Hassan Nemeh - Academia.edu (original) (raw)

Papers by Hassan Nemeh

Research paper thumbnail of Restrictive interatrial communication in hypoplastic left heart syndrome after modified Fontan repair

The Annals of Thoracic Surgery, 2003

It is imperative to recognize arch anatomy involving an anomalous right subclavian artery when tr... more It is imperative to recognize arch anatomy involving an anomalous right subclavian artery when treating a traumatic aortic transection. This variable may influence the diagnosis and location of the injury and have consequences on the surgical repair of the lesion.

Research paper thumbnail of Mid-ileal perforation secondary to colonoscopy

The American surgeon

Perforation of the bowel is a known complication of colonoscopy. Ileal perforation is a very rare... more Perforation of the bowel is a known complication of colonoscopy. Ileal perforation is a very rare complication of this procedure. We present a previously unreported case of double ileal perforation following colonoscopy secondary to dense, fixed pelvic adhesions.

Research paper thumbnail of Timing of basiliximab induction and development of acute rejection in lung transplant patients

The Journal of Heart and Lung Transplantation, 2011

Acute rejection affects more than 36% of recipients within the first year post-transplantation. T... more Acute rejection affects more than 36% of recipients within the first year post-transplantation. The interleukin-2 (IL-2) receptor antagonist basiliximab has been associated with decreased frequency and severity of acute rejection. We investigated whether the timing of induction administration would impact the frequency and severity of acute rejection in the first year after transplantation. In this study we reviewed 119 patients who underwent lung transplantation at Henry Ford Hospital from October 1994 to January 2009. Prior to January 2000 no patients received induction. From January 2000 to March 2006 the initial dose was given after implantation, and from March 2006 to 2009 basiliximab was given prior to implantation. The primary outcome was cumulative acute rejection score (CAR) in the first post-operative year comparing post- vs pre-implant induction. The CAR score for pre-implant basiliximab was 2.5 ± 2.3. This was significantly lower than CAR score of 4.6 ± 3.9 in the post-implant group (p = 0.025). The no-induction group had the highest CAR score at 6.3 ± 3.8 (p = 0.077 compared with the post group). The mean follow-up times in the post and pre group were 5.9 ± 2.3 and 2.3 ± 0.7 years, respectively (p < 0.001). There was no difference in freedom from bronchiolitis obliterans syndrome (BOS), survival or invasive infections between pre- and post-implant induction groups. Basiliximab prior to implant is associated with a lower cumulative acute rejection score over 1 year compared with induction post-implantation. Despite a lower cumulative acute rejection score, there was no significant difference in freedom from BOS or survival.

Research paper thumbnail of Effects of Basiliximab Induction on Development of Acute Rejection and Bronchiolitis Obliterans Syndrome (BOS) in Lung Transplant Patients

Research paper thumbnail of Restrictive interatrial communication in hypoplastic left heart syndrome after modified Fontan repair

The Annals of Thoracic Surgery, 2003

It is imperative to recognize arch anatomy involving an anomalous right subclavian artery when tr... more It is imperative to recognize arch anatomy involving an anomalous right subclavian artery when treating a traumatic aortic transection. This variable may influence the diagnosis and location of the injury and have consequences on the surgical repair of the lesion.

Research paper thumbnail of Effect of Body Mass Index on Outcomes in Left Ventricular Assist Device Recipients

Journal of cardiac surgery, Jan 9, 2016

Obesity is associated with higher mortality following heart transplantation, but there remains no... more Obesity is associated with higher mortality following heart transplantation, but there remains no consensus regarding outcomes in left ventricular assist device (LVAD) recipients. We sought to determine the impact of body mass index (BMI) on outcomes in patients undergoing LVAD implantation. This was a single-institution retrospective review, including all patients who received a HeartMate II LVAD or HeartWare HVAD between March 2006 and June 2014. Patients were stratified into three groups based on normal (<25 kg/m(2) ), overweight (25-30 kg/m(2) ), and obese (>30 kg/m(2) ) BMI. Two hundred patients were included in the analysis. Mean BMI was 28.3 kg/m(2) , (27% normal, 36% overweight, and 36.5% obese). Obese patients were younger (51.9 years, p = 0.03) and had higher incidence of diabetes (58.9% vs. 24.1%; p < 0.001) and peripheral vascular disease (16.4% vs. 1.9%; p = 0.03). Normal BMI patients were more likely to undergo LVAD implantation as destination therapy compared...

Research paper thumbnail of Cannulation of the axillary artery with a side graft reduces morbidity

The Annals of Thoracic Surgery, Jan 4, 2004

Background. The axillary artery is our preferred arterial cannulation site when the ascending aor... more Background. The axillary artery is our preferred arterial cannulation site when the ascending aorta cannot be cannulated. Previously, we cannulated the artery directly; now we use a side graft. The purposes of this study were to (1) investigate cannulation-related morbidity and (2) determine whether use of a side graft reduces it.

