29 results on '"Carmelo A. Milano"'
Search Results
2. Cardiac magnetic resonance imaging characterization of acute rejection in a porcine heterotopic heart transplantation model
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Michelle Mendiola Pla, Carmelo A. Milano, Carolyn Glass, Dawn E. Bowles, and David C. Wendell
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Medicine ,Science - Published
- 2024
3. Variation among organ procurement organizations in experience and practice of heart donation after circulatory deathCentral Message
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Austin Ayer, BS, Benjamin S. Bryner, MD, MS, Chetan B. Patel, MD, Jacob N. Schroder, MD, Carmelo A. Milano, MD, Muath A. Bishawi, MD, PhD, Sarah Casalinova, BS, and Adam D. DeVore, MD, MHS
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Published
- 2023
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4. Video analysis of ex vivo beating hearts during preservation on the TransMedics® organ care system
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Michelle Mendiola Pla, Silvia Berrettoni, Franklin H. Lee, Giacomo Rozzi, Federica Marrano, Ryan T. Gross, Amy Evans, David C. Wendell, Paul Lezberg, Margherita Burattini, Francesco Paolo lo Muzio, Lorenzo Fassina, Carmelo A. Milano, Marie-Louise Bang, Dawn E. Bowles, and Michele Miragoli
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ex vivo perfusion ,normothermic ,video ,kinematics ,biomarker ,cardiac transplantation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundReliable biomarkers for assessing the viability of the donor hearts undergoing ex vivo perfusion remain elusive. A unique feature of normothermic ex vivo perfusion on the TransMedics® Organ Care System (OCS™) is that the donor heart is maintained in a beating state throughout the preservation period. We applied a video algorithm for an in vivo assessment of cardiac kinematics, video kinematic evaluation (Vi.Ki.E.), to the donor hearts undergoing ex vivo perfusion on the OCS™ to assess the feasibility of applying this algorithm in this setting.MethodsHealthy donor porcine hearts (n = 6) were procured from Yucatan pigs and underwent 2 h of normothermic ex vivo perfusion on the OCS™ device. During the preservation period, serial high-resolution videos were captured at 30 frames per second. Using Vi.Ki.E., we assessed the force, energy, contractility, and trajectory parameters of each heart.ResultsThere were no significant changes in any of the measured parameters of the heart on the OCS™ device over time as judged by linear regression analysis. Importantly, there were no significant changes in contractility during the duration of the preservation period (time 0–30 min, 918 ± 430 px/s; time 31–60 min, 1,386 ± 603 px/s; time 61–90 min, 1,299 ± 617 px/s; time 91–120 min, 1,535 ± 728 px/s). Similarly, there were no significant changes in the force, energy, or trajectory parameters. Post-transplantation echocardiograms demonstrated robust contractility of each allograft.ConclusionVi.Ki.E. assessment of the donor hearts undergoing ex vivo perfusion is feasible on the TransMedics OCS™, and we observed that the donor hearts maintain steady kinematic measurements throughout the duration.
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- 2023
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5. Right and left ventricular assist devices are an option for bridge to heart transplantCentral MessagePerspective
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Yaron D. Barac, MD, PhD, Ronen Toledano, MD, Oliver K. Jawitz, MD, Jacob N. Schroder, MD, Mani A. Daneshmand, MD, Chetan B. Patel, MD, Dan Aravot, MD, and Carmelo A. Milano, MD
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heart transplantation ,LVAD ,RV failure ,UNOS ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Abstract
Background: Patients with a left ventricular assist device with right ventricular failure are prioritized on the heart transplant waitlist; however, their post-transplant survival is less well characterized. We aimed to determine whether pretransplant right ventricular failure affects postoperative survival in patients with a left ventricular assist device as a bridge to transplant. Methods: We performed a retrospective review of the 2005-2018 Organ Procurement and Transplantation Network/United Network for Organ Sharing registry for candidates aged 18 years or more waitlisted for first-time isolated heart transplantation after left ventricular assist device implantation. Candidates were stratified on the basis of having right ventricular failure, defined as the need for right ventricular assist device or intravenous inotropes. Baseline demographic and clinical characteristics were compared among the 3 groups, and post-transplant survival was assessed. Results: Our cohort included 5605 candidates who met inclusion criteria, including 450 patients with right ventricular failure, 344 patients with a left ventricular assist device and intravenous inotropes as a bridge to transplant, 106 patients with a left ventricular assist device and right ventricular assist device, and 5155 patients with a left ventricular assist device as a bridge to transplant without the need for right side support. Compared with patients without right ventricular failure, patients with a left ventricular assist device as a bridge to transplant with right ventricular failure were younger (median age 51 years, 55 vs 56 years, P 2) was an independent predictor of worse survival (hazard ratio, 1.74; 95% confidence interval, 1.39-2.17; P
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- 2022
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6. Heart transplant advances: Ex vivo organ-preservation systemsCentral Message
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Benjamin S. Bryner, MD, Jacob N. Schroder, MD, and Carmelo A. Milano, MD
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heart transplantation ,ex vivo heart perfusion ,organ perfusion ,organ recovery ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Published
- 2021
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7. Ex Vivo Gene Delivery to Porcine Cardiac Allografts Using a Myocardial-Enhanced Adeno-Associated Viral Vector
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Michelle Mendiola Pla, Yuting Chiang, Antonio Roki, Chunbo Wang, Franklin H. Lee, Matthew F. Smith, Ryan T. Gross, Jun-Neng Roan, Muath Bishawi, Amy Evans, Lynden E. Gault, Sam Ho, Carolyn Glass, Jacob N. Schroder, Paul Lezberg, Carmelo A. Milano, and Dawn E. Bowles
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Genetics ,Molecular Medicine ,Molecular Biology - Published
- 2023
8. Cardiovascular mechanism of donor brain death and heart recipient survival
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Christopher W. Jensen, Oliver K. Jawitz, Abigail R. Benkert, Philip J. Spencer, Benjamin S. Bryner, Jacob N. Schroder, and Carmelo A. Milano
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2022
9. Late Durability of Mitral Repair for Ischemic Versus Nonischemic Functional Mitral Regurgitation
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Jeffrey G. Gaca, Keith Carr, Andrew Wang, Muath Bishawi, Carmelo A. Milano, and Donald D. Glower
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Pulmonary and Respiratory Medicine ,Surgical repair ,Mitral regurgitation ,medicine.medical_specialty ,Ejection fraction ,business.industry ,Regurgitation (circulation) ,medicine.disease ,Concomitant ,Heart failure ,Internal medicine ,Propensity score matching ,Etiology ,medicine ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Concerns regarding long-term durability of surgical repair for functional mitral regurgitation are based on short-term data, with few comparisons of ischemic (IMR) versus non-ischemic (NIFMR) etiology. Methods 788 consecutive patients receiving mitral repair for functional mitral regurgitation were evaluated from a prospectively maintained database. Patients with other surgical procedures were included. Propensity score matching was used to compare outcomes in IMR versus NIFMR. Results Unmatched IMR patients tended to be older men with greater comorbidities. 198 matched pairs of IMR versus NIFMR patients had similar demographics with relatively preserved ejection fraction 40±13% and end-systolic diameter 4.3±1.1cm. Concomitant coronary revascularization occurred in 70% of matched IMR patients. All patients received an annuloplasty ring, usually 24-26 mm. Heart failure class improved from 2.8 preop to 1.5 at 5 years (P =2+) mitral regurgitation (27±4% v 26±4%, P=0.4), severe regurgitation (10±3% v 8±2%, P=0.5), and mitral reoperation (3±1% v 3±1%, P=0.4) were not different between IMR v NIFMR. Recurrent moderate regurgitation was associated with heart failure readmission but not with mortality. Conclusions In propensity-matched patients, IMR versus NIFMR had worse survival but similar repair durability, with moderate regurgitation in 27% at 10 years and rare severe regurgitation or mitral reoperation. In selected patients with relatively preserved function, mitral repair for IMR or NIFMR can improve symptoms with durable mild regurgitation in most patients out to 10 years.
