Browsing by Subject "Heart transplantation"
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Item A Case Report of Postheart Transplant Epicardial Adipose Deposition in a Patient With Dunnigan Syndrome(American College of Physicians, 2022) Bajpai, Vatsal; Damera, Nihanth; Pattisapu, Anish; Oral, Elif; Bateman, Pantila; Rao, Roopa A.; Medicine, School of MedicineDunnigan syndrome is a rare genetic disorder that is a type of familial partial lipodystrophy. In some patients, severe cardiomyopathy and heart transplantation have been reported in this syndrome. Here, we describe a 40-year-old patient with Dunnigan syndrome who underwent heart transplantation for end-stage heart failure. Post-transplantation, routine imaging showed an accumulation of epicardial adipose tissue around the heart. In general, in Dunnigan syndrome, epicardial fat accumulation is not different compared with that of the general population. This is the first case report of exaggerated accumulation of adipose tissue around the heart causing subtle pericardial tamponade physiology.Item Bone marrow- or adipose-mesenchymal stromal cell secretome preserves myocardial transcriptome profile and ameliorates cardiac damage following ex vivo cold storage(Elsevier, 2022) Scott, Susan R.; March, Keith L.; Wang, I-Wen; Singh, Kanhaiya; Liu, Jianyun; Turrentin, Mark; Sen, Chandan K.; Wang, Meijing; Surgery, School of MedicineBackground: Heart transplantation, a life-saving approach for patients with end-stage heart disease, is limited by shortage of donor organs. While prolonged storage provides more organs, it increases the extent of ischemia. Therefore, we seek to understand molecular mechanisms underlying pathophysiological changes of donor hearts during prolonged storage. Additionally, considering mesenchymal stromal cell (MSC)-derived paracrine protection, we aim to test if MSC secretome preserves myocardial transcriptome profile and whether MSC secretome from a certain source provides the optimal protection in donor hearts during cold storage. Methods and results: Isolated mouse hearts were divided into: no cold storage (control), 6 h cold storage (6 h-I), 6 h-I + conditioned media from bone marrow MSCs (BM-MSC CM), and 6 h-I + adipose-MSC CM (Ad-MSC CM). Deep RNA sequencing analysis revealed that compared to control, 6 h-I led to 266 differentially expressed genes, many of which were implicated in modulating mitochondrial performance, oxidative stress response, myocardial function, and apoptosis. BM-MSC CM and Ad-MSC CM restored these gene expression towards control. They also improved 6 h-I-induced myocardial functional depression, reduced inflammatory cytokine production, decreased apoptosis, and reduced myocardial H2O2. However, neither MSC-exosomes nor exosome-depleted CM recapitulated MSC CM-ameliorated apoptosis and CM-improved mitochondrial preservation during cold ischemia. Knockdown of Per2 by specific siRNA abolished MSC CM-mediated these protective effects in cardiomyocytes following 6 h cold storage. Conclusions: Our results demonstrated that using MSC secretome (BM-MSCs and Ad-MSCs) during prolonged cold storage confers preservation of the normal transcriptional "fingerprint", and reduces donor heart damage. MSC-released soluble factors and exosomes may synergistically act for donor heart protection.Item Donor Utilization in the Recent Era: Effect of Sex, Drugs, and Increased Risk(American Heart Association, 2022) Baran, David A.; Long, Ashleigh; Lansinger, Justin; Copeland, Jack G.; Copeland, Hannah; Surgery, School of MedicineBackground: Heart transplantation volumes have increased in recent years, yet less than a third of donors are typically accepted for transplantation. Whether donor sex, donor drug use, or perception of increased risk affects utilization for transplantation is unclear. Methods: The United Network for Organ Sharing database was queried for donors from January 1, 2007, to December 31, 2017. Donor toxicology was collected when available. Multivariate analysis was conducted to examine correlations with donor utilization. Results: Between January 1, 2007, and December 31, 2017, there were 87 816 heart donors aged ≥15 