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Chamogeorgakis T, Toumpoulis I, Bonios MJ, Lanfear D, Williams C, Koliopoulou A, Cowger J. Treatment Strategies and Outcomes of Right Ventricular Failure Post Left Ventricular Assist Device Implantation: An INTERMACS Analysis. ASAIO J 2024; 70:264-271. [PMID: 38029763 DOI: 10.1097/mat.0000000000002105] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Right heart failure (RHF) management after left ventricular assist device (LVAD) implantation includes inotropes, right ventricular mechanical support, and heart transplantation. The purpose of this study is to compare different RHF treatment strategies in patients with a magnetically levitated centrifugal LVAD. A total of 6,632 Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) patients from 2013 to 2020 were included. Of which, 769 (69.6%) patients (group 1) were supported with inotropes (≥14 days post-LVAD implantation), 233 (21.1%) patients (group 2) were supported with temporary right ventricular assist device (RVAD) that was implanted during LVAD implant, 77 (7.0%) patients (group 3) with durable centrifugal RVAD implanted during the LVAD implant, and 26 (2.4%) patients (group 4) were supported with RVAD (temporary or permanent), which was implanted at a later stage. Groups 1 and 4 had higher survival rates in comparison with group 2 (hazard ratio [HR] = 0.513, 95% confidence intervals [CIs] = 0.402-0.655, p < 0.001, versus group 1) and group 3 (HR = 0.461, 95% CIs = 0.320-0.666, p < 0.001, versus group 1). Patients in group 3 showed higher heart transplantation rates at 12 and 36 months as compared with group 1 (40.4% and 46.6% vs. 21.9% and 37.4%, respectively), group 2 (40.4% and 46.6% vs. 25.8% and 39.3%, respectively), and group 4 (40.4% and 46.6% vs. 3.8% and 12.0%, respectively). Severe RHF post-LVAD is associated with poor survival. Patients with LVAD who during the perioperative period are in need of right ventricular temporary or durable mechanical circulatory support constitute a group at particular risk. Improvement of devices tailored for right ventricular support is mandatory for further evolution of the field.
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Affiliation(s)
- Themistokles Chamogeorgakis
- From the Henry Ford, Transplant Institute, Detroit, Michigan
- 2nd Cardiac Surgery Department, Onassis Cardiac Surgery Centre, Athens, Greece
| | | | - Michael J Bonios
- 2nd Cardiac Surgery Department, Onassis Cardiac Surgery Centre, Athens, Greece
| | - David Lanfear
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Celeste Williams
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | | | - Jennifer Cowger
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan
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Chrysostomidis G, Apostolos A, Papanikolaou A, Konstantinou K, Tsigkas G, Koliopoulou A, Chamogeorgakis T. The Application of Precision Medicine in Structural Heart Diseases: A Step towards the Future. J Pers Med 2024; 14:375. [PMID: 38673001 PMCID: PMC11051532 DOI: 10.3390/jpm14040375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024] Open
Abstract
The personalized applications of 3D printing in interventional cardiology and cardiac surgery represent a transformative paradigm in the management of structural heart diseases. This review underscores the pivotal role of 3D printing in enhancing procedural precision, from preoperative planning to procedural simulation, particularly in valvular heart diseases, such as aortic stenosis and mitral regurgitation. The ability to create patient-specific models contributes significantly to predicting and preventing complications like paravalvular leakage, ensuring optimal device selection, and improving outcomes. Additionally, 3D printing extends its impact beyond valvular diseases to tricuspid regurgitation and non-valvular structural heart conditions. The comprehensive synthesis of the existing literature presented here emphasizes the promising trajectory of individualized approaches facilitated by 3D printing, promising a future where tailored interventions based on precise anatomical considerations become standard practice in cardiovascular care.
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Affiliation(s)
- Grigorios Chrysostomidis
- Second Department of Adult Cardiac Surgery—Heart and Lung Transplantation, Onassis Cardiac Surgery Center, 176 74 Athens, Greece; (G.C.); (A.K.); (T.C.)
| | - Anastasios Apostolos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippocration General Hospital, 115 27 Athens, Greece;
| | - Amalia Papanikolaou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippocration General Hospital, 115 27 Athens, Greece;
| | - Konstantinos Konstantinou
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London 26504, UK;
| | - Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece;
| | - Antigoni Koliopoulou
- Second Department of Adult Cardiac Surgery—Heart and Lung Transplantation, Onassis Cardiac Surgery Center, 176 74 Athens, Greece; (G.C.); (A.K.); (T.C.)
| | - Themistokles Chamogeorgakis
- Second Department of Adult Cardiac Surgery—Heart and Lung Transplantation, Onassis Cardiac Surgery Center, 176 74 Athens, Greece; (G.C.); (A.K.); (T.C.)
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Kanakis M, Chatziantoniou A, Rorris FP, Chamogeorgakis T, Kostolny M, Bobos D. Converting the Fontan Circulation: Challenges and Evolution. Heart Surg Forum 2023; 26:E917-E923. [PMID: 38178331 DOI: 10.59958/hsf.6983] [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: 11/08/2023] [Accepted: 12/12/2023] [Indexed: 01/06/2024]
Abstract
The Fontan operation, the final palliative step after a series of complex operations in patients with univentricular hearts, has undergone multiple modifications throughout the last decades, with the goal of finding the method which combines the optimal hemodynamic effects of the Fontan circulation with minimal long term side effects. An understanding of the operative evolution and subsequent side effects, as well as the management thereof seems imperative. Since its inception by Francis Fontan the, now obsolete, initial atriopulmonary connection has passed through several milestones into having now reached the era of total cavopulmonary connection. However, recently published results bring to light the new option of biventricular conversion which comes to challenge the management of Fontan patients as we know it. Currently, there is no consensus as to whether to continue with palliation in this challenging group of patients or proceed with heart transplantation. In this collective review, we provide a historic overview of the Fontan evolution as well as future insights, discussing the perspectives of options for patients with failing Fontan, including the latest addition of biventricular correction.
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Affiliation(s)
- Meletios Kanakis
- Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center, 17674 Athens, Greece.
| | | | - Filippos-Paschalis Rorris
- Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center, 17674 Athens, Greece.
| | - Themistokles Chamogeorgakis
- Department of Heart Transplantation and Mechanical Circulatory Support, Onassis Cardiac Surgery Center, 17674 Athens, Greece.
| | - Martin Kostolny
- Cardiothoracic Unit, Great Ormond Street Hospital, WC1N 3JH London, UK; Institute of Cardiovascular Science, UCL, WC1N 3JH London, UK.
| | - Dimitrios Bobos
- Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center, 17674 Athens, Greece.
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Bonios M, Armenis I, Kogerakis N, Thodou A, Fragkoulis S, Gkouziouta A, Leontiadis E, Vartela V, Georgiadou P, Zarkalis D, Tsiapras D, Koliopoulou A, Chamogeorgakis T, Drakos S, Adamopoulos S. The effect of prolonged Intraaortic ballon pump (IABP) support on right ventricular function in end-stage heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0943] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Right Ventricular (RV) function has prognostic implications in end-stage heart failure (ESHF) patients. RV failure following Left Ventricular Assist Device (LVAD) implantation increases morbidity and mortality. Achieving optimal RV function before LVAD implantation is of paramount importance.
Purpose
Purpose was to investigate the effect of Intra-aortic Balloon Pump (IABP) on RV function optimization in patients with bi-ventricular ESHF.
Methods
ESHF patients with poor RV function, presenting with acutely decompensated heart failure resistant to inotropes/vasopressors, thus requiring IABP for stabilization, were prospectively enrolled. Serum biochemistry, echocardiography and invasive hemodynamics were applied and eligibility for LVAD according to RV function was determined on the basis of pre-specified criteria (Right atrium Pressure (RAP) <12mmHg, Pulmonary Artery Pulsatility index (PAPi) >1.85, RAP/Pulmonary Capillary Wedge Pressure (PCWP) <0.67, RV strain <−14%). LV and RV tissue was harvested during LVAD or bi-ventricular mechanical circulatory implantation or at the time of heart transplantation. Fibrosis of the myocardial tissue was quantified.