Research paper thumbnail of LVAD destination therapy: applying what we know about psychiatric evaluation and management from cardiac failure and transplant

Heart Failure Reviews, Mar 1, 2009

Left ventricular assist devices (LVADs) have evolved into long-term use as destination therapy fo... more Left ventricular assist devices (LVADs) have evolved into long-term use as destination therapy for those with severe end-stage heart failure due to other medical risks. Success with LVAD depends on adherence to a complicated mechanical regimen, and acceptance of a life that is far from normal. Patients with LVADs share characteristics with other end-stage cardiac failure patients and those waiting for or receiving heart transplants. Understanding the more thoroughly studied issues of psychiatric disorders, adherence, and behavioral correlates of success in heart failure and transplantation may identify feasible strategies for optimizing care of LVAD patients and suggest directions for future research. Depression and distress complicate post-transplant care. Psychiatric morbidity is associated with poor outcomes, including graft rejection, non-adherence, hospitalizations, infection, and death. With a high risk of embolic neurological events, patients' ability for self-care may be compromised. Psychiatric symptoms are underdiagnosed and undertreated, which may impact overall survival and quality of life.

Research paper thumbnail of Short and long term outcomes of 200 patients supported by continuous-flow left ventricular assist devices

World journal of cardiology, Jan 26, 2015

To study the institutional experience over 8 years with 200 continuous-flow (CF) - left ventricul... more To study the institutional experience over 8 years with 200 continuous-flow (CF) - left ventricular assist devices (LVAD). We evaluated our institution's LVAD database and analyzed all patients who received a CF LVAD as a bridge to transplant (BTT) or destination therapy from March 2006 until June 2014. We identified 200 patients, of which 179 were implanted with a HeartMate II device (Thoratec Corp., Pleasanton, CA) and 21 received a Heartware HVAD (HeartWare Inc., Framingham, MA). The mean age of our LVAD recipients was 59.3 years (range 17-81), 76% (152/200) were males, and 49% were implanted for the indication of BTT. The survival rate for our LVAD patients at 30 d, 6 mo, 12 mo, 2 years, 3 years, and 4 years was 94%, 86%, 78%, 71%, 62% and 45% respectively. The mean duration of LVAD support was 581 d (range 2-2595 d). Gastrointestinal bleeding (was the most common adverse event (43/200, 21%), followed by right ventricular failure (38/200, 19%), stroke (31/200, 15%), re explo...

Research paper thumbnail of Effect of Preoperative Albumin Levels on Outcomes in Patients Undergoing Left Ventricular Device Implantation

ASAIO Journal, 2015

Hypoalbuminemia is a well-known predictor of morbidity and mortality in cardiac surgery. Our aim ... more Hypoalbuminemia is a well-known predictor of morbidity and mortality in cardiac surgery. Our aim was to establish the impact of serum albumin on outcomes following left ventricular assist device (LVAD) implantation.This was a single-institution retrospective review, including all patients who underwent LVAD implantation between March 2006 and June 2014.Two hundred patients were included in the analysis. Mean serum albumin was 3.27 ± 0.47 g/dL, with 7% in the low albumin group (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;2.5 mg/dL), 67.5% in the mid-range (2.5-3.5 mg/dL) and 25.5% in the normal albumin groups (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 3.5 mg/dL). Lower albumin was associated with a significant increase in postoperative renal failure (42.9% vs. 16.5% vs. 17.3%; p=0.05) and prolonged hospitalization (median 28.5 vs. 16 vs. 15.5 days; p=0.008). Six-month, 1-year and 5-year survival was 79%, 79% and 49% with low, 84%, 78% and 51% with mid-range, and 94%, 88% and 60% with normal albumin, respectively (p=0.22).Preoperative hypoalbuminemia is associated with post-operative ARF and prolonged hospitalization following LVAD implantation, with no effect on overall survival. Hypoalbuminemia is most likely a marker of advanced disease and should not, in itself, be considered a contraindication to LVAD candidacy.

