1
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Loebe M, Deuse T, Sinha N, Koster A, Erdoes G. Lung Transplantation in Patients with Cystic Fibrosis: A Complex Task, A Changing Target. J Cardiothorac Vasc Anesth 2024; 38:635-637. [PMID: 38195272 DOI: 10.1053/j.jvca.2023.12.020] [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: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/11/2024]
Affiliation(s)
- Matthias Loebe
- Heart and Lung Transplant National Recovery Program, Miami, FL
| | - Tobias Deuse
- Department of Surgery University of California at San Francisco, San Francisco, CA
| | - Neeraj Sinha
- Lung Transplant Division, Jefferson Medical College, Philadelphia, PA
| | - Andreas Koster
- Institute of Anesthesiology and Pain Therapy, Heart, and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Gabor Erdoes
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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2
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Breda JR, Parker BM, Guerra G, Dawson A, Loebe M. Should VV ECMO be considered as treatment option in COVID-19 infection after kidney transplant? A word of caution. Clin Transplant 2023; 37:e15020. [PMID: 37198961 DOI: 10.1111/ctr.15020] [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] [Received: 12/22/2022] [Revised: 04/03/2023] [Accepted: 05/04/2023] [Indexed: 05/19/2023]
Abstract
Several reports have shown that hospitalized kidney transplant recipients (KTR) had high mortality rates when infected with COVID-19. Extracorporeal Membrane Oxygenation (ECMO) has been shown to be an option for refractory respiratory failure in COVID-19 patients with variable rates of recovery. The outcome of ECMO in respiratory failure is highly related to cohort investigated and patient selection. Over a 10-month period in the height of COVID-19 pandemic 5 KTR patients were placed on ECMO with none of the patients surviving to discharge. All patients experienced multisystem organ failure (MSOF) and hematologic pathology while on ECMO. We concluded that COVID-19 in KTR patients presents with a refractory MSOF that is not well supported with ECMO in a traditional approach. Future work is needed to determine how to best support refractory respiratory failure in KTR patients with COVID-19.
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Affiliation(s)
- Joao Roberto Breda
- Division of Thoracic Transplantation and Mechanical Support, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Brandon Masi Parker
- Division of Trauma and Surgical Critical Care, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Giselle Guerra
- Division of Kidney Transplant, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Akia Dawson
- Medical Student, Ross University School of Medicine, Miramar, Florida, USA
| | - Matthias Loebe
- Division of Thoracic Transplantation and Mechanical Support, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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3
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Dangl M, Albosta M, Butros H, Loebe M. Temporary Mechanical Circulatory Support: Left, Right, and Biventricular Devices. Curr Cardiol Rev 2023; 19:27-42. [PMID: 36918790 PMCID: PMC10518886 DOI: 10.2174/1573403x19666230314115853] [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: 08/24/2022] [Revised: 01/08/2023] [Accepted: 01/16/2023] [Indexed: 03/16/2023] Open
Abstract
Temporary mechanical circulatory support (MCS) encompasses a wide array of invasive devices, which provide short-term hemodynamic support for multiple clinical indications. Although initially developed for the management of cardiogenic shock, indications for MCS have expanded to include prophylactic insertion prior to high-risk percutaneous coronary intervention, treatment of acute circulatory failure following cardiac surgery, and bridging of end-stage heart failure patients to more definitive therapies, such as left ventricular assist devices and cardiac transplantation. A wide variety of devices are available to provide left ventricular, right ventricular, or biventricular support. The choice of a temporary MCS device requires consideration of the clinical scenario, patient characteristics, institution protocols, and provider familiarity and training. In this review, the most common forms of left, right, and biventricular temporary MCS are discussed, along with their indications, contraindications, complications, cannulations, hemodynamic effects, and available clinical data.
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Affiliation(s)
- Michael Dangl
- Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | - Michael Albosta
- Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | - Hoda Butros
- Department of Medicine, Cardiovascular Division, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | - Matthias Loebe
- Department of Surgery, Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
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4
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Loebe M, Delmo EJ, Hetzer R. Remembering Hans Georg Borst, surgical pioneer, educator, innovator, and medical statesman. J Card Surg 2022; 37:4196-4198. [PMID: 36251329 DOI: 10.1111/jocs.17033] [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: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 01/06/2023]
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5
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Loebe M, Bruckner BA. Should there be an age limit for advanced therapies? J Card Surg 2022; 37:4446-4447. [PMID: 36229971 DOI: 10.1111/jocs.17018] [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: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 01/06/2023]
Abstract
Combined heart lung transplant has become a rare procedure. However, there is a significant number of patients potentially benefitting from replacement of both heart and lungs. This represents a quite diverse patient population. Decisions in patient selection have to be adjusted to individual needs and distinct constellation of the patient. Age may be a risk factor, but should be carefully integrated into the evaluation of perioperative and long term risks.
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6
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Manikavel S, Loebe M. Long-term survival: Achilles heel of lung transplantation. J Card Surg 2022; 37:5439-5440. [PMID: 35419871 DOI: 10.1111/jocs.16508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 01/06/2023]
Abstract
Long-term survival after lung transplantation has dramatically increased over recent years. But it still falls short of providing a solid extended life expectancy of more than 10 to 15 years. Patients and their families have to informed about this observation so that they can make informed descisions.
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Affiliation(s)
- Suresh Manikavel
- Pulmonology, University of Miami School of Medicine, Miami, Florida, USA.,Transplant Pulmonology, Jackson Memorial Hospital, Miami, Florida, USA
| | - Matthias Loebe
- Surgery, University of Miami School of Medicine, Miami, Florida, USA
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7
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Scherer C, Endres S, Orban M, Kaeaeb S, Massberg S, Winter A, Loebe M. Implementation of a clinical trial recruitment support system based on fast healthcare interoperability resources (FHIR) in a cardiology department. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Clinical Trial Recruitment Support Systems can booster patient inclusion of clinical trials by automatically analyzing eligibility criteria based on electronic health records. However, missing interoperability has hindered introduction of those systems on a broader scale.
Purpose
Our aim was to develop a recruitment support system based on FHIR R4 and evaluate its usage and features in a cardiology department.
Methods/Implementation
Clinical conditions, anamnesis, examinations, allergies, medication, laboratory data and echocardiography results were imported as FHIR resources. Trial study nurses and physicians were enabled to add new and edit trial information and input inclusion and exclusion criteria using a web-browser user interface in the hospital intranet. All information were recorded on the server side as the FHIR resources “ResearchStudy” and “Group”. Eligibility criteria linked by the logical operation “OR” were represented by using multiple FHIR Group resources for enrollment. On the client side, eligibility criteria were transformed to a tree-like structure (see Figure 1). Upon user demand, all hospitalized and ambulatory patients in the cardiology department were instantly screened for trial eligibility using the FHIR eligibility criteria on the existing patients' FHIR resources. Furthermore, study personal was able to manually edit trial status (i.e. ineligible, on-study, ...) of patients, which was implemented using the FHIR resource “ResearchSubject”.
Results
This implementation of a CTRSS based on FHIR R4 was evaluated in clinical practice: Beginning from 1st April 2021 the application was used as an additional patient screening tool for the four trials CLOSURE-AF, FAIR-HF2, SPRIRIT-HF and TORCH-PLUS of the German Centre for Cardiovascular Research. As the COVID-19 pandemic is prohibiting any proper comparison of patient inclusion rates, efficacy of the recruitment support system was tested by comparing the numbers of patients identified by the recruitment support system and enrolled in a trial to the actual number of enrolled patients irrespective of the screening method from 1st April 2021 to 23rd November 2021. The system was able to identify 52 of 55 patients included in those four clinical trials.
Conclusion
Use of FHIR for defining eligibility criteria of clinical trials may facilitate interoperability and allow automatic screening for eligible patients at multiple sites of different healthcare providers in the future. Upcoming changes in FHIR should allow easier description of “OR”-linked eligibility criteria.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Deutsche Forschungsgemeinschaft
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Affiliation(s)
- C Scherer
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - S Endres
- Ludwig-Maximilians University , Munich , Germany
| | - M Orban
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - S Kaeaeb
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - S Massberg
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - A Winter
- University of Leipzig, Institute for Medical Informatics, Statistics and Epidemiology , Leipzig , Germany
| | - M Loebe
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
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8
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Anjan S, Khatri A, Viotti JB, Cheung T, Garcia LAC, Simkins J, Loebe M, Phancao A, O'Brien CB, Sinha N, Ciancio G, Vianna RM, Andrews D, Abbo LM, Guerra G, Natori Y. Is the Omicron variant truly less virulent in solid organ transplant recipients? Transpl Infect Dis 2022; 24:e13923. [PMID: 35915957 PMCID: PMC9538470 DOI: 10.1111/tid.13923] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/04/2022] [Accepted: 06/24/2022] [Indexed: 12/24/2022]
Abstract
Solid organ transplant (SOT) recipients are at high risk for severe disease with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Emerging variants of concern have disproportionately affected this population. Data on severity and outcomes with the Omicron variant in SOT recipients are limited. Thus we conducted this single-center, retrospective cohort study of SOT recipients diagnosed with SARS-CoV-2 infection from December 18, 2021 to January 18, 2022, when prevalence of the Omicron variant was more than 80%-95% in the community. Univariate and multivariate logistic regression analysis was performed to identify risk factors for hospital admission. We identified 166 SOT patients: 112 (67.5%) kidney, 22 (13.3%) liver, 10 (6.0%) lung, seven (4.2%) heart, and 15 (9.0%) combined transplants. SARS-CoV-2 vaccine series was completed in 59 (35.5%) recipients. Ninety-nine (59.6%) and 13 (7.8%) recipients received casirivimab/imdevimab and sotrovimab, respectively. Fifty-three (32%) recipients required hospital admission, of which 19 (35.8%) required intensive care unit level of care. Median follow-up was 50 (interquartile range, 25-59) days, with mortality reported in six (3.6%) patients. Risk factors identified for hospital admission were African American race (p < .001, odds ratio [OR] 4.00, 95% confidence interval [CI] 1.84-8.70), history of coronary artery disease (p = .031, OR 3.50, 95% CI 1.12-10.87), and maintenance immunosuppression with corticosteroids (p = .048, OR 2.00, 95% CI 1.01-4.00). In conclusion, contrary to that in the general population, we found a higher hospital admission rate in SOT recipients with omicron variant infection. Further studies to investigate the efficacy of newer treatments are necessary, even as outcomes continue to improve.