Results
Sixteen patients aged 38±14 years were enrolled. Duration of IABP support was 62±50 (3–180) days. Three patients deteriorated requiring additional mechanical circulatory support. Two patients were stabilized without RV function improvement. In the remaining 11 patients, RV improved and fulfilled LVAD eligibility criteria (IABP responders); RA and RA/PCWP decreased from 18±6 to 10±4mmHg (p=0.0001) and from 0.60±0.19 to 0.42±0.11 (p=0.011) respectively. PAPi and RV strain improved from 1.46±0.65 to 3.20±0.58 (p=0.0001) and from −12.9±3.4% to −18.7±1.7% (p=0.0001) respectively. Significantly lower baseline NTproBNP and total bilirubin values were observed in the responders group. Six patients finally received LVAD and none suffered RV failure post-operatively (the remaining 5 were successfully transplanted). RV fibrosis correlated with post-IABP NTproBNP (r=0.91, p=0.001), total bilirubin (r=0.79, p=0.011), RAP (r=0.78, p=0.014), PAPi (r=−0.69, p=0.040), RAP/PCWP (r=0.74, p=0.022) and LV fibrosis (r=0.77, p=0.016), but not with baseline (pre-IABP) parameters.
Conclusions
Prolonged IABP support contributes to partial RV function recovery in patients with ESHF and bi-ventricular failure, thus leading to eligibility for LVAD implantation. RV fibrosis may predict RV response to IABP and post-IABP eligibility for LVAD.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M.J Bonios
- Onassis Cardiac Surgery Center, Department of Heart Failure and Transplantation, Athens, Greece
| | - I Armenis
- Onassis Cardiac Surgery Center, Department of Heart Failure and Transplantation, Athens, Greece
| | - N Kogerakis
- Onassis Cardiac Surgery Center, Department of Heart Failure and Transplantation, Athens, Greece
| | - A Thodou
- University of Utah Health Care, Division of Cardiovascular Medicine, Salt Lake City, United States of America
| | - S Fragkoulis
- Onassis Cardiac Surgery Center, Department of Heart Failure and Transplantation, Athens, Greece
| | - A Gkouziouta
- Onassis Cardiac Surgery Center, Department of Heart Failure and Transplantation, Athens, Greece
| | - E Leontiadis
- Onassis Cardiac Surgery Center, Department of Heart Failure and Transplantation, Athens, Greece
| | - V Vartela
- Onassis Cardiac Surgery Center, Department of Heart Failure and Transplantation, Athens, Greece
| | - P Georgiadou
- Onassis Cardiac Surgery Center, Department of Heart Failure and Transplantation, Athens, Greece
| | - D Zarkalis
- Onassis Cardiac Surgery Center, Department of Heart Failure and Transplantation, Athens, Greece
| | - D Tsiapras
- Onassis Cardiac Surgery Center, Department of Noninvasive Diagnostics, Athens, Greece
| | - A Koliopoulou
- Onassis Cardiac Surgery Center, Department of Heart Failure and Transplantation, Athens, Greece
| | - T Chamogeorgakis
- Onassis Cardiac Surgery Center, Department of Heart Failure and Transplantation, Athens, Greece
| | - S.G Drakos
- University of Utah Health Care, Division of Cardiovascular Medicine, Salt Lake City, United States of America
| | - S Adamopoulos
- Onassis Cardiac Surgery Center, Department of Heart Failure and Transplantation, Athens, Greece
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Nemeh H, Coba V, Chulkov M, Gupta A, Yeldo N, Chamogeorgakis T, Tanaka D, Allenspach L, Simanovski J, Shanti C. Lung Transplantation for the Treatment of Vaping-Induced, Irreversible, End-Stage Lung Injury. Ann Thorac Surg 2021; 111:e353-e355. [DOI: 10.1016/j.athoracsur.2020.07.097] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/09/2020] [Accepted: 07/25/2020] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Bronchial anastomotic complications are reported in 2 to 18% of patients after lung transplantation. The majority of complications can be managed with bronchoscopic intervention. When extensive dehiscence is present, surgical intervention can be entertained. MATERIALS AND METHODS Between March 1, 2006, and December 31, 2019, our program performed 244 lung transplantations. We conducted a retrospective review of our patient cohort and identified patients who suffered from significant anastomotic complications that required surgical interventions. RESULTS Twenty-eight and 216 patients underwent single and bilateral lung transplantations, respectively. Eighteen patients developed airway complications (7.4%). The incidence of anastomotic complications was 5.2% (24 complications for a total of 460 bronchial anastomoses). Four patients were managed conservatively. The majority of the bronchial anastomotic complications were managed endoscopically (eight patients). Four patients with associated massive air leak underwent repair of the bronchial anastomosis and two patients were retransplanted because they developed severe distal airway stenosis. CONCLUSION Bronchial anastomotic complications are a major cause of morbidity in lung transplantation. The majority of cases can be managed bronchoscopically. In more severe cases associated with massive air leak or imminent massive hemoptysis from bronchopulmonary arterial fistula, surgical intervention is necessary. Aortic homograft interposition along with vascularized pedicle wrapping may be a viable option to re-establish airway continuity when tension-free bronchial anastomotic revision is not possible. In cases with smaller bronchial defects, primary repair with utilization of a vascularized flap can be effective as treatment option.
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Affiliation(s)
- Themistokles Chamogeorgakis
- Department of Cardiac and Thoracic Surgery, Henry Ford Health System, Detroit, Michigan, United States.,Onassis Cardiac Surgery Center, Athens, Greece
| | - Kenneth Moquin
- Division of Plastic Surgery, Henry Ford Health System, Detroit, Michigan, United States
| | - Michael Simoff
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan, United States
| | - Hassan Nemeh
- Department of Cardiac and Thoracic Surgery, Henry Ford Health System, Detroit, Michigan, United States
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Bendix S, Rteil A, Potti C, Chamogeorgakis T, Lace B, Woodward A, Kabbani L. Mycotic Aneurysm After Metallic Foreign Body Ingestion. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.06.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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8
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Chamogeorgakis T, Cowger J, Apostolou D, Tanaka D, Nemeh H. Right Ventricular Device HeartWare Implant to the Right Atrium with Fixation to the Chest Wall in Patient with Biventricular Support. ASAIO J 2020; 66:e102-e104. [PMID: 32740361 DOI: 10.1097/mat.0000000000001143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Jennifer Cowger
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan
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Chamogeorgakis T, Kostopanagiotou K, Behler A, Apostolou D. HeartMate 3 left ventricular assist device implant after excision of a large apical aneurysm. Proc (Bayl Univ Med Cent) 2020; 33:455-456. [PMID: 32675986 DOI: 10.1080/08998280.2020.1759334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022] Open
Abstract
The presence of a left ventricular apical aneurysm may pose a technical challenge during implantation of a left ventricular assist device (LVAD). We describe implantation of a HeartMate III LVAD under cardioplegic arrest. A ventricular aneurysmectomy was performed and the LVAD was implanted at the left ventricular apex at the level of the transition zone between the scar tissue and the viable myocardium. Two pursestring 2-0 Prolene Fontan sutures were placed circumferentially at the transition zone to make up for the size discrepancy between the left ventricular opening and the HeartMate 3 pump. The echocardiographic analysis demonstrated optimal inflow cannula orientation, and the patient had an uneventful recovery.
