427 results on '"Ashish S. Shah"'
Search Results
2. Modeling the impact of delaying transcatheter aortic valve replacement for the treatment of aortic stenosis in the era of COVID-19Central MessagePerspective
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Daniel R. Freno, MD, Maren E. Shipe, MD, MPH, Melissa M. Levack, MD, Ashish S. Shah, MD, Stephen A. Deppen, PhD, Jared M. O'Leary, MD, and Eric L. Grogan, MD, MPH, FACS
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aortic stenosis ,COVID-19 ,transcatheter aortic valve replacement ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Abstract
Objective: The aim of this study was to model the short term and 2-year overall survival (OS) for intermediate-risk and low-risk patients with severe symptomatic aortic stenosis (AS) undergoing timely or delayed transcatheter aortic valve replacement (TAVR) during the 2019 novel coronavirus (COVID-19) pandemic. Methods: We developed a decision analysis model to evaluate 2 treatment strategies for both low-risk and intermediate-risk patients with AS during the COVID-19 novel coronavirus pandemic. Results: Prompt TAVR resulted in improved 2-year OS compared with delayed intervention for intermediate-risk patients (0.81 vs 0.67) and low-risk patients (0.95 vs 0.85), owing to the risk of death or the need for urgent/emergent TAVR in the waiting period. However, if the probability of acquiring COVID-19 novel coronavirus is >55% (intermediate-risk patients) or 47% (low-risk patients), delayed TAVR is favored over prompt intervention (0.66 vs 0.67 for intermediate risk; 0.84 vs 0.85 for low risk). Conclusions: Prompt transcatheter aortic valve replacement for both intermediate-risk and low-risk patients with symptomatic severe AS results in improved 2-year survival when local healthcare system resources are not significantly constrained by the COVID-19.
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- 2021
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3. Safe surgical zone during TORS radical tonsillectomy: An anatomical and radiological study
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J.G. Aishwarya, Ashish S. Shah, Satish Nair, Savith Kumar, Swetha Kumar, K.V.R. Brijith, Namrata Srivastava, and Ameena Ibrahim
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Radical tonsillectomy ,Transoral robotic surgery ,Parapharyngeal space ,Styloglossus ,Stylopharyngeus ,Surgery ,RD1-811 - Abstract
Objective: Parapharyngeal space contains intricate vascular anatomy (external and internal carotid arteries) that might be inadvertently injured during the dissection in this plane. None of the bony landmarks can be used during the transoral robotic surgery (TORS) radical tonsillectomy as these landmarks lie lateral to the internal carotid artery (ICA) and external carotid artery (ECA) in transoral approach. Our study aims to identify the safe surgical limits during the dissection of parapharyneal space in TORS radical tonsillectomy and to correlate the same with radiological study. Material and methods: Fifteen cadavers (30 head and neck regions) and 50 CT-Angiogram of neck (100 head and neck regions) were included in the anatomical and radiological study respectively. The vertical midpoint of anterior tonsillar pillar (palatoglossus muscle) was taken as the reference point and all the measurements were done at the level of reference point both for anatomical and radiological study. Distance between tonsillar fossa and ECA, distance between tonsillar fossa and ICA, relation between ECA and styloglossus and relation between ICA and stylopharyngeus at reference level were studied. Results: The mean distance of ECA from the tonsillar fossa at the reference point was 18.2 mm in the anatomical study and 16.2 mm in the radiological study. The mean distance of ICA from the tonsillar fossa was 23.4 mm and 23.3 mm in the anatomical study and radiological study. There was no significant difference between the anatomical and radiological findings for both the mean distance between ECA and ICA to the tonsillar fossa (p value was 0.45 and 0.30 respectively). ECA was located posterolateral to styloglossus in 24 cases (80.0%) and 79 cases (79.0%) in the anatomical and radiological study respectively. ICA was found posterolateral to stylopharyngeus in 21 cases (70.0%) and 69 cases (69.0%) in the anatomical and radiological study respectively. Conclusion: The muscular plane between styloglossus and stylopharyngeus can be used as an envelope to locate the ECA and ICA that lie medial to these critical vascular structures during TORS. We propose to divide the parapharyngeal space into two compartments (anterior and posterior) based on the surgical perspective of inside-out anatomy. The anterior compartment houses styloglossus muscle with ECA posterolateral to it and the posterior compartment has stylopharyngeus and ICA posterolateral to it.
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- 2020
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4. Commentary: Primary graft dysfunction is leaving us curiouser and curiouserCentral Message
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Ashish S. Shah, MD
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Published
- 2021
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5. Commentary: If it's difficult, we are doing something wrongCentral Message
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Ashish S. Shah, MD
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Published
- 2021
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6. Surgical correction of tricuspid regurgitation in patients with ARVD/C
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George Katritsis, BSc, MB ChB, Ashish S. Shah, MD, Cynthia A. James, PhD, Brittney Murray, MS, Crystal Tichnell, MGC, Daniel P. Judge, MD, Hugh Calkins, MD, FHRS, and Ryan J. Tedford, MD
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Arrhythmogenic right ventricular dysplasia/cardiomyopathy ,Tricuspid regurgitation ,Surgical repair ,Surgical replacement ,Right heart failure ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2015
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7. Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement Outcomes in Left Ventricular Assist Device Patients with Aortic Insufficiency
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Aniket S Rali, Siva S Taduru, Lena E Tran, Sagar Ranka, Kelly H Schlendorf, Colin M Barker, Ashish S Shah, JoAnn Lindenfeld, and Sandip K Zalawadiya
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Worsening aortic insufficiency (AI) is a known sequela of prolonged continuous-flow left ventricular assist device (LVAD) support with a significant impact on patient outcomes. While medical treatment may relieve symptoms, it is unlikely to halt progression. Surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) are among non-medical interventions available to address post-LVAD AI. Limited data are available on outcomes with either SAVR or TAVR for the management of post-LVAD AI. Methods: The National Inpatient Sample data collected for hospital admissions between the years 2015 and 2018 for patients with pre-existing continuous-flow LVAD undergoing TAVR or SAVR for AI were queried. The primary outcome of interest was a composite of in-hospital mortality, stroke, transient ischaemic attack, MI, pacemaker implantation, need for open aortic valve surgery, vascular complications and cardiac tamponade. Results: Patients undergoing TAVR were more likely to receive their procedure during an elective admission (57.1 versus 30%, p=0.002), and a significantly higher prevalence of comorbidities, as assessed by the Elixhauser Comorbidity Index, was observed in the SAVR group (29 versus 18; p=0.0001). We observed a significantly higher prevalence of the primary composite outcome in patients undergoing SAVR (30%) compared with TAVR (14.3%; p=0.001). Upon multivariable analysis adjusting for the type of admission and Elixhauser Comorbidity Index, TAVR was associated with significantly lower odds of the composite outcome (odds ratio 0.243; 95% CI [0.06–0.97]; p=0.045). Conclusion: In this nationally representative cohort of LVAD patients with post-implant AI, it was observed that TAVR was associated with a lower risk of adverse short-term outcomes compared with SAVR.
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- 2022
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8. Processed Electroencephalographic Use During Anesthesia and Outcomes: Analysis of The Society of Thoracic Surgeons Adult Cardiac Surgery Database
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Ashish S. Shah, Sounak Roy, Xiaoke Feng, Matthew S. Shotwell, Miklos D. Kertai, and Frederick W. Lombard
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Adult ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Encephalopathy ,computer.software_genre ,Postoperative Complications ,Anesthesiology ,medicine ,Humans ,Anesthesia ,Cardiac Surgical Procedures ,Coma ,Stroke ,Retrospective Studies ,Surgeons ,Database ,business.industry ,Delirium ,Odds ratio ,medicine.disease ,Cardiac surgery ,Propensity score matching ,Surgery ,Electrocorticography ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,computer - Abstract
Background This study assessed associations between processed electroencephalographic (pEEG) use during anesthesia, surgery- and anesthesia-related risk factors, and neurologic outcomes and mortality after cardiac surgery. Methods Drawing from the Society of Thoracic Surgeons Adult Cardiac Surgery Database and its Adult Cardiac Anesthesiology Section, we identified 42,932 records for elective, urgent, and emergency cardiac surgery procedures between July 1, 2017, to December 31, 2019. Using propensity score weighted regression analysis, we analyzed the associations between pEEG use during anesthesia on the primary outcome, postoperative delirium (POD), and secondary outcomes (stroke, encephalopathy, coma, and operative mortality). Results The rate of pEEG use during anesthesia use was 32.8% (n=14,086), and its use was not associated with decreased odds for POD (odds ratio [OR], 0.88; 95%CI, 0.78-1.02) or encephalopathy (OR, 0.85; 95%CI, 0.70-1.03). Intraoperative pEEG monitoring use was also not associated with increased odds for stroke (OR, 1.17; 95%CI, 0.97-1.42) or coma (OR, 1.44; 95%CI, 0.82-2.52). In contrast, pEEG use during anesthesia was associated with higher odds for operative mortality (OR, 1.23; 95%CI, 1.05-1.44). This association remained significant after adjusting for POD (OR: 1.21, 95%CI: 1.03-1.41), stroke (OR: 1.21, 95%CI:1.04-1.42), and encephalopathy (OR: 1.28, 95%CI: 1.07-1.52). Conclusions This large retrospective database study found no association between pEEG use during cardiac surgery and postoperative neurologic outcomes such as POD, stroke, encephalopathy, or coma. However, patients who underwent pEEG monitoring during anesthesia experienced higher mortality, even after adjustment for neurologic outcomes.