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- 2022
10. Predictive capabilities of the European registry for patients with mechanical circulatory support right-sided heart failure risk score after left ventricular assist device implantation
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Alina Nicoara, Mary Cooter Wright, Daniel Rosenkrans, Chetan B. Patel, Jacob N. Schroder, Anne D. Cherry, Nazish K. Hashmi, Angela L. Pollak, Sharon L. McCartney, Jason Katz, Carmelo A. Milano, and Mihai V. Podgoreanu
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Adult ,Heart Failure ,Treatment Outcome ,Anesthesiology and Pain Medicine ,Risk Factors ,Ventricular Dysfunction, Right ,Humans ,Heart-Assist Devices ,Registries ,Cardiology and Cardiovascular Medicine ,Retrospective Studies - Abstract
The prediction of right heart failure (RHF) after left ventricular assist device (LVAD) implantation remains a challenge. Recently, risk scores were derived from analysis of the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) data, the EUROMACS-RHF, and the modified postoperative EUROMACS-RHF. The authors assessed the performance characteristics of these 2 risk score formulations in a continuous-flow LVAD cohort at their institution.A retrospective, observational study.At a tertiary-care academic medical center.Adult patients who underwent durable LVAD implantation between 2015 and 2018.None MEASUREMENTS AND MAIN RESULTS: Early post-LVAD RHF was defined as follows: (1) need for right ventricular assist device, or (2) inotropic or inhaled pulmonary vasodilator support for ≥14 postoperative days. The authors used logistic regression and examined receiver operating characteristic (ROC) curves to evaluate the ability of the 2 risk scores to distinguish between outcome groups. A total of 207 patients met the inclusion criteria. Of the patients, 16% developed RHF (33/207). The EUROMACS-RHF score was not predictive of RHF in the authors' cohort (odds ratio [OR] 1.25; 95% CI [0.99-1.60]; p = 0.06), but the postoperative EUROMACS-RHF CPB score was significantly associated (OR 1.38; 95% CI [1.03-1.89]; p = 0.03). The scores had similar ROC curves, with weak discriminatory performance: 0.601 (95% CI [0.509-0.692]) and 0.599 (95% CI [0.505-0.693]) for EUROMACS-RHF and postoperative EUROMACS-RHF, respectively.In the authors' single-center retrospective analysis, the EUROMACS-RHF risk score did not predict early RHF. An optimized risk score for the prediction of RHF after LVAD implantation remains an urgent unmet need.
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- 2022
11. Incidence and Diagnostic Challenges of Bowel Ischemia after Continuous-flow Left Ventricular Assist Device Therapy
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Michelle A Mendiola, Suresh M. Agarwal, Carmelo A. Milano, Jacob N. Schroder, Fabian Jimenez Contreras, Muath Bishawi, Jatin Anand, Cory Vatsaas, Ashley Y. Choi, Samantha E. Halpern, and Mani A. Daneshmand
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Biomedical Engineering ,Biophysics ,Bioengineering ,Article ,Biomaterials ,Ischemia ,medicine ,Humans ,Renal replacement therapy ,Stroke ,Retrospective Studies ,Heart Failure ,business.industry ,Incidence ,Atrial fibrillation ,General Medicine ,medicine.disease ,Surgery ,Treatment Outcome ,Ventricular assist device ,Current Procedural Terminology ,Female ,Kidney Diseases ,Heart-Assist Devices ,business ,Complication ,Kidney disease ,Destination therapy - Abstract
Long-term continuous-flow left ventricular assist device (CFLVAD) therapy is limited by complications. Compared with stroke and renal dysfunction, post-CFLVAD bowel ischemia is poorly characterized. Adult patients who underwent first-time durable CFLVAD implantation at our institution between 2008 and 2018 were identified and screened for bowel ischemia using Current Procedural Terminology codes for abdominal surgical exploration and International Classification of Disease codes for intestinal vascular insufficiency. Patients who developed biopsy-proven bowel ischemia (cases) were matched to controls (1:1, nearest neighbor, caliper = 0.29) based on preoperative characteristics. Incidences of postoperative right heart failure and renal replacement therapy were compared using McNemar's test. One year survival was estimated using the Kaplan-Meier method. Overall, 711 patients underwent CFLVAD implantation. Nineteen (2.7%) developed bowel ischemia (cases) median 17 days postimplantation (IQR 8-71). The majority of cases were male (78.9%), Black (63.2%), received HeartMate II (57.9%), treated as destination therapy (78.9%), and had a history of hypertension (89.5%), chronic kidney disease (84.2%), hyperlipidemia (84.2%), smoking (78.9%), and atrial fibrillation (57.9%). Post-LVAD, case patients were more likely to develop moderate-severe right heart failure (89.5% vs. 68.4%, p = 0.005), require renal replacement therapy (21.1% vs. 0%, p < 0.001), and less likely to survive to discharge (52.6% vs. 89.5%, p = 0.02) compared with controls. Case subjects demonstrated worse 1 year survival. While less common than stroke and renal dysfunction, post-CFLVAD bowel ischemia is associated with high 1 year mortality. Multi-institutional registries should consider reporting abdominal complications such as bowel ischemia as an adverse event to further investigate these trends and identify predictors of this complication to reduce patient mortality.
