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2. Metabolomic profiling during ex situ normothermic perfusion before heart transplantation defines patterns of substrate utilization and correlates with markers of allograft injury

Author

Truby, Lauren K., Kwee, Lydia Coulter, Bowles, Dawn E., Casalinova, Sarah, Ilkayeva, Olga, Muehlbauer, Michael J., Huebner, Janet L., Holley, Christopher L., DeVore, Adam D., Patel, Chetan B., Kang, Lillian, Pla, Michelle Mendiola, Gross, Ryan, McGarrah, Robert W., Schroder, Jacob N., Milano, Carmelo A., and Shah, Svati H.

Published
2024
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4. Increasing Utilization of Extended Criteria Donor Hearts for Transplantation: The OCS Heart EXPAND Trial

Author

Schroder, Jacob N., Patel, Chetan B., DeVore, Adam D., Casalinova, Sarah, Koomalsingh, Kevin J., Shah, Ashish S., Anyanwu, Anelechi C., D’Alessandro, David A., Mudy, Karol, Sun, Benjamin, Strueber, Martin, Khaghani, Asghar, Shudo, Yasuhiro, Esmailian, Fardad, Liao, Kenneth, Pagani, Francis D., Silvestry, Scott, Wang, I-wen, Salerno, Christopher T., Absi, Tarek S., Madsen, Joren C., Mancini, Donna, Fiedler, Amy G., Milano, Carmelo A., and Smith, Jason W.

Published
2024
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7. Late follow-up for a randomized trial of surgical treatment of tricuspid valve regurgitation in patients undergoing left ventricular assist device implantation

Author

Mendiola Pla, Michelle, Russell, Stuart D., Milano, Carmelo A., Chiang, Yuting, Kang, Lillian, Poehlein, Emily, Green, Cynthia L., Benedetti, Frank, Billard, Han, Bryner, Benjamin S., Schroder, Jacob N., Daneshmand, Mani A., Nicoara, Alina, DeVore, Adam D., Patel, Chetan B., and Bishawi, Muath

Published
2024
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14. Validation of donor fraction cell-free DNA with biopsy-proven cardiac allograft rejection in children and adults

Author

Richmond, Marc E., Deshpande, Shriprasad R., Zangwill, Steven D., Bichell, David P., Kindel, Steven J., Mahle, William T., Schroder, Jacob N., Wigger, Mark A., Knecht, Kenneth R., Pahl, Elfriede, Gaglianello, Nunzio A., Goetsch, Mary A., Simpson, Pippa, Dasgupta, Mahua, Zhang, Liyun, North, Paula E., Tomita-Mitchell, Aoy, and Mitchell, Michael E.

Published
2023
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23. Abstract 15042: Cardiac-Enhanced Adeno-Associated Viral Vector Achieves Long-Term Transgene Expression in Transplanted Porcine Hearts When Administered During Ex Vivo Perfusion

Author

Mendiola Pla, Michelle, Chiang, Yuting, Roki, Antonio, Wang, Chunbo, Lee, Franklin H, Smith, Matthew F, Gross, Ryan, Evans, Amy, Carnes, Alexis, Bonadonna, Desiree, Glass, Carolyn, Bishawi, Muath, Schroder, Jacob N, Lezberg, Paul M, Milano, Carmelo A, and Bowles, Dawn E

Published
2022
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24. Severe obesity among patients with left ventricular assist devices.

Author

Medina, Cathlyn K, Barnes, Stephanie G, Felker, G Michael, Mentz, Robert J, Pagidipati, Neha J, Seymour, Keri A, Schroder, Jacob N, and Harrington, Josephine

Abstract

Patients with obesity and advanced heart failure requiring left ventricular assist device (LVAD) support are more likely to experience LVAD complications and may be disproportionately Black and/or female when compared to patients without obesity. Among these patients, obesity may represent a barrier to transplant eligibility and a marker of inequity in heart transplantation and health outcomes in advanced heart failure. To better understand this issue at our institution, we examined our active LVAD cohort and found that almost one-third of all patients had severe obesity with BMI ≥ 35 kg/m2. Patients with LVADs and severe obesity were significantly younger and more likely to self-identify as Black, and numerically more likely to be female. Weight management in this group represents a vital area for improved equity in health outcomes and barriers to heart transplantation. NA. [ABSTRACT FROM AUTHOR]

Published
2024
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25. Microaxial Flow Pumps for Cardiogenic Shock: Effects on Hemodynamics, Hemolysis, and End‐Organ Recovery.