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Affiliation(s)
- Shweta Anjan
- Department of MedicineDivision of Infectious DiseaseUniversity of Miami Miller School of Medicine MiamiMiamiFloridaUSA,Miami Transplant InstituteJackson Health SystemMiamiFloridaUSA
| | - Akshay Khatri
- Department of MedicineDivision of Infectious DiseaseUniversity of Miami Miller School of Medicine MiamiMiamiFloridaUSA
| | - Julia Bini Viotti
- Department of MedicineDivision of Infectious DiseaseUniversity of Miami Miller School of Medicine MiamiMiamiFloridaUSA
| | - Teresa Cheung
- Department of MedicineDivision of Infectious DiseaseUniversity of Miami Miller School of Medicine MiamiMiamiFloridaUSA
| | - Leopoldo A. Cordova Garcia
- Department of MedicineDivision of Infectious DiseaseUniversity of Miami Miller School of Medicine MiamiMiamiFloridaUSA
| | - Jacques Simkins
- Department of MedicineDivision of Infectious DiseaseUniversity of Miami Miller School of Medicine MiamiMiamiFloridaUSA,Miami Transplant InstituteJackson Health SystemMiamiFloridaUSA
| | - Matthias Loebe
- Miami Transplant InstituteJackson Health SystemMiamiFloridaUSA,Department of SurgeryUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Anita Phancao
- Miami Transplant InstituteJackson Health SystemMiamiFloridaUSA,Department of MedicineDivision of CardiologyUniversity of Miami Miller School of Medicine MiamiMiamiFloridaUSA
| | - Christopher B. O'Brien
- Miami Transplant InstituteJackson Health SystemMiamiFloridaUSA,Department of MedicineDivision of HepatologyUniversity of Miami Miller School of Medicine MiamiMiamiFloridaUSA
| | - Neeraj Sinha
- Miami Transplant InstituteJackson Health SystemMiamiFloridaUSA,Department of MedicineDivision of PulmonologyUniversity of Miami Miller School of Medicine MiamiMiamiFloridaUSA
| | - Gaetano Ciancio
- Miami Transplant InstituteJackson Health SystemMiamiFloridaUSA,Department of SurgeryUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Rodrigo M. Vianna
- Miami Transplant InstituteJackson Health SystemMiamiFloridaUSA,Department of SurgeryUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - David Andrews
- Department of PathologyUniversity of Miami Miller School of Medicine MiamiMiamiFloridaUSA
| | - Lilian M. Abbo
- Department of MedicineDivision of Infectious DiseaseUniversity of Miami Miller School of Medicine MiamiMiamiFloridaUSA,Miami Transplant InstituteJackson Health SystemMiamiFloridaUSA
| | - Giselle Guerra
- Miami Transplant InstituteJackson Health SystemMiamiFloridaUSA,Department of MedicineDivision of NephrologyUniversity of Miami Miller School of Medicine MiamiMiamiFloridaUSA
| | - Yoichiro Natori
- Department of MedicineDivision of Infectious DiseaseUniversity of Miami Miller School of Medicine MiamiMiamiFloridaUSA,Miami Transplant InstituteJackson Health SystemMiamiFloridaUSA
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9
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Scheinin SA, Singh G, Loebe M. Adding complexity to complexity: The role of concomitant cardiac surgery in lung transplantation. J Card Surg 2022; 37:3353-3354. [PMID: 35811494 DOI: 10.1111/jocs.16743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 11/28/2022]
Abstract
Outcomes of lung transplantation have greatly improved over recent years. While patients with concomitant cardiac pathology used to be excluded from lung transplant, today, most of these cardiac conditions can be addressed safely and effectively. Interventional techniques should be preferred. Lung transplant performed by cardiac surgeons allows for concomitant interventions.
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Affiliation(s)
- Scott A Scheinin
- Department of Cardiovascular Surgery, Mount Sinai Hospital New York, New York, New York, USA
| | - Gopal Singh
- Department of Cardiovascular Surgery, Mount Sinai Hospital New York, New York, New York, USA
| | - Matthias Loebe
- Department of Surgery, Division of Thoracic Transplant and Mechanical Support, University of Miami, Florida, USA
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10
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Bini Viotti J, Natori Y, Loebe M. Infections in LVAD patients. J Card Surg 2022; 37:2090-2091. [PMID: 35490345 DOI: 10.1111/jocs.16576] [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: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 01/05/2023]
Abstract
Infections in left ventricular assist device (LVAD) patients remain common. Differentiating into device related and non-device related infection is crucial. The incidence of non-device related infections seems to be more determined by the overall condition of the LVAD recipient. Device related infections can be treated by innovative surgical approaches or by transplant. Infection increases the risk of mortaility while on LVAD.
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Affiliation(s)
- Julia Bini Viotti
- Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA.,Division of Infectious Diseases, University of Miami School of Medicine, Miami, Florida, USA
| | - Yochiro Natori
- Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA.,Division of Infectious Diseases, University of Miami School of Medicine, Miami, Florida, USA
| | - Matthias Loebe
- Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
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11
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Finkelstein ER, Buitrago DH, Breda JR, Loebe M. Left ventricular assist device placement in the setting of congenital VSD. J Card Surg 2022; 37:2423-2425. [PMID: 35485742 DOI: 10.1111/jocs.16572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/19/2022] [Accepted: 04/13/2022] [Indexed: 12/01/2022]
Abstract
We describe the management of a 59-year-old female with an unrepaired congenital ventricular septal defect (VSD) and end stage nonischemic cardiomyopathy necessitating placement of a left ventricular assist device (LVAD) as a destination treatment. Simultaneous repair of the VSD was performed during the LVAD implantation under a beating heart. The patient remained hemodynamically stable throughout her postoperative course, without signs of hypoxia or cyanosis. Following discharge, outpatient surveillance echocardiogram demonstrated successful VSD closure and no residual shunt.
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Affiliation(s)
- Emily R Finkelstein
- Division of Cardiothoracic Transplantation and Mechanical Support, Jackson Memorial Hospital, University of Miami Hospital System, Miami, Florida, USA
| | - Daniel H Buitrago
- Division of Cardiothoracic Transplantation and Mechanical Support, Jackson Memorial Hospital, University of Miami Hospital System, Miami, Florida, USA
| | - Joao R Breda
- Division of Cardiothoracic Transplantation and Mechanical Support, Jackson Memorial Hospital, University of Miami Hospital System, Miami, Florida, USA
| | - Matthias Loebe
- Division of Cardiothoracic Transplantation and Mechanical Support, Jackson Memorial Hospital, University of Miami Hospital System, Miami, Florida, USA
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12
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Breda JR, Gergis R, Ahmed Z, Loebe M. Right- Sided Heart Reperfusion (“Berlin Bridge Technique”) for Right Ventricle Support during Left Ventricular Assist Device (LVAD) implantation. JTCVS Tech 2022; 13:115-118. [PMID: 35711196 PMCID: PMC9196759 DOI: 10.1016/j.xjtc.2022.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/16/2022] [Indexed: 11/22/2022] Open
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13
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Heldman MR, Kates OS, Safa K, Kotton CN, Multani A, Georgia SJ, Steinbrink JM, Alexander BD, Blumberg EA, Haydel B, Hemmige V, Hemmersbach-Miller M, La Hoz RM, Moni L, Condor Y, Flores S, Munoz CG, Guitierrez J, Diaz EI, Diaz D, Vianna R, Guerra G, Loebe M, Yabu JM, Kramer KH, Tanna SD, Ison MG, Rakita RM, Malinis M, Azar MM, McCort ME, Singh PP, Velioglu A, Mehta SA, van Duin D, Goldman JD, Lease ED, Wald A, Limaye AP, Fisher CE. Delayed mortality among solid organ transplant recipients hospitalized for COVID-19. Clin Infect Dis 2022; 78:ciac159. [PMID: 35212363 PMCID: PMC9383518 DOI: 10.1093/cid/ciac159] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Most studies of solid organ transplant (SOT) recipients with COVID-19 focus on outcomes within one month of illness onset. Delayed mortality in SOT recipients hospitalized for COVID-19 has not been fully examined. METHODS We used data from a multicenter registry to calculate mortality by 90 days following initial SARS-CoV-2 detection in SOT recipients hospitalized for COVID-19 and developed multivariable Cox proportional-hazards models to compare risk factors for death by days 28 and 90. RESULTS Vital status at day 90 was available for 936 of 1117 (84%) SOT recipients hospitalized for COVID-19: 190 of 936 (20%) died by 28 days and an additional 56 of 246 deaths (23%) occurred between days 29 and 90. Factors associated with mortality by day 90 included: age > 65 years [aHR 1.8 (1.3-2.4), p =<0.001], lung transplant (vs. non-lung transplant) [aHR 1.5 (1.0-2.3), p=0.05], heart failure [aHR 1.9 (1.2-2.9), p=0.006], chronic lung disease [aHR 2.3 (1.5-3.6), p<0.001] and body mass index ≥ 30 kg/m 2 [aHR 1.5 (1.1-2.0), p=0.02]. These associations were similar for mortality by day 28. Compared to diagnosis during early 2020 (March 1-June 19, 2020), diagnosis during late 2020 (June 20-December 31, 2020) was associated with lower mortality by day 28 [aHR 0.7 (0.5-1.0, p=0.04] but not by day 90 [aHR 0.9 (0.7-1.3), p=0.61]. CONCLUSIONS In SOT recipients hospitalized for COVID-19, >20% of deaths occurred between 28 and 90 days following SARS-CoV-2 diagnosis. Future investigations should consider extending follow-up duration to 90 days for more complete mortality assessment.
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Affiliation(s)
- Madeleine R Heldman
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Olivia S Kates
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kassem Safa
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Ashrit Multani
- Department of Medicine, David Geffen School of Medicine at the University of California–Los Angeles, Los Angeles, California, USA
| | | | - Julie M Steinbrink
- Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Barbara D Alexander
- Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Emily A Blumberg
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brandy Haydel
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vagish Hemmige
- Division of Infectious Disease, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | | | - Ricardo M La Hoz
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lisset Moni
- University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Yesabeli Condor
- University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Sandra Flores
- University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Carlos G Munoz
- University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Juan Guitierrez
- University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Esther I Diaz
- University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Daniela Diaz
- University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Rodrigo Vianna
- University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Giselle Guerra
- University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Matthias Loebe
- University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Julie M Yabu
- Department of Medicine, David Geffen School of Medicine at the University of California–Los Angeles, Los Angeles, California, USA
| | - Kailey Hughes Kramer
- Transplant Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sajal D Tanna
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael G Ison
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Robert M Rakita
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Maricar Malinis
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Marwan M Azar
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Margaret E McCort
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Pooja P Singh
- Division of Nephrology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Arzu Velioglu
- Marmara University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Sapna A Mehta
- New York University Langone Transplant Institute, New York, New York, USA
| | - David van Duin
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jason D Goldman
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Swedish Medical Center, Seattle, Washington, USA
| | - Erika D Lease
- Division of Pulmonology, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Anna Wald
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Ajit P Limaye
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Cynthia E Fisher
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
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14
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Loebe M, Breda JR, Sinha N. Risk factors of bronchial dehiscence after primary lung transplantation. J Card Surg 2022; 37:958-959. [PMID: 35141941 DOI: 10.1111/jocs.16292] [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: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
Complications of the bronchial anastomosis in lung transplantation, once the Achilles heel of the procedure, have become quite rare. The surgical technique is well established and safe. Risks contributing to anastomotic complications are primarily related to patients pre-existing conditions. The key factor is good blood flow to the bronchial stump. Postoperative infection can also contribute to the breakdown of the anastomosis. This may be the reason why different immunosuppressive regimes lead to differences in the incidence of bronchial dehiscence.
