476 results on '"Mark S. Slaughter"'
Search Results
2. Techniques and Technologies to Improve Vein Graft Patency in Coronary Surgery
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Marco Gemelli, Mariangela Addonizio, Veronica Geatti, Michele Gallo, Lauren K. Dixon, Mark S. Slaughter, and Gino Gerosa
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CABG ,vein graft ,graft patency ,long-term outcomes ,vein graft failure ,Medicine - Abstract
Vein grafts are the most used conduits in coronary artery bypass grafting (CABG), even though many studies have suggested their lower patency compared to arterial alternatives. We have reviewed the techniques and technologies that have been investigated over the years with the aim of improving the quality of these conduits. We found that preoperative and postoperative optimal medical therapy and no-touch harvesting techniques have the strongest evidence for optimizing vein graft patency. On the other hand, the use of venous external support, endoscopic harvesting, vein preservation solution and anastomosis, and graft configuration need further investigation. We have also analyzed strategies to treat vein graft failure: when feasible, re-doing the CABG and native vessel primary coronary intervention (PCI) are the best options, followed by percutaneous procedures targeting the failed grafts.
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- 2024
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3. Implantable cardioverter-defibrillator–related procedures and associated complications in continuous flow left ventricular assist device recipients: A multicenter experience
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Ashwin Ravichandran, MD, Naga Venkata K. Pothineni, MD, Jaimin R. Trivedi, MD, MPH, Henri Roukoz, MD, Mustafa M. Ahmed, MD, Adarsh Bhan, MD, Geetha Bhat, MD, Jennifer Cowger, MD, Amin Al Ahmad, MD, FHRS, Andrea Natale, MD, FHRS, Luigi Di Biase, MD, FHRS, Mark S. Slaughter, MD, Dhanunjaya Lakkireddy, MD, FHRS, and Rakesh Gopinathannair, MD, MA, FHRS
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Cardiac implantable electronic device ,Generator change ,Heart failure ,ICD ,Left ventricular assist device ,Procedures ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Limited data exist regarding complication rates of implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy devices (CRT-D) in patients with left ventricular assist devices (LVAD). Objective: We describe the incidence and characteristics of ICD- and CRT-D-related procedures and complications in a multicenter LVAD cohort. Methods: A total of 537 LVAD patients with a pre-existing ICD or CRT-D from 5 centers were included. Details on device type, device therapies, procedural complications, and long-term survival were analyzed. Results: Of 537 patients, 280 had a CRT-D and 257 had ICD only. During a median follow-up of 538 days, 126 patients underwent generator replacement with significantly higher rate in the CRT group (79 [28.2%] vs 47 [18.3%], P = .0006). Device-related complications occurred in 36 (13%) CRT-D and 20 (8%) ICD patients (P = .06). Incidence of pocket hematoma (3.2% vs 2.7%), infection (4.3% vs 1.6%), and lead malfunction (3.1% vs 2.8%) was similar in both groups, with no effect of device complication on long-term survival (log-rank P = .7). There was a higher incidence of post-LVAD antitachycardia pacing for ventricular arrhythmias in the CRT-D group compared to the ICD group (35% vs 26%, P = .03). Conclusion: Cardiac implantable electronic device–related procedures are common in LVAD patients. Compared to ICD only, continued CRT-D therapy post-LVAD results in a significantly higher number of generator changes and a trend towards higher device- or lead-related complications. Device-related complications were not associated with reduced survival.
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- 2021
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4. Cost‐effectiveness of left ventricular assist devices as destination therapy in the United Kingdom
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Stephan Schueler, Scott C. Silvestry, William G. Cotts, Mark S. Slaughter, Wayne C. Levy, Richard K. Cheng, Jennifer A. Beckman, Jonas Villinger, Eleni Ismyrloglou, Stelios I. Tsintzos, and Claudius Mahr
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Mechanical circulatory support ,Ventricular assist device ,Destination therapy ,Cost‐effectiveness ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Aims Continuous‐flow left ventricular assist devices (LVADs) as destination therapy (DT) are a recommended treatment by National Institute for Health and Care Excellence England for end‐stage heart failure patients ineligible for cardiac transplantation. Despite the fact that DT is frequently used as an LVAD indication across other major European countries and the United States, with consistent improvements in quality‐of‐life and longevity, National Health Service (NHS) England does not currently fund DT, mainly due to concerns over cost‐effectiveness. On the basis of the recently published ENDURANCE Supplemental Trial studying DT patients, we assessed for the first time the cost‐effectiveness of DT LVADs compared with medical management (MM) in the NHS England. Methods and results We developed a Markov multiple‐state economic model using NHS cost data. LVAD survival and adverse event rates were derived from the ENDURANCE Supplemental Trial. MM survival was based on Seattle Heart Failure Model estimates in the absence of contemporary clinical trials for this population. Incremental cost‐effectiveness ratios (ICERs) were calculated over a lifetime horizon. A discount rate of 3.5% per year was applied to costs and benefits. Deterministic ICER was £46 207 per quality‐adjusted life year (QALY). Costs and utilities were £204 022 and 3.27 QALYs for the LVAD arm vs. £77 790 and 0.54 QALYs for the MM arm. Sensitivity analyses confirmed robustness of the primary analysis. Conclusions The implantation of the HeartWare™ HVAD™ System in patients ineligible for cardiac transplantation as DT is a cost‐effective therapy in the NHS England healthcare system under the end‐of‐life willingness‐to‐pay threshold of £50 000/QALY, which applies for VAD patients.
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- 2021
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5. Amiodarone Use and All‐Cause Mortality in Patients With a Continuous‐Flow Left Ventricular Assist Device
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Rakesh Gopinathannair, Naga Venkata K. Pothineni, Jaimin R. Trivedi, Henri Roukoz, Jennifer Cowger, Mustafa M. Ahmed, Adarsh Bhan, Ashwin K. Ravichandran, Geetha Bhat, Amin Al Ahmad, Andrea Natale, Luigi Di Biase, Mark S. Slaughter, and Dhanunjaya Lakkireddy
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amiodarone ,arrhythmias ,left ventricular assist device ,mortality ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Atrial and ventricular arrhythmias are commonly encountered in patients with advanced heart failure, with amiodarone being the most commonly used antiarrhythmic drug in continuous‐flow left ventricular assist device (CF‐LVAD) recipients. The purpose of this study was to assess the impact of amiodarone use on long‐term all‐cause mortality in ptients with a CF‐LVAD. Methods and Results A retrospective multicenter study of CF‐LVAD was conducted at 5 centers including all CF‐LVAD implants from 2007 to 2015. Patients were stratified based on pre–CF‐LVAD implant amiodarone use. Additional use of amiodarone after CF‐LVAD implantation was also evaluated. Primary outcome was all‐cause mortality during long‐term follow‐up. Kaplan‐Meier curves were used to assess survival outcomes. Multivariable Cox regression was used to identify predictors of outcomes. Propensity matching was done to address baseline differences. A total of 480 patients with a CF‐LVAD (aged 58±13 years, 81% men) were included. Of these, 170 (35.4%) were on chronic amiodarone therapy at the time of CF‐LVAD implant, and 310 (64.6%) were not on amiodarone. Rate of all‐cause mortality over the follow‐up period was 32.9% in the amiodarone group compared with 29.6% in those not on amiodarone (P=0.008). Similar results were noted in the propensity‐matched group (log‐rank, P=0.04). On multivariable Cox regression analysis, amiodarone use at baseline was independently associated with all‐cause mortality (hazard ratio, 1.68 [95% CI, 1.1–2.5]; P=0.01). Conclusions Amiodarone use was associated with significantly increased rates of all‐cause mortality in CF‐LVAD recipients. Earlier interventions for arrhythmias to avoid long‐term amiodarone exposure may improve long‐term outcomes in CF‐LVAD recipients and needs further study.
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- 2022
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6. Racial disparities in cardiac transplantation: Chronological perspective and outcomes
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Jaimin R. Trivedi, Siddharth V. Pahwa, Katherine R. Whitehouse, Bradley M. Ceremuga, and Mark S. Slaughter
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Medicine ,Science - Abstract
Background The objective of this study was to evaluate annual heart transplant volumes and 3-year post-transplant outcomes since establishment of United Network for Organ Sharing (UNOS) database stratified by race. Methods The UNOS thoracic transplant database was evaluated for adult patients since 1987. The available database was then stratified by Race: Black, White and Other and era of transplant: group 1(1987–1991), group 2(1992–1996), group 3(1997–2001), group 4(2002–2006), group 5(2007–2011), group 6(2012–2016) and group 7(2017 and later). Demographic and clinical factors were evaluated. Results A total of 105,266 adults have been listed since 1987 and 67,824 have been transplanted. Of the transplanted patients 11,235 were Black, 48,786 White and 6803 were of Other race. The proportion of Black patients listed increased from 7% in 1987 to 13.4% in 1999 and 25% in 2019 and those transplanted increased from 5% in 1987 to 13.4% in 2001 and 26% in 2019. The survival of Black patients gradually improved. Conclusion Historically, fewer Black patients received cardiac transplantation however, their access gradually improved over the years and account for over 25% of cardiac transplantations performed in recent years. The historically poor survival of Black patients has recently improved and became comparable to the rest.
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- 2022
7. Feasibility testing of the Inspired Therapeutics NeoMate mechanical circulatory support system for neonates and infants
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Gretel Monreal, Steven C. Koenig, Mark S. Slaughter, Gino F. Morello, Steven R. Prina, Landon H. Tompkins, Jiapeng Huang, Barry N. Gellman, and Kurt A. Dasse
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Medicine ,Science - Abstract
Inspired Therapeutics (Merritt Island, FL) is developing a mechanical circulatory support (MCS) system designed as a single driver with interchangeable, extracorporeal, magnetically levitated pumps. The NeoMate system design features an integrated centrifugal rotary pump, motor, and controller that will be housed in a single compact unit. Conceptually, the primary innovation of this technology will be the combination of disposable, low-cost pumps for use with a single, multi-functional, universal controller to support multiple pediatric cardiopulmonary indications. In response to the paucity of clinically available pediatric devices, Inspired Therapeutics is specifically targeting the underserved neonate and infant heart failure (HF) patient population first. In this article, we present the development of the prototype Inspired Therapeutics NeoMate System for pediatric left ventricular assist device (LVAD) support, and feasibility testing in static mock flow loops (H-Q curves), dynamic mock flow loops (hemodynamics), and in an acute healthy ovine model (hemodynamics and clinical applicability). The resultant hydrodynamic and hemodynamic data demonstrated the ability of this prototype pediatric LVAD and universal controller to function over a range of rotary pump speeds (500–6000 RPM), to provide pump flow rates of up to 2.6 L/min, and to volume unload the left ventricle in acute animals. Key engineering challenges observed and proposed solutions for the next design iteration are also presented.