Author

Parker, Lauren E., Kang, Lillian, Milano, Carmelo A., Lobo, Alejandro A., Doberne, Julie W., Bishawi, Muath, Jensen, Christopher. W., Patel, Chetan B., DeVore, Adam D., Russell, Stuart D., Katz, Jason N., Schroder, Jacob N., and Topcu, Ahmet Can

Subjects
VASCULAR resistance, CARDIOGENIC shock, LACTATE dehydrogenase, CARDIAC surgery, HEMOLYSIS & hemolysins, HEART assist devices
Abstract

Background. The Impella 5.5 offers a less invasive transvalvular approach to left ventricular mechanical support. End‐organ recovery and hemolysis have been well‐studied with durable left ventricular assist devices but effects of Impella 5.5 on these parameters are less well described. Methods. All Impella 5.5 recipients between August 2020 and June 2023 were reviewed from a single institution. Hemodynamics and laboratory values were compared between preimplant and prior to device removal. Hemolysis was defined as postoperative lactate dehydrogenase >1000 IU/L with concurrent plasma‐free hemoglobin >50 mg/dL. Paired Wilcoxon tests compared the median of differences between preimplant and pre‐explant values. Results. We studied 127 consecutive implants of the Impella 5.5. Thirty‐one patients had concomitant VA‐ECMO, and one received Impella 5.5 after durable LVAD explant; these cases were excluded. Our final cohort included 95 patients, with an average age of 55.29 ± 14.5 years. Median implant duration was 11 days (IQR:6–16 days). To avoid confounding hemodynamic factors, we restricted hemodynamic analysis to the 37 patients who received isolated Impella 5.5, excluding those with prior IABP, Impella CP, acute MI, or prior cardiac surgery. These patients experienced improvements from baseline in pulmonary vascular resistance (−77.03 dynes/sec/cm−5, p < 0.01) and wedge pressure (−6.5 mmHg, p < 0.01). Furthermore, cardiac index improved from baseline (+1.3, p < 0.01). In the total cohort (n = 95), pre‐explant creatinine (−0.2 mg/dL, p < 0.01) and ALT (−9.0 mg/dL, p < 0.01) decreased relative to values before the implant. Twenty‐three (24%) met criteria for hemolysis; however, none underwent device removal for clinically significant hemolysis. Takeback was required in 25 patients, 22 of which were for axillary hematoma. Conclusions. Impella 5.5 support acutely improved markers of end‐organ function and hemodynamics, including PVR. [ABSTRACT FROM AUTHOR]

Published
2024
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35. Evaluating threshold for donor fraction cell‐free DNA using clinically available assay for rejection in pediatric and adult heart transplantation.

Author

Deshpande, Shriprasad R., Zangwill, Steven D., Richmond, Marc E., Kindel, Steven J., Schroder, Jacob N., Gaglianello, Nunzio, Bichell, David P., Wigger, Mark A., Knecht, Kenneth R., Thrush, Phillip T., Mahle, William T., North, Paula E., Simpson, Pippa M., Zhang, Liyun, Dasgupta, Mahua, Tomita‐Mitchell, Aoy, and Mitchell, Michael E.