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- 2022
9. An Unusual Finding in a Patient Presenting for Pulmonary Thromboendarterectomy: Pulmonary Venous Thrombosis
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Susan S. Eagle, Kara K. Siegrist, Karl D Hillenbrand, Ashish S. Shah, and Austin A. Woolard
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medicine.medical_specialty ,genetic structures ,Hypertension, Pulmonary ,medicine.medical_treatment ,Radiography ,Catheter ablation ,Endarterectomy ,Malignancy ,Asymptomatic ,Biopsy ,medicine ,Humans ,Lung ,Venous Thrombosis ,Pulmonary thromboendarterectomy ,medicine.diagnostic_test ,business.industry ,Atrial fibrillation ,medicine.disease ,Anesthesiology and Pain Medicine ,Etiology ,Radiology ,medicine.symptom ,Pulmonary Embolism ,Cardiology and Cardiovascular Medicine ,business - Abstract
Pulmonary venous thrombosis (PVT) is a rare but potentially devastating disease state with a largely unknown incidence. The most common etiologies of PVT are secondary to complications of lung surgery, malignancy, catheter ablation for atrial fibrillation, and idiopathic causes. Diagnosis can be challenging because presenting symptoms often are vague and nonspecific, or even asymptomatic, and traditional diagnostic modalities, such as chest radiography and arterial phase computed tomography scans, are poor techniques for diagnosis. The authors present a case of a patient presenting for pulmonary thromboendarterectomy for a presumed diagnosis of chronic thromboembolic pulmonary hypertension who was found incidentally to have a PVT, on intraoperative transesophageal echocardiography. Due to significant thrombus burden, the new finding of PVT, and known association of PVT and malignancy, a biopsy of mediastinal lymph nodes was obtained, which revealed metastatic cervical carcinoma. The pulmonary endarterectomy procedure was aborted.
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- 2022
10. Normothermic regional perfusion in donor heart recovery: Establishing a new normal
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Ashish S, Shah
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Perfusion ,Pulmonary and Respiratory Medicine ,Tissue and Organ Procurement ,Heart Transplantation ,Humans ,Surgery ,Organ Preservation ,Cardiology and Cardiovascular Medicine ,Tissue Donors - Published
- 2022
11. Modifiable Mechanical Ventilation Targets Are Associated With Improved Survival in Ventilated VA-ECLS Patients
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Aniket S. Rali, Lena E. Tran, Bryan Auvil, Meng Xu, Shi Huang, Lyana Labrada, Kelly H. Schlendorf, Matthew D. Bacchetta, Ashish S. Shah, Antonio Hernandez, and JoAnn Lindenfeld
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Cardiology and Cardiovascular Medicine - Published
- 2023
12. Bridge to Transplant: Central Extracorporeal Membrane Oxygenation With Pulmonary Artery Drainage
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Yatrik Patel, John W. Stokes, Whitney D. Gannon, James T. Zorn, Jordan Hoffman, Ashish S. Shah, and Matthew Bacchetta
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2022
13. Early Blood Pressure Variables Associated With Improved Outcomes in VA-ECLS
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Aniket S. Rali, Sagar Ranka, Amy Butcher, Zubair Shah, Joseph E. Tonna, Marc M. Anders, Marshal D. Brinkley, Hasan Siddiqi, Lynn Punnoose, Mark Wigger, Suzanne B. Sacks, Dawn Pedrotty, Henry Ooi, Matthew D. Bacchetta, Jordan Hoffman, William McMaster, Keki Balsara, Ashish S. Shah, Jonathan N. Menachem, Kelly H. Schlendorf, JoAnn Lindenfeld, and Sandip K. Zalawadiya
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Cardiology and Cardiovascular Medicine - Published
- 2022
14. The Price of Being Mostly Right
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Ashish S. Shah
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
15. Area Deprivation Index and Distress Community Index Scores Are Not Associated With Short-Term and Long-Term Extracorporeal Life Support Outcomes
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Aniket S. Rali, Emilee E. Larson, Lena E. Tran, Zakiur M. Rahaman, Lawrence J. Charles, John W. Stokes, Clifford Chin, Alistair Hilton, Whitney D. Gannon, Matthew D. Bacchetta, and Ashish S. Shah
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Biomaterials ,Biomedical Engineering ,Biophysics ,Bioengineering ,General Medicine - Published
- 2023
16. Early US experience with cardiac donation after circulatory death (DCD) using normothermic regional perfusion
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Keki R. Balsara, Mark Wigger, Lynne W. Stevenson, L. Punnoose, Tarek S. Absi, Jordan R.H. Hoffman, Ashish S. Shah, Melissa Levack, Jonathan N. Menachem, William G. McMaster, Aniket S Rali, Zakiur Rahaman, JoAnn Lindenfeld, Kelly Schlendorf, M. Brinkley, Sandip Zalawadiya, and Suzanne Brown Sacks
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Adult ,Graft Rejection ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,Tissue and Organ Procurement ,Adolescent ,medicine.medical_treatment ,Primary Graft Dysfunction ,Young Adult ,Internal medicine ,medicine ,Humans ,Lung transplantation ,Child ,Retrospective Studies ,Heart Failure ,Transplantation ,Ejection fraction ,business.industry ,Cold Ischemia ,Graft Survival ,Organ Preservation ,medicine.disease ,Perfusion ,medicine.anatomical_structure ,Ventricle ,Ventricular assist device ,Heart failure ,Cardiology ,Heart Transplantation ,Female ,Surgery ,Transthoracic echocardiogram ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background Given the shortage of suitable donor hearts for cardiac transplantation and the growing interest in donation after circulatory death (DCD), our institution recently began procuring cardiac allografts from DCD donors. Methods Between October 2020 and March 2021, 15 patients with heart failure underwent cardiac transplantation using DCD allografts. Allografts were procured using a modified extracorporeal membrane oxygenation circuit for thoracic normothermic regional perfusion (TA-NRP) and were subsequently transported using cold static storage. Data collection and analysis were performed with institutional review board approval. Results The mean age of the DCD donors was 23 ± 7 years and average time on TA-NRP was 56 ± 8 minutes. Total ischemic time was 183 ± 31 minutes and distance from transplant center was 373 ± 203 nautical miles. Recipient age was 55 ± 14 years, with 8 (55.3%) recipients on durable left ventricular assist device support. Post-transplant, 6 (40%) recipients experienced mild left ventricle primary graft dysfunction (PGD-LV), 3 (20%) recipients experienced moderate PGD-LV, and no recipients experienced severe PGD-LV. Postoperative transthoracic echocardiogram demonstrated left ventricular ejection fraction >55% in all recipients. One recipient (6.6%) developed International Society for Heart and Lung Transplantation 2R acute cellular rejection on first biopsy. At last follow-up, all 15 recipients were alive past 30-days. Conclusions Cardiac DCD provides an opportunity to increase the availability of donor hearts for transplantation. Utilizing TA-NRP with cold static storage, we have extended the cold ischemic time of DCD allografts to almost 3 hours, allowing for inter-hospital organ transport.
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- 2021
17. Association of Intraoperative Red Blood Cell Transfusions with Venous Thromboembolism and Adverse Outcomes after Cardiac Surgery
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Jacob Raphael, Xiaoke Feng, Matthew S. Shotwell, Michael A. Mazzeffi, Bruce A. Bollen, Ashish S. Shah, and Miklos D. Kertai
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Surgery - Abstract
We determined whether intraoperative packed red blood cell transfusion (PRBC) was associated with a higher incidence of hospital-acquired venous thromboembolic (HA-VTE) complications and adverse outcomes after isolated coronary artery bypass grafting (CABG) surgery.Intraoperative PRBC has been associated with increased risk for postoperative deep venous thrombosis after cardiac surgery, but validation of these findings in a large, multi-institutional, national cohort of cardiac surgery patients has been lacking.A registry-based cohort study of 751,893 patients with isolated CABG between January 1, 2015, to December 31, 2019. Using propensity-score-weighted regression analysis, we analyzed the effect of intraoperative PRBC on the incidence of HA-VTE and adverse outcomes.Administration of 1, 2, 3 and ≥4 units of PRBC transfusion was associated with increased odds for HA-VTE [odds ratios (ORs) 1.27 (1.22-1.32), 1.21 (1.16-1.26), 1.93 (1.85-2.00), 1.82 (1.75-1.89)], deep venous thrombosis [ORs 1.39 (1.33-1.46), 1.38 (1.32-1.44), 2.18 (2.09-2.28), 1.82 (1.74-1.91], operative mortality [ORs 1.11 (1.08-1.14), 1.16 (1.13-1.19), 1.29 (1.26-1.32), 1.47 (1.43-1.50)], readmission within 30 days [ORs 1.05 (1.04-1.06), 1.16 (1.13-1.19), 1.29 (1.26-1.32), 1.47 (1.43-1.50)], and a prolonged postoperative length of stay [mean difference in days, 0.23 (0.19-0.27), 0.34 (0.30-0.39), 0.69 (0.64-0.74), 0.77 (0.72-0.820]. The odds of pulmonary venous thromboembolism were lower for patients transfused with 1 or 2 units [ORs 0.98 (0.91-1.06), 0.75 (0.68-0.81)] of PRBC but remained significantly elevated for those receiving 3 and ≥4 units [ORs 1.19 (1.09-1.29), 1.35 (1.25-1.48)].Intraoperative PRBC transfusion was associated with HA-VTE and adverse outcomes after isolated CABG surgery.