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- 2023
12. 2022 ACC/AHA/HFSA Guideline for the Management of Heart Failure
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Paul A. Heidenreich, Biykem Bozkurt, David Aguilar, Larry A. Allen, Joni J. Byun, Monica M. Colvin, Anita Deswal, Mark H. Drazner, Shannon M. Dunlay, Linda R. Evers, James C. Fang, Savitri E. Fedson, Gregg C. Fonarow, Salim S. Hayek, Adrian F. Hernandez, Prateeti Khazanie, Michelle M. Kittleson, Christopher S. Lee, Mark S. Link, Carmelo A. Milano, Lorraine C. Nnacheta, Alexander T. Sandhu, Lynne Warner Stevenson, Orly Vardeny, Amanda R. Vest, Clyde W. Yancy, Joshua A. Beckman, Patrick T. O'Gara, Sana M. Al-Khatib, Anastasia L. Armbruster, Kim K. Birtcher, Joaquin E. Cigarroa, Lisa de las Fuentes, Dave L. Dixon, Lee A. Fleisher, Federico Gentile, Zachary D. Goldberger, Bulent Gorenek, Norrisa Haynes, Mark A. Hlatky, José A. Joglar, W. Schuyler Jones, Joseph E. Marine, Daniel B. Mark, Debabrata Mukherjee, Latha P. Palaniappan, Mariann R. Piano, Tanveer Rab, Erica S. Spatz, Jacqueline E. Tamis-Holland, Duminda N. Wijeysundera, and Y. Joseph Woo
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Heart Failure ,Research Report ,Cardiology ,Humans ,American Heart Association ,Cardiology and Cardiovascular Medicine ,United States - Abstract
The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure.A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021.Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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- 2022
13. Proteomic profiling identifies CLEC4C expression as a novel biomarker of primary graft dysfunction after heart transplantation
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Carmelo A. Milano, Chetan B. Patel, Christopher L. Holley, Dawn E. Bowles, Lydia Coulter Kwee, Richa Agarwal, Dong-Feng Chen, Adam D. DeVore, Lauren K. Truby, Jacob N. Schroder, Svati H. Shah, and Elizabeth Grass
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Male ,Proteomics ,Pulmonary and Respiratory Medicine ,Oncology ,medicine.medical_specialty ,medicine.medical_treatment ,Primary Graft Dysfunction ,Sensitivity and Specificity ,Article ,chemistry.chemical_compound ,Postoperative Complications ,Internal medicine ,Humans ,Medicine ,Lectins, C-Type ,Receptors, Immunologic ,Aged ,Aged, 80 and over ,Heart transplantation ,Transplantation ,Creatinine ,Membrane Glycoproteins ,business.industry ,Middle Aged ,Pathophysiology ,chemistry ,Heart Transplantation ,Biomarker (medicine) ,Population study ,Female ,Surgery ,Cardiomyopathies ,Cardiology and Cardiovascular Medicine ,Complication ,business ,Biomarkers - Abstract
PURPOSE: Clinical models to identify patients at high risk of primary graft dysfunction (PGD) after heart transplantation (HT) are limited, and the underlying pathophysiology of this common post-transplant complication remains poorly understood. We sought to identify whether pre-transplant levels of circulating proteins reporting on immune activation and inflammation are associated with incident PGD. METHODS: The study population consisted of 219 adult heart transplant recipients identified between 2016 and 2020 at Duke University Medical Center, randomly divided into derivation (n = 131) and validation (n = 88) sets. PGD was defined using modified ISHLT criteria. Proteomic profiling was performed using Olink panels (n = 354 proteins) with serum samples collected immediately prior to transplantation. Association between normalized relative protein expression and PGD was tested using univariate and multivariable (recipient age, creatinine, mechanical circulatory support, and sex; donor age; ischemic time) models. Significant proteins identified in the derivation set (p < 0.05 in univariate models), were then tested in the validation set. Pathway enrichment analysis was used to test candidate biological processes. The predictive performance of proteins was compared to that of the RADIAL score. RESULTS: Nine proteins were associated with PGD in univariate models in the derivation set. Of these, only CLEC4C remained associated with PGD in the validation set after Bonferroni correction (OR [95% CI] = 3.04 [1.74,5.82], p = 2.8×10(−4)). Patterns of association were consistent for CLEC4C in analyses stratified by biventricular/left ventricular and isolated right ventricular PGD. Pathway analysis identified interferon-alpha response and C-type lectin signaling as significantly enriched biologic processes. The RADIAL score was a poor predictor of PGD (AUC = 0.55). CLEC4C alone (AUC = 0.66, p = 0.048) and in combination with the clinical covariates from the multivariable model (AUC = 0.69, p = 0.018) improved discrimination for the primary outcome. CONCLUSIONS: Pre-transplantation circulating levels of CLEC4C, a protein marker of plasmacytoid dendritic cells (pDCs), may identify HT recipients at risk for PGD. Further studies are needed to better understand the potential role pDCs and the innate immune response in PGD.
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- 2021
14. Transvenous Endomyocardial Biopsy Technique for Intra-abdominal Heterotopic Cardiac Grafts
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Michelle Mendiola Pla, Carmelo A. Milano, Yuting Chiang, Muath Bishawi, Lillian Kang, Franklin H. Lee, Matthew F. Smith, Ryan T. Gross, Fabian Jimenez Contreras, Carolyn Glass, Dawn E. Bowles, and Marat Fudim
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Genetics ,Pharmaceutical Science ,Molecular Medicine ,Cardiology and Cardiovascular Medicine ,Genetics (clinical) - Published
- 2022
15. Surgical Treatment of Tricuspid Valve Regurgitation in Patients Undergoing Left Ventricular Assist Device Implantation: Interim analysis of the TVVAD trial
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Michelle Mendiola Pla, Yuting Chiang, Alina Nicoara, Emily Poehlein, Cynthia L. Green, Ryan Gross, Benjamin S. Bryner, Jacob N. Schroder, Mani A. Daneshmand, Stuart D. Russell, Adam D. DeVore, Chetan B. Patel, Jason N. Katz, Carmelo A. Milano, and Muath Bishawi
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2022
16. The outcome of mitral repair for degenerative versus ischemic mitral regurgitation using a single complete ring
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Donald D. Glower, Jeffrey G. Gaca, Andrew Wang, Keith Carr, Carmelo A. Milano, and Muath Bishawi
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Mitral Valve Annuloplasty ,New york heart association ,Internal medicine ,medicine ,Humans ,Less urgent ,Surgical repair ,Mitral regurgitation ,Ischemic mitral regurgitation ,business.industry ,Mitral Valve Insufficiency ,Large cohort ,Treatment Outcome ,embryonic structures ,Etiology ,Cardiology ,Mitral Valve ,Female ,Surgery ,Tricuspid Valve ,Operative risk ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
The durability of surgical repair for degenerative versus ischemic mitral regurgitation (MR) is thought to be markedly different. We, therefore, examined late outcomes and durability for mitral repair in a large cohort of patients receiving a single annuloplasty device.A total of 749 consecutive patients receiving mitral repair for degenerative mitral regurgitation (DMR) or ischemic mitral regurgitation (IMR) were evaluated from a prospective database. Patients with tricuspid or maze surgery were included. Papillary muscle rupture and mixed valve etiologies were excluded. Outcomes were compared for IMR versus DMR.Patients with DMR were younger and less urgent. Patients with IMR had mean end-systolic diameter 4.5 ± 1.1 cm. All patients received the same complete semirigid annuloplasty device with median ring size 32 mm for DMR and 24 mm for IMR. New York Heart Association failure class improved from 2.8 to 1.5 (p .001). Patients with DMR had lower operative mortality (1/384 [0.3%] vs. 26/365 [7%], p .0001) and shorter length of stay. A 15-year survival was better with DMR (63% ± 3% vs. 13% ± 2%, p .001). At 10 years, the incidence of recurrent ≥2+ MR (10% ± 2% vs. 16% ± 2%, p = .16) was not significantly different. Predictors of recurrent ≥2+ MR were female gender (odds ratio [OR]: 3.0 (1.9-4.8, p .0001), and prior operation (OR: 2.4 [1.3-4.5], p = .02) but not IMR (OR: 1.4 [0.9-2.3], p = .15).In this series, where patients with IMR had relatively preserved ventricular dimensions, the primary determinants of late recurrent MR were female gender and prior operation but not IMR versus DMR. Selected patients with IMR can obtain relatively durable mitral repair despite higher operative risk and lower survival compared to DMR.