Subjects
CELL-free DNA, HEART transplantation, HEART transplant recipients, ADULTS, CHILD patients, CIRCULATING tumor DNA
Abstract

Background: The aims of the study were to assess the performance of a clinically available cell‐free DNA (cfDNA) assay in a large cohort of pediatric and adult heart transplant recipients and to evaluate performance at specific cut points in detection of rejection. Methods: Observational, non‐interventional, prospective study enrolled pediatric and adult heart transplant recipients from seven centers. Biopsy‐associated plasma samples were used for cfDNA measurements. Pre‐determined cut points were tested for analytic performance. Results: A total of 487 samples from 160 subjects were used for the analysis. There were significant differences for df‐cfDNA values between rejection [0.21% (IQR 0.12–0.69)] and healthy samples [0.05% (IQR 0.01–0.14), p <.0001]. The pediatric rejection group had a median df‐cfDNA value of 0.93% (IQR 0.28–2.84) compared to 0.09% (IQR 0.04–0.23) for healthy samples, p =.005. Overall negative predictive value was 0.94 while it was 0.99 for pediatric patients. Cut points of 0.13% and 0.15% were tested for various types of rejection profiles and were appropriate to rule out rejection. Conclusion: The study suggests that pediatric patients with rejection show higher levels of circulating df‐cfDNA compared to adults and supports the specific cut points for clinical use in pediatric and adult patients with overall acceptable performance. [ABSTRACT FROM AUTHOR]

Published
2024
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39. Two-Phase Hospital-Associated Outbreak of Mycobacterium abscessus: Investigation and Mitigation

Author

Baker, Arthur W., Lewis, Sarah S., Alexander, Barbara D., Chen, Luke F., Wallace, Richard J., Brown-Elliott, Barbara A., Isaacs, Pamela J., Pickett, Lisa C., Patel, Chetan B., Smith, Peter K., Reynolds, John M., Engel, Jill, Wolfe, Cameron R., Milano, Carmelo A., Schroder, Jacob N., Davis, Robert D., Hartwig, Matthew G., Stout, Jason E., Strittholt, Nancy, Maziarz, Eileen K., Saullo, Jennifer Horan, Hazen, Kevin C., Walczak, Richard J., Vasireddy, Ravikiran, Vasireddy, Sruthi, McKnight, Celeste M., Anderson, Deverick J., and Sexton, Daniel J.

Published
2017

47. Health care resource utilization and clinical outcomes for adult heart transplant recipients with primary graft dysfunction.

Author

McCartney, Sharon L., Peskoe, Sarah, Wright, Mary Cooter, Mamoun, Negmeldeen, Schroder, Jacob N., DeVore, Adam D., and Nicoara, Alina

Subjects
HEART transplant recipients, MEDICAL care use, BK virus, HEART transplantation, TREATMENT effectiveness, HOSPITAL mortality, ORGAN transplant waiting lists
Abstract

Introduction: The advent of new technologies to reduce primary graft dysfunction (PGD) and improve outcomes after heart transplantation are costly. Adoption of these technologies requires a better understanding of health care utilization, specifically the costs related to PGD. Methods: Records were examined from all adult patients who underwent orthotopic heart transplantation (OHT) between July 1, 2013 and July 30, 2019 at a single institution. Total costs were categorized into variable, fixed, direct, and indirect costs. Patient costs from time of transplantation to hospital discharge were transformed with the z‐score transformation and modeled in a linear regression model, adjusted for potential confounders and in‐hospital mortality. The quintile of patient costs was modeled using a proportional odds model, adjusted for confounders and in‐hospital mortality. Results: 359 patients were analyzed, including 142 with PGD and 217 without PGD. PGD was associated with a.42 increase in z‐score of total patient costs (95% CI:.22‐.62; p <.0001). Additionally, any grade of PGD was associated with a 2.95 increase in odds for a higher cost of transplant (95% CI: 1.94‐4.46, p <.0001). These differences were substantially greater when PGD was categorized as severe. Similar results were obtained for fixed, variable, direct, and indirect costs. Conclusions: PGD after OHT impacts morbidity, mortality, and health care utilization. We found that PGD after OHT results in a significant increase in total patient costs. This increase was substantially higher if the PGD was severe. Summary: Primary graft dysfunction after heart transplantation impacts morbidity, mortality, and health care utilization. PGD after OHT is costly and investments should be made to reduce the burden of PGD after OHT to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Published
2023
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