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Affiliation(s)
| | | | - Allison Behler
- Division of Cardiac Surgery, Henry Ford HospitalDetroitMichigan
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10
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Cowger JA, Shah P, Pagani FD, Grafton G, Stulak J, Chamogeorgakis T, Lanfear D, Nemeh H, Pinney S. Outcomes based on blood pressure in patients on continuous flow left ventricular assist device support: An Interagency Registry for Mechanically Assisted Circulatory Support analysis. J Heart Lung Transplant 2020; 39:441-453. [PMID: 31831209 PMCID: PMC7200289 DOI: 10.1016/j.healun.2019.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 11/14/2019] [Accepted: 11/20/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND An optimal blood pressure (BP) range to mitigate morbidity and mortality on left ventricular assist device (LVAD) support has not been clearly defined. METHODS Average Doppler opening pressure, mean arterial pressure (MAP), and/or systolic blood pressure (SBP) were calculated in operative survivors (n = 16,155) of LVAD support in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). BP distributions were used to group patients into low (BP <25th percentile), normal (25-75th percentile), high (75th-95th percentile), and very high (>95th percentile). Associations between BP and adverse events were evaluated using Cox regression (hazard ratio[HR], 95% confidence interval). RESULTS The median (25th, 75th) MAP, Doppler, and SBP (mm Hg) during continuous flow LVAD support were 84 (77, 90), 85 (80, 92), and 99 (90, 107) mm Hg, respectively. BP had a bimodal risk association with survival. At 3 years, survival was 58% ± 1.8% in those with low MAP (≤75 mm Hg) vs 70% ± 0.9%, 71% ± 1.5%, and 63% ± 3.0% in the those with normal, high, or very high average MAP, respectively. Patients with chronically low MAP (≤75 mm Hg), Doppler (≤80 mm Hg), and SBP (<90 mm Hg) had 35%-42% higher adjusted hazards of death than patients with normal or high BP (p ≤ 0.0001). Patients with MAP >100 mm Hg, Doppler ≥105 mm Hg, and SBP ≥120 mm Hg had 17%-20% higher adjusted hazards of death than those with normal pressures (p < 0.05). In patients on axial flow LVADs, elevated SBP (HR 1.08 [95% confidence interval, 1.04-1.13] per 10 mm Hg increase) but not MAP correlated with increased incident of stroke. CONCLUSIONS In INTERMACS, BP extremes during LVAD support increase the risk for adverse events, supporting a MAP goal >75 mm Hg and <90 mm Hg. Hypotension conferred the highest risk for mortality. Excessive BP control should be avoided, and Doppler opening pressure should not be assumed to represent MAP in all patients.
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Affiliation(s)
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | | | | | | | | | | | - Sean Pinney
- Mount Sinai Medical Center, New York City, New York
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Aurora L, Grafton G, Nemeh H, Chamogeorgakis T, Apostolou D, Tanaka D, Cowger J. Indications for LVAD Explant and Predictors of Mortality after Explant in IMACS. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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12
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Patel A, Grafton G, Tita C, Hannawi B, Selektor Y, Chamogeorgakis T, Apostolou D, Lanfear D, Williams C, Nemeh H, Cowger J. Survival and Predictors of Mortality in Patients Undergoing RVAD Explant in IMACS. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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13
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Hariri I, Hannawi B, Grafton G, Nemeh H, Chamogeorgakis T, Lanfear D, Apostolou D, Selektor Y, Williams C, Tita C, Tanaka D, Myers S, Kirklin J, Pagani F, Cowger J. Ventricular Assist Device Patient Phenotypes: What Attributes Describe Long Term Survival? J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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14
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Rteil A, Shepard A, Nypaver T, Weaver M, Mohammad F, Nemeh H, Chamogeorgakis T, Kabbani L. Lower Limb Malperfusion in Acute Type A Dissection. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.06.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Rteil A, Shepard A, Nypaver T, Weaver M, Mohammad F, Nemeh H, Chamogeorgakis T, Kabbani L. PC024. Lower Limb Malperfusion in Acute Type A Dissection. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.04.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Cowger J, Chamogeorgakis T, Borgi J, Grafton G, Selektor Y, Nemeh H, Williams C, Tita C, Lanfear D. Systolic Blood Pressure and Outcomes in Patients on Continuous Flow LVAD Support: An INTERMACS Analysis. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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Still S, Shaikh AF, Qin H, Felius J, Jamil AK, Saracino G, Chamogeorgakis T, Rafael AE, MacHannaford JC, Joseph SM, Hall SA, Gonzalez-Stawinski GV, Lima B. Reoperative sternotomy is associated with primary graft dysfunction following heart transplantation†. Interact Cardiovasc Thorac Surg 2018; 27:343-349. [DOI: 10.1093/icvts/ivy084] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/22/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sasha Still
- Department of General Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Asad F Shaikh
- College of Medicine, Texas A&M Health Science Center, Dallas, TX, USA
| | - Huanying Qin
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Joost Felius
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Aayla K Jamil
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Giovanna Saracino
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Themistokles Chamogeorgakis
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA
- Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Aldo E Rafael
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA
- Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Juan C MacHannaford
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA
- Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Susan M Joseph
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA
- Division of Cardiology, Baylor University Medical Center, Dallas, TX, USA
| | - Shelley A Hall
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA
- Division of Cardiology, Baylor University Medical Center, Dallas, TX, USA
| | - Gonzalo V Gonzalez-Stawinski
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA
- Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Brian Lima
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX, USA
- Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, TX, USA
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Bryce K, Peterson E, Cowger J, Liu B, Chamogeorgakis T, Lanfear DE. BASELINE COGNITIVE FUNCTIONING IN LVAD PATIENTS AND ANTICOAGULATION TIME IN RANGE. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31495-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
A 70-year-old man who presented with dyspnea and intermittent chest pain was found to have a large free-floating right atrial thrombus on two-dimensional echocardiogram. Atriotomy was performed, and an 18-cm-long thrombus was removed from the right atrium and inferior vena cava. Postoperatively, the patient developed cardiogenic shock treated by intravenous vasopressor agents and extracorporeal membrane oxygenation. The postoperative course was also complicated by bilateral pulmonary emboli requiring pulmonary artery thrombectomy. Right atrial thrombus is an underdiagnosed condition with a high mortality rate. The best management modality has not yet been established.
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Affiliation(s)
| | - Aasim Afzal
- Baylor University Medical Center at Dallas, Dallas, Texas
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Jacob S, MacHannaford JC, Chamogeorgakis T, Gonzalez-Stawinski GV, Felius J, Rafael AE, Malyala RS, Lima B. Ambulatory extracorporeal membrane oxygenation with subclavian venoarterial cannulation to increase mobility and recovery in a patient awaiting cardiac transplantation. Proc (Bayl Univ Med Cent) 2017; 30:224-225. [PMID: 28405091 DOI: 10.1080/08998280.2017.11929596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Venoarterial extracorporeal membrane oxygenation (ECMO) can provide temporary cardiopulmonary support for patients in hemodynamic extremis or refractory heart failure until more durable therapies-such as cardiac transplantation or a left ventricular assist device-can be safely implemented. Conventional ECMO cannulation strategies commonly employ the femoral artery and vein, constraining the patients to the supine position for the duration of ECMO support. We have recently adopted a modified cannulation approach to promote patient mobility, rehabilitation, and faster recovery and to mitigate complications associated with femoral arterial cannulation, such as limb ischemia and compartment syndrome. This technique involves cannulation of the subclavian artery and vein. The current case report details our recent experience with this approach in a critically ill patient awaiting cardiac transplantation.