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- 2022
18. Normothermic regional perfusion for donation after circulatory death donors
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Chetan Pasrija, Yuliya Tipograf, Ashish S. Shah, and John M. Trahanas
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Transplantation ,Immunology and Allergy - Abstract
This review is intended to provide an update on the logistics, technique, and outcomes associated with normothermic regional perfusion (NRP), as well as provide a discussion of the associated ethical issues.There has been renewed interest in utilizing NRP to increase quality and availability of organs from donation after circulatory death (DCD) donors. Our institution has increasing experience with thoraco-abdominal NRP (TA-NRP) in controlled DCD donors (cDCD), whereas abdominal NRP (A-NRP) has been used with success in both cDCD and uncontrolled DCD (uDCD). There is increasing evidence that NRP can be conducted in a practical and cost-efficient manner, and that the organ yield may be of better quality than standard direct procurement and perfusion (DPP).NRP is increasingly successful and will likely prove to be a superior method for cDCD recovery. However, before TA-NRP can be widely accepted the ethical debate surrounding this technique must be settled.http://links.lww.com/COOT/A11.
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- 2022
19. Canaries, Coal Mines, and Kidneys
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Ashish S, Shah
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
20. Surgical Explantation After TAVR Failure
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Vinayak N. Bapat, Syed Zaid, Shinichi Fukuhara, Shekhar Saha, Keti Vitanova, Philipp Kiefer, John J. Squiers, Pierre Voisine, Luigi Pirelli, Moritz Wyler von Ballmoos, Michael W.A. Chu, Josep Rodés-Cabau, J. Michael DiMaio, Michael A. Borger, Rudiger Lange, Christian Hagl, Paolo Denti, Thomas Modine, Tsuyoshi Kaneko, Gilbert H.L. Tang, Aditya Sengupta, David Holzhey, Thilo Noack, Katherine B. Harrington, Siamak Mohammadi, Derek R. Brinster, Marvin D. Atkins, Muhanad Algadheeb, Rodrigo Bagur, Nimesh D. Desai, Oliver D. Bhadra, Lenard Conradi, Christian Shults, Lowell F. Satler, Basel Ramlawi, Newell B. Robinson, Lin Wang, George A. Petrossian, Martin Andreas, Paul Werner, Andrea Garatti, Flavien Vincent, Eric Van Belle, Francis Juthier, Lionel Leroux, John R. Doty, Joshua B. Goldberg, Hasan A. Ahmad, Kashish Goel, Ashish S. Shah, Arnar Geirsson, John K. Forrest, Kendra J. Grubb, Sameer Hirji, Pinak B. Shah, Giuseppe Bruschi, Guido Gelpi, Igor Belluschi, Maral Ouzounian, Marc Ruel, Talal Al-Atassi, Joerg Kempfert, Axel Unbehaun, Nicholas M. Van Mieghem, Thijmen W. Hokken, Walid Ben Ali, Reda Ibrahim, Philippe Demers, Alejandro Pizano, Marco Di Eusanio, Filippo Capestro, Rodrigo Estevez-Loureiro, Miguel A. Pinon, Michael H. Salinger, Joshua Rovin, Augusto D'Onofrio, Chiara Tessari, Antonio Di Virgilio, Maurizio Taramasso, Marco Gennari, Andrea Colli, Brian K. Whisenant, Tamim M. Nazif, Neal S. Kleiman, Molly Y. Szerlip, Ron Waksman, Isaac George, Tom C. Nguyen, Francesco Maisano, G. Michael Deeb, Joseph E. Bavaria, Michael J. Reardon, Michael J. Mack, William T. Brinkman, Timothy J. George, Srinivasa Potluri, William H. Ryan, Justin M. Schaffer, Robert L. Smith, Molly Szerlip, Tamim Nazif, Hussein Rahim, Kendra Grubb, Marvin Atkins, Sachin Goel, Neal Kleiman, Michael Reardon, John Doty, Brian Whisenant, Michael Salinger, Lowell Satler, Christian Schults, Susan Fisher, Sophia L. Alexis, Chad A. Kliger, Bruce Rutkin, Pey-Jen Yu, George Petrossian, Newell Robinson, Michael Deeb, Jessica Oakley, Joseph Bavaria, Nimesh Desai, Lisa Walsh, Tom Nguyen, Hasan Ahmad, Joshua Goldberg, David Spielvogel, John Forrest, Michael Chu, Raymond Cartier, Josep Rodes-Cabau, Alain-Philippe Abois, Munir Boodhwani, Alexander Dick, Christopher Glover, Marino Labinaz, Buu-Khanh Lam, Cedric Delhaye, Adeline Delsaux, Tom Denimal, Anaïs Gaul, Mohammad Koussa, Thibault Pamart, Svetlana Sonnabend, Markus Krane, Andrea Munsterer, Michael Borger, Philippe Kiefer, Oliver Bhadra, Len Conradi, Bruno Merlanti, Claudio F. Russo, Claudia Romagnoni, Nicholas Van Mieghem, and Miguel Pinnon
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Mortality rate ,medicine.disease ,Surgery ,Stenosis ,Valve replacement ,Interquartile range ,Concomitant ,medicine ,Endocarditis ,Paravalvular leak ,Cardiology and Cardiovascular Medicine ,business ,Stroke - Abstract
Objectives The aim of this study was to evaluate clinical characteristics, mechanisms of failure, and outcomes of transcatheter aortic valve replacement (TAVR) explantation. Background Surgical explantation following TAVR may be required for structural valve degeneration, paravalvular leak, infection, or other reasons. However, in-depth data on indications and outcomes are lacking. Methods Data from a multicenter, international registry (EXPLANT-TAVR) of patients who underwent TAVR explantation were reviewed retrospectively. Explantations performed during the same admission as initial TAVR were excluded. Clinical and echocardiographic outcomes were evaluated. Median follow-up duration was 6.7 months (interquartile range [IQR]: 1.0-18.8 months) after TAVR explantation and was 97.7% complete at 30 days and 86.1% complete at 1 year. Results From November 2009 to September 2020, 269 patients across 42 centers with a mean age of 72.7 ± 10.4 years underwent TAVR explantation. About one quarter (25.9%) were deemed low surgical risk at index TAVR, and median Society of Thoracic Surgeons risk at TAVR explantation was 5.6% (IQR: 3.2%-9.6%). The median time to explantation was 11.5 months (IQR: 4.0-32.4 months). Balloon-expandable and self-expanding or mechanically expandable valves accounted for 50.9% and 49.1%, respectively. Indications for explantation included endocarditis (43.1%), structural valve degeneration (20.1%), paravalvular leak (18.2%), and prosthesis-patient mismatch (10.8%). Redo TAVR was not feasible because of unfavorable anatomy in 26.8% of patients. Urgent or emergency cases were performed in 53.1% of patients, aortic root replacement in 13.4%, and 54.6% had concomitant cardiac procedures. Overall survival at last follow-up was 76.1%. In-hospital, 30-day, and 1-year mortality rates were 11.9%, 13.1%, and 28.5%, respectively, and stroke rates were 5.9%, 8.6%, and 18.7%, respectively. Conclusions The EXPLANT-TAVR registry reveals that surgical risks associated with TAVR explantation are not negligible and should be taken into consideration in the lifetime management of aortic stenosis.
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- 2021
21. Mitral Valve Surgery After Transcatheter Edge-to-Edge Repair
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Alejandro Pizano, Serdar Akansel, Augusto D'Onofrio, Miguel A. Pinon, Marco Di Eusanio, George Petrossian, Nicholas Dumonteil, Chawannuch Ruaengsri, Guido Ascione, Francesco Massi, Moritz C. Wyler von Ballmoos, Flavien Vincent, Anita W. Asgar, Ana Paula Tagliari, Filippo Capestro, Philippe Demers, Pinak B. Shah, Kendra J. Grubb, Basel Ramlawi, John J. Squiers, Jean-François Obadia, Lionel Leroux, Rebecca T. Hahn, Michele Flagiello, Ryan Kaple, Vinayak Bapat, Guillaume Leurent, Michael W.A. Chu, Tamim Nazif, Michele Triggiani, Matthew A. Romano, Michael A. Borger, Arnar Geirsson, Ashish S. Shah, Gorav Ailawadi, Kashish Goel, Marco Gennari, Gilbert H.L. Tang, Amedeo Anselmi, Paul Werner, Tsuyoshi Kaneko, Keti Vitanova, Shahar Lavi, Markus Krane, Luigi Pirelli, Rüdiger Lange, Martin Andreas, Michael J. Reardon, Christian Hagl, Shekhar Saha, Eric Van Belle, J. Michael DiMaio, Andrea Garatti, Sameer A. Hirji, D. Scott Lim, Maurizio Taramasso, Tom C. Nguyen, Neal S. Kleiman, Erik Bagaev, Tom Denimal, Herve Corbineau, Michael J. Mack, Molly I. Szerlip, Michel Pellerin, Isaac George, Didier Tchetche, Robert L. Smith, Francesco Maisano, Chiara Tessari, Antonio L. Bartorelli, Volkmar Falk, Chad Kliger, Rodrigo Estévez-Loureiro, Marissa Donatelle, Lin Wang, Marvin D. Atkins, Jörg Kempfert, Thomas Modine, Newell Robinson, Joachim Schofer, Oliver D. Bhadra, Paolo Denti, Syed Zaid, Denis Bouchard, Walid Ben Ali, Angie Ghattas, Christina Brinkmann, Muhanad Algadheeb, Thilo Noack, Lenard Conradi, and Florian Fahr
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Mitral regurgitation ,medicine.medical_specialty ,Longitudinal data ,business.industry ,medicine.medical_treatment ,Mortality rate ,Mitral valve replacement ,030204 cardiovascular system & hematology ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Interquartile range ,Mitral valve ,Concomitant ,medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Mitral valve surgery - Abstract