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15
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Ghodsizad A, Grant AA, Mohammed AN, Navas-Blanco J, Ruhparwar A, Mirsaeidi M, Hare JM, DeMarchena E, Loebe M. Bilateral pneumonectomy and lung transplant for COVID-19 induced respiratory failure. JTCVS Tech 2022; 13:282-287. [PMID: 35098171 PMCID: PMC8780122 DOI: 10.1016/j.xjtc.2022.01.019] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ali Ghodsizad
- Division of Cardiothoracic Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, Fla
- Address for reprints: Ali Ghodsizad, MD, PhD, Division of Cardiothoracic Surgery, University of Miami, Leonard M. Miller School of Medicine, 1801 NW 9th Ave, 6th Floor, Miami, FL 33136.
| | - April A. Grant
- Department of Surgery, Emory University School of Medicine and Grady Hospital, Atlanta, Ga
| | - Asif N. Mohammed
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Leonard M. Miller School of Medicine, Miami, Fla
| | - Jose Navas-Blanco
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Leonard M. Miller School of Medicine, Miami, Fla
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, University Hospital Essen, Essen, Germany
| | - Mehdi Mirsaeidi
- Division of Pulmonary Critical Care, University of Miami, Leonard M. Miller School of Medicine, Miami, Fla
| | - Joshua M. Hare
- Division of Cardiology, University of Miami, Leonard M. Miller School of Medicine, Miami, Fla
| | - Eduardo DeMarchena
- Division of Cardiology, University of Miami, Leonard M. Miller School of Medicine, Miami, Fla
| | - Matthias Loebe
- Division of Cardiothoracic Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, Fla
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16
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Heldman MR, Kates OS, Safa K, Kotton CN, Georgia SJ, Steinbrink JM, Alexander BD, Hemmersbach-Miller M, Blumberg EA, Multani A, Haydel B, La Hoz RM, Moni L, Condor Y, Flores S, Munoz CG, Guitierrez J, Diaz EI, Diaz D, Vianna R, Guerra G, Loebe M, Rakita RM, Malinis M, Azar MM, Hemmige V, McCort ME, Chaudhry ZS, Singh PP, Hughes Kramer K, Velioglu A, Yabu JM, Morillis JA, Mehta SA, Tanna SD, Ison MG, Derenge AC, van Duin D, Maximin A, Gilbert C, Goldman JD, Lease ED, Fisher CE, Limaye AP. Changing trends in mortality among solid organ transplant recipients hospitalized for COVID-19 during the course of the pandemic. Am J Transplant 2022; 22:279-288. [PMID: 34514710 PMCID: PMC8653312 DOI: 10.1111/ajt.16840] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 01/25/2023]
Abstract
Mortality among patients hospitalized for COVID-19 has declined over the course of the pandemic. Mortality trends specifically in solid organ transplant recipients (SOTR) are unknown. Using data from a multicenter registry of SOTR hospitalized for COVID-19, we compared 28-day mortality between early 2020 (March 1, 2020-June 19, 2020) and late 2020 (June 20, 2020-December 31, 2020). Multivariable logistic regression was used to assess comorbidity-adjusted mortality. Time period of diagnosis was available for 1435/1616 (88.8%) SOTR and 971/1435 (67.7%) were hospitalized: 571/753 (75.8%) in early 2020 and 402/682 (58.9%) in late 2020 (p < .001). Crude 28-day mortality decreased between the early and late periods (112/571 [19.6%] vs. 55/402 [13.7%]) and remained lower in the late period even after adjusting for baseline comorbidities (aOR 0.67, 95% CI 0.46-0.98, p = .016). Between the early and late periods, the use of corticosteroids (≥6 mg dexamethasone/day) and remdesivir increased (62/571 [10.9%] vs. 243/402 [61.5%], p < .001 and 50/571 [8.8%] vs. 213/402 [52.2%], p < .001, respectively), and the use of hydroxychloroquine and IL-6/IL-6 receptor inhibitor decreased (329/571 [60.0%] vs. 4/492 [1.0%], p < .001 and 73/571 [12.8%] vs. 5/402 [1.2%], p < .001, respectively). Mortality among SOTR hospitalized for COVID-19 declined between early and late 2020, consistent with trends reported in the general population. The mechanism(s) underlying improved survival require further study.
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Affiliation(s)
- Madeleine R. Heldman
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington,Correspondence Madeleine R. Heldman, MD, University of Washington Medical Center, Seattle, WA, USA.
| | - Olivia S. Kates
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Kassem Safa
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Julie M. Steinbrink
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina
| | - Barbara D. Alexander
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina
| | | | - Emily A. Blumberg
- Department of Medicine, Division of Infectious Diseases, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ashrit Multani
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Brandy Haydel
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ricardo M. La Hoz
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lisset Moni
- University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Yesabeli Condor
- University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Sandra Flores
- University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Carlos G. Munoz
- University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Juan Guitierrez
- University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Esther I. Diaz
- University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Daniela Diaz
- University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Rodrigo Vianna
- University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Giselle Guerra
- University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Matthias Loebe
- University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Robert M. Rakita
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Maricar Malinis
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marwan M. Azar
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Vagish Hemmige
- Division of Infectious Disease, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Margaret E. McCort
- Division of Infectious Disease, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Zohra S. Chaudhry
- Transplantation Infectious Diseases and Immunotherapy, Henry Ford Health System, Detroit, Michigan
| | - Pooja P. Singh
- Division of Nephrology, University of New Mexico, Albuquerque, New Mexico
| | - Kailey Hughes Kramer
- Transplant Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Arzu Velioglu
- Department of Internal Medicine, Division of Nephrology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Julie M. Yabu
- Division of Nephrology, Department of Medicine, University of California, Los Angeles, California
| | - Jose A. Morillis
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | | | - Sajal D. Tanna
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael G. Ison
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ariella C. Derenge
- Department of Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - David van Duin
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | | | | | - Jason D. Goldman
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington,Swedish Medical Center, Seattle, Washington
| | - Erika D. Lease
- Division of Pulmonology, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | - Cynthia E. Fisher
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Ajit P. Limaye
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
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17
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Affiliation(s)
- Matthias Loebe
- Division of Thoracic Transplant and Mechanical Support, University of Miami, Miami, FL, USA
| | - Ali Ghodsizad
- Division of Thoracic Transplant and Mechanical Support, University of Miami, Miami, FL, USA
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18
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Cardenas-Alvarez JL, Suarez J, Motoa G, Anjan S, Natori Y, Loebe M, Breda JR, Thakkar-Rivera N, Phancao A, Ghodsizad A, Bauerlein JE, Munagala MR, Simkins J. Cefazolin plus ertapenem and heart transplantation as salvage therapy for refractory LVAD infection due to methicillin-susceptible Staphylococcus aureus: A case series. J Card Surg 2021; 36:4786-4788. [PMID: 34599521 DOI: 10.1111/jocs.16040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/07/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022]
Abstract
The use of left ventricular assist devices (LVADs) is increasingly more common as the availability of donor organs in relation to failing hearts is outstandingly limited. Infections are the most common complications in LVAD recipients, particularly those caused by Staphylococcus spp. Refractory LVAD-related infections are not uncommon as achieving adequate source control is often not feasible before heart transplantation. Evidence suggest that cefazolin plus ertapenem is effective in refractory methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, but this approach has not been described in LVAD recipients. In this article, we report two cases of refractory MSSA bacteremia in LVAD recipients that were successfully treated with salvage therapy with cefazolin plus ertapenem and subsequent heart transplantation. This treatment strategy should be considered in patients with refractory LVAD-associated infection due to MSSA that are not responding to standard treatment.
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Affiliation(s)
- Jorge L Cardenas-Alvarez
- Department of Medicine, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Jose Suarez
- Division of Infectious Diseases, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Gabriel Motoa
- Department of Medicine, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Shweta Anjan
- Division of Infectious Diseases, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Yoichiro Natori
- Division of Infectious Diseases, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Matthias Loebe
- Department of Surgery, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Joao R Breda
- Department of Surgery, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Nina Thakkar-Rivera
- Division of Cardiology, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Anita Phancao
- Division of Cardiology, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Ali Ghodsizad
- Department of Surgery, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Joseph E Bauerlein
- Division of Cardiology, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Mrudula R Munagala
- Division of Cardiology, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
| | - Jacques Simkins
- Division of Infectious Diseases, Miami Transplant Institute, University of Miami School of Medicine, Miami, Florida, USA
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19
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Breda JR, Aljure O, Sfakianaki AK, Loebe M. Cesarean section in patient with metastatic Ewing sarcoma requiring VA-ECMO support. J Card Surg 2021; 36:4756-4758. [PMID: 34523160 DOI: 10.1111/jocs.15984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/24/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022]
Abstract
A 26-year-old pregnant woman, with multiple metastatic Ewing sarcoma, presented with a sternal mass that began enlarging during pregnancy. Due to high-risk pregnancy, the patient was discussed in a multidisciplinary meeting and intubation was considered too risky without cardiopulmonary support. Computed tomography showed extrinsic tumor compression of the right ventricle outflow tract. Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) was initiated before general anesthesia, followed by Cesarean section (C-section). VA ECMO was initiated with the patient in the awake position, ECMO support was discontinued when the patient had stable ventilation and hemodynamics. This case represents a unique indication of VA ECMO, during C-section, with maternal and fetal survival.
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Affiliation(s)
- Joao R Breda
- Division of Thoracic Transplantation and Mechanical Support, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Oscar Aljure
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Anna K Sfakianaki
- Department of Maternal and Fetal Medicine, Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Matthias Loebe
- Division of Thoracic Transplantation and Mechanical Support, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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20
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Ghodsizad A, Gant A, Koerner MM, Loebe M. Venovenous ECMO application as bridge to recovery or lung transplantation; ongoing challenge as we look at a pre- and post-COVID-19 era. J Card Surg 2021; 36:3747-3748. [PMID: 34351004 PMCID: PMC8447170 DOI: 10.1111/jocs.15892] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ali Ghodsizad
- Department of Surgery, University of Miami, Florida, USA
| | - April Gant
- Department of Surgery, Grady Health System, EMORY University, Atlanta, Georgia, USA
| | - Michael M Koerner
- Department of Internal Medicine, Baylor Scott & White Health, Texas A&M College of Medicine, Dallas, Texas, USA
| | - Matthias Loebe
- Department of Surgery, University of Miami, Florida, USA
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21
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Heldman MR, Kates OS, Safa K, Kotton CN, Georgia SJ, Steinbrink JM, Alexander BD, Hemmersbach-Miller M, Blumberg EA, Crespo MM, Multani A, Lewis AV, Eugene Beaird O, Haydel B, La Hoz RM, Moni L, Condor Y, Flores S, Munoz CG, Guitierrez J, Diaz EI, Diaz D, Vianna R, Guerra G, Loebe M, Rakita RM, Malinis M, Azar MM, Hemmige V, McCort ME, Chaudhry ZS, Singh P, Hughes K, Velioglu A, Yabu JM, Morillis JA, Mehta SA, Tanna SD, Ison MG, Tomic R, Derenge AC, van Duin D, Maximin A, Gilbert C, Goldman JD, Sehgal S, Weisshaar D, Girgis RE, Nelson J, Lease ED, Limaye AP, Fisher CE. COVID-19 in hospitalized lung and non-lung solid organ transplant recipients: A comparative analysis from a multicenter study. Am J Transplant 2021; 21:2774-2784. [PMID: 34008917 PMCID: PMC9215359 DOI: 10.1111/ajt.16692] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/23/2021] [Accepted: 05/06/2021] [Indexed: 01/25/2023]
Abstract
Lung transplant recipients (LTR) with coronavirus disease 2019 (COVID-19) may have higher mortality than non-lung solid organ transplant recipients (SOTR), but direct comparisons are limited. Risk factors for mortality specifically in LTR have not been explored. We performed a multicenter cohort study of adult SOTR with COVID-19 to compare mortality by 28 days between hospitalized LTR and non-lung SOTR. Multivariable logistic regression models were used to assess comorbidity-adjusted mortality among LTR vs. non-lung SOTR and to determine risk factors for death in LTR. Of 1,616 SOTR with COVID-19, 1,081 (66%) were hospitalized including 120/159 (75%) LTR and 961/1457 (66%) non-lung SOTR (p = .02). Mortality was higher among LTR compared to non-lung SOTR (24% vs. 16%, respectively, p = .032), and lung transplant was independently associated with death after adjusting for age and comorbidities (aOR 1.7, 95% CI 1.0-2.6, p = .04). Among LTR, chronic lung allograft dysfunction (aOR 3.3, 95% CI 1.0-11.3, p = .05) was the only independent risk factor for mortality and age >65 years, heart failure and obesity were not independently associated with death. Among SOTR hospitalized for COVID-19, LTR had higher mortality than non-lung SOTR. In LTR, chronic allograft dysfunction was independently associated with mortality.
