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Nimesh Desai

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https://www.readbyqxmd.com/read/27749338/veno-venous-extracorporeal-life-support-in-hemodynamically-unstable-patients-with-ards
#1
Jacob T Gutsche, Mark E Mikkelsen, Fenton H McCarthy, Todd A Miano, William J Vernick, Harish Ramakrishna, Prakash A Patel, Yianni Augoustides, Wilson Y Szeto, Nimesh D Desai, Meghan B Lane-Fall, Matthew L Williams
When clinicians consider extracorporeal life support (ECLS) for acute respiratory distress syndrome (ARDS) patients with hemodynamic instability, both veno-arterial (VA) and veno-venous (VV) ECLS are therapeutic possibilities. We analyzed 17 patients with ARDS on inotropic or vasopressor support requiring ECLS for refractory hypoxemia. After implementing VV ECLS, pressor requirements (based on norepinephrine equivalents) were significantly lower in all patients (P = .0001 for overall comparison across time points)...
October 4, 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27563547/irad-experience-on-surgical-type-a-acute-dissection-patients-results-and-predictors-of-mortality
#2
Paolo Berretta, Himanshu J Patel, Thomas G Gleason, Thoralf M Sundt, Truls Myrmel, Nimesh Desai, Amit Korach, Antonello Panza, Joe Bavaria, Ali Khoynezhad, Elise Woznicki, Dan Montgomery, Eric M Isselbacher, Roberto Di Bartolomeo, Rossella Fattori, Christoph A Nienaber, Kim A Eagle, Santi Trimarchi, Marco Di Eusanio
Type A acute aortic dissection (TAAD) is a disease that has a catastrophic impact on a patient's life and emergent surgery represents a key goal of early treatment. Despite continuous improvements in imaging techniques, medical therapy and surgical management, early mortality in patients undergoing TAAD repair still remains high, ranging from 17% to 26%. In this setting, the International Registry of Acute Aortic Dissection (IRAD), the largest worldwide registry for acute aortic dissection, was established to assess clinical characteristics, management and outcomes of TAAD patients...
July 2016: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/27544289/valve-selection-in-end-stage-renal-disease-should-it-always-be-biological
#3
Matthew L Williams, Joseph E Bavaria, Michael A Acker, Nimesh D Desai, Prashanth Vallabhajosyula, W Clark Hargrove, Pavan Atluri, Wilson Y Szeto
BACKGROUND: When valve replacement is required in patients with end-stage renal disease (ESRD), it is not clear if mechanical or bioprosthetic valve selection is better. We compared outcomes between ESRD patients who underwent either mechanical or biologic valve replacements at our institution. METHODS: All patients with ESRD who underwent either mitral or aortic valve replacement from 2002 to 2014 at our institution were reviewed (n = 215; mechanical = 64, biological = 151)...
August 17, 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27424469/impact-of-retrograde-arch-extension-in-acute-type-b-aortic-dissection-on-management-and-outcomes
#4
Foeke J H Nauta, Jip L Tolenaar, Himanshu J Patel, Jehangir J Appoo, Thomas T Tsai, Nimesh D Desai, Daniel G Montgomery, Firas F Mussa, Gilbert R Upchurch, Rosella Fattori, G Chad Hughes, Christoph A Nienaber, Eric M Isselbacher, Kim A Eagle, Santi Trimarchi
BACKGROUND: Optimal management of acute type B aortic dissection with retrograde arch extension is controversial. The effect of retrograde arch extension on operative and long-term mortality has not been studied and is not incorporated into clinical treatment pathways. METHODS: The International Registry of Acute Aortic Dissection was queried for all patients presenting with acute type B dissection and an identifiable primary intimal tear. Outcomes were stratified according to management for patients with and without retrograde arch extension...
December 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27400898/one-year-clinical-outcomes-with-sapien-3-transcatheter-aortic-valve-replacement-in-high-risk-and-inoperable-patients-with-severe-aortic-stenosis
#5
Howard C Herrmann, Vinod H Thourani, Susheel K Kodali, Raj R Makkar, Wilson Y Szeto, Saif Anwaruddin, Nimesh Desai, Scott Lim, S Chris Malaisrie, Dean J Kereiakes, Steven Ramee, Kevin L Greason, Samir Kapadia, Vasilis Babaliaros, Rebecca T Hahn, Philippe Pibarot, Neil J Weissman, Jonathon Leipsic, Brian K Whisenant, John G Webb, Michael J Mack, Martin B Leon
BACKGROUND: In the initial PARTNER trial (Placement of Aortic Transcatheter Valves) of transcatheter aortic valve replacement for high-risk (HR) and inoperable patients, mortality at 1 year was 24% in HR and 31% in inoperable patients. A recent report of the 30-day outcomes with the low-profile SAPIEN 3 transcatheter aortic valve replacement system demonstrated very low rates of adverse events, but little is known about the longer-term outcomes with this device. METHODS: Between October 2013 and September 2014, 583 HR (65%) or inoperable (35%) patients were treated via the transfemoral (84%) or transapical/transaortic (16%) access route at 29 US sites...
