255 results on '"Pham SM"'
Search Results
2. A clinical trial combining donor bone marrow infusion and heart transplantation: intermediate-term results.
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Pham, SM, Rao, AS, Zeevi, A, Kormos, RL, McCurry, KR, Hattler, BG, Fung, JJ, Starzl, TE, Griffith, BP, Pham, SM, Rao, AS, Zeevi, A, Kormos, RL, McCurry, KR, Hattler, BG, Fung, JJ, Starzl, TE, and Griffith, BP
- Abstract
BACKGROUND: Donor chimerism (the presence of donor cells of bone marrow origin) is present for years after transplantation in recipients of solid organs. In lung recipients, chimerism is associated with a lower incidence of chronic rejection. To augment donor chimerism with the aim to enhance graft acceptance and to reduce immunosuppression, we initiated a trial combining infusion of donor bone marrow with heart transplantation. Reported herein are the intermediate-term results of this ongoing trial. METHODS: Between September 1993 and August 1998, 28 patients received concurrent heart transplantation and infusion of donor bone marrow at 3.0 x 10(8) cells/kg (study group). Twenty-four contemporaneous heart recipients who did not receive bone marrow served as controls. All patients received an immunosuppressive regimen consisting of tacrolimus and steroids. RESULTS: Patient survival was similar between the study and control groups (86% and 87% at 3 years, respectively). However, the proportion of patients free from grade 3A rejection was higher in the study group (64% at 6 months) than in the control group (40%; P =.03). The prevalence of coronary artery disease was similar between the two groups (freedom from disease at 3 years was 78% in study patients and 69% in controls). Similar proportions of study (18%) and control (15%) patients exhibited in vitro evidence of donor-specific hyporesponsiveness. CONCLUSIONS: The infusion of donor bone marrow reduces the rate of acute rejection in heart recipients. Donor bone marrow may play an important role in strategies aiming to enhance the graft acceptance.
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- 2000
3. Effects of donor bone marrow infusion in clinical lung transplantation
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Pham, SM, Rao, AS, Zeevi, A, McCurry, KR, Keenan, RJ, Vega, JD, Kormos, RL, Hattler, BG, Fung, JJ, Starzl, TE, Griffith, BP, Pham, SM, Rao, AS, Zeevi, A, McCurry, KR, Keenan, RJ, Vega, JD, Kormos, RL, Hattler, BG, Fung, JJ, Starzl, TE, and Griffith, BP
- Abstract
Background. We have demonstrated that donor cell chimerism is associated with a lower incidence of obliterative bronchiolitis (OB) in lung recipients, and that donor chimerism is augmented by the infusion of donor bone marrow (BM). We herein report the intermediate results of a trial combining the infusion of donor BM and lung transplantation. Methods. Clinical and in vitro data of 26 lung recipients receiving concurrent infusion of donor bone marrow (3.0 to 6.0 x 108 cells/kg) were compared with those of 13 patients receiving lung transplant alone. Results. Patient survival and freedom from acute rejection were similar between groups. Of the patients whose graft survived greater than 4 months, 5% (1 of 22) of BM and 33% (4 of 12) of control patients, developed histologic evidence of OB (p = 0.04). A higher proportion (but not statistically significant) of BM recipients (7 of 10, 70%) exhibited donor-specific hyporeactivity by mixed lymphocyte reaction assays as compared with the controls (2 of 7, 28%). Conclusions. Infusion of donor BM at the time of lung transplantation is safe, and is associated with recipients' immune modulation and a lower rate of obliterative bronchiolitis. (C) 2000 by The Society of Thoracic Surgeons.
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- 2000
4. Effects of oestrogen deficiency on rat mandibular and tibial microarchitecture
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Yang, J, primary, Pham, SM, additional, and Crabbe, DL, additional
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- 2003
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5. Adult heart transplantation under tacrolimus (FK506) immunosuppression: Histopathologic observations and comparison to a cyclosporine-based regimen with lympholytic (ATG) induction
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Tsamandas, AC, Pham, SM, Seaberg, EC, Pappo, O, Kormos, RL, Kawai, A, Griffith, BP, Zeevi, A, Duquesnoy, R, Fung, JJ, Starzl, TE, Demetris, AJ, Tsamandas, AC, Pham, SM, Seaberg, EC, Pappo, O, Kormos, RL, Kawai, A, Griffith, BP, Zeevi, A, Duquesnoy, R, Fung, JJ, Starzl, TE, and Demetris, AJ
- Abstract
Background: Tacrolimus (FK506) is an effective immunosuppressant for human heart transplantation, but information about its effects on cardiac allograft and nonallograft kidney and liver histopathologic study is limited. Methods: We therefore reviewed 1145 endomyocardial biopsy specimens and eight autopsy results from 80 heart transplant recipients who received tacrolimus as baseline immunosuppression. These were compared with 619 endomyocardial biopsy specimens and four autopsy results from 51 patients treated with cyclosporine-based immunosuppression with lympholytic induction (CLI) by use of rabbit anti-thymocyte globulin. Twenty-one histologic features including the International Society for Heart and Lung Transplantation histopathologic grade were retrospectively assessed without knowledge of the treatment regimen. The lymphocyte growth index on biopsy specimens obtained from these patients was also compared. Results: In general, there were no qualitative differences in the histopathologic appearance of various allograft syndromes between tacrolimus- and CLI-treated patients. Thus histopathologic criteria used to diagnose various graft syndromes are applicable under tacrolimus immunosuppression. However, early (between 10 and 30 days) after transplantation, biopsy specimens from patients treated with tacrolimus showed a significantly higher percentage of inflamed fragments (p = 0.02), the inflammation tended to be more severe (p = 0.09), and the rejection grade tended to be slightly higher (p = 0.08). In contrast, during the late transplantation period (275 to 548 days), biopsy specimens from patients treated with CLI showed a significantly higher percentage of inflamed fragments (p = 0.03), more severe inflammation (p = 0.03), higher rejection grades (p = 0.01), and a higher frequency of Quilty lesions (p = 0.05). Although overall freedom from any grade 3A or higher rejection was greater in the CLI-treated arm, tacrolimus was successfully used to treat refract
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- 1997
6. A prospective trial of tacrolimus (FK 506) in clinical heart transplantation: Intermediate-term results
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Pham, SM, Kormos, RL, Hattler, BG, Kawai, A, Tsamandas, AC, Demetris, AJ, Murali, S, Fricker, FJ, Chang, HC, Jain, AB, Starzl, TE, Hardesty, RL, Griffith, BP, Rose, EA, Castaneda, AR, Pham, SM, Kormos, RL, Hattler, BG, Kawai, A, Tsamandas, AC, Demetris, AJ, Murali, S, Fricker, FJ, Chang, HC, Jain, AB, Starzl, TE, Hardesty, RL, Griffith, BP, Rose, EA, and Castaneda, AR
- Abstract
Between January 1, 1989, and December 31, 1994, we have treated 122 primary heart recipients with FK 506 (group I) and 121 with cyclosporine (group II). Fifty patients in the cyclosporine (CyA) group received no lympholytic induction (CyA alone) and 71 others received lympholytic induction with either rabbit antithymocyte globulin or OKT3 (CyA+LI). The mean follow-up was longer in the FK 506 group than in the CyA groups (3.2 ± 1.3 vs 2.3 ± 1.8 years; p < 0.01). Patient survival did not differ on the basis of the type of immunosuppression used. At 3 months after transplantation, the freedom from rejection in the FK 506 group was higher than that of the CyA-alone group (47% vs 22%, p < 0.01) but similar to that of the CyA+LI group (47% vs 53%). The linearized rejection rate (episodes/100 patient-days) of the FK 506 group (0.09 episodes) was lower (p < 0.05) than that of the CyA-alone group (0.26) and the CyA+LI group (0.13). The requirement for pulsed steroids to treat rejection was less in common in the FK 506 group than in either CyA group. Eighteen patients in the CyA group had refractory rejections; all resolved with FK 506 rescue. Two patients in the FK 506 group had refractory rejection that resolved with total lymphoid irradiation (n = 1) and methotrexate therapy (n = 1). Patients receiving FK 506 had a lower risk of hypertension and required a lower dose of steroids. Although the mean serum creatinine concentration at 1 year was higher in the FK 506 group, this difference disappeared after 2 years. No patients required discontinuation of FK 506 because of its side effects. Our intermediate-term results indicate that FK 506 compares favorably with CyA as a primary immunosuppressant in heart transplantation.