years. The mean age was 42.7±15.8 years, and 24 831 donors (28.3%) were utilized for heart transplantation. Subsequent analyses focused on donors between 15 and 39 years old. The strongest associations with donor acceptance were for male donor sex, blood type, hepatitis C antibody, donor age, left ventricular hypertrophy, and history of donor drug use. After removing hepatitis C, Public Health Service Increased Risk was identified as a strong negative predictor. Most positive drug toxicology results were associated with donor nonuse except for donors between 15 and 19 years of age. Exceptions included alcohol, marijuana, and cocaine. Opiates were associated with less utilization at all donor ages. The Public Health Service Increased Risk status was associated with significantly less utilization in all age groups except 15- to 19-year-old donors. Conclusions: While male donors were preferentially utilized, donors with drug use or those deemed Public Health Service Increased Risk were significantly less utilized for heart transplantation. Further consideration of such donors would be appropriate particularly as the demand for transplantation continues to increase.Item Group Dynamics and Allocation of Advanced Heart Failure Therapies-Heart Transplants and Ventricular Assist Devices-By Gender, Racial, and Ethnic Group(American Heart Association, 2023) Breathett, Khadijah; Yee, Ryan; Pool, Natalie; Thomas Hebdon, Megan C.; Knapp, Shannon M.; Herrera-Theut, Kathryn; de Groot, Esther; Yee, Erika; Allen, Larry A.; Hasan, Ayesha; Lindenfeld, JoAnn; Calhoun, Elizabeth; Carnes, Molly; Sweitzer, Nancy K.; Medicine, School of MedicineBackground: US regulatory framework for advanced heart failure therapies (AHFT), ventricular assist devices, and heart transplants, delegate eligibility decisions to multidisciplinary groups at the center level. The subjective nature of decision‐making is at risk for racial, ethnic, and gender bias. We sought to determine how group dynamics impact allocation decision‐making by patient gender, racial, and ethnic group. Methods and Results: We performed a mixed‐methods study among 4 AHFT centers. For ≈ 1 month, AHFT meetings were audio recorded. Meeting transcripts were evaluated for group function scores using de Groot Critically Reflective Diagnoses protocol (metrics: challenging groupthink, critical opinion sharing, openness to mistakes, asking/giving feedback, and experimentation; scoring: 1 to 4 [high to low quality]). The relationship between summed group function scores and AHFT allocation was assessed via hierarchical logistic regression with patients nested within meetings nested within centers, and interaction effects of group function score with gender and race, adjusting for patient age and comorbidities. Among 87 patients (24% women, 66% White race) evaluated for AHFT, 57% of women, 38% of men, 44% of White race, and 40% of patients of color were allocated to AHFT. The interaction between group function score and allocation by patient gender was statistically significant (P=0.035); as group function scores improved, the probability of AHFT allocation increased for women and decreased for men, a pattern that was similar irrespective of racial and ethnic groups. Conclusions: Women evaluated for AHFT were more likely to receive AHFT when group decision‐making processes were of higher quality. Further investigation is needed to promote routine high‐quality group decision‐making and reduce known disparities in AHFT allocation.Item Imbalance in Heart Transplant to Heart Failure Mortality Ratio Among African-American, Hispanic, and White Patients(American Heart Association, 2021) Breathett, Khadijah; Knapp, Shannon M.; Carnes, Molly; Calhoun, Elizabeth; Sweitzer, Nancy K.; Medicine, School of MedicineItem In-hospital complications associated with total artificial heart implantation in the United States between 2004 to 2011(e-Century, 2022-10-15) Pasha, Ahmed K.; Lee, Justin Z.; Desai, Hem; Hashemzadeh, Mehrtash; Movahed, Mohammad Reza; Medicine, School of MedicineObjective: Total artificial heart (TAH) utilization has increased over the recent years. The goal of this study was to evaluate the trend of