July 12, 2016: Circulation
https://www.readbyqxmd.com/read/27386414/routine-use-of-hemiarch-during-acute-type-a-aortic-dissection-repair
#6
REVIEW
Ibrahim Sultan, Jeremy McGarvey, Prashanth Vallabhajosyula, Nimesh D Desai, Joseph E Bavaria, Wilson Y Szeto
No abstract text is available yet for this article.
May 2016: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/27342207/new-ventricular-septal-defects-following-balloon-expandable-transcatheter-aortic-valve-replacement
#7
A Garvey Rene, Dinesh Jagasia, S Rasi Wickramasinghe, Nimesh Desai, Wilson Szeto, Prashanth Vallabhajosyula, Robert H Li, Frank E Silvestry, Jay Giri, Saurabh Jha, Howard C Herrmann, Saif Anwaruddin
Transcatheter aortic valve replacement (TAVR) has been commercially approved in the United States for the treatment of high-risk and inoperable patients with severe symptomatic aortic stenosis. While TAVR has proven benefits with regard to survival and quality of life in studied populations, the procedure is also associated with several well-described complications including stroke, vascular injury, and paravalvular regurgitation. More infrequent complications are less well described. Here, we report the development of new ventricular septal defects after TAVR in 4 patients with left ventricular outflow tract calcification...
July 2016: Journal of Invasive Cardiology
https://www.readbyqxmd.com/read/27318775/the-impact-of-deep-versus-moderate-hypothermia-on-postoperative-kidney-function-after-elective-aortic-hemiarch-repair
#8
George J Arnaoutakis, Prashanth Vallabhajosyula, Joseph E Bavaria, Ibrahim Sultan, Mary Siki, Suveeksha Naidu, Rita K Milewski, Matthew L Williams, W Clark Hargrove, Nimesh D Desai, Wilson Y Szeto
BACKGROUND: There remains concern that moderate hypothermic circulatory arrest (MHCA) with antegrade cerebral perfusion (ACP) may provide suboptimal distal organ protection compared with deep hypothermic circulatory arrest (DHCA) with retrograde cerebral perfusion (RCP). We compared postoperative acute kidney injury (AKI) in in patients who underwent elective hemiarch repair with either DHCA/RCP or MHCA/ACP. METHODS: This was a retrospective review of all patients undergoing elective aortic hemiarch reconstruction for aneurysmal disease between 2009 and 2014...
October 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27264225/shock-complicating-type-a-acute-aortic-dissection-clinical-correlates-management-and-outcomes
#9
Eduardo Bossone, Reed E Pyeritz, Alan C Braverman, Mark D Peterson, Marek Ehrlich, Patrick O'Gara, Toru Suzuki, Santi Trimarchi, Dan Gilon, Kevin Greason, Nimesh D Desai, Daniel G Montgomery, Eric M Isselbacher, Christoph A Nienaber, Kim A Eagle
AIMS: Shock is among the most dreaded and common complications of type A acute aortic dissection (TAAAD). However, clinical correlates, management, and short- and long-term outcomes of TAAAD patients presenting with shock in real-world clinical practice are not known. METHODS AND RESULTS: We evaluated 2,704 patients with TAAAD enrolled in the International Registry of Acute Aortic Dissection between January 1, 1996, and August 18, 2012. On admission, 407 (15.1%) TAAAD patients presented with shock...
June 2016: American Heart Journal
https://www.readbyqxmd.com/read/27261086/bicuspid-aortic-insufficiency-with-aortic-root-aneurysm-root-reimplantation-versus-bentall-root-replacement
#10
Prashanth Vallabhajosyula, Wilson Y Szeto, Andreas Habertheuer, Caroline Komlo, Rita K Milewski, Fenton McCarthy, Nimesh D Desai, Joseph E Bavaria
BACKGROUND: In patients with a bicuspid aortic valve presenting with aortic insufficiency (AI) and root aneurysm, we assessed whether outcomes with primary cusp repair with root reimplantation were equivalent to the gold standard Bentall procedures. METHODS: From 2002 to 2014, 710 patients with bicuspid aortic valve underwent aortic root procedures. Of these, only patients presenting with noncalcified type I bicuspid aortic valve with AI (n = 165) were included to maintain anatomic and physiologic homogeneity between the groups...