Objectives The aim of this study was to determine clinical and echocardiographic characteristics, mechanisms of failure, and outcomes of mitral valve (MV) surgery after transcatheter edge-to-edge repair (TEER). Background Although >100,000 mitral TEER procedures have been performed worldwide, longitudinal data on MV surgery after TEER are lacking. Methods Data from the multicenter, international CUTTING-EDGE registry were retrospectively analyzed. Clinical and echocardiographic outcomes were evaluated. Median follow-up duration was 9.0 months (interquartile range [IQR]: 1.2-25.7 months) after MV surgery, and follow-up was 96.1% complete at 30 days and 81.1% complete at 1 year. Results From July 2009 to July 2020, 332 patients across 34 centers underwent MV surgery after TEER. The mean age was 73.8 ± 10.1 years, median Society of Thoracic Surgeons risk for MV repair at initial TEER was 4.0 (IQR: 2.3-7.3), and primary/mixed and secondary mitral regurgitation were present in 59.0% and 38.5%, respectively. The median interval from TEER to surgery was 3.5 months (IQR: 0.5-11.9 months), with overall median Society of Thoracic Surgeons risk of 4.8% for MV replacement (IQR: 2.8%-8.4%). The primary indication for surgery was recurrent mitral regurgitation (33.5%), and MV replacement and concomitant tricuspid surgery were performed in 92.5% and 42.2% of patients, respectively. The 30-day and 1-year mortality rates were 16.6% and 31.3%, respectively. On Kaplan-Meier analysis, the actuarial estimates of mortality were 24.1% at 1 year and 31.7% at 3 years after MV surgery. Conclusions In this first report of the CUTTING-EDGE registry, the mortality and morbidity risks of MV surgery after TEER were not negligible, and only
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- 2021
22. Modeling the impact of delaying transcatheter aortic valve replacement for the treatment of aortic stenosis in the era of COVID-19
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Stephen A. Deppen, Eric L. Grogan, Daniel R. Freno, Ashish S. Shah, Jared O'Leary, Melissa Levack, and Maren E. Shipe
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Adult ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Transcatheter aortic ,AS, aortic stenosis ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,medicine.medical_treatment ,OS, overall survival ,Valve replacement ,Internal medicine ,medicine ,AVR, aortic valve replacement ,COVID-19, coronavirus disease 2019 ,TAVR, transcatheter aortic valve replacement ,business.industry ,aortic stenosis ,COVID-19 ,medicine.disease ,Stenosis ,Cardiology ,transcatheter aortic valve replacement ,Treatment strategy ,ACC, American College of Cardiology ,Risk of death ,business ,Healthcare system - Abstract
Objective The aim of this study was to model the short term and 2-year overall survival (OS) for intermediate-risk and low-risk patients with severe symptomatic aortic stenosis (AS) undergoing timely or delayed transcatheter aortic valve replacement (TAVR) during the 2019 novel coronavirus (COVID-19) pandemic. Methods We developed a decision analysis model to evaluate 2 treatment strategies for both low-risk and intermediate-risk patients with AS during the COVID-19 novel coronavirus pandemic. Results Prompt TAVR resulted in improved 2-year OS compared with delayed intervention for intermediate-risk patients (0.81 vs 0.67) and low-risk patients (0.95 vs 0.85), owing to the risk of death or the need for urgent/emergent TAVR in the waiting period. However, if the probability of acquiring COVID-19 novel coronavirus is >55% (intermediate-risk patients) or 47% (low-risk patients), delayed TAVR is favored over prompt intervention (0.66 vs 0.67 for intermediate risk; 0.84 vs 0.85 for low risk). Conclusions Prompt transcatheter aortic valve replacement for both intermediate-risk and low-risk patients with symptomatic severe AS results in improved 2-year survival when local healthcare system resources are not significantly constrained by the COVID-19., Graphical abstract
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- 2021
23. Mean Platelet Volume and Cardiac Surgery-Associated Atrial Fibrillation
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Rushikesh Vyas, Manuel L. Fontes, Frederic W. Lombard, Miklos D. Kertai, Abinaya Ramakrishnan, Yaping Shi, Frederic T. Billings th, Yurim Hong, Matthew S. Shotwell, Mias Pretorius, Tarek S. Absi, Mark J. Abdelmalak, Jonathan P. Wanderer, and Ashish S. Shah
- Subjects
medicine.medical_specialty ,business.industry ,MEDLINE ,Atrial fibrillation ,Platelet Activation ,medicine.disease ,Cardiac surgery ,Anesthesiology and Pain Medicine ,Text mining ,Internal medicine ,Atrial Fibrillation ,Cardiology ,Humans ,Medicine ,Cardiac Surgical Procedures ,Mean platelet volume ,Cardiology and Cardiovascular Medicine ,business ,Mean Platelet Volume - Published
- 2021
24. Impact of increased donor distances following adult heart allocation system changes: A single center review of 1‐year outcomes
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Sandip Zalawadiya, Tarek S. Absi, L. Punnoose, Ashish S. Shah, Jordan R.H. Hoffman, Suzanne Brown Sacks, Mark Wigger, M. Brinkley, Keki R. Balsara, Lynne W. Stevenson, Kelly Schlendorf, Emilee E. Larson, William G. McMaster, Zakiur Rahaman, Jonathan N. Menachem, JoAnn Lindenfeld, and Melissa Levack
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Adult ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Waiting Lists ,medicine.medical_treatment ,Primary Graft Dysfunction ,Single Center ,Internal medicine ,medicine ,Humans ,Survival analysis ,Retrospective Studies ,Heart transplantation ,business.industry ,Retrospective cohort study ,Survival Analysis ,Tissue Donors ,Donor heart ,medicine.anatomical_structure ,Ventricle ,Cohort ,Cardiology ,Heart Transplantation ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background On October 18, 2018, several changes to the donor heart allocation system were enacted. We hypothesize that patients undergoing orthotopic heart transplantation (OHT) under the new allocation system will see an increase in ischemic times, rates of primary graft dysfunction, and 1-year mortality due to these changes. Methods In this single-center retrospective study, we reviewed the charts of all OHT patients from October 2017 through October 2019. Pre- and postallocation recipient demographics were compared. Survival analysis was performed using the Kaplan-Meier method. Results A total of 184 patients underwent OHT. Recipient demographics were similar between cohorts. The average distance from donor increased by more than 150 km (p = .006). Patients in the postallocation change cohort demonstrated a significant increase in the rate of severe left ventricle primary graft dysfunction from 5.4% to 18.7% (p = .005). There were no statistically significant differences in 30-day mortality or 1-year survival. Time on the waitlist was reduced from 203.8 to 103.7 days (p = .006). Conclusions Changes in heart allocation resulted in shorter waitlist times at the expense of longer donor distances and ischemic times, with an associated negative impact on early post-transplantation outcomes. No significant differences in 30-day or 1-year mortality were observed.
- Published
- 2021
25. Prioritizing heart transplantation during the COVID‐19 pandemic
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JoAnn Lindenfeld, Ashish S. Shah, Mark Wigger, Tarek S. Absi, S.B. Sacks, Sandip Zalawadiya, L. Punnoose, Jonathan N. Menachem, Emily Sandhaus, Jordan R.H. Hoffman, Keki R. Balsara, Kelly Schlendorf, Zakiur Rahaman, William G. McMaster, and D.M. Brinkley
- Subjects
Adult ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Tissue and Organ Procurement ,Coronavirus disease 2019 (COVID-19) ,Demographics ,medicine.medical_treatment ,resource allocation ,Primary Graft Dysfunction ,030204 cardiovascular system & hematology ,heart transplantation ,03 medical and health sciences ,0302 clinical medicine ,COVID‐19 ,Internal medicine ,Pandemic ,Humans ,Medicine ,Renal replacement therapy ,Pandemics ,Retrospective Studies ,Heart transplantation ,SARS-CoV-2 ,business.industry ,Incidence (epidemiology) ,Significant difference ,COVID-19 ,Retrospective cohort study ,Tissue Donors ,United States ,030228 respiratory system ,Emergency medicine ,Original Article ,Surgery ,Solid organ transplantation ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Coronavirus disease 2019 (COVID‐19) has significantly impacted the healthcare landscape in the United States in a variety of ways including a nation‐wide reduction in operative volume. The impact of COVID‐19 on the availability of donor organs and the impact on solid organ transplant remains unclear. We examine the impact of COVID‐19 on a single, large‐volume heart transplant program. Methods A retrospective chart review was performed examining all adult heart transplants performed at a single institution between March 2020 and June 2020. This was compared to the same time frame in 2019. We examined incidence of primary graft dysfunction, continuous renal replacement therapy (CRRT) and 30‐day survival. Results From March to June 2020, 43 orthotopic heart transplants were performed compared to 31 performed during 2019. Donor and recipient demographics demonstrated no differences. There was no difference in 30‐day survival. There was a statistically significant difference in incidence of postoperative CRRT (9/31 vs. 3/43; p = .01). There was a statistically significant difference in race (23 W/8B/1AA vs. 30 W/13B; p = .029). Conclusion We demonstrate that a single, large‐volume transplant program was able to grow volume with little difference in donor variables and clinical outcomes following transplant. While multiple reasons are possible, most likely the reduction of volume at other programs allowed us to utilize organs to which we would not have previously had access. More significantly, our growth in volume was coupled with no instances of COVID‐19 infection or transmission amongst patients or staff due to an aggressive testing and surveillance program.