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- 1996
7. Augmentation of chimerism in whole organ recipients by simultaneous infusion of donor bone marrow cells
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Rao, AS, Fontes, P, Zeevi, A, Trucco, M, Dodson, FS, Rybka, WB, Shapiro, R, Jordan, M, Pham, SM, Rilo, HL, Seskey, T, Todo, S, Scantlebury, V, Vivas, C, Demetris, AJ, Fung, JJ, Starzl, TE, Rao, AS, Fontes, P, Zeevi, A, Trucco, M, Dodson, FS, Rybka, WB, Shapiro, R, Jordan, M, Pham, SM, Rilo, HL, Seskey, T, Todo, S, Scantlebury, V, Vivas, C, Demetris, AJ, Fung, JJ, and Starzl, TE
- Published
- 1995
8. Perioperative donor bone marrow infusion augments chimerism in heart and lung transplant recipients
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Pham, SM, Keenan, RJ, Rao, AS, Fontes, PA, Kormos, RL, Abu-Elmagd, K, Zeevi, A, Kawai, A, Hattler, BG, Hardesty, RL, Demetris, AJ, Trucco, MM, Rosner, GL, Fung, JJ, Starzl, TE, Griffith, BP, Pham, SM, Keenan, RJ, Rao, AS, Fontes, PA, Kormos, RL, Abu-Elmagd, K, Zeevi, A, Kawai, A, Hattler, BG, Hardesty, RL, Demetris, AJ, Trucco, MM, Rosner, GL, Fung, JJ, Starzl, TE, and Griffith, BP
- Abstract
Background.: We and others have demonstrated that a low level of donor cell chimerism was present for years after transplantation in tissues and peripheral blood of heart and lung recipients; it was associated, in the latter, with a lower incidence of chronic rejection. To augment this phenomenon, we initiated a trial combining simultaneous infusion of donor bone marrow with heart or lung allotransplantation. Methods.: Between September 1993 and January 1995, 15 nonconditioned patients received either heart (n = 10) or lung (n = 5) allografts concurrently with an infusion of unmodified donor bone marrow (3.0 × 108 cells/kg), and were maintained on an immunosuppressive regimen consisting of tacrolimus and steroids. Results.: There was no complication associated with the infusion of donor bone marrow. Chimerism was detectable in 73% of bone marrow-augmented patients up to the last sample tested. Of the 5 control recipients who did not receive bone marrow infusion, only 1 had detectable chimerism by flow on postoperative day 15, which dwindled to an undetectable level by postoperative day 36. None of the patients had evidence of donor-specific immune modulation by mixed lymphocyte reaction. Conclusions.: The combined infusion of donor bone marrow and heart or lung transplantation, without preconditioning of the recipient, is safe and is associated with an augmentation of donor cell chimerism. © 1995 The Society of Thoracic Surgeons.
- Published
- 1995
9. Combined bone marrow and whole organ transplantation from the same donor
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Rao, AS, Fontes, P, Zeevi, A, Trucco, M, Shapiro, R, Demetris, AJ, Tzakis, AG, Carroll, PB, Rudert, WA, Dodson, FS, Rybka, WB, Pham, SM, Scantlebury, V, Rohal, S, Ricordi, C, Fung, JJ, Starzl, TE, Rao, AS, Fontes, P, Zeevi, A, Trucco, M, Shapiro, R, Demetris, AJ, Tzakis, AG, Carroll, PB, Rudert, WA, Dodson, FS, Rybka, WB, Pham, SM, Scantlebury, V, Rohal, S, Ricordi, C, Fung, JJ, and Starzl, TE
- Published
- 1994
10. A prospective randomized trial of fk506 versus cyclosporine after human pulmonary transplantation
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Griffith, BP, Bando, KO, Hardesty, RL, Armitage, JM, Keenan, RJ, Pham, SM, Paradis, IL, Yousem, SA, Komatsu, K, Konishi, H, Fung, JJ, Starzl, TE, Griffith, BP, Bando, KO, Hardesty, RL, Armitage, JM, Keenan, RJ, Pham, SM, Paradis, IL, Yousem, SA, Komatsu, K, Konishi, H, Fung, JJ, and Starzl, TE
- Abstract
We have conducted a unique prospective randomized study to compare the effect of PK506 and cyclosporine (CsA) as the principal immunosuppressive agents after pulmonary transplantation. Between October 1991 and March 1993, 74 lung transplants (35 single lung transplants [SLT], 39 bilateral lung transplant [BLT]) were performed on 74 recipients who were randomly assigned to receive either FK or CsA. Thirty-eight recipients (19 SLT, 19 BLT) received FK and 36 recipients (16 SLT, 20 BLT) received CsA. Recipients receiving FK or CsA were similar in age, gender, preoperative New York Heart Association functional class, and underlying disease. Acute rejection (ACR) was assessed by clinical, radiographic, and histologic criteria. ACR was treated with methylprednisolone, 1 g i.v./day, for three days or rabbit antithymocyte globulin if steroid-resistant.During the first 30 days after transplant, one patient in the FK group died of cerebral edema, while two recipients treated with CsA died of bacterial pneumonia (1) and cardiac arrest (1) (P=NS). Although one-year survival was similar between the groups, the number of recipients free from ACR in the FK group was significantly higher as compared with the CsA group (P<0.05). Bacterial and viral pneumonias were the major causes of late graft failure in both groups. The mean number of episodes of ACR/ 100 patient days was significantly fewer in the FK group (1.2) as compared with the CsA group (2.0) (P<0.05). While only one recipient (1/36=3%) in the group treated with CsA remained free from ACR within 120 days of transplantation, 13% (5/38) of the group treated with FK remained free from ACR during this interval (P<0.05). The prevalence of bacterial infection in the CsA group was 1.5 episodes/100 patient days and 0.6 episodes/100 patient days in the FK group. The prevalence of cytomegaloviral and fungal infection was similar in both groups.Although the presence of bacterial, fungal, and viral infections was similar in the two gro
- Published
- 1994
11. Ubiquitin enhances the Th2 cytokine response and attenuates ischemia-reperfusion injury in the lung.
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Garcia-Covarrubias L, Manning EW III, Sorell LT, Pham SM, and Majetschak M
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- 2008
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12. Novel use of an FDA-approved BiVAD for total cardiopulmonary support.
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Kaplon RJ, Nejman A, Andreopoulos F, Katariya K, Bolooki H, Kanevsky A, Parpard M, Qi X, Pham SM, Kaplon, Richard J, Nejman, Antoni, Andreopoulos, Fotios, Katariya, Kushagra, Bolooki, Hooshang, Kanevsky, Anatole, Parpard, Michael, Qi, Xiao, and Pham, Si M
- Abstract
We describe the use of an Abiomed BVS 5000i with an oxygenator spliced into the right side for total cardiopulmonary support after orthotopic heart transplantation. As compared to ECMO, we believe that the mechanical ventricular unloading seen with this type of assist device increases the likelihood of myocardial recovery. This report demonstrates that even with an in-line oxygenator, adequate flow can be delivered to both the RVAD and LVAD, providing complete cardiopulmonary support. [ABSTRACT FROM AUTHOR]
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- 2003
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13. Beating-heart valvular surgery: a possible alternative for patients with severely compromised ventricular function.
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Kaplon RJ, Pham SM, Salerno TA, Kaplon, Richard J, Pham, Si M, and Salerno, Tomas A
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- 2002
14. Resolution of Acute Respiratory Distress Syndrome-Induced Takotsubo Cardiomyopathy with Venovenous Extracorporeal Membrane Oxygenation.
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Wadiwala IJ, Garg P, Allen WL, Pham SM, and Thomas M
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- Humans, Female, Middle Aged, Treatment Outcome, Male, Takotsubo Cardiomyopathy etiology, Takotsubo Cardiomyopathy therapy, Extracorporeal Membrane Oxygenation, Respiratory Distress Syndrome therapy, Respiratory Distress Syndrome etiology
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Introduction: Takotsubo cardiomyopathy (TTCM) can occur in acute respiratory distress syndrome (ARDS) and a few cases in literature were reported to be associated with hemodynamic instability. All these patients were managed with venoarterial extracorporeal membrane oxygenation (VA-ECMO).Case presentation: We present two patients with ARDS-induced TTCM who were managed successfully with venovenous ECMO (VV-ECMO)., Conclusion: Ventricular function in both patients fully recovered three days after ECMO initiation, and they were subsequently weaned from ECMO once pulmonary function improved.
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- 2024
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15. Outcomes after noncardiac surgery in patients with left ventricular assist devices: a systematic review.