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- 2022
8. High shear induces platelet dysfunction leading to enhanced thrombotic propensity and diminished hemostatic capacity
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Zengsheng Chen, Nandan K. Mondal, Shirong Zheng, Steven C. Koenig, Mark S. Slaughter, Bartley P. Griffith, and Zhongjun J. Wu
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bleeding ,blood-contacting medical devices ,non-physiological shear stress ,platelet dysfunction ,thrombosis ,Diseases of the blood and blood-forming organs ,RC633-647.5 - Abstract
Thrombosis and bleeding are devastating adverse events in patients supported with blood-contacting medical devices (BCMDs). In this study, we delineated that high non-physiological shear stress (NPSS) caused platelet dysfunction that may contribute to both thrombosis and bleeding. Human blood was subjected to NPSS with short exposure time. Levels of platelet surface GPIbα and GPVI receptors as well as activation level of GPIIb/IIIa in NPSS-sheared blood were examined with flow cytometry. Adhesion of sheared platelets on fibrinogen, von Willibrand factor (VWF), and collagen was quantified with fluorescent microscopy. Ristocetin- and collagen-induced platelet aggregation was characterized by aggregometry. NPSS activated platelets in a shear and exposure time-dependent manner. The number of activated platelets increased with increasing levels of NPSS and exposure time, which corresponded well with increased adhesion of sheared platelets on fibrinogen. Concurrently, NPSS caused shedding of GPIbα and GPVI in a manner dependent on shear and exposure time. The loss of intact GPIbα and GPVI increased with increasing levels of NPSS and exposure time. The number of platelets adhered on VWF and collagen decreased with increasing levels of NPSS and exposure time, respectively. The decrease in the number of platelets adhered on VWF and collagen corresponded well with the loss in GPIbα and GPVI on platelet surface. Both ristocetin- and collagen-induced platelet aggregation in sheared blood decreased with increasing levels of NPSS and exposure time. The study clearly demonstrated that high NPSS causes simultaneous platelet activation and receptor shedding, resulting in a paradoxical effect on platelet function via two distinct mechanisms. The results from the study suggested that the NPSS could induce the concurrent propensity for both thrombosis and bleeding in patients.
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- 2019
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9. Biomarker enhanced risk prediction for development of AKI after cardiac surgery
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Michael L. Merchant, Michael E. Brier, Mark S. Slaughter, Jon B. Klein, and Kenneth R. McLeish
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AKI ,Cardiac surgery ,Urine ,Biomarker ,Prognostic ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Abstract Background Acute kidney injury (AKI) is a common post-cardiac surgery complication and influences patient morbidity and prognosis. This study was designed to identify preoperative candidate urine biomarkers in patients undergoing cardiac surgery. Methods A prospective cohort study of adults undergoing cardiac surgery at increased risk for AKI at a single hospital between July 2010 and September 2012 was performed. The primary outcome was the development of AKI, defined as an absolute serum creatinine (SCr) level increase ≥ 0.5 mg/dL or a ≥ 50% relative increase within 72 h of surgery. A secondary outcome was development of AKI defined by Kidney Disease Improving Global Outcomes (KDIGO). Urine collected by voiding within 4 h prior to surgery was used for proteomic analysis and confirmatory enzyme linked immunosorbent assays (ELISAs) studies. Biomarkers were tested for AKI-prediction using Cox and Snell R2, area under the receiver operating curve (AUROC), and percent of corrected classifications. To evaluate the added effect of each candidate biomarker on AKI discrimination, receiver operator characteristic (ROC) curves, integrated discrimination improvement (IDI), and net reclassification improvement (NRI) were calculated. Results Forty-seven of 755 patients met screening criteria including 15 with AKI. Proteomic analysis identified 29 proteins with a significant ≥2-fold change. Confirmatory ELISA measurements of five candidate markers showed urinary complement factor B (CFB) and histidine rich glycoprotein (HRG) concentrations were significantly increased in patients with AKI. By multivariate analysis, NRI, and IDI the addition of CFB and HRG to the standard clinical assessment significantly improved risk prediction for the primary outcome. Only HRG was a significant predictor in the 21 patients with AKI defined by KDIGO criteria. Conclusions Pre-operative urine measurement of CFB or HRG significantly enhanced the current post-surgery AKI risk stratification for more restrictive definition of AKI. HRG, but not CFB or clinical risk stratification, predicted AKI defined by KDIGO. The ability of these biomarkers to predict risk for dialysis-requiring AKI or death could not be reliably assessed in our study due to a small number of patients with either outcome.
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- 2018
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10. Alteration in Leukocyte Subsets and Expressions of FcγR and Complement Receptors among Female Ragpickers in Eastern India
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Nandan K. Mondal, Shabana Siddique, Madhuchanda Banerjee, Sanghita Roychoudhury, Sayali Mukherjee, Mark S. Slaughter, Twisha Lahiri, and Manas R. Ray
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complement receptors ,FcγR ,lymphocyte ,monocyte ,ragpicker ,Public aspects of medicine ,RA1-1270 - Abstract
Background: There are a million ragpickers in India who gather and trade recyclable municipal solid wastes materials for a living. The objective of this study was to examine whether their occupation adversely affects their immunity. Methods: Seventy-four women ragpickers (median age, 30 years) and 65 age-matched control housemaids were enrolled. Flow cytometry was used to measure leukocyte subsets, and leukocyte expressions of Fcγ receptor I (CD64), FcγRIII (CD16), complement receptor 1 (CD35) and CR3 (CD11b/CD18), and CD14. Serum total immunoglobulin-E was estimated with enzyme-linked immunosorbent assay. Results: Compared with the controls, ragpickers had significantly (p
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- 2017
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11. Cardiac Resynchronization Therapy and Clinical Outcomes in Continuous Flow Left Ventricular Assist Device Recipients
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Rakesh Gopinathannair, Henri Roukoz, Adarsh Bhan, Ashwin Ravichandran, Mustafa M. Ahmed, Dmitry Familtsev, Geetha Bhat, Jennifer Cowger, Munazzah Abdullah, Chirag Sandesara, Rahul Dhawan, Emma J. Birks, Jaimin R. Trivedi, and Mark S. Slaughter
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cardiac resynchronization therapy ,heart failure ,implanted cardioverter defibrillator ,left ventricular assist device ,ventricular arrhythmia ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Many patients with heart failure continue cardiac resynchronization therapy (CRT) after continuous flow left ventricular assist device (CF‐LVAD) implant. We report the first multicenter study to assess the impact of CRT on clinical outcomes in CF‐LVAD patients. Methods and Results Analysis was performed on 488 patients (58±13 years, 81% male) with an implantable cardioverter defibrillator (ICD) (n=223) or CRT‐D (n=265) who underwent CF‐LVAD implantation at 5 centers from 2007 to 2015. Effects of CRT on mortality, hospitalizations, and ventricular arrhythmia incidence were compared against CF‐LVAD patients with an ICD alone. Baseline differences were noted between the 2 groups in age (60±12 versus 55±14, P
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- 2018
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12. Sensorless Physiologic Control, Suction Prevention, and Flow Balancing Algorithm for Rotary Biventricular Assist Devices.
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Yu Wang 0100, Steven C. Koenig, Zhongjun J. Wu, Mark S. Slaughter, and Guruprasad A. Giridharan
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- 2019
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13. Shear stress and blood trauma under constant and pulse-modulated speed CF-VAD operations: CFD analysis of the HVAD.
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Zengsheng Chen, Sofen K. Jena, Guruprasad A. Giridharan, Michael A. Sobieski, Steven C. Koenig, Mark S. Slaughter, Bartley P. Griffith, and Zhongjun J. Wu
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- 2019
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14. COMPETENCE Trial: The EVAHEART 2 continuous flow left ventricular assist device
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Steven R. Allen, Mark S. Slaughter, Mustafa M. Ahmed, Carlo R. Bartoli, Ravi Dhingra, Gregory F. Egnaczyk, Sanjeev K. Gulati, Michael S. Kiernan, Claudius Mahr, Dan M. Meyer, Tadashi Motomura, Masahiro Ono, Ashwin Ravichandran, Alexis Shafii, Jason Smith, Behzad Soleimani, Yoshiya Toyoda, Leora T. Yarboro, and Robert D. Dowling
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Heart Failure ,Pulmonary and Respiratory Medicine ,Transplantation ,Treatment Outcome ,Heart Ventricles ,Humans ,Heart Transplantation ,Surgery ,Heart-Assist Devices ,Prospective Studies ,Cardiology and Cardiovascular Medicine - Abstract
Continuous flow left ventricular assist devices have improved outcomes in patients with end-stage heart failure that require mechanical circulatory support. Current devices have an adverse event profile that has hindered widespread application. The EVAHEART®2 left ventricular assist device (EVA2) has design features such as large blood gaps, lower pump speeds and an inflow cannula that does not protrude into the left ventricle that may mitigate the adverse events currently seen with other continuous flow devices.A prospective, multi-center randomized non-inferiority study, COMPETENCE Trial, is underway to assess non-inferiority of the EVA2 to the HeartMate 3 LVAS when used for the treatment of refractory advanced heart failure. The primary end-point is a composite of the individual primary outcomes: Survival to cardiac transplant or device explant for recovery; Free from disabling stroke; Free from severe Right Heart Failure after implantation of original device. Randomization is in a 2:1 (EVA2:HM3) ratio.The first patient was enrolled into the COMPETENCE Trial in December of 2020, and 25 subjects (16 EVA2 and 9 HM3) are currently enrolled. Enrollment of a safety cohort is projected to be completed by third quarter of 2022 at which time an interim analysis will be performed. Short-term cohort (92 EVA2 subjects) and long-term cohort is expected to be completed by the end of 2023 and 2024, respectively.The design features of the EVA2 such as a novel inflow cannula and large blood gaps may improve clinical outcomes but require further study. The ongoing COMPETENCE trial is designed to determine if the EVA2 is non-inferior to the HM3.