- Published
- 2021
26. Anatomical and Surgical Study to Evaluate the Accuracy of 'C-M-S' Technique in Facial Nerve Identification During Parotid Surgery
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J. G. Aishwarya, Satish Nair, V. Pavithra, Ashish S. Shah, Deeksha Thakur, and K. V. R. Brijith
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Digastric muscle ,business.industry ,Anatomy ,Parotidectomy ,medicine.disease ,Facial nerve ,Trunk ,Facial paralysis ,stomatognathic diseases ,03 medical and health sciences ,0302 clinical medicine ,Otorhinolaryngology ,Suture (anatomy) ,Cadaver ,030220 oncology & carcinogenesis ,medicine ,Original Article ,Surgery ,030223 otorhinolaryngology ,Cadaveric spasm ,business - Abstract
Facial nerve identification is considered to be a crucial step in parotid surgery as inadvertent injury to the nerve will lead to facial paralysis. Multiple landmarks are described in literature to identify the facial nerve during parotid surgery but controversies remain as the consistency and accuracy of these landmarks vary. Numerous studies exist in literature but they fail to address a single landmark that is most reliable to identify the facial nerve during parotid surgery. The purpose of this study is to find reliable landmarks for identification of the main trunk of facial nerve during parotid surgery by evidence gathered by cadaveric dissection and intraoperative study during parotid surgery and develop a systematic approach to identify the facial nerve trunk. This prospective study included 41 cadavers (82 parotid regions) and 20 patients with parotid pathology who underwent parotidectomy. We evaluated the feasibility of our C-M-S technique to identify the main trunk of facial nerve in both anatomical and surgical study. The relationship of landmarks (tragal pointer, tympanomastoid suture, superior border of posterior belly of digastric muscle) to the facial nerve trunk was assessed and the shortest distance between them from the facial trunk was measured using a slide caliper. The measurements were compared between the anatomical and surgical study. The main trunk of facial nerve was successfully identified in all cases using C-M-S technique in both anatomical and surgical study. Distance of facial nerve trunk to tragal pointer was more in the cadaveric sample (13.04 ± 5.238 mm) compared to live patients (9.95 ± 3.967 mm) with statistically significant difference (p = 0.036). The mean distance of tympanomastoid suture and posterior belly of digastric muscle to the facial nerve trunk was similar in anatomical and surgical study with p value of 0.877 and 0.083 respectively. The tympanomastoid suture, posterior belly of digastric muscle and tragal pointer are the most useful landmarks for facial nerve identification during parotid surgery. In our study we found that the tympanomastoid suture line is the most consistent landmark present in all our cases and being closest to the facial nerve trunk in both anatomical and surgical study. Further we recommend using the “C-M-S technique” in order to locate the main trunk of the facial nerve.
- Published
- 2021
27. 2020 EACTS/ELSO/STS/AATS Expert Consensus on Post-cardiotomy Extracorporeal Life Support in Adult Patients
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Giuseppe Maria Raffa, Udo Boeken, Christian A. Bermudez, Glenn J.R. Whitman, David M. McMullan, Ashish S. Shah, David A. D'Alessandro, Jonathan W. Haft, Roberto Lorusso, Milan Milojevic, Cardiothoracic Surgery, CTC, MUMC+: MA Med Staf Spec CTC (9), and RS: Carim - V04 Surgical intervention
- Subjects
postcardiotomy failure ,NEAR-INFRARED SPECTROSCOPY ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,extracorporeal life support ,law.invention ,0302 clinical medicine ,Resource (project management) ,Randomized controlled trial ,law ,VENTRICULAR ASSIST DEVICE ,guidelines ,respiratory-distress-syndrome ,RENAL REPLACEMENT THERAPY ,Mediastinum ,Prostheses and Implants ,General Medicine ,Prognosis ,Intensive Care Units ,Treatment Outcome ,Pericardiectomy ,primary graft dysfunction ,Cardiology and Cardiovascular Medicine ,cardiac surgery ,Adult ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,endocrine system ,membrane-oxygenation support ,Consensus ,Critical Care ,Critical Illness ,Biomedical Engineering ,Biophysics ,MEDLINE ,Bioengineering ,postcardiotomy cardiogenic-shock ,INTRAAORTIC BALLOON SUPPORT ,Advanced Cardiac Life Support ,Extracorporeal ,consensus statements ,Contraindications, Procedure ,Biomaterials ,03 medical and health sciences ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Extracorporeal cardiopulmonary resuscitation ,Cardiac Surgical Procedures ,Intensive care medicine ,Postoperative Care ,mechanical circulatory support ,VENTILATOR-ASSOCIATED PNEUMONIA ,Adult patients ,business.industry ,Anticoagulants ,Expert consensus ,extracorporeal membrane oxygenation ,mechanical support ,030228 respiratory system ,Ventricular assist device ,Life support ,Surgery ,Cardiotomy ,business - Abstract
Post-cardiotomy extracorporeal life support (PC-ECLS) in adult patients has been used only rarely but recent data have shown a remarkable increase in its use, almost certainly due to improved technology, ease of management, growing familiarity with its capability and decreased costs. Trends in worldwide in-hospital survival, however, rather than improving, have shown a decline in some experiences, likely due to increased use in more complex, critically ill patients rather than to suboptimal management. Nevertheless, PC-ECLS is proving to be a valuable resource for temporary cardiocirculatory and respiratory support in patients who would otherwise most likely die. Because a comprehensive review of PC-ECLS might be of use for the practitioner, and possibly improve patient management in this setting, the authors have attempted to create a concise, comprehensive and relevant analysis of all aspects related to PC-ECLS, with a particular emphasis on indications, technique, management and avoidance of complications, appraisal of new approaches and ethics, education and training. (C) 2021 Jointly between The Society of Thoracic Surgeons, the American Association for Thoracic Surgery, the European Association for Cardio-Thoracic Surgery, and the Extracorporeal Life Support Organization
- Published
- 2021
28. Paving the Swamp
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Ashish S, Shah
- Subjects
Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
29. Rapid Training in Extracorporeal Membrane Oxygenation for a Large Health System
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Whitney D. Gannon, Matthew W. Semler, Matthew Bacchetta, Yuliya Tipograf, Todd W. Rice, Lynne Craig, John W. Stokes, and Ashish S. Shah
- Subjects
education ,medicine.medical_specialty ,intensive care units ,business.industry ,medicine.medical_treatment ,General Medicine ,critical care ,surgical procedures, operative ,Intensive care ,medicine ,Extracorporeal membrane oxygenation ,Innovations ,Intensive care medicine ,business - Abstract
Background: Despite the rapid integration of extracorporeal membrane oxygenation (ECMO) into intensive care units over the past decade, established programs for training critical care clinicians to provide ECMO are lacking. Objective: To evaluate the development and implementation of a multidisciplinary ECMO training program for the rapid deployment of ECMO training for a high volume of critical care clinicians. Methods: We performed a prospective cohort study examining a program for rapid training of multiple disciplines of critical care clinicians to deliver ECMO during the implementation of ECMO services across the intensive care units of an academic tertiary care center between October 2018 and January 2019. The multidisciplinary ECMO training program included didactic and simulation-based teaching and emphasized new, universal clinical protocols to improve consistency of care across the institution. Pre- and post-program written examinations evaluated knowledge acquisition, and an electronically distributed program evaluation assessed perceptions of content and delivery. Results: Among the 97 clinicians who completed the program, 49 (51%) were physicians and 48 (49%) were advanced practice providers from the departments of surgery (n = 42), medicine (n = 29), and anesthesia (n = 26). There was a significant difference in knowledge about ECMO between the pre- and post-program examination score (median [interquartile range] 70% [60–80%] vs. 90% [80–90%], respectively, P
- Published
- 2020
30. Modified CT Scan Scoring System for Evaluating Symptom Severity of Chronic Rhinosinusitis
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J. G. Aishwarya, K. V. R. Brijith, Ashish S. Shah, and Satish Nair
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medicine.medical_specialty ,Scoring system ,medicine.diagnostic_test ,Chronic rhinosinusitis ,business.industry ,Computed tomography ,medicine.disease ,Correlation ,03 medical and health sciences ,0302 clinical medicine ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,medicine ,Chi-square test ,Surgery ,Observational study ,Radiology ,030223 otorhinolaryngology ,Sinusitis ,business - Abstract
There are various subjective as well as objective tools to evaluate the severity of chronic rhinosinusitis (CRS). SNOT-22 is the most commonly used subjective scoring system to determine the severity of CRS. Lund-Mackay (LM) CT scan scoring is widely used as an objective tool in CRS. However LM scores does not correlate well with the subjective tools. We evaluated the modified CT scan scoring system (SN score) for its efficacy in determining the severity of CRS in both subjective as well as objective manner. To correlate the severity of symptoms and CT scan findings in adult patients with chronic rhinosinusitis by estimating the strength of correlation of severity of symptoms of CRS assessed by SNOT-22 scorings with CT scan findings by Lund Mackay scoring system and SN CT scan scoring system. A prospective, observational study was conducted in the tertiary care center from June 2019 to August 2020. The study included 150 adult patients diagnosed with Chronic Rhino Sinusitis resistant to primary medical therapy, who were subjected to CT scan imaging. The symptom severity of CRS was assessed by the SNOT 22 scores. CT scan was done and Lund Mackay scores and SN CT scan scores by the senior author were calculated. The correlation of SNOT 22 score with LM score and Modified CT score were assessed. The correlation of LM score with SNOT 22 score was assessed by plotting Scattered plot diagram, which showed a moderate positive, statistically significant correlation (Person correlation co-efficient: 0.466; p value: 0.032). The correlation of SN CT score with SNOT 22 was assessed by Chi Square test which showed a highly significant, positive correlation (p value of 0.000793). Our study shows a positive correlation of symptoms assessed by SNOT 22 system with radiological findings analyzed by both LM system as well as SN CT scan scoring system. However, SN CT scan scoring system showed a highly significant positive correlation over LM system as it correlates well with symptoms and also provides a grading of disease severity. SN CT scan scoring system can be considered as a tool for assessing the disease severity both in subjective and objective manner. It can be used in place of subjective tools like SNOT 22 for assessing the severity of symptoms in CRS where subjective analysis of the disease is difficult.