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Alamouti-Fard E, Garg P, Yazji J, Brigham T, Jacob S, Wadiwala IJ, and Pham SM
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Background: The number of patients living with left ventricular assist devices (LVADs) has gradually increased in the past decade. Non-cardiac surgery (NCS) in patients with LVAD poses a unique situation with its inherent challenges., Aim: We conducted a comprehensive review to investigate the perioperative complications and mortality associated with emergent or elective NCS in patients with LVAD., Method: A comprehensive literature search for any papers referring to continuous LVAD patients with NCS. All publications with at least five durable LVAD patients who had NCS were eligible for inclusion., Result: Twenty articles matching our criteria were found and included in our study. This systematic review included 6,476 LVAD patients who underwent 6,824 NCS. There were 5-3,216 LVAD patients with NCS in each study. The median age was between 39 and 65 years, and most of the patients (78.8%) were male. Thirty-day postoperative mortality ranged from 0% to 60%. Eight studies reported no death within the 30 days of the operation. Common complications include gastrointestinal (GI) bleeding, intracranial bleeding, infection, acute kidney injury (AKI), urinary tract infection (UTI), stroke, sepsis, pneumonia, and VAD exchange. Emergent abdominal surgery had the highest (up to 60%) mortality rate, and vascular and neurological operations had the highest complication rates. Due to the diverse range of patients in each publication and the combination of outcomes presented in various publications, a meta-analysis was not conducted., Conclusion: In LVAD patients, noncardiac surgery may be performed effectively and safely. LVAD patients who undergo non-cardiac surgery may require more transfusions due to their complex coagulopathies. However, perioperative management of LVAD patients undergoing emergent NCS should be optimized to reduce mortality., Systematic Review Registration: https://osf.io/fetsb/., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Alamouti-Fard, Garg, Yazji, Brigham, Jacob, Wadiwala and Pham.)
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- 2024
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16. Impact of controlled hypothermic preservation on outcomes following heart transplantation.
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D'Alessandro D, Schroder J, Meyer DM, Vidic A, Shudo Y, Silvestry S, Leacche M, Sciortino CM, Rodrigo ME, Pham SM, Copeland H, Jacobs JP, Kawabori M, Takeda K, and Zuckermann A
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- Humans, Female, Male, Middle Aged, Primary Graft Dysfunction prevention & control, Primary Graft Dysfunction epidemiology, Primary Graft Dysfunction etiology, Registries, Adult, Retrospective Studies, Risk Factors, United States epidemiology, Survival Rate trends, Tissue Donors, Graft Survival, Aged, Heart Transplantation, Organ Preservation methods
- Abstract
Background: Severe primary graft dysfunction (PGD) is a major cause of early mortality after heart transplant, but the impact of donor organ preservation conditions on severity of PGD and survival has not been well characterized., Methods: Data from US adult heart-transplant recipients in the Global Utilization and Registry Database for Improved Heart Preservation-Heart Registry (NCT04141605) were analyzed to quantify PGD severity, mortality, and associated risk factors. The independent contributions of organ preservation method (traditional ice storage vs controlled hypothermic preservation) and ischemic time were analyzed using propensity matching and logistic regression., Results: Among 1,061 US adult heart transplants performed between October 2015 and December 2022, controlled hypothermic preservation was associated with a significant reduction in the incidence of severe PGD compared to ice (6.6% [37/559] vs 10.4% [47/452], p = 0.039). Following propensity matching, severe PGD was reduced by 50% (6.0% [17/281] vs 12.1% [34/281], respectively; p = 0.018). The Kaplan-Meier terminal probability of 1-year mortality was 4.2% for recipients without PGD, 7.2% for mild or moderate PGD, and 32.1%, for severe PGD (p < 0.001). The probability of severe PGD increased for both cohorts with longer ischemic time, but donor hearts stored on ice were more likely to develop severe PGD at all ischemic times compared to controlled hypothermic preservation., Conclusions: Severe PGD is the deadliest complication of heart transplantation and is associated with a 7.8-fold increase in probability of 1-year mortality. Controlled hypothermic preservation significantly attenuates the risk of severe PGD and is a simple yet highly effective tool for mitigating post-transplant morbidity., (Copyright © 2024 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)
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- 2024
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17. Multidisciplinary Management Strategies for Long COVID: A Narrative Review.
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Prusinski C, Yan D, Klasova J, McVeigh KH, Shah SZ, Fermo OP, Kubrova E, Farr EM, Williams LC, Gerardo-Manrique G, Bergquist TF, Pham SM, Engelberg-Cook E, Hare JM, March KL, Caplan AI, and Qu W
- Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused millions of infections to date and has led to a worldwide pandemic. Most patients had a complete recovery from the acute infection, however, a large number of the affected individuals experienced symptoms that persisted more than 3 months after diagnosis. These symptoms most commonly include fatigue, memory difficulties, brain fog, dyspnea, cough, and other less common ones such as headache, chest pain, paresthesias, mood changes, muscle pain, and weakness, skin rashes, and cardiac, endocrine, renal and hepatic manifestations. The treatment of this syndrome remains challenging. A multidisciplinary approach to address combinations of symptoms affecting multiple organ systems has been widely adopted. This narrative review aims to bridge the gap surrounding the broad treatment approaches by providing an overview of multidisciplinary management strategies for the most common long COVID conditions., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Prusinski et al.)
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- 2024
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18. Quadricuspid Aortic Valve: Imaging, Diagnosis, and Prognosis.
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Alomari M, El-Sayed Ahmed MM, Ali M, Wadiwala IJ, Pham SM, and Sareyyupoglu B
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- Humans, Female, Middle Aged, Predictive Value of Tests, Heart Valve Prosthesis Implantation, Echocardiography, Doppler, Color, Aortic Valve abnormalities, Aortic Valve diagnostic imaging, Aortic Valve surgery, Echocardiography, Transesophageal methods, Incidental Findings, Aortic Valve Insufficiency surgery, Aortic Valve Insufficiency diagnosis, Aortic Valve Insufficiency etiology, Heart Defects, Congenital diagnosis, Heart Defects, Congenital surgery, Heart Defects, Congenital diagnostic imaging
- Abstract
Quadricuspid aortic valve is a rare congenital cardiac anomaly with an incidence of 0.008% to 0.043%. Its clinical course varies depending on cusp anatomy, function, and associated cardiac malformations. It frequently progresses to aortic valve regurgitation that may require surgical valve replacement. Detection has shifted from incidental discovery during autopsies or cardiac surgeries in the early 20th century to various cardiac imaging methods in recent decades. In addition to contributing to the literature, this report supports the use of transesophageal echocardiography more liberally to detect aortic valve abnormalities. The case presents a 48-year-old female patient with an incidentally discovered quadricuspid aortic valve., (© 2024 The Authors. Published by The Texas Heart Institute®.)
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- 2024
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19. Outcome of lung transplantation in patients with pulmonary alveolar microlithiasis in the era of COVID-19 infection.
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Raavi L, Garg P, Alomari M, Celik NB, Makey IA, Thomas M, Nassar A, Sareyyupoglu B, Jacob S, Pham SM, and El-Sayed Ahmed MM
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Lung transplant recipients are at higher risk of developing COVID-19 infection compared to other solid organ transplants. The risk further increases in the unvaccinated patients. We present a case of a 43-year-old male who underwent bilateral sequential lung transplantation for pulmonary alveolar microlithiasis (PAM) and had an uneventful recovery. However, two years post-transplantation, the patient developed chronic lung allograft dysfunction (CLAD) with bronchiolitis obliterans syndrome and two episodes of COVID-19 infection. During the second episode of COVID-19 infection, the patient developed sepsis and multi-organ dysfunction ultimately resulting in death. Our case report highlights the increased susceptibility of PAM patients' post-lung transplant to COVID-19 infection. Continuous follow-up of PAM patients' post-lung transplantation is necessary to prevent unfavorable outcomes., Competing Interests: The authors have no conflict of interest, and this study was not financially supported., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2024.)
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- 2024
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20. Reduction aortoplasty of donor ascending aorta aneurysm during heart transplant: A case report.
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Celik NB, Alomari M, Garg P, Sareyyupoglu B, and Pham SM
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Competing Interests: The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.
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- 2024
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21. The Use of Ex Situ Normothermic Machine Perfusion in Combined Cardiac and Liver Transplantation Procedures.
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Das I, Pham SM, Perry DK, and Croome KP
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Competing Interests: The authors declare no funding or conflicts of interest.
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- 2024
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22. Survival Outcomes of Lung Transplant Recipients From Donors With Abnormal Kidney Function.