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- 2021
17. Improved Outcomes in Severe Primary Graft Dysfunction After Heart Transplantation Following Donation After Circulatory Death Compared With Donation After Brain Death
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Austin Ayer, Lauren K. Truby, Jacob N. Schroder, Sarah Casalinova, Cynthia L. Green, Muath A. Bishawi, Benjamin S. Bryner, Carmelo A. Milano, Chetan B. Patel, and Adam D. Devore
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Cardiology and Cardiovascular Medicine - Abstract
Primary graft dysfunction (PGD), the leading cause of early mortality after heart transplantation, is more common following donation after circulatory death (DCD) than donation after brain death (DBD). We conducted a single-center, retrospective cohort study to compare the incidence, severity and outcomes of patients experiencing PGD after DCD compared to DBD heart transplantation.Medical records were reviewed for all adult heart transplant recipients at our institution between March 2016 and December 2021. PGD was diagnosed within 24 hours after transplant according to modified International Society for Heart and Lung Transplant criteria. A total of 459 patients underwent isolated heart transplantation during the study period, 65 (14%) following DCD and 394 (86%) following DBD. The incidence of moderate or severe PGD in DCD and DBD recipients was 34% and 23%, respectively (P = 0.070). DCD recipients were more likely to experience severe biventricular PGD than DBD recipients (19% vs 7.4%; P = 0.004). Among patients with severe PGD, DCD recipients experienced shorter median (Q1, Q3) duration of post-transplant mechanical circulatory support (6 [4, 7] vs 9 [5, 14] days; P = 0.039), shorter median post-transplant hospital length of stay (17 [15, 29] vs 52 [26, 83] days; P = 0.004), and similar 60-day survival rates (100% [95% CI: 76.8%-100%] vs 80.0% [63.1%-91.6%]; P = 0.17) and overall survival (log-rank; P = 0.078) compared with DBD recipients.DCD heart transplant recipients were more likely to experience severe, biventricular PGD than DBD recipients. Despite this, DCD recipients with severe PGD spent fewer days on mechanical circulatory support and in the hospital than similar DBD patients. These findings suggest that patterns of graft dysfunction and recovery may differ between donor types, and they support the expansion of the heart-donor pool with DCD.
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- 2022
18. Commentary: An innovative strategy for expanding the donor pool
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Oliver K. Jawitz and Carmelo A. Milano
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,MEDLINE ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,Donor pool - Published
- 2022
19. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
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Paul A. Heidenreich, Biykem Bozkurt, David Aguilar, Larry A. Allen, Joni J. Byun, Monica M. Colvin, Anita Deswal, Mark H. Drazner, Shannon M. Dunlay, Linda R. Evers, James C. Fang, Savitri E. Fedson, Gregg C. Fonarow, Salim S. Hayek, Adrian F. Hernandez, Prateeti Khazanie, Michelle M. Kittleson, Christopher S. Lee, Mark S. Link, Carmelo A. Milano, Lorraine C. Nnacheta, Alexander T. Sandhu, Lynne Warner Stevenson, Orly Vardeny, Amanda R. Vest, and Clyde W. Yancy
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Heart Failure ,Research Report ,Physiology (medical) ,Cardiology ,Humans ,American Heart Association ,Cardiology and Cardiovascular Medicine ,Cardiovascular System ,United States - Abstract
Aim: The “2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure” replaces the “2013 ACCF/AHA Guideline for the Management of Heart Failure” and the “2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure.” The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. Methods: A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients’ interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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- 2022
20. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
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Paul A. Heidenreich, Biykem Bozkurt, David Aguilar, Larry A. Allen, Joni J. Byun, Monica M. Colvin, Anita Deswal, Mark H. Drazner, Shannon M. Dunlay, Linda R. Evers, James C. Fang, Savitri E. Fedson, Gregg C. Fonarow, Salim S. Hayek, Adrian F. Hernandez, Prateeti Khazanie, Michelle M. Kittleson, Christopher S. Lee, Mark S. Link, Carmelo A. Milano, Lorraine C. Nnacheta, Alexander T. Sandhu, Lynne Warner Stevenson, Orly Vardeny, Amanda R. Vest, and Clyde W. Yancy
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Research Report ,Heart Failure ,Physiology (medical) ,Cardiology ,Humans ,American Heart Association ,Cardiology and Cardiovascular Medicine ,Cardiovascular System ,United States - Abstract
Aim: The “2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure” replaces the “2013 ACCF/AHA Guideline for the Management of Heart Failure” and the “2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure.” The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. Methods: A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients’ interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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- 2022
21. 2022 American College of Cardiology/American Heart Association/Heart Failure Society of America Guideline for the Management of Heart Failure: Executive Summary
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Paul A, Heidenreich, Biykem, Bozkurt, David, Aguilar, Larry A, Allen, Joni-J, Byun, Monica M, Colvin, Anita, Deswal, Mark H, Drazner, Shannon M, Dunlay, Linda R, Evers, James C, Fang, Savitri E, Fedson, Gregg C, Fonarow, Salim S, Hayek, Adrian F, Hernandez, Prateeti, Khazanie, Michelle M, Kittleson, Christopher S, Lee, Mark S, Link, Carmelo A, Milano, Lorraine C, Nnacheta, Alexander T, Sandhu, Lynne Warner, Stevenson, Orly, Vardeny, Amanda R, Vest, and Clyde W, Yancy
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Heart Failure ,Research Report ,Cardiology ,Humans ,American Heart Association ,United States - Abstract
The 2022 American College of Cardiology/American Heart Association/Heart Failure Society of America (AHA/ACC/HFSA) Guideline for the Management of Heart Failure replaces the 2013 ACCF/AHA Guideline for the Management of Heart Failure and the 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose and manage patients with heart failure.A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews and other evidence conducted in human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies published through September 2021 were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021.Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments that have high-quality published economic analyses.