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Affiliation(s)
- Madeleine R. Heldman
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Olivia S. Kates
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Kassem Safa
- Transplant Center and Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
| | - Camille N. Kotton
- Division of Transplant Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - Sarah J. Georgia
- Transplant Center and Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
| | - Julie M. Steinbrink
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina
| | - Barbara D. Alexander
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina
| | | | - Emily A. Blumberg
- Department of Medicine, Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maria M. Crespo
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ashrit Multani
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Angelica V. Lewis
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Omer Eugene Beaird
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Brandy Haydel
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Ricardo M. La Hoz
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lisset Moni
- Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Yesabeli Condor
- Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Sandra Flores
- Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Carlos G. Munoz
- Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Juan Guitierrez
- Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Esther I. Diaz
- Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Daniela Diaz
- Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Rodrigo Vianna
- Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Giselle Guerra
- Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Matthias Loebe
- Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Robert M. Rakita
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Maricar Malinis
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marwan M. Azar
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Vagish Hemmige
- Division of Infectious Disease, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Margaret E. McCort
- Division of Infectious Disease, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Zohra S. Chaudhry
- Transplantation Infectious Diseases and Immunotherapy, Henry Ford Health System, Detroit, Michigan
| | - Pooja Singh
- Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Kailey Hughes
- Transplant Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Arzu Velioglu
- School of Medicine, Division of Nephrology, Department of Internal Medicine, Marmara University, Istanbul, Turkey
| | - Julie M. Yabu
- Division of Nephrology, Department of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Jose A. Morillis
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Sapna A. Mehta
- NYU Langone Transplant Institute, New York University, New York City, New York
| | - Sajal D. Tanna
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael G. Ison
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rade Tomic
- Division of Pulmonology and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - David van Duin
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Adrienne Maximin
- Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma
| | - Carlene Gilbert
- Banner-University Medicine Transplant Institute, Banner Health, Phoenix, Arizona
| | - Jason D. Goldman
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington,Division of Infectious Diseases, Swedish Medical Center, Seattle, Washington
| | - Sameep Sehgal
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, Pennsylvania
| | - Dana Weisshaar
- Heart Transplant Department, Kaiser Permanente, Santa Clara, California
| | - Reda E. Girgis
- Richard DeVos Lung Transplant Program, Spectrum Health, Grand Rapids, Michigan
| | - Joanna Nelson
- Division of Infectious Diseases, Stanford University, Palo Alto, California
| | - Erika D. Lease
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - Ajit P. Limaye
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Cynthia E. Fisher
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
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22
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Loebe M, Parker B. Don't pig(!) the wrong heart! J Card Surg 2021; 36:3802-3804. [PMID: 34309898 DOI: 10.1111/jocs.15842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/29/2022]
Abstract
Cardiac xenotransplantation is believed to have approached clinical application. However, this approach to advanced heart failure is burdened with a multitude of ethical issues. These issues need to be addressed openly and be broadly discussed in public. Only through an honest and transparent approach, it will be possible to engage the lay audience in the evaluation of pig to human transplant.
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Affiliation(s)
- Matthias Loebe
- Department of Surgery, University of Miami, Miami, Florida, USA
| | - Brandon Parker
- Department of Surgery, University of Miami, Miami, Florida, USA
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23
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Bruckner BA, Spotnitz WD, Suarez E, Loebe M, Ngo U, Gillen DL, Manson RJ. Evaluation of the Safety and Efficacy of a Novel Thrombin Containing Combination Hemostatic Powder Using a Historical Control. Clin Appl Thromb Hemost 2021; 27:10760296211017238. [PMID: 34024165 PMCID: PMC8150456 DOI: 10.1177/10760296211017238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This clinical study compares 2 hemostatic agents, a novel combination powder (CP) (HEMOBLAST™ Bellows) and an established polysaccharide starch powder (PP) (Arista™ AH) to assess the usefulness of CP. Retrospective comparative analysis of CP (July 2018 to July 2019, 68 patients) to PP (January 2011 to January 2013, 94 patients) in cardiothoracic patients was performed using linear regression models adjusting for age, sex, and procedure type for the endpoints: blood loss; protamine to skin closure time (hemostasis time); chest tube output and blood products required 48 hours postoperatively; ICU stay; postoperative comorbidities; and 30 day mortality. 162 patients (108 M: 54 F) underwent 162 cardiothoracic surgical procedures including: transplantation (n = 44), placement of ventricular assist device (n = 87), and others (n = 31). Use of CP compared to PP (Estimated Mean Difference [95% CI], P-value) produced significant reductions: blood loss (mL) (-886.51 [-1457.76, -312.26], P = 0.003); protamine to skin closure time (min) (-16.81 [-28.03, -5.59], P = 0.004); chest tube output (48 hrs, mL) (-445.76 [-669.38, -222.14], P < 0.001); packed red blood cell transfusions (units) (-0.98 [-1.56, -0.4], P = 0.001); and postoperative comorbidities (-0.31 [-0.55, -0.07], P = 0.012). There were no differences in the ICU stay (4.07 [-2.01, 10.15], P = 0.188) or 30-day mortality (0.57 [0.20, 1.63], P = 0.291). The use of CP in complex cardiothoracic operations resulted in improved hemostasis and significant clinical benefits in blood loss, transfusion requirements, morbidity, and time in operating room.
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Affiliation(s)
- Brian A Bruckner
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - William D Spotnitz
- Department of Surgery, University of Virginia, Charlottesville, VA, USA.,Department of Medical Affairs, Biom'Up France SAS, Lyon, France
| | - Erik Suarez
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Matthias Loebe
- Miami Transplant Institute, University of Miami Health System, Miami, FL, USA
| | - Uy Ngo
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Daniel L Gillen
- Department of Statistics, University of California at Irvine, Irvine, CA, USA.,Department of Epidemiology, University of California at Irvine, Irvine, CA, USA
| | - Roberto J Manson
- Department of Medical Affairs, Biom'Up France SAS, Lyon, France.,Department of Surgery, Duke University, Durham, NC, USA.,Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
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Kostick KM, Trejo M, Bhimaraj A, Civitello A, Grinstein J, Horstmanshof D, Jorde UP, Loebe M, Mehra MR, Sulemanjee NZ, Thohan V, Trachtenberg BH, Uriel N, Volk RJ, Estep JD, Blumenthal-Barby JS. A principal components analysis of factors associated with successful implementation of an LVAD decision support tool. BMC Med Inform Decis Mak 2021; 21:106. [PMID: 33743685 PMCID: PMC7980808 DOI: 10.1186/s12911-021-01468-z] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/10/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A central goal among researchers and policy makers seeking to implement clinical interventions is to identify key facilitators and barriers that contribute to implementation success. Despite calls from a number of scholars, empirical insights into the complex structural and cultural predictors of why decision aids (DAs) become routinely embedded in health care settings remains limited and highly variable across implementation contexts. METHODS We examined associations between "reach", a widely used indicator (from the RE-AIM model) of implementation success, and multi-level site characteristics of nine LVAD clinics engaged over 18 months in implementation and dissemination of a decision aid for left ventricular assist device (LVAD) treatment. Based on data collected from nurse coordinators, we explored factors at the level of the organization (e.g. patient volume), patient population (e.g. health literacy; average sickness level), clinician characteristics (e.g. attitudes towards decision aid; readiness for change) and process (how the aid was administered). We generated descriptive statistics for each site and calculated zero-order correlations (Pearson's r) between all multi-level site variables including cumulative reach at 12 months and 18 months for all sites. We used principal components analysis (PCA) to examine any latent factors governing relationships between and among all site characteristics, including reach. RESULTS We observed strongest inclines in reach of our decision aid across the first year, with uptake fluctuating over the second year. Average reach across sites was 63% (s.d. = 19.56) at 12 months and 66% (s.d. = 19.39) at 18 months. Our PCA revealed that site characteristics positively associated with reach on two distinct dimensions, including a first dimension reflecting greater organizational infrastructure and standardization (characteristic of larger, more established clinics) and a second dimension reflecting positive attitudinal orientations, specifically, openness and capacity to give and receive decision support among coordinators and patients. CONCLUSIONS Successful implementation plans should incorporate specific efforts to promote supportive and mutually informative interactions between clinical staff members and to institute systematic and standardized protocols to enhance the availability, convenience and salience of intervention tool in routine practice. Further research is needed to understand whether "core predictors" of success vary across different intervention types.
