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1,096 results on '"Kurlansky, Paul A."'

14. Early outcomes following transatrial transcatheter mitral valve replacement in patients with severe mitral annular calcification

Author

Brener, Michael I., Hamandi, Mohanad, Hong, Estee, Pizano, Alejandro, Harloff, Morgan T., Garner, Evan F., El Sabbagh, Abdallah, Kaple, Ryan K., Geirsson, Arnar, Deaton, David W., Islam, Ashequl M., Veeregandham, Ramesh, Bapat, Vinayak, Khalique, Omar K., Ning, Yuming, Kurlansky, Paul A., Grayburn, Paul A., Nazif, Tamim M., Kodali, Susheel K., Leon, Martin B., Borger, Michael A., Lee, Raymond, Kohli, Keshav, Yoganathan, Ajit P., Colli, Andrea, Guerrero, Mayra E., Davies, James E., Eudailey, Kyle W., Kaneko, Tsuyoshi, Nguyen, Tom C., Russell, Hyde, Smith, Robert L., III, and George, Isaac

Published
2024
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29. Expert Systematic Review on the Choice of Conduits for Coronary Artery Bypass Grafting: Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) and The Society of Thoracic Surgeons (STS)

Author

Gaudino, Mario, Bakaeen, Faisal G., Sandner, Sigrid, Aldea, Gabriel S., Arai, Hirokuni, Chikwe, Joanna, Firestone, Scott, Fremes, Stephen E., Gomes, Walter J., Bong-Kim, Ki, Kisson, Kalie, Kurlansky, Paul, Lawton, Jennifer, Navia, Daniel, Puskas, John D., Ruel, Marc, Sabik, Joseph F., Schwann, Thomas A., Taggart, David P., Tatoulis, James, and Wyler von Ballmoos, Moritz

Published
2023
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47. Long-term outcomes of patients bridged to recovery with venoarterial extracorporeal life support.

Author

Dardik, Gabriel, Ning, Yuming, Kurlansky, Paul, Almodovar Cruz, Guillermo, Vinogradsky, Alice, Fried, Justin, Topkara, Veli K, and Takeda, Koji

Subjects
CARDIOGENIC shock, PEARSON correlation (Statistics), EXTRACORPOREAL membrane oxygenation, RESEARCH funding, ACADEMIC medical centers, T-test (Statistics), SURVIVAL rate, VENTRICULAR ejection fraction, PROBABILITY theory, MULTIPLE regression analysis, DISCHARGE planning, TREATMENT effectiveness, RETROSPECTIVE studies, DESCRIPTIVE statistics, MANN Whitney U Test, CHI-squared test, HEART failure, LONGITUDINAL method, KAPLAN-Meier estimator, LOG-rank test, CONVALESCENCE, MEDICAL records, ACQUISITION of data, ADRENERGIC beta blockers, CONFIDENCE intervals, DATA analysis software, PROPORTIONAL hazards models, REGRESSION analysis, PATIENT aftercare
Abstract

Objective: Our study examines the long-term outcomes of patients discharged from the hospital without heart replacement therapy (HRT) after recovery from cardiogenic shock using venoarterial extracorporeal life support (VA-ECLS). Methods: We retrospectively reviewed 615 cardiogenic shock patients who recovered from VA-ECLS at our institution between January 2015 and July 2021. Of those, 166 patients (27.0%) who recovered from VA-ECLS without HRT were included in this study. Baseline characteristics, discharge labs, vitals, electrocardiograms and echocardiograms were assessed. Patients were contacted to determine vital status. The primary outcome was post-discharge mortality. Results: Of 166 patients, 158 patients (95.2%) had post-discharge follow-up, with a median time of follow-up of 2 years (IQR: [1 year, 4 years]). At discharge, the median ejection fraction (EF) was 52.5% (IQR: [32.5, 57.5]). At discharge, 92 patients (56%) were prescribed β-blockers, 28 (17%) were prescribed an ACE inhibitor, ARB or ARNI, and 50 (30%) were prescribed loop diuretics. Kaplan-Meier analysis showed a 1-year survival rate of 85.6% (95% CI: [80.1%, 91.2%]) and a 5-year survival rate of 60.6% (95% CI: [49.9%, 71.3%]). A Cox regression model demonstrated that a history of congestive heart failure (CHF) was strongly predictive of increased mortality hazard (HR = 1.929; p = 0.036), while neither discharge EF nor etiology of VA-ECLS were associated with increased post-discharge mortality. Conclusions: Patients discharged from the hospital after full myocardial recovery from VA-ECLS support without HRT should have close outpatient follow-up due to the risk of recurrent heart failure and increased mortality in these patients. [ABSTRACT FROM AUTHOR]