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- 2022
22. The impact of perioperative stroke and delirium on outcomes after surgical aortic valve replacement
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Steven R. Messé, Jessica R. Overbey, Vinod H. Thourani, Alan J. Moskowitz, Annetine C. Gelijns, Mark A. Groh, Michael J. Mack, Gorav Ailawadi, Karen L. Furie, Andrew M. Southerland, Michael L. James, Claudia Scala Moy, Lopa Gupta, Pierre Voisine, Louis P. Perrault, Michael E. Bowdish, A. Marc Gillinov, Patrick T. O'Gara, Maral Ouzounian, Bryan A. Whitson, John C. Mullen, Marissa A. Miller, James S. Gammie, Stephanie Pan, Guray Erus, Jeffrey N. Browndyke, Wendy C. Taddei-Peters, Neal O. Jeffries, Dennis Buxton, Nancy L. Geller, David Gordon, Catherine Burke, Albert Lee, Tyrone Smith, Claudia S. Moy, Ilana Kogan Gombos, Richard Weisel, Timothy J. Gardner, Eric A. Rose, Michael K. Parides, Deborah D. Ascheim, Emilia Bagiella, Ellen Moquete, Kinjal Shah, Helena Chang, Melissa Chase, Seth Goldfarb, Katherine Kirkwood, Edlira Dobrev, Ron Levitan, Karen O'Sullivan, Milerva Santos, Xia Ye, Michael Mack, Rachelle Winkle, Haley Boswell, Amanda Fenlon, Melissa Johnson, Jessica Jones, Megan Kolb, Sarah Lam, Lucy Miranda, Jackie Ward, Renessa Whitman, Brittany Zingler, William Ryan, Robert L. Smith, Paul Grayburn, Pedro Nosnik, Eugene H. Blackstone, Nader Moazami, Randall C. Starling, Benico Barzilai, Richard A. Grimm, Edward G. Soltesz, Irene Katzan, Brian Strippy, Shoi Smith, Michelle Garcia, Mary Alice bowman, Carrie Geither, Robert Wang, Michael Argenziano, Michael Borger, Hiroo Takayama, Martin B. Leon, Lyn Goldsmith, Allan Schwartz, Nadia Sookraj, Talaya McCright-Gill, Sowmya Sreekanth, Jock N. McCullough, Alexander Iribarne, Joseph P. DeSimone, Anthony W. DiScipio, Henry Stokes, Amanda St. Ivany, Gaylin Petty, Peter K. Smith, John H. Alexander, Carmelo A. Milano, Donald D. Glower, Joel Huber, Joel Morganlander, Joseph P. Mathew, Stacey Welsh, Sarah Casalinova, Victoria Johnson, Kathleen Lane, Derek Smith, Greg Tipton, Mark F. Berry, Judson B. Williams, Brian Englum, Matthew Hartwig, Robert Guyton, Omar Lattouf, Edward Chen, J. David Vega, Jefferson Baer, Duc Nguyen, Michael Halkos, Kim Baio, Tamara Prince, Natascha Cook, Alexis A. Neill, Mario Senechal, François Dagenais, Robert Laforce, Kim O'Connor, Gladys Dussault, Manon Caouette, Hugo Tremblay, Nathalie Gagne, Julie Dumont, Patricia Landry, Benjamin H. Trichon, Oliver A. Binns, Stephen W. Ely, Alan M. Johnson, Todd H. Hansen, John G. Short, Reid D. Taylor, Ralph Mangusan, Tracy Nanney, Holly Aubart, Kristin Cross, Leslie McPeters, Christina Riggsbee, Lucy Rixey, Robert E. Michler, Joseph J. DeRose, Daniel J. Goldstein, Ricardo A. Bello, Cynthia Taub, Daniel Spevack, Kathryn Kirchoff, Rebecca Meli, Juan Garcia, Jon Goldenberg, Lauren Kealy, Denis Bouchard, Jean François Tanguay, Eileen O'Meara, Jonathan Lacharité, Sophie Robichaud, Keith A. Horvath, Philip C. Corcoran, Michael P. Siegenthaler, Mandy Murphy, Margaret Iraola, Ann Greenberg, Greg Kumkumian, Mark Milner, Zurab Nadareishvili, Ayesha Hasan, Asia McDavid, Denise Fadorsen, Terry Yau, Michael Farkouh, Anna Woo, Robert James Cusimano, Tirone David, Christopher Feindel, Nishit Fumakia, Shakira Christie, Asvina Bissonauth, Alexandra Hripko, Zahid Noor, Kristen Mackowick, Stephanie Deasey, Manal Al-Suqi, Julia Collins, Michael A. Acker, Steven Messé, James Kirkpatrick, Mary Lou Mayer, Caitlin McDonald, Holley Fok, Breanna Maffei, Stephen Cresse, Christine Gepty, Michael Bowdish, Vaughn A. Starnes, David Shavalle, Christi Heck, Amy Hackmann, Craig Baker, Fernando Fleischman, Mark Cunningham, Edward Lozano, Michelle Hernandez, Irving L. Kron, Karen Johnston, Ravi K. Ghanta, John M. Dent, John Kern, Leora Yarboro, Michael Ragosta, Brian Annex, Jim Bergin, Sandra Burks, Mike Cosner, China Green, Samantha Loya, Hye Ryun Kim, David A. Bull, Patrice Desvigne-Nickens, Dennis O. Dixon, Rebecca Gottesman, Mark Haigney, Richard Holubkov, Constantino Iadecola, Alice Jacobs, Eric M. Meslin, John M. Murkin, John A. Spertus, Frank Sellke, Cheryl L. McDonald, John Canty, Neal Dickert, John S. Ikonomidis, KyungMann Kim, David O. Williams, Clyde W. Yancy, Seemant Chaturvedi, Marc Chimowitz, James C. Fang, Wayne Richenbacher, Vivek Rao, Rachel Miller, Jennifer Cook, David D'Alessandro, Frederick Han, Sean Pinney, Mary N. Walsh, David Greer, Koto Ishida, Christian Stapf, Judy Hung, Xin Zeng, David Hung, Sudarat Satitthummanid, Michel Billelo, Christos Davatzikos, Lauren Karpf, Lisa Desiderio, Yanne Toulgoat-Dubois, Rachele Brassard, Renu Virmanu, Maria E. Romero, and Ryan Braumann
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
The effects of stroke and delirium on postdischarge cognition and patient-centered health outcomes after surgical aortic valve replacement (SAVR) are not well characterized. Here, we assess the impact of postoperative stroke and delirium on these health outcomes in SAVR patients at 90 days.Patients (N = 383) undergoing SAVR (41% received concomitant coronary artery bypass graft) enrolled in a randomized trial of embolic protection devices underwent serial neurologic and delirium evaluations at postoperative days 1, 3, and 7 and magnetic resonance imaging at day 7. Outcomes included 90-day functional status, neurocognitive decline from presurgical baseline, and quality of life.By postoperative day 7, 25 (6.6%) patients experienced clinical stroke and 103 (28.5%) manifested delirium. During index hospitalization, time to discharge was longer in patients experiencing stroke (hazard ratio, 0.62; 95% confidence interval [CI], 0.42-0.94; P = .02) and patients experiencing delirium (hazard ratio, 0.68; 95% CI, 0.54-0.86; P = .001). At day 90, patients experiencing stroke were more likely to have a modified Rankin score2 (odds ratio [OR], 5.9; 95% CI, 1.7-20.1; P = .01), depression (OR, 5.3; 95% CI, 1.6-17.3; P = .006), a lower 12-Item Short Form Survey physical health score (adjusted mean difference -3.3 ± 1.9; P = .08), and neurocognitive decline (OR, 7.8; 95% CI, 2.3-26.4; P = .001). Delirium was associated with depression (OR, 2.2; 95% CI, 0.9-5.3; P = .08), lower 12-Item Short Form Survey physical health (adjusted mean difference -2.3 ± 1.1; P = .03), and neurocognitive decline (OR, 2.2; 95% CI, 1.2-4.0; P = .01).Stroke and delirium occur more frequently after SAVR than is commonly recognized, and these events are associated with disability, depression, cognitive decline, and poorer quality of life at 90 days postoperatively. These findings support the need for new interventions to reduce these events and improve patient-centered outcomes.