Research paper thumbnail of Baseline Pulmonary Function and Outcomes in Patients Receiving Left Ventricular Assist Devices

Journal of Cardiac Failure, 2015

Research paper thumbnail of Changes in Pulmonary Function After Left Ventricular Assist Device Implantation

Journal of Cardiac Failure, 2015

Research paper thumbnail of Autorenverzeichnis · Authors Index

Research paper thumbnail of Factors determining post-operative readmissions after left ventricular assist device implantation

The Journal of Heart and Lung Transplantation, 2014

Research paper thumbnail of Stroke While on Long-Term Left Ventricular Assist Device Support

ASAIO Journal, 2014

Development of stroke while on left ventricular assist device (LVAD) support can be a source of s... more Development of stroke while on left ventricular assist device (LVAD) support can be a source of significant morbidity and mortality. From March 2006 through November 2011, one hundred patients with chronic heart failure underwent implantation of a HeartMate II (HM II) LVAD (Thoratec Corp.) as a bridge to transplant (BTT; n = 65) or destination therapy (DT; n = 35). Records were reviewed to determine the prevalence and type of postimplant stroke, anatomic cerebral location of strokes, and associated morbidity and mortality. Cox multivariate logistic regression analysis was conducted to identify independent predictors of postoperative stroke. Strokes occurred in 12 patients (12.0%): four embolic and eight hemorrhagic. Median duration of support at the time of stroke was 281.0 days for embolic strokes and 380.5 days for hemorrhagic strokes (p = 0.028). Stroke patients had a significantly higher incidence of diabetes (66.7% vs. 40.9%; p = 0.024), history of preimplant stroke (16.7% vs. 4.5%; p = 0.046), and aortic cross-clamping with cardioplegic arrest during their LVAD implant (50.0% vs. 20.2%; p = 0.034) compared with patients without postoperative strokes. Mean international normalized ratio (INR) at the time of stroke was subtherapeutic in all four patients with embolic strokes (mean: 1.5 ± 0.1 IU; range 1.3-1.6 IU) and supratherapeutic in four of eight patients with hemorrhagic strokes (mean: 3.2 ± 2.2 IU, range: 1.4-7.0 IU; p = 0.024). There was a 25.0% 30 day mortality after stroke. Diabetes (odds ratio [OR] 6.36; p = 0.029), aortic cross-clamping with cardioplegic arrest (OR 4.75; p = 0.025), duration of LVAD support (OR 1.00; p = 0.008), and INR (OR 4.42; p = 0.020) were independent predictors of stroke in multivariate analysis with a trend toward significance for history of stroke (OR 6.25; p = 0.075). Stroke represented an important source of morbidity and mortality for patients on HM II LVAD support. As long-term device therapy continues to gain popularity for both BTT and DT, a better understanding of the predictors of stroke, more strict control of postoperative anticoagulation, and the establishment of a risk stratification model may aid in minimizing its occurrence.

Research paper thumbnail of Left Ventricular Assist Devices and Changes in Leukocyte Count

Journal of Cardiac Failure, 2014

was the primary indication for device placement (n59), followed by chronic ischemic cardiomyopath... more was the primary indication for device placement (n59), followed by chronic ischemic cardiomyopathy (n53) and cardiac transplant rejection (n51). The average duration of Impella support was 1167.5 days. Within 24 hours of device placement, patients had an increase in cardiac output to 5.5L/min61.4 vs 4.4L/min61.3 (p50.005), which was associated with an improvement in GFR from 45.0613.5 to 52.0614.5 (p50.01), pulmonary artery pressures 41 613.0 to 3167.0 (p50.01), right atrial pressures 11 64 to 1066 (p50.04) and pulmonary capillary wedge pressure 326 12.0 to 2065.0 (p50.03). In 84% of cases (n511), the Impella provided adequate left ventricular support, with patients either successfully weaned off support completely (n54), or receiving permanent LVADs (n55) or cardiac transplant (n52). Only 16% of patients (n52) died while actively on the Impella .The 30 day mortality was 23% (n53), while overall mortality at 90 days stood at 54% (n57). The causes of mortality included device malfunction, fatal arrhythmia 24 hours after Impella removal and withdrawal of care in 1 patient each and multi-organ failure in 4 patients who were transitioned to permanent LVAD's. Conclusions: The Impella 5.0 has been shown to be a safe and efficacious device for use in patients with cardiogenic shock. In our high risk population, the device was easily and quickly inserted and demonstrated consistent hemodynamic augmentation. It also established itself as a good supportive modality in our acutely ill patients as well. Though our overall results in terms of mortality have not been very encouraging, the Impella was indeed successful in bridging patients to either, a permanent LVAD, transplant or in some cases ventricular recovery as well. Therefore in these high risk patients with profound cardiogenic shock, this is indeed a suitable treatment strategy.