- Published
- 2020
31. Commentary: At least we still have taxes
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Ashish S, Shah
- Subjects
Pulmonary and Respiratory Medicine ,Humans ,Surgery ,Taxes ,Cardiology and Cardiovascular Medicine - Published
- 2022
32. Early United States experience with liver donation after circulatory determination of death using thoraco-abdominal normothermic regional perfusion: A multi-institutional observational study
- Author
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Marty T. Sellers, Ahmed Nassar, Musab Alebrahim, Kazunari Sasaki, David D. Lee, Humberto Bohorquez, Robert M. Cannon, Gennaro Selvaggi, Nikole Neidlinger, William G. McMaster, Jordan R.H. Hoffman, Ashish S. Shah, and Martin I. Montenovo
- Subjects
Adult ,Transplantation ,Carcinoma, Hepatocellular ,Tissue and Organ Procurement ,Graft Survival ,Liver Neoplasms ,Organ Preservation ,Middle Aged ,Kidney Transplantation ,Tissue Donors ,United States ,Death ,Perfusion ,Humans ,Retrospective Studies - Abstract
Mortality on the liver waitlist remains unacceptably high. Donation after circulatory determination of death (DCD) donors are considered marginal but are a potentially underutilized resource. Thoraco-abdominal normothermic perfusion (TA-NRP) in DCD donors might result in higher quality livers and offset waitlist mortality. We retrospectively reviewed outcomes of the first 13 livers transplanted from TA-NRP donors in the US. Nine centers transplanted livers from eight organ procurement organizations. Median donor age was 25 years; median agonal phase was 13 minutes. Median recipient age was 60 years; median lab MELD score was 21. Three patients (23%) met early allograft dysfunction (EAD) criteria. Three received simultaneous liver-kidney transplants; neither had EAD nor delayed renal allograft function. One recipient died 186 days post-transplant from sepsis but had normal presepsis liver function. One patient developed a biliary anastomotic stricture, managed endoscopically; no recipient developed clinical evidence of ischemic cholangiopathy (IC). Twelve of 13 (92%) patients are alive with good liver function at 439 days median follow-up; one patient has extrahepatic recurrent HCC. TA-NRP DCD livers in these recipients all functioned well, particularly with respect to IC, and provide a valuable option to decrease deaths on the waiting list.
- Published
- 2022
33. Sympathectomy is Back. Again
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Ashish S. Shah and William G. McMaster
- Subjects
Pulmonary and Respiratory Medicine ,Humans ,Hyperhidrosis ,Surgery ,Sympathectomy ,Cardiology and Cardiovascular Medicine - Published
- 2022
34. Going viral: A scoping review of the current state and impact of online research dissemination in emergency medicine
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James M. Gray, David Schnadower, Ryan LaFollette, Ashish S. Shah, and Brad Sobolewski
- Subjects
Emergency Medicine ,Original Contribution ,Emergency Nursing ,Education - Abstract
BACKGROUND: The use of free open‐access medical education (FOAM) and other online knowledge dissemination methods has increased over the past decade. However, the role and impact of these tools in the knowledge translation continuum are poorly understood, potentially limiting the ability of knowledge generators to fully harness and exploit their potential. Here, we aim to comprehensively map and synthesize the literature describing the use of online tools for the dissemination of emergency medicine research. METHODS: Using scoping review methodology, we searched the traditional literature via PubMed, CINAHL, EMBASE, ERIC, SCOPUS, and the gray literature for publications exploring online methods to disseminate new research findings. We synthesized the results and constructed a conceptual model of current research dissemination methods. RESULTS: We included 79 out of 655 unique abstracts and articles identified in our search, 62 of which were from the traditional literature. We describe six primary domains: integration with traditional literature, measurement of dissemination, online organizations and communities of practice, professional development, quality assurance tools and techniques, and advantages and disadvantages of FOAM. For each domain we present an exemplar article and prevailing gaps in knowledge. Finally, we propose a current conceptual framework for dissemination of new research findings that describes both traditional and novel methods of dissemination. CONCLUSIONS: This comprehensive review of the literature and current dissemination framework will empower researchers, research networks, and granting organizations to maximize their use of FOAM and other online methods to disseminate new knowledge as well as provide clinicians a better understanding of the tools and methods by which to access and implement new research findings.
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- 2022
35. Aortic valve versus root surgery after failed transcatheter aortic valve replacement
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Keti Vitanova, Syed Zaid, Gilbert H.L. Tang, Tsuyoshi Kaneko, Vinayak N. Bapat, Thomas Modine, Paolo Denti, Shekhar Saha, Christian Hagl, Philipp Kiefer, David Holzhey, Thilo Noack, Michael A. Borger, Nimesh D. Desai, Joseph E. Bavaria, MDPierre Voisine, Siamak Mohammadi, Josep Rodés-Cabau, Katherine B. Harrington, John J. Squiers, Molly I. Szerlip, J. Michael DiMaio, Michael J. Mack, Joshua Rovin, Marco Gennari, Shinichi Fukuhara, G. Michael Deeb, Aditya Sengupta, Philippe Demers, Reda Ibrahim, Moritz Wyler von Ballmoos, Marvin D. Atkins, Neal S. Kleiman, Michael J. Reardon, Francesco Maisano, Oliver D. Bhadra, Lenard Conradi, Christian Shults, Lowell F. Satler, Ron Waksman, Luigi Pirelli, Derek R. Brinster, Muhanad Algadheeb, Michael W.A. Chu, Rodrigo Bagur, Basel Ramlawi, Kendra J. Grubb, Newell B. Robinson, Lin Wang, George A. Petrossian, Lionel Leroux, John R. Doty, Brian K. Whisenant, Joerg Kempfert, Axel Unbehaun, Hussein Rahim, Tamim M. Nazif, Isaac George, Arnar Geirsson, John K. Forrest, Flavien Vincent, Eric Van Belle, Mohamad Koussa, Joshua B. Goldberg, Hasan A. Ahmad, Walid Ben Ali, Martin Andreas, Paul Werner, Kashish Goel, Ashish S. Shah, Guido Gelpi, Marc Ruel, Talal Al-Atassi, Nicholas M. Van Mieghem, Thijmen W. Hokken, Augusto D'Onofrio, Chiara Tessari, Sameer Hirji, Pinak B. Shah, Igor Belluschi, Andrea Garatti, Giuseppe Bruschi, Maral Ouzounian, Alejandro Pizano, Marco Di Eusanio, Filippo Capestro, Maurizio Taramasso, Andrea Colli, Rodrigo Estevez-Loureiro, Miguel A. Pinon, Michael H. Salinger, Antonio Di Virgilio, Tom C. Nguyen, and Rudiger Lange
- Subjects
Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
We sought to determine outcomes of aortic valve replacement (AVR) versus root replacement after transcatheter AVR (TAVR) explantation because they remain unknown.From November 2009 to September 2020, data from the EXPLANT-TAVR International Registry of patients who underwent TAVR explant were retrospectively reviewed, divided by AVR versus root replacement. After excluding explants performed during the same admission as the initial TAVR and concomitant procedures involving the other valves, 168 AVR cases were compared with 28 root replacements, and outcomes were reported at 30 days and 1 year.Among 196 patients (mean age, 73.5 ± 9.9 years) who had primary aortic valve intervention at TAVR explant, the median time from TAVR to surgical explant was 11.2 months (interquartile range, 4.4-32.9 months). Indications for explant were similar between the 2 groups. Compared with AVR, patients requiring root replacement had fewer comorbidities but more unfavorable anatomy for redo TAVR (52.6% vs 26.4%; P = .032), fewer urgent/emergency cases (32.1% vs 58.3%; P = .013), longer median interval from index TAVR to TAVR explant (17.6 vs 9.9 months; P = .047), and more concomitant ascending aortic replacement (58.8% vs 14.0%; P .001). Median follow-up was 6.9 months (interquartile range, 1.4-21.6 months) after TAVR explant and 97.4% complete. Overall survival at follow-up was 81.2% with no differences between groups (log rank P = .54). In-hospital, 30-day, and 1-year mortality rates and stroke rates were not different between the 2 groups.In the EXPLANT-TAVR Registry, AVR and root replacement groups had different clinical characteristics, but no differences in short-term mortality and morbidities. Further investigations are necessary to identify patients at risk of root replacement in TAVR explant.
- Published
- 2022
36. Mean platelet volume and cardiac-surgery–associated acute kidney injury: a retrospective study
- Author
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Ashish S. Shah, Tarek S. Absi, Frederic W. Lombard, Mias Pretorius, Frederic T. Billings, Austin A. Woolard, Cynthia Zheng, Miklos D. Kertai, Abinaya Ramakrishnan, Yaping Shi, Rushikesh Vyas, Manuel L. Fontes, Matthew S. Shotwell, and Jonathan P. Wanderer
- Subjects
medicine.medical_specialty ,Creatinine ,business.industry ,Acute kidney injury ,Retrospective cohort study ,General Medicine ,Odds ratio ,030204 cardiovascular system & hematology ,medicine.disease ,Cardiac surgery ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,030228 respiratory system ,chemistry ,Anesthesia ,Internal medicine ,Cardiology ,Medicine ,Platelet activation ,Mean platelet volume ,business ,Kidney disease - Abstract
Increased mean platelet volume (MPV) may indicate platelet activation, platelet aggregation, and a resulting prothrombotic state. Such changes in the postoperative period have been associated with organ injury and adverse outcomes. We hypothesized that changes in MPV after cardiac surgery are associated with both a higher risk of acute kidney injury (AKI) and mortality. In this retrospective study, we evaluated consecutive patients undergoing adult cardiac surgery patients between 12 December 2011 and 5 June 2018. The change in MPV was derived by calculating the difference between the baseline MPV before surgery and the average postoperative MPV just prior to the occurrence of AKI. We defined postoperative AKI according to Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for Acute Kidney Injury as either a ≥ 50% increase in serum creatinine in the first ten postoperative days, or an increase of ≥ 0.3 mg·dL−1 during any 48-hr window across the ten-day postoperative period. Multivariable logistic regression analysis was used to examine the association between MPV change and postoperative AKI and mortality. Of the 4,204 patients studied, 1,373 (32.7%) developed postoperative AKI, including 83 (2.0%) and 38 (0.9%) who developed stages II and III AKI, respectively. Compared with patients who had an increase in median postoperative MPV of 0.2 femtolitre (fL), those with an increase of 0.8 fL had an 80% increase in the odds of developing AKI (adjusted odds ratio [aOR], 1.80; 95% confidence interval [CI],1.36 to 2.38; P < 0.001) and were almost twice as likely to progress to a higher severity AKI (aOR, 1.66; 95% CI, 1.28 to 2.16; P < 0.001). Change in MPV was not associated with mortality (aOR,1.32; 95% CI, 0.92 to 1.89; P = 0.14). Increased MPV change in the postoperative period was associated with both increased risk and severity of AKI, but not mortality.