Published
2024
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48. Acute kidney injury during extracorporeal life support in cardiogenic shock: Does flow matter?

Author

Vaynrub, Anna, Ning, Yuming, Kurlansky, Paul, Wang, Amy S, Beck, James, Fried, Justin A, and Takeda, Koji

Subjects
MORTALITY risk factors, CARDIOGENIC shock, RISK assessment, PEARSON correlation (Statistics), BODY surface area, EXTRACORPOREAL membrane oxygenation, CREATININE, THERAPEUTICS, RENAL replacement therapy, RESEARCH funding, CORONARY circulation, KRUSKAL-Wallis Test, MULTIPLE regression analysis, HEART assist devices, ACUTE kidney failure, RETROSPECTIVE studies, DESCRIPTIVE statistics, CHI-squared test, LONGITUDINAL method, KAPLAN-Meier estimator, LOG-rank test, ODDS ratio, MEDICAL records, ACQUISITION of data, LACTATES, ANALYSIS of variance, ELECTRONIC health records, COMPARATIVE studies, DATA analysis software, CONFIDENCE intervals, PROPORTIONAL hazards models, OVERALL survival, DISEASE risk factors
Abstract

Background: This study examines the role of extracorporeal life support flow in the development of acute kidney injury in cardiogenic shock. Methods: We performed a retrospective analysis of 465 patients placed on extracorporeal life support at our institution between January 2015 and December 2020 for cardiogenic shock. Flow index was calculated by dividing mean flow by body surface. Stages of acute kidney injury were determined according to Kidney Disease: Improving Global Outcomes (KDIGO) organization guidelines. Results: There were 179 (38.5%) patients who developed acute kidney injury, 63.1% of which were classified as Stage 3--the only subgroup associated with 1-year mortality (hazard ratio = 2.03, p <.001). Risk of k idney injury increased up to a flow index of 1.6 L/min/m2, and kidney injury was more common among patients with flow index greater than 1.6 L/min/m2 (p =.034). Those with kidney injury had higher baseline lactate levels (4.4 vs 3.1, p =.04), and Stage 3 was associated wit higher baseline creatinine (p <.001). Conclusions: In our cohort, kidney injury was common and Stage 3 kidney injury was associated with worse outcomes compared to other stages. Low flow was not associated with increased risk of kidney injury. Elevated baseline lactate and creatinine among patients with acute kidney injury suggest underlying illness severity, rather than flow, may influence kidney injury risk. [ABSTRACT FROM AUTHOR]

Published
2024
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49. Anti‐factor Xa and activated partial thromboplastin time strategies for unfractionated heparin dosing after HeartMate 3 left ventricular assist device implantation.

Author

Feng, Iris, Kurlansky, Paul A., Powley, Tanner R., Hynds, Melissa A., Yang, Christine G., Eisenberger, Andrew, Hastie, Jonathan M., Sutherland, Lauren D., Yuzefpolskaya, Melana, Colombo, Paolo C., Sayer, Gabriel T., Uriel, Nir Y., Naka, Yoshifumi, and Takeda, Koji

Subjects
*PARTIAL thromboplastin time, *CORONARY artery disease, *HEART failure, *HEPARIN, *THROMBOEMBOLISM, *HEART assist devices
Abstract