artificial hearts used in the USA with its associated morbidity and mortality based on a large in-hospital database. Materials and methods: Using a very large nationwide inpatient samples (NIS) database, we used ICD-9 code for a total artificial heart. We evaluated the utilization of this device over the years studied. Furthermore, we evaluated any associated complications and mortality in patients receiving this device. Results: From 2004 until 2011, the rate of total artificial heart implants increased over the years from 5 in 2004 to the highest of 26 in 2011 across the United State. TAH was insesrted in 75 patients. Death was reported in 22 patients (29.3%). Acute renal failure was the most common complication (69.3%). This is followed by post-operative infectious complications (28.0%), acute renal failure requiring dialysis (16%), bleeding complications requiring blood transfusion (14.7%) respiratory complications (6.7%), and stroke/TIA (4.0%). There was no post-operative deep vein thrmobosis or pulmonary embolism. Conclusions: The use of total artificial heart has increased in the United State steadily with substantial morbidity and mortality associated with this device.Item Indications, Complications, and Outcomes of Cardiac Surgery After Heart Transplantation: Results From the Cash Study(Frontiers Media, 2022-06-09) Gökler, Johannes; Aliabadi-Zuckermann, Arezu Z.; Kaider, Alexandra; Ambardekar, Amrut V.; Antretter, Herwig; Artemiou, Panagiotis; Bertolotti, Alejandro M.; Boeken, Udo; Brossa, Vicens; Copeland, Hannah; Crespo-Leiro, Maria Generosa; Eixerés-Esteve, Andrea; Epailly, Eric; Farag, Mina; Hulman, Michal; Khush, Kiran K.; Masetti, Marco; Patel, Jignesh; Ross, Heather J.; Rudež, Igor; Silvestry, Scott; Martin Suarez, Sofia; Vest, Amanda; Zuckermann, Andreas O.; Surgery, School of MedicineBackground: Allograft pathologies, such as valvular, coronary artery, or aortic disease, may occur early and late after cardiac transplantation. Cardiac surgery after heart transplantation (CASH) may be an option to improve quality of life and allograft function and prolong survival. Experience with CASH, however, has been limited to single-center reports. Methods: We performed a retrospective, multicenter study of heart transplant recipients with CASH between January 1984 and December 2020. In this study, 60 high-volume cardiac transplant centers were invited to participate. Results: Data were available from 19 centers in North America (n = 7), South America (n = 1), and Europe (n = 11), with a total of 110 patients. A median of 3 (IQR 2-8.5) operations was reported by each center; five centers included ≥ 10 patients. Indications for CASH were valvular disease (n = 62), coronary artery disease (CAD) (n = 16), constrictive pericarditis (n = 17), aortic pathology (n = 13), and myxoma (n = 2). The median age at CASH was 57.7 (47.8-63.1) years, with a median time from transplant to CASH of 4.4 (1-9.6) years. Reoperation within the first year after transplantation was performed in 24.5%. In-hospital mortality was 9.1% (n = 10). 1-year survival was 86.2% and median follow-up was 8.2 (3.8-14.6) years. The most frequent perioperative complications were acute kidney injury and bleeding revision in 18 and 9.1%, respectively. Conclusion: Cardiac surgery after heart transplantation has low in-hospital mortality and postoperative complications in carefully selected patients. The incidence and type of CASH vary between international centers. Risk factors for the worse outcome are higher European System for Cardiac Operative Risk Evaluation (EuroSCORE II) and postoperative renal failure.Item Pilot test of a Multi-Component Implementation Strategy for Equity in Advanced Heart Failure Allocation(Elsevier, 2023) Breathett, Khadijah; Yee, Ryan H.; Pool, Natalie; Hebdon, Megan C.; Knapp, Shannon M.; Calhoun, Elizabeth; Sweitzer, Nancy K.; Carnes, Molly; Medicine, School of MedicineAdvanced heart failure (AHF) therapy allocation is vulnerable to bias related to subjective assessments and poor group dynamics. Our objective was to determine whether an implementation strategy for AHF team members could feasibly contribute to organizational and