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Affiliation(s)
- Kristin M Kostick
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza MC: 420, Houston, TX, 77030, USA.
| | - Meredith Trejo
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza MC: 420, Houston, TX, 77030, USA
| | - Arvind Bhimaraj
- Division of Heart Failure, Houston Methodist Hospital, Smith Tower, 6550 Fannin St., Ste 1901, Houston, TX, 77030, USA
| | - Andrew Civitello
- Baylor St. Luke's Medical Center, Texas Heart Institute, 7200 Cambridge Street, Ste 6C, Houston, TX, 77030, USA
| | - Jonathan Grinstein
- Duchossois Center for Advanced Medicine - Hyde Park, University of Chicago Medicine, 5758 S. Maryland Ave., Chicago, IL, 60637, USA
| | - Douglas Horstmanshof
- INTREGIS Advanced Cardiac Care, 3400 N.W. Expressway, Bldg C. Suite 200, Oklahoma City, OK, 73112, USA
| | - Ulrich P Jorde
- Division of Cardiology, Montefiore Medical Center, Bronx, NY, 10467, USA
| | - Matthias Loebe
- Miami Transplant Institute, University of Miami Health System, Miami, FL, 33136, USA
| | - Mandeep R Mehra
- Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Nasir Z Sulemanjee
- Aurora St. Luke's Medical Center, 2900 W Oklahoma Ave, Milwaukee, WI, 53215, USA
| | - Vinay Thohan
- Asheville Cardiology Associates, 5 Vanderbilt Park Dr., Asheville, NC, 28803, USA
| | - Barry H Trachtenberg
- Division of Heart Failure, Houston Methodist Hospital, Smith Tower, 6550 Fannin St., Ste 1901, Houston, TX, 77030, USA
| | - Nir Uriel
- Columbia Presbyterian Medical Center, Columbia University Irving Medical Center, 622 West 168th St., Room 129, New York, NY, 10032, USA
| | - Robert J Volk
- Department of Health Services Research, Division of Cancer Prevention and Population Services, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1465, Houston, TX, USA
| | - Jerry D Estep
- Miller Family Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA
| | - J S Blumenthal-Barby
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza MC: 420, Houston, TX, 77030, USA
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25
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Navas-Blanco JR, Lifgren SA, Dudaryk R, Scott J, Loebe M, Ghodsizad A. Parallel veno-venous and veno-arterial extracorporeal membrane circuits for coexisting refractory hypoxemia and cardiovascular failure: a case report. BMC Anesthesiol 2021; 21:77. [PMID: 33711919 PMCID: PMC7952814 DOI: 10.1186/s12871-021-01299-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background The complexity of extracorporeal membrane oxygenation (ECMO) techniques continues to evolve. Different cannulation methods and configurations have been proposed as a response to a challenging cardiovascular and pulmonary physiology of the patients. The use of parallel ECMO circuits represents a unique and novel approach for patients with refractory respiratory failure and cardiovascular collapse with very large body surface areas. Case presentation We present the case of a 25-year-old morbidly obese male patient admitted for severe acute respiratory distress syndrome (ARDS) and refractory hypoxemia, requiring institution of double cannulation for veno-venous ECMO. Since his hypoxemia persisted, likely due to insufficient flows given his large body surface area, an additional drainage venous cannula was implemented to provide higher flows, temporarily addressing his oxygenation status. Unfortunately, the patient developed concomitant cardiogenic shock refractory to inotropic support and extracorporeal fluid removal, further worsening his oxygenation status, thus the decision was to institute four-cannulation/parallel-circuits veno-venous and veno-arterial ECMO, successfully controlling both refractory hypoxemia and cardiogenic shock. Conclusions Our case illustrates a novel and complex approach for combined severe ARDS and cardiovascular collapse through the use of parallel veno-venous and veno-arterial ECMO circuits, and exemplifies the expansion of ECMO techniques and its life-saving capabilities when conservative approaches are futile.
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Affiliation(s)
- Jose R Navas-Blanco
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1800 NW 10 Avenue (M-820), Miami, FL, 33136, USA.
| | - Sofia A Lifgren
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1800 NW 10 Avenue (M-820), Miami, FL, 33136, USA
| | - Roman Dudaryk
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1800 NW 10 Avenue (M-820), Miami, FL, 33136, USA
| | - Jeffrey Scott
- Department of Critical Care, Miami Transplant Institute, Jackson Memorial Hospital, Miami, FL, USA
| | - Matthias Loebe
- Department of Surgery, University of Miami Hospital, Miami Transplant Institute, Jackson Memorial Hospital, Miami, FL, USA
| | - Ali Ghodsizad
- Department of Surgery, University of Miami Hospital, Miami Transplant Institute, Jackson Memorial Hospital, Miami, FL, USA
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Hetzer R, Javier MFDM, Dandel M, Loebe M, Javier Delmo EM. Mechanical circulatory support systems: evolution, the systems and outlook. Cardiovasc Diagn Ther 2021; 11:309-322. [PMID: 33708502 DOI: 10.21037/cdt-20-283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/27/2023]
Abstract
The joint efforts in the fields of surgery, medicine and biomedical engineering, sponsored by both the government and the industry, have led to the development of mechanical support devices that can provide reliable circulatory support, which can temporarily support a patient's circulation until either the heart recovers or until a new heart can be transplanted or permanently replace a failed heart. Their development has been driven by the shortage of donor organs. Various systems have eventually evolved for short or long-term support of patients suffering from cardiogenic and/or advanced heart failure (HF). Over time, several have been withdrawn from the market due to high rate of thromboembolism and pump-related complications, but many others remained with modern principles of circulatory support proved to be durable and reliable. Hopefully, the ever-evolving technology will yield several devices aimed at their miniaturization, with an energy supply without risk of infection, a system which is simple to implant and to exchange, minimalization of thrombus formation by optimal interior pump design, new antithrombotic medications and a system with demand-based pump activity. It is important to remember that such devices are only implanted to keep a patient alive or in an immediate life-threatening stage. In such circumstances, attribution of aforementioned difficulties to pump limitations or to advanced disease states remains difficult. In the coming years, ventricular assist devices (VADs) could be the most common surgical preference for treating severe HF.
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Affiliation(s)
- Roland Hetzer
- Department of Cardiothoracic and Vascular Surgery, Cardio Centrum Berlin, Berlin, Germany
| | | | - Michael Dandel
- Department of Cardiothoracic and Vascular Surgery, Cardio Centrum Berlin, Berlin, Germany
| | - Matthias Loebe
- Thoracic Transplant and Mechanical Support, Miami Transplant Institute, Memorial Jackson Health System, University of Miami, Miami, FL, USA
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Abstract
Over time, various surgical treatment strategies have evolved to manage advanced heart failure (HF). Scientific and technological breakthroughs through the last 50 years have put forward various surgical alternatives to patients with advanced HF encompassing surgical ventricular restoration to surgical gene therapy and stem cell replacement of the diseased ventricles. Organ-saving surgical options which used to be promising included dynamic cardiomyoplasty, partial resection of ventricle and cardiac wrapping with Acorn CorCap cardiac support device. These procedures were eventually abandoned due to negative outcomes and without proven disadvantages. Another organ-saving surgical option currently being considered but still make little sense is cardiac regeneration by stem cell therapy, i.e., cardiomyocyte restoration and replacement. Presently, the organ-saving surgical alternatives to treat end-stage HF are revascularization for ischemic cardiomyopathy, mitral valve surgery (repair or replacement) for ischemic mitral incompetence (IMI), left ventricular (LV) aneurysmectomy (surgical ventricular restoration) and mitral valve repair for IMI. These aforementioned procedures have become quite established approaches and with increasing experience are continuously being modified to improve outcome. Various mechanical circulatory support systems have emerged over time to improve functional status of patients with advanced HF, either as a bridge to heart transplantation or as a bridge to myocardial recovery. Likewise offered in those with contraindications to transplantation. Ventricular assist devices (VAD) can keep patients alive until an eventual transplantation. This article reviews the variety of the myriad of alternative organ-saving surgical alternatives that have been available or are currently available provided to patients with end-stage HF, their advantages and deficiencies, as well as prospects in HF therapy.
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Affiliation(s)
- Roland Hetzer
- Department of Cardiothoracic and Vascular Surgery, Cardio Centrum Berlin, Berlin, Germany
| | | | - Frank Wagner
- Charité Research Organization, Universitätsmedizin Berlin-Charité, Berlin, Germany
| | - Matthias Loebe
- Thoracic Transplant and Mechanical Support, Miami Transplant Institute, Memorial Jackson Health System, University of Miami, Miami, FL, USA
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Dandel M, Javier MFDM, Javier Delmo EM, Loebe M, Hetzer R. Weaning from ventricular assist device support after recovery from left ventricular failure with or without secondary right ventricular failure. Cardiovasc Diagn Ther 2021; 11:226-242. [PMID: 33708495 DOI: 10.21037/cdt-20-288] [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: 11/06/2022]
Abstract
Although complete myocardial recovery after ventricular assist device (VAD) implantation is rather seldom, systematic search for recovery is worthwhile because for recovered patients weaning from VADs is feasible and can provide survival benefits with long-term freedom from heart failure (HF) recurrence, even if a chronic cardiomyopathy was the primary cause for the drug-refractory HF necessitating left ventricular (LVAD) or biventricular support (as bridge-to-transplantation or definitive therapy) and even if recovery remains incomplete. LVAD patients explanted for myoacardial recovery compared to those transplanted from LVAD support showed similar survival rates and a significant proportion of explanted patients can achieve cardiac and physical functional capacities that are within the normal range of healthy controls. In apparently sufficiently recovered patients, a major challenge remains still the pre-explant prediction of the weaning success which is meanwhile reliably possible for experienced clinicians. In weaning candidates, the combined use of certain echocardiography and right heart catheterization parameters recorded before VAD explantation can predict post-weaning cardiac stability with good accuracy. However, in the absence of standardization or binding recommendations, the protocols for assessment of native cardiac improvement and also the weaning criteria differ widely among centers. Currently there are still only few larger studies on myocardial recovery assessment after VAD implantation. Therefore, the weaning practice relies mostly on small case series, local practice patterns, and case reports, and the existing knowledge, as well as the partially differing recommendations which are based mainly on expert opinions, need to be periodically systematised. Addressing these shortcomings, our review aims to summarize the evidence and expert opinion on the evaluation of cardiac recovery during mechanical ventricular support by paying special attention to the reliability of the methods and parameters used for assessment of myocardial recovery and the challenges met in both evaluation of recovery and weaning decision making.
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Affiliation(s)
- Michael Dandel
- Department of Cardiology, Cardio Centrum Berlin, Berlin, Germany
| | | | | | - Matthias Loebe
- Thoracic Transplant and Mechanical Support, Miami Transplant Institute, Memorial Jackson Health System, University of Miami, Miami, Florida, USA
| | - Roland Hetzer
- Department of Cardiothoracic and Vascular Surgery, Cardio Centrum Berlin, Berlin, Germany
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29
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Brozzi NA, Cifuentes RO, Saba IC, Macon C, Ghodsizad A, Andreopoulos F, Loebe M. Long-term outcomes of elderly patients receiving continuous flow left ventricular support. J Card Surg 2020; 35:3405-3408. [PMID: 33001467 DOI: 10.1111/jocs.15074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Heart failure is an epidemic affecting over 6 million people in the United States. Eighty percent of all heart failure patients are older than 65 years of age. Heart transplant is the gold standard treatment for patients suffering advanced heart failure, but only 18.5% of patients receiving heart transplant in the United States are 65 years of age or older. Continuous-flow left ventricular assist devices are a safe and effective therapy for patients with advanced heart failure, and can be used to bridge patients to a heart transplant or to support patients long-term as destination therapy. MATERIAL AND METHODS We sought to characterize long-term outcomes of elderly patients receiving continuous-flow left ventricular support in our program. CONCLUSION Elderly patients with advanced heart failure presented comparable operative results to those of younger patients. The rate of complications up to 6 years of support was low, and comparable to those of younger patients. An effective and safe alternative for patients whom are less likely to receive heart transplantation.
