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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/29628015/clinical-outcomes-of-weight-based-norepinephrine-dosing-in-underweight-and-morbidly-obese-patients-a-propensity-matched-analysis
#3
Aditya A Kotecha, Saraschandra Vallabhajosyula, Dinesh R Apala, Erin Frazee, Vivek N Iyer
BACKGROUND: Weight-based dosing strategy for norepinephrine in septic shock patients with extremes of body mass index has been lesser studied. METHODS: This historical study of adult septic shock patients was conducted from January 1, 2010, to December 31, 2015, at all intensive care units (ICUs) in Mayo Clinic, Rochester. Patients with documented body mass index were classified into underweight (body mass index <18.5 kg/m2 ), normal weight (18.5-24.9 kg/m2 ), and morbidly obese (≥40 kg/m2 ) patients...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29610444/hemodynamic-effects-of-valve-asymmetry-in-sapien-3-transcatheter-aortic-valves
#4
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/29552957/global-longitudinal-strain-using-speckle-tracking-echocardiography-as-a-mortality-predictor-in-sepsis-a-systematic-review
#5
Saraschandra Vallabhajosyula, Hamza A Rayes, Ankit Sakhuja, Mohammad Hassan Murad, Jeffrey B Geske, Jacob C Jentzer
The data on speckle-tracking echocardiography (STE) in patients with sepsis are limited. This systematic review from 1975 to 2016 included studies in adults and children evaluating cardiovascular dysfunction in sepsis, severe sepsis, and septic shock utilizing STE for systolic global longitudinal strain (GLS). The primary outcome was short- or long-term mortality. Given the significant methodological and statistical differences between published studies, combining the data using meta-analysis methods was not appropriate...
January 1, 2018: Journal of Intensive Care Medicine
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
#6
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/29499866/donor-tissue-specific-exosome-profiling-enables-noninvasive-monitoring-of-acute-rejection-in-mouse-allogeneic-heart-transplantation
#7
Andreas Habertheuer, Laxminarayana Korutla, Susan Rostami, Sanjana Reddy, Priti Lal, Ali Naji, Prashanth Vallabhajosyula
OBJECTIVE: In heart transplantation, there is a critical need for development of biomarkers to noninvasively monitor cardiac allografts for immunologic rejection or injury. Exosomes are tissue-specific nanovesicles released into circulation by many cell types. Their profiles are dynamic, reflecting conditional changes imposed on their tissue counterparts. We proposed that a transplanted heart releases donor-specific exosomes into the recipient's circulation that are conditionally altered during immunologic rejection...
February 1, 2018: Journal of Thoracic and Cardiovascular 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/29361252/basic-and-advanced-echocardiographic-evaluation-of-myocardial-dysfunction-in-sepsis-and-septic-shock
#9
REVIEW
S Vallabhajosyula, S Pruthi, S Shah, B M Wiley, S V Mankad, J C Jentzer
Sepsis continues to be a leading cause of mortality and morbidity in the intensive care unit. Cardiovascular dysfunction in sepsis is associated with worse short- and long-term outcomes. Sepsis-related myocardial dysfunction is noted in 20%-65% of these patients and manifests as isolated or combined left or right ventricular systolic or diastolic dysfunction. Echocardiography is the most commonly used modality for the diagnosis of sepsis-related myocardial dysfunction. With the increasing use of ultrasonography in the intensive care unit, there is a renewed interest in sepsis-related myocardial dysfunction...
January 2018: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/29338381/effect-of-the-diabetic-state-on-islet-engraftment-and-function-in-a-large-animal-model-of-islet-kidney-transplantation
#10
Prashanth Vallabhajosyula, Atsushi Hirakata, Matthew Weiss, Adam Griesemer, Akira Shimizu, Hanzhou Hong, Andreas Habertheuer, Vaja Tchipashvili, Kazuhiko Yamada, David H Sachs
In islet transplantation, in addition to immunologic and ischemic factors, the diabetic/hyperglycemic state of the recipient has been proposed, although not yet validated, as a possible cause of islet toxicity, contributing to islet loss during the engraftment period. Using a miniature swine model of islet transplantation, we have now assessed the effect of a persistent state of hyperglycemia on islet engraftment and subsequent function. An islet-kidney (IK) model previously described by our laboratory was utilized...