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- 2023
15. The ongoing quest for the first total artificial heart as destination therapy
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Annemijn Vis, Maziar Arfaee, Husain Khambati, Mark S. Slaughter, Jan F. Gummert, Johannes T. B. Overvelde, and Jolanda Kluin
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Cardiology and Cardiovascular Medicine - Abstract
Many patients with end-stage heart disease die because of the scarcity of donor hearts. A total artificial heart (TAH), an implantable machine that replaces the heart, has so far been successfully used in over 1,700 patients as a temporary life-saving technology for bridging to heart transplantation. However, after more than six decades of research on TAHs, a TAH that is suitable for destination therapy is not yet available. High complication rates, bulky devices, poor durability, poor biocompatibility and low patient quality of life are some of the major drawbacks of current TAH devices that must be addressed before TAHs can be used as a destination therapy. Quickly emerging innovations in battery technology, wireless energy transmission, biocompatible materials and soft robotics are providing a promising opportunity for TAH development and might help to solve the drawbacks of current TAHs. In this Review, we describe the milestones in the history of TAH research and reflect on lessons learned during TAH development. We summarize the differences in the working mechanisms of these devices, discuss the next generation of TAHs and highlight emerging technologies that will promote TAH development in the coming decade. Finally, we present current challenges and future perspectives for the field.
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- 2022
16. Mechanical circulatory support for bridge to transplant therapy: data on use and patient outcomes
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Jaimin R. Trivedi, Siddharth V. Pahwa, and Mark S. Slaughter
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
17. A Rapidly Growing Cardiac Mass—Malignant or Benign?
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Amit Rout, Mounica Vorla, Afolasayo A. Aromiwura, Siddharth V. Pahwa, Marcus F. Stoddard, Mark S. Slaughter, and Dinesh K. Kalra
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General Medicine - Published
- 2023
18. Observe, Record, and Incremental Improvement in Clinical Outcomes
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Mark S. Slaughter and Jaimin R. Trivedi
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Biomaterials ,Biomedical Engineering ,Biophysics ,Bioengineering ,General Medicine - Published
- 2023
19. Trends in Contemporary Use of Ventricular Assist Devices in Children Awaiting Heart Transplantation and Their Outcomes by Race/Ethnicity
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Jaimin, Trivedi, Mark S, Slaughter, William B, Moskowitz, Stephanie, Ghaleb, and Bibhuti B, Das
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Biomaterials ,Biomedical Engineering ,Biophysics ,Bioengineering ,General Medicine - Abstract
This retrospective study included children aged ≤18 years who had durable ventricular assist devices (VADs) as a bridge to transplantation from the United Network Organ Sharing (UNOS) database between 2011 and 2020. We evaluated 90-day waitlist mortality and 1-year posttransplant mortality after VAD implantation in children stratified by race/ethnicity: Black, White, and Others. The VAD was used in a higher proportion of Black children listed for heart transplantation (HT) (26%) versus Other (25%) versus White (22%); p0.01. Black children had Medicaid health insurance coverage (67%) predominantly at the time of listing for HT. There was no significant overall difference in waitlist survival among the three groups supported with VAD at the time of listing (log-rank p = 0.4). On the other hand, the 90-day waitlist mortality after the VAD implantation at listing and while listed was the lowest among Black (6%) compared with White (13%) and Other (14%) (p0.01). The multivariate regression analysis showed that Other race (hazard ratio [HR], 2.29; p0.01), Black race (HR, 2.13; p0.01), use of mechanical ventilation (HR, 1.72; p = 0.01), and Medicaid insurance (HR, 1.54; p = 0.04) were independently associated with increased 1-year posttransplant mortality. In conclusion, Black children had more access to durable VAD support than White children. The 90-day waitlist mortality was significantly lower in Black children compared with White and Other after VAD implantation. However, Black and Other racial/ethnic children with VAD at transplant had higher 1-year posttransplant mortality than White children. Future studies to elucidate the reasons for these disparities are needed.
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- 2022
20. Timing and Outcomes of Concurrent and Sequential Biventricular Assist Device Implantation: A Society of Thoracic Surgeons Intermacs Analysis
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Mustafa M. Ahmed, Jeffrey P. Jacobs, Lauren E. Meece, Eric I. Jeng, Mark S. Bleiweis, Ryan S. Cantor, Brandon Singletary, James K. Kirklin, and Mark S. Slaughter
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
21. Feasibility Testing of the RT Cardiac Systems Percutaneous Mechanical Circulatory Support Device
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Gretel Monreal, Steven C. Koenig, Mustafa Ertan Taskin, Charles Shambaugh, Jeffrey A. LaRose, and Mark S. Slaughter
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Biomaterials ,Biomedical Engineering ,Biophysics ,Bioengineering ,General Medicine - Published
- 2023
22. A Tale of Two Centrifugal-Flow Ventricular Assist Devices As Bridge to Heart Transplant
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Katherine Whitehouse, Hazaim Alwair, Mark S. Slaughter, and Jaimin R. Trivedi
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Waiting Lists ,Transplants ,Patient characteristics ,law.invention ,Randomized controlled trial ,law ,Diabetes mellitus ,medicine ,Humans ,Aged ,Retrospective Studies ,Heart Failure ,Bridge to transplant ,End point ,business.industry ,medicine.disease ,Surgery ,Treatment Outcome ,Bridge (graph theory) ,Waiting list ,Heart Transplantation ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business ,Body mass index - Abstract
Background Use of continuous-flow left ventricular assist devices (LVAD) has increased over the years as a bridge to transplant. The HeartWare HVAD (Medtronic, Minneapolis, MN) and HeartMate III (HM3, Abbott, Abbott Park, IL) are currently approved centrifugal-flow devices used for bridge to transplant. We sought to evaluate outcomes of the patients listed and who received a transplant after receiving these 2 devices. Methods The United Network of Organ Sharing thoracic transplant database was queried after August 23, 2017, until December 2018 to identify patients aged older than 18 years listed for heart transplant and supported by the HVAD or HM3. Patient characteristics were evaluated at the time of listing and transplant. The primary study end point was 1-year mortality after LVAD implantation. Nonparametric tests were used to evaluate the device groups. Results Of 569 patients listed for heart transplant during the study period, 226 had HM3 and 343 had HVAD. The HM3 group had more men (82% vs 74%, P = .02), patients with diabetes (38% vs 29%, P = .02), and the body mass index was higher (28 vs 27 kg/m2, P = .04) at listing. Between the HM3 and HVAD groups, the 1-year mortality was 20% vs 17%, respectively (log-rank P = .28; Figure 1), and the posttransplant survival at 1 year was 97% and 94%, respectively (P = .1). Conclusions In a relatively well-matched group of patients listed for heart transplant with a centrifugal-flow LVAD, the 6-month and 1-year mortality on the waiting list as well as after transplant were not statistically different. Additional real-world experience or a randomized trial would be needed to determine whether one LVAD is superior.
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- 2022
23. Use of Impella in Patients Listed for Heart Transplantation
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Siddharth Pahwa, Christina Dunbar-Matos, Mark S. Slaughter, and Jaimin R. Trivedi
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Biomaterials ,Biomedical Engineering ,Biophysics ,Bioengineering ,General Medicine - Published
- 2022
24. Venous External Support in Coronary Artery Bypass Surgery: A Systematic Review and Meta-Analysis
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Marco Gemelli, Michele Gallo, Mariangela Addonizio, Siddharth Pahwa, Jef Van den Eynde, Jaimin Trivedi, Mark S. Slaughter, and Gino Gerosa
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General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
25. Impact of 2016 UNOS pediatric heart allocation policy changes on VAD utilization, waitlist, and post-transplant survival outcomes in children with CHD versus Non-CHD
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Bibhuti B. Das, Chad T. Blackshear, Seth T. Lirette, Mark S. Slaughter, Stephanie Ghaleb, William Moskowitz, Mohammad Ghanamah, and Phillip T. Burch
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Transplantation ,Article - Abstract
AIMS: We analyzed the impact of the revised pediatric heart allocation policy on types of ventricular assist device (VAD) utilization, and waitlist (WL) and post-heart transplant (HT) survival outcomes in congenital heart disease (CHD) versus non-CHD patients before (Era-1) and after (Era-2) pediatric heart allocation policy implementation. METHODS: We retrospectively reviewed the UNOS database from December 16, 2011, through March 31, 2021, for patients < 18 years old and listed for primary HT. We compared the differences observed between Era-1 and Era-2. RESULTS: 5551 patients were listed for HT, of whom 2447(44%) were in Era-1 and 3104(56%) were in Era-2. CHD patients were listed as status 1A unchanged, but the number of patients listed as status 1B decreased in Era-2, whereas the number of non-CHD patients listed as status 1A decreased, but status 1B increased. In Era-2 compared to Era-1, both temporary (1% to 4%, p < .001) and durable VAD (13.6% to 17.8%, p < .001) utilization increased, and the transplantation rate per 100-patient years increased in both groups. The median WL period for CHD patients increased marginally from 70 to 71 days (p = .06), whereas for non-CHD patients it decreased from 61 to 54 days (p < .001). Adjusted 90-day WL survival increased from 84% to 88%, p = .016 in CHD, but there was no significant change in non-CHD patients (p = .57). There was no significant difference in 1-year post-HT survival in CHD and non-CHD patients between Era-1 and Era-2. CONCLUSIONS: In summary, after the revised heart allocation policy implementation, temporary and durable VAD support increased, HT rate increased, waitlist duration marginally increased in the CHD cohort and decreased in the non-CHD cohort, and 90-day WL survival probability improved in children with CHD without significant change in 1-year post-HT outcomes. Future studies are needed to identify changes to the policy that may further improve the listing criteria to improve WL duration and post-HT survival.