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- 2022
23. A Porcine Heterotopic Heart Transplantation Protocol for Delivery of Therapeutics to a Cardiac Allograft
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Dawn E. Bowles, Carmelo A. Milano, Jacob N. Schroder, Benjamin S. Bryner, Paul Lezberg, Sam Ho, Desiree Bonadonna, Julie A. Balko, Lynden E. Gault, Alexis Carnes, Ryan Gross, Diego Zapata, Lillian Kang, Andrew Vekstein, Muath Bishawi, Yuting Chiang, Franklin H. Lee, Amy Evans, and Michelle Mendiola Pla
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Graft Rejection ,Transplantation, Heterotopic ,General Immunology and Microbiology ,Swine ,General Chemical Engineering ,General Neuroscience ,Graft Survival ,Allografts ,Article ,Tissue Donors ,General Biochemistry, Genetics and Molecular Biology ,Animals ,Heart Transplantation ,Humans - Abstract
Cardiac transplantation remains the gold standard therapy for end stage heart failure. However, it remains limited by the number of available donor hearts and by complications such as primary graft dysfunction and graft rejection. The recent clinical use of an ex vivo perfusion device in cardiac transplantation introduces a unique opportunity for treating cardiac allografts with therapeutic interventions to improve function and avoid deleterious recipient responses. Establishing a translational, large-animal model for therapeutic delivery to the entire allograft is essential for testing novel therapeutic approaches in cardiac transplantation. The porcine, heterotopic heart transplantation model in the intra-abdominal position serves as an excellent model for assessing the effects of novel interventions as well as the immunopathology of graft rejection. This model additionally offers long-term survival for the pig given that the graft is not required to maintain the recipient’s circulation. The aim of this protocol is to provide a reproducible and robust approach for achieving ex vivo delivery of a therapeutic to the entire cardiac allograft prior to transplantation and provide technical details to perform a survival heterotopic transplant of the ex vivo perfused heart.
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- 2022
24. Treatment of Perioperative Ischemia, Infarction, and Ventricular Failure in Cardiac Surgery
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Muath Bishawi and Carmelo A. Milano
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Ventricular failure ,medicine.medical_specialty ,business.industry ,Internal medicine ,Ischemia ,Cardiology ,Medicine ,Infarction ,Perioperative ,business ,medicine.disease ,Cardiac surgery - Published
- 2022
25. Contributors
- Author
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Vatche G. Agopian, Ehab Al-Bizri, Benjamin Y. Andrew, Thomas L. Archer, Gareth L. Ackland, John G. Augoustides, Diana Ayubcha, Angela Bader, Shyamasundar Balasubramanya, Peyman Benharash, Miles Berger, Muath Bishawi, Victoria Bradford, Thomas Buchheit, Christopher R. Burke, Maurizio Cereda, Anne Cherry, Albert T. Cheung, Kathleen Claus, Benedict Charles Creagh-Brown, Jovany Cruz Navarro, James DeBritz, null Timothy J. Donahue, Stephen A. Esper, Amanda L. Faulkner, Duane J. Funk, Robert Gaiser, Tong J. Gan, Stephen Harrison Gregory, Michael P.W. Grocott, Taras Grosh, Holden K. Groves, Dhanesh K. Gupta, Rachel A. Hadler, Steven Ellis Hill, Michael Holmes, Q. Lina Hu, Peter Inglis, Andrew Iskander, Alexander I.R. Jackson, Amir K. Jaffer, Michael L. James, Timothy F. Jones, Tammy Ju, Lillian S. Kao, John A. Kellum, Miklos D. Kertai, Clifford Y. Ko, W. Andrew Kofke, H.T. Lee, Jane Lee, Jason B. Liu, Jessica Y. Liu, Alex Macario, G. Burkhard Mackensen, Erin Maddy, Aman Mahajan, Joseph P. Mathew, Megan Maxwell, David L. McDonagh, Meghan Michael, Carmelo A. Milano, Richard C. Month, Eugene W. Moretti, Rotem Naftalovich, Mark F. Newman, Daisuke Francis Nonaka, Prakash A. Patel, Jamie R. Privratsky, Vijay K. Ramaiah, Neil Ray, Annette Rebel, Lisbi Rivas, Kristen C. Rock, Jill S. Sage, Yas Sanaiha, Babak Sarani, Ryan D. Scully, Jyotirmay Sharma, Robert A. Sickeler, Martin I. Sigurdsson, Mervyn Singer, Pingping Song, Audrey E. Spelde, Mark Stafford-Smith, Kirsten R. Steffner, Toby B. Steinberg, Dr. Charlotte Summers, Ramesh Swamiappan, Annemarie Thompson, Rachel E. Thompson, Thomas K. Varghese, Edward D. Verrier, Nathan H. Waldron, Sophie Louisa May Walker, and Ian J. Welsby
- Published
- 2022
26. Design and Rationale of a Phase 2 Study of NeurOtoxin (Botulinum Toxin Type A) for the PreVention of Post-Operative Atrial Fibrillation - The NOVA Study
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Mitchell F. Brin, Jonathan S. Steinberg, Anders Ahlsson, Nathan H. Waldron, Louis P. Perrault, Paul Dorian, Michael J. Mack, Lawrence M. Adams, William G. Ferguson, Stefano Benussi, David B. Bharucha, Jonathan P. Piccini, Peter R. Kowey, Marc Gillinov, and Carmelo A. Milano
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Tachycardia ,medicine.medical_specialty ,Time Factors ,Botulinum Toxins ,Neurotoxins ,Placebo ,law.invention ,Type A ,Postoperative Complications ,law ,Atrial Fibrillation ,Clinical endpoint ,medicine ,Humans ,Botulinum Toxins, Type A ,Cardiac Surgical Procedures ,business.industry ,Atrial fibrillation ,medicine.disease ,Botulinum toxin ,Intensive care unit ,Cardiac surgery ,Anesthesia ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Complication ,medicine.drug - Abstract