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Affiliation(s)
- Samuel Jacob
- Department of Cardiac and Thoracic Surgery (Jacob, MacHannaford, Chamogeorgakis, Gonzalez-Stawinski, Rafael, Malyala, Lima) and the Annette C. and Harold C. Simmons Transplant Institute (MacHannaford, Chamogeorgakis, Gonzalez-Stawinski, Felius, Rafael, Malyala, Lima), Baylor University Medical Center at Dallas, Texas
| | - Juan C MacHannaford
- Department of Cardiac and Thoracic Surgery (Jacob, MacHannaford, Chamogeorgakis, Gonzalez-Stawinski, Rafael, Malyala, Lima) and the Annette C. and Harold C. Simmons Transplant Institute (MacHannaford, Chamogeorgakis, Gonzalez-Stawinski, Felius, Rafael, Malyala, Lima), Baylor University Medical Center at Dallas, Texas
| | - Themistokles Chamogeorgakis
- Department of Cardiac and Thoracic Surgery (Jacob, MacHannaford, Chamogeorgakis, Gonzalez-Stawinski, Rafael, Malyala, Lima) and the Annette C. and Harold C. Simmons Transplant Institute (MacHannaford, Chamogeorgakis, Gonzalez-Stawinski, Felius, Rafael, Malyala, Lima), Baylor University Medical Center at Dallas, Texas
| | - Gonzalo V Gonzalez-Stawinski
- Department of Cardiac and Thoracic Surgery (Jacob, MacHannaford, Chamogeorgakis, Gonzalez-Stawinski, Rafael, Malyala, Lima) and the Annette C. and Harold C. Simmons Transplant Institute (MacHannaford, Chamogeorgakis, Gonzalez-Stawinski, Felius, Rafael, Malyala, Lima), Baylor University Medical Center at Dallas, Texas
| | - Joost Felius
- Department of Cardiac and Thoracic Surgery (Jacob, MacHannaford, Chamogeorgakis, Gonzalez-Stawinski, Rafael, Malyala, Lima) and the Annette C. and Harold C. Simmons Transplant Institute (MacHannaford, Chamogeorgakis, Gonzalez-Stawinski, Felius, Rafael, Malyala, Lima), Baylor University Medical Center at Dallas, Texas
| | - Aldo E Rafael
- Department of Cardiac and Thoracic Surgery (Jacob, MacHannaford, Chamogeorgakis, Gonzalez-Stawinski, Rafael, Malyala, Lima) and the Annette C. and Harold C. Simmons Transplant Institute (MacHannaford, Chamogeorgakis, Gonzalez-Stawinski, Felius, Rafael, Malyala, Lima), Baylor University Medical Center at Dallas, Texas
| | - Rajasekhar S Malyala
- Department of Cardiac and Thoracic Surgery (Jacob, MacHannaford, Chamogeorgakis, Gonzalez-Stawinski, Rafael, Malyala, Lima) and the Annette C. and Harold C. Simmons Transplant Institute (MacHannaford, Chamogeorgakis, Gonzalez-Stawinski, Felius, Rafael, Malyala, Lima), Baylor University Medical Center at Dallas, Texas
| | - Brian Lima
- Department of Cardiac and Thoracic Surgery (Jacob, MacHannaford, Chamogeorgakis, Gonzalez-Stawinski, Rafael, Malyala, Lima) and the Annette C. and Harold C. Simmons Transplant Institute (MacHannaford, Chamogeorgakis, Gonzalez-Stawinski, Felius, Rafael, Malyala, Lima), Baylor University Medical Center at Dallas, Texas
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Squiers JJ, DiMaio JM, Saracino G, Qin H, Felius J, Chamogeorgakis T, MacHannaford JC, Rafael AE, Kale P, Joseph SM, Hall SA, Gonzalez-Stawinski GV, Lima B. Utilization of high donor sequence number grafts in cardiac transplantation. Clin Transplant 2017; 32. [DOI: 10.1111/ctr.13128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 11/30/2022]
Affiliation(s)
- John J. Squiers
- Baylor Scott & White Research Institute; Dallas TX USA
- Department of Surgery; Baylor University Medical Center; Dallas TX USA
| | | | | | - Huanying Qin
- Baylor Scott & White Research Institute; Dallas TX USA
| | - Joost Felius
- Baylor Scott & White Research Institute; Dallas TX USA
| | - Themistokles Chamogeorgakis
- Baylor Scott & White Research Institute; Dallas TX USA
- Department of Cardiac and Thoracic Surgery; Baylor University Medical Center; Dallas TX USA
| | - Juan C. MacHannaford
- Baylor Scott & White Research Institute; Dallas TX USA
- Department of Cardiac and Thoracic Surgery; Baylor University Medical Center; Dallas TX USA
| | - Aldo E. Rafael
- Baylor Scott & White Research Institute; Dallas TX USA
- Department of Cardiac and Thoracic Surgery; Baylor University Medical Center; Dallas TX USA
| | - Parag Kale
- Baylor Scott & White Research Institute; Dallas TX USA
- Division of Cardiology; Department of Internal Medicine; Baylor University Medical Center; Dallas TX USA
| | - Susan M. Joseph
- Baylor Scott & White Research Institute; Dallas TX USA
- Division of Cardiology; Department of Internal Medicine; Baylor University Medical Center; Dallas TX USA
| | - Shelley A. Hall
- Baylor Scott & White Research Institute; Dallas TX USA
- Division of Cardiology; Department of Internal Medicine; Baylor University Medical Center; Dallas TX USA
| | | | - Brian Lima
- Department of Cardiac and Thoracic Surgery; Baylor University Medical Center; Dallas TX USA
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Squiers JJ, Saracino G, Chamogeorgakis T, MacHannaford JC, Rafael AE, Gonzalez-Stawinski GV, Hall SA, DiMaio JM, Lima B. Application of the International Society for Heart and Lung Transplantation (ISHLT) criteria for primary graft dysfunction after cardiac transplantation: outcomes from a high-volume centre†. Eur J Cardiothorac Surg 2017; 51:263-270. [PMID: 28186268 DOI: 10.1093/ejcts/ezw271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/16/2016] [Accepted: 07/04/2016] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES A standardized definition for primary graft dysfunction (PGD) after cardiac transplantation was recently proposed by the International Society of Heart and Lung Transplantation (ISHLT). We sought to characterize the outcomes associated with and identify risk factors for PGD following cardiac transplantation using these criteria at a high volume centre. METHODS Donor and recipient medical records of 201 consecutive adult cardiac transplantations performed between November 2012 and March 2015 were retrospectively reviewed. Patients undergoing isolated heart transplantation were diagnosed with none, mild, moderate, or severe PGD using ISHLT criteria. Cumulative survival was calculated according to the Kaplan–Meier method. Associations of risk factors for combined moderate/severe PGD were assessed with univariate and multivariate analyses. RESULTS A total of 191 consecutive patients underwent isolated heart transplantation, and 59 (30%) met ISHLT criteria for PGD: 35 (18%) mild, 8 (4%) moderate and 16 (8%) severe. Thirty-day/in-hospital mortality occurred in six (3%) patients, all of whom were diagnosed with severe PGD. Patients with moderate/severe PGD also had significantly increased intensive care unit length of stay (LOS), total LOS, reoperations for bleeding and postoperative infections. Survival at 1-year was diminished with increasing severity of PGD (none 93%, mild 94%, moderate 75% and severe 44%; log-rank P < 0.001). Elevated preoperative creatinine, pretransplantation hospitalized recipient and undersized donor were independently predictive of moderate/severe PGD. CONCLUSIONS A diagnosis of PGD portends worse outcomes including increased 30-day and 1-year mortality. The ISHLT diagnostic criteria for moderate and severe PGD identify and discriminate patients with PGD in a clinically relevant manner.
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Affiliation(s)
- John J Squiers
- Baylor Research Institute, Baylor Scott & White Health, Dallas, TX, USA
| | - Giovanna Saracino
- Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA
| | | | - Juan C MacHannaford
- Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Aldo E Rafael
- Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, TX, USA
| | | | - Shelley A Hall
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX, USA
| | - J Michael DiMaio
- Baylor Research Institute, Baylor Scott & White Health, Dallas, TX, USA
| | - Brian Lima
- Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, TX, USA
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Arsalan M, Squiers JJ, Herbert MA, MacHannaford JC, Chamogeorgakis T, Prince SL, Hamman BL, Knoff C, Moore DO, Harrington KB, DiMaio JM, Mack MJ, Brinkman WT. Comparison of Outcomes of Operative Therapy for Acute Type A Aortic Dissections Provided at High-Volume Versus Low-Volume Medical Centers in North Texas. Am J Cardiol 2017; 119:323-327. [PMID: 27839772 DOI: 10.1016/j.amjcard.2016.09.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 09/29/2016] [Accepted: 09/29/2016] [Indexed: 12/12/2022]
Abstract
Immediate surgery is standard therapy for acute type A aortic dissections (TAAD). Because of its low incidence, many smaller cardiac surgery programs do not routinely perform this procedure because it may negatively affect outcomes. Many high-risk, low-volume (LV) surgical procedures are now preferentially performed in reference centers. We compared the outcomes of surgery for TAAD in high-volume (HV) and LV centers in a single metropolitan area to determine the optimal setting for treatment. Thirty-five of the 37 cardiac surgery programs in the Dallas Ft. Worth metropolitan area participate in a regional consortium to measure outcomes collected in the Society of Thoracic Surgeons Adult Cardiac Database. From January 01, 2008, to December 31, 2014, 29 programs had treated TAAD. Those programs performing at least 100 operations for TAAD were considered HV centers and the others LV. Surgery for TAAD was performed in 672 patients over the 7-year study period with HV centers performing 469 of 672 (70%) of the operations. Despite similar preoperative characteristics, operative mortality was significantly lower in HV versus LV centers (14.1% vs 24.1%; p = 0.001). There was no significant difference in postoperative paralysis rates (2.6% vs 4.5%; p = 0.196), stroke rates (10.7% vs 9.4%; p = 0.623), or 30-day readmission rates (12.1% vs 15.5%; p = 0.292). An improved survival rate in HV centers was maintained over a 5-year follow-up period. Surgery for TAAD in a single large metropolitan area was most commonly performed in HV centers. In conclusion, the treatment of acute thoracic aortic dissection is recommended to be performed in reference centers because of lower early and midterm mortality.