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- 2022
26. Time in Therapeutic Range Significantly Impacts Survival and Adverse Events in Destination Therapy Patients
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Georg Wieselthaler, Joseph G. Rogers, Antone Tatooles, Gregory Macaluso, Carmelo A. Milano, Erika D. Feller, Mark S. Slaughter, and Francis D. Pagani
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endocrine system ,medicine.medical_specialty ,Biomedical Engineering ,Biophysics ,Time in therapeutic range ,Hemorrhage ,Bioengineering ,Gastroenterology ,HVAD ,Biomaterials ,Therapeutic index ,Internal medicine ,Atrial Fibrillation ,left ventricular assist device ,medicine ,Humans ,International Normalized Ratio ,Thrombus ,Adverse effect ,Stroke ,biology ,business.industry ,Anticoagulants ,General Medicine ,medicine.disease ,Transthyretin ,Treatment Outcome ,time in therapeutic range ,Adult Circulatory Support ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,biology.protein ,destination therapy ,business ,Major bleeding ,Destination therapy - Abstract
Supplemental Digital Content is available in the text., The study aim was to examine the impact time in therapeutic range (TTR, International Normalized Ratio [INR] 2.0–3.0) has on survival and adverse events in patients receiving the HeartWare HVAD System in the ENDURANCE and ENDURANCE Supplemental Trials. Evaluable subjects (n = 495) had >1 INR value recorded 1–24 months postimplant and were categorized as: low TTR (10–39%), moderate TTR (40–69%), and high TTR (≥70%). Baseline characteristics, adverse events, and survival were analyzed. Low TTR patients experienced higher rates of major bleeding (1.69 vs. 0.54 events per patient year [EPPY]; p < 0.001), GI bleeding (1.22 vs. 0.38 EPPY; p < 0.001), stroke (0.47 vs. 0.17 EPPY; p < 0.001), thrombus requiring exchange (0.05 vs. 0.01 EPPY; p = 0.02), infection (1.44 vs. 0.69 EPPY; p < 0.001), and renal dysfunction (0.23 vs. 0.05 EPPY; p < 0.001) compared with high TTR. Moderate TTR had higher rates of major bleeding (0.75 vs. 0.54 EPPY; p < 0.001), thrombus requiring exchange (0.05 vs. 0.01 EPPY; p = 0.007), cardiac arrhythmia (0.32 vs. 0.24 EPPY; p = 0.04), and infection (0.90 vs. 0.69 EPPY; p = 0.001) compared with high TTR. Two year survival was greater among moderate and high versus low cohorts (Log-rank p = 0.001). The significant reduction in morbidity and mortality in destination therapy (DT) HVAD patients with well-controlled TTR (≥70%) emphasizes the importance of vigilant anticoagulation management.
- Published
- 2021
27. Aortic root replacement with Medtronic Freestyle bioprosthesis: 25‐year experience
- Author
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Susan A. Smith, Divya Avula, Jaimin R. Trivedi, Joseph C Sweeney, Mark S. Slaughter, and Brian L. Ganzel
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Swine ,Prosthesis Design ,chemistry.chemical_compound ,Diabetes mellitus ,medicine ,Animals ,Humans ,Aged ,Bioprosthesis ,Heart Valve Prosthesis Implantation ,Creatinine ,Ejection fraction ,business.industry ,Perioperative ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,chemistry ,Aortic Valve ,Heart Valve Prosthesis ,Concomitant ,Circulatory system ,Cohort ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,Artery - Abstract
Stentless porcine bioprothesis is a surgical strategy to treat aortic root disease. Use has been limited due to the concern for long-term valve degeneration. This study evaluated the perioperative and late outcomes of patients with aortic root disease requiring root replacement.A total of 409 patients underwent aortic root replacement by a single surgeon using a stentless porcine bioroot between February 1996 and May 2020. The cohort was divided into two groups (age ≤65 and65 years). Descriptive statistics were used to analyze the data and Kaplan-Meier curves used to evaluate long-term outcomes.Patients age65 years were more likely to be female (p = .01), have hypertension (p = .01), require circulatory arrest (p = .01), and have concomitant coronary artery bypass grafting (CABG) (p = .04). Baseline creatinine1.8 (p = .20), diabetes (p = .06), and ejection fraction (p = .20) were similar between groups. The 1-, 5-, and 10-year survival for patients age ≤65 years were 92%, 87%, and 69%, respectively, significantly better than patients age65 (88%, 73%, and 43%, respectively) (p .01, Figure 1). The 1-, 5-, and 10-year freedom from reoperation for patients ≤65 years were 99%, 97%, and 93% versus 99%, 98%, and 96% in patients age65 years, respectively (p = .24).Patients with aortic root disease can be treated with acceptable perioperative outcomes, long-term survival, and low reoperation rates using a stentless porcine bioprothesis. It should be considered irrespective of age due to its excellent durability and freedom from anti-coagulation requirement.
- Published
- 2021
28. Validation of a Novel NeurOs Cerebral Oximetry Monitor Against the INVOS Monitor During Cardiac Surgery
- Author
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Jiapeng Huang, Heidi M. Koenig, Kaicheng Song, Maiying Kong, Sean P. Clifford, Yuguang Huang, Qian Xu, and Mark S. Slaughter
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medicine.medical_specialty ,030204 cardiovascular system & hematology ,Tertiary care ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,law ,medicine ,Cardiopulmonary bypass ,Humans ,Oximetry ,Prospective Studies ,Cardiac Surgical Procedures ,Cerebral oximetry ,Cardiopulmonary Bypass ,Receiver operating characteristic analysis ,business.industry ,Brain ,Oxygenation ,University hospital ,Cardiac surgery ,Oxygen ,Anesthesiology and Pain Medicine ,Cerebrovascular Circulation ,Anesthesia ,Cardiology and Cardiovascular Medicine ,business ,Blinded study - Abstract
To compare the performance of a novel NeurOs cerebral oximetry monitor against the INVOS monitor during the entire intraoperative phase of cardiac surgery, including periods of known fluctuation in brain oxygenation, such as preoxygenation, induction, cannulation, and cardiopulmonary bypass.This study was a prospective, nonrandomized, healthcare-provider and outcome-assessor blinded study.Tertiary care university hospital; single institutional study.Twenty-three patients who underwent cardiac surgery with cardiopulmonary bypass.Both self-adhesive INVOS sensors and the assembled NeurOs sensors were placed accordingly when the patient arrived in the operating room.Ten out of 13 cases under the normal mode and eight out of the 10 cases under the high- sensitivity mode showed significant correlations between the NeurOs and INVOS groups (p0.05, r value from 0.24-0.88). When all cases were combined, NeurOs demonstrated significant correlation with INVOS (r = 0.5, 95% confidence interval [CI] 0.44-0.56, p0.01 for normal mode; r = 0.69, 95% CI 0.64 to 0.74, p0.01 for high-sensitivity mode) in both modes. To evaluate the data diversity, the authors performed a cluster analysis and found much less variation existed in the NeurOs normal mode when compared with INVOS (standard deviation [SD] 16.6% in INVOS, 4% in NeurOs normal mode) but similar patterns in the high-sensitivity mode (SD 17.6% in INVOS, 15.2% in NeurOs high-sensitivity mode). Bland-Altman plot analysis showed that most of the data fell between ± 1.96 SD lines, which demonstrated good consistency between these two methods under both modes of NeurOs (-28.8 to 30.8 in the normal mode; -36.6 to 32.7 in high-sensitivity mode). In the normal mode of NeurOs monitoring, receiver operating characteristic analysis suggested a 2% cutoff point was most optimal from the baseline for detecting hyperoxia (sensitivity 73%; specificity 66%) and minus 1% (sensitivity 66%; specificity 67%) for detecting hypoxia. Whereas in the high-sensitivity mode, the optimal cutoff point was 3% from baseline for detecting hyperoxia (sensitivity 75%; specificity 68%), and minus 3% for detecting hypoxia (sensitivity 90%; specificity 45%).In conclusion, the novel NeurOs system was found to correlate with INVOS cerebral oximetry measurements during cardiac surgery.
- Published
- 2021
29. A Power Tracking Algorithm for Early Detection of Centrifugal Flow Pump Thrombosis
- Author
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Mark S. Slaughter, Abhijit Kadrolkar, Andrew J. Sauer, Jonathan D. Rich, Robert W. Stadler, Veronica Ramos, Nir Uriel, Thomas Schlöglhofer, Claudius Mahr, and Michael C. Brown
- Subjects
Biomedical Engineering ,Biophysics ,pump thrombosis ,Early detection ,Bioengineering ,Tracking (particle physics) ,HVAD ,power tracking ,Biomaterials ,Humans ,Medicine ,In patient ,Pump thrombosis ,Retrospective Studies ,Heart Failure ,algorithm ,business.industry ,Thrombosis ,logfiles ,General Medicine ,Power (physics) ,Early Diagnosis ,Adult Circulatory Support ,Heart-Assist Devices ,False alarm ,left-ventricular assist device ,business ,Algorithm ,Algorithms - Abstract
Logfiles from the HeartWare HVAD System provide operational pump trend data to aid in patient management. Pump thrombosis is commonly associated with increases in the logfile power that may precede the clinical presentation. A Power Tracking algorithm was developed to detect significant deviations in pump power that may be associated with pump thrombus (PT). The Power Tracking algorithm was applied retrospectively to logfiles captured in the ENDURANCE, ENDURANCE Supplemental, and LATERAL clinical trials. From a combined dataset of 896 patients, available logfiles with suspected PT (n = 70 events in 60 patients) and available logfiles from patients without adverse events (AEs) (n = 106 patients, consisting of 27.4 patient-years of monitoring) were organized into two cohorts. The Power Tracking algorithm detected PT cases on or before the recorded AE date with a sensitivity of 85.7%, with detection occurring an average of 3.9 days before clinical presentation. The algorithm averaged one false alarm for every 6.85 patient-years of monitoring from logfiles without AEs. The favorable performance of the Power Tracking algorithm may enable earlier detection of pump thrombosis and allow early medical management versus surgical intervention.
