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Sosa CV, Ohira S, Ahmad H, Isath A, De La Pena C, Spielvogel D, Kai M. Escalation from intra-aortic balloon pump to axillary impella 5.5 support: Staged removal of the femoral access. Perfusion 2024; 39:469-472. [PMID: 36537179 DOI: 10.1177/02676591221147431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Background: With the growing population of advanced heart failure, the use of Impella 5.5 has been increasing. Here, we report an effective strategy of removing the intra-aortic balloon pump (IABP) in the setting of escalation of support to Impella 5.5.Results: From January 1, 2022 to June 30, 2022, a total of 6 patients have undergone IABP removal during Impella 5.5 insertion. The IABP was subsequently removed over the long wire with manual compression on the femoral artery to control bleeding. An 8 or 9 Fr short sheath is inserted over the wire. Staged hemostasis was successfully performed in 4 patients, and the remaining two patients required escalation of support to veno-arterial membrane oxygenation as EC-PELLA utilizing the femoral arterial sheath.Conclusion: This does not only achieve secured hemostasis but also enables a smooth transition to further escalate support such as extracorporeal membrane oxygenation support, if necessary.
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Affiliation(s)
- Carlos Vazquez Sosa
- Department of Cardiology, Westchester Medical Center, Valhalla, NT, USA
- New York Medical College, Valhalla, NY, USA
| | - Suguru Ohira
- New York Medical College, Valhalla, NY, USA
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Hasan Ahmad
- Department of Cardiology, Westchester Medical Center, Valhalla, NT, USA
- New York Medical College, Valhalla, NY, USA
| | - Ameesh Isath
- Department of Cardiology, Westchester Medical Center, Valhalla, NT, USA
| | - Corazon De La Pena
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - David Spielvogel
- New York Medical College, Valhalla, NY, USA
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Masashi Kai
- New York Medical College, Valhalla, NY, USA
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
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2
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Ohira S, Kai M, Goldberg JB, Malekan R, Gregory V, Pena CDL, Aoki K, Egawa S, Lansman SL, Spielvogel D. Stroke After Acute Type A Dissection Repair Using Right Axillary Cannulation First Approach. Ann Thorac Surg 2024; 117:753-760. [PMID: 38081500 DOI: 10.1016/j.athoracsur.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 10/12/2023] [Accepted: 11/20/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND This study sought to analyze the details of strokes after acute type A dissection repair (ATAD) using a right axillary artery (RAX) first approach. METHODS A total of 356 consecutive ATAD repairs from 2005 to 2022 were analyzed on the basis of arterial cannulation site. Strokes were evaluated by head computed tomography. RESULTS The rate of RAX cannulation was 82.6% (n = 294), with a 38.2% rate of antegrade cerebral perfusion use, both of which had increased over the years. The non-RAX group had more cardiogenic shock (RAX, 16.3% vs non-RAX, 37.1%; P < .001), cerebral malperfusion (8.8% vs 25.8%, respectively; P < .001), and innominate artery dissection (45.9% vs 69.2%, respectively; P = .007). Eight patients died before undergoing a full neurologic assessment. The overall stroke rate was 8.4% (n = 30), and it was lower in the RAX group (5.1% vs 24.2%; P < .001). All strokes were ischemic, with concomitant hemorrhagic strokes occurring in 6 patients. Strokes diagnosed immediately after surgery (perioperative stroke) accounted for 70% (n = 21 of 30) of cases. Strokes predominantly affected the right anterior circulation (right anterior, 80% vs left anterior, 46.7% vs left posterior, 26.7%; P = .013), independent of arterial cannulation site. The proposed mechanism of perioperative strokes was not uniform (embolism, 33.3%; hypoperfusion, 42.8%; embolism and hypoperfusion, 14.3%; lacunar infarct, 10%), whereas most postoperative strokes were embolic (77.8%). The mean National Institutes of Health Stroke Scale score was 20.6 ± 9.9, and the modified Rankin score at discharge was 4.1±2.2. CONCLUSIONS Most strokes in ATAD occurred perioperatively from various mechanisms predominantly affecting the right anterior circulation irrespective of the arterial cannulation site. This complication is most likely the result of unstable hemodynamics and dissection of the innominate artery (IA) or its downstream vessels.
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Affiliation(s)
- Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York.
| | - Masashi Kai
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Joshua B Goldberg
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Ramin Malekan
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Vasiliki Gregory
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Corazon de la Pena
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Kosuke Aoki
- Department of Neurosurgery and Biochemistry, University of Miami, Miami, Florida
| | - Satoshi Egawa
- Department of Neurology, Colombia University Irving Medical Center, New York, New York
| | - Steven L Lansman
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - David Spielvogel
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York
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3
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Washio H, Kashimoto K, Sakashita N, Ohira S, Tanaka J, Maeda N, Shimada M, Kawamata M, Yoneda A, Nakanishi K. Practical use of the central venous access port for contrast-enhanced CT: comparison with peripheral intravenous access regarding enhancement and safety. Clin Radiol 2024; 79:213-220. [PMID: 38218706 DOI: 10.1016/j.crad.2023.12.010] [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: 06/26/2023] [Revised: 12/01/2023] [Accepted: 12/09/2023] [Indexed: 01/15/2024]
Abstract
AIM To evaluate the efficacy of using the central venous (CV) port compared with peripheral intravenous access for contrast-material injection for contrast enhancement during the portal venous phase. MATERIALS AND METHODS Patients were divided into three groups: CV delay, CV routine, and peripheral access (PA) groups. Patients in the CV delay group underwent injection in the arm-down position with an additional delay, while those in the CV routine and PA groups underwent injections with the routine injection protocol for portal venous phase imaging. Contrast enhancement was evaluated by measuring the mean radiodensity (Hounsfield units) values for the aortic arch, abdominal aorta, inferior vena cava, portal vein, and spleen. The peak injection pressure was recorded and compared among the three groups. RESULTS No complications related to power injection were observed during 119 contrast-material injections performed using the CV port device. The CV delay group showed significantly lower radiodensity values than the PA group (165.7 ± 20.1 versus 181 ± 19 HU [p<0.01] for the portal vein); however, no significant differences in mean radiodensity values were observed between the CV routine and PA groups (p>0.05). The median peak injection pressure was 73.5, 67, and 47 psi in the CV delay, CV routine, and PA groups, respectively (p<0.01). CONCLUSION The CV port can be used for safe contrast-material injection while maintaining contrast enhancement on portal venous phase comparable to that achieved with peripheral intravenous access.
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Affiliation(s)
- H Washio
- Department of Diagnosis and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan.
| | - K Kashimoto
- Department of Diagnosis and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - N Sakashita
- Department of Diagnosis and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - S Ohira
- Department of Comprehensive Radiation Oncology, The University of Tokyo, Tokyo, Japan; Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - J Tanaka
- Department of Diagnosis and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - N Maeda
- Department of Diagnosis and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - M Shimada
- Department of Diagnosis and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - M Kawamata
- Department of Diagnosis and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - A Yoneda
- Department of Diagnosis and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - K Nakanishi
- Department of Diagnosis and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
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4
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Gregory V, Spielvogel D, Ohira S. Optimal arch repair in acute type A aortic dissection: Striking a balance between safety and efficacy. J Thorac Cardiovasc Surg 2024; 167:e64-e65. [PMID: 37306640 DOI: 10.1016/j.jtcvs.2023.05.016] [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: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 06/13/2023]
Affiliation(s)
| | - David Spielvogel
- School of Medicine, New York Medical College, Valhalla, NY; Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY
| | - Suguru Ohira
- School of Medicine, New York Medical College, Valhalla, NY; Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY
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5
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Kapur R, Okumura K, Ohira S, Isath A, Gandhi A, Keller M, Nog R, Gass A, Spielvogel D, Lansman S, Dhand A. Coronavirus Disease 2019 (COVID-19) in Heart Transplant Recipients and Anti-SARS-CoV-2 Monoclonal Antibodies: Experience, Lessons Learnt, and Future Challenges. Cardiol Rev 2024:00045415-990000000-00208. [PMID: 38334977 DOI: 10.1097/crd.0000000000000640] [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: 02/10/2024]
Abstract
Solid organ transplant recipients (SOTRs), including heart transplant (HT) recipients, infected with Coronavirus disease 2019 (COVID-19) are at higher risk of hospitalization, mechanical ventilation, or death when compared with general population. Advances in diagnosis and treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have reduced COVID-19-related mortality rates from ~30% in the early pandemic to <3% in 2022 among HT recipients. We performed a retrospective chart review including adult HT recipients at Westchester Medical Center from January 1, 2020 to December 10, 2022, who received anti-SARS-CoV-2 monoclonal antibodies (mAbs) for treatment of mild-to-moderate COVID-19, and those who received tixagevimab/cilgavimab for preexposure prophylaxis. Additionally, a comprehensive review of the literature involving SOTRs who received mAbs for COVID-19 was conducted. In this largest single-center study in this population, 42 adult HT recipients received casirivimab/imdevimab (36%), sotrovimab (31%), or bebtelovimab (29%) for treatment of mild-to-moderate COVID-19. Among these recipients, no infusion-associated adverse effects, progression of disease, COVID-19-associated hospitalizations, or death were noted. Preexposure prophylaxis with tixagevimab/cilgavimab was given to 63 HT recipients in a dedicated infusion center (40%), inpatient setting (33%), or at time of annual heart biopsy (27%). No immediate adverse events were noted. There were 11 breakthrough infections, all mild. Overall, the data suggests that HT recipients receiving mAbs have reduced rates of hospitalization, need for intensive care unit care, or death. Use of anti-SARS-CoV-2 mAbs in SOTRs is resource intensive and requires a programmatic team approach for optimal administration and to minimize any risk of disparities in their use.