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El-Sayed Ahmed MM, Shah SZ, Zhang N, Jarmi T, Jacob S, Makey IA, Thomas M, Sareyyupoglu B, Landolfo KP, Erasmus DB, and Pham SM
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Background: Recovering lungs with pulmonary edema due to abnormal kidney function is considered one of the expanded selection criteria for lung transplant. The aim of this study is to assess lung transplant recipients' survival from donors with abnormal kidney function and to determine differences in lung recovery rates from donors with and donors without abnormal kidney function., Methods: We reviewed the United Network for Organ Sharing registry for first-time adult lung transplant donors and recipients from June 2005 to March 2017. Donor kidney function was categorized into three groups based on estimated glomerular filtration rate: group I, greater than 60 mL/min; group II, 15 to 59 mL/min; and group III, less than 15 mL/min. Recipient survival was stratified based on estimated glomerular filtration rate using Kaplan-Meier. A multivariate Cox Regression model with known risk factors that affect survival was used to compare survival among groups. Comparison of lung recovery among the three groups was also performed., Results: Lung recovery rates were 29.7% (15,670 of 52,747), 19.4% (3879 of 20,040), and 18.1% (704 of 3898) for groups I, II, and III, respectively. The 1-, 3-, and 5-year recipient survival rates were 86.2%, 69.2%, and 55.7% for group I; 84.9%, 66.9%, and 53.8% for group II; and 85.5%, 65.3%, and 50.3% for group III, respectively (adjusted P = .25; multivariate Cox regression method). When group I was used as reference, the adjusted hazard ratio for group II was 1.04 (95% CI, 0.98-1.10) and for group III, it was 1.08 (95% CI, 0.96-1.23), after adjusting with the multivariate Cox regression model., Conclusions: There was no significant difference in lung recipient survival. The lung recovery rate from donors with abnormal kidney function was lower compared with that of donors with normal kidney function., (Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2023
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23. Percutaneous Transseptal Extracorporeal Membrane Oxygenation to Rescue a Failing Right Ventricle in an Animal Model.
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Castillo-Larios R, Pollak PM, Chaudhary S, Case JB, Guru PK, Alomari M, Song Z, Johnson JL Jr, Narula T, Pham SM, and Makey IA
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- Humans, Animals, Swine, Heart Ventricles surgery, Heart Atria surgery, Models, Animal, Extracorporeal Membrane Oxygenation, Heart Failure therapy, Hypertension, Pulmonary surgery, Hypertension, Pulmonary complications
- Abstract
Objective: We tested the feasibility and effectiveness of a percutaneous atrial transseptal extracorporeal membrane oxygenation (ECMO) cannulation strategy in a right ventricular failure (RVF) model., Methods: We performed 4 nonsurvival porcine experiments. Percutaneous transseptal access was achieved using a steerable introducer. For guidance, we used fluoroscopy, transesophageal echocardiogram (TEE), and intracardiac echocardiography (ICE). A ProtekDuo rapid deployment cannula (LivaNova, London, UK) was advanced across the septum into the left atrium by 2 to 3 cm. Pulmonary hypertension (PH) was induced by partially clamping the pulmonary artery. ECMO flow was cycled from high (2 to 3 L/min) to low (0.2 to 0.3 L/min) over 2 to 3 hours., Results: Transseptal access using TEE and fluoroscopy was successful in 1 animal and unsuccessful in 1 animal. ICE provided optimal visualization for the remaining 2 animals. Mean arterial pressure (MAP) was associated immediately and consistently with high versus low ECMO flow rate (mean difference: 29 ± 3.1 mm Hg, P = 0.004) but was not restored to baseline values. RV pressure values were dynamic. Given time to equilibrate, mean RV pressure was restored to a baseline level., Conclusions: Percutaneous right atrium to left atrium transseptal cannulation relieved PH-RVF. MAP was restored to a viable level, and mean RV pressure was restored to a baseline level. Transseptal ECMO shows promise as a cannulation strategy to bridge patients with PH-RVF to lung transplant., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2023
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24. Trends and predictors of intracranial hemorrhage in patients with advanced heart failure on left ventricular assist device from 2005 to 2014 in the United States.
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Shourav MMI, Goswami RM, Pham SM, Anisetti B, Markovic D, and Lin MP
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Objectives: Left ventricular assist devices are known to extend survival in patients with advanced heart failure; however, their association with intracranial hemorrhage is also well-known. We aimed to explore the risk trend and predictors of intracranial hemorrhage in patients with left ventricular assist devices., Material and Methods: We included patients aged 18 years or older with left ventricular assist devices hospitalized in the US from 2005 to 2014 using the National Inpatient Sample. We computed the survey-weighted percentages with intracranial hemorrhage across the 10-year study period and assessed whether the proportions changed over time. Predictors of intracranial hemorrhage were evaluated using multivariable logistic regression model., Results: Of 33,246 hospitalizations, 568 (1.7%) had intracranial hemorrhage. The number of left ventricular assist devices placements increased from 873 in 2005 to 5175 in 2014. However, the risk of intracranial hemorrhage remained largely unchanged (1.7% to 2.3%; linear trend, P = 0.604). The adjusted odds of intracranial hemorrhage were increased with the presence of one of the following variables: female sex (odds ratio [OR], 1.58; 95% CI, 1.03-2.43), history of ischemic stroke (OR, 3.13; 95% CI, 1.86-5.28), or Charlson Comorbidity Index score of 3 or more (OR, 77.40; 95% CI, 10.03-597.60)., Conclusions: Over the last decade, the risk of intracranial hemorrhage has remained relatively unchanged despite an increase in the use of left ventricular assist devices in patients with advanced heart failure. Women, higher Charlson Comorbidity Index scores, and history of ischemic stroke were associated with higher odds of intracranial hemorrhage in patients with left ventricular assist devices., Competing Interests: Declaration of Competing Interest The authors declare there is no conflict of interests., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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25. A Paradigm Shift in Heart Preservation: Improved Post-transplant Outcomes in Recipients of Donor Hearts Preserved With the SherpaPak System.
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Shudo Y, Leacche M, Copeland H, Silvestry S, Pham SM, Molina E, Schroder JN, Sciortino CM, Jacobs JP, Kawabori M, Meyer DM, Zuckermann A, and D'Alessandro DA
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- Adult, Humans, Ice, Heart, Incidence, Retrospective Studies, Tissue Donors, Heart Transplantation adverse effects, Heart Transplantation methods
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Traditional ice storage has been the historic standard for preserving donor's hearts. However, this approach provides variability in cooling, increasing risks of freezing injury. To date, no preservation technology has been reported to improve survival after transplantation. The Paragonix SherpaPak Cardiac Transport System (SCTS) is a controlled hypothermic technology clinically used since 2018. Real-world evidence on clinical benefits of SCTS compared to conventional ice cold storage (ICS) was evaluated. Between October 2015 and January 2022, 569 US adults receiving donor hearts preserved and transported either in SCTS (n = 255) or ICS (n = 314) were analyzed from the Global Utilization And Registry Database for Improved heArt preservatioN (GUARDIAN-Heart) registry. Propensity matching and a subgroup analysis of >240 minutes ischemic time were performed to evaluate comparative outcomes. Overall, the SCTS cohort had significantly lower rates of severe primary graft dysfunction (PGD) ( p = 0.03). When propensity matched, SCTS had improving 1-year survival ( p = 0.10), significantly lower rates of severe PGD ( p = 0.011), and lower overall post-transplant MCS utilization ( p = 0.098). For patients with ischemic times >4 hours, the SCTS cohort had reduced post-transplant MCS utilization ( p = 0.01), reduced incidence of severe PGD ( p = 0.005), and improved 30-day survival ( p = 0.02). A multivariate analysis of independent risk factors revealed that compared to SCTS, use of ice results in a 3.4-fold greater chance of severe PGD ( p = 0.014). Utilization of SCTS is associated with a trend toward increased post-transplant survival and significantly lower severe PGD and MCS utilization. These findings fundamentally challenge the decades-long status quo of transporting donor hearts using ice., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the ASAIO.)
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- 2023
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26. Initial experience and outcomes with a hybrid extracorporeal membrane oxygenation and cardiopulmonary bypass circuit for lung transplantation.
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Martin AK, Fritz AV, Pham SM, Landolfo KP, Sareyyupoglu B, Brown TE, Logvinov I, Li Z, Narula T, Makey IA, and Thomas M
- Abstract
Background: The utilization of extracorporeal life support (ECLS) for intraoperative support during lung transplantation has increased over the past decade. Although veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has recently emerged as the preferred modality over cardiopulmonary bypass (CPB), many centers continue to use both forms of ECLS during lung transplantation. Our novel hybrid VA-ECMO/CPB circuit allows for seamless transition from VA-ECMO to CPB at a significant cost savings compared to a standalone VA-ECMO circuit. This study describes our initial experience and outcomes in the first 100 bilateral lung transplantations using this novel hybrid VA-ECMO/CPB circuit., Methods: Medical records from September 2017 to May 2021 of the first 100 consecutive patients undergoing bilateral lung transplantation with intraoperative hybrid VA-ECMO support were examined retrospectively. We excluded patients with single lung transplants, retransplantations, preoperative ECLS bridging, and veno-venous (VV) ECMO and those supported with CPB only. Perioperative recipient, anesthetic, perfusion variables, and outcomes were assessed., Results: Of the 100 patients supported with VA-ECMO, 19 were converted intraoperatively to CPB. Right ventricular dysfunction was seen in 37% of patients, and the median mean pulmonary artery pressure was 28 mm Hg. No oxygenator clotting was observed with a median heparin dose of 13,000 units in the VA-ECMO group. Primary graft dysfunction grade 3 at 72 hours was observed in 10.1% of all patients and observed 1-year mortality was 4%., Conclusions: The use of a hybrid VA-ECMO/CPB circuit in our institution allows for rapid conversion to CPB with acceptable outcomes across a diverse recipient group at a significantly reduced cost compared to standalone VA-ECMO circuits., Competing Interests: A.K.M. serves as a consultant and scientific advisory board member for Attgeno AB, with all compensation to the Mayo Clinic. T.N. serves on an advisory board for Lung Bioengineering, with all compensation to the Mayo Clinic. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (© 2023 The Author(s).)