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- 2020
37. Safe surgical zone during TORS radical tonsillectomy: An anatomical and radiological study
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K. V. R. Brijith, S. R. Kumar, Satish Nair, Namrata Srivastava, J. G. Aishwarya, Ashish S. Shah, Savith Kumar, and Ameena Ibrahim
- Subjects
business.industry ,External carotid artery ,lcsh:Surgery ,Radical tonsillectomy ,Anatomy ,lcsh:RD1-811 ,Stylopharyngeus ,03 medical and health sciences ,Dissection ,Parapharyngeal space ,0302 clinical medicine ,Cadaver ,Transoral robotic surgery ,030220 oncology & carcinogenesis ,medicine.artery ,Styloglossus ,medicine ,Tonsillar fossa ,030211 gastroenterology & hepatology ,Internal carotid artery ,business - Abstract
Objective Parapharyngeal space contains intricate vascular anatomy (external and internal carotid arteries) that might be inadvertently injured during the dissection in this plane. None of the bony landmarks can be used during the transoral robotic surgery (TORS) radical tonsillectomy as these landmarks lie lateral to the internal carotid artery (ICA) and external carotid artery (ECA) in transoral approach. Our study aims to identify the safe surgical limits during the dissection of parapharyneal space in TORS radical tonsillectomy and to correlate the same with radiological study. Material and methods Fifteen cadavers (30 head and neck regions) and 50 CT-Angiogram of neck (100 head and neck regions) were included in the anatomical and radiological study respectively. The vertical midpoint of anterior tonsillar pillar (palatoglossus muscle) was taken as the reference point and all the measurements were done at the level of reference point both for anatomical and radiological study. Distance between tonsillar fossa and ECA, distance between tonsillar fossa and ICA, relation between ECA and styloglossus and relation between ICA and stylopharyngeus at reference level were studied. Results The mean distance of ECA from the tonsillar fossa at the reference point was 18.2 mm in the anatomical study and 16.2 mm in the radiological study. The mean distance of ICA from the tonsillar fossa was 23.4 mm and 23.3 mm in the anatomical study and radiological study. There was no significant difference between the anatomical and radiological findings for both the mean distance between ECA and ICA to the tonsillar fossa (p value was 0.45 and 0.30 respectively). ECA was located posterolateral to styloglossus in 24 cases (80.0%) and 79 cases (79.0%) in the anatomical and radiological study respectively. ICA was found posterolateral to stylopharyngeus in 21 cases (70.0%) and 69 cases (69.0%) in the anatomical and radiological study respectively. Conclusion The muscular plane between styloglossus and stylopharyngeus can be used as an envelope to locate the ECA and ICA that lie medial to these critical vascular structures during TORS. We propose to divide the parapharyngeal space into two compartments (anterior and posterior) based on the surgical perspective of inside-out anatomy. The anterior compartment houses styloglossus muscle with ECA posterolateral to it and the posterior compartment has stylopharyngeus and ICA posterolateral to it.
- Published
- 2020
38. The 4 Dimensions of Heart Allocation in an Increasingly Complex Universe
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Ashish S. Shah and Lynne W. Stevenson
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Heart transplantation ,business.industry ,media_common.quotation_subject ,Heart failure ,medicine.medical_treatment ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,Universe ,media_common ,Epistemology - Published
- 2020
39. A Dual-Lumen Bicaval Cannula for Venovenous Extracorporeal Membrane Oxygenation
- Author
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Ahmed E. Hozain, Ashish S. Shah, Whitney D. Gannon, Matthew Warhoover, Rei Ukita, Yuliya Tipograf, Matthew Bacchetta, Jonathan C. Nesbitt, William G. McMaster, and Neal M. Foley
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Catheterization ,Methods statistical ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Interquartile range ,Fraction of inspired oxygen ,medicine ,Extracorporeal membrane oxygenation ,Cannula ,Humans ,Retrospective Studies ,Mechanical ventilation ,business.industry ,Equipment Design ,Blood flow ,Middle Aged ,Respiration, Artificial ,Catheter ,030228 respiratory system ,Anesthesia ,Acute Disease ,Female ,Surgery ,Respiratory Insufficiency ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Single-site, dual-lumen venovenous extracorporeal membrane oxygenation ECMO) facilitates mobilization, reduces recirculation, and mitigates insertion and infectious risks of an additional access site. This study reports the experience with a bicaval dual-lumen cannula that comprises a robust physical design allowing for easy and safe cannulation, precise positioning and monitoring, and appropriate physiologic support for patients with acute respiratory failure. Methods Statistical analysis was performed from data gathered retrospectively from the electronic medical records of 20 adult patients who were cannulated for ECMO with this bicaval dual-lumen cannula from August 2018 through May 2019. Results Gas exchange and blood flow were optimized in all patients after cannulation (median pH, 7.42 [interquartile range {IQR}, 7.39, 7.44], ratio of arterial partial pressure of oxygen to fraction of inspired oxygen, 186.5 [Pa o 2:Fi o 2, 116.5, 247.0]; pump flow, 3.9 L/min [IQR, 3.1, 4.3]). Eleven patients (55%) were able to be freed from mechanical ventilation after cannulation, 9 (45%) patients underwent a tracheostomy procedure while undergoing ECMO, and no patients required reintubation. No morbidity or mortality was related to the cannulation strategy or the catheter. Two patients required cannula repositioning. Survival to decannulation was 90%, and survival to hospital discharge was 80%. Conclusions The bicaval dual-lumen cannula maintains the advantages of upper body single-site configuration to provide the adjunctive respiratory support necessary to facilitate awakening and rehabilitation while minimizing the use of invasive mechanical ventilation. This cannula introduces design qualities that may offer advantages for acute respiratory failure requiring venovenous ECMO.
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- 2020
40. Intraoperative Oxidative Damage and Delirium after Cardiac Surgery
- Author
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Christopher Hughes, Frederic T. Billings, Michael R. Petracek, Ashish S. Shah, Jennifer Morse, Nancy J. Brown, J. Brennan McNeil, Anthony DeMatteo, Jason B. O’Neal, Marcos G. Lopez, and Matthew S. Shotwell
- Subjects
Male ,medicine.medical_specialty ,Atorvastatin ,medicine.disease_cause ,Blood–brain barrier ,Gastroenterology ,law.invention ,Cohort Studies ,03 medical and health sciences ,Emergence Delirium ,Postoperative Complications ,0302 clinical medicine ,030202 anesthesiology ,law ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Cardiac Surgical Procedures ,Furans ,Prospective cohort study ,Aged ,Aged, 80 and over ,F2-Isoprostanes ,business.industry ,S100 Proteins ,Odds ratio ,Middle Aged ,Intensive care unit ,Cardiac surgery ,Oxidative Stress ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Blood-Brain Barrier ,Delirium ,Female ,medicine.symptom ,business ,Ubiquitin Thiolesterase ,030217 neurology & neurosurgery ,Oxidative stress ,medicine.drug - Abstract
Background Mechanisms of postoperative delirium remain poorly understood, limiting development of effective treatments. We tested the hypothesis that intraoperative oxidative damage is associated with delirium and neuronal injury and that disruption of the blood–brain barrier modifies these associations. Methods In a prespecified cohort study of 400 cardiac surgery patients enrolled in a clinical trial of atorvastatin to reduce kidney injury and delirium, we measured plasma concentrations of F2-isoprostanes and isofurans using gas chromatography-mass spectrometry to quantify oxidative damage, ubiquitin carboxyl-terminal hydrolase isozyme L1 to quantify neuronal injury, and S100 calcium-binding protein B using enzyme-linked immunosorbent assays to quantify blood–brain barrier disruption before, during, and after surgery. We performed the Confusion Assessment Method for the Intensive Care Unit twice daily to diagnose delirium. We measured the independent associations between intraoperative F2-isoprostanes and isofurans and delirium (primary outcome) and postoperative ubiquitin carboxyl-terminal hydrolase isozyme L1 (secondary outcome), and we assessed if S100 calcium-binding protein B modified these associations. Results Delirium occurred in 109 of 400 (27.3%) patients for a median (10th, 90th percentile) of 1.0 (0.5, 3.0) days. In the total cohort, plasma ubiquitin carboxyl-terminal hydrolase isozyme L1 concentration was 6.3 ng/ml (2.7, 14.9) at baseline and 12.4 ng/ml (7.9, 31.2) on postoperative day 1. F2-isoprostanes and isofurans increased throughout surgery, and the log-transformed sum of intraoperative F2-isoprostanes and isofurans was independently associated with increased odds of postoperative delirium (odds ratio, 3.70 [95% CI, 1.41 to 9.70]; P = 0.008) and with increased postoperative ubiquitin carboxyl-terminal hydrolase isozyme L1 (ratio of geometric means, 1.42 [1.11 to 1.81]; P = 0.005). The association between increased intraoperative F2-isoprostanes and isofurans and increased postoperative ubiquitin carboxyl-terminal hydrolase isozyme L1 was amplified in patients with elevated S100 calcium-binding protein B (P = 0.049). Conclusions Intraoperative oxidative damage was associated with increased postoperative delirium and neuronal injury, and the association between oxidative damage and neuronal injury was stronger among patients with increased blood–brain barrier disruption. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
- Published
- 2020
41. Advanced Heart Failure in Adults With Congenital Heart Disease
- Author
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JoAnn Lindenfeld, Kelly Schlendorf, Benjamin P. Frischhertz, David P. Bichell, Bret A. Mettler, D. Marshall Brinkley, Sandip Zalawadiya, Jeremy A. Mazurek, Jonathan N. Menachem, Wendy Book, and Ashish S. Shah
- Subjects
Adult ,Heart Defects, Congenital ,medicine.medical_specialty ,Heart disease ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Global Health ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,cardiovascular diseases ,030212 general & internal medicine ,Cause of death ,Heart Failure ,Heart transplantation ,business.industry ,medicine.disease ,Heart failure ,Ventricular assist device ,Circulatory system ,Cardiology ,Morbidity ,Cardiology and Cardiovascular Medicine ,business - Abstract
As a result of improvements in care for patients with congenital heart disease (CHD), >90% of children born with CHD are expected to survive to adulthood. For those adults, heart failure (HF) is the leading cause of death. Advances in recognition of, and treatments for, these patients continue to improve. Specifically, adults with CHD are candidates for both heart transplantation and mechanical circulatory support. However, challenges remain that require investigation to improve outcomes.