November 2017: Cell Transplantation
https://www.readbyqxmd.com/read/29329694/management-of-refractory-vasodilatory-shock
#11
REVIEW
Jacob C Jentzer, Saraschandra Vallabhajosyula, Ashish K Khanna, Lakhmir S Chawla, Laurence W Busse, Kianoush B Kashani
Refractory shock is a lethal manifestation of cardiovascular failure defined by an inadequate hemodynamic response to high doses of vasopressor medications. Approximately 7% of critically ill patients will develop refractory shock, with short-term mortality exceeding 50%. Refractory vasodilatory shock develops from uncontrolled vasodilation and vascular hyporesponsiveness to endogenous vasoconstrictors, causing failure of physiologic vasoregulatory mechanisms. Standard approaches to the initial management of shock include fluid resuscitation and initiation of norepinephrine...
January 9, 2018: Chest
https://www.readbyqxmd.com/read/29315332/clinical-profile-and-outcomes-of-acute-cardiorenal-syndrome-type-5-in-sepsis-an-eight-year-cohort-study
#12
Saraschandra Vallabhajosyula, Ankit Sakhuja, Jeffrey B Geske, Mukesh Kumar, Rahul Kashyap, Kianoush Kashani, Jacob C Jentzer
BACKGROUND: To evaluate the clinical features and outcomes of acute cardiorenal syndrome type-5 in patients with severe sepsis and septic shock. METHODS: Historical cohort study of all adult patients with severe sepsis and septic shock admitted to the intensive care units (ICU) at Mayo Clinic Rochester from January 1, 2007 through December 31, 2014. Patients with prior renal or cardiac dysfunction were excluded. Patients were divided into groups with and without cardiorenal syndrome type-5...
2018: PloS One
https://www.readbyqxmd.com/read/29279635/reliability-and-validity-of-the-checklist-for-early-recognition-and-treatment-of-acute-illness-and-injury-as-a-charting-tool-in-the-medical-intensive-care-unit
#13
Alexander Kogan, Kelly M Pennington, Saraschandra Vallabhajosyula, Mikhail Dziadzko, Courtney E Bennett, Jeffrey B Jensen, Ognjen Gajic, John C O'Horo
Background: Resuscitation of critically ill patients is complex and potentially prone to diagnostic errors and therapeutic harm. The Checklist for early recognition and treatment of acute illness and injury (CERTAIN) is an electronic tool that aims to provide decision-support, charting, and prompting for standardization. This study sought to evaluate the validity and reliability of CERTAIN in a real-time Intensive Care Unit (ICU). Materials and Methods: This was a prospective pilot study in the medical ICU of a tertiary care medical center...
November 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29216679/the-role-of-extracorporeal-membrane-oxygenator-therapy-in-the-setting-of-type-a-aortic-dissection
#14
Ibrahim Sultan, Andreas Habertheuer, Tyler Wallen, Mary Siki, Wilson Szeto, Joseph E Bavaria, Matthew Williams, Prashanth Vallabhajosyula
BACKGROUND AND AIM: Patients presenting with type A aortic dissection (TAAD) present with a wide clinical spectrum ranging from hemodynamic stability to multiorgan malperfusion with cardiovascular collapse. Extracorporeal membrane oxygenator (ECMO) therapy is increasingly being utilized as salvage therapy in patients with acute cardiopulmonary failure and for post-cardiotomy shock. We sought to determine the utility of ECMO implementation post-TAAD repair. METHODS: The Pennsylvania Health Care Cost Containment Council (PHC4) database, maintained by an independently functioning state agency, was retrospectively reviewed from 2004 to 2014...