Research paper thumbnail of Sex-Specific Outcomes in Patients Receiving Continuous-Flow Left Ventricular Devices as a Bridge to Transplantation or Destination Therapy

ASAIO Journal, 2014

Reports on sex-related outcomes in left ventricular assist device (LVAD) patients are conflicting... more Reports on sex-related outcomes in left ventricular assist device (LVAD) patients are conflicting. In addition, females have been underrepresented in most multicenter randomized controlled trials for mechanical circulatory support (MCS). The objective of our study was to analyze our experience implanting 130 continuous-flow LVADs and to determine the impact of sex on survival. We identified 130 patients who underwent implantation of a continuous-flow LVAD at our institution. Patients were stratified into two groups based on sex. Variables were compared using two-sided t-tests, χ 2 tests, Cox proportional hazards models, and log-rank tests to determine whether there was a difference between the two groups and if sex was a significant independent predictor of outcome. Of the 130 patients, 35 were females and 95 were males. Female patients had worse pre-LVAD cardiac output and cardiac index and were more likely to be on MCS at the time of implantation. Male patients had worse renal function. Survival was analogous for both cohorts with 30 day, 6 month, 1 year, and 2 year survivals of 97%, 90.8%, 90.8%, and 84.3%, respectively, for female patients versus 94.7%, 87.9%, 78.4%, and 72.8%, respectively, for male patients. The incidence of other LVADrelated complications was also similar in both groups. Gender did not predict postoperative mortality on univariate analysis. Contrary to most published reports, female and male LVAD patients have similar postoperative and midterm survival, length of hospital stay, readmission rates, and postoperative complications. It appears that females have gained more benefit from newer generation devices compared to males. ASAIO Journal 2014; 60:199-206.

Research paper thumbnail of Lessons Learned From 150 Continuous Flow Left Ventricular Assist Devices

ASAIO Journal, 2014

Continuous flow left ventricular assist devices (LVADs) have become the standard of care for pati... more Continuous flow left ventricular assist devices (LVADs) have become the standard of care for patients with advanced heart failure refractory to optimal medical therapy. The goal of this study was to review our seven year single institutional experience with CF LVADs. Mean age was 50.4 + 12.5 (17-69) years for BTT patients and 57.6 + 10.4 (31-81) years for DT patients (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001).Overall, 38 (26%) patients were female and 58 (41%) African American. Etiology of heart failure was ischemic in 54 (37%) patients and non ischemic in 93 (63%) patients. Overall survival at 30 days, 6 months, 12 months and 2 years was 93%, 89%, 84% and 81% respectively. Gastrointestinal bleeding (GIB) was the most common complication (24%), followed by stroke (18%), right ventricular (RV) failure (18%), ventilator dependent respiratory failure (VDRF) (10%), reoperation for bleeding (10%), and driveline infection (9%). These data demonstrate excellent survival with low mortality for both BTT and DT patients on long-term LVAD support. However, for LVAD therapy to become the gold standard for long-term treatment of end-stage heart failure and a plausible alternative to heart transplantation, we need to continue to improve the incidence of frequent postoperative complications, such as right ventricular failure, drive-line infections, strokes, and gastrointestinal bleeding.

Research paper thumbnail of Should Left Ventricular Assist Devices be Implanted in Patients Seventy Years of Age and Older: A Comparative Analysis

The Heart Surgery Forum, 2014

We evaluated outcomes in left ventricular assist device (LVAD) recipients aged seventy years and ... more We evaluated outcomes in left ventricular assist device (LVAD) recipients aged seventy years and above and compared results to outcomes in LVAD recipients below seventy years of age. From March 2006 through June 2012, 130 patients underwent implantation of either a HeartMate II (HM II; Thoratec Corp., Pleasanton, CA) or HeartWare (HeartWare Inc., Framingham, MA) LVAD at our institution. Four patients underwent device exchanges and were excluded. Of the remaining 126 patients, 6 (4.7%) were ≥70 years of age. Patients in the age group ≥70 years were compared to the group of patients &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 70 years for perioperative mortality, long-term survival and incidence of postoperative complications. Mean age was 72.2 ± 2.3 (70-75) years for the older group and 52.8 ± 11.4 (18-69) years for the younger group (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). There was no significant difference in the incidence of diabetes, hypertension, chronic renal insufficiency, dialysis, hepatic function, preoperative ventilation or previous cardiac surgery between the groups (P = NS). There was no significant difference in survival between the groups, with survival at 6 months, 1 year, and 2 years of 100%, 100% and 66.7% respectively for the older groups, versus 88.6%, 81.3% and 76.7% for the younger group (P = .634). There was no significant difference in postoperative bleeding requiring re-exploration, driveline infections, strokes, pneumonia, right ventricular failure, gastrointestinal bleeding or readmissions within thirty days (P = NS). These data demonstrate similar short- and long-term results for the two groups of recipients of LVAD implantation. RESULTS support the use of long-term mechanical circulatory support in carefully selected elderly patients.