- Published
- 2020
42. Recovery from Total Acute Lung Failure After 20 Months of Extracorporeal Life Support
- Author
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Ashish S. Shah, Kristen Nelson-McMillan, Luca A. Vricella, John D. Coulson, Narutoshi Hibino, Fray Dylan Stewart, and John S. Young
- Subjects
medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Biomedical Engineering ,Biophysics ,Bioengineering ,030204 cardiovascular system & hematology ,Lung injury ,Extracorporeal ,Biomaterials ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Extracorporeal membrane oxygenation ,medicine ,Humans ,Child ,Lung ,business.industry ,Recovery of Function ,General Medicine ,medicine.disease ,Surgery ,surgical procedures, operative ,medicine.anatomical_structure ,030228 respiratory system ,Respiratory failure ,Ventricular assist device ,Life support ,Heart failure ,Female ,Respiratory Insufficiency ,business ,Burns, Inhalation - Abstract
Since the first successful case report in 1972, extracorporeal life support or extracorporeal membrane oxygenation (ECMO) has become a standard approach for severe respiratory failure unresponsive to other therapy. In the past, if there was no recovery by approximately 30 days or if right ventricular heart failure occurred, ECMO was discontinued and the patient died. More recently patients with severe lung disease have been maintained for months, as opposed to days, with eventual decannulation and recovery. We report the case of a child, 7 years old, with severe inhalational burn injury and rapid progression to multisystem organ failure. She was supported by ECMO with no lung function for almost 2 years. Central nervous system function remained normal and lung function recovered. This is the longest successful case of ECMO to date and prompts further discussion regarding "irreversible" lung injury.
- Published
- 2020
43. Predictors of Stroke After Minimally Invasive Mitral Valve Surgery Without the Cross-Clamp
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Renaldo D. Williams, Tarek S. Absi, Miklos D. Kertai, Ashish S. Shah, Rushikesh Vyas, Michael R. Petracek, Neal M. Foley, Keki R. Balsara, and Shi Huang
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Mitral Valve Annuloplasty ,Time Factors ,Heart Valve Diseases ,030204 cardiovascular system & hematology ,Risk Assessment ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,law ,Interquartile range ,Mitral valve ,medicine ,Cardiopulmonary bypass ,Humans ,Endocarditis ,Stroke ,Aged ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,business.industry ,Hazard ratio ,Hemodynamics ,General Medicine ,Odds ratio ,Middle Aged ,medicine.disease ,Intensive care unit ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Thoracotomy ,030228 respiratory system ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Minimally invasive mitral valve surgery (mini-MVS) with hypothermic fibrillatory arrest has been associated with an increased risk of stroke. We aim to investigate the incidence, predictors, and outcomes of stroke in a large cohort of patient who underwent clampless mini-MVS. Between January 2008 and June 2017, we performed 1247 mini-MVSs. The clinical, operative, and postoperative outcomes were analyzed. Univariable and multivariable regression analyses were used to identify predictors of postoperative stroke. The median follow-up was 5.2 years (interquartile range 2.6-7.5). The etiology of mitral valve (MV) disease was degenerative (60.4%, n = 753), functional (12.8%, n = 160), rheumatic (8.7%, n = 109), endocarditis (3.1%, n = 39), and reoperative MV surgery (14.9%, n = 186). The overall incidence of postoperative neurologic event was 2.5% (n = 31/1247). Univariable predictors of stroke were a higher Society of Thoracic Surgeons mortality risk (6.0 ± 11.8% vs 3.3 ± 5.2%, P0.001), advanced age, (69.6 ± 12.1 years vs 63.0 ± 13.6 years, P = 0.002), female gender (71.0% vs 46.3%, P = 0.007), and a history of a cerebrovascular accident (22.6% vs 8.7%, P = 0.008). Stroke patients had a higher 30-day mortality (22.6% vs 1.6%, P0.001) and a higher risk for long-term mortality (hazard ratio = 5.56, 95% confidence interval [CI] 3.2-9.6, P0.001). Advanced age (odds ratio [OR] 2.1; 95% CI 1.1-4.0; P = 0.02), female gender (OR 2.3; 95% CI 0.9-5.2; P = 0.05), and history of cerebrovascular accident (OR 3.1; 95% CI 0.98-10.1; P = 0.05) remained as independent predictors of stroke in the multivariable analysis. Our decade-long experience indicates that clampless mini-MVS is associated with a low incidence of postoperative stroke, and that the predictors of stroke are not specific to this approach.
- Published
- 2020
44. Structured review of post-cardiotomy extracorporeal membrane oxygenation: Part 2—pediatric patients
- Author
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Roberto Lorusso, Giuseppe Maria Raffa, Mariusz Kowalewski, Khalid Alenizy, Niels Sluijpers, Maged Makhoul, Daniel Brodie, Mike McMullan, I-Wen Wang, Paolo Meani, Graeme MacLaren, Heidi Dalton, Ryan Barbaro, Xaotong Hou, Nicholas Cavarocchi, Yih-Sharng Chen, Ravi Thiagarajan, Peta Alexander, Bahaaldin Alsoufi, Christian A. Bermudez, Ashish S. Shah, Jonathan Haft, Lilia Oreto, David A. D'Alessandro, Udo Boeken, and Glenn Whitman
- Subjects
Heart Defects, Congenital ,Pulmonary and Respiratory Medicine ,PEDIATRIC CARDIAC-SURGERY ,LIFE-SUPPORT ,RESPIRATORY-DISTRESS-SYNDROME ,TERM SURVIVAL ,Article ,Postoperative Complications ,post-cardiotomy cardiogenic shock ,Humans ,cardiac surgical procedures ,child ,Transplantation ,congenital ,MECHANICAL CIRCULATORY SUPPORT ,extracorporeal membrane oxygenation ,SINGLE-VENTRICLE ,RESIDUAL LESIONS ,CONGENITAL HEART-DISEASE ,surgical procedures, operative ,Treatment Outcome ,CARDIOPULMONARY-RESUSCITATION ,RISK-FACTORS ,post-cardiotomy circulatory assistance ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
Veno-arterial extracorporeal membrane oxygenation (ECMO) is established therapy for short-term circulatory support for children with life-treating cardiorespiratory dysfunction. In children with congenital heart disease (CHD), ECMO is commonly used to support patients with post-cardiotomy shock or complications including intractable arrhythmias, cardiac arrest, and acute respiratory failure. Cannulation configurations include central, when the right atrium and aorta are utilized in patients with recent sternotomy, or peripheral, when cannulation of the neck or femoral vessels are used in non-operative patients. ECMO can be used to support any form of cardiac disease, including univentricular palliated circulation. Although veno-arterial ECMO is commonly used to support children with CHD, venovenous ECMO has been used in selected patients with hypoxemia or ventilatory failure in the presence of good cardiac function. ECMO use and outcomes in the CHD population are mainly informed by single-center studies and reports from collated registry data. Significant knowledge gaps remain, including optimal patient selection, timing of ECMO deployment, duration of support, anti-coagulation, complications, and the impact of these factors on short- and long-term outcomes. This report, therefore, aims to present a comprehensive overview of the available literature informing patient selection, ECMO management, and in-hospital and early post-discharge outcomes in pediatric patients treated with ECMO for post-cardiotomy cardiorespiratory failure. (C) 2019 International Society for Heart and Lung Transplantation. All rights reserved.
- Published
- 2019
45. Structured review of post-cardiotomy extracorporeal membrane oxygenation
- Author
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Khalid Alenizy, Yih-Sharng Chen, Lilia Oreto, Giuseppe Maria Raffa, Paolo Meani, Niels Sluijpers, Ryan P. Barbaro, Ravi R. Thiagarajan, Nicholas C. Cavarocchi, Bahaaldin Alsoufi, Udo Boeken, Christian A. Bermudez, David A. D'Alessandro, Daniel Brodie, Peta M. A. Alexander, Jonathan W. Haft, Glenn J.R. Whitman, Mike McMullan, Mariusz Kowalewski, Maged Makhoul, Heidi J. Dalton, Ashish S. Shah, