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Nimesh Desai

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https://www.readbyqxmd.com/read/29673638/outcome-after-surgery-for-aortic-dissection-type-a-in-morbidly-obese-patients
#1
Maximilian Kreibich, Bartosz Rylski, Joseph E Bavaria, Emanuela Branchetti, Daniel Dohle, Patrick Moeller, Prashanth Vallabhajosyula, Wilson Y Szeto, Nimesh D Desai
BACKGROUND: The number of obese patients is increasing and more obese patients are likely to present for surgical repair of aortic dissection Type A (ADA). We evaluated the effect of this procedure on mortality and morbidity of patients based on their body-mass-index (BMI; kg*m-2 ). METHODS: A total of 667 patients that underwent surgical repair of ADA between 2003 and 2017 were retrospectively analyzed. Patients were divided into four groups according to BMI: normal weight (18≤BMI<25; n=186), overweight (25≤BMI<30; n=238), obese (30≤BMI<35, n=144), and morbidly obese (BMI≥35; n=99)...
April 16, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29663522/tricuspid-valve-endocarditis-in-the-era-of-the-opioid-epidemic
#2
Tyler J Wallen, Wilson Szeto, Matthew Williams, Pavan Atluri, George Arnaoutakis, Marci Fults, Ibrahim Sultan, Nimesh Desai, Michael Acker, Prashanth Vallabhajosyula
BACKGROUND AND AIM: We reviewed our institutional experience with tricuspid valve endocarditis to understand the impact of the opioid epidemic on the incidence of right heart endocarditis. METHODS: We retrospectively reviewed all cases of tricuspid endocarditis managed surgically from January of 2011 to May of 2017. There were no exclusion criteria. RESULTS: A total of 126 patients were identified. There were seven cases in 2011 and 36 in 2016...
April 16, 2018: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/29610444/hemodynamic-effects-of-valve-asymmetry-in-sapien-3-transcatheter-aortic-valves
#3
Daniel R Mangels, Mary Siki, Rohan Menon, Joseph Bavaria, Saif Anwaruddin, Jay Giri, Nimesh Desai, Wilson Y Szeto, Prashanth Vallabhajosyula, Howard C Herrmann
BACKGROUND: Eccentric valve deployment after transcatheter aortic valve replacement (TAVR) has been associated with abnormal leaflet shear stresses that may accelerate structural valve deterioration (SVD). This phenomenon has not been studied in patients receiving Sapien 3 prostheses (Edwards Lifesciences). METHODS: A retrospective cohort analysis of 100 patients who received Sapien 3 valves between 2013 and 2015 at a single institution was performed. Axial fluoroscopic images from the co-planar view were used to assess TAVR asymmetry, which was defined as a ratio of left-to-right valve heights ≤0...
April 2018: Journal of Invasive Cardiology
https://www.readbyqxmd.com/read/29577925/the-society-of-thoracic-surgeons-2018-adult-cardiac-surgery-risk-models-part-1-background-design-considerations-and-model-development
#4
David M Shahian, Jeffrey P Jacobs, Vinay Badhwar, Paul A Kurlansky, Anthony P Furnary, Joseph C Cleveland, Kevin W Lobdell, Christina Vassileva, Moritz C Wyler von Ballmoos, Vinod H Thourani, J Scott Rankin, James R Edgerton, Richard S D'Agostino, Nimesh D Desai, Liqi Feng, Xia He, Sean M O'Brien
BACKGROUND: The last published version of the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) risk models were developed in 2008 based on patient data from 2002 to 2006 and have been periodically recalibrated. In response to evolving changes in patient characteristics, risk profiles, surgical practice, and outcomes, STS has now developed a set of entirely new risk models for adult cardiac surgery. METHODS: New models were estimated for isolated coronary artery bypass grafting surgery (CABG, n = 439,092), isolated aortic or mitral valve surgery (n = 150,150), and combined valve + CABG (n = 81,588) procedures...