October 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27261085/at-the-root-of-the-repair-debate-outcomes-after-elective-aortic-root-replacements-for-aortic-insufficiency-with-aneurysm
#11
Fenton H McCarthy, Joseph E Bavaria, Katherine M McDermott, Patrick Moeller, Danielle Spragan, Ashley Hoedt, Taylor Dibble, Danielle Savino, Matthew L Williams, Prashanth Vallabhajosyula, Wilson Y Szeto, Nimesh D Desai
BACKGROUND: There is growing interest in aortic valve-sparing and valve repair operations, but the ideal operation and timing of intervention in these generally younger patients undergoing operations for aortic insufficiency (AI) and dilated ascending aorta remains controversial. METHODS: Root replacements at a single institution from 2002 to 2014 were reviewed. Inclusion criteria were age younger than 70 and presence of moderate or greater aortic insufficiency (AI), with or without aortic aneurysm...
October 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27207130/lower-extremity-complications-with-femoral-extracorporeal-life-support
#12
Prashanth Vallabhajosyula, Matthew Kramer, Sofiane Lazar, Fenton McCarthy, Eduardo Rame, Joyce Wald, Wilson Szeto, Matthew Williams, Pavan Atluri, Nimesh Desai, Michael Acker
OBJECTIVE: Patients undergoing emergency peripheral arteriovenous extracorporeal life support were evaluated for lower-extremity complications on the basis of the ipsilateral limb perfusion strategy. METHODS: In a retrospective review of patients receiving extracorporeal life support (2008-2013), 105 of 250 underwent femoral extracorporeal life support. For ipsilateral lower-extremity perfusion, patients underwent no superficial femoral artery cannulation (n = 35), percutaneous superficial femoral artery cannulation (n = 23), or open superficial femoral artery cannulation (n = 47)...
June 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27145743/echocardiographic-determinants-of-lv-functional-improvement-after-transcatheter-aortic-valve-replacement
#13
Jinling Chen, Nasir Nawaz, Zachary Fox, Caroline Komlo, Saif Anwaruddin, Nimesh Desai, Dinesh Jagasia, Howard C Herrmann, Yuchi Han
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an established therapy in high-risk patients with severe aortic stenosis. Among patients with reduced left ventricular ejection fraction (LVEF), it is unclear which patients will derive maximal benefit from TAVR. METHODS: Clinical and echocardiographic data of patients with severe aortic stenosis and low LVEF (≤50%) who underwent TAVR at a single institution during 2009-2013 were retrospectively analyzed...
May 2016: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/27130248/unconventional-volume-outcome-associations-in-adult-extracorporeal-membrane-oxygenation-in-the-united-states
#14
Fenton H McCarthy, Katherine M McDermott, Danielle Spragan, Ashley Hoedt, Vinay Kini, Pavan Atluri, Ann Gaffey, Wilson Y Szeto, Michael A Acker, Nimesh D Desai
BACKGROUND: The aim of this study was to evaluate institutional volume-outcome relationships in extracorporeal membrane oxygenation (ECMO) with subanalyses of ECMO in patients with a primary diagnosis of respiratory failure. METHODS: All institutions with adult ECMO discharges in the Nationwide Inpatient Sample from 2002 to 2011 were evaluated. International Classification of Diseases (ninth revision) codes were used to identify ECMO-treated patients, indications, and concurrent procedures...
August 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27061075/transfemoral-valve-in-valve-sapien-3-in-a-patient-with-an-ascending-aortic-aneurysm
#15
Stephane Leung Wai Sang, Joseph E Bavaria, Jay S Giri, Rasi Wickramasinghe, Nimesh Desai
The presence of thoracic aortic aneurysms, particularly in the ascending aorta and arch, presents a challenge to transcatheter aortic valve replacement. We present a case of TAVR in the presence of a chronic ascending aortic aneurysm. doi: 10.1111/jocs.12724 (J Card Surg 2016;31:318-320).