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- 2023
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27. Iatrogenic Acute Ascending Aortic Dissection During Combined Heart/Liver Transplant for Amyloidosis.
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Wadiwala IJ, Garg P, Pham V, Taner CB, Farres H, Krishna M, and Pham SM
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- Humans, Iatrogenic Disease, Aortic Aneurysm diagnostic imaging, Aortic Aneurysm etiology, Aortic Aneurysm surgery, Liver Transplantation adverse effects, Dissection, Ascending Aorta, Aortic Dissection diagnostic imaging, Aortic Dissection etiology, Aortic Dissection surgery, Heart Transplantation adverse effects, Amyloidosis complications
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We report a case of iatrogenic acute type A aortic dissection (ATAAD) during a combined heart-liver transplant in a patient with amyloid-associated cardiac and hepatic failure. The patient developed ATAAD of the recipient's aorta during the heart transplantation. Because there was no sign of malperfusion or proximal extension into the donor aorta, we proceeded with the liver transplantation and continued medical management for ATAAD. The patient was discharged uneventfully 30 days after the transplant, and computed tomography coronary angiogram after 4 months showed stable dissection. During a heart transplant, ATAAD of the native aorta without malperfusion syndrome can be managed conservatively with close progress monitoring., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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28. Short-term outcomes of heart transplant patients bridged with Impella 5.5 ventricular assist device.
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Haddad O, Sareyyupoglu B, Goswami RM, Bitargil M, Patel PC, Jacob S, El-Sayed Ahmed MM, Leoni Moreno JC, Yip DS, Landolfo K, and Pham SM
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- Humans, Retrospective Studies, Treatment Outcome, Heart-Assist Devices adverse effects, Heart Transplantation, Heart Failure surgery, Heart Failure etiology
- Abstract
Aims: We sought to investigate the outcomes of heart transplant patients supported with Impella 5.5 temporary mechanical circulatory support., Methods and Results: Patient demographics, perioperative data, hospital timeline, and haemodynamic parameters were followed during initial admission, Impella support, and post-transplant period. Vasoactive-inotropic score, primary graft failure, and complications were recorded. Between March 2020 and March 2021, 16 advanced heart failure patients underwent Impella 5.5 temporary left ventricular assist device support through axillary approach. Subsequently, all these patients had heart transplantation. All patients were either ambulatory or chair bound during their temporary mechanical circulatory support until heart transplantation. Patients were kept on Impella support median of 19 days (3-31) with the median lactate dehydrogenase level of 220 (149-430). All Impella devices were removed during heart transplantation. During Impella support, patients had improved renal function with median creatinine serum level of 1.55 mg/dL decreased to 1.25 (P = 0.007), pulmonary artery pulsatility index scores increased from 2.56 (0.86-10) to 4.2 (1.3-10) (P = 0.048), and right ventricular function improved (P = 0.003). Patients maintained improved renal function and favourable haemodynamics after their heart transplantation as well. All patients survived without any significant morbidity after their heart transplantation., Conclusions: Impella 5.5 temporary left ventricular assist device optimizes care of heart transplant recipients providing superior haemodynamic support, mobility, improved renal function, pulmonary haemodynamics, and right ventricular function. Utilizing Impella 5.5 as a direct bridging strategy to heart transplantation resulted in excellent outcomes., (© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
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- 2023
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29. Septal myectomy for hypertrophic obstructive cardiomyopathy using a pulsed radiofrequency energy soft tissue dissection instrument.
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Alomari M, Garg P, Wadiwala I, Pham SM, and Sareyyupoglu B
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- 2023
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30. Novel treatment of bronchopleural fistula in a lung transplant recipient with endobronchial sealant and endobronchial valve placement via robotic-assisted bronchoscopy.
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Wadiwala IJ, Fernandez-Bussy S, Garg P, Ali M, Feinglass NG, Thomas M, and Pham SM
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Bronchopleural fistulas (BPFs) are a dreaded complication following pulmonary surgery. Endobronchial valves (EVs), with endobronchial sealant (ES), instilled with robotic bronchoscopy (RB), allow occlusion of BPF, avoiding surgery. The patient was a 71-year-old woman with a history of chronic obstructive pulmonary disease and bronchiectasis who underwent bilateral lung transplantation and wedge resection of the right middle lobe and left lingula. A BPF was discovered on postoperative day (POD) 21. Conservative measures with chest tubes failed, and robotic-assisted bronchoscopy aided in reaching the bronchial segment and instilling ES, and EV was deployed with the conventional bronchoscope. The pneumothorax was cleared 12 days later, and on POD 56, she was discharged. The RB procedure was successful, with no pneumothorax or BPF symptoms after a median follow-up of POD 284. Robotic endobronchial closure of BPF with EV and ES is an effective treatment option avoiding invasive surgeries., Competing Interests: None declared., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2023.)
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- 2023
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31. No Sex Differences in the Prevalence of Intracranial Aneurysms in Patients with Ascending Thoracic Aortic Aneurysms: A Multi-Center Experience.
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Franco-Mesa C, Erben Y, Perez AF, Ball CT, Barrett KM, Pham SM, Pochettino A, Fox WC, Miller DA, Sandhu SJS, Brott TG, and Meschia JF
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- Humans, Male, Female, Middle Aged, Aged, Retrospective Studies, Prevalence, Risk Factors, Treatment Outcome, Multicenter Studies as Topic, Intracranial Aneurysm diagnostic imaging, Intracranial Aneurysm epidemiology, Intracranial Aneurysm surgery, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic epidemiology, Aortic Aneurysm, Thoracic surgery, Aortic Aneurysm complications
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Background: Previous studies suggest a coprevalence of intracranial aneurysms (IA) in patients with infrarenal abdominal aortic aneurysms (AAA). We reviewed our multicenter experience in the detection/treatment of IAs in patients with ascending thoracic aortic aneurysms (ATAA) relative to patients without ATAA., Methods: Surgical cases of ATAA repaired at 3 sites from January 1998 to December 2018 were retrospectively reviewed. Out of these patients, those with intracranial vascular imaging were selected for our study, and these individuals were concurrently randomly matched with a control group of patients who underwent intracranial vascular imaging without an ATAA in a 1:1 ratio by age, sex, smoking history, and year of intracranial vascular imaging. Conditional logistic regression was used to calculate odds ratios (OR)., Results: We reviewed 2176 ATAA repairs. 74% (n = 1,615) were men. Intracranial vascular imaging was available in 298 (13.7%) patients. Ninteen patients were found to have 22 IAs for a prevalence of 6.4%. Mean size of IA was 4.6 ± 3.3 mm; mean age at IA detection, 63.4 ± 12.1 years. IA was present on head imaging in 4.7% of male and 12.5% of female patients. Eleven (58%) patients were men. The OR of having IA in female versus male patients is 2.90, 95% confidence interval [CI] [1.08-7.50], P = 0.029. Time from IA diagnosis to ATAA repair was 1.7 ± 116.2 months. Two patients underwent treatment for IA, one ruptured and one unruptured. All were diagnosed before ATAA repair. Treatment included 1 clipping and 1 coiling with subsequent reintervention of the coiling using a flow diversion device. In the matched group of patients who had intracranial vascular imaging without ATAA, the rate of IA is 5.0%. IA was detected in 3.8% of males and 9.4% of female patients for an OR of 2.59, 95% CI [0.84-7.47], P = 0.083. Association within our study and matched groups, the OR of developing an IA with and without ATAA was not statistically significant 1.29, 95% CI [0.642.59], P = 0.48. There was also no evidence of sex differences in the association of ATAA with IA (interaction P = 0.88). The OR for the association of ATAA with IA was 1.33, 95% CI [0.46-3.84], P = 0.59 in females and 1.25, 95% CI [0.49-3.17], P = 0.64 in males., Conclusions: Our study found that IA was present in 6.4% of patients with ATAA who had intracranial vascular imaging available. The odds of IA were 1.29 times higher than a matched cohort of patients who had intracranial vascular imaging without ATAA but this failed to achieve statistical significance. We found that the odds of IA were more than 2 times higher in females than males for both those with ATAA (OR = 2.90) and those without ATAA (OR = 2.59); however, it only reached statistical significance in those with ATAA., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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32. Transplantation Outcomes with Donor Hearts after Circulatory Death.