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Affiliation(s)
- Nicolas A Brozzi
- Department of Surgery, Division of Thoracic Transplantation and Mechanical Circulatory Support, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Renzo O Cifuentes
- Department of Surgery, Division of Thoracic Transplantation and Mechanical Circulatory Support, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Isabela C Saba
- Department of Surgery, Division of Thoracic Transplantation and Mechanical Circulatory Support, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Conrad Macon
- Department of Surgery, Division of Thoracic Transplantation and Mechanical Circulatory Support, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ali Ghodsizad
- Department of Surgery, Division of Thoracic Transplantation and Mechanical Circulatory Support, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Fotios Andreopoulos
- Department of Surgery, Division of Thoracic Transplantation and Mechanical Circulatory Support, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Matthias Loebe
- Department of Surgery, Division of Thoracic Transplantation and Mechanical Circulatory Support, Miller School of Medicine, University of Miami, Miami, Florida, USA
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30
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Grant AA, Lineen EB, Villamizar NR, Galbut D, Brozzi N, Loebe M, Ghodsizad A. Traumatic Tracheal Injury and Pulmonary Contusions : Buying Time With ECMO. Am Surg 2020; 87:2006-2008. [PMID: 33174433 DOI: 10.1177/0003134820940262] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- April A Grant
- Department of Surgery, Emory University School of Medicine and Grady Hospital, Atlanta, GA, USA
- Department of Trauma Surgery, Ryder Trauma Center, Miami, FL, USA
- Dewitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Edward B Lineen
- Department of Trauma Surgery, Ryder Trauma Center, Miami, FL, USA
- Dewitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Nestor R Villamizar
- Dewitt Daughtry Family Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, Leonard M Miller School of Medicine, Miami, FI, USA
| | - David Galbut
- Division of Cardiothoracic Surgery, Jackson Health System, Miami, FL, USA
| | - Nicolas Brozzi
- Dewitt Daughtry Family Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, Leonard M Miller School of Medicine, Miami, FI, USA
| | - Matthias Loebe
- Dewitt Daughtry Family Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, Leonard M Miller School of Medicine, Miami, FI, USA
| | - Ali Ghodsizad
- Dewitt Daughtry Family Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, Leonard M Miller School of Medicine, Miami, FI, USA
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Blumenthal-Barby J, Kostick K, Trejo M, Bhimaraj A, Civitello A, Horstmanshof DA, Jorde UP, Loebe M, Mehra MR, Thohan V, Trachtenberg BH, Uriel N, Volk BJ, Estep JD. Shared Decision Making In Cardiology Practice: 15 Month Results of A Multi-Site Study of Decision Aid Implementation. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Brozzi NA, Cifuentes RO, Figueiro JM, Ghodsizad A, Loebe M. "Heart and kidney transplant from donor with recent veno-arterial extracorporeal cardiopulmonary resuscitation". J Card Surg 2020; 35:2814-2816. [PMID: 32939787 DOI: 10.1111/jocs.14856] [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: 12/20/2019] [Revised: 04/21/2020] [Accepted: 05/11/2020] [Indexed: 11/28/2022]
Abstract
OBJETIVES ECMO is progressively being adopted as a last resort to stabilize patients receiving cardiopulmonary resuscitation (ECMO CPR). A significant number of these patients will present recovery of end-organ function, but evolve with brain death, accounting for only 30% of patients discharged from the hospital alive. Harvesting organs from donors on VA ECMO has recently been proposed as a strategy to expand the pool of available organs for transplantation. METHODS We present a case of combined heart and kidney transplantation from a brain death donor with recent out of hospital cardiac arrest rescued with eCPR. RESULTS A 31 year old male patient was admitted to local hospital with diagnosis of drowning after seizure episode. Patient received two rounds of CPR for 8 and 30 minutes respectively, and required emergency insertion of VA ECMO. Patient developed compartment syndrome of right lower extremity (RLE) with CPK = 30,720, prompting discontinuation of ECMO support within 48 hours as cardiac function had recovered, reflected on echocardiographic and enzymatic parameters. Patient was declared brain death and became organ donor. Multiple organ procurement was performed. Combined heart and right kidney transplant was then performed on a 61-year-old male with uneventful course, and with normal function of all implanted allografts at 3 months follow up. CONCLUSION Our experience supports the concept that VA ECMO is not a contraindication for solid organ donation. Individual evaluation of organ function can lead to successful transplantation of multiple organs from donors with recent history of VA ECMO support.
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Affiliation(s)
- Nicolas A Brozzi
- Division of Thoracic Transplantation and Mechanical Circulatory Support, Department of Surgery, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, Florida
| | - Renzo O Cifuentes
- Division of Thoracic Transplantation and Mechanical Circulatory Support, Department of Surgery, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, Florida
| | - Jose M Figueiro
- Division of Abdominal Transplantation, Department of Surgery, Jackson Memorial Hospital, Miami Transplant Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Ali Ghodsizad
- Division of Thoracic Transplantation and Mechanical Circulatory Support, Department of Surgery, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, Florida
| | - Matthias Loebe
- Division of Thoracic Transplantation and Mechanical Circulatory Support, Department of Surgery, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, Florida
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33
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Grant AA, Badiye A, Mehta C, Wu Z, Koerner M, Vianna R, Loebe M, Ghodsizad A. EMPROVING outcomes: Evaluating the effect of an ultralung protective strategy for patients with ARDS treated with ECMO. J Card Surg 2020; 35:2495-2499. [PMID: 32939799 DOI: 10.1111/jocs.14923] [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: 12/13/2022]
Abstract
OBJECTIVE Since the initiation of an adult extracorporeal membrane oxygenation (ECMO) program at our institution, the program has managed well over 200 patients with ECMO in a 3-year time frame. While there is a plethora of research evaluating ECMO for acute respiratory distress syndrome (ARDS), few studies have evaluated the impact that ventilator management after cannulation might have on outcomes. We hypothesized that failure to properly protect the lungs after cannulation would lead to higher mortality. MATERIALS AND METHODS This was a retrospective observational study performed from 1 January 2014 to 8 July 2018. RESULTS A total of 196 patients were treated with ECMO, 57 of whom were diagnosed with ARDS and treated with venovenous ECMO. The univariable analysis revealed a statistically higher total serum bilirubin and lower total days on ECMO in those who died vs those who lived. During ECMO, higher mean peak inspiratory pressures (PIP) and higher FiO2 were found in those who died vs those who lived. In multivariable analysis, increasing age (odds ratio [OR] = 1.2; confidence interval [CI] = 1.04-1.39, P = .02), increasing mean PIP, and increasing mean FiO2 concentration during ECMO (PIP: OR = 1.40, CI = 1.03-1.89, P = .03; FiO2 : OR = 1.16, CI = 1.02-1.32, P = .02) were all associated with increased mortality. CONCLUSION Failing to protect the lungs with a lung protective strategy such as the EMPROVE protocol after ECMO cannulation was associated with mortality. For every 1 mm Hg increase in the mean PIP, the odds of dying increased 1.4 times, and for every 1% increase in the mean FiO2 , the odds of dying increased 1.16 times. For lung rest to truly be effective, the lungs must be relieved of the burden of gas exchange.
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Affiliation(s)
- April A Grant
- Department of surgery, Trauma and Surgical Critical Care, Grady Hospital, Emory University School of Medicine, Atlanta, Georgia
| | - Amit Badiye
- Department of Cardiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Christina Mehta
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ziyue Wu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Michael Koerner
- Department of Critical Care, Integris Baptist Medical Center, Oklahoma City, Oklahoma
| | - Rodrigo Vianna
- Division of Heart and Lung Transplant and Mechanical Support, Miami Transplant Institute, Miami, Florida
| | - Matthias Loebe
- Division of Heart and Lung Transplant and Mechanical Support, Miami Transplant Institute, Miami, Florida.,Division of Cardiothoracic Surgery, Dewitt Daughtry Family Department of Surgery, Leonard M Miller School of Medicine, University of Miami, Miami, Florida
| | - Ali Ghodsizad
- Division of Heart and Lung Transplant and Mechanical Support, Miami Transplant Institute, Miami, Florida.,Division of Cardiothoracic Surgery, Dewitt Daughtry Family Department of Surgery, Leonard M Miller School of Medicine, University of Miami, Miami, Florida
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Irion CI, Dunkley JC, John-Williams K, Condor Capcha JM, Shehadeh SA, Pinto A, Loebe M, Webster KA, Brozzi NA, Shehadeh LA. Nuclear Osteopontin Is a Marker of Advanced Heart Failure and Cardiac Allograft Vasculopathy: Evidence From Transplant and Retransplant Hearts. Front Physiol 2020; 11:928. [PMID: 32903540 PMCID: PMC7438570 DOI: 10.3389/fphys.2020.00928] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/10/2020] [Indexed: 12/22/2022] Open
Abstract
Background Heart transplant is the gold standard therapy for patients with advanced heart failure. Over 5,500 heart transplants are performed every year worldwide. Cardiac allograft vasculopathy (CAV) is a common complication post-heart transplant which reduces survival and often necessitates heart retransplantation. Post-transplant follow-up requires serial coronary angiography and endomyocardial biopsy (EMB) for CAV and allograft rejection screening, respectively; both of which are invasive procedures. This study aims to determine whether osteopontin (OPN) protein, a fibrosis marker often present in chronic heart disease, represents a novel biomarker for CAV. Methods Expression of OPN was analyzed in cardiac tissue obtained from patients undergoing heart retransplantation using immunofluorescence imaging (n = 20). Tissues from native explanted hearts and three serial follow-up EMB samples of transplanted hearts were also analyzed in five of these patients. Results Fifteen out of 20 patients undergoing retransplantation had CAV. 13/15 patients with CAV expressed nuclear OPN. 5/5 patients with multiple tissue samples expressed nuclear OPN in both 1st and 2nd explanted hearts, while 0/5 expressed nuclear OPN in any of the follow-up EMBs. 4/5 of these patients had an initial diagnosis of dilated cardiomyopathy (DCM). Conclusion Nuclear localization of OPN in cardiomyocytes of patients with CAV was evident at the time of cardiac retransplant as well as in patients with DCM at the time of the 1st transplant. The results implicate nuclear OPN as a novel biomarker for severe CAV and DCM.