May 2016: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/26897808/aortic-annulus-diameter-affects-durability-of-the-repaired-bicuspid-aortic-valve
#16
Prashanth Vallabhajosyula, Caroline M Komlo, Wilson Y Szeto, Tyler Rhode, Rohan Menon, Nimesh D Desai, Joseph E Bavaria
BACKGROUND AND AIM OF THE STUDY: An investigation was made as to whether the preoperative aortic annular diameter affects the durability of bicuspid aortic valve (BAV) repair in patients who had undergone concomitant root stabilization with subcommissural annuloplasty (SCA) compared to valve-sparing root reimplantation (VSRR). METHODS: Among a retrospective review of 74 patients who underwent BAV repair between 2005 and 2012,42 had SCA and 32 had VSRR. RESULTS: The preoperative annulus was similar in the two groups (29 +/- 3 mm for SCA; 30 +/- 4 mm for VSRR, p = 0...
July 2015: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/26725716/direct-innominate-artery-cannulation-an-alternate-technique-for-antegrade-cerebral-perfusion-during-aortic-hemiarch-reconstruction
#17
Arminder S Jassar, Prashanth Vallabhajosyula, Joseph E Bavaria, Jacob Gutsche, Nimesh D Desai, Matthew L Williams, Rita K Milewski, W Clark Hargrove, Wilson Y Szeto
OBJECTIVE: We describe an alternate technique for establishing antegrade cerebral perfusion (ACP) during hypothermic circulatory arrest via direct, central cannulation of the innominate artery. METHODS: From 2009 to 2015, 100 elective hemiarch reconstructions for proximal aortic aneurysms were performed under moderate hypothermic circulatory arrest (MHCA). Cerebral perfusion was instituted with ACP via direct cannulation of the innominate artery. RESULTS: Mean patient age was 63 ± 13 years (72 men; 72%)...
April 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/26686427/trends-in-u-s-extracorporeal-membrane-oxygenation-use-and-outcomes-2002-2012
#18
Fenton H McCarthy, Katherine M McDermott, Vinay Kini, Jacob T Gutsche, Joyce W Wald, Dawei Xie, Wilson Y Szeto, Christian A Bermudez, Pavan Atluri, Michael A Acker, Nimesh D Desai
This study evaluates contemporary trends in the use and outcomes of adult patients undergoing extracorporeal membrane oxygenation (ECMO) in U.S. hospitals. All adult discharges in the Nationwide Inpatient Sample database during the years 2002-2012 that included ECMO were used to estimate the total number of U.S. ECMO hospitalizations (n = 12,407). Diagnostic codes were used to group patients by indication for ECMO use into postcardiotomy, heart transplant, lung transplant, cardiogenic shock, respiratory failure, and cardiopulmonary failure...
2015: Seminars in Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/26286740/effect-of-clinical-trial-experience-on-transcatheter-aortic-valve-replacement-outcomes
#19
Fenton H McCarthy, Peter W Groeneveld, Dale Kobrin, Katherine M McDermott, Christopher Wirtalla, Nimesh D Desai
BACKGROUND: Transcatheter aortic valve replacement (TAVR) was approved by the Food and Drug Administration (FDA) in November 2011 after a collaborative technology development process involving professional medical societies, the medical device industry, and the FDA. After FDA approval, TAVR was adopted by numerous hospitals that had not participated in TAVR clinical trials. It is uncertain if outcomes at these hospitals were comparable with those at clinical trial hospitals. METHODS AND RESULTS: All patients with Medicare physician claims for TAVR between January 1, 2011, and November 30, 2012, were identified, and postoperative mortality was assessed using Medicare enrollment data...
September 2015: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/26271581/transcatheter-and-surgical-aortic-valve-replacement-in-dialysis-patients-a-propensity-matched-comparison
#20
Dale M Kobrin, Fenton H McCarthy, Howard C Herrmann, Saif Anwaruddin, Sidney Kobrin, Wilson Y Szeto, Joseph E Bavaria, Peter W Groeneveld, Nimesh D Desai
BACKGROUND: Transcatheter aortic valve replacement (TAVR) clinical trials in North America excluded patients on dialysis and, consequently, the outcomes of TAVR in dialysis-dependent patients remain unknown. METHODS: All Medicare fee-for-service patients undergoing TAVR (n = 5,005) or surgical aortic valve replacement (SAVR) (n = 32,634) between January 1, 2011, and November 30, 2012, were identified using procedural codes collected by the Centers for Medicare & Medicaid Services...
October 2015: Annals of Thoracic Surgery
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