- Published
- 2021
30. Machine Learning Identification Of Transcriptomics And Clinical Characteristics Associated With Myocardial Recovery In Heart Failure Patients Undergoing Mechanical Circulatory Support
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Christos P Kyriakopoulos, Joseph R Visker, Ben J Brintz, Iosif Taleb, Rachit Badolia, Benjamin Haaland, Thirupura S Shankar, Jing Ling, Rana Hamouche, Eleni Tseliou, Konstantinos Sideris, Monte Scott, Ethan Krauspe, Sutip Navankasattusas, Omar Wever-Pinzon, Thomas C Hanff, Stephen Bailey, Steven Koenig, Rami Alharethi, Tom H Greene, Craig H Selzman, Mark S Slaughter, Manreet Kanwar, Palak Shah, and Stavros G Drakos
- Subjects
Cardiology and Cardiovascular Medicine - Published
- 2023
31. Cost‐effectiveness of left ventricular assist devices as destination therapy in the United Kingdom
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Stelios I Tsintzos, Claudius Mahr, Mark S. Slaughter, William Cotts, Richard Cheng, Eleni Ismyrloglou, Jennifer A. Beckman, Wayne C. Levy, Scott C. Silvestry, Jonas Villinger, and Stephan Schueler
- Subjects
medicine.medical_specialty ,Cost effectiveness ,Cost-Benefit Analysis ,medicine.medical_treatment ,Population ,Destination therapy ,030204 cardiovascular system & hematology ,State Medicine ,03 medical and health sciences ,0302 clinical medicine ,Mechanical circulatory support ,Original Research Articles ,Cost‐effectiveness ,medicine ,Humans ,Diseases of the circulatory (Cardiovascular) system ,030212 general & internal medicine ,Original Research Article ,education ,health care economics and organizations ,Heart Failure ,education.field_of_study ,Cost–benefit analysis ,business.industry ,medicine.disease ,United States ,Clinical trial ,Transplantation ,Heart failure ,Ventricular assist device ,RC666-701 ,Emergency medicine ,Heart Transplantation ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims Continuous‐flow left ventricular assist devices (LVADs) as destination therapy (DT) are a recommended treatment by National Institute for Health and Care Excellence England for end‐stage heart failure patients ineligible for cardiac transplantation. Despite the fact that DT is frequently used as an LVAD indication across other major European countries and the United States, with consistent improvements in quality‐of‐life and longevity, National Health Service (NHS) England does not currently fund DT, mainly due to concerns over cost‐effectiveness. On the basis of the recently published ENDURANCE Supplemental Trial studying DT patients, we assessed for the first time the cost‐effectiveness of DT LVADs compared with medical management (MM) in the NHS England. Methods and results We developed a Markov multiple‐state economic model using NHS cost data. LVAD survival and adverse event rates were derived from the ENDURANCE Supplemental Trial. MM survival was based on Seattle Heart Failure Model estimates in the absence of contemporary clinical trials for this population. Incremental cost‐effectiveness ratios (ICERs) were calculated over a lifetime horizon. A discount rate of 3.5% per year was applied to costs and benefits. Deterministic ICER was £46 207 per quality‐adjusted life year (QALY). Costs and utilities were £204 022 and 3.27 QALYs for the LVAD arm vs. £77 790 and 0.54 QALYs for the MM arm. Sensitivity analyses confirmed robustness of the primary analysis. Conclusions The implantation of the HeartWare™ HVAD™ System in patients ineligible for cardiac transplantation as DT is a cost‐effective therapy in the NHS England healthcare system under the end‐of‐life willingness‐to‐pay threshold of £50 000/QALY, which applies for VAD patients.
- Published
- 2021
32. Letter to Editor Response RE: Apixaban: Alternative Anticoagulation for HeartMate 3 Ventricular Assist Device
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Katherine R. Whitehouse, Jaimin R. Trivedi, and Mark S. Slaughter
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Biomaterials ,Biomedical Engineering ,Biophysics ,Bioengineering ,General Medicine - Published
- 2022
33. Role of implantable cardioverter‐defibrillator in patients awaiting heart transplant in the continuous‐flow left ventricular assist device era
- Author
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Queeny Pan, Mark S. Slaughter, Raj Vijaykrishnan, Rakesh Gopinathannair, and Jaimin R. Trivedi
- Subjects
Adult ,Male ,medicine.medical_specialty ,Databases, Factual ,Waiting Lists ,medicine.medical_treatment ,0206 medical engineering ,Biomedical Engineering ,Medicine (miscellaneous) ,Bioengineering ,02 engineering and technology ,030204 cardiovascular system & hematology ,Biomaterials ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Survival advantage ,In patient ,Heart Failure ,Continuous flow ,business.industry ,General Medicine ,Middle Aged ,Implantable cardioverter-defibrillator ,medicine.disease ,Survival Analysis ,020601 biomedical engineering ,Defibrillators, Implantable ,Survival benefit ,Waiting list ,Ventricular assist device ,Heart failure ,Heart Transplantation ,Female ,Heart-Assist Devices ,business - Abstract
Implantable cardioverter-defibrillators (ICDs) have been shown to have survival advantage in advanced heart failure patients. Few studies have evaluated the role of ICDs in patients supported with continuous-flow left ventricular assist devices (CFVADs). We aimed to evaluate the impact of ICD and CFVAD on heart transplant (HTx) waiting list survival. We queried the United Network for Organ Sharing (UNOS) thoracic transplant database between years 2007 and 2016 for patients aged ≥ 18 years listed for HTx. Patients receiving devices other than CFVAD were excluded. Patients were divided into groups-with and without CFVAD and further subdivided into groups-with and without ICD use. Kaplan-Meier curves were used to evaluate the survival outcomes. There were 34 860 patients listed for HTx during study period of which 11 481 (32%) had a CFVAD and 26 139 (75%) had an ICD. Within CFVAD group, patients with ICD were older, more likely male, with higher creatinine and listed as UNOS status 1A. In the No-CFVAD group, 1-year waitlist survival was significantly better with ICD use (81% vs. 73%, P < .0001); however, in CFVAD patients, 1-year survival with ICD use was comparable to No-ICD use (95% vs. 94%, P = .1). Use of ICD is associated with significantly better heart transplant waitlist survival in patients not supported by CFVAD. In patients supported with CFVAD, the ICD does not offer additional survival benefit.
- Published
- 2021
34. Prospective Multicenter Study of Myocardial Recovery Using Left Ventricular Assist Devices (RESTAGE-HF [Remission from Stage D Heart Failure])
- Author
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Kenneth B. Margulies, J. Um, Emma J. Birks, Randall C. Starling, Brian D. Lowes, Christopher Cunningham, Craig H. Selzman, J.E. Rame, David J. Farrar, Jaimin R. Trivedi, Stavros G. Drakos, Snehal R. Patel, Daniel J. Goldstein, Pavin Alturi, Josef Stehlik, S. Maybaum, and Mark S. Slaughter
- Subjects
Adult ,Male ,Cardiac function curve ,medicine.medical_specialty ,medicine.medical_treatment ,Cardiomyopathy ,Hemodynamics ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,Article ,Medium term ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Clinical endpoint ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Device Removal ,Heart Failure ,business.industry ,Remission Induction ,Recovery of Function ,Middle Aged ,medicine.disease ,Transplantation ,Ventricular assist device ,Heart failure ,Cardiology ,Female ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Left ventricular assist device (LVAD) unloading and hemodynamic support in patients with advanced chronic heart failure can result in significant improvement in cardiac function allowing LVAD removal; however, the rate of this is generally considered to be low. This prospective multicenter nonrandomized study (RESTAGE-HF [Remission from Stage D Heart Failure]) investigated whether a protocol of optimized LVAD mechanical unloading, combined with standardized specific pharmacological therapy to induce reverse remodeling and regular testing of underlying myocardial function, could produce a higher incidence of LVAD explantation. Methods: Forty patients with chronic advanced heart failure from nonischemic cardiomyopathy receiving the Heartmate II LVAD were enrolled from 6 centers. LVAD speed was optimized with an aggressive pharmacological regimen, and regular echocardiograms were performed at reduced LVAD speed (6000 rpm, no net flow) to test underlying myocardial function. The primary end point was the proportion of patients with sufficient improvement of myocardial function to reach criteria for explantation within 18 months with sustained remission from heart failure (freedom from transplant/ventricular assist device/death) at 12 months. Results: Before LVAD, age was 35.1±10.8 years, 67.5% were men, heart failure mean duration was 20.8±20.6 months, 95% required inotropic and 20% temporary mechanical support, left ventricular ejection fraction was 14.5±5.3%, end-diastolic diameter was 7.33±0.89 cm, end-systolic diameter was 6.74±0.88 cm, pulmonary artery saturations were 46.7±9.2%, and pulmonary capillary wedge pressure was 26.2±7.6 mm Hg. Four enrolled patients did not undergo the protocol because of medical complications unrelated to the study procedures. Overall, 40% of all enrolled (16/40) patients achieved the primary end point, P Conclusions: In this multicenter prospective study, this strategy of LVAD support combined with a standardized pharmacological and cardiac function monitoring protocol resulted in a high rate of LVAD explantation and was feasible and reproducible with explants occurring in all 6 participating sites. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01774656.