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Affiliation(s)
- Camila Iansen Irion
- Interdisciplinary Stem Cell Institute, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States.,Division of Cardiology, Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Julian C Dunkley
- Interdisciplinary Stem Cell Institute, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States.,Division of Cardiology, Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Krista John-Williams
- Interdisciplinary Stem Cell Institute, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States.,Division of Cardiology, Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | - José Manuel Condor Capcha
- Interdisciplinary Stem Cell Institute, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States.,Division of Cardiology, Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Serene A Shehadeh
- Interdisciplinary Stem Cell Institute, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Andre Pinto
- Department of Pathology, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Matthias Loebe
- Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Keith A Webster
- Vascular Biology Institute, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Nicolas A Brozzi
- Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Lina A Shehadeh
- Interdisciplinary Stem Cell Institute, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States.,Division of Cardiology, Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States.,Vascular Biology Institute, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States.,Peggy and Harold Katz Family Drug Discovery Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
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Ghodsizad A, Grant AA, Mirsaeidi M, Sneij WC, Khalid L, Delazerda D, Auerbach JS, Alvarez RA, de Marchena EJ, Hare J, Guerra G, Vianna R, Loebe M. Management of crash and burn patients with SARS-CoV-2 associated ARDS. J Card Surg 2020; 35:2129-2130. [PMID: 32663349 PMCID: PMC7405179 DOI: 10.1111/jocs.14699] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ali Ghodsizad
- Heart and Lung Transplant and Mechanical Circulatory Support, Miller School of Medicine, University of Miami, Miami, Florida.,Heart and Lung Transplant and Mechanical Circulatory Support, Miami Transplant Institute, Miami, Florida
| | - April A Grant
- School of Medicine and Grady Hospital System, Emory University, Atlanta, Georgia
| | - Mehdi Mirsaeidi
- Pulmonary Critical Care, Miller School of Medicine, University of Miami, Miami, Florida
| | - Waleed C Sneij
- Pulmonary Critical Care, Miller School of Medicine, University of Miami, Miami, Florida
| | - Laiqua Khalid
- Pulmonary Critical Care, Miller School of Medicine, University of Miami, Miami, Florida
| | - David Delazerda
- Pulmonary Critical Care, Miller School of Medicine, University of Miami, Miami, Florida
| | - Jonathan S Auerbach
- Pulmonary Critical Care, Miller School of Medicine, University of Miami, Miami, Florida
| | - Roger A Alvarez
- Pulmonary Critical Care, Miller School of Medicine, University of Miami, Miami, Florida
| | - Eduardo J de Marchena
- Department of Cardiology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Joshua Hare
- Department of Cardiology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Giselle Guerra
- Department of Nephrology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Rodrigo Vianna
- Heart and Lung Transplant and Mechanical Circulatory Support, Miller School of Medicine, University of Miami, Miami, Florida.,Heart and Lung Transplant and Mechanical Circulatory Support, Miami Transplant Institute, Miami, Florida
| | - Matthias Loebe
- Heart and Lung Transplant and Mechanical Circulatory Support, Miller School of Medicine, University of Miami, Miami, Florida.,Heart and Lung Transplant and Mechanical Circulatory Support, Miami Transplant Institute, Miami, Florida
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Loebe M, Ghodsizad A. Commentary: The feng shui of LVAD implantation. J Thorac Cardiovasc Surg 2020; 162:1564-1566. [PMID: 32534752 DOI: 10.1016/j.jtcvs.2020.04.122] [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: 04/16/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Matthias Loebe
- Division of Thoracic Transplantation and Mechanical Support, Miami Transplant Institute, Miami, Fla.
| | - Ali Ghodsizad
- Division of Thoracic Transplantation and Mechanical Support, Miami Transplant Institute, Miami, Fla
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Kambali S, Mantero AMA, Ghodsizad A, Loebe M, Mirsaeidi M. Improving survival outcome among elderly lung transplant recipients. Eur J Intern Med 2020; 74:121-124. [PMID: 32001096 DOI: 10.1016/j.ejim.2020.01.012] [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: 01/03/2020] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Shweta Kambali
- Division of Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| | | | - Ali Ghodsizad
- Heart and Lung Transplant, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| | - Matthias Loebe
- Heart and Lung Transplant, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| | - Mehdi Mirsaeidi
- Division of Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA; Section of Pulmonary Medicine, Miami Veterans Affairs Healthcare System, Miami, FL 33136, USA.
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Blumenthal-Barby J, Kostick K, Trejo M, Bhimaraj A, Civitello A, Horstmanshof D, Jorde U, Loebe M, Mehra M, Thohan V, Trachtenberg B, Uriel N, Volk R, Estep J. Implementation of Patient-Centered Shared Decision Making for LVAD Candidates: Year 1 Results of a Multi-Site Study. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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39
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Xiao J, Brozzi N, Cifuentes R, Ghodsizad A, Loebe M. Application of total artificial heart in patients with primary malignant cardiac tumors-current treatment strategies. Ann Cardiothorac Surg 2020; 9:113-115. [PMID: 32309160 DOI: 10.21037/acs.2020.02.12] [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: 11/06/2022]
Affiliation(s)
- Jiewen Xiao
- Division of Thoracic Transplantation & Mechanical Circulatory Support, Department of Surgery, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Nicolas Brozzi
- Division of Thoracic Transplantation & Mechanical Circulatory Support, Department of Surgery, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Renzo Cifuentes
- Division of Thoracic Transplantation & Mechanical Circulatory Support, Department of Surgery, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Ali Ghodsizad
- Division of Thoracic Transplantation & Mechanical Circulatory Support, Department of Surgery, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Matthias Loebe
- Division of Thoracic Transplantation & Mechanical Circulatory Support, Department of Surgery, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
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40
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Brozzi NA, Simkins J, Cifuentes RO, Ghodsizad A, Thakkar Rivera N, Loebe M. Advanced heart failure therapies in patients with stable HIV infection. J Card Surg 2020; 35:908-911. [PMID: 32048338 DOI: 10.1111/jocs.14452] [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: 11/28/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection affects nearly 38 million people worldwide. Patients living with HIV (PLHIV) on modern highly active antiretroviral therapy face significant morbidity and mortality related to the progression of chronic diseases, which lead to an increase in the burden of end-stage organ disease and organ failure. PLHIV present a two fold increased risk of heart failure as compared with the general population, with a prevalence of clinical heart failure of 6.5 %. Orthotopic heart transplantation (OHT) is rarely performed in HIV-positive patients despite the fact that HIV-associated cardiomyopathy is a major long-term complication of HIV infection. MATERIAL AND METHODS We present a case of PLHIV presenting with decompensated heart failure, requiring initial therapy with left ventricular assist device, followed by heart transplantation, accompanied by an update on current concepts, and experience in the field. DISCUSSION AND CONCLUSION HIV-associated cardiomyopathy is a major long-term complication of HIV infection. LVAD support or OHT should also be encouraged among HIV-positive patients as current data indicates that AHFT is safe in carefully selected HIV-positive patients and outcomes are similar to those of HIV-negative patients.
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Affiliation(s)
- Nicolas A Brozzi
- Division of Thoracic Transplantation and Mechanical Circulatory Support, Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Jacques Simkins
- Division of Infectious Diseases, Miller School of Medicine, University of Miami, Miami, Florida
| | - Renzo O Cifuentes
- Division of Thoracic Transplantation and Mechanical Circulatory Support, Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Ali Ghodsizad
- Division of Thoracic Transplantation and Mechanical Circulatory Support, Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Nina Thakkar Rivera
- Division of Cardiology, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida
| | - Matthias Loebe
- Division of Thoracic Transplantation and Mechanical Circulatory Support, Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
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Brozzi N, Cifuentes R, Haq S, Ghodsizad A, Loebe M. Aorto-pulmonary bypass shunt for intraoperative right ventricular support during LVAD implantation. J Card Surg 2019; 35:188-190. [PMID: 31778573 DOI: 10.1111/jocs.14375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We describe a simple modification of the cardiopulmonary bypass (CPB) circuit that allows selective intraoperative circulatory support of the right ventricle during left ventricular assist device (LVAD) implantation. The addition of a side branch to the arterial line and an intermediate line connector allows selective venting and perfusion through a cannula inserted in the main pulmonary artery. This modification of the CPB circuit allows for selective evaluation of right ventricular function, titration of inotropic support, and early identification of patients that require right ventricular assist device (RVAD) support.
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Affiliation(s)
- Nicolas Brozzi
- Division of Thoracic Transplantation & Mechanical Circulatory Support, Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Renzo Cifuentes
- Division of Thoracic Transplantation & Mechanical Circulatory Support, Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Safi Haq
- Division of Cardiothoracic Surgery, Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Ali Ghodsizad
- Division of Thoracic Transplantation & Mechanical Circulatory Support, Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Matthias Loebe
- Division of Thoracic Transplantation & Mechanical Circulatory Support, Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
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Mohammad S, Loebe M, Grant AA, Vianna R, Brozzi N, Ghodsizad A. Horner's syndrome following single lung transplantation. J Card Surg 2019; 35:258-259. [PMID: 31778550 DOI: 10.1111/jocs.14328] [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: 11/27/2022]
Abstract
Lung transplantation have significantly improved quality of life in patients with end stage respiratory failure, however use of lifelong immunosuppressive therapy and development of bronchiolitis obliterans reflects in a 5-year survival is less the 60%. Ophthalmic complications following lung transplantation are uncommon. Some cases of infectious and malignant ophthalmic complications have been described previously. Here we describe a case of Horner's syndrome following single lung transplantation.
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Affiliation(s)
- Sanna Mohammad
- Department of Surgery, Miami Transplant Institute, University of Miami, Miami, Florida
| | - Matthias Loebe
- Department of Surgery, Miami Transplant Institute, University of Miami, Miami, Florida
| | - April A Grant
- Trauma and Surgical Critical Care, Grady Health System, Emory University School of Medicine, Atlanta, Georgia
| | - Rodrigo Vianna
- Miami Transplant Institute, University of Miami and Jackson Health System, Miami, Florida
| | - Nicolas Brozzi
- Department of Surgery, Miami Transplant Institute, University of Miami, Miami, Florida
| | - Ali Ghodsizad
- Department of Surgery, Miami Transplant Institute, University of Miami, Miami, Florida
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43
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Grant AA, Klima A, Duenas A, Gardiner A, Thomas M, Badiye A, Vianna R, Loebe M, Ghodsizad A. In vivo resuscitation, perfusion, and transplantation of a porcine cardiac allograft donated after circulatory death. J Card Surg 2019; 35:300-303. [PMID: 31765013 DOI: 10.1111/jocs.14349] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To test the feasibility of a novel method of heart donation under circulatory death criteria that allows precardiectomy donor heart assessment. MATERIALS AND METHODS This is a translational study utilizing 16 female Yorkshire pigs in a series of eight heart transplant procedures under a circulatory death model. RESULTS Successful resuscitation of the donor hearts occurred in seven out of eight animals. All seven of these hearts were deemed to have good function and were successfully transplanted. In the animal in which donor heart resuscitation was not successful, the transplant was aborted, and a left ventricular assist device (LVAD) was placed in the recipient's heart. CONCLUSION This animal study demonstrates the feasibility of using this novel technique for resuscitation and precardiectomy evaluation of donated after circulatory death hearts. For those donor hearts without adequate function, an LVAD can be safely implanted as a "bail-out" option. The limitations of this technique are the patient population to which it can be applied (only those patients eligible and consented for LVAD).