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Schroder JN, Patel CB, DeVore AD, Bryner BS, Casalinova S, Shah A, Smith JW, Fiedler AG, Daneshmand M, Silvestry S, Geirsson A, Pretorius V, Joyce DL, Um JY, Esmailian F, Takeda K, Mudy K, Shudo Y, Salerno CT, Pham SM, Goldstein DJ, Philpott J, Dunning J, Lozonschi L, Couper GS, Mallidi HR, Givertz MM, Pham DT, Shaffer AW, Kai M, Quader MA, Absi T, Attia TS, Shukrallah B, Sun BC, Farr M, Mehra MR, Madsen JC, Milano CA, and D'Alessandro DA
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- Adult, Humans, Graft Survival, Organ Preservation, Tissue Donors, Death, Patient Safety, Brain Death, Heart Transplantation, Tissue and Organ Procurement
- Abstract
Background: Data showing the efficacy and safety of the transplantation of hearts obtained from donors after circulatory death as compared with hearts obtained from donors after brain death are limited., Methods: We conducted a randomized, noninferiority trial in which adult candidates for heart transplantation were assigned in a 3:1 ratio to receive a heart after the circulatory death of the donor or a heart from a donor after brain death if that heart was available first (circulatory-death group) or to receive only a heart that had been preserved with the use of traditional cold storage after the brain death of the donor (brain-death group). The primary end point was the risk-adjusted survival at 6 months in the as-treated circulatory-death group as compared with the brain-death group. The primary safety end point was serious adverse events associated with the heart graft at 30 days after transplantation., Results: A total of 180 patients underwent transplantation; 90 (assigned to the circulatory-death group) received a heart donated after circulatory death and 90 (regardless of group assignment) received a heart donated after brain death. A total of 166 transplant recipients were included in the as-treated primary analysis (80 who received a heart from a circulatory-death donor and 86 who received a heart from a brain-death donor). The risk-adjusted 6-month survival in the as-treated population was 94% (95% confidence interval [CI], 88 to 99) among recipients of a heart from a circulatory-death donor, as compared with 90% (95% CI, 84 to 97) among recipients of a heart from a brain-death donor (least-squares mean difference, -3 percentage points; 90% CI, -10 to 3; P<0.001 for noninferiority [margin, 20 percentage points]). There were no substantial between-group differences in the mean per-patient number of serious adverse events associated with the heart graft at 30 days after transplantation., Conclusions: In this trial, risk-adjusted survival at 6 months after transplantation with a donor heart that had been reanimated and assessed with the use of extracorporeal nonischemic perfusion after circulatory death was not inferior to that after standard-care transplantation with a donor heart that had been preserved with the use of cold storage after brain death. (Funded by TransMedics; ClinicalTrials.gov number, NCT03831048.)., (Copyright © 2023 Massachusetts Medical Society.)
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- 2023
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33. Multiplex RT Real-Time PCR Based on Target Failure to Detect and Identify Different Variants of SARS-CoV-2: A Feasible Method That Can Be Applied in Clinical Laboratories.
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Pham VH, Pham HT, Balzanelli MG, Distratis P, Lazzaro R, Nguyen QV, Tran VQ, Tran DK, Phan LD, Pham SM, Pham BT, Duc CV, Nguyen HM, Nguyen DNT, Tran NV, Pham ST, Queck C, Nguyen KDC, Inchingolo F, Del Prete R, Nguyen NHD, Santacroce L, and Gargiulo Isacco C
- Abstract
Shortly after its emergence, Omicron and its sub-variants have quickly replaced the Delta variant during the current COVID-19 outbreaks in Vietnam and around the world. To enable the rapid and timely detection of existing and future variants for epidemiological surveillance and diagnostic applications, a robust, economical real-time PCR method that can specifically and sensitively detect and identify multiple different circulating variants is needed. The principle of target- failure (TF) real-time PCR is simple. If a target contains a deletion mutation, then there is a mismatch with the primer or probe, and the real-time PCR will fail to amplify the target. In this study, we designed and evaluated a novel multiplex RT real-time PCR (MPL RT-rPCR) based on the principle of target failure to detect and identify different variants of SARS-CoV-2 directly from the nasopharyngeal swabs collected from COVID-19 suspected cases. The primers and probes were designed based on the specific deletion mutations of current circulating variants. To evaluate the results from the MPL RT-rPCR, this study also designed nine pairs of primers for amplifying and sequencing of nine fragments from the S gene containing mutations of known variants. We demonstrated that (i) our MPL RT-rPCR was able to accurately detect multiple variants that existed in a single sample; (ii) the limit of detection of the MPL RT-rPCR in the detection of the variants ranged from 1 to 10 copies for Omicron BA.2 and BA.5, and from 10 to 100 copies for Delta, Omicron BA.1, recombination of BA.1 and BA.2, and BA.4; (iii) between January and September 2022, Omicron BA.1 emerged and co-existed with the Delta variant during the early period, both of which were rapidly replaced by Omicron BA.2, and this was followed by Omicron BA.5 as the dominant variant toward the later period. Our results showed that SARS-CoV-2 variants rapidly evolved within a short period of time, proving the importance of a robust, economical, and easy-to-access method not just for epidemiological surveillance but also for diagnoses around the world where SARS-CoV-2 variants remain the WHO's highest health concern. Our highly sensitive and specific MPL RT-rPCR is considered suitable for further implementation in many laboratories, especially in developing countries.
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- 2023
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34. Coronavirus Disease 2019 Causing Infection of Transplanted Lung Allograft: A Pitfall of Prolonged Shedding of Severe Acute Respiratory Syndrome Coronavirus-2 Pretransplant.
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Shah SZ, Alvarez FG, Sanghavi DK, Moreno Franco P, Isha S, Marquez CP, Libertin C, Guru PK, Sareyyupoglu B, and Pham SM
- Abstract
Coronavirus disease 2019 (COVID-19) pandemic has led to considerable morbidity and mortality across the world. Lung transplant is a viable option for a few with COVID-19-related lung disease. Whom and when to transplant has been the major question impacting the transplant community given the novelty of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We describe a pitfall of presumed prolonged shedding of SARS-CoV-2 in a patient with COVID-19 associated acute respiratory distress syndrome leading to COVID-19 pneumonia after lung transplant. This raises concerns that replication-competent SARS-CoV-2 virus can persist for months post-infection and can lead to re-infection of grafts in the future., (© 2023 The Authors.)
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- 2023
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35. Multicenter Registry Using Propensity Score Analysis to Compare a Novel Transport/Preservation System to Traditional Means on Postoperative Hospital Outcomes and Costs for Heart Transplant Patients.
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Voigt JD, Leacche M, Copeland H, Wolfe SB, Pham SM, Shudo Y, Molina E, Jacobs JP, Stukov Y, Meyer D, Philpott J, Kawabori M, Schroder J, Silvestry S, and D'Alessandro D
- Subjects
- Humans, Propensity Score, Hospitals, Registries, Retrospective Studies, Treatment Outcome, Ice, Heart Transplantation adverse effects
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The standard method for cardiac allograft preservation for the past 50 years has been static storage using crushed ice. A heart transplant transportation system designed to improve preservation quality with temperature monitoring, the Paragonix SherpaPak Cardiac Transport System (SCTS), was evaluated for its impact on postoperative costs relative to conventional ice storage. Observational US multicenter registry data collected during the August 2015 to November 2021 timeframe from 12 transplant hospitals were analyzed using logistic regression analysis and propensity matching to balance measured baseline covariates and to reduce selection bias. Hospital cost and outcome data post-transplant were then evaluated using various statistical methods. One hundred seventy-four (174) patients were identified resulting in 87 matches. Baseline characteristics were similar between groups. The SCTS group had a significantly lower proportion of ICU days on post-transplant mechanical circulatory support ( p < 0.0001); significantly fewer patients on extracorporeal membrane oxygenation ( p = 0.017); and significantly fewer patients experiencing severe primary graft dysfunction (PGD) ( p = 0.03). Overall hospital plus mechanical circulatory support post-transplant costs were significantly lower by $26.7K in the CTS cohort ( p = 0.03). Use of the SCTS is associated with improved clinical outcomes resulting in significantly lower overall hospital care costs., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the ASAIO.)
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- 2023
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36. A novel technique for insertion of left ventricular assist device in a patient with severely calcified left ventricle apex.
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Khan FW, Pham V, Garg P, Hussain MWA, and Pham SM
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- 2023
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37. Discovery of novel N-acylpyrazoles as potent and selective thrombin inhibitors.