- Published
- 2020
35. Apixaban: Alternative Anticoagulation for HeartMate 3 Ventricular Assist Device
- Author
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Katherine R. Whitehouse, Divya Avula, Tanvir Kahlon, Devan Costelle, Christina Dunbar-Matos, Siddharth Pahwa, Jaimin R. Trivedi, and Mark S. Slaughter
- Subjects
Heart Failure ,Male ,Pyridones ,Biomedical Engineering ,Biophysics ,Anticoagulants ,Bioengineering ,General Medicine ,Biomaterials ,Stroke ,Treatment Outcome ,Humans ,Pyrazoles ,Heart-Assist Devices ,Retrospective Studies - Abstract
Patients with left ventricular assist devices currently require long-term anticoagulation with warfarin. Warfarin requires frequent blood tests and is associated with adverse events when not in the therapeutic range. Apixaban is a possible alternative that is potentially better for compliance and requires no additional testing. The purpose of this study was to compare adverse events in patients with a HeartMate 3 LVAD receiving apixaban versus warfarin. Thirty-five patients underwent HM3 implantation between January 01, 2016 to January 31, 2021. The groups compared were apixaban (n = 15, 43%) and warfarin (n = 20, 57%). All patients received 325 mg aspirin daily. Stroke, bleeding, and death were identified as primary outcomes after LVAD implant. Univariate nonparametric statistical analysis was performed. The median duration of treatment with apixaban was 148 days (37-606 days). The groups were comparable in terms of age (56 vs. 54 years), gender (male, 85% vs. 75%), and renal function (Cr 1.5 vs. 1.4). The apixaban group had significantly higher mean pulmonary artery pressure (41 vs. 34, p = 0.03) and there were more (p0.05) ischemic cardiomyopathy and INTERMACS profile3 in the warfarin group. At 6 months, thrombotic complications and death were not different between the groups. The two deaths in the apixaban group were from right heart failure. The apixaban group had clinically lower rates of bleeding complications (5% vs. 30%). The adverse events of bleeding, stroke, and death were similar in HM3 patients receiving warfarin or apixaban. Apixaban may be a safe alternative anticoagulant therapy in HM 3 LVAD patients.
- Published
- 2022
36. Recent Era Outcomes of Mechanical Circulatory Support in Children With Congenital Heart Disease as a Bridge to Heart Transplantation
- Author
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Bahaaldin Alsoufi, Shriprasad R. Deshpande, Bibhuti B. Das, Mark S. Slaughter, and Jaimin R. Trivedi
- Subjects
Heart Defects, Congenital ,medicine.medical_specialty ,Heart disease ,medicine.medical_treatment ,Biomedical Engineering ,Biophysics ,Bioengineering ,Bridge (interpersonal) ,Biomaterials ,Extracorporeal Membrane Oxygenation ,Internal medicine ,Medicine ,Humans ,Child ,Retrospective Studies ,Heart transplantation ,Heart Failure ,business.industry ,General Medicine ,medicine.disease ,Treatment Outcome ,Circulatory system ,Cardiology ,Heart Transplantation ,Heart-Assist Devices ,business - Abstract
The objective of the study is to compare the clinical characteristics, risk factors, and overall survival (waitlist and posttransplant) outcomes in children with congenital heart disease (CHD) bridged to transplantation with either a ventricular assist device (VAD) versus extracorporeal membrane oxygenation (ECMO) versus no mechanical circulatory support (MCS) in the recent era. The study included 2,899 primary heart transplantations in patients18 years with CHD between 2010 and 2019 from the United Network Organ Sharing database. Patients who had ECMO or VAD at listing or while listed were included, and their waitlist and posttransplant outcomes were compared with CHD patients who did not require MCS. Of all, 464 (16%) had ECMO and 200 (7%) VAD at the time of or during the listing. The VAD utilization increased over the last decade (4% in 2010 to 10% in 2019, p0.01). The 90 days post-MCS survival was better with VAD than ECMO (67 vs. 49%, p0.01). The transplantability rate at 90 days was decreased with younger age (odds ratio [OR], 0.91; 95% CI, 0.86-0.95), lower body mass index (BMI) (OR, 0.93; 95% CI, 0.89-0.98) and lower albumin3g/dl (OR, 0.6; 95% CI, 0.53-0.7). The multivariate model predicted that lower BMI (OR, 1.12; 95% CI, 1.06-1.18), pretransplant ECMO (OR, 2.19; 95% CI, 1.39-3.45), and higher bilirubin (OR, 1.15; 95% CI, 0.97-1.36) decreased 1-year posttransplant survival. Patients transplanted with VAD had better 1-year survival than ECMO (88 vs. 70%, p = 0.01). Waiting list survival of children with CHD supported by VAD is better compared to ECMO. The 1-year posttransplantation outcome of CHD patients supported by VAD is similar to the no MCS patients and better than ECMO-supported patients. There is no significant difference in post-HT survival between patients transitioned from ECMO to VAD while listed and those with VAD-first.
- Published
- 2022
37. Preoperative Functional Platelet Number Is Inversely Associated With 30-Day Mortality After Cardiac Surgery: A Retrospective Cohort Study
- Author
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Lei Zhao, Mark S. Slaughter, Maiying Kong, Soutik Ghosal, Jiapeng Huang, Daniel Barlowe, Xiaolin Ji, and Jaimin R. Trivedi
- Subjects
Male ,medicine.medical_specialty ,Databases, Factual ,Platelet Aggregation ,Platelet aggregation ,030204 cardiovascular system & hematology ,Time ,Cohort Studies ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,030202 anesthesiology ,Internal medicine ,medicine ,Humans ,Platelet ,Cardiac Surgical Procedures ,Aged ,Retrospective Studies ,Platelet Count ,business.industry ,Retrospective cohort study ,Middle Aged ,Cardiac surgery ,Anesthesiology and Pain Medicine ,Coagulation ,30 day mortality ,Preoperative Period ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background. We hypothesize that preoperative functional platelet number (platelet count multiplied by platelet aggregation percentage) are associated with 30-day mortality after cardiac surgery. Methods. We linked our preoperative testing database with the STS (Society of Thoracic Surgeon) database to form a study cohort of 1390 patients who had cardiac surgeries between January 2008 and December 2013. Preoperative tests of platelet count and platelet aggregation were routinely performed on all cardiac surgical patients within 24 hours before entering the operating room. Multiple logistic regression models were used to determine whether functional platelet number are associated with 30-day mortality, modified composite major adverse cardiocerebral events, postoperative renal failure or requirement for new renal replacement therapy, and reoperation for bleeding. Log-linear models were used to examine whether functional platelet numbers are associated with hospital length of stay and intensive care unit length of stay. Results. Functional platelet number had an inverse association with 30-day mortality, and each 50 × 109/L increase in functional platelet number resulted in decreased 30-day mortality (odds ratio of 0.767 with 95% confidence interval = 0.591-0.996). For secondary outcomes, functional platelet number was neither associated with major adverse cardiocerebral event nor length of stay. However, we found that each 50 × 109/L increase in functional platelet number was associated with decreased reoperations for bleeding (odds ratio of 0.778 with 95% confidence interval = 0.636-0.951). Conclusions. The preoperative functional platelet number had significant associations with 30-day mortality after cardiac surgery. Functional platelet number could be used to guide timing of cardiac surgery, especially as more and more patients are receiving antiplatelet medications nowadays.
- Published
- 2020
38. Cost-Effectiveness of Thoracotomy Approach for the Implantation of a Centrifugal Left Ventricular Assist Device
- Author
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Stelios I. Tsintzos, Jennifer A. Beckman, Anson Cheung, Wayne C. Levy, Martin Strueber, Scott C. Silvestry, Damian M May, Matthew R. Danter, Eleni Ismyrloglou, Nahush A. Mokadam, Mark S. Slaughter, Claudius Mahr, Richard Cheng, and Edwin C. McGee
- Subjects
Male ,medicine.medical_specialty ,Cost effectiveness ,medicine.medical_treatment ,Cost-Benefit Analysis ,Biomedical Engineering ,Biophysics ,Bioengineering ,thoracotomy ,030204 cardiovascular system & hematology ,bridge-to-transplant ,Medicare ,Biomaterials ,03 medical and health sciences ,0302 clinical medicine ,medicine ,left ventricular assist device ,Lung transplantation ,Humans ,Thoracotomy ,cost-effectiveness ,Aged ,Heart transplantation ,Heart Failure ,mechanical circulatory support ,business.industry ,General Medicine ,Middle Aged ,equipment and supplies ,medicine.disease ,Markov Chains ,United States ,Surgery ,Quality-adjusted life year ,Clinical trial ,030228 respiratory system ,Ventricular assist device ,Heart failure ,Adult Circulatory Support ,Quality of Life ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,minimally invasive ,Heart Transplantation ,Female ,Quality-Adjusted Life Years ,Heart-Assist Devices ,business - Abstract
Supplemental Digital Content is available in the text., This study reports the first analysis regarding cost-effectiveness of left ventricular assist device (LVAD) implantation via thoracotomy. Cost-effectiveness of LVADs implanted via the traditional surgical approach of sternotomy has been improved through the years because of technological advances, along with understanding the importance of patient selection and postimplant management have on positively affecting outcomes. Given the positive clinical outcomes of the thoracotomy approach, we seek to study the cost-effectiveness of a centrifugal LVAD via this less invasive approach. We developed a Markov model. Survival and quality of life inputs (QALY) for the LVAD arm were based on data from the LATERAL clinical trial. For the Medical Management arm, survival was derived from the Seattle Heart Failure Model. The heart transplant probability was derived from INTERMACS. Survival after heart transplantation used International Society for Heart and Lung Transplantation data. Cost inputs were calculated based on Medicare data and past literature. The incremental cost-effectiveness ratio was found to be $64,632 per quality adjusted life year and $57,891 per life year in the bridge to transplant indication. These results demonstrate further improvement in the overall cost-effectiveness of LVAD therapy and confirm implantation of LVADs via a less invasive approach as being cost-effective.