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Affiliation(s)
| | - Kenji Okumura
- Department of Surgery, New York Medical College/Westchester Medical Center, Valhalla, NY
| | - Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery
| | - Ameesh Isath
- Division of Cardiology, Department of Medicine, Westchester Medical Center, Valhalla, NY
| | | | | | - Rajat Nog
- From the Department of Medicine
- Department of Surgery, New York Medical College/Westchester Medical Center, Valhalla, NY
| | - Alan Gass
- Division of Cardiology, Department of Medicine, Westchester Medical Center, Valhalla, NY
| | | | - Steven Lansman
- Department of Surgery, New York Medical College/Westchester Medical Center, Valhalla, NY
| | - Abhay Dhand
- From the Department of Medicine
- Department of Surgery, New York Medical College/Westchester Medical Center, Valhalla, NY
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6
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Okumura K, Ohira S, Kai M, Misawa R, Wolfe K, Sogawa H, Veillette G, Nishida S, Spielvogel D, Lansman S, Dhand A. High Rate of Kidney Graft Failure after Simultaneous Heart-Kidney Transplantation. Kidney360 2024; 5:252-261. [PMID: 38268085 PMCID: PMC10914208 DOI: 10.34067/kid.0000000000000365] [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] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024]
Abstract
Key Points Simultaneous heart–kidney transplant is associated with high rates of kidney graft failure which are worse when compared with kidney transplant alone. The major causes of kidney graft failure in simultaneous heart–kidney transplant recipients were patient death and primary nonfunction of kidney graft. Background The indications and outcomes of simultaneous heart–kidney transplantation (SHKT) remain suboptimally defined. Risk factors for renal graft failure after SHKT also remain poorly defined. Methods We analyzed the renal graft outcomes among SHKT recipients using United Network for Organ Sharing database from 2015 to 2020. To evaluate for factors associated with poor renal outcomes, we compared SHKT and kidney transplantation alone recipients using propensity score matching. Results Among SHKT recipients, the rate of primary nonfunction (PNF) of kidney graft was 3%, the 30-day kidney graft failure rate was 7.0%, and the 30-day post-transplant mortality rate was 4.1%. The incidence of kidney delayed graft function was 27.5%. Kidney graft failure was seen early post-SHKT with most common causes of patient death (43.9%) and PNF of kidney graft (41.5%). One- and 2-year patient survival was 89.2% and 86.5%, and 1- and 2-year freedom from kidney graft failure was 85.4% and 82.7%, respectively. In subgroup analysis of SHKT recipients, use of pretransplant mechanical cardiac support (adjusted odds ratio [aOR], 2.57; P = 0.017), higher calculated panel reactive antibody (aOR, 1.76; P = 0.016), and older donor age per 10 years (aOR, 1.94; P = 0.001) were associated with PNF. Pretransplant extracorporeal membrane oxygenation support was associated with the increased risk of 30-day recipient mortality (aOR, 5.55; P = 0.002). Increased 30-day graft failure was seen in SHKT recipients with pretransplant mechanical cardiac support (aOR, 1.77; P = 0.038) and dialysis at the time of transplant (aOR, 1.72; P = 0.044). Multivariable Cox hazard analysis demonstrated that SHKT, when compared with kidney transplantation alone, is associated with increased kidney graft failure (hazard ratio, 2.56; P < 0.001) and recipient mortality (hazard ratio, 2.65; P < 0.001). Conclusions SHKT is associated with high rates of kidney graft failure. Identification of risk factors of renal graft failure can help optimize recipient selection for SHKT versus kidney after heart transplantation, especially after introduction of the new safety-net policy.
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Affiliation(s)
- Kenji Okumura
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Suguru Ohira
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York
| | - Masashi Kai
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York
| | - Ryosuke Misawa
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Kevin Wolfe
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Hiroshi Sogawa
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Gregory Veillette
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Seigo Nishida
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - David Spielvogel
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York
| | - Steven Lansman
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York
| | - Abhay Dhand
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
- Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, New York
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7
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Gregory V, Goldberg JB, Haidry A, Ahmad H, Isath A, Kai M, Ohira S. Practical approach to confirm femoral artery patency after percutaneous closure for veno-arterial extracorporeal membrane oxygenation decannulation. Perfusion 2023:2676591231220820. [PMID: 38041692 DOI: 10.1177/02676591231220820] [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: 12/03/2023]
Abstract
BACKGROUND We describe a technique to assess blood flow distal to the decannulation site after deployment of Perclose ProGlide (Abbott Vascular, Abbott Park, Ill) in patients on femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. TECHNIQUE An antegrade distal perfusion catheter was placed in all patients, and decannulation was primarily performed at bedside (N = 11/12). With the VA-ECMO circuit switched off, a needle was inserted into the arterial tubing, passed through the femoral arterial cannula into the artery. The arterial cannula was removed over a wire and the previously placed Proglide Perclose sutures were secured. Back bleeding from the antegrade distal perfusion catheter, confirmed using a three-way connector, indicated blood flow to the superficial femoral artery. This was followed by confirmation of blood flow to the lower leg using a Doppler ultrasound. Hemostasis of the antegrade perfusion catheter was achieved through manual compression. RESULTS We implemented this technique in 12 patients with a technical success rate of 100%. There were no ipsilateral leg ischemia, bleeding, pseudoaneurysm, or infection after decannulation. CONCLUSIONS This technique allows prompt assessment of blood flow to the distal leg immediately following arterial decannulation.
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Affiliation(s)
| | - Joshua B Goldberg
- New York Medical College, Valhalla, NY, USA
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Abbas Haidry
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| | - Hasan Ahmad
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| | - Ameesh Isath
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Masashi Kai
- Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Suguru Ohira
- New York Medical College, Valhalla, NY, USA
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
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8
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Isath A, Gregory V, Ohira S, Levine A, Dhand A, Laskowski I, Mateo R, Babu S, Spielvogel D, Kai M. Groin wound management after decannulation of veno-arterial extracorporeal membrane oxygenation in heart transplantation: Role of sartorius muscle flap. Clin Transplant 2023; 37:e15147. [PMID: 37755149 DOI: 10.1111/ctr.15147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/07/2023] [Accepted: 09/21/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND The management of complex groin wounds following VA-ECMO after heart transplant (HT) is uncertain due to limited experience. Sartorius muscle flaps (SMF) have been used in vascular surgery for groin wound complications. However, their use in HT recipients with perioperative VA-ECMO is unclear. This study aims to describe characteristics and outcomes of HT patients with groin complications after arterial decannulation for femoral VA-ECMO. METHODS We retrospectively reviewed HT patients who underwent peri-transplant femoral VA-ECMO at our institution from April 2011 to February 2023. Patients were categorized into two groups based on the presence of cannulation-related wound complications. RESULTS Among the 34 patients requiring VA-ECMO peri-transplant, 17 (50%) experienced complications at the cannulation site. Baseline characteristics including duration of VA-ECMO support were comparable in both groups. Patients with complications presented mostly with open wounds (41.1%) after a median duration of 22 days post-transplant. Concurrent groin infections were observed in 52.3% of patients, all caused by gram-negative bacteria. Wound complications were managed with 12 (70.6%) undergoing SMF treatment and 5 (31.2%) receiving conventional therapy. Four SMF recipients had preemptive procedures for wound dehiscence, while eight underwent SMF for groin infections. Among the SMF group, 11 patients had favorable outcomes without recurrent complications, except for one patient who developed a groin infection with pseudoaneurysm formation. Conventional therapy with vacuum assisted closure (VAC) and antibiotics were utilized in four patients without infection and one patient with infection. Three patients required additional surgeries with favorable healing of the wound. CONCLUSION Complications related to femoral VA-ECMO are common in HT patients, with infection being the most frequent complication. SMFs can be a useful tool to prevent progression of infection and improve local healing.
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Affiliation(s)
- Ameesh Isath
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | | | - Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Avi Levine
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Abhay Dhand
- Transplant Infectious Disease, Department of Medicine, Westchester Medical Center, Valhalla, New York, USA
| | - Igor Laskowski
- Division of Vascular Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Romeo Mateo
- Division of Vascular Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Sateesh Babu
- Division of Vascular Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - David Spielvogel
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Masashi Kai
- Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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9
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Hirani R, Okumura K, Isath A, Gregory V, Khan S, Dhand A, Lanier GM, Spielvogel D, Kai M, Ohira S. Utilization of hepatitis C virus infected donors in heart transplant recipients with elevated MELD-XI score. Clin Transplant 2023; 37:e15124. [PMID: 37688341 DOI: 10.1111/ctr.15124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND The advent of direct-acting antivirals has helped to increase the safe utilization of organs from hepatitis C virus positive (HCV+) donors. However, the outcomes of heart transplantation (HT) using an HCV+ donor are unclear in recipients with underlying liver disease represented by an elevated model for end-stage liver disease excluding international normalized ratio (MELD-XI). METHODS The United Network of Organ Sharing database was queried from Jan 2016 to Dec 2021. Post-transplant outcomes stratified by recipient MELD-XI score (low <10.37, medium, 10.38-13.39, and high >13.4) was compared between patients with HT from HCV+ (N = 792) and patients with HT from HCV-negative donors (N = 15,266). RESULTS The median MELD-XI score was comparable (HCV+, 12.1, vs. HCV-negative, 11.8, p = .37). In the HCV+ group, donors were older (33 vs. 31 years, p < .001). Ischemic time of donor hearts (3.48 vs. 3.28 h, p < .001) and travel distance (250 vs. 157 miles, p < .001) were longer in HCV+ group. In the Kaplan Meier analysis with a median follow-up of 750 days, survival was comparable between the two groups (2-year survival, MELD-XI Low: HCV+, 92.4 ± 3.6% vs. HCV-negative, 91.1 ±.8%, p = .83, Medium: HCV+ 89.2 ± 4.3% vs. HCV-negative, 88.2 ± 1.0%, p = .68, and High: HCV+, 84.9 ± 4.5% vs. HCV-negative, 84.6 ± 1.1%, p = .75) In multivariate Cox hazard models, HCV donors were not associated with mortality in each MELD-XI subgroup (Low: adjusted hazard ratio (aHR), 1.02, p = .94; Medium: aHR, .95, p = .81; and High: aHR, .93, p = .68). CONCLUSION Utilization of HCV+ hearts was not associated with an increased risk of adverse outcomes in recipients with an elevated MELD- XI score.
