Browsing by Author "Nandi, Deipanjan"

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    Current Practices in Treating Cardiomyopathy and Heart Failure in Duchenne Muscular Dystrophy (DMD): Understanding Care Practices in Order to Optimize DMD Heart Failure Through ACTION
    (Springer Nature, 2022) Villa, Chet; Auerbach, Scott R.; Bansal, Neha; Birnbaum, Brian F.; Conway, Jennifer; Esteso, Paul; Gambetta, Katheryn; Hall, E. Kevin; Kaufman, Beth D.; Kirmani, Sonya; Lal, Ashwin K.; Martinez, Hugo R.; Nandi, Deipanjan; O’Connor, Matthew J.; Parent, John J.; Raucci, Frank J.; Shih, Renata; Shugh, Svetlana; Soslow, Jonathan H.; Tunuguntla, Hari; Wittlieb‑Weber, Carol A.; Kinnett, Kathi; Cripe, Linda; Pediatrics, School of Medicine
    Cardiac disease has emerged as a leading cause of mortality in Duchenne muscular dystrophy in the current era. This survey sought to identify the diagnostic and therapeutic approach to DMD among pediatric cardiologists in Advanced Cardiac Therapies Improving Outcomes Network. Pediatric cardiology providers within ACTION (a multi-center pediatric heart failure learning network) were surveyed regarding their approaches to cardiac care in DMD. Thirty-one providers from 23 centers responded. Cardiac MRI and Holter monitoring are routinely obtained, but the frequency of use and indications for ordering these tests varied widely. Angiotensin converting enzyme inhibitor and aldosterone antagonist are generally initiated prior to onset of systolic dysfunction, while the indications for initiating beta-blocker therapy vary more widely. Seventeen (55%) providers report their center has placed an implantable cardioverter defibrillator in at least 1 DMD patient, while 11 providers (35%) would not place an ICD for primary prevention in a DMD patient. Twenty-three providers (74%) would consider placement of a ventricular assist device (VAD) as destination therapy (n = 23, 74%) and three providers (10%) would consider a VAD only as bridge to transplant. Five providers (16%) would not consider VAD at their institution. Cardiac diagnostic and therapeutic approaches vary among ACTION centers, with notable variation present regarding the use of advanced therapies (ICD and VAD). The network is currently working to harmonize medical practices and optimize clinical care in an era of rapidly evolving outcomes and cardiac/skeletal muscle therapies.
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    Impact of HeartWare ventricular assist device discontinuation on the pediatric population: An Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry analysis
    (Elsevier, 2024-02-05) Niebler, Robert A.; Shezad, Muhammad; Absi, Mohammed; Aljohani, Othman A.; Amdani, Shahnawaz; Auerbach, Scott; Bearl, David W.; Boucek, Katerina; Buchholz, Holger; Castleberry, Chesney; Dykes, John; Engelhardt, Kevin; Friedland-Little, Joshua; Hope, Kyle; Iqbal, Mehreen; Jeewa, Aamir; Joong, Anna; Lorts, Angela; May, Lindsay; Mokshagundam, Deepa; Nandi, Deipanjan; O'Connor, Matthew; Parent, John J.; Peng, David M.; Shwaish, Natalie; Shugh, Svetlana B.; VanderPluym, Christina; Vaughn, Gabrielle; Zinn, Mattew; Pediatrics, School of Medicine
    Background: The HeartWare ventricular assist device (HVAD) was discontinued in July 2021. The study aims to describe the impact the discontinuation the HVAD had on pediatric ventricular assist device (VAD) utilization and outcomes. Methods: The Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry was queried for type of VAD utilization and outcomes/adverse event rates in patients with a body surface area of 0.7 to 1.4 m2. Results were compared from before and after July 2021. All patients in the registry implanted with an HVAD were reported to determine overall outcomes of these patients and define who remains on the device. Results: The HeartMate 3 (HM3) primarily replaced the HVAD in pediatric patients increasing from 29 of 258 (11%) of implants before July 2021 to 31 of 109 (29%) of implants after. A small increase in the use of the Berlin Heart EXCOR (40 of 258, 16% before to 20 of 109, 18% after) and paracorporeal continuous flow devices (116 of 258, 45% before to 58 of 109, 53% after) was also observed. The rate of ischemic stroke increased in the overall population and a decrease in bleeding complications in the EXCOR group was observed. Of the 187 pediatric patients implanted with an HVAD in the registry, 7 patients remain supported, 1 patient transitioned from the HVAD to an HM3, and 6 patients were lost to follow-up. Conclusions: The HM3 has been the primary replacement for the HVAD in the medium-sized pediatric population. The rate of ischemic stroke was higher after July 2021.