December 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/29174745/stroke-after-transcatheter-aortic-valve-replacement-incidence-definitions-etiologies-and-management-options
#15
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/29143378/management-of-coronary-obstruction-following-transcatheter-aortic-valve-replacement
#16
REVIEW
Ibrahim Sultan, Mary Siki, Tyler Wallen, Wilson Szeto, Prashanth Vallabhajosyula
Although occlusion of the coronary arteries during transcatheter aortic valve replacement is rare, the mortality is high. In this review, we discuss the prevention and management of this complication. Occlusion of coronary ostia is a very rare, but serious, complication of transcatheter aortic valve replacement (TAVR). Although reported as only occurring in <1% of TAVR cases, it carries a high risk of fatality, with some series reporting a mortality rate as high as 40%. We present the management of an occluded left coronary artery after a self-expanding TAVR, and review the incidence, prevention, and management of this complication...
December 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/29037885/national-trends-and-outcomes-of-cardiac-arrest-in-opioid-overdose
#17
Ankit Sakhuja, Matthew Sztajnkrycer, Saraschandra Vallabhajosyula, Wisit Cheungpasitporn, Richard Patch, Jacob Jentzer
AIM: To investigate the epidemiology and outcomes of cardiac arrests associated with opioid overdoses. Recent data suggest that drug overdoses are responsible for more deaths than motor vehicle crashes or firearms in the United States each year, with opioids being involved in majority of drug overdose deaths. Despite the potential for opioids to cause cardiac arrest, few studies have examined this association. PATIENTS AND METHODS: Using data from National (Nationwide) Inpatient Sample database from years 2000-2013, we identified hospitalizations with drug overdoses using ICD-9-CM codes...
December 2017: Resuscitation
https://www.readbyqxmd.com/read/28924310/use-of-corticosteroids-in-acute-respiratory-distress-syndrome-perspective-from-an-indian-intensive-care-unit
#18
Naveen G S Chandra, Saraschandra Vallabhajosyula, Barkur A Shastry, Shashaank Vallabhajosyula, Saarwaani Vallabhajosyula, Kavita Saravu
BACKGROUND: Acute respiratory distress syndrome (ARDS) causes overwhelming inflammation, which serves as a potential target for corticosteroids. Despite extensive Western literature, there are no Indian studies evaluating steroids in ARDS. METHODS: This was a retrospective study at an Indian intensive care unit (ICU) on ARDS patients. Demographic, clinical, laboratory, and imaging parameters were collected. Patients were divided into cohorts based on steroid use, and some received high-dose (2 mg/kg/day), whereas others received low-dose (1 mg/kg/day) steroids...
April 2017: Medical Journal, Armed Forces India
https://www.readbyqxmd.com/read/28889100/role-of-admission-troponin-t-and-serial-troponin-t-testing-in-predicting-outcomes-in-severe-sepsis-and-septic-shock
#19
Saraschandra Vallabhajosyula, Ankit Sakhuja, Jeffrey B Geske, Mukesh Kumar, Joseph T Poterucha, Rahul Kashyap, Kianoush Kashani, Allan S Jaffe, Jacob C Jentzer
BACKGROUND: Troponin-T elevation is seen commonly in sepsis and septic shock patients admitted to the intensive care unit. We sought to evaluate the role of admission and serial troponin-T testing in the prognostication of these patients. METHODS AND RESULTS: This was a retrospective cohort study from 2007 to 2014 on patients admitted to the intensive care units at the Mayo Clinic with severe sepsis and septic shock. Elevated admission troponin-T and significant delta troponin-T were defined as ≥0...
September 9, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28884343/prognostic-impact-of-isolated-right-ventricular-dysfunction-in-sepsis-and-septic-shock-an-8-year-historical-cohort-study
#20
Saraschandra Vallabhajosyula, Mukesh Kumar, Govind Pandompatam, Ankit Sakhuja, Rahul Kashyap, Kianoush Kashani, Ognjen Gajic, Jeffrey B Geske, Jacob C Jentzer
BACKGROUND: Echocardiographic myocardial dysfunction is reported commonly in sepsis and septic shock, but there are limited data on sepsis-related right ventricular dysfunction. This study sought to evaluate the association of right ventricular dysfunction with clinical outcomes in patients with severe sepsis and septic shock. METHODS: Historical cohort study of adult patients admitted to all intensive care units at the Mayo Clinic from January 1, 2007 through December 31, 2014 for severe sepsis and septic shock, who had an echocardiogram performed within 72 h of admission...
September 7, 2017: Annals of Intensive Care
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