Research paper thumbnail of Mechanical treatment of heart failure: the growing role of LVADs and artificial hearts

Cleveland Clinic Journal of Medicine, 2003

Research paper thumbnail of Restrictive interatrial communication in hypoplastic left heart syndrome after modified Fontan repair

The Annals of Thoracic Surgery, 2003

It is imperative to recognize arch anatomy involving an anomalous right subclavian artery when tr... more It is imperative to recognize arch anatomy involving an anomalous right subclavian artery when treating a traumatic aortic transection. This variable may influence the diagnosis and location of the injury and have consequences on the surgical repair of the lesion.

Research paper thumbnail of Mid-ileal perforation secondary to colonoscopy

The American surgeon

Perforation of the bowel is a known complication of colonoscopy. Ileal perforation is a very rare... more Perforation of the bowel is a known complication of colonoscopy. Ileal perforation is a very rare complication of this procedure. We present a previously unreported case of double ileal perforation following colonoscopy secondary to dense, fixed pelvic adhesions.

Research paper thumbnail of Timing of basiliximab induction and development of acute rejection in lung transplant patients

The Journal of Heart and Lung Transplantation, 2011

Acute rejection affects more than 36% of recipients within the first year post-transplantation. T... more Acute rejection affects more than 36% of recipients within the first year post-transplantation. The interleukin-2 (IL-2) receptor antagonist basiliximab has been associated with decreased frequency and severity of acute rejection. We investigated whether the timing of induction administration would impact the frequency and severity of acute rejection in the first year after transplantation. In this study we reviewed 119 patients who underwent lung transplantation at Henry Ford Hospital from October 1994 to January 2009. Prior to January 2000 no patients received induction. From January 2000 to March 2006 the initial dose was given after implantation, and from March 2006 to 2009 basiliximab was given prior to implantation. The primary outcome was cumulative acute rejection score (CAR) in the first post-operative year comparing post- vs pre-implant induction. The CAR score for pre-implant basiliximab was 2.5 ± 2.3. This was significantly lower than CAR score of 4.6 ± 3.9 in the post-implant group (p = 0.025). The no-induction group had the highest CAR score at 6.3 ± 3.8 (p = 0.077 compared with the post group). The mean follow-up times in the post and pre group were 5.9 ± 2.3 and 2.3 ± 0.7 years, respectively (p &amp;amp;amp;amp;lt; 0.001). There was no difference in freedom from bronchiolitis obliterans syndrome (BOS), survival or invasive infections between pre- and post-implant induction groups. Basiliximab prior to implant is associated with a lower cumulative acute rejection score over 1 year compared with induction post-implantation. Despite a lower cumulative acute rejection score, there was no significant difference in freedom from BOS or survival.

Research paper thumbnail of Effects of Basiliximab Induction on Development of Acute Rejection and Bronchiolitis Obliterans Syndrome (BOS) in Lung Transplant Patients

Research paper thumbnail of Restrictive interatrial communication in hypoplastic left heart syndrome after modified Fontan repair

The Annals of Thoracic Surgery, 2003

It is imperative to recognize arch anatomy involving an anomalous right subclavian artery when tr... more It is imperative to recognize arch anatomy involving an anomalous right subclavian artery when treating a traumatic aortic transection. This variable may influence the diagnosis and location of the injury and have consequences on the surgical repair of the lesion.

Research paper thumbnail of Effect of Body Mass Index on Outcomes in Left Ventricular Assist Device Recipients

Journal of cardiac surgery, Jan 9, 2016

Obesity is associated with higher mortality following heart transplantation, but there remains no... more Obesity is associated with higher mortality following heart transplantation, but there remains no consensus regarding outcomes in left ventricular assist device (LVAD) recipients. We sought to determine the impact of body mass index (BMI) on outcomes in patients undergoing LVAD implantation. This was a single-institution retrospective review, including all patients who received a HeartMate II LVAD or HeartWare HVAD between March 2006 and June 2014. Patients were stratified into three groups based on normal (<25 kg/m(2) ), overweight (25-30 kg/m(2) ), and obese (>30 kg/m(2) ) BMI. Two hundred patients were included in the analysis. Mean BMI was 28.3 kg/m(2) , (27% normal, 36% overweight, and 36.5% obese). Obese patients were younger (51.9 years, p = 0.03) and had higher incidence of diabetes (58.9% vs. 24.1%; p < 0.001) and peripheral vascular disease (16.4% vs. 1.9%; p = 0.03). Normal BMI patients were more likely to undergo LVAD implantation as destination therapy compared...

Research paper thumbnail of Cannulation of the axillary artery with a side graft reduces morbidity

The Annals of Thoracic Surgery, Jan 4, 2004

Background. The axillary artery is our preferred arterial cannulation site when the ascending aor... more Background. The axillary artery is our preferred arterial cannulation site when the ascending aorta cannot be cannulated. Previously, we cannulated the artery directly; now we use a side graft. The purposes of this study were to (1) investigate cannulation-related morbidity and (2) determine whether use of a side graft reduces it.