- Published
- 2020
39. Combined Heart-Kidney Transplant Versus Sequential Kidney Transplant in Heart Transplant Recipients
- Author
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Erin M. Schumer, Michele Gallo, Jaimin R. Trivedi, and Mark S. Slaughter
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Population ,Urology ,Renal function ,030204 cardiovascular system & hematology ,Kidney ,Kidney transplant ,03 medical and health sciences ,Calcineurin Inhibitor Nephrotoxicity ,0302 clinical medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,education ,Retrospective Studies ,Heart Failure ,Heart transplantation ,education.field_of_study ,business.industry ,Patient survival ,Kidney Insufficiency ,Kidney Transplantation ,Heart Transplantation ,Cardiology and Cardiovascular Medicine ,business ,Glomerular Filtration Rate - Abstract
In patients with reduced kidney function there are no established guidelines to suggest combined heart-kidney transplant (HKTx) versus sequential kidney transplant (SKTx) using preoperative value of estimated glomerular filtration (eGFR).The United Network for Organ Sharing database was queried from 2000 to 2015 to evaluate survival of HKTx and SKTx population stratified by preoperative eGFR rate45 mL/min. Aim of the study was to assess the eGFR rate that is most beneficial to perform a concomitant or a SKTx at time of transplant evaluation.In our analysis, patients who required SKTx are recipients that, after heart transplantation, developed or worsened kidney insufficiency due to calcineurin inhibitor nephrotoxicity. In recipients with eGFR30 or dialysis, a total of 545 received HKTx and 80 received SKTx. The median waiting time between heart and kidney transplant in SKTx group was 6 years. The overall post-transplant survival was 81% and 80% and 75% and 59% at 5 and 1 years for the HKTx and SKTx groups, respectively (P = .04). In recipients with eGFR from 30 to 44, a total of 107 received HKTx and 112 received SKTx. The median waiting time between heart and kidney transplant in SKTx group was 4 years. Overall post-transplant survival showed no statistically significant differences in HKTx group (n=107) compared with SKTx group (n=112) and was 90% and 95% at 1 year and 74% and 52% at 5 years, respectively (P = .4) .To optimize organ and patient survival, eGFR value can be utilized to discern between HKTx versus SKTx in patients with decreased renal function at the time of heart transplantation. Patients with eGFR30 or in dialysis presented better survival with HKTx, while both SKTx and HKTx are suitable for patients with eGFR between 30 and 45.
- Published
- 2020
40. Advanced Pulmonary and Cardiac Support of COVID-19 Patients: Emerging Recommendations From ASAIO—A 'Living Working Document'
- Author
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Steven P. Keller, Keshava Rajagopal, Christian Bime, Faisal H. Cheema, Federico Pappalardo, Marvin J. Slepian, Aly El Banayosy, Bindu Akkanti, Joseph B. Zwischenberger, Pranav Loyalka, and Mark S. Slaughter
- Subjects
medicine.medical_specialty ,ARDS ,Heart Diseases ,medicine.medical_treatment ,Pneumonia, Viral ,coronavirus ,Biomedical Engineering ,Biophysics ,Bioengineering ,mechanical ventilation ,030204 cardiovascular system & hematology ,medicine.disease_cause ,Biomaterials ,Betacoronavirus ,03 medical and health sciences ,0302 clinical medicine ,Pandemic ,medicine ,Extracorporeal membrane oxygenation ,Animals ,Humans ,Clinical Critical Care ,Intensive care medicine ,Pandemics ,Coronavirus ,Cause of death ,mechanical circulatory support ,Modalities ,SARS-CoV-2 ,Septic shock ,business.industry ,COVID-19 ,General Medicine ,extracorporeal membrane oxygenation ,medicine.disease ,Human morbidity ,030228 respiratory system ,Respiratory failure ,Original Article ,Cardiology and Cardiovascular Medicine ,Coronavirus Infections ,Respiratory Insufficiency ,business - Abstract
The severe acute respiratory syndrome-CoV-2 is an emerging viral pathogen responsible for the global coronavirus disease 2019 pandemic resulting in significant human morbidity and mortality. Based on preliminary clinical reports, hypoxic respiratory failure complicated by acute respiratory distress syndrome is the leading cause of death. Further, septic shock, late-onset cardiac dysfunction, and multiorgan system failure are also described as contributors to overall mortality. Although extracorporeal membrane oxygenation and other modalities of mechanical cardiopulmonary support are increasingly being utilized in the treatment of respiratory and circulatory failure refractory to conventional management, their role and efficacy as support modalities in the present pandemic are unclear. We review the rapidly changing epidemiology, pathophysiology, emerging therapy, and clinical outcomes of coronavirus disease 2019; and based on these data and previous experience with artificial cardiopulmonary support strategies, particularly in the setting of infectious diseases, provide consensus recommendations from American Society for Artificial Internal Organs. Of note, this is a living document, which will be updated periodically, as additional information and understanding emerges.
- Published
- 2020
41. The opioid epidemic and intravenous drug–associated endocarditis: A path forward
- Author
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Harold G. Roberts, Chris C. Cook, Vinay Badhwar, Mark S. Slaughter, J. Scott Rankin, Lawrence M. Wei, and Gorav Ailawadi
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Opioid epidemic ,Intravenous drug ,business.industry ,MEDLINE ,medicine.disease ,Opioid ,Path (graph theory) ,Medicine ,Endocarditis ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,medicine.drug - Published
- 2020
42. Risk Factors and Outcomes in Redo Coronary Artery Bypass Grafting
- Author
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Michele Gallo, Gretel Monreal, Jaimin R. Trivedi, Mark S. Slaughter, and Brian L. Ganzel
- Subjects
Male ,Reoperation ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Logistic regression ,Disease-Free Survival ,Coronary artery disease ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,Hospital Mortality ,cardiovascular diseases ,030212 general & internal medicine ,Coronary Artery Bypass ,Aged ,Retrospective Studies ,business.industry ,Percutaneous coronary intervention ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Survival Rate ,surgical procedures, operative ,medicine.anatomical_structure ,Propensity score matching ,Conventional PCI ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Reoperative coronary artery bypass grafting (redo-CABG) has declined during the last decade, while use of percutaneous coronary intervention (PCI) has increased. The aim of this retrospective study was to evaluate risk factors, in-hospital mortality, and long-term survival between first-time CABG and redo-CABG.From January 2009 to December 2015, 2,581 patients underwent first-time CABG procedures while 132 underwent isolated redo-CABG. Logistic regression was used to identify risk factors predictive of redo-CABG and after propensity matching the in-hospital morbidity and long-term all-cause mortality were compared.Risk factors for redo-CABG were prior PCI, dyslipidaemia, diabetes and hypertension. After propensity matching there were no significant differences between the redo-CABG (n = 126) and first-time CABG groups (n = 232) in baseline characteristics. The adjusted in-hospital mortality was 3.1% for redo-CABG and 2.1% for first-time CABG (p = 0.55). Redo-CABG required significantly more intraoperative red blood cells (p = 0.03), platelets (p 0.001), cryoprecipitate (p 0.007) and fresh frozen plasma (p 0.001) than first-time CABG. There was no significant difference in reoperation for bleeding (p = 0.72), prolonged ventilation (p = 0.98), postoperative stroke (p = 0.92) or dialysis (p = 0.44). The survival at 1, 3 and 5 years for redo-CABG was 93.5%, 90%, and 85% respectively, and 95.5%, 94.5%, 93% for first-time CABG, respectively (p = 0.2).Prior PCI after first time CABG and the risk factors for atherosclerotic disease are predictive for redo-CABG. An increased use of blood products is required during redo-CABG. After propensity matching, in-hospital mortality and long-term survival for redo-CABG is comparable to first-time operation. Re-sternotomy does not impact the survival in redo-CABG.
- Published
- 2020
43. Updated definitions of adverse events for trials and registries of mechanical circulatory support: A consensus statement of the mechanical circulatory support academic research consortium
- Author
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Christiaan F J Antonides, Paul Mohacsi, Josef Stehlik, J. Eduardo Rame, Mark S. Slaughter, Francis D. Pagani, Steve C. Koenig, Heinrich Schima, Vivek Rao, Evgenij V. Potapov, Robert L. Kormos, David N. Rosenthal, Kadir Caliskan, Steven R. Messé, Jeffrey J. Teuteberg, Daniel J. Goldstein, Jennifer A Cowger, James K. Kirklin, Susan M. Joseph, Martha L. Mooney, Randall C. Starling, Cardiothoracic Surgery, and Cardiology
- Subjects
Heart Failure ,Pulmonary and Respiratory Medicine ,Clinical Trials as Topic ,Transplantation ,medicine.medical_specialty ,Consensus ,business.industry ,Statement (logic) ,MEDLINE ,Humans ,Medicine ,Surgery ,Heart-Assist Devices ,Registries ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,Adverse effect - Published
- 2020
44. Comparison of Neurologic Event Rates Among HeartMate II, HeartMate 3, and HVAD
- Author
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Joni Herrington, Jennifer A. Beckman, Wayne C. Levy, Shin Lin, Claire J. Creutzfeldt, Mark S. Slaughter, Jason Bjelkengren, Alberto Aliseda, David L. Tirschwell, Richard Cheng, Chinwe Ibeh, Daniel P. Fishbein, Claudius Mahr, Daniel Zimpfer, Song Li, April Stempien-Otero, and Kevin J. Koomalsingh
- Subjects
Male ,medicine.medical_specialty ,Biomedical Engineering ,Biophysics ,MEDLINE ,Bioengineering ,030204 cardiovascular system & hematology ,Biomaterials ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,Registries ,cardiovascular diseases ,Stroke ,Retrospective Studies ,Event (probability theory) ,Heartmate ii ,business.industry ,Atrial fibrillation ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Clinical trial ,030228 respiratory system ,Emergency medicine ,Etiology ,Female ,Heart-Assist Devices ,business - Abstract
Strokes remain a leading cause of morbidity and mortality in patients with ventricular assist devices (VADs). Varying study populations, event definitions, and reporting methods make direct comparison of neurologic event risk across clinical trials and registries challenging. We aim to highlight important differences among major VAD studies and standardize rates of neurologic events to facilitate a comprehensive and objective comparison. We systematically identified and analyzed key clinical trials and registries evaluating the HeartMate II (HMII), HeartMate 3 (HM3), and HVAD devices. Reported neurologic events were nonexclusively categorized into ischemic stroke, hemorrhagic stroke, disabling stroke, fatal stroke, and other neurologic events per the studies' definitions. Event rates were standardized to events per patient-year (EPPY) and freedom from event formats. Seven key clinical trials and registries were included in our analysis. There is significant variation and overlap in neurologic event rates for the three VAD platforms across clinical trials (all neurologic events [EPPY]: HM3 0.17-0.21; HMII 0.19-0.26; HVAD 0.16-0.28). None performs consistently better for all types of neurologic events. Furthermore, stroke rates among VAD trials correlated with baseline stroke risk factors including ischemic etiology, history of atrial fibrillation, and history of prior stroke.