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Lima B, Chamogeorgakis T, MacHannaford JC, Rafael A, Gonzalez-Stawinski GV, Lima, MD B. How to Do It: The Commando Operation for Reconstruction of the Fibrous Skeleton with Double Valve Replacement. Heart Surg Forum 2016; 19:E308-E310. [DOI: 10.1532/hsf.1514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 09/28/2016] [Indexed: 11/20/2022]
Abstract
Infiltrative processes that extend into the intervalvular fibrosa, such as infection or calcification, often mandate a complex reconstructive procedure known as the Commando operation. First described less than 20 years ago, this operation is not widely implemented, with experience limited to a few select centers. This report provides a detailed summary of our approach to this intricate procedure.
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Shaikh AF, Joseph SM, Lima B, Hall SA, Malyala R, Rafael AE, Gonzalez-Stawinski GV, Chamogeorgakis T. HeartMate II Left Ventricular Assist Device Pump Exchange: A Single-Institution Experience. Thorac Cardiovasc Surg 2016; 65:410-414. [PMID: 27903010 DOI: 10.1055/s-0036-1593867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background Left ventricular assist devices (LVADs) have revolutionized the treatment of patients with end-stage heart failure. These devices are replaced when pump complications arise if heart transplant is not possible. We present our experience with HeartMate II (HMII (Thoratec, Plesanton, California, United States)) LVAD pump exchange. Materials and Methods We retrospectively reviewed all cases that required pump exchange due to LVAD complication from November 2011 until June 2016 at a single high-volume institution. The indications, demographics, and outcome were extracted and analyzed. Results Of 250 total patients with implanted HMII LVADs, 16 (6%) required pump exchange during the study period. The initial indications for LVAD placement in these patients were bridge to transplantation (n = 6 [37.5%]) or destination therapy (n = 10 [62.5%]). Fifteen patients (93.8%) required pump exchange due to pump thrombosis and 1 (6.2%) due to refractory driveline infection. Nine patients (56.2%) underwent repeat median sternotomy while a left subcostal approach was used in the remaining seven patients. Fifteen patients (93.7%) survived until hospital discharge. During the follow-up period (median, 155 days), 11 patients remained alive and 4 of these underwent successful cardiac transplantation. Conclusion HMII LVAD pump exchange can be safely performed for driveline infection or pump thrombosis when heart transplantation is not an option.
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Affiliation(s)
- Asad F Shaikh
- College of Medicine, Texas A&M University Health Science Center, Dallas, Texas, United States
| | - Susan M Joseph
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, United States
| | - Brian Lima
- Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas, United States
| | - Shelley A Hall
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, United States
| | - Rajasekhar Malyala
- Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas, United States
| | - Aldo E Rafael
- Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas, United States
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Jacob S, Patel MJ, Lima B, Felius J, Malyala RS, Chamogeorgakis T, MacHannaford JC, Gonzalez-Stawinski GV, Rafael AE. Using extracorporeal membrane oxygenation support preoperatively and postoperatively as a successful bridge to recovery in a patient with a large infarct-induced ventricular septal defect. Proc (Bayl Univ Med Cent) 2016; 29:301-4. [PMID: 27365878 DOI: 10.1080/08998280.2016.11929443] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Rupture of the ventricular septum during acute myocardial infarction usually occurs within the first week. The event is usually followed by low cardiac output, heart failure, and multiorgan failure. Despite the many advances in the nonoperative treatment of heart failure and cardiogenic shock, including the intra-aortic balloon pump and a multitude of new inotropic agents and vasodilators, these do not supplant the need for operative intervention in these critically ill patients. This article describes the successful use of extracorporeal membrane oxygenation support as a bridge to recovery postoperatively in a patient with a large infarct-produced ventricular septal defect.
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Affiliation(s)
- Samuel Jacob
- Department of Cardiac and Thoracic Surgery (Jacob, Patel, Lima, Malyala, Chamogeorgakis, MacHannaford, Gonzalez-Stawinski, Rafael) and the Annette C. and Harold C. Simmons Transplant Institute (Lima, Felius, Chamogeorgakis, Gonzalez-Stawinski), Baylor University Medical Center at Dallas
| | - Mitesh J Patel
- Department of Cardiac and Thoracic Surgery (Jacob, Patel, Lima, Malyala, Chamogeorgakis, MacHannaford, Gonzalez-Stawinski, Rafael) and the Annette C. and Harold C. Simmons Transplant Institute (Lima, Felius, Chamogeorgakis, Gonzalez-Stawinski), Baylor University Medical Center at Dallas
| | - Brian Lima
- Department of Cardiac and Thoracic Surgery (Jacob, Patel, Lima, Malyala, Chamogeorgakis, MacHannaford, Gonzalez-Stawinski, Rafael) and the Annette C. and Harold C. Simmons Transplant Institute (Lima, Felius, Chamogeorgakis, Gonzalez-Stawinski), Baylor University Medical Center at Dallas
| | - Joost Felius
- Department of Cardiac and Thoracic Surgery (Jacob, Patel, Lima, Malyala, Chamogeorgakis, MacHannaford, Gonzalez-Stawinski, Rafael) and the Annette C. and Harold C. Simmons Transplant Institute (Lima, Felius, Chamogeorgakis, Gonzalez-Stawinski), Baylor University Medical Center at Dallas
| | - Rajasekhar S Malyala
- Department of Cardiac and Thoracic Surgery (Jacob, Patel, Lima, Malyala, Chamogeorgakis, MacHannaford, Gonzalez-Stawinski, Rafael) and the Annette C. and Harold C. Simmons Transplant Institute (Lima, Felius, Chamogeorgakis, Gonzalez-Stawinski), Baylor University Medical Center at Dallas
| | - Themistokles Chamogeorgakis
- Department of Cardiac and Thoracic Surgery (Jacob, Patel, Lima, Malyala, Chamogeorgakis, MacHannaford, Gonzalez-Stawinski, Rafael) and the Annette C. and Harold C. Simmons Transplant Institute (Lima, Felius, Chamogeorgakis, Gonzalez-Stawinski), Baylor University Medical Center at Dallas
| | - Juan C MacHannaford
- Department of Cardiac and Thoracic Surgery (Jacob, Patel, Lima, Malyala, Chamogeorgakis, MacHannaford, Gonzalez-Stawinski, Rafael) and the Annette C. and Harold C. Simmons Transplant Institute (Lima, Felius, Chamogeorgakis, Gonzalez-Stawinski), Baylor University Medical Center at Dallas
| | - Gonzalo V Gonzalez-Stawinski
- Department of Cardiac and Thoracic Surgery (Jacob, Patel, Lima, Malyala, Chamogeorgakis, MacHannaford, Gonzalez-Stawinski, Rafael) and the Annette C. and Harold C. Simmons Transplant Institute (Lima, Felius, Chamogeorgakis, Gonzalez-Stawinski), Baylor University Medical Center at Dallas
| | - Aldo E Rafael
- Department of Cardiac and Thoracic Surgery (Jacob, Patel, Lima, Malyala, Chamogeorgakis, MacHannaford, Gonzalez-Stawinski, Rafael) and the Annette C. and Harold C. Simmons Transplant Institute (Lima, Felius, Chamogeorgakis, Gonzalez-Stawinski), Baylor University Medical Center at Dallas
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Chamogeorgakis T, Joseph S, Hall S, Gonzalez-Stawinski GV, Saracino G, Rafael A, MacHannaford J, Toumpoulis I, Mendez J, Lima B. Impact of donor age on cardiac transplantation outcomes and on cardiac function. Interact Cardiovasc Thorac Surg 2016; 23:580-3. [PMID: 27252239 DOI: 10.1093/icvts/ivw172] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/26/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Although the impact of older donors on heart transplant outcomes has been previously published, the survival results are conflicting. We herein analyse the impact of older donors on transplant survival and myocardial function. METHODS The records of the patients who underwent heart transplant at Baylor University Medical Center at Dallas from November 2012 until March 2015 were reviewed and the data were extracted. The heart recipients were divided into two groups based on donors age; 50 years of age was the division point. The two groups were compared with regard to the following transplant outcomes: in-hospital and 1-year survival, severe (3R) rejection, primary graft dysfunction, myocardial performance as reflected by the inotropic score, left ventricular ejection fraction, intensive care unit and overall length of stay. RESULTS Anoxia was more common cause of death in younger donors (43.9%), whereas intracranial bleeding was more frequent in older donors (48.1%, P = 0.016). The in-hospital survival and 1-year survival were the same between the two groups. Additionally, cardiac transplantation from older donors was not associated with higher incidence of graft dysfunction, higher inotropic support score, longer intensive care unit and total hospital length of stay or more frequent severe rejection episodes. The left ventricular ejection fraction was similar between the two groups. CONCLUSIONS Heart transplant from older donors is not associated with lower in-hospital and mid-term survival if donors are carefully selected; furthermore, the graft function is comparable. The use of hearts from donors older than 50 years of age can be expanded beyond critically ill recipients in carefully selected recipients.