Research paper thumbnail of LVAD destination therapy: applying what we know about psychiatric evaluation and management from cardiac failure and transplant

Heart Failure Reviews, Mar 1, 2009

Left ventricular assist devices (LVADs) have evolved into long-term use as destination therapy fo... more Left ventricular assist devices (LVADs) have evolved into long-term use as destination therapy for those with severe end-stage heart failure due to other medical risks. Success with LVAD depends on adherence to a complicated mechanical regimen, and acceptance of a life that is far from normal. Patients with LVADs share characteristics with other end-stage cardiac failure patients and those waiting for or receiving heart transplants. Understanding the more thoroughly studied issues of psychiatric disorders, adherence, and behavioral correlates of success in heart failure and transplantation may identify feasible strategies for optimizing care of LVAD patients and suggest directions for future research. Depression and distress complicate post-transplant care. Psychiatric morbidity is associated with poor outcomes, including graft rejection, non-adherence, hospitalizations, infection, and death. With a high risk of embolic neurological events, patients' ability for self-care may be compromised. Psychiatric symptoms are underdiagnosed and undertreated, which may impact overall survival and quality of life.

Research paper thumbnail of Short and long term outcomes of 200 patients supported by continuous-flow left ventricular assist devices

World journal of cardiology, Jan 26, 2015

To study the institutional experience over 8 years with 200 continuous-flow (CF) - left ventricul... more To study the institutional experience over 8 years with 200 continuous-flow (CF) - left ventricular assist devices (LVAD). We evaluated our institution's LVAD database and analyzed all patients who received a CF LVAD as a bridge to transplant (BTT) or destination therapy from March 2006 until June 2014. We identified 200 patients, of which 179 were implanted with a HeartMate II device (Thoratec Corp., Pleasanton, CA) and 21 received a Heartware HVAD (HeartWare Inc., Framingham, MA). The mean age of our LVAD recipients was 59.3 years (range 17-81), 76% (152/200) were males, and 49% were implanted for the indication of BTT. The survival rate for our LVAD patients at 30 d, 6 mo, 12 mo, 2 years, 3 years, and 4 years was 94%, 86%, 78%, 71%, 62% and 45% respectively. The mean duration of LVAD support was 581 d (range 2-2595 d). Gastrointestinal bleeding (was the most common adverse event (43/200, 21%), followed by right ventricular failure (38/200, 19%), stroke (31/200, 15%), re explo...

Research paper thumbnail of Effect of Preoperative Albumin Levels on Outcomes in Patients Undergoing Left Ventricular Device Implantation

ASAIO Journal, 2015

Hypoalbuminemia is a well-known predictor of morbidity and mortality in cardiac surgery. Our aim ... more Hypoalbuminemia is a well-known predictor of morbidity and mortality in cardiac surgery. Our aim was to establish the impact of serum albumin on outcomes following left ventricular assist device (LVAD) implantation.This was a single-institution retrospective review, including all patients who underwent LVAD implantation between March 2006 and June 2014.Two hundred patients were included in the analysis. Mean serum albumin was 3.27 ± 0.47 g/dL, with 7% in the low albumin group (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;2.5 mg/dL), 67.5% in the mid-range (2.5-3.5 mg/dL) and 25.5% in the normal albumin groups (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 3.5 mg/dL). Lower albumin was associated with a significant increase in postoperative renal failure (42.9% vs. 16.5% vs. 17.3%; p=0.05) and prolonged hospitalization (median 28.5 vs. 16 vs. 15.5 days; p=0.008). Six-month, 1-year and 5-year survival was 79%, 79% and 49% with low, 84%, 78% and 51% with mid-range, and 94%, 88% and 60% with normal albumin, respectively (p=0.22).Preoperative hypoalbuminemia is associated with post-operative ARF and prolonged hospitalization following LVAD implantation, with no effect on overall survival. Hypoalbuminemia is most likely a marker of advanced disease and should not, in itself, be considered a contraindication to LVAD candidacy.