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Affiliation(s)
- April A Grant
- Department of Surgery, Emory University and Grady Memorial Hospital, Atlanta, Georgia.,Division of Heart and Lung Transplant and Mechanical Support, Miami Transplant Institute, Miami, Florida
| | - Alan Klima
- Comprehensive Care Services, Inc, Livonia, Michigan
| | | | - Amy Gardiner
- Department of Veterinary Resources, University of Miami, Miami, Florida
| | - Maeghan Thomas
- Department of Veterinary Resources, University of Miami, Miami, Florida
| | - Amit Badiye
- Division of Heart and Lung Transplant and Mechanical Support, Miami Transplant Institute, Miami, Florida.,Division of Cardiology, University of Miami Leonard M Miller School of Medicine, Miami, Florida
| | - Rodrigo Vianna
- Division of Heart and Lung Transplant and Mechanical Support, Miami Transplant Institute, Miami, Florida.,Division of Cardiothoracic Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Leonard M Miller School of Medicine, Miami, Florida
| | - Matthias Loebe
- Division of Heart and Lung Transplant and Mechanical Support, Miami Transplant Institute, Miami, Florida.,Division of Cardiothoracic Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Leonard M Miller School of Medicine, Miami, Florida
| | - Ali Ghodsizad
- Division of Heart and Lung Transplant and Mechanical Support, Miami Transplant Institute, Miami, Florida.,Division of Cardiothoracic Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Leonard M Miller School of Medicine, Miami, Florida
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Brozzi NA, Beduschi T, Salerno T, Cifuentes R, Ghodsizad A, Martin E, Vianna R, Loebe M. Combined off‐pump coronary bypass grafting without heparin and liver transplantation: A novel approach to a complex dilemma. J Card Surg 2019; 35:450-453. [DOI: 10.1111/jocs.14344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Nicolas A. Brozzi
- Divisions of Thoracic TransplantationUniversity of Miami Miller School of MedicineMiami Florida
| | - Thiago Beduschi
- Division of Abdominal TransplantationUniversity of Miami Miller School of MedicineMiami Florida
| | - Tomas Salerno
- Cardiothoracic Surgery of the Department of SurgeryUniversity of Miami Miller School of MedicineMiami Florida
| | - Renzo Cifuentes
- Divisions of Thoracic TransplantationUniversity of Miami Miller School of MedicineMiami Florida
| | - Ali Ghodsizad
- Divisions of Thoracic TransplantationUniversity of Miami Miller School of MedicineMiami Florida
| | - Eric Martin
- Division of Abdominal TransplantationUniversity of Miami Miller School of MedicineMiami Florida
| | - Rodrigo Vianna
- Division of Abdominal TransplantationUniversity of Miami Miller School of MedicineMiami Florida
| | - Matthias Loebe
- Divisions of Thoracic TransplantationUniversity of Miami Miller School of MedicineMiami Florida
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45
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Grant AA, Lineen EB, Klima A, Vianna R, Loebe M, Ghodsizad A. Refractory traumatic bronchopleural fistula: Is extracorporeal membrane oxygenation the new gold standard? J Card Surg 2019; 35:242-245. [PMID: 31899836 DOI: 10.1111/jocs.14298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A refractory bronchopleural fistula leading to respiratory failure in a trauma patient is one of the most challenging pathologies to manage in one of the most challenging patient populations. Modern equipment and techniques have decreased and perhaps even eliminated the need for anticoagulation with ECMO, and it is finding an important niche in saving this patient population from refractory hypoxia. We review here our experience with three refractory traumatic bronchopleural fistulae utilizing venovenous ECMO as the primary treatment modality. MATERIAL AND METHODS Retrospective chart review of three cases of refractory traumatic bronchopleural fistula treated primarily with ECMO and an ultra-lung protective strategy. RESULTS The use of an ultra-lung protective strategy with ECMO allowed sealing of all three bronchopleural fistula. CONCLUSIONS Traumatic bronchopleural fistulae require careful thought and early utilization of lung protective strategies to facilitate healing of the injured lung.
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Affiliation(s)
- April A Grant
- Division of Trauma and Surgical Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida.,Jackson Health System and Ryder Trauma Center, Miami, Florida
| | - Edward B Lineen
- Division of Trauma and Surgical Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida.,Jackson Health System and Ryder Trauma Center, Miami, Florida
| | - Alan Klima
- Comprehensive Care Services, Inc, Livonia, Michigan
| | - Rodrigo Vianna
- Division of Liver, Intestinal and Multivisceral Transplant, Leonard M Miller School of Medicine, University of Miami, Miami, Florida.,Division of Heart and Lung Transplant and Mechanical Circulatory Support, Miami, Florida
| | - Matthias Loebe
- Division of Heart and Lung Transplant and Mechanical Circulatory Support, Miami, Florida.,Division of Cardiothoracic Surgery, Dewitt Daughtry Family Department of Surgery, Leonard M Miller School of Medicine, University of Miami, Miami, Florida
| | - Ali Ghodsizad
- Division of Heart and Lung Transplant and Mechanical Circulatory Support, Miami, Florida.,Division of Cardiothoracic Surgery, Dewitt Daughtry Family Department of Surgery, Leonard M Miller School of Medicine, University of Miami, Miami, Florida
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Grant AA, Bhakta S, Brozzi N, Talon A, Klima A, Duenas A, Galbut D, Loebe M, Ghodsizad A. DCD and DBD lung transplantation optimized by ex vivo perfusion: What to do when the pump fails. J Card Surg 2019; 35:191-194. [PMID: 31899833 DOI: 10.1111/jocs.14273] [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: 11/28/2022]
Abstract
BACKGROUND Ex vivo perfusion is a safe and feasible method of assessing and using high-risk donor organs. AIM We describe a case of successfully ex vivo treated and transplanted human lung allografts. METHODS Donor human lungs were assessed using ex vivo, our trouble shooting protocol allowed safe recovery. RESULTS We successfully implanted our ex vivo treated organs.
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Affiliation(s)
- April A Grant
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Miami School of Medicine, Miami, Florida.,Heart and Lung Transplant and Mechanical Circulatory Support, Miami Transplant Institute, Miami, Florida
| | - Shivang Bhakta
- Heart and Lung Transplant and Mechanical Circulatory Support, Miami Transplant Institute, Miami, Florida
| | - Nicholas Brozzi
- Heart and Lung Transplant and Mechanical Circulatory Support, Miami Transplant Institute, Miami, Florida.,Division Heart and Lung Transplant and Mechanical Circulatory Support, Department of Surgery, University of Miami School of Medicine, Miami, Florida
| | - Andrew Talon
- Heart and Lung Transplant and Mechanical Circulatory Support, Miami Transplant Institute, Miami, Florida
| | - Alan Klima
- Comprehensive Care Services, Inc, Livonia, Michigan
| | | | - David Galbut
- Division of Cardiothoracic Surgery, Department of Surgery, Jackson Hospital System, Miami, Florida
| | - Matthias Loebe
- Heart and Lung Transplant and Mechanical Circulatory Support, Miami Transplant Institute, Miami, Florida.,Division Heart and Lung Transplant and Mechanical Circulatory Support, Department of Surgery, University of Miami School of Medicine, Miami, Florida
| | - Ali Ghodsizad
- Heart and Lung Transplant and Mechanical Circulatory Support, Miami Transplant Institute, Miami, Florida.,Division Heart and Lung Transplant and Mechanical Circulatory Support, Department of Surgery, University of Miami School of Medicine, Miami, Florida
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Donato-Santana C, Loebe M, Brozzi N, Chaparro S, Bauerlein EJ, Badiye A, Ghodsizad A, Simkins J. Is it safe to remove an infected cardiac implantable electronic device at the time of heart transplantation? Report of two cases. J Card Surg 2019; 35:226-228. [PMID: 31609492 DOI: 10.1111/jocs.14279] [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: 11/27/2022]
Abstract
Cardiac implantable electronic device (CIED) infections are treated with antibiotics and device explantation. Lack of CIED removal is associated with infection recurrence. However, CIED removal can be associated with major complications including death. We reported two patients with advanced heart disease who developed CIED infection due Staphylococcus epidermidis while awaiting for orthotopic heart transplantation (OHT). Both patients were managed with a different approach. They were treated with antibiotic therapy and had their CIED removal postponed until OHT. Both patients were kept on suppressive antibiotic treatment until undergoing simultaneous OHT and removal of infected CIED. None of the patients had infection recurrence. Large studies are needed to assess whether the approach of delaying CIED removal until OHT is safe among carefully selected patients with CIED infection.
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Affiliation(s)
- Christian Donato-Santana
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
| | - Matthias Loebe
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Nicolas Brozzi
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Sandra Chaparro
- Department of Medicine, Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Eugene J Bauerlein
- Department of Medicine, Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Amit Badiye
- Department of Medicine, Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Ali Ghodsizad
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Jacques Simkins
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
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48
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Brozzi NA, Cifuentes RO, Saba IC, Lineen EB, Loebe M, Ghodsizad A, Salerno TA. Heparineless off-pump coronary artery bypass in a patient with gunshot wound to chest and heart. J Card Surg 2019; 34:632-634. [PMID: 31212380 DOI: 10.1111/jocs.14090] [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: 05/06/2019] [Accepted: 05/11/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Administration of heparin is standard in coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (OPCABG). In some circumstances, the risk of heparinization may outweigh its benefits, and there is scarce literature on how to proceed in these cases. We describe the technique used for OPCABG without heparin. METHODS We report the case of a patient with a gunshot wound to the chest resulting in multiple lung lacerations and transection of the proximal left anterior descending coronary artery (LAD) leading to hemorrhagic shock with tamponade, and cardiogenic shock due to myocardial ischemia who received OPCABG without heparin. RESULTS A 23-year-old patient suffered multiple gunshot wounds to the chest and was admitted in shock with massive left hemothorax. Emergency left thoracotomy revealed multiple lung lacerations and transection of the proximal left anterior coronary artery. The patient presented acute myocardial ischemia and progressed to cardiogenic shock requiring insertion of intra-aortic balloon pump (IABP) to try to support hemodynamics. OPCABG with a segment of reversed saphenous vein graft to the LAD coronary artery was performed using standard techniques but without heparinization. The graft was flushed with normal saline before completing both anastomosis. Myocardial ischemic changes reversed, and the patient stabilized immediately after completing OPCABG, allowing to wean off IABP in the operating room. Postoperative recovery was unremarkable, and the patient was discharged home on postoperative day 9. CONCLUSION Benefits of OPCABG include decreased bleeding and lower requirement of blood transfusions. This experience shows that OPCABG can be performed without systemic heparinization in selected cases.
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Affiliation(s)
- Nicolas A Brozzi
- Division of Cardiothoracic Surgery and Heart and Lung Transplantation, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida
| | - Renzo O Cifuentes
- Division of Cardiothoracic Surgery and Heart and Lung Transplantation, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida
| | - Isabela C Saba
- Division of Cardiothoracic Surgery and Heart and Lung Transplantation, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida
| | - Edward B Lineen
- Division of Trauma Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida
| | - Matthias Loebe
- Division of Cardiothoracic Surgery and Heart and Lung Transplantation, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida
| | - Ali Ghodsizad
- Division of Cardiothoracic Surgery and Heart and Lung Transplantation, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida
| | - Thomas A Salerno
- Division of Cardiothoracic Surgery at Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida
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49
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Gonzalez R, Grant A, DeMarchena E, Klima A, Armor M, Badiye A, Loebe M, Cohen M, Ghodsizad A. “The Right Stuff”: Using a Caval Stent Valve to Mitigate the Effect of Right Heart Failure in LVAD Patients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.930] [Citation(s) in RCA: 1] [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: 10/27/2022] Open
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50
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Brozzi N, Vianna R, Souki F, Saba I, Ghodzisad A, Tekin A, Selvaggi G, Beduschi T, Badiye A, Chaparro S, Aljure O, Nicolau-Raducu A, Loebe M. En-Block Heart-Liver Transplantation in Adults - Technique and Mid Term Outcomes. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.996] [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: 11/26/2022] Open
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