (p = 0.0316), the need for epinephrine (p = 0.0003), identification of electromechanical dissociation or asystole as initial rhythms (p = 0.0000), and cardiac vs respiratory mechanism of arrest (p = 0.0000).
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Affiliation(s)
- D Roberts
- Section of Critical Care Medicine, University of Manitoba, Winnipeg, Canada
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Landolfo K, Low DE, Rogers AG. Cimetidine-induced fever. Can Med Assoc J 1984; 130:1580. [PMID: 6733633 PMCID: PMC1483372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Cimetidine is a rare cause of drug-induced fever. In a patient without evidence of hypersensitivity (the lymphocytes did not react to the drug in vitro) fever was the sole manifestation of an adverse reaction to cimetidine that was confirmed by challenge with the drug.
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