Background : Post-operative AF (POAF) is the most common complication following cardiac surgery, occurring in 30% to 60% of patients undergoing bypass and/or valve surgery. POAF is associated with longer intensive care unit/hospital stays, increased healthcare utilization, and increased morbidity and mortality. Injection of botulinum toxin type A into the epicardial fat pads resulted in reduction of AF in animal models, and in 2 clinical studies of cardiac surgery patients, without new safety observations. Methods : The objective of NOVA is to assess the use of AGN-151607 (botulinum toxin type A) for prevention of POAF in cardiac surgery patients. This randomized, multi-site, placebo-controlled trial will study one-time injections of AGN-151607 125 U (25 U / fat pad) and 250 U (50 U / fat pad) or placebo during cardiac surgery in ∼330 participants. Primary endpoint: % of patients with continuous AF ≥ 30 s. Secondary endpoints include several measures of AF frequency, duration, and burden. Additional endpoints include clinically important tachycardia during AF, time to AF termination, and healthcare utilization. Primary and secondary efficacy endpoints will be assessed using continuous ECG monitoring for 30 days following surgery. All patients will be followed for up to 1 year for safety. Conclusion : The NOVA Study will test the hypothesis that injections of AGN-151607 will reduce the incidence of POAF and associated resource utilization. If demonstrated to be safe and effective, the availability of a one-time therapy for the prevention of POAF would represent an important treatment option for patients undergoing cardiac surgery.
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- 2022
27. Right and left ventricular assist devices are an option for bridge to heart transplant
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Yaron D. Barac, Ronen Toledano, Oliver K. Jawitz, Jacob N. Schroder, Mani A. Daneshmand, Chetan B. Patel, Dan Aravot, and Carmelo A. Milano
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
Patients with a left ventricular assist device with right ventricular failure are prioritized on the heart transplant waitlist; however, their post-transplant survival is less well characterized. We aimed to determine whether pretransplant right ventricular failure affects postoperative survival in patients with a left ventricular assist device as a bridge to transplant.We performed a retrospective review of the 2005-2018 Organ Procurement and Transplantation Network/United Network for Organ Sharing registry for candidates aged 18 years or more waitlisted for first-time isolated heart transplantation after left ventricular assist device implantation. Candidates were stratified on the basis of having right ventricular failure, defined as the need for right ventricular assist device or intravenous inotropes. Baseline demographic and clinical characteristics were compared among the 3 groups, and post-transplant survival was assessed.Our cohort included 5605 candidates who met inclusion criteria, including 450 patients with right ventricular failure, 344 patients with a left ventricular assist device and intravenous inotropes as a bridge to transplant, 106 patients with a left ventricular assist device and right ventricular assist device, and 5155 patients with a left ventricular assist device as a bridge to transplant without the need for right side support. Compared with patients without right ventricular failure, patients with a left ventricular assist device as a bridge to transplant with right ventricular failure were younger (median age 51 years, 55 vs 56 years,Patients with biventricular failure are prioritized on the waiting list, because their critical pretransplant condition has limited impact on their post-transplant survival (short-term effect only); thus, surgeons should be confident to perform transplantation in these severely ill patients. Because liver dysfunction (a surrogate marker of right ventricular failure) was found to affect long-term survival in patients with a left ventricular assist device, surgeons should be encouraged to perform transplantation in these severely ill patients after a recipient's optimization by inotropes or a right ventricular assist device because even when the bilirubin level is elevated in these patients (treated with right ventricular assist device/inotropes), their long-term survival is not affected. Future studies should assess recipients' optimization before organ acceptance to improve long-term survival.
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- 2021
28. BIO26: Evaluation of the Hemocompatibility and Efficacy of Counterpulsation Support Provided by the NuPulse Intra-Aortic Balloon Pump Device in an Ovine Model
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Michelle Mendiola Pla, Lillian Kang, Franklin H. Lee, Matthew F. Smith, Ryan Gross, Chunbo Wang, Gabriela O’Brien, Japen Mehta, Andrew M. Vekstein, Marat Fudim, Joshua R. Woolley, Guruprasad A. Giridharan, Sonna Patel-Raman, Dawn E. Bowles, Joseph W. Turek, Benjamin S. Bryner, Carmelo A. Milano, and Satya Achanta
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Biomaterials ,Biomedical Engineering ,Biophysics ,Bioengineering ,General Medicine - Published
- 2022
29. Risk for non-home discharge following surgery for ischemic mitral valve disease