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Affiliation(s)
| | - Susie Joseph
- Department of Cardiology, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Shelley Hall
- Department of Cardiology, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | | | | | - Aldo Rafael
- Department of Thoracic and Cardiac Surgery, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Juan MacHannaford
- Department of Thoracic and Cardiac Surgery, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | | | - Jose Mendez
- Department of Cardiology, Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Brian Lima
- Department of Thoracic and Cardiac Surgery, Baylor University Medical Center at Dallas, Dallas, TX, USA
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Lima B, Squiers J, Saracino G, Chamogeorgakis T, MacHannaford J, Rafael A, Gonazalez-Stawinksi G, Hall S, DiMaio J. Application of the ISHLT Criteria for Primary Graft Dysfunction After Cardiac Transplantation: Risk Factors and Outcomes from a High-Volume Center. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Squiers J, Saracino G, Chamogeorgakis T, MacHannaford J, Rafael A, Gonzalez-Stawinski G, Hall S, DiMaio J, Lima B. High Donor Sequence Number Grafts Can Be Safely Transplanted into Select Patients. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Chamogeorgakis T, Joseph S, Hall S, Saracino G, Carey S, Kale P, Sherwood M, Gonzalez-Stawinski G, Lima B. Donor Age for Heart Transplantation Does Not Affect Short or Mid-Term Outcomes. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Lima B, Dur O, Chuang J, Chamogeorgakis T, Farrar D, Sundareswaran K, Hall S, Gonzalez-Stawinski G. A Novel Cardiac Coordinate Modeling System for Three Dimensional Quantification of Inflow Cannula Malposition in HeartMate II Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Arsalan M, Squiers J, Herbert M, Mac Hannaford J, Chamogeorgakis T, Moore D, Harrington K, Mack M, Brinkman W. Hospital Volume Impacts Outcomes in the Treatment of Type A Aortic Dissection. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lima B, Chamogeorgakis T, MacHannaford JC, Gonzalez-Stawinski GV. Hypothermic Circulatory Arrest in Cardiac Transplantation. Transplant Proc 2015; 47:2719-21. [PMID: 26680080 DOI: 10.1016/j.transproceed.2015.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 06/20/2015] [Accepted: 07/08/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Infrequently, hypothermic circulatory arrest (HCA) must be used during cardiac transplantation. Such cases may include concomitant aortic arch surgery, explantation of ventricular assist devices with outflow grafts or pseudoaneurysms closely abutting the sternum, and other scenarios for which dense mediastinal adhesions preclude exposure and anatomic dissection by conventional methods of adhesiolysis. Outcomes of heart transplantations performed with HCA have not been previously catalogued in the literature and are presented in the current case series. METHODS Between November 2012 and December 2014, 193 patients underwent heart transplantation at a single institution. Of these, 7 cases (3.6%) required implementation of HCA. Postoperative outcomes in these patients were analyzed using a prospectively maintained clinical database. RESULTS The HCA patients included 28% females, with mean age of 46 years, and 71% had nonischemic cardiomyopathies. The majority (N = 5, 71%) had prior ventricular assist device implantation, including 1 patient with a paracorporeal biventricular assist device. One of the remaining 2 patients had three previous surgeries for repair of tetralogy of Fallot, with a completely calcified right ventricular outflow tract and pulmonary arterial system. Mean HCA and cold ischemic times were 25 minutes (range, 9-34 minutes) and 285 minutes (range, 181-425 minutes), respectively. Mean postoperative length of stay was 31 days, and six of seven patients (86%) survived to hospital discharge. One patient expired as an outpatient 2 months following transplant. Rates of postoperative renal failure, respiratory failure, and stroke were 43%, 43%, and 29%, respectively. CONCLUSION On rare occasions, HCA must be instituted to safely conduct a complex heart transplantation procedure. Based on this small case series, these patients can be salvaged and discharged from the hospital, but may experience prolonged lengths of stay with moderate rates of other end-organ complications.
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Affiliation(s)
- B Lima
- Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas.
| | - T Chamogeorgakis
- Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas
| | - J C MacHannaford
- Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas
| | - G V Gonzalez-Stawinski
- Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas
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Lima B, Chamogeorgakis T, Mountis M, Gonzalez-Stawinski GV. Replacement of the aortic valve with a bioprosthesis at the time of continuous flow ventricular assist device implantation for preexisting aortic valve dysfunction. Proc (Bayl Univ Med Cent) 2015; 28:454-6. [PMID: 26424939 DOI: 10.1080/08998280.2015.11929306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Left ventricular assist device (LVAD) implantation has become a mainstay of therapy for advanced heart failure patients who are either ineligible for, or awaiting, cardiac transplantation. Controversy remains over the optimal therapeutic strategy for preexisting aortic valvular dysfunction in these patients at the time of LVAD implant. In patients with moderate to severe aortic regurgitation, surgical approaches are center specific and range from variable leaflet closure techniques to concomitant aortic valve replacement (AVR) with a bioprosthesis. In the present study, we retrospectively analyzed our outcomes in patients who underwent simultaneous AVR and LVAD implantation secondary to antecedent aortic valve pathology. Between January 2004 and June 2010, 144 patients underwent LVAD implantation at a single institution. Of these, 7 patients (4.8%) required concomitant AVR. Five of the 7 patients (71%) survived to hospital discharge and suffered no adverse events in the perioperative period. One-year survival for the discharged patients was 80%, and no prosthetic valve-related adverse events were observed in long-term follow-up. Given our experience, we conclude that bioprosthetic AVR is a plausible alternative for end-stage heart failure patients at the time of LVAD implantation.
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Affiliation(s)
- Brian Lima
- Department of Cardiac Surgery, Baylor University Medical Center at Dallas, Dallas, Texas (Lima, Chamogeorgakis), and the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio (Mountis, Gonzalez-Stawinski). Dr. Gonzalez-Stawinski is now affiliated with Baylor University Medical Center at Dallas
| | - Themistokles Chamogeorgakis
- Department of Cardiac Surgery, Baylor University Medical Center at Dallas, Dallas, Texas (Lima, Chamogeorgakis), and the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio (Mountis, Gonzalez-Stawinski). Dr. Gonzalez-Stawinski is now affiliated with Baylor University Medical Center at Dallas
| | - Maria Mountis
- Department of Cardiac Surgery, Baylor University Medical Center at Dallas, Dallas, Texas (Lima, Chamogeorgakis), and the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio (Mountis, Gonzalez-Stawinski). Dr. Gonzalez-Stawinski is now affiliated with Baylor University Medical Center at Dallas
| | - Gonzalo V Gonzalez-Stawinski
- Department of Cardiac Surgery, Baylor University Medical Center at Dallas, Dallas, Texas (Lima, Chamogeorgakis), and the Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio (Mountis, Gonzalez-Stawinski). Dr. Gonzalez-Stawinski is now affiliated with Baylor University Medical Center at Dallas
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Reinhold SM, Lima B, Khalid A, Gonzalez-Stawinski GV, Stoler RC, Hall SA, Chamogeorgakis T. Heart transplantation in the Ehlers-Danlos syndrome. Proc AMIA Symp 2015; 28:492-3. [PMID: 26424951 DOI: 10.1080/08998280.2015.11929319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We describe a woman with Ehlers-Danlos syndrome and aortic aneurysm who experienced a myocardial infarction due to spontaneous left circumflex coronary artery dissection 3 weeks postpartum. She developed end-stage heart failure and subsequently underwent a successful orthotopic heart transplantation. To our knowledge, this is the first report of a heart transplant performed in an individual with Ehlers-Danlos syndrome.