Background Methods Results Conclusions No clear guidelines exist for perioperative anticoagulation management after durable left ventricular assist device insertion. In this study, we sought to compare outcomes between anti‐factor Xa (FXa) and activated partial thromboplastin time (aPTT) in monitoring unfractionated heparin (UFH) dosing after HeartMate 3 (HM3) insertion.This is a single‐center retrospective review of patients who received UFH after HM3 insertion between 01/2020–12/2022. Post‐operative UFH dose was titrated by aPTT goal 45–60 sec (n = 53) or FXa goal 0.1–0.2 U/mL (n = 59). Baseline differences between cohorts were balanced by inverse probability treatment weighting.At baseline, unadjusted FXa patients were more likely to be white (47.5% vs. 35.8%, p < 0.001), INTERMACS 1–2 (69.5% vs. 47.2%, p = 0.013), have history of coronary artery disease (66.1% vs. 43.4%, p = 0.026), and lower eGFR (54.1 vs. 63.7 mL/min/1.73 m2, p = 0.029) compared to the aPTT group. After adjusting for several bleeding/thrombosis risk factors, 97.5% of FXa and 91.0% of aPTT patients reached therapeutic levels with comparable UFH duration and maximum dose. Moreover, in‐hospital mortality (2.5% vs. 3.1%, p = 0.842), major bleeding events (4.2% vs. 9.2%, p = 0.360), and thromboembolic events (21.8% vs. 10.1%, p = 0.151) remained without significant differences between FXa and aPTT cohorts. There was a high degree of variability in FXa (r2 = 0.20) and aPTT (r2 = 0.22) values for any given UFH dose.No differences in frequency of bleeding or thromboembolic events were observed in this study between FXa versus aPTT cohorts after HM3 implantation. More longitudinal studies are warranted to determine whether or not one assay is superior to the other. [ABSTRACT FROM AUTHOR]

Published
2024
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50. Re-Dosing del Nido cardioplegia in adult cardiac surgery: Perfusion characteristics and outcomes--Is there an optimal redosing strategy?

Author

Kossar, Alexander P, Nemeth, Samantha, Kosuri, Yaagnik D, Kazzi, Brigitte E, Honzel, Emily, D'Angelo, Alex, Spellman, Jessica, Takeda, Koji, Takayama, Hiroo, Bapat, Vinayak, Argenziano, Michael, Beck, James, Smith, Craig R, Kurlansky, Paul, and George, Isaac

Subjects
MYOCARDIAL infarction, POSTOPERATIVE care, SURGERY, PATIENTS, VENTRICULAR ejection fraction, SECONDARY analysis, CARDIOPLEGIC solutions, MULTIPLE regression analysis, EVALUATION of medical care, CARDIOPULMONARY bypass, HEART failure, RETROSPECTIVE studies, MEDICAL records, ACQUISITION of data, PERFUSION, CARDIAC surgery
Abstract

Objectives: del Nido cardioplegia is utilized for myocardial protection in adult patients undergoing cardiac surgery; however, no standardized re-dosing protocol exists. We describe perfusion characteristics and clinical outcomes in adult cardiac surgery patients who were re-dosed with del Nido cardioplegia. Methods: Chart review was performed for adult patients undergoing cardiac surgery (specific inclusion/exclusion criteria below) who received exactly two doses of del Nido cardioplegia from 2012 to 2019; n = 542 patients. The main outcome was a composite endpoint comprised of operative mortality, myocardial infarction, post-operative cardiac support device (CSD), and postoperative decrease in ejection fraction (EF), which was analyzed via multivariable logistic regression (MVLR). A secondary analysis evaluated postoperative vasoactive-inotropic scores (VIS) via gamma log link regression (GLLR) as a more physiologic indication of myocardial recovery. Results: MVLR demonstrated that increased total cardiopulmonary bypass (CPB) time was associated with a positive composite outcome (p <.001), whereas time between doses (p =.237) and the volume of each dose was not (p =.626). GLLR also demonstrated that prolonged CBP, decreased EF, congestive heart failure at time of surgery, and low hematocrit at the start of the surgery were all associated with higher VIS. Conclusions: In this retrospective study, variations in re-dosing strategy for del Nido cardioplegia do not affect postoperative outcomes and increased CPB time is associated with increased operative mortality, myocardial infarction, need for post-operative CSDs, and reduced postoperative EF, and increased VIS, irrespective of the re-dosing strategy. Further studies are warranted to to identify additional patient and operative characteristics that predispose to complications. [ABSTRACT FROM AUTHOR]

Published
2024
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