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Short KM, Estiarte MA, Pham SM, Williams DC, Igoudin L, Dash S, Sandoval N, Datta A, Pozzi N, Di Cera E, and Kita DB
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- Humans, Factor Xa Inhibitors pharmacology, Anticoagulants pharmacology, Anticoagulants therapeutic use, Heparin, Warfarin therapeutic use, Administration, Oral, Thrombin, Thrombosis drug therapy
- Abstract
Direct oral anticoagulants (DOACs), which includes thrombin and factor Xa inhibitors, have emerged as the preferred therapeutics for thrombotic disorders, penetrating a market previously dominated by warfarin and heparin. This article describes the discovery and profiling of a novel series of N-acylpyrazoles, which act as selective, covalent, reversible, non-competitive inhibitors of thrombin. We describe in vitro stability issues associated with this chemotype and, importantly, demonstrate that N-acylpyrazoles successfully act in vivo as anticoagulants in basic thrombotic animal models. Crucially, this anticoagulant nature is unaccompanied by the higher bleeding risk profile that has become an undesirable characteristic of the DTIs and factor Xa inhibitors. We propose that the N-acylpyrazole chemotype shows intriguing promise as next-generation oral anticoagulants., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Enrico DiCera reports financial support was provided by National Institutes of Health. Kevin M. Short has patent #US9,533,967 issued to Verseon Corporation. Kevin M. Short has patent #US9,963,440 issued to Verseon Corporation. Kevin M. Short has patent #US10,653,674 issued to Verseon Corporation., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)
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- 2023
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38. Transesophageal echocardiography: a tool for intraoperative assessment of coronary blood flow.
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Garg P, Wadiwala IJ, Raavi L, Mateen N, Crestanello J, Pham SM, and Jacob S
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Transesophageal echocardiography (TEE) has become an indispensable part of cardiac surgery, but its potential for assessing coronary anatomy and blood flow remains underutilised. This case report presents a case of acute iatrogenic left main coronary artery obstruction following re-operative aortic valve replacement that was promptly diagnosed by intraoperative TEE and managed successfully by Bentall operation. We also emphasise the technique of TEE for coronary evaluation, its caveats and its clinical application during cardiac surgery., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2023.)
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- 2023
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39. Accelerated LVAD pump thrombosis in COVID-19 patient: Case report and mini review.
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Wadiwala IJ, Garg P, Alomari M, Elawady MS, Alamouti-Fard E, Raavi L, Mateen N, Khan F, Hussain MWA, Pham SM, and Jacob S
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- Humans, Heart-Assist Devices adverse effects, COVID-19 complications, Thrombosis therapy, Heart Failure therapy, Heart Failure complications
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Background: Coronavirus (COVID-19) infection exposes patients with heart failure specially who are on mechanical support to a higher risk of morbidity and mortality., Aims: To investigate the impact of COVID-19 infection on left ventricular assist device (LVAD) thrombosis in heart failure patients., Materials & Methods: We searched the medical electronic records, Medline, PubMed and Cochrane databases for; (LVAD) AND (thrombosis)) AND (covid-19)) AND (heart failure). We divided cases reported into, LVAD thrombosis with COVID-19 infection and compare them with LVAD thrombosis without COVID-19 infection. Demographic data, LVAD device, presentation, treatment and outcomes were reviewed in all the LVAD thrombosis patients., Results: In addition to our case, 8 other cases of LVAD thrombosis associated with COVID and 9 cases of LVAD thrombosis without covid infection were found. Patients with Covid infection had worse presentation and outcomes (3 deaths VS. 1 death in non-covid group)., Discussion: In LVAD patients, pump malfunction due to thrombus development in the inflow cannula, device body, or outflow graft can result in hemodynamic instability, hemolysis and other life-threatening complications. COVID infection significantly increases the risk of mortality in LVAD patient by accelerating the pump thrombosis due to elevated levels of endothelial protein C receptor and thrombomodulin along with procoagulants such as factor VIII, P-selectin, and von Willebrand factor., Conclusion: Significant morbidity and mortality are attributed to LVAD thrombosis, which are exasperated by prothrombotic conditions created in COVID-19 infections., (© 2022 Wiley Periodicals LLC.)
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- 2022
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40. Safe heart flush technique during recovery from donors after circulatory death.
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El-Sayed Ahmed MM, Landolfo KP, Jacob S, Sareyyupoglu B, Thomas M, Pham SM, and Makey IA
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- Humans, Tissue Donors, Heart, Warm Ischemia methods, Death, Tissue and Organ Procurement, Heart Transplantation methods
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Background: Donation after circulatory death is the donation after cardiac arrest. This technique has been employed and adopted by clinicians to overcome the shortage of available hearts for transplant. Warm ischemia time plays a pivotal role in the survival outcome of the heart recipients., Aim of the Study: To assess the efficacy of using the Foley catheter to flush the heart during procurement from donation after circulatory death donors., Methods: We utilized a 2-WAY Foley catheter to flush the heart during procurement. The catheter was prepared and modified on the back table., Results: We were successfully able to flush the heart within 3 minutes from skin incision with a good recipient outcome., Conclusions: Using the Foley catheter to flush the heart during recovery from donation after circulatory death donors was both efficient and fast., (© 2022 The Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC.)
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- 2022
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41. Mycotic Thoracic Aortic Aneurysm: Epidemiology, Pathophysiology, Diagnosis, and Management.
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Raavi L, Garg P, Hussain MWA, Wadiwala IJ, Mateen NT, Elawady MS, Alomari M, Alamouti-Fard E, Pham SM, and Jacob S
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Mycotic thoracic aortic aneurysm (MTAA) is an aneurysm of the aorta caused by infection of the vessel tissue through microbial inoculation of the diseased aortic endothelium. It is most commonly caused by bacteria. Rarely, it can be caused by fungi. However, viral aortic aneurysm has never been reported. Depending on the area and time period investigated, the infections organism discovered may vary significantly. Little is known about the natural history of MTAA due to its rarity. It is not known if they follow the same pattern as other TAAs. However, it is unclear whether MTAA follows a similar clinical course. The combination of clinical presentation, laboratory results, and radiographic results are used to make the diagnosis of MTAA. Treatment of MTAA is complex since patients frequently present at a late stage, frequently with fulminant sepsis, as well as concomitant complications such as aneurysm rupture. While medical treatment, including antibiotics, is recommended, surgery is still the mainstay of management. Surgery to treat MTAA is complicated and carries a high risk of morbidity and mortality and includes both open repairs and endovascular ones. In this review, we explore the etiology, pathogenesis, clinical presentations, diagnostic modalities as well as treatment management available for MTAA., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Raavi et al.)
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- 2022
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42. Association between SARS-CoV-2 infection and de novo HLA donor specific antibody production in lung transplant recipients: Single-center study.
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Shah SZ, Abdelmoneim Y, Pham SM, and Elrefaei M
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- Antibodies, Antibody Formation, COVID-19 Testing, Graft Rejection, Graft Survival, HLA Antigens, Humans, Isoantibodies, Lung, Pandemics, Retrospective Studies, SARS-CoV-2, Tissue Donors, COVID-19, Transplant Recipients
- Abstract
The COVID-19 pandemic has led to significant morbidity and mortality in lung transplant recipients. Respiratory viral infections may be associated with de-novo HLA donor-specific antibody production and impact lung transplant outcome. Since one of the immunomodulation strategies post-SARS-CoV-2 infection in lung transplant recipients include decreasing or holding anti-metabolites, concerns have been raised for higher incidence of de-novo HLA donor specific antibody production in lung transplant recipients. We performed a retrospective chart review of 24 consecutive lung transplant recipients diagnosed with COVID-19 to investigate this concern. We observed no significant differences in the CPRA or MFI levels of HLA class I and II antibodies pre- COVID-19 compared to 1 and 6 months post-COVID-19 diagnosis in 11/24 (45.8 %) LTR (p = 0.98 and p = 0.63 respectively). HLA class I and II DSA were detected in 5/24 LTR pre-COVID-19 diagnosis and persisted with no significant differences in the median MFI levels at 1 and 6 months post-COVID-19 diagnosis (p = 0.89). De-novo HLA class I and II DSA were detected in 1/24 (4.2 %) LTR at one month post-COVID-19 diagnosis and persisted with no significant differences in the median MFI levels at 1 and 6 months post-COVID-19 diagnosis (p = 0.54). Our results suggest that there was no significant association between SARS-CoV-2 infection and immunomodulation on pre-existing or de novo HLA donor specific antibodies., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.)
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- 2022
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43. Discovery of MDV6058 (PF-06952229), a selective and potent TGFβR1 inhibitor: Design, synthesis and optimization.