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Anuradha Lala, Helena L. Chang, Xiaoyu Liu, Eric J. Charles, Babatunde A. Yerokun, Michael E. Bowdish, Vinod H. Thourani, Michael J. Mack, Marissa A. Miller, Patrick T. O'Gara, Eugene H. Blackstone, Alan J. Moskowitz, Annetine C. Gelijns, John C. Mullen, Lynne W. Stevenson, Joseph J. DeRose, Alice Wang, Peter K. Smith, Michael A. Acker, Gorav Ailawadi, Wendy C. Taddei-Peters, Dennis Buxton, Ron Caulder, Nancy L. Geller, David Gordon, Neal O. Jeffries, Albert Lee, Ilana Kogan Gombos, Jennifer Ralph, Richard D. Weisel, Timothy J. Gardner, Eric A. Rose, Michael K. Parides, Deborah D. Ascheim, Emilia Bagiella, Ellen Moquete, Helena Chang, Melissa Chase, James Foo, Yingchun Chen, Seth Goldfarb, Lopa Gupta, Katherine Kirkwood, Edlira Dobrev, Ron Levitan, Karen O'Sullivan, Jessica Overbey, Milerva Santos, Deborah Williams, Michael Weglinski, Paula Williams, Carrie Wood, Xia Ye, Sten Lyager Nielsen, Henrik Wiggers, Henning Malgaard, Michael Mack, Tracine Adame, Natalie Settele, Jenny Adams, William Ryan, Robert L. Smith, Paul Grayburn, Frederick Y. Chen, Anju Nohria, Lawrence Cohn, Prem Shekar, Sary Aranki, Gregory Couper, Michael Davidson, R. Morton Bolman, Anne Burgess, Debra Conboy, Rita Lawrence, Nicolas Noiseux, Louis-Mathieu Stevens, Ignacio Prieto, Fadi Basile, Joannie Dionne, Julie Fecteau, A. Marc Gillinov, Pamela Lackner, Leoma Berroteran, Diana Dolney, Suzanne Fleming, Roberta Palumbo, Christine Whitman, Kathy Sankovic, Denise Kosty Sweeney, Carrie Geither, Kristen Doud, Gregory Pattakos, Pamela A. Clarke, Michael Argenziano, Mathew Williams, Lyn Goldsmith, Craig R. Smith, Yoshifumi Naka, Allan Stewart, Allan Schwartz, Daniel Bell, Danielle Van Patten, Sowmya Sreekanth, John H. Alexander, Carmelo A. Milano, Donald D. Glower, Joseph P. Mathew, J. Kevin Harrison, Stacey Welsh, Mark F. Berry, Cyrus J. Parsa, Betty C. Tong, Judson B. Williams, T. Bruce Ferguson, Alan P. Kypson, Evelio Rodriguez, Malissa Harris, Brenda Akers, Allison O'Neal, John D. Puskas, Robert Guyton, Jefferson Baer, Kim Baio, Alexis A. Neill, Pierre Voisine, Mario Senechal, François Dagenais, Kim O'Connor, Gladys Dussault, Tatiana Ballivian, Suzanne Keilani, Alan M. Speir, Patrick Magee, Niv Ad, Sally Keyte, Minh Dang, Mark Slaughter, Marsha Headlee, Heather Moody, Naresh Solankhi, Emma Birks, Mark A. Groh, Leslie E. Shell, Stephanie A. Shepard, Benjamin H. Trichon, Tracy Nanney, Lynne C. Hampton, Ralph Mangusan, Robert E. Michler, David A. D'Alessandro, Daniel J. Goldstein, Ricardo Bello, William Jakobleff, Mario Garcia, Cynthia Taub, Daniel Spevak, Roger Swayze, Nadia Sookraj, Louis P. Perrault, Arsène-Joseph Basmadjian, Denis Bouchard, Michel Carrier, Raymond Cartier, Michel Pellerin, Jean François Tanguay, Ismail El-Hamamsy, André Denault, Philippe Demers, Sophie Robichaud Jonathan Lacharité, Keith A. Horvath, Philip C. Corcoran, Michael P. Siegenthaler, Mandy Murphy, Margaret Iraola, Ann Greenberg, Chittoor Sai-Sudhakar, Ayseha Hasan, Asia McDavid, Bradley Kinn, Pierre Pagé, Carole Sirois, David Latter, Howard Leong-Poi, Daniel Bonneau, Lee Errett, Mark D. Peterson, Subodh Verma, Randi Feder-Elituv, Gideon Cohen, Campbell Joyner, Stephen E. Fremes, Fuad Moussa, George Christakis, Reena Karkhanis, Terry Yau, Michael Farkouh, Anna Woo, Robert James Cusimano, Tirone David, Christopher Feindel, Lisa Garrard, Suzanne Fredericks, Amelia Mociornita, Jonathan Choy, Steven Meyer, Emily Kuurstra, James S. Gammie, Cindi A. Young, Dana Beach, Robert Villanueva, Pavan Atluri, Y. Joseph Woo, Mary Lou Mayer, Michael Bowdish, Vaughn A. Starnes, David Shavalle, Ray Matthews, Shadi Javadifar, Linda Romar, Irving L. Kron, Karen Johnston, John M. Dent, John Kern, Jessica Keim, Sandra Burks, Kim Gahring, David A. Bull, Dennis O. Dixon, Mark Haigney, Richard Holubkov, Alice Jacobs, Frank Miller, John M. Murkin, John Spertus, Andrew S. Wechsler, Frank Sellke, Robert Byington, Neal Dickert, John S. Ikonomidis, David O. Williams, Clyde W. Yancy, James C. Fang, Nadia Giannetti, Wayne Richenbacher, Vivek Rao, Karen L. Furie, Rachel Miller, Sean Pinney, William C. Roberts, Mary N. Walsh, Judy Hung, Xin Zeng, Niamh Kilcullen, David Hung, Stephen J. Keteyian, Clinton A. Brawner, Heather Aldred, Jeffrey Browndyke, and Yanne Toulgoat-Dubois
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Myocardial Ischemia ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Risk Factors ,Mitral valve ,Humans ,Medicine ,Prospective Studies ,Adverse effect ,Aged ,Mitral regurgitation ,business.industry ,Mitral Valve Insufficiency ,Odds ratio ,Middle Aged ,medicine.disease ,Patient Discharge ,Confidence interval ,3. Good health ,Cardiac surgery ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,030228 respiratory system ,Heart failure ,Quality of Life ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
To determine the frequency and risk factors for non-home discharge (NHD) and its association with clinical outcomes and quality of life (QOL) at 1 year following cardiac surgery in patients with ischemic mitral regurgitation (IMR).Discharge disposition was evaluated in 552 patients enrolled in trials of severe or moderate IMR. Patient and in-hospital factors associated with NHD were identified using logistic regression. Subsequently, association of NHD with 1-year mortality, serious adverse events (SAEs), and QOL was assessed.NHD was observed in 30% (154/522) with 25% (n = 71/289) in moderate and 36% (n = 83/233) in patients with severe IMR (unadjusted P = .006), a difference not significant after including age (5-year change: adjusted odds ratio [adjOR], 1.52; 95% confidence interval [CI], 1.35-1.72; P .001), diabetes (adjOR, 1.94; 95% CI, 1.27-2.94; P = .002), and previous heart failure (adjOR, 1.64; 95% CI, 1.06-2.52; P = .03). Odds of NHD were increased for patients with postoperative SAEs (adjOR, 1.85; 95% CI, 1.19-2.86; P = .01) but not based on type of cardiac surgery. Greater rates of death and SAEs were observed in NHD patients at 1 year: adjusted hazard ratio, 4.29 (95% CI, 2.14-8.59; P .001) and adjusted rate ratio, 1.45 (95% CI, 1.03-2.02; P = .03), respectively. QOL did not differ significantly between groups.NHD is common following surgery for IMR, influenced by older age, diabetes, previous heart failure, and postoperative SAEs. These patients may be at greater risk of death and subsequent SAEs after discharge. Discussion of NHD with patients may have important implications for decision-making and guiding expectations following cardiac surgery.
- Published
- 2021
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