March 22, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29577924/the-society-of-thoracic-surgeons-2018-adult-cardiac-surgery-risk-models-part-2-statistical-methods-and-results
#5
Sean M O'Brien, Liqi Feng, Xia He, Ying Xian, Jeffrey P Jacobs, Vinay Badhwar, Paul A Kurlansky, Anthony P Furnary, Joseph C Cleveland, Kevin W Lobdell, Christina Vassileva, Moritz C Wyler von Ballmoos, Vinod H Thourani, J Scott Rankin, James R Edgerton, Richard S D'Agostino, Nimesh D Desai, Fred H Edwards, David M Shahian
BACKGROUND: The Society of Thoracic Surgeons (STS) uses statistical models to create risk-adjusted performance metrics for Adult Cardiac Surgery Database (ACSD) participants. Because of temporal changes in patient characteristics and outcomes, evolution of surgical practice, and additional risk factors available in recent ACSD versions, completely new risk models have been developed. METHODS: Using July 2011 to June 2014 ACSD data, risk models were developed for operative mortality, stroke, renal failure, prolonged ventilation, mediastinitis /deep sternal wound infection (DSWI), reoperation, major morbidity or mortality composite, and prolonged postoperative length of stay (PLOS) or short PLOS among patients who underwent isolated coronary artery bypass grafting (CABG; n = 439,092), aortic or mitral valve surgery (n = 150,150), or combined valve + CABG (n = 81,588)...
March 22, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29525191/the-ross-operation-in-the-adult-what-why-and-when
#6
REVIEW
Michael Ibrahim, Audrey E Spelde, Timothy I Carter, Prakash A Patel, Nimesh Desai
The normal aortic valve is a sophisticated and dynamic structure whose equal replacement has not yet been actualized by modern technology. The use of the pulmonary autograft as a substitute for a diseased aortic valve (the Ross procedure) has been in practice for several decades in many types of patient. In the adult, it has not been adopted widely due to concerns about its technical challenge, complex perioperative care, the development of pulmonic valve disease, and concerns about long-term dilatation of the neo-aortic root, among others...
December 29, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29502934/association-of-tricuspid-regurgitation-with-transcatheter-aortic-valve-replacement-outcomes-a-report-from-the-society-of-thoracic-surgeons-american-college-of-cardiology-transcatheter-valve-therapy-registry
#7
Fenton H McCarthy, Sreekanth Vemulapalli, Zhuokai Li, Vinod Thourani, Roland A Matsouaka, Nimesh D Desai, Ajay Kirtane, Saif Anwaruddin, Matthew L Williams, Jay Giri, Prashanth Vallabhajosyula, Robert H Li, Howard C Herrmann, Joseph E Bavaria, Wilson Y Szeto
BACKGROUND: The purpose of this study is to evaluate the association of tricuspid regurgitation (TR) severity with outcomes after transcatheter aortic valve replacement (TAVR). METHODS: We analyzed data from 34,576 patients who underwent TAVR at 365 US hospitals from November 2011 through March 2015 submitted to The Society of Thoracic Surgeon/American College of Cardiology Transcatheter Valve Therapy Registry. We examined unadjusted mortality and heart failure readmission stratified by degree of preoperative TR and used multivariable models for 1-year mortality and heart failure readmission...
April 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29391144/predicting-distal-aortic-remodeling-after-endovascular-repair-for-chronic-debakey-iii-aortic-dissection
#8
Ibrahim Sultan, Mary A Siki, Joseph E Bavaria, Taylor R Dibble, Danielle C Savino, Arman Kilic, Wilson Szeto, Prashanth Vallabhajosyula, Ronald M Fairman, Benjamin M Jackson, Grace J Wang, Nimesh D Desai
BACKGROUND: Chronic DeBakey III (CD3) aortic dissection is typically managed with open aortic reconstruction. Thoracic endovascular aortic grafting (TEVAR) has been attempted in patients with CD3 with improved outcomes over medical management, however with frequent failures. This study investigates factors associated with positive aortic remodeling from a large aortic center. METHODS: Three dimensional reconstructions (M2S, West Lebanon, NH) of computed tomography angiography scans of 48 patients who underwent TEVAR from 2005 to 2015 were analyzed...
January 29, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29337125/facilitating-hemostasis-after-proximal-aortic-surgery-results-of-the-protect-trial
#9
Ali Khoynezhad, Jacob DelaRosa, Marc R Moon, William T Brinkman, Richard B Thompson, Nimesh D Desai, S Chris Malaisrie, Leonard N Girardi, Joseph E Bavaria, T Brett Reece
BACKGROUND: This study intended to evaluate the safety and hemostatic efficacy of a novel vascular sealant (Tridyne; Neomend, Inc, Irvine, CA) compared with an accepted adjunctive hemostatic agent applied to aortotomy and sutures lines in cardiovascular operations. METHODS: Patients undergoing aortic valve replacement, ascending aortic replacement, or aortic root replacement were randomly assigned 2:1 to Tridyne (n = 107) or Gelfoam Plus (Baxter Healthcare Corp, Hayward, CA) (n = 51)...