Research paper thumbnail of Baseline Pulmonary Function and Outcomes in Patients Receiving Left Ventricular Assist Devices

Journal of Cardiac Failure, 2015

Research paper thumbnail of Changes in Pulmonary Function After Left Ventricular Assist Device Implantation

Journal of Cardiac Failure, 2015

Research paper thumbnail of Autorenverzeichnis · Authors Index

Research paper thumbnail of Factors determining post-operative readmissions after left ventricular assist device implantation

The Journal of Heart and Lung Transplantation, 2014

Research paper thumbnail of Stroke While on Long-Term Left Ventricular Assist Device Support

ASAIO Journal, 2014

Development of stroke while on left ventricular assist device (LVAD) support can be a source of s... more Development of stroke while on left ventricular assist device (LVAD) support can be a source of significant morbidity and mortality. From March 2006 through November 2011, one hundred patients with chronic heart failure underwent implantation of a HeartMate II (HM II) LVAD (Thoratec Corp.) as a bridge to transplant (BTT; n = 65) or destination therapy (DT; n = 35). Records were reviewed to determine the prevalence and type of postimplant stroke, anatomic cerebral location of strokes, and associated morbidity and mortality. Cox multivariate logistic regression analysis was conducted to identify independent predictors of postoperative stroke. Strokes occurred in 12 patients (12.0%): four embolic and eight hemorrhagic. Median duration of support at the time of stroke was 281.0 days for embolic strokes and 380.5 days for hemorrhagic strokes (p = 0.028). Stroke patients had a significantly higher incidence of diabetes (66.7% vs. 40.9%; p = 0.024), history of preimplant stroke (16.7% vs. 4.5%; p = 0.046), and aortic cross-clamping with cardioplegic arrest during their LVAD implant (50.0% vs. 20.2%; p = 0.034) compared with patients without postoperative strokes. Mean international normalized ratio (INR) at the time of stroke was subtherapeutic in all four patients with embolic strokes (mean: 1.5 ± 0.1 IU; range 1.3-1.6 IU) and supratherapeutic in four of eight patients with hemorrhagic strokes (mean: 3.2 ± 2.2 IU, range: 1.4-7.0 IU; p = 0.024). There was a 25.0% 30 day mortality after stroke. Diabetes (odds ratio [OR] 6.36; p = 0.029), aortic cross-clamping with cardioplegic arrest (OR 4.75; p = 0.025), duration of LVAD support (OR 1.00; p = 0.008), and INR (OR 4.42; p = 0.020) were independent predictors of stroke in multivariate analysis with a trend toward significance for history of stroke (OR 6.25; p = 0.075). Stroke represented an important source of morbidity and mortality for patients on HM II LVAD support. As long-term device therapy continues to gain popularity for both BTT and DT, a better understanding of the predictors of stroke, more strict control of postoperative anticoagulation, and the establishment of a risk stratification model may aid in minimizing its occurrence.

Research paper thumbnail of Left Ventricular Assist Devices and Changes in Leukocyte Count

Journal of Cardiac Failure, 2014

was the primary indication for device placement (n59), followed by chronic ischemic cardiomyopath... more was the primary indication for device placement (n59), followed by chronic ischemic cardiomyopathy (n53) and cardiac transplant rejection (n51). The average duration of Impella support was 1167.5 days. Within 24 hours of device placement, patients had an increase in cardiac output to 5.5L/min61.4 vs 4.4L/min61.3 (p50.005), which was associated with an improvement in GFR from 45.0613.5 to 52.0614.5 (p50.01), pulmonary artery pressures 41 613.0 to 3167.0 (p50.01), right atrial pressures 11 64 to 1066 (p50.04) and pulmonary capillary wedge pressure 326 12.0 to 2065.0 (p50.03). In 84% of cases (n511), the Impella provided adequate left ventricular support, with patients either successfully weaned off support completely (n54), or receiving permanent LVADs (n55) or cardiac transplant (n52). Only 16% of patients (n52) died while actively on the Impella .The 30 day mortality was 23% (n53), while overall mortality at 90 days stood at 54% (n57). The causes of mortality included device malfunction, fatal arrhythmia 24 hours after Impella removal and withdrawal of care in 1 patient each and multi-organ failure in 4 patients who were transitioned to permanent LVAD's. Conclusions: The Impella 5.0 has been shown to be a safe and efficacious device for use in patients with cardiogenic shock. In our high risk population, the device was easily and quickly inserted and demonstrated consistent hemodynamic augmentation. It also established itself as a good supportive modality in our acutely ill patients as well. Though our overall results in terms of mortality have not been very encouraging, the Impella was indeed successful in bridging patients to either, a permanent LVAD, transplant or in some cases ventricular recovery as well. Therefore in these high risk patients with profound cardiogenic shock, this is indeed a suitable treatment strategy.