- Author
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Pujala B, Ramachandran SA, Sonawane M, Kamble MM, Panpatil D, Adhikari S, Soni S, Subbareddy V, Shinde BU, Nayak AK, Bansal C, Gupta A, Mukherjee K, Agarwal AK, Guerrero J, Herrera FJ, Bernales S, Guha M, Chakravarty S, Pham SM, and Rai R
- Subjects
- Animals, Mice, Solvents, Receptors, Transforming Growth Factor beta
- Abstract
Compound 1 is a potent TGF-β receptor type-1 (TGFβR1 or ALK5) inhibitor but is metabolically unstable. A solvent-exposed part of this molecule was used to analogue and modulate cell activity, liver microsome stability and mouse pharmacokinetics. The evolution of SAR that led to the selection of 2 (MDV6058 / PF-06952229) as a preclinical lead compound is described., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)
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- 2022
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44. Incidentally Discovered Cor Triatriatum Sinistrum Anomaly During Heart Transplant.
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El-Sayed Ahmed MM, Makey IA, Thomas M, Jacob S, Landolfo KP, and Pham SM
- Subjects
- Humans, Heart Transplantation adverse effects
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- 2022
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45. Regression of Tricuspid Valve Regurgitation After Lung Transplant: A Single-Center Experience.
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Jacob S, Ahmed MME, Haddad OK, Orlando D, Landolfo C, Thomas M, Makey IA, Sareyyupoglu B, Landolfo K, and Pham SM
- Subjects
- Adult, Male, Humans, Middle Aged, Female, Retrospective Studies, Severity of Illness Index, Echocardiography, Treatment Outcome, Tricuspid Valve Insufficiency diagnostic imaging, Tricuspid Valve Insufficiency etiology, Tricuspid Valve Insufficiency surgery, Lung Transplantation adverse effects
- Abstract
Background: Although tricuspid regurgitation (TR) is common in candidates for lung transplant, no data or established guidelines exist regarding the need for surgical repair at the time of transplant. We aimed to evaluate the natural course of TR by assessing the incidence and extent of TR regression among patients who did not undergo tricuspid valve repair (TVR) concomitantly with lung transplant., Methods: We retrospectively identified adult patients who underwent lung transplant without TVR at our institution from 2001 through 2017. Pretransplant and posttransplant echocardiograms were reviewed to assess severity of TR, tricuspid annular plane systolic excursion, central venous pressure, mean pulmonary arterial pressure, and right ventricular size and function., Results: Among 553 included patients, 324 (58.7%) were men, the mean (SD) age was 61.9 years (12.7), and 417 (75.4%) had a double lung transplant. TR before transplant was reported as trivial in 265 patients (47.9%), mild in 235 (42.5%), moderate in 40 (7.2%), and severe in 13 (2.4%). After transplant, TR improved significantly overall (P < .001). TR improved in 193 patients: 158 patients (81.9%) by 1 grade and 35 patients (18.1%) by 2 or more grades. Additionally, of 53 patients with pretransplant moderate or severe TR, 44 (83%) had improvement to mild, trivial, or no TR. After transplant, 12 patients (2.2%) had no remaining TR., Conclusion: The severity of TR improved or showed no change in most patients after lung transplant, which obviates the need for TVR among most lung transplant recipients., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2022
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46. Strategies for Expanding Donors Pool in Heart Transplantation.
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Jacob S, Garg P, Wadiwala I, Yazji JH, Alomari M, Alamouti-Fard E, Akram Hussain MW, and Pham SM
- Abstract
Heart transplant remains the criterion standard treatment for patients in end-stage heart failure. Improvement in the post-heart transplant outcomes in the last decade has contributed to increased demand for organs. Worldwide each year, more than 5000 heart transplants are performed and 50,000 people become candidates for heart transplant. In the last 50 years, there have been several attempts to expand donor criteria to increase the donor pool. Despite making hepatitis C virus, opioid overdose death, old age allowable and changing the allocation system, the gap between supply and demand is widening and unfortunately, thousands die every year waiting due to the critical shortage of organs. New technologies for heart donation after circulatory death have emerged, particularly normothermic regional organ perfusion and ex-vivo heart perfusion using organ care systems. However, these technologies still do not fill the gap. Continuous advancements in areas such as regenerative medicine and xenotransplantation, among others, are needed to overcome the shortage of heart donors for heart transplantation., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2022 The Author(s). Published by IMR Press.)
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- 2022
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47. Packing the donor heart: Is SherpaPak cold preservation technique safer compared to ice cold storage.
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Bitargil M, Haddad O, Pham SM, Garg N, Jacob S, El-Sayed Ahmed MM, Landolfo K, Patel PC, Goswami RM, Leoni Moreno JC, Yip DS, and Sareyyupoglu B
- Subjects
- Cryopreservation, Heart, Humans, Ice, Organ Preservation methods, Heart Transplantation, Tissue Donors
- Abstract
Introduction: The present study aimed to compare the clinical outcomes of heart transplant patients whose donor hearts were preserved with the SherpaPak controlled cold organ system versus the conventional ice storage technique., Methods: All patients undergoing heart transplantation at our center between January 2019 and April 2021 were divided into two groups according to the technique used during donor heart preservation and transport. The first group consisted of 34 SherpaPak controlled temperature preservation patients, and the second group consisted of 47 patients where the conventional three bags and ice technique was utilized during organ transportation. The two groups were compared based on demographics, operative details, and postoperative outcomes., Results: There were no significant differences between the groups regarding Vasoactive Inotropic Score (VIS), Primary Graft Dysfunction (PGD), and the need for a transient pacer. However, the VIS, PGD, and pacing trends were lower in the SherpaPak patients even though the total ischemic and cardiopulmonary bypass times were significantly longer. Furthermore, SherpaPak patients exhibited a shorter stay in the ICU with no severe PGD and mortality., Conclusion: The SherpaPak donor heart preservation provides safe outcomes in heart transplant patients. Further research is needed to utilize this method for longer durations of ischemic time and expand travel distances for organ transportation., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
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- 2022
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48. Combined cardiac surgery procedures and liver transplant: a single-center experience.
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Jacob S, Nguyen JH, El-Sayed Ahmed MM, Makey IA, Haddad OK, Thomas M, Sareyyupoglu B, Pham SM, and Landolfo KP
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- Aged, Female, Humans, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Severity of Illness Index, Stroke Volume, Treatment Outcome, Ventricular Function, Left, Cardiac Surgical Procedures adverse effects, End Stage Liver Disease diagnosis, End Stage Liver Disease surgery, Liver Transplantation adverse effects
- Abstract
Objective: Morbidity and mortality rates associated with liver transplant are high for patients with concomitant heart disease. Traditionally, such cases were considered contraindications for transplant. The objective of our study was to assess the outcome of combined surgical approaches., Methods: A prospectively maintained database was analyzed of patients undergoing cardiac surgery and liver transplant at our institution. Twelve identified patients underwent combined cardiac operation and liver transplant. A control group was created (n = 24) with the same selection criteria., Results: Median patient age was 64.94 years in the combined group vs 63.80 in the control, and in both groups, 58% were male. Left ventricular ejection fraction (0.60), body mass index (30.1), and median (range) score of the Model for End-stage Liver Disease (18 [9-33]) were the same in both groups. The cardiac operations combined with liver transplant were coronary artery bypass grafting, valve replacement procedures, and ascending thoracic aortic aneurysm repair. Piggyback liver transplant was performed for all patients. Survival periods of 1, 5, and 10 years for control vs combined cases were 90 vs 62%, 79 vs 55%, and 70 vs 45%, respectively (P = 0.03)., Conclusion: Concomitant cardiac procedure and liver transplant is a valid treatment option and should be considered with risk stratification criteria of the patient with end-stage liver disease and cardiac surgical pathologic characteristics., (© 2022. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.)
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- 2022
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49. Bench valvular surgery in donor's hearts before transplantation: Choice versus necessity.
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El-Sayed Ahmed MM, Pham A, Sareyyupoglu B, and Pham SM
- Subjects
- Humans, Waiting Lists, Heart Transplantation, Tissue Donors
- Abstract
The severe shortage of donor's hearts has increased the mortality of patients on the transplant waiting list. However, donor hearts with valvular dysfunction are rarely used. Utilizing donor hearts with valvular lesions that can be repaired or replaced at the time of transplant will decrease waitlist mortality and offer many patients a second chance in life., (© 2022 Wiley Periodicals LLC.)
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- 2022
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50. Multidisciplinary Approach for Lung Transplantation due to COVID-19.
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Martin AK, Shah SZ, Guru PK, Chaudhary S, Franco PM, Makey I, Fritz AV, Pham SM, and Thomas M
- Abstract
Coronavirus disease 2019 (COVID-19), a novel etiology of end-stage lung disease, has resulted in major disruptions to the process of health care delivery worldwide. These disruptions have led to team-based innovations globally, resulting in a broad range of new processes in cardiopulmonary perioperative management. A key intersection of multidisciplinary teamwork and COVID-19 is found in lung transplantation, in which diverse teams collaborate throughout the perioperative period to achieve optimal outcomes. In this article, we describe the multidisciplinary approach taken by Mayo clinic in Florida to manage patients with COVID-19 presenting for lung transplantation., (© 2022 The Authors.)
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- 2022
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