January 12, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29331552/malperfusion-during-hypothermic-antegrade-cerebral-perfusion-cerebral-perfusion-index-an-early-indicator-compared-to-cerebral-oximetry
#10
Mark W Fegley, Audrey Spelde, David Johnson, Nimesh D Desai, Warren J Levy
No abstract text is available yet for this article.
September 21, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29242071/impact-of-acute-postoperative-limb-ischemia-after-cardiac-and-thoracic-aortic-surgery
#11
Ian W Folkert, Paul J Foley, Grace J Wang, Benjamin M Jackson, Joseph E Bavaria, Nimesh D Desai, Ronald M Fairman, Scott M Damrauer
OBJECTIVE: Acute limb ischemia (ALI) is the cause of significant morbidity and mortality. Although ALI after cardiac surgery is associated with high rates of morbidity and mortality, there are no robust, controlled analyses of the risk factors and outcomes of ALI in this setting. We aimed to identify risk factors for and to delineate outcomes after ALI in patients undergoing cardiac surgery. METHODS: We performed a retrospective review of prospectively collected data on patients undergoing cardiac surgery at our institution between 2002 and 2012...
December 11, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29178215/transfemoral-transcatheter-aortic-valve-replacement-with-a-self-expanding-valve-for-severe-aortic-regurgitation-in-a-patient-with-left-ventricular-assist-device
#12
A Garvey Rene, Nimesh Desai, Joyce Wald, Jesus Eduardo Rame, Jonathan K Frogel, Saif Anwaruddin
Aortic insufficiency following left ventricular assist device implantation (LVAD) has been reported in up to 40% of patients and is associated with a worse prognosis. We describe the case of a successful transfemoral transcatheter aortic valve replacement with a self-expanding bioprosthesis for aortic insufficiency following destination LVAD implantation.
November 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/29174745/stroke-after-transcatheter-aortic-valve-replacement-incidence-definitions-etiologies-and-management-options
#13
REVIEW
Prakash A Patel, Saumil Patel, Jared W Feinman, Jacob T Gutsche, Prashanth Vallabhajosyula, Ronak Shah, Jay Giri, Nimesh D Desai, Elizabeth Zhou, Stuart J Weiss, John G Augoustides
Neurologic complications after transcatheter aortic valve replacement are devastating. The etiologies of stroke in this setting are best addressed in an integrated fashion during each phase of the perioperative pathway. The conduct of this triphasic approach will continue to be refined to reduce the stroke risks even further, given the major focus on aspects such as embolic protection devices and valve thrombosis. This neurologic focus in transcatheter aortic valve replacement has transformed the investigational approach to neurologic events in cardiovascular clinical trials, resulting in novel guidelines for the diagnosis and assessment of neurologic injury after cardiovascular interventions...
August 24, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29074152/patients-with-type-a-acute-aortic-dissection-presenting-with-an-abnormal-electrocardiogram
#14
Nathaniel I Costin, Amit Korach, Gabriel Loor, Mark D Peterson, Nimesh D Desai, Santi Trimarchi, Carlo de Vincentiis, Takeyoshi Ota, T Brett Reece, Thoralf M Sundt, Himanshu J Patel, Edward P Chen, Dan G Montgomery, Christoph A Nienaber, Eric M Isselbacher, Kim A Eagle, Thomas G Gleason
BACKGROUND: The electrocardiogram (ECG) is often used in the diagnosis of patients presenting with chest pain to emergency departments. Because chest pain is a common manifestation of type A acute aortic dissection (TAAAD), ECGs are obtained in much of this population. We evaluated the effect of particular ECG patterns on the diagnosis and treatment of TAAAD. METHODS: TAAAD patients (N = 2,765) enrolled in the International Registry of Acute Aortic Dissection were stratified based on normal (n = 1,094 [39...