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Affiliation(s)
- Rahim Hirani
- New York Medical College, Valhalla, New York, USA
| | - Kenji Okumura
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Ameesh Isath
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | | | - Shazli Khan
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Abhay Dhand
- Transplant Infectious Disease, Department of Medicine, Westchester Medical Center, Valhalla, New York, USA
| | - Gregg M Lanier
- New York Medical College, Valhalla, New York, USA
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - David Spielvogel
- New York Medical College, Valhalla, New York, USA
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Masashi Kai
- Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Suguru Ohira
- New York Medical College, Valhalla, New York, USA
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA
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10
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Gregory V, Isath A, Bali AD, Al-Mufti F, Levine A, Kai M, Ohira S. Catheter thrombectomy for basilar artery stroke immediately after insertion of durable left ventricular assist device. Perfusion 2023:2676591231216793. [PMID: 37967279 DOI: 10.1177/02676591231216793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Background: Acute ischemic stroke (AIS) following left ventricular assist device (LVAD) implantation is a serious complication associated with device morbidity. AIS development following LVAD placement typically presents between 6- and 24-months post implantation.Case/Results: We report a case of a 67-year-old male who initially presented with reduced ejection fraction and severe coronary vessel disease. Following coronary artery bypass graft surgery, the patient remained in a low output state necessitating placement of an LVAD device. Approximately 4.5 hours following LVAD implantation, a severe acute decrease in mental status revealed new development of ischemic stroke of the basilar artery, which was successfully treated in one pass with catheter endovascular thrombectomy.Conclusion: While embolic stroke management in these cases remains difficult as patients are usually anticoagulated, our case demonstrates the utilization of endovascular thrombectomy as a viable therapeutic option in the setting of an uncommon occurrence of embolic stroke in the hours following LVAD implantation.
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Affiliation(s)
| | - Ameesh Isath
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Atul D Bali
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Avi Levine
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Masashi Kai
- Beth Israel Deaconess Medical Center, Cardiac Surgery, Boston, MA, USA
| | - Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY, USA
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11
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Okumura K, Ohira S, Misawa R, Dhand A, Nishida S. Promising role of normothermic regional perfusion in donation after circulatory death. Am J Transplant 2023; 23:1815-1816. [PMID: 37429390 DOI: 10.1016/j.ajt.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 06/29/2023] [Indexed: 07/12/2023]
Affiliation(s)
- Kenji Okumura
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Suguru Ohira
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York, USA; Division of cardiothoracic surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Ryosuke Misawa
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Abhay Dhand
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York, USA; Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Seigo Nishida
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York, USA.
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12
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Rzechorzek W, Dey S, Shah A, Michaud L, Boyle D, Pitaktong A, Levine A, Pan S, Ohira S, Gass A, Kai M, Lanier GM. High-Risk Pulmonary Hypertension Does Not Worsen Outcomes in Heart Transplantation. Am J Cardiol 2023; 205:290-297. [PMID: 37625227 DOI: 10.1016/j.amjcard.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/17/2023] [Accepted: 07/05/2023] [Indexed: 08/27/2023]
Abstract
Pulmonary hypertension (PH) is a relative contraindication to heart transplantation (HT). Multiple studies showed increased mortality in patients with PH. Advances in care may have led to improved outcomes in the modern era. We analyzed patients who underwent HT at our institution between 2014 and 2018. We divided patients into 2 groups based on the presence of high-risk PH defined as either pulmonary vascular resistance >3 Wood units or transpulmonary gradient >15 mm Hg. The primary outcome was survival. Secondary outcomes were post-HT morbidity and changes in hemodynamics. Subsequently, we analyzed national trends of single organ HT recipients with a high-risk PH between 1994 and 2018 from the United Network for Organ Sharing registry. Of 98 patients who underwent HT at our center, 32% had PH. In patients without and with PH, the survival was 100% at 30 days, 87%, and 81% at 3 years (p = 0.96). In both groups, pulmonary vascular resistance and trans-pulmonary gradient decreased after HT. Nationwide data revealed 30-day survival without and with PH at 97% and 98% (p = 0.47) and 3-year survival at 86% and 87% (p = 0.84), respectively, in 2018. The proportion of recipients with PH decreased from 25% in 1994 to 19% in 2018. Recipients of HT with and without high-risk PH had similar early and late mortality in a single-center and nationwide analysis. PH improved immediately after transplant. The United Network for Organ Sharing registry analysis demonstrates continued improvement in survival in patients with PH in the modern era, whereas the relative percentage of recipients with PH decreased over time.
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Affiliation(s)
- Wojciech Rzechorzek
- Departments of Cardiology, New York Medical College/Westchester Medical Center, Valhalla, New York
| | - Subo Dey
- Departments of Internal Medicine, New York Medical College/Westchester Medical Center, Valhalla, New York.
| | - Avisha Shah
- Departments of Internal Medicine, New York Medical College/Westchester Medical Center, Valhalla, New York
| | - Liana Michaud
- Departments of Internal Medicine, New York Medical College/Westchester Medical Center, Valhalla, New York
| | - Dennis Boyle
- Departments of Internal Medicine, New York Medical College/Westchester Medical Center, Valhalla, New York
| | - Areen Pitaktong
- Departments of Internal Medicine, New York Medical College/Westchester Medical Center, Valhalla, New York
| | - Avi Levine
- Departments of Cardiology, New York Medical College/Westchester Medical Center, Valhalla, New York
| | - Stephen Pan
- Departments of Cardiology, New York Medical College/Westchester Medical Center, Valhalla, New York
| | - Suguru Ohira
- Departments of Cardiothoracic Surgery, New York Medical College/Westchester Medical Center, Valhalla, New York
| | - Alan Gass
- Departments of Cardiothoracic Surgery, New York Medical College/Westchester Medical Center, Valhalla, New York
| | - Masashi Kai
- Departments of Cardiothoracic Surgery, New York Medical College/Westchester Medical Center, Valhalla, New York
| | - Gregg M Lanier
- Departments of Cardiology, New York Medical College/Westchester Medical Center, Valhalla, New York
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Ohira S, Gregory V, Goldberg JB, Malekan R, Laskowski I, De La Pena C, Lansman SL, Spielvogel D, Kai M. Zone 2 arch repair for acute type A dissection: Evolution from arch-first to proximal-first repair. JTCVS Tech 2023; 21:7-17. [PMID: 37854804 PMCID: PMC10580043 DOI: 10.1016/j.xjtc.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 10/20/2023] Open
Abstract
Objective With growing experience of acute type A aortic dissection repair, Zone 2 arch repair has been advocated. The aim of this study is to compare the outcome between "proximal-first" and "arch-first" Zone 2 repair. Methods From January 2015 to March 2023, 45 patients underwent Zone 2 arch repair out of 208 acute type A aortic dissection repairs: arch-first, N = 19, and proximal-first technique, N = 26, since January 2021. Indications were aortic arch or descending tear, complex dissection in neck vessels, cerebral malperfusion, or aneurysm of the aortic arch. Results The lowest bladder temperature was higher in the proximal-first technique (24.9 °C vs 19.7 °C, P < .001). Cardiopulmonary bypass (230 vs 177.5 minutes, P < .001), myocardial ischemic (124 vs 91 minutes, P < .001), and lower-body circulatory arrest (87 vs 28 minutes, P < .001) times were shorter in the proximal-first technique. The arch-first group required more packed red blood cells (arch-first, 2 units vs proximal-first, 0 units, P = .048), platelets (arch-first, 4 units vs proximal-first, 2 units, P = .003), and cryoprecipitates (arch-first, 2 units vs proximal-first, 1 unit, P = .024). Operative mortality and major morbidities were higher in the arch-first group (57.9% vs 11.5%, P = .001). One-year survival was comparable (arch-first, 89.5% ± 7.0% vs proximal-first, 92.0% ± 5.5%, P = .739). Distal intervention was successfully performed in 5 patients (endovascular, N = 3, and open repair, N = 2). Conclusions Zone 2 arch repair using the proximal-first technique for acute type A aortic dissection repair yields shorter lower-body ischemic time with a warmer core temperature, resulting in shorter cardiopulmonary bypass time, less blood product use, and fewer morbidities when compared with the arch-first technique.
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Affiliation(s)
- Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY
- New York Medical College, Valhalla, NY
| | | | - Joshua B. Goldberg
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY
- New York Medical College, Valhalla, NY
| | - Ramin Malekan
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY
- New York Medical College, Valhalla, NY
| | - Igor Laskowski
- New York Medical College, Valhalla, NY
- Division of Vascular Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY
| | - Corazon De La Pena
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY
- New York Medical College, Valhalla, NY
| | - Steven L. Lansman
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY
- New York Medical College, Valhalla, NY
| | - David Spielvogel
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY
- New York Medical College, Valhalla, NY
| | - Masashi Kai
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY
- New York Medical College, Valhalla, NY
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14
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Inui S, Tomita N, Takaoka T, Ueda Y, Ohira S, Tsuchiya T, Miyazaki M, Nishio T, Koizumi M, Konishi K. Dosimetric Comparison of Automated Non-Coplanar Volumetric-Modulated Arc Therapy and Intensity-Modulated Proton Therapy in Angiosarcoma of the Scalp. Int J Radiat Oncol Biol Phys 2023; 117:e675. [PMID: 37785989 DOI: 10.1016/j.ijrobp.2023.06.2128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Angiosarcoma of the scalp (AS) is a rare tumor and has often been treated by total scalp irradiation (TSI). TSI is a challenging technique because of the target close to the organs at risks (OARs), located in the skin surface, and helmet-shape of the target. We performed the dosimetric comparison of automated non-coplanar volumetric-modulated arc therapy (HA) and intensity-modulated proton therapy (IMPT) in TSI for AS. MATERIALS/METHODS A planning study was performed on 20 patients with AS. The clinical target volume (CTV) 1 and CTV2 were defined as gross tumor volume with margin and entire scalp, respectively. For HA, planning target volume (PTV) 1 and PTV2 were defined as CTV1 and CTV2 with 5-mm margins, respectively. For IMPT, robust optimization was utilized which accounted for a 5-mm setup and a 3.5% range uncertainty and dose was prescribed to CTV1 robust and CTV2 robust. The prescription doses were 70 Gy and 56 Gy in 35 fractions to PTV1 (CTV1 robust) and PTV2 (CTV2 robust), respectively, using the simultaneous integrated boost technique. The HA plan was performed using a 6-MV photon beam machine and a 1-cm thick virtual bolus. The HA plan included three half non-coplanar and one full coplanar arc fields. The HA plan used collimator angles of 15°, 60°, 15°, and 120° in the beam with couch rotations of 0°, 45°, 90°, and 315°, respectively. The IMPT plan was performed using a compact proton beam machine dedicated to pencil beam scanning. The IMPT plan used gantry angles of 70°, 150°, 70°, 150°, and 30° in the beam with couch rotations of 0°, 0°, 180°, 180°, and 270°, respectively. The IMPT plan was optimized assuming a relative biological effectiveness of 1.1. The dose distribution and dosimetric parameters for each plan were evaluated. RESULTS All plans met the goals within the acceptable range in target volume coverage, conformity, and homogeneity. Table shows the dosimetric parameters of OARs in HA and IMPT plans. The doses receiving 0.1 cc of the volume for hippocampus, optic passway, eye, and lens in the IMPT plan were significantly lower than those in the HA plan. The IMPT plan showed a significant reduction in the percentage of brain volume receiving at least 5 Gy (V5 Gy) compared to the HA plan, while the HA plan showed a significant reduction of V10 Gy - V60 Gy and mean brain dose compared to the IMPT plan. The HA plan provided a shorter beam-on time (184 ± 9 s) than did the IMPT plan (446 ± 49 s). CONCLUSION The HA and IMPT plans demonstrated different strengths with respect to OARs sparing.
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Affiliation(s)
- S Inui
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan; Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - N Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - T Takaoka
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Y Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - S Ohira
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - T Tsuchiya
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - M Miyazaki
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - T Nishio
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - M Koizumi
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - K Konishi
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
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15
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Sakata T, De La Pena C, Ohira S. Functional or Anatomical Completeness of Revascularization After Coronary Artery Bypass Grafting. Ann Thorac Surg 2023; 116:862. [PMID: 37054929 DOI: 10.1016/j.athoracsur.2023.04.006] [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: 03/29/2023] [Accepted: 04/02/2023] [Indexed: 04/15/2023]
Affiliation(s)
- Tomoki Sakata
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Corazon De La Pena
- Division of Cardiothoracic Surgery, Westchester Medical Center, 100 Woods Rd, Macy Pavilion, Valhalla, NY 10595
| | - Suguru Ohira
- Division of Cardiothoracic Surgery, Westchester Medical Center, 100 Woods Rd, Macy Pavilion, Valhalla, NY 10595.
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16
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Ohira S, Lansman SL, Spielvogel D. Collateral network concept in 2023. Ann Cardiothorac Surg 2023; 12:450-462. [PMID: 37817844 PMCID: PMC10561329 DOI: 10.21037/acs-2023-scp-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/10/2023] [Indexed: 10/12/2023]
Abstract
Extensive thoracoabdominal aortic aneurysm repair can cause spinal cord ischemia which significantly impacts survival and quality of life. Although this complication is uncommon, it is important to recognize the pathophysiology and preventative measures. In the 1990s, Dr. Griepp and colleagues proposed the existence of an extensive collateral network that supports spinal cord perfusion, "the collateral network concept". This includes an interconnecting complex of vessels in the intraspinal, paraspinous, and epidural spaces, and in the paravertebral muscles, involving the intercostal and lumbar segmental arteries as well as the subclavian and hypogastric (iliac) arteries. In this concept, as opposed to the one major segmental input model such as the Adamkiewicz artery, recognition of the importance of multiple inputs to the spinal circulation is paramount to maintaining the spinal blood flow and preventing spinal cord ischemia. In this article, we review the current evidence of the collateral concept and its application in aortic surgery.
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Affiliation(s)
- Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Steven L Lansman
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - David Spielvogel
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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17
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Ohira S, Okumura K, Hirani R, Martinez S, Ichikawa H, Isath A, Lanier GM, De La Pena C, Spielvogel D, Kai M. Use of Donor Hearts ≥50 Years Old for Septuagenarians in Heart Transplantation. Ann Thorac Surg 2023; 116:580-586. [PMID: 37146787 DOI: 10.1016/j.athoracsur.2023.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/04/2023] [Accepted: 04/24/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND The impact of using donors ≥50 years old on heart transplantation outcomes of septuagenarians is unknown, which may have a potential to expand the donor pool. METHODS From January 2011 to December 2021, 817 septuagenarians received donor hearts <50 years old (DON<50) and 172 septuagenarians received donor hearts ≥50 years old (DON≥50) in the United Network for Organ Sharing database. Propensity score matching was performed using recipient characteristics (167 pairs). The Kaplan-Meier method and Cox proportional hazards model were used to analyze death and graft failure. RESULTS The number of heart transplants in septuagenarians has been increasing (54 per year in 2011 to 137 per year in 2021). In a matched cohort, the donor age was 30 years in DON<50 and 54 years in DON≥50. In DON≥50, cerebrovascular disease was the main cause of death (43%), whereas head trauma (38%) and anoxia (37%) were the causes in DON<50 (P < .001). The median heart ischemia time was comparable (DON<50, 3.3 hours; DON≥50, 3.2 hours; P = .54). In matched patients, 1- and 5-year survival rates were 88.0% (DON<50) vs 87.2% (DON≥50) and 79.2% (DON<50) vs 72.3% (DON≥50), respectively (log-rank, P = .41). In the multivariable Cox proportional hazards models, donors ≥50 years old were not associated with death in matched (hazard ratio, 1.05; 95% CI, 0.67-1.65; P = .83) and nonmatched groups (hazard ratio, 1.11; 95% CI, 0.82-1.50; P = .49). CONCLUSIONS The use of donor hearts older than 50 years can be an effective option for septuagenarians, thereby potentially increasing organ availability without compromising outcomes.
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Affiliation(s)
- Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York; New York Medical College, Valhalla, New York.
| | - Kenji Okumura
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York
| | | | | | - Hajime Ichikawa
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York
| | - Ameesh Isath
- Department of Cardiology, Westchester Medical Center, Valhalla, New York
| | - Gregg M Lanier
- Department of Cardiology, Westchester Medical Center, Valhalla, New York
| | - Corazon De La Pena
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York
| | - David Spielvogel
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York; New York Medical College, Valhalla, New York
| | - Masashi Kai
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York; New York Medical College, Valhalla, New York
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18
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Gregory V, Sakata T, Isath A, Ishikawa K, Ohira S. Clinical Implication of Transvalvular Unloading With Venoarterial Extracorporeal Membrane Oxygenation Support in Acute Myocardial Infarction. JACC Basic Transl Sci 2023; 8:1243-1244. [PMID: 37791307 PMCID: PMC10543915 DOI: 10.1016/j.jacbts.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Affiliation(s)
| | | | | | | | - Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, 100 Woods Road, Valhalla, New York 10595, USA
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19
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Koziol KJ, Isath A, Rao S, Gregory V, Ohira S, Van Diepen S, Lorusso R, Krittanawong C. Extracorporeal Membrane Oxygenation (VA-ECMO) in Management of Cardiogenic Shock. J Clin Med 2023; 12:5576. [PMID: 37685643 PMCID: PMC10488419 DOI: 10.3390/jcm12175576] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/13/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
Cardiogenic shock is a critical condition of low cardiac output resulting in insufficient systemic perfusion and end-organ dysfunction. Though significant advances have been achieved in reperfusion therapy and mechanical circulatory support, cardiogenic shock continues to be a life-threatening condition associated with a high rate of complications and excessively high patient mortality, reported to be between 35% and 50%. Extracorporeal membrane oxygenation can provide full cardiopulmonary support, has been increasingly used in the last two decades, and can be used to restore systemic end-organ hypoperfusion. However, a paucity of randomized controlled trials in combination with high complication and mortality rates suggest the need for more research to better define its efficacy, safety, and optimal patient selection. In this review, we provide an updated review on VA-ECMO, with an emphasis on its application in cardiogenic shock, including indications and contraindications, expected hemodynamic and echocardiographic findings, recommendations for weaning, complications, and outcomes. Furthermore, specific emphasis will be devoted to the two published randomized controlled trials recently presented in this setting.
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Affiliation(s)
- Klaudia J. Koziol
- School of Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY 10595, USA
| | - Ameesh Isath
- Department of Cardiology, Westchester Medical Center, Valhalla, NY 10595, USA
| | - Shiavax Rao
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD 21218, USA
| | - Vasiliki Gregory
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD 21218, USA
| | - Suguru Ohira
- Division of Cardiothoracic Surgery, New York Medical College and Westchester Medical Center, Valhalla, NY 10595, USA
| | - Sean Van Diepen
- Division of Cardiology and Critical Care, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, 6202 AZ Maastricht, The Netherlands
| | - Chayakrit Krittanawong
- Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY 10016, USA
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20
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Isath A, Ohira S, Levine A, Lanier GM, Pan S, Aggarwal-Gupta C, Mason I, Gregory V, Spielvogel D, Gass AL, Kai M. Evolution of concomitant use of veno-arterial extracorporeal membrane oxygenation support with Impella in cardiogenic shock: From percutaneous femoral Impella to axillary Impella 5.5. Artif Organs 2023; 47:1404-1412. [PMID: 37335815 DOI: 10.1111/aor.14594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/05/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Little is known about safety and efficacy of the use of Impella 5.5 compared to previous iterations in the setting of Impella with Veno-Arterial Extracorporeal Membrane Oxygenation Support as ECPELLA. METHODS Consecutive patients who were treated by ECPELLA with surgically implanted axillary Impella 5.5 (N = 13) were compared with patients supported by ECPELLA with percutaneous femoral Impella CP or 2.5 (Control, N = 13). RESULTS The total ECPELLA flow was higher in ECPELLA 5.5 group (6.9 vs. 5.4 L/min, p = 0.019). Actual hospital survival was higher than predicted and comparable in both groups (ECPELLA 5.5, 61.5% vs. Control, 53.8%, p = 0.691). Both total device complications (ECPELLA 5.5, 7.7% vs. Control, 46.1%, p = 0.021) and Impella-specific complications (ECPELLA 5.5, 0% vs. Control, 30.8%, p = 0.012) were significantly lower in the ECPELLA 5.5 group. CONCLUSIONS Utilization of Impella 5.5 in the setting of ECPELLA provides greater hemodynamic support with a lower risk of complications compared to Impella CP or 2.5.
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Affiliation(s)
- Ameesh Isath
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA
- New York Medical College, Valhalla, New York, USA
| | - Avi Levine
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Gregg M Lanier
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Stephen Pan
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Chhaya Aggarwal-Gupta
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Ian Mason
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Vasiliki Gregory
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - David Spielvogel
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA
- New York Medical College, Valhalla, New York, USA
| | - Alan L Gass
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Masashi Kai
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA
- New York Medical College, Valhalla, New York, USA
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21
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Ohira S, Malekan R, Kai M, Goldberg JB, Laskowski I, De La Pena C, Mason I, Lansman SL, Spielvogel D. Aortic Reoperation After Prior Acute Type A Aortic Dissection Repair: Don't Despair the Repair. Ann Thorac Surg 2023; 116:43-50. [PMID: 36653324 DOI: 10.1016/j.athoracsur.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND There is paucity of data regarding reoperation after acute type A aortic dissection (ATAD) repair. METHODS From October 2006 to March 2022, 75 patients received 123 reoperations after ATAD (proximal, n = 17; distal, n = 103; and both, n = 3) utilizing redo sternotomy (RS, n = 68), left thoracotomy (LT, n = 44), and endovascular approach (TEVAR, n = 11). The axillary artery cannulation was utilized in 97.1% of the RS cases. A classic elephant trunk technique was used as a 2-staged procedure for distal pathology. Most LT repairs (95.5%) were completed above the celiac axis. RESULTS Index ATAD repairs were predominantly ascending/hemiarch repair (73.3%). The median duration from the index repair was 2.0 years. Most reoperations were elective procedures (82.1%). Hospital mortality was 2.4% (RS, 1.5%; LT, 4.5%; TEVAR, 0%), and the stroke rate was 1.6%. There was no spinal cord ischemia. The 5-year overall survival and freedom from aortic mortality or procedure were 85.2% ± 5.6% and 80.6% ± 6.1%, respectively. There were 7 distal reinterventions (prior TEVAR, n = 3; prior LT, n = 4). Two patients required LT repair after prior TEVAR and 3 patients received infrarenal aortic repair after prior LT repair. Computed tomography after completion of the distal repair (n = 45) showed an increase of distal aorta at each level as follows: celiac axis 1.2 mm/y; renal artery 1.0 mm/y; and terminal aorta 1.2 mm/y. CONCLUSIONS Reoperation after ATAD repair can be safely performed as an elective procedure at experienced centers. Staged distal interventions utilizing classic elephant trunk insertion and open repair above the celiac axis showed durable outcomes.
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Affiliation(s)
- Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York.
| | - Ramin Malekan
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York
| | - Masashi Kai
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York
| | - Joshua B Goldberg
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York
| | - Igor Laskowski
- Division of Vascular Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York
| | - Corazon De La Pena
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York
| | - Ian Mason
- New York Medical College, Valhalla, New York
| | - Steven L Lansman
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York
| | - David Spielvogel
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York
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22
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Gregory V, Grunfeld M, Kanwal A, Bali AD, Pan S, Spielvogel D, Kai M, Ohira S. Escalation from impella 5.5 to ECPELLA support as a bridge to mitral valve surgery in a patient with degenerative mitral regurgitation. Perfusion 2023:2676591231186725. [PMID: 37354131 DOI: 10.1177/02676591231186725] [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: 06/26/2023]
Abstract
Severe mitral regurgitation (MR) is an important cause of acute heart failure and significant contributor to morbidity and mortality. Mechanical circulatory support (MCS) devices such as Impella are readily used to hemodynamically stabilize patients with cardiogenic shock (CS) secondary to this valvular pathology. Impella can also be combined with VA-ECMO to an "ECPELLA" configuration if further escalation of hemodynamic support is needed. We report a case of a 57-year-old female who presented with CS secondary to a perforated anterior mitral valve leaflet and non-ischemic cardiomyopathy that did not stabilize with initial choice of Impella 5.5. She required further escalation from axillary Impella 5.5 to the combined ECPELLA configuration, which allowed hemodynamic stabilization and ultimately a successful high-risk isolated mitral valve replacement. Despite adequate Impella flow, escalation to a combined MCS configuration, such as ECPELLA, may need to be considered upfront for acute valvular insufficiency in the setting of pre-existing cardiomyopathy.
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Affiliation(s)
| | - Matan Grunfeld
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Arjun Kanwal
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
| | - Atul D Bali
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
| | - Stephen Pan
- Department of Cardiology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
| | - David Spielvogel
- Division of Cardiothoracic Surgery, Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
| | - Masashi Kai
- Division of Cardiothoracic Surgery, Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
| | - Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
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23
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Dhand A, Okumura K, Ohira S, Kapur R, Wolfe K, Nishida S. Molnupiravir for Treatment of COVID-19 in Solid Organ Transplant Recipients. Transplantation 2023; 107:e182-e183. [PMID: 36959161 PMCID: PMC10205063 DOI: 10.1097/tp.0000000000004588] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/25/2023] [Accepted: 02/13/2023] [Indexed: 03/25/2023]
Affiliation(s)
- Abhay Dhand
- Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, NY
- Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Kenji Okumura
- Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Suguru Ohira
- Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Rohan Kapur
- Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Kevin Wolfe
- Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Seigo Nishida
- Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY
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24
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Gregory V, Hirani R, Harwood K, Isath A, Spielvogel D, Ohira S. Repair of infectious thoracoabdominal aneurysm and coeliacomesenteric trunk with removal of endovascular graft. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 37212027 DOI: 10.1510/mmcts.2023.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Infectious aneurysm of the thoracic or abdominal aorta is a rare clinical condition. We present the case of a 72-year-old female with an infectious thoracoabdominal aortic aneurysm with a coeliacomesenteric trunk requiring open repair following endovascular therapy. Following removal of the endovascular graft, the thoracoabdominal aorta was repaired using cardiopulmonary bypass and deep hypothermia. The common trunk of the superior mesenteric artery and the coeliac artery was then reconstructed, which included endarterectomy of the super mesenteric artery to create a cuff for an anastomosis. This case demonstrates the challenges associated with the endovascular repair of a condition with an infectious aetiology and highlights the necessity of open repair in complex cases with aberrant vascular anatomy.
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Affiliation(s)
| | | | | | - Ameesh Isath
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| | | | - Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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25
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Kim JK, Bali AD, Smith SC, Ohira S, Cooper HA. Acute occlusion of the left main coronary ostium by an endocarditis vegetation. Echocardiography 2023; 40:447-451. [PMID: 37010977 DOI: 10.1111/echo.15557] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/14/2023] [Indexed: 04/04/2023] Open
Affiliation(s)
- John K Kim
- Westchester Medical Center, Valhalla, New York, USA
| | - Atul D Bali
- Westchester Medical Center, Valhalla, New York, USA
| | | | - Suguru Ohira
- Westchester Medical Center, Valhalla, New York, USA
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26
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Gregory V, Grunfeld M, Kanwal A, Bali A, Isath A, Pan S, Spielvogel D, Kai M, Ohira S. Escalation from Impella 5.5 to Ecpella Support as a Bridge to Mitral Valve Surgery in a Patient with Non-Ischemic Cardiomyopathy with Degenerative Mitral Regurgitation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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27
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Isath A, Gass A, Pan S, Levine E, Gupta C, Lanier G, Spielvogel D, Kai M, Ohira S. Impella 5.5 with Veno-Arterial Extracorporeal Membrane Oxygenation Support as Ecpella 5.5. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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28
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Isath A, Ohira S, Hoch E, Frenkel D, Jacobson J, Lanier G, Kai M, Gass A, Levine E. Escalation of Mechanical Circulatory Support in a Patient with an Acute Myocardial Infarction, Cardiogenic Shock and Refractory Ventricular Tachycardia. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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29
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Ohira S, Okumura K, Isath A, Abhay D, Lanier G, Levine E, Pan S, Aggarwal Gupta C, Gass A, Spielvogel D, Kai M. Utilization of Hepatitis C Virus Infected Donor in Heart Transplant Recipients with Elevated Meld-Xi Score. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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30
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Khan S, Seplowe M, Vemulakonda L, Shakil F, Aggarwal-Gupta C, Lanier G, Levine E, Ohira S, Spielvogel D, Gass A, Kai M, Pan S. Early Recurrence of Cardiac Sarcoidosis after Orthotopic Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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31
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Ohira S, Pan S, Levine A, Aggarwal-Gupta C, Lanier GM, Gass AL, Spielvogel D, Kai M. Simple technique of distal leg perfusion during heart transplant in patients with preoperative veno-arterial extracorporeal membrane oxygenation support. Perfusion 2023; 38:473-476. [PMID: 34958280 DOI: 10.1177/02676591211064721] [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: 11/16/2022]
Abstract
Direct heart transplant from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support is challenging. Continuation of postoperative VA-ECMO support may be required in the setting of primary graft dysfunction or severe vasoplegia. We describe a simple technique to perfuse the ipsilateral leg of an arterial ECMO cannula during heart transplant while the ECMO circuit is turned off but maintaining the arterial cannula and distal perfusion catheter in place. This technique minimizes the number of intraoperative procedures with a minimal risk of leg ischemia, and provides a smooth transition to postoperative VA-ECMO support if necessary.
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Affiliation(s)
- Suguru Ohira
- Department of Surgery, Division of Cardiothoracic Surgery, New York Medical College, 8138Westchester Medical Center, Valhalla, NY, USA
| | - Stephen Pan
- Department of Cardiology, New York Medical College, 8138Westchester Medical Center, Valhalla, NY, USA
| | - Avi Levine
- Department of Cardiology, New York Medical College, 8138Westchester Medical Center, Valhalla, NY, USA
| | - Chhaya Aggarwal-Gupta
- Department of Cardiology, New York Medical College, 8138Westchester Medical Center, Valhalla, NY, USA
| | - Gregg M Lanier
- Department of Cardiology, New York Medical College, 8138Westchester Medical Center, Valhalla, NY, USA
| | - Alan L Gass
- Department of Cardiology, New York Medical College, 8138Westchester Medical Center, Valhalla, NY, USA
| | - David Spielvogel
- Department of Surgery, Division of Cardiothoracic Surgery, New York Medical College, 8138Westchester Medical Center, Valhalla, NY, USA
| | - Masashi Kai
- Department of Surgery, Division of Cardiothoracic Surgery, New York Medical College, 8138Westchester Medical Center, Valhalla, NY, USA
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32
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Isath A, Ohira S, Levine E, Pan S, Lanier G, Gupta C, Wolfe K, Spielvogel D, Gass A, Kai M. Ex-Vivo Heart Perfusion for Cardiac Transplantation: An Initial Experience in the United States. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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33
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Sakata T, De La Pena C, Ohira S. Rapid-Deployment Aortic Valve Replacement: Patient Selection and Special Considerations. Vasc Health Risk Manag 2023; 19:169-180. [PMID: 37016696 PMCID: PMC10066891 DOI: 10.2147/vhrm.s374410] [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: 01/05/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
Sutureless or rapid deployment valves in the setting of aortic valve replacement (AVR) is an emerging surgical technique using the transcatheter valve technology, which may lead to reduction in cross-clamp time and potentially better hemodynamics compared to a stented bioprosthetic valve. The absence of subannular pledgets results to excellent hemodynamic performance with reduced turbulent flow and larger effective orifice area. However, complications from both surgical and transcatheter AVR may still occur and impact survival. The incidence of paravalvular leakage and permanent pacemaker implantation are not low. Although technical modifications can improve these outcomes, there is a learning curve effect. Therefore, technical and anatomical considerations as well as better patient selection are paramount for better outcomes. In this review, we discuss the use of sutureless or rapid deployment valves in setting of (1) complex procedures, (2) minimally invasive AVR, and (3) small aortic annulus. The advantage of sutureless or rapid deployment valves in terms of mortality remains to be clarified; therefore, it is necessary to accumulate long-term outcomes in an appropriate patient cohort.
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Affiliation(s)
- Tomoki Sakata
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Corazon De La Pena
- Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Suguru Ohira
- Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
- Correspondence: Suguru Ohira, Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, 100 Woods Road, Macy Pavilion, Valhalla, NY, 10595, USA, Tel +1 404 234 5433, Email
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34
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Ohira S, Dhand A, Hirani R, Martinez S, Lanier GM, Levine A, Pan S, Aggarwal-Gupta C, Gass AL, Wolfe K, Spielvogel D, Kai M. Cannulation-related adverse events of peripheral veno-arterial extracorporeal membrane oxygenation support in heart transplantation: Axillary versus femoral artery cannulation. Clin Transplant 2023; 37:e14871. [PMID: 36468757 DOI: 10.1111/ctr.14871] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/14/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND In heart transplantation (HT), peripheral veno-arterial extracorporeal membranous oxygenation (VA-ECMO) is utilized preoperatively as a direct bridge to HT or postoperatively for primary graft dysfunction (PGD). Little is known about wound complications of an arterial VA-ECMO cannulation site which can be fatal. METHODS From 2009 to 2021, outcomes of 80 HT recipients who were supported with peripheral VA-ECMO either preoperatively or postoperatively were compared based on the site of arterial cannulation: axillary (AX: N = 49) versus femoral artery (FA: N = 31). RESULTS Patients in the AX group were older (AX: 59 years vs. 52 years, p = .006), and less likely to have extracorporeal cardiopulmonary resuscitation (0% vs. 12.9%, p = .040). Survival to discharge (AX, 81.6% vs. FA. 90.3%, p = .460), incidence of stroke (10.2% vs. 6.5%, p = .863), VA-ECMO cannulation-related bleeding (6.1% vs. 12.9%, p = .522), and arm or limb ischemia (0% vs. 3.2%, p = .816) were comparable. ECMO cannulation-related wound complications were lower in the AX group (AX, 4.1% vs. FA, 45.2%, p < .001) including the wound infections (2.0% vs. 32.3%, p < .001). In FA group, all organisms were gram-negative species. In univariate logistic regression analysis, AX cannulation was associated with less ECMO cannulation-related wound complications (Odds ratio, .23, p < .001). There was no difference between cutdown and percutaneous FA insertion regarding cannulation-related complications. CONCLUSIONS Given the lower rate of wound complications and comparable hospital outcomes with femoral cannulation, axillary VA-ECMO may be an excellent option in HT candidates or recipients when possible.
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Affiliation(s)
- Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA.,New York Medical College, Valhalla, New York, USA
| | - Abhay Dhand
- New York Medical College, Valhalla, New York, USA.,Transplant Infectious Disease, Department of Medicine, Westchester Medical Center, Valhalla, New York, USA
| | - Rahim Hirani
- New York Medical College, Valhalla, New York, USA
| | | | - Gregg M Lanier
- New York Medical College, Valhalla, New York, USA.,Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Avi Levine
- New York Medical College, Valhalla, New York, USA.,Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Stephen Pan
- New York Medical College, Valhalla, New York, USA.,Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Chhaya Aggarwal-Gupta
- New York Medical College, Valhalla, New York, USA.,Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Alan L Gass
- New York Medical College, Valhalla, New York, USA.,Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Kevin Wolfe
- Division of Data Compliance, Transplant Services, Westchester Medical Center, Valhalla, New York, USA
| | - David Spielvogel
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA.,New York Medical College, Valhalla, New York, USA
| | - Masashi Kai
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA.,New York Medical College, Valhalla, New York, USA
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35
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Ahsan SA, Laird R, Dooley C, Akbar S, Sweeney J, Ohira S, Kai M, Levine A, Gass AL, Frishman WH, Aronow WS, Lanier GM. An Update on the Diagnosis and Management of Acute Right Heart Failure. Cardiol Rev 2023:e000538. [PMID: 36847512 DOI: 10.1097/crd.0000000000000538] [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: 03/01/2023]
Abstract
Right ventricular (RV) dysfunction and resultant acute right heart failure (ARHF) is a rapidly growing field of interest, driven by increasing appreciation of its contribution to heart failure morbidity and mortality. Understanding of ARHF pathophysiology has advanced dramatically over recent years and can be broadly described as RV dysfunction related to acute changes in RV afterload, contractility, preload, or left ventricular dysfunction. There are several diagnostic clinical signs and symptoms as well as imaging and hemodynamic assessments that can provide insight into the degree of RV dysfunction. Medical management is tailored to the different causative pathologies, and in cases of severe or end-stage dysfunction, mechanical circulatory support can be utilized. In this review, we describe the pathophysiology of ARHF, how its diagnosis is established by clinical signs and symptoms and imaging findings, and provide an overview of treatment options, both medical and mechanical.
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Affiliation(s)
- Syed Adeel Ahsan
- From the Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Rachel Laird
- Department of Medicine, Houston Methodist Hospital, Houston, TX
| | - Caroline Dooley
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Sara Akbar
- Department of pulmonary and critical care medicine, Spectrum Health/Michigan State University, Detroit, MI
| | - James Sweeney
- Division of Cardiology, Hackensack Meridian Jersey Shore University Medical Center, Neptune, NJ
| | - Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY
| | - Masashi Kai
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY
| | - Avi Levine
- Departments of Cardiology and Medicine Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Alan L Gass
- Departments of Cardiology and Medicine Westchester Medical Center and New York Medical College, Valhalla, NY
| | - William H Frishman
- Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Wilbert S Aronow
- Departments of Cardiology and Medicine Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Gregg M Lanier
- Departments of Cardiology and Medicine Westchester Medical Center and New York Medical College, Valhalla, NY
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36
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Ohira S, Okumura K, Pan S, Dhand A, Levine E, De La Pena CB, Nishida S, Spielvogel D, Kai M. Outcomes of Combined Heart and Kidney Transplantation Under the New Heart Allocation Policy: A United Organ Network for Organ Sharing Database Analysis. Circ Heart Fail 2023; 16:e010059. [PMID: 36811827 DOI: 10.1161/circheartfailure.122.010059] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND The impact of the new heart allocation policy, which prioritizes acutely ill patients on temporary mechanical circulatory support and provides broader sharing of donor organs, on patient and graft survival in combined heart and kidney transplantation (HKT) is unknown. METHODS In the United Network for Organ Sharing data, patients were divided in groups before and after the policy change (OLD, January 1, 2015 to October 17, 2018, N=533; and NEW, October 18, 2018 to December 31, 2020, N=370). Propensity score matching was performed utilizing recipient characteristics (283 pairs). The median follow-up was 1099 days. RESULTS The annual volume of HKT increased approximately 2-fold during this period (N=117 in 2015 and N=237 in 2020), predominantly among patients not on hemodialysis at time of transplantation. Ischemic times for heart (OLD, 2.94 versus NEW, 3.37 hours; P<0.001) and kidney grafts (14.1 versus 16.0 hours; P<0.001) were longer under the new policy, as was the travel distance (47 versus 183 miles; P<0.001). In the matched cohort, 1-year overall survival (OLD, 91.1% versus NEW, 84.8%; P<0.001), and freedom from heart and kidney graft failure rate were worse under the new policy. Patients not on hemodialysis at time of HKT demonstrated worse survival and a higher risk of kidney graft failure under the new policy compared with the old policy. In multivariate Cox proportional-hazards analysis, the new policy was associated with an increased risk of mortality (hazard ratio, 1.81; P=0.007), and graft failure among HKT recipients (heart, hazard ratio, 1.81; P=0.007; and kidney, hazard ratio, 1.83; P=0.002). CONCLUSIONS The new heart allocation policy was associated with worse overall survival and decreased freedom from heart and kidney graft failure in HKT recipients.
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Affiliation(s)
- Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, New York Medical College, Valhalla. (S.O., K.O., C.B.D.L.P., D.S., M.K.)
| | - Kenji Okumura
- Division of Cardiothoracic Surgery, Department of Surgery, New York Medical College, Valhalla. (S.O., K.O., C.B.D.L.P., D.S., M.K.)
| | - Stephen Pan
- Department of Cardiology, New York Medical College, Valhalla. (S.P., E.L.)
| | - Abhay Dhand
- Transplant Infectious Disease, Department of Medicine and Surgery, New York Medical College, Valhalla. (A.D.)
| | - Elliot Levine
- Department of Cardiology, New York Medical College, Valhalla. (S.P., E.L.)
| | - Corazon B De La Pena
- Division of Cardiothoracic Surgery, Department of Surgery, New York Medical College, Valhalla. (S.O., K.O., C.B.D.L.P., D.S., M.K.)
| | - Seigo Nishida
- Division of Abdominal Transplant Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla. (S.N.)
| | - David Spielvogel
- Division of Cardiothoracic Surgery, Department of Surgery, New York Medical College, Valhalla. (S.O., K.O., C.B.D.L.P., D.S., M.K.)
| | - Masashi Kai
- Division of Cardiothoracic Surgery, Department of Surgery, New York Medical College, Valhalla. (S.O., K.O., C.B.D.L.P., D.S., M.K.)
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Nakatsuka T, Ohira S, Tone S, Kakumae S, Morinaka H, Hirata K, Kaifu M, Shimizu S, Fujii T, Miyaji Y. Search for novel biomarkers that reflect the pathology of age-related bladder dysfunction. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00110-0] [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: 02/12/2023]
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Hirata K, Ohira S, Tone S, Kakumae S, Nakatsuka T, Morinaka H, Takasaki H, Shimizu S, Kaifu M, Fujii T, Miyaji Y. Pathological analysis of spermatic dysfunction following testicular ischemia-reperfusion injury. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00260-9] [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: 02/12/2023]
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Morinaka H, Ohira S, Tone S, Kakumae S, Nakatsuka T, Takasaki H, Hirata K, Shimizu S, Kaifu M, Fujii T, Miyaji Y. Pathophysiological analysis of detrusor overactivity following partial bladder outlet obstruction. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00095-7] [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: 02/12/2023]
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Yaqoob H, Greenberg D, Huang L, Henson T, Pitaktong A, Peneyra D, Spencer PJ, Malekan R, Goldberg JB, Kai M, Ohira S, Wang Z, Murad MH, Chandy D, Epelbaum O. Extracorporeal membrane oxygenation in COVID-19 compared to other etiologies of acute respiratory failure: A single-center experience. Heart Lung 2023; 57:243-249. [PMID: 36274533 PMCID: PMC9582301 DOI: 10.1016/j.hrtlng.2022.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/03/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The COVID-19 pandemic has led to a boom in the use of V-V ECMO for ARDS secondary to COVID. Comparisons of outcomes of ECMO for COVID to ECMO for influenza have emerged. Very few comparisons of ECMO for COVID to ECMO for ARDS of all etiologies are available. OBJECTIVES To compare clinically important outcome measures in recipients of ECMO for COVID to those observed in recipients of ECMO for ARDS of other etiologies. METHODS V-V ECMO recipients between March 2020 and March 2022 consisted exclusively of COVID patients and formed the COVID ECMO group. All patients who underwent V-V ECMO for ARDS between January 2014 and March 2020 were eligible for analysis as the non-COVID ECMO comparator group. The primary outcome was survival to hospital discharge. Secondary outcomes included ECMO decannulation, ECMO duration >30 days, and serious complications. RESULTS Thirty-six patients comprised the COVID ECMO group and were compared to 18 non-COVID ECMO patients. Survival to hospital discharge was not significantly different between the two groups (33% in COVID vs. 50% in non-COVID; p = 0.255) nor was there a significant difference in the rate of non-palliative ECMO decannulation. The proportion of patients connected to ECMO for >30 days was significantly higher in the COVID ECMO group: 69% vs. 17%; p = 0.001. There was no significant difference in serious complications. CONCLUSION This study could not identify a statistically significant difference in hospital survival and rate of successful ECMO decannulation between COVID ECMO and non-COVID ECMO patients. Prolonged ECMO may be more common in COVID. Complications were not significantly different.
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Affiliation(s)
- Hamid Yaqoob
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, 100 Woods Road Macy Pavilion, Valhalla, NY 10595, USA.
| | - Daniel Greenberg
- Department of Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Lawrence Huang
- Department of Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Theresa Henson
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, 100 Woods Road Macy Pavilion, Valhalla, NY 10595, USA
| | - Areen Pitaktong
- Department of Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Daniel Peneyra
- Department of Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Philip J Spencer
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ramin Malekan
- Division of Cardiothoracic Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Joshua B Goldberg
- Division of Cardiothoracic Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Masashi Kai
- Division of Cardiothoracic Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Suguru Ohira
- Division of Cardiothoracic Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Zhen Wang
- Evidence-Based Practice Center, Mayo Clinic, Rochester, MN, USA
| | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Rochester, MN, USA
| | - Dipak Chandy
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, 100 Woods Road Macy Pavilion, Valhalla, NY 10595, USA
| | - Oleg Epelbaum
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, 100 Woods Road Macy Pavilion, Valhalla, NY 10595, USA
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Grunfeld M, Ohira S, Choe J, Lanier GM, Martin K, Spielvogel D, Kai M. Heart recovery from a brain-dead donor with a history of Ravitch procedure for repair of pectus excavatum. J Card Surg 2022; 37:5531-5533. [PMID: 36273420 DOI: 10.1111/jocs.17065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/06/2022] [Accepted: 10/15/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND We describe the successful heart transplantation of a brain-dead male donor with a remote history of pectus excavatum repair. METHOD AND RESULTS On computed tomography, the ascending aorta was in close proximity to metallic struts from the donor's sternal repair. Before harvesting the heart, visual and digital inspections revealed minimal space between the sternum and ascending aorta, complicated by severe adhesions in the lower sternum. After the pericardium was opened, the subsequent recovery of the heart was performed in a standard fashion. At one-year post-transplant, the recipient continues to have normal graft function. CONCLUSIONS Careful evaluation, intraoperative consideration, and coordination with other transplant teams were essential in the successful recovery of the heart during a time of organ shortages.
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Affiliation(s)
| | - Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Joshua Choe
- New York Medical College, Valhalla, New York, USA
| | - Gregg M Lanier
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Kathryn Martin
- Division of Pediatric Surgery, Department of Surgery, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - David Spielvogel
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Masashi Kai
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA
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Ohira S, Malekan R, Kai M, Spielvogel D. Safe Technique of Coronary Button Preparation in Redo Bentall Operation. Thorac Cardiovasc Surg 2022; 70:684-686. [PMID: 35439834 DOI: 10.1055/s-0042-1744263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
We introduce a technique of coronary button reconstruction in performing a redo Bentall procedure. A coronary button is prepared leaving a 3 to 4 mm rim of old Dacron graft surrounding the previous button. The Dacron rim may be sewn to the new aortic root graft directly or via an interposed 8- or 10-mm graft, using a modified Cabrol technique. If the button is comprised of good tissue and can be well-mobilized, it is removed from the Dacron rim and anastomosed directly to the new Dacron graft.
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Affiliation(s)
- Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, United States
| | - Ramin Malekan
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, United States
| | - Masashi Kai
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, United States
| | - David Spielvogel
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, United States
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43
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Ohira S, Spielvogel D, Lanier GM, Kai M. Heart transplantation using manubrium-sparing sternotomy for sternal re-entry. J Card Surg 2022; 37:5643-5645. [PMID: 36316823 DOI: 10.1111/jocs.17071] [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: 04/12/2022] [Revised: 07/29/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022]
Abstract
We report a technique of heart transplantation performed by manubrium-sparing sternotomy for challenging re-entry after minimally invasive left ventricular assist device insertion. A T-shaped, manubrium-sparing sternotomy was performed using an oscillating saw up to the first intercostal space. After cardiopulmonary bypass was established via the right axillary artery and percutaneous venous cannulation of the right jugular and femoral vein, the outflow graft was ligated and divided via a left thoracotomy. All anastomoses were performed with a standard technique with an excellent exposure and outcome.
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Affiliation(s)
- Suguru Ohira
- Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - David Spielvogel
- Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Gregg M Lanier
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Masashi Kai
- Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
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Kanwal A, Ohira S, Levine A, Isath A, Pan S, Dhand A, Aggarwal-Gupta C, Lanier GM, Gass A, Spielvogel D, Kai M. Survival and renal outcomes of direct heart transplant from veno-arterial extracorporeal membrane oxygenation support. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2156] [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: 11/15/2022] Open
Abstract
Abstract
Backgrounds
Patients on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support are given the highest priority for cardiac transplantation (OHT) in the new UNOS heart allocation policy adopted in October 2018. Although patients may receive an organ quicker there may not be enough time to recover end-organ function. To date, little is known about survival and renal outcomes of direct OHT in patients that have been supported with VA-ECMO as a bridge to transplant due to limited experience in most transplant centers.
Purpose
The aim of this study was to investigate survival and renal outcomes of direct OHT in patients supported with VA-ECMO prior to transplant.
Methods
From January 2010 to February 2022, 23 patients who received single organ OHT alone directly from VA-ECMO support were retrospectively analyzed (16 patients after the new allocation policy). Kaplan-Meier analysis was used to estimate event-free survival.
Results
The median age of recipients was 48 years. The median length of pre-transplant VA-ECMO support was 5 days. Additional pre-transplant support with intra-aortic balloon pump or Impella was utilized in 15 patients (65.2%) and 2 patients (9%) respectively. There was a trend toward improvement of serum creatinine after initiation of VA-ECMO support (Pre-ECMO: 1.66±1.22 mg/dl vs. Pre-OHT: 1.20±0.74 mg/dl, P=0.084). Four patients required preoperative renal replacement therapy (RRT); three were on RRT at the time of OHT. The median ischemic time of donor hearts was 168 minutes. VA-ECMO support was continued in 10 patients (43.5%) after OHT.
Hospital mortality was 8.7% (2 patients). Post-transplant RRT was required in 9 patients (39.1%), and, of these, 5 patients were transitioned to permanent dialysis. Among the 14 patients who did not require post-transplant RRT, none required RRT during the follow-up period (median, 21.5 months). Kaplan-Meier survival analysis showed that estimated survival at 1 year and 3 years were 86.1%, and 77.5%, respectively (Figure 1A). The freedom from dialysis rate was 82.4% at 1 year, and 74.9% at 3 years (Figure 2A). Both survival (100% vs. 66.7%, P=0.008, Fig.1B) and dialysis free rate (100% vs. 55.6%, P=0.002, Figure 2B) at one-year were significantly worse in patients who required postoperative RRT.
Conclusions
To our knowledge this is the largest single center study of OHT in patients that were supported with VA-ECMO. VA-ECMO as a bridge to end-organ recovery and OHT resulted in excellent outcomes. Patients who required post-transplant RRT more likely to require long-term dialysis, while those that did not receive RRT showed favorable outcomes. Overall survival in this patient population is comparable to patients that were not on VA-ECMO prior to transplant.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Kanwal
- Westchester Medical Center , New York , United States of America
| | - S Ohira
- Westchester Medical Center , New York , United States of America
| | - A Levine
- Westchester Medical Center , New York , United States of America
| | - A Isath
- Westchester Medical Center , New York , United States of America
| | - S Pan
- Westchester Medical Center , New York , United States of America
| | - A Dhand
- Westchester Medical Center , New York , United States of America
| | - C Aggarwal-Gupta
- Westchester Medical Center , New York , United States of America
| | - G M Lanier
- Westchester Medical Center , New York , United States of America
| | - A Gass
- Westchester Medical Center , New York , United States of America
| | - D Spielvogel
- Westchester Medical Center , New York , United States of America
| | - M Kai
- Westchester Medical Center , New York , United States of America
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Hirani R, Ohira S, Spielvogel D, De La Pena C, Kai M. Insertion of durable left ventricular assist device with repair of ischemic ventricular septal rupture. J Card Surg 2022; 37:3896-3898. [DOI: 10.1111/jocs.16952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/03/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Rahim Hirani
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center New York Medical College Valhalla New York USA
| | - Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center New York Medical College Valhalla New York USA
| | - David Spielvogel
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center New York Medical College Valhalla New York USA
| | - Corazon De La Pena
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center New York Medical College Valhalla New York USA
| | - Masashi Kai
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center New York Medical College Valhalla New York USA
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46
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Levine A, Kai M, Ohira S, Panza JA, Pan S, Lanier G, Aggarwal-Gupta C, Gass A. Ecpella 5.5: An Evolution in the Management of Mechanical Circulatory Support. Cardiol Rev 2022; Publish Ahead of Print:CRD.0000000000000466. [PMID: 35713936 DOI: 10.1097/crd.0000000000000466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There are several endovascular options for temporary mechanical circulatory support in patients with refractory cardiogenic shock. These devices are often utilized in tandem to provide maximal support, including the combination of venoarterial extracorporeal membrane oxygenation with the Impella device, termed ECPELLA. An underappreciated characteristic of mechanical circulatory support is whether they provide cardiac "replacement" and/or cardiac "assistance." Within this framework, we propose an evolution in the approach to ECPELLA utilizing the Impella 5.5, with a focus on the Impella 5.5 as the primary support device.
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Affiliation(s)
- Avi Levine
- From the Department of Cardiology, Westchester Medical Center, Valhalla, NY
| | - Masashi Kai
- Department of Cardiothoracic Surgery, Westchester Medical Center, Valhalla, NY
| | - Suguru Ohira
- Department of Cardiothoracic Surgery, Westchester Medical Center, Valhalla, NY
| | - Julio A Panza
- From the Department of Cardiology, Westchester Medical Center, Valhalla, NY
| | - Stephen Pan
- From the Department of Cardiology, Westchester Medical Center, Valhalla, NY
| | - Gregg Lanier
- From the Department of Cardiology, Westchester Medical Center, Valhalla, NY
| | | | - Alan Gass
- From the Department of Cardiology, Westchester Medical Center, Valhalla, NY
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47
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Okumura K, Misawa R, Ohira S, Dhand A, Kai M, Nishida S. Re: The impact of machine perfusion of the heart on warm ischemia time and organ yield in donation after circulatory death. Am J Transplant 2022; 22:2122-2123. [PMID: 35325507 DOI: 10.1111/ajt.17040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Kenji Okumura
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Ryosuke Misawa
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Suguru Ohira
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York.,Division of Cardiothoracic Surgery, Westchester Medical Center, Valhalla, New York
| | - Abhay Dhand
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York.,Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Masashi Kai
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York.,Division of Cardiothoracic Surgery, Westchester Medical Center, Valhalla, New York
| | - Seigo Nishida
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York
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48
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Dhand A, Gass A, John D, Kai M, Wolf D, Bodin R, Okumura K, Veillette G, Nog R, Ohira S, Diflo T, Wolfe K, Spielvogel D, Lansman S, Nishida S. Long-term and Short-term Outcomes of Solid Organ Transplantation From Donors With a Positive SARS-CoV-2 Test. Transplantation 2022; 106:e384-e385. [PMID: 35575769 PMCID: PMC9311281 DOI: 10.1097/tp.0000000000004196] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Abhay Dhand
- Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, NY
- Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Alan Gass
- Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Devon John
- Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Masashi Kai
- Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - David Wolf
- Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, NY
- Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Roxana Bodin
- Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, NY
- Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Kenji Okumura
- Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Gregory Veillette
- Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Rajat Nog
- Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, NY
- Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Suguru Ohira
- Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Thomas Diflo
- Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Kevin Wolfe
- Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - David Spielvogel
- Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Steven Lansman
- Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Seigo Nishida
- Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY
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49
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Ohira S, Pena CDL. The role of sutureless or rapid-deployment aortic valve prosthesis in bicuspid aortic valve: Standard AVR, TAVR, or somewhere in between? J Card Surg 2022; 37:3363-3364. [PMID: 35904124 DOI: 10.1111/jocs.16802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Suguru Ohira
- Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Corazon De La Pena
- Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
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50
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Okumura K, Misawa R, Ohira S, Dhand A, Kai M, Sogawa H, Veillette G, John D, Diflo T, Nishida S. Does utilization of heart machine perfusion for donation after cardiac death transplantation affect outcomes of other abdominal transplanted organs? Clin Transplant 2022; 36:e14751. [PMID: 35706100 DOI: 10.1111/ctr.14751] [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: 05/01/2022] [Revised: 05/15/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Machine perfusion of heart for donation after circulatory death (DCD) is being increasingly utilized. Current protocols for utilizing heart DCD's machine perfusion might prolong donor warm ischemic time for nonheart organs. The aim of this study was to analyze the effects of utilizing heart machine perfusion on liver and kidney transplants from the same donor. METHODS We analyzed data of DCD donors from the United Network for Organ Sharing (UNOS) from January-2020 to September-2021 among two groups: donors with heart machine perfusion (HM) and without heart machine perfusion (NHM). Propensity score (PS) matching was performed to compare the short-term outcomes of liver and kidney transplants between two groups. RESULTS Total of 102 liver and 319 kidney transplants were performed using organs from donors with HM. After PS matching, no statistically significant difference was seen in 1-year graft survival (GS) for both liver and kidney transplants between two groups (liver HM 90.6% vs. NHM 90.2%, p = .47; kidney HM 95.2% vs. NHM 92.9%, p = .40). There was no difference in the delayed graft function (DGF) rates in kidney transplantation (KT) (HM 42% vs. NHM 35%, p = .062). CONCLUSION Utilization of heart machine perfusion in DCD donors had no significant impact on 1-year outcomes of liver and kidney transplantation.
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Affiliation(s)
- Kenji Okumura
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Ryosuke Misawa
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Suguru Ohira
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York, USA.,Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Abhay Dhand
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York, USA.,Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Masashi Kai
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York, USA.,Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Hiroshi Sogawa
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Gregory Veillette
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Devon John
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Thomas Diflo
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Seigo Nishida
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
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