culture change supporting equity in AHF allocation. Using a pretest-posttest design, the strategy included an 8-week multicomponent training on bias reduction, standardized numerical social assessments, and enhanced group dynamics at an AHF center. Evaluations of organizational and cultural changes included pretest-posttest AHF team member surveys, transcripts of AHF meetings to assess group dynamics using a standardized scoring system, and posttest interviews guided by a framework for implementing a complex strategy. Results were analyzed with qualitative descriptive methods and Brunner-Munzel tests for relative effect (RE, RE >0.5 signals posttest improvement). The majority of survey metrics revealed potential benefit with RE >0.5. REs were >0.5 for 5 of 6 group dynamics metrics. Themes for implementation included (1) promoting equitable distribution of scarce resources, (2) requiring a change in team members' time investment to correct bias and change the meeting structure, (3) slowing and then accelerating the allocation process, and (4) adaptable beyond AHF and reinforceable with semi-annual trainings. An implementation strategy for AHF equity demonstrated the feasibility for organizational and culture changes.Item Sex Associated Differences in the Clinical Outcomes of Left Ventricular Assist Device Recipients: Insights from INTERMACS(American Heart Association, 2023) Shetty, Naman S.; Parcha, Vibhu; Abdelmessih, Peter; Patel, Nirav; Hasnie, Ammar A.; Kalra, Rajat; Pandey, Ambarish; Breathett, Khadijah; Morris, Alanna A.; Arora, Garima; Arora, Pankaj; Medicine, School of MedicineBackground: Sex-associated differences in clinical outcomes among left ventricular assist device recipients in the United States have been recognized. However, an investigation of the social and clinical determinants of sex-associated differences is lacking. Methods: Left ventricular assist device receiving patients enrolled in Interagency Registry for Mechanically Assisted Circulatory Support between 2005 and 2017 were included. The primary outcome was all-cause mortality. Secondary outcomes included heart transplantation and postimplantation adverse event rates. The cohort was stratified by the social subgroup of race and ethnicity (non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic), and clinical subgroups of device strategy (destination therapy, bridge to transplant, and bridge to candidacy), and implantation center volume (low [≤20 implants/y], medium [21-30 implants/y], and high [>30 implants/y]). A multivariable-adjusted Cox proportional hazard model was used to assess the risk of death and heart transplantation with prespecified interaction testing. Poisson regression was used to estimate adverse events by sex across the various subgroups. Results: Among 18 525 patients, there were 3968 (21.4%) females. Compared with their male counterparts, Hispanic (adjusted hazard ratio [HRadj], 1.75 [1.23-2.47]) females had the highest risk of death followed by non-Hispanic White females (HRadj, 1.15 [1.07-1.25]; Pinteraction=0.02). Hispanic (HRadj, 0.60 [0.40-0.89]) females had the lowest cumulative incidence of heart transplantation followed by non-Hispanic Black females (HRadj, 0.76 [0.67-0.86]), and non-Hispanic White females (HRadj, 0.88 [0.80-0.96]) compared with their male counterparts (Pinteraction<0.001). Compared with their male counterparts, females on the bridge to candidacy strategy (HRadj, 1.32 [1.18-1.48]) had the highest risk of death (Pinteraction=0.01). The risk of death (Pinteraction=0.44) and cumulative incidence of heart transplantation (Pinteraction=0.40) did not vary by sex in the center volume subgroup. A higher incidence rate of adverse events after left ventricular assist device implantation was also seen in females compared with the males, overall, and across all subgroups. Conclusions: Among left ventricular assist device recipients, the risk of death, the cumulative incidence of heart transplantation, and adverse events differ by sex across the social and clinical subgroups.Item U.S. Heart Transplantation Allocation: Injustice in Complacency(Elsevier, 2023) Breathett, Khadijah; Medicine, School of Medicine