January 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28977503/extended-versus-limited-arch-replacement-in-acute-type-a-aortic-dissection
#15
Magnus Larsen, Santi Trimarchi, Himanshu J Patel, Marco Di Eusanio, Kevin L Greason, Mark D Peterson, Rossella Fattori, Stuart Hutchison, Nimesh D Desai, Amit Korach, Daniel G Montgomery, Eric M Isselbacher, Christoph A Nienaber, Kim A Eagle, Kristian Bartnes, Truls Myrmel
OBJECTIVES: The recommended extent of surgical resection and reconstruction of the arch in acute DeBakey Type I aortic dissection is an ongoing controversy. However, several recent reports indicate a trend towards a more extensive arch operation in several institutions. We have analysed the recent data from the International Registry of Acute Aortic Dissection to assess the choice of procedure over time and to evaluate the surgical outcome in a 'real-world' database. Our aim was to compare short- and mid-term outcomes of limited repairs versus complete arch surgery...
December 1, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28927697/aortic-regurgitation-in-acute-type-a-aortic-dissection-a-clinical-classification-for-the-perioperative-echocardiographer-in-the-era-of-the-functional-aortic-annulus
#16
REVIEW
Prakash A Patel, Joseph E Bavaria, Kamrouz Ghadimi, Jacob T Gutsche, Prashanth Vallabhajosyula, Hanjo A Ko, Nimesh D Desai, Emily Mackay, Stuart J Weiss, John G T Augoustides
The functional aortic annulus offers a clinical approach for the perioperative echocardiographer to classify the mechanisms of aortic regurgitation in acute type-A dissection. Comprehensive examination of the functional aortic annulus in this setting using transesophageal echocardiography can guide surgical therapy for the aortic root by considering the following important aspects: severity and mechanism of aortic regurgitation, extent of root dissection, and the pattern of coronary artery involvement. The final choice of surgical therapy also should take into account factors, such as patient presentation and surgical experience, to limit mortality and morbidity from this challenging acute aortic syndrome...
February 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28874033/thoracic-aortic-surgery-enters-the-era-of-big-data
#17
Joseph E Bavaria, Shinichi Fukuhara, Nimesh D Desai
No abstract text is available yet for this article.
September 1, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28864443/conscious-sedation-versus-general-anesthesia-for-transcatheter-aortic-valve-replacement-insights-from-the-national-cardiovascular-data-registry-society-of-thoracic-surgeons-american-college-of-cardiology-transcatheter-valve-therapy-registry
#18
COMPARATIVE STUDY
Matthew C Hyman, Sreekanth Vemulapalli, Wilson Y Szeto, Amanda Stebbins, Prakash A Patel, Roland A Matsouaka, Howard C Herrmann, Saif Anwaruddin, Taisei Kobayashi, Nimesh D Desai, Prashanth Vallabhajosyula, Fenton H McCarthy, Robert Li, Joseph E Bavaria, Jay Giri
BACKGROUND: Conscious sedation is used during transcatheter aortic valve replacement (TAVR) with limited evidence as to the safety and efficacy of this practice. METHODS: The National Cardiovascular Data Registry Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry was used to characterize the anesthesia choice and clinical outcomes of all US patients undergoing elective percutaneous transfemoral TAVR between April 1, 2014, and June 30, 2015...
November 28, 2017: Circulation
https://www.readbyqxmd.com/read/28833637/concomitant-transfemoral-transcatheter-aortic-and-mitral-valve-in-valve-replacement
#19
A Garvey Rene, Nimesh Desai, Saif Anwaruddin
The valve-in-valve (viv) procedure has been shown to be effective in treating patients with a degenerated bioprosthesis who are also considered high risk or inoperable for a reoperation. We describe a case of concomitant transfemoral transcatheter viv aortic and mitral valve replacements.
August 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/28712581/cost-and-contribution-margin-of-transcatheter-versus-surgical-aortic-valve-replacement
#20
Fenton H McCarthy, Danielle C Savino, Chase R Brown, Joseph E Bavaria, Vinay Kini, Danielle D Spragan, Taylor R Dibble, Howard C Herrmann, Saif Anwaruddin, Jay Giri, Wilson Y Szeto, Peter W Groeneveld, Nimesh D Desai
OBJECTIVE: To compare the cost of and payments for transcatheter aortic valve replacement (TAVR), a novel and expensive technology, and surgical aortic valve replacement (SAVR). METHODS: Medicare claims provided hospital charges, payments, and outcomes between January and December 2012. Hospital costs and charges were estimated using hospital-specific cost-to-charge ratios. Costs and payments were examined in propensity score- matched TAVR and SAVR patients. RESULTS: Medicare spent $215,770,200 nationally on 4083 patients who underwent TAVR in 2012...
June 21, 2017: Journal of Thoracic and Cardiovascular Surgery
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