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Affiliation(s)
- Stephanie M Reinhold
- Texas A&M Health Science Center College of Medicine (Reinhold); the Division of Cardiology (Khalid, Stoler, Hall) and the Department of Cardiovascular and Thoracic Surgery (Lima, Gonzalez-Stawinski, Chamogeorgakis), Baylor University Medical Center at Dallas and the Baylor Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Brian Lima
- Texas A&M Health Science Center College of Medicine (Reinhold); the Division of Cardiology (Khalid, Stoler, Hall) and the Department of Cardiovascular and Thoracic Surgery (Lima, Gonzalez-Stawinski, Chamogeorgakis), Baylor University Medical Center at Dallas and the Baylor Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Adnan Khalid
- Texas A&M Health Science Center College of Medicine (Reinhold); the Division of Cardiology (Khalid, Stoler, Hall) and the Department of Cardiovascular and Thoracic Surgery (Lima, Gonzalez-Stawinski, Chamogeorgakis), Baylor University Medical Center at Dallas and the Baylor Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Gonzalo V Gonzalez-Stawinski
- Texas A&M Health Science Center College of Medicine (Reinhold); the Division of Cardiology (Khalid, Stoler, Hall) and the Department of Cardiovascular and Thoracic Surgery (Lima, Gonzalez-Stawinski, Chamogeorgakis), Baylor University Medical Center at Dallas and the Baylor Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Robert C Stoler
- Texas A&M Health Science Center College of Medicine (Reinhold); the Division of Cardiology (Khalid, Stoler, Hall) and the Department of Cardiovascular and Thoracic Surgery (Lima, Gonzalez-Stawinski, Chamogeorgakis), Baylor University Medical Center at Dallas and the Baylor Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Shelley A Hall
- Texas A&M Health Science Center College of Medicine (Reinhold); the Division of Cardiology (Khalid, Stoler, Hall) and the Department of Cardiovascular and Thoracic Surgery (Lima, Gonzalez-Stawinski, Chamogeorgakis), Baylor University Medical Center at Dallas and the Baylor Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Themistokles Chamogeorgakis
- Texas A&M Health Science Center College of Medicine (Reinhold); the Division of Cardiology (Khalid, Stoler, Hall) and the Department of Cardiovascular and Thoracic Surgery (Lima, Gonzalez-Stawinski, Chamogeorgakis), Baylor University Medical Center at Dallas and the Baylor Hamilton Heart and Vascular Hospital, Dallas, Texas
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Sacks J, Gonzalez-Stawinski GV, Hall S, Lima B, MacHannaford J, Dockery W, Cura M, Chamogeorgakis T. Utility of cardiac computed tomography for inflow cannula patency assessment and prediction of clinical outcome in patients with the HeartMate II left ventricular assist device. Interact Cardiovasc Thorac Surg 2015. [DOI: 10.1093/icvts/ivv205] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Munkres AG, Ball TN, Chamogeorgakis T, Ausloos KA, Hall SA, Choi JW. Usefulness of percutaneous closure of patent foramen ovale for hypoxia. Proc AMIA Symp 2015; 28:204-6. [PMID: 25829655 DOI: 10.1080/08998280.2015.11929230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We report a patient with hypoxia secondary to a right-to-left shunt through a patent foramen ovale, following aortic root, valve, and arch replacement due to an aortic dissection in the setting of the Marfan syndrome. Following the operation, he failed extubation twice due to hypoxia. An extensive workup revealed a right-to-left shunt previously not seen. The patent foramen ovale was closed using a percutaneous closure device. Following closure, our patient was extubated without difficulty and has done well postoperatively.
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Affiliation(s)
- Alyssa G Munkres
- Division of Cardiology, Department of Internal Medicine, Baylor Hamilton Heart and Vascular Hospital and Baylor University Medical Center at Dallas
| | - Timothy N Ball
- Division of Cardiology, Department of Internal Medicine, Baylor Hamilton Heart and Vascular Hospital and Baylor University Medical Center at Dallas
| | - Themistokles Chamogeorgakis
- Division of Cardiology, Department of Internal Medicine, Baylor Hamilton Heart and Vascular Hospital and Baylor University Medical Center at Dallas
| | - Kenneth A Ausloos
- Division of Cardiology, Department of Internal Medicine, Baylor Hamilton Heart and Vascular Hospital and Baylor University Medical Center at Dallas
| | - Shelley A Hall
- Division of Cardiology, Department of Internal Medicine, Baylor Hamilton Heart and Vascular Hospital and Baylor University Medical Center at Dallas
| | - James W Choi
- Division of Cardiology, Department of Internal Medicine, Baylor Hamilton Heart and Vascular Hospital and Baylor University Medical Center at Dallas
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Lima B, Manos J, Duncan M, Noesges S, Anonetapipat W, Stockard E, Hernandez O, Shafii A, Chamogeorgakis T, Mac J, Hannaford, Smith R, Hall S, Gonzalez-Stawinski G. Overview of a Newly Developed Hub and Spoke Extracorporeal Membrane Oxygenation Inter-Hospital Transport Program. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
Described herein is a 68-year-old man who underwent cardiac transplantation for severe chronic heart failure resulting from ischemic cardiomyopathy. Examination of the excised heart showed not only extensive left ventricular scarring but also a huge collection of adipose tissue in the subepicardial region and surprisingly also in the ventricular septum. The finding of fat in the ventricular septum is extremely rare and prompted this report.
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Affiliation(s)
- Erin E Donaldson
- Baylor Heart and Vascular Institute (Donaldson, Ko, Roberts) and the Departments of Internal Medicine, Division of Cardiology (Kuiper, Roberts), Pathology (Roberts), and Cardiothoracic Surgery (Chamogeorgakis), Baylor University Medical Center at Dallas. Dr. Donaldson is now with the Department of Family Medicine, Methodist Charlton Medical Center, Dallas, Texas
| | - Jong Mi Ko
- Baylor Heart and Vascular Institute (Donaldson, Ko, Roberts) and the Departments of Internal Medicine, Division of Cardiology (Kuiper, Roberts), Pathology (Roberts), and Cardiothoracic Surgery (Chamogeorgakis), Baylor University Medical Center at Dallas. Dr. Donaldson is now with the Department of Family Medicine, Methodist Charlton Medical Center, Dallas, Texas
| | - Johannes J Kuiper
- Baylor Heart and Vascular Institute (Donaldson, Ko, Roberts) and the Departments of Internal Medicine, Division of Cardiology (Kuiper, Roberts), Pathology (Roberts), and Cardiothoracic Surgery (Chamogeorgakis), Baylor University Medical Center at Dallas. Dr. Donaldson is now with the Department of Family Medicine, Methodist Charlton Medical Center, Dallas, Texas
| | - Themistokles Chamogeorgakis
- Baylor Heart and Vascular Institute (Donaldson, Ko, Roberts) and the Departments of Internal Medicine, Division of Cardiology (Kuiper, Roberts), Pathology (Roberts), and Cardiothoracic Surgery (Chamogeorgakis), Baylor University Medical Center at Dallas. Dr. Donaldson is now with the Department of Family Medicine, Methodist Charlton Medical Center, Dallas, Texas
| | - William C Roberts
- Baylor Heart and Vascular Institute (Donaldson, Ko, Roberts) and the Departments of Internal Medicine, Division of Cardiology (Kuiper, Roberts), Pathology (Roberts), and Cardiothoracic Surgery (Chamogeorgakis), Baylor University Medical Center at Dallas. Dr. Donaldson is now with the Department of Family Medicine, Methodist Charlton Medical Center, Dallas, Texas
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Sacks JD, Compton PA, Cura MA, Chamogeorgakis T. Surgical repair of postoperative lymphoceles in cardiac transplant patients following inguinal lymphangiography with methylene blue dye injection. J Vasc Interv Radiol 2014; 25:656-8. [PMID: 24674224 DOI: 10.1016/j.jvir.2014.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 01/09/2014] [Accepted: 01/10/2014] [Indexed: 10/25/2022] Open
Affiliation(s)
- Justin D Sacks
- Department of Radiology, Baylor University Medical Center, 3500 Gaston Ave., Dallas, TX 75246
| | | | - Marco A Cura
- Department of Radiology, Baylor University Medical Center, 3500 Gaston Ave., Dallas, TX 75246
| | - Themistokles Chamogeorgakis
- Department of Cardiothoracic Surgery, Baylor University Medical Center, 3500 Gaston Ave., Dallas, TX 75246; Department of Cardiothoracic Surgery, National and Kapodistrian University of Athens, Athens, Greece
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Abstract
The Bernheim syndrome has been a topic of discussion for over a century. It has been reported to be caused by severe rightward movement of the ventricular septum resulting in compression of the right ventricular cavity leading to right-sided heart failure without pulmonary congestion. Hemodynamic findings have been described in a few patients with the so-called Bernheim syndrome. We describe a patient in whom the ventricular septum dramatically decreased the size of the right ventricular cavity and yet peak systolic pressures in both the right ventricle and pulmonary trunk were identical. Thus, it is difficult to view the Bernheim syndrome as a real entity.