- Published
- 2019
45. Feasibility testing of the Inspired Therapeutics NeoMate mechanical circulatory support system for neonates and infants
- Author
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Gretel Monreal, Steven C. Koenig, Mark S. Slaughter, Gino F. Morello, Steven R. Prina, Landon H. Tompkins, Jiapeng Huang, Barry N. Gellman, and Kurt A. Dasse
- Subjects
Heart Failure ,Multidisciplinary ,Sheep ,Hemodynamics ,Infant, Newborn ,Animals ,Feasibility Studies ,Humans ,Equipment Design ,Heart-Assist Devices ,Child - Abstract
Inspired Therapeutics (Merritt Island, FL) is developing a mechanical circulatory support (MCS) system designed as a single driver with interchangeable, extracorporeal, magnetically levitated pumps. The NeoMate system design features an integrated centrifugal rotary pump, motor, and controller that will be housed in a single compact unit. Conceptually, the primary innovation of this technology will be the combination of disposable, low-cost pumps for use with a single, multi-functional, universal controller to support multiple pediatric cardiopulmonary indications. In response to the paucity of clinically available pediatric devices, Inspired Therapeutics is specifically targeting the underserved neonate and infant heart failure (HF) patient population first. In this article, we present the development of the prototype Inspired Therapeutics NeoMate System for pediatric left ventricular assist device (LVAD) support, and feasibility testing in static mock flow loops (H-Q curves), dynamic mock flow loops (hemodynamics), and in an acute healthy ovine model (hemodynamics and clinical applicability). The resultant hydrodynamic and hemodynamic data demonstrated the ability of this prototype pediatric LVAD and universal controller to function over a range of rotary pump speeds (500–6000 RPM), to provide pump flow rates of up to 2.6 L/min, and to volume unload the left ventricle in acute animals. Key engineering challenges observed and proposed solutions for the next design iteration are also presented.
- Published
- 2021
46. HVAD to HeartMate 3 Left Ventricular Assist Device Exchange: Best Practices Recommendations
- Author
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Christopher T. Salerno, Christopher Hayward, Shelley Hall, Daniel Goldstein, Diyar Saeed, Jan Schmitto, David Kaczorowski, Ezequiel Molina, Daniel Zimpfer, Steven Tsui, Edward Soltesz, Duc Thin Pham, Nahush A. Mokadam, Arman Kilic, Erin Davis, Erika Feller, Angela Lorts, Scott Silvestry, Mark S. Slaughter, Evgenij Potapov, Pavan Atluri, Jennifer Cowger, and Francis D. Pagani
- Subjects
Pulmonary and Respiratory Medicine ,Heart Failure ,Stroke ,Humans ,Surgery ,Equipment Design ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,Retrospective Studies - Abstract
The HeartWare HVAD System (Medtronic) is a durable implantable left ventricular assist device that has been implanted in approximately 20,000 patients worldwide for bridge to transplant and destination therapy indications. In December 2020, Medtronic issued an Urgent Medical Device Communication informing clinicians of a critical device malfunction in which the HVAD may experience a delay or failure to restart after elective or accidental discontinuation of pump operation. Moreover, evolving retrospective comparative effectiveness studies of patients supported with the HVAD demonstrated a significantly higher risk of stroke and all-cause mortality when compared with a newer generation of a commercially available durable left ventricular assist device. Considering the totality of this new information on HVAD performance and the availability of an alternate commercially available device, Medtronic halted the sale and distribution of the HVAD System in June 2021. The decision to remove the HVAD from commercial distribution now requires the use of the HeartMate 3 left ventricular assist system (Abbott, Inc) if a patient previously implanted with an HVAD requires a pump exchange. The goal of this document is to review important differences in the design of the HVAD and HeartMate 3 that are relevant to the medical management of patients supported with these devices, and to assess the technical aspects of an HVAD-to-HeartMate 3 exchange. This document provides the best available evidence that supports best practices. (J Thorac Cardiovasc Surg 2022;-:1-8).
- Published
- 2021
47. Contemporary outcomes of durable ventricular assist devices in adults with congenital heart disease as a bridge to heart transplantation
- Author
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Mark S. Slaughter, Bibhuti B Das, Jaimin R. Trivedi, Shriprasad R. Deshpande, and Brian Kogon
- Subjects
Adult ,Heart Defects, Congenital ,Male ,medicine.medical_specialty ,Heart disease ,Adolescent ,medicine.medical_treatment ,Biomedical Engineering ,Medicine (miscellaneous) ,Bioengineering ,Biomaterials ,chemistry.chemical_compound ,Internal medicine ,medicine.artery ,parasitic diseases ,Medicine ,Humans ,cardiovascular diseases ,Retrospective Studies ,Heart transplantation ,Heart Failure ,Creatinine ,business.industry ,Mortality rate ,General Medicine ,medicine.disease ,Transplantation ,Bridge (graph theory) ,Treatment Outcome ,chemistry ,Ventricular assist device ,Pulmonary artery ,Cardiology ,Heart Transplantation ,Female ,Heart-Assist Devices ,biological phenomena, cell phenomena, and immunity ,business - Abstract
This study aimed to compare the clinical characteristics, risk factors, and overall survival outcomes in adults with congenital heart disease (ACHD) bridged to transplantation with a ventricular assist device (VAD) versus no-VAD.The study included 894 ACHD patients aged ≥18 years listed for primary heart transplantation between 2010 and 2019 from the United Network for Organ Sharing database. Primary outcomes were waitlist and 1-year post-transplant mortality between VAD and no-VAD ACHD patients.Of 894 ACHD patients included in the study, 91(10.1%) had VAD support at the time of listing. Patients who needed VAD support were mostly males, heavier, and had higher pulmonary artery pressure than the no-VAD group at the listing. The overall waitlist mortality was 38% in the VAD group than 17% in the no-VAD group (p 0.01). ECMO use was associated with significantly higher mortality than either group. There was no significant difference in 1-year post-transplant mortality between VAD versus no-VAD at the time of transplant (15% vs. 17%; p = 0.66). Multivariate regression analysis found that BMI20 kg/mThe one-year post-transplant mortality rate was no different for ACHD patients that received VAD versus no-VAD. These findings suggest that a VAD should be considered an option to support ACHD patients as a bridge to heart transplantation.
- Published
- 2021
48. Cardiac Surgery in Chronic Renal Failure
- Author
-
Mark S. Slaughter and Mark S. Slaughter
- Published
- 2008
49. The Impact of Adverse Events on Functional Capacity and Quality of Life After HeartWare Ventricular Assist Device Implantation
- Author
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Keith D. Aaronson, Nahush A. Mokadam, Joseph G. Rogers, Francis D. Pagani, Carmelo A. Milano, Samer S. Najjar, Akinobu Itoh, Emma J. Birks, Salpy V. Pamboukian, Bruce B. Reid, Marc D. Samsky, Mark S. Slaughter, and Steven W. Boyce
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Biomedical Engineering ,Biophysics ,Cardiomyopathy ,Bioengineering ,Walking ,Article ,Biomaterials ,Quality of life ,Internal medicine ,medicine ,Humans ,Adverse effect ,Heart Failure ,business.industry ,Walk distance ,General Medicine ,medicine.disease ,humanities ,Treatment Outcome ,Ventricular assist device ,Heart failure ,Quality of Life ,Cardiology ,Heart-Assist Devices ,Overall summary score ,business - Abstract
Left ventricular assist devices (LVADs) improve quality of life (QoL) and functional capacity (FC) for patients with advanced heart failure. The association between adverse events (AEs) and changes in QoL and FC are unknown. Patients treated with the HeartWare ventricular assist device (HVAD) with paired 6-minute walk distance (6MWD, n = 263) and Kansas City Cardiomyopathy Questionnaires (KCCQ, n = 272) at baseline and 24 months in the ENDURANCE and ENDURANCE Supplemental Trial databases were included. Patients were stratified based upon occurrence of clinically significant AEs during the first 24 months of support and analyzed for the mean change in 6MWD and KCCQ. The impact of AE frequency on change in 6MWD and KCCQ from baseline to 24 months was evaluated. Of the AEs examined, only sepsis was associated with an improvement in 6MWD (109 m vs. 16 m, p = 0.002). Patients without improvement in 6MWD test from baseline to 24 months had significantly more AEs than those with FC improvement (p = 0.0002). Adverse events did not affect the KCCQ overall summary score. In this analysis, patients with fewer AEs had greater improvement in FC during the 24-month follow up. The frequency of AEs did not have a significant impact on QoL after LVAD implantation.
- Published
- 2021
50. 2021: The American Association for Thoracic Surgery Expert Consensus Document: Coronary artery bypass grafting in patients with ischemic cardiomyopathy and heart failure
- Author
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Faisal G. Bakaeen, Mario Gaudino, Glenn Whitman, Torsten Doenst, Marc Ruel, David P. Taggart, John M. Stulak, Umberto Benedetto, Anelechi Anyanwu, Joanna Chikwe, Biykem Bozkurt, John D. Puskas, Scott C. Silvestry, Eric Velazquez, Mark S. Slaughter, Patrick M. McCarthy, Edward G. Soltesz, Marc R. Moon, S. Chris Malaisrie, Leonard N. Girardi, Wilson Szeto, Deepak Bhatt, Jerry Estep, Roxana Mehran, Hirukuni Arai, Daniel Goldstein, Walter J. Gomes, Michael Halkos, Ki-Bong Kim, Craig Selzman, Nicholas G. Smedira, Miguel Sousa Uva, Lars G. Svensson, James Tatoulis, Michael Z. Tong, Marco Zenati, and Bruce Wilkoff
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Consensus ,Delphi Technique ,medicine.medical_treatment ,Cardiology ,Coronary Artery Disease ,Risk Assessment ,Ventricular Function, Left ,Coronary artery disease ,Postoperative Complications ,Risk Factors ,Internal medicine ,Medicine ,Humans ,Coronary Artery Bypass ,Intra-aortic balloon pump ,Heart Failure ,Ischemic cardiomyopathy ,Ejection fraction ,business.industry ,Percutaneous coronary intervention ,Atrial fibrillation ,Stroke Volume ,medicine.disease ,Treatment Outcome ,Cardiothoracic surgery ,Heart failure ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Cardiomyopathies - Published
- 2021
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