Research paper thumbnail of Sex-Specific Outcomes in Patients Receiving Continuous-Flow Left Ventricular Devices as a Bridge to Transplantation or Destination Therapy

ASAIO Journal, 2014

Reports on sex-related outcomes in left ventricular assist device (LVAD) patients are conflicting... more Reports on sex-related outcomes in left ventricular assist device (LVAD) patients are conflicting. In addition, females have been underrepresented in most multicenter randomized controlled trials for mechanical circulatory support (MCS). The objective of our study was to analyze our experience implanting 130 continuous-flow LVADs and to determine the impact of sex on survival. We identified 130 patients who underwent implantation of a continuous-flow LVAD at our institution. Patients were stratified into two groups based on sex. Variables were compared using two-sided t-tests, χ 2 tests, Cox proportional hazards models, and log-rank tests to determine whether there was a difference between the two groups and if sex was a significant independent predictor of outcome. Of the 130 patients, 35 were females and 95 were males. Female patients had worse pre-LVAD cardiac output and cardiac index and were more likely to be on MCS at the time of implantation. Male patients had worse renal function. Survival was analogous for both cohorts with 30 day, 6 month, 1 year, and 2 year survivals of 97%, 90.8%, 90.8%, and 84.3%, respectively, for female patients versus 94.7%, 87.9%, 78.4%, and 72.8%, respectively, for male patients. The incidence of other LVADrelated complications was also similar in both groups. Gender did not predict postoperative mortality on univariate analysis. Contrary to most published reports, female and male LVAD patients have similar postoperative and midterm survival, length of hospital stay, readmission rates, and postoperative complications. It appears that females have gained more benefit from newer generation devices compared to males. ASAIO Journal 2014; 60:199-206.

Research paper thumbnail of Lessons Learned From 150 Continuous Flow Left Ventricular Assist Devices

ASAIO Journal, 2014

Continuous flow left ventricular assist devices (LVADs) have become the standard of care for pati... more Continuous flow left ventricular assist devices (LVADs) have become the standard of care for patients with advanced heart failure refractory to optimal medical therapy. The goal of this study was to review our seven year single institutional experience with CF LVADs. Mean age was 50.4 + 12.5 (17-69) years for BTT patients and 57.6 + 10.4 (31-81) years for DT patients (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001).Overall, 38 (26%) patients were female and 58 (41%) African American. Etiology of heart failure was ischemic in 54 (37%) patients and non ischemic in 93 (63%) patients. Overall survival at 30 days, 6 months, 12 months and 2 years was 93%, 89%, 84% and 81% respectively. Gastrointestinal bleeding (GIB) was the most common complication (24%), followed by stroke (18%), right ventricular (RV) failure (18%), ventilator dependent respiratory failure (VDRF) (10%), reoperation for bleeding (10%), and driveline infection (9%). These data demonstrate excellent survival with low mortality for both BTT and DT patients on long-term LVAD support. However, for LVAD therapy to become the gold standard for long-term treatment of end-stage heart failure and a plausible alternative to heart transplantation, we need to continue to improve the incidence of frequent postoperative complications, such as right ventricular failure, drive-line infections, strokes, and gastrointestinal bleeding.

Research paper thumbnail of Should Left Ventricular Assist Devices be Implanted in Patients Seventy Years of Age and Older: A Comparative Analysis

The Heart Surgery Forum, 2014

We evaluated outcomes in left ventricular assist device (LVAD) recipients aged seventy years and ... more We evaluated outcomes in left ventricular assist device (LVAD) recipients aged seventy years and above and compared results to outcomes in LVAD recipients below seventy years of age. From March 2006 through June 2012, 130 patients underwent implantation of either a HeartMate II (HM II; Thoratec Corp., Pleasanton, CA) or HeartWare (HeartWare Inc., Framingham, MA) LVAD at our institution. Four patients underwent device exchanges and were excluded. Of the remaining 126 patients, 6 (4.7%) were ≥70 years of age. Patients in the age group ≥70 years were compared to the group of patients &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 70 years for perioperative mortality, long-term survival and incidence of postoperative complications. Mean age was 72.2 ± 2.3 (70-75) years for the older group and 52.8 ± 11.4 (18-69) years for the younger group (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). There was no significant difference in the incidence of diabetes, hypertension, chronic renal insufficiency, dialysis, hepatic function, preoperative ventilation or previous cardiac surgery between the groups (P = NS). There was no significant difference in survival between the groups, with survival at 6 months, 1 year, and 2 years of 100%, 100% and 66.7% respectively for the older groups, versus 88.6%, 81.3% and 76.7% for the younger group (P = .634). There was no significant difference in postoperative bleeding requiring re-exploration, driveline infections, strokes, pneumonia, right ventricular failure, gastrointestinal bleeding or readmissions within thirty days (P = NS). These data demonstrate similar short- and long-term results for the two groups of recipients of LVAD implantation. RESULTS support the use of long-term mechanical circulatory support in carefully selected elderly patients.

Research paper thumbnail of Mechanical treatment of heart failure: the growing role of LVADs and artificial hearts

Cleveland Clinic Journal of Medicine, 2003