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Affiliation(s)
- Monica S Chung
- Division of Cardiology, Department of Internal Medicine (Chung, Ko, Hall, Roberts), the Department of Pathology (Roberts), the Department of Cardiothoracic Surgery (Chamogeorgakis), and the Baylor Heart and Vascular Institute (Ko, Roberts), Baylor University Medical Center at Dallas. Ms. Chung is currently a medical student at Texas Tech University Health Science Center and Paul L. Foster School of Medicine, El Paso, Texas
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Chamogeorgakis T, Bhora F, Toumpoulis I, Nabong A, Connery C. Effect of postoperative course on midterm outcome after esophageal resection for cancer. Proc (Bayl Univ Med Cent) 2013; 26:239-42. [PMID: 23814379 DOI: 10.1080/08998280.2013.11928970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Esophageal resections are challenging procedures often associated with postoperative complications and a prolonged hospital stay. This study investigated the impact of postoperative course on midterm survival in 35 patients undergoing esophageal resection for malignancy between January 2002 and November 2007. The impact of preoperative and operative variables, pathology, staging, early postoperative complications, and length of hospital stay on midterm survival was determined with Cox regression analysis. During the follow-up period, 17 (48.6%) patients died. Multivariate analysis identified surgical stage and length of stay as independent predictors of midterm survival; in addition, the total number of complications reached statistical significance. In conclusion, in addition to surgical stage, postoperative course has an impact upon midterm survival after esophageal resection.
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Affiliation(s)
- Themistokles Chamogeorgakis
- Department of Cardiothoracic Surgery, Baylor University Medical Center at Dallas (Chamogeorgakis); and the Department of Cardiothoracic Surgery, Continuum Cancer Centers, St. Luke's-Roosevelt Hospital, New York, NY (Bhora, Toumpoulis, Nabong, Connery)
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Chamogeorgakis T, Mason DP, Murthy SC, Thuita L, Raymond DP, Pettersson GB, Blackstone EH. Impact of nutritional state on lung transplant outcomes. J Heart Lung Transplant 2013; 32:693-700. [PMID: 23664761 DOI: 10.1016/j.healun.2013.04.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 03/06/2013] [Accepted: 04/01/2013] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND When high-risk lung transplant candidates are evaluated, nutritional state is often neglected. We evaluated the prevalence of markers reflecting pre-transplant malnutrition and their association with post-operative complications and death. METHODS From January 2005 to July 2010, 453 patients underwent primary lung transplantation at our institution. Pre-operative nutrition-related variables, including body mass index and weight/height ratio, reflecting cachexia, and albumin, total protein, immunoglobulins, and absolute lymphocyte count were considered in identifying risk factors for time-related major post-operative complications (renal failure requiring dialysis, respiratory failure requiring tracheostomy), pulmonary or bloodstream infections, and death. RESULTS Forty-eight patients had BMI <18.5 kg/m(2), 41 had a weight/height ratio ≤ 0.3, 102 had albumin <3.5 g/dl, 110 had total protein <6 g/dl, and 112 had an absolute lymphocyte count <1,000/μl, indicative of a malnourished state. At 6 months, 30% had experienced pulmonary infection, with lower total serum protein concentration an important risk (p = 0.02). One-year actuarial mortality was 15%; risk factors included lower serum albumin (p = 0.004), particularly when <3 g/dl. In contrast, variables reflecting nutritional state were not statistically significantly correlated with dialysis, respiratory failure requiring tracheostomy, or bloodstream infections. CONCLUSION Although malnutrition is uncommon in lung transplant patients, those at extremes of low serum albumin and total protein have worse survival and increased risk of post-operative infection. Strategies to improve nutrition of these high-risk candidates awaiting lung transplantation should be developed.
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Affiliation(s)
- Themistokles Chamogeorgakis
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Tong M, Kalavrouzioutis D, Nagpal D, Chamogeorgakis T, Soltesz E, Smedira N, Lee S, Moazami N. Late Onset Infection in Patients with Ventricular Assist Devices: Etiology, Management and Outcomes. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Chamogeorgakis T, Lima B, Shafii AE, Nagpal D, Pokersnik JA, Navia JL, Mason D, Gonzalez-Stawinski GV. Outcomes of axillary artery side graft cannulation for extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg 2013; 145:1088-1092. [DOI: 10.1016/j.jtcvs.2012.08.070] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 08/17/2012] [Accepted: 08/24/2012] [Indexed: 11/25/2022]
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Nagpal AD, Chamogeorgakis T, Shafii AE, Hanna M, Miller CM, Fung J, Gonzalez-Stawinski GV. Combined Heart and Liver Transplantation: The Cleveland Clinic Experience. Ann Thorac Surg 2013; 95:179-82. [DOI: 10.1016/j.athoracsur.2012.09.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 08/29/2012] [Accepted: 09/04/2012] [Indexed: 11/29/2022]
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Shafii AE, Chamogeorgakis T, Mountis M, Gonzalez-Stawinski G. Fate of retained right ventricular assist device outflow grafts after right ventricular recovery. J Heart Lung Transplant 2012; 31:672-3. [DOI: 10.1016/j.healun.2012.02.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 02/15/2012] [Accepted: 02/27/2012] [Indexed: 10/28/2022] Open
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Chamogeorgakis T, Toumpoulis I, Tomos P, Ieromonachos C, Angouras D, Georgiannakis E, Michail P, Rokkas C. External validation of the modified Thoracoscore in a new thoracic surgery program: prediction of in-hospital mortality. Interact Cardiovasc Thorac Surg 2009; 9:463-6. [PMID: 19549645 DOI: 10.1510/icvts.2008.201178] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Informed consent prior to any surgical intervention should include in-hospital survival estimation after the procedure performed. The recently developed Thoracoscore predicts well the postoperative mortality possibility. The purpose of our study was to test the modified Thoracoscore performance in our new thoracic program. One hundred and fifty-five consecutive patients underwent thoracic surgery procedure within two years. The procedures performed were: 62 lung resections, 10 open tumor biopsies, 21 neck and mediastinal procedures, 33 chest wall and pleural procedures, 8 tracheal procedures, 3 esophageal procedures, 13 minor cardiac procedures, and 5 chest trauma cases. The modified Thoracoscore was calculated based on the following variables: age, gender, priority of the procedure, malignancy, type of procedure, Zubrod score, ASA class, and number of co-morbidities. The observed mortality was 5.2% (eight deaths) while the predicted one based on the modified Thoracoscore was 4.9%. The scoring system we used had excellent discriminatory ability with a C statistic (0.95, 95% CIs 0.91-0.99). The Hosmer-Lemeshow goodness-of-fit was not statistically significant (P=0.82), indicating acceptable calibration of the model for the present series. The modified Thoracoscore's ability to predict postoperative survival in the whole context of thoracic surgery performs well in our program. Application of any risk scoring system requires external validation and provides comparison of the actual outcomes with other programs.
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Giannitsioti E, Angouras D, Chamogeorgakis T, Matiatou S, Christodoulaki K, Mallios D, Ieromonachos K, Santaintidis I, Tourmousoglou C, Giamarellou H, Rokkas C. 102 SURGICAL TREATMENT OF INFECTIVE ENDOCARDITIS: INITIAL EXPERIENCE OF A NEW UNIVERSITY CARDIAC SURGICAL UNIT. Int J Antimicrob Agents 2009. [DOI: 10.1016/s0924-8579(09)70121-9] [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: 11/27/2022]
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Chamogeorgakis T, Ieromonachos C, Georgiannakis E, Mallios D. Does lobectomy achieve better survival and recurrence rates than limited pulmonary resection for T1N0M0 non-small cell lung cancer patients? Interact Cardiovasc Thorac Surg 2008; 8:364-72. [DOI: 10.1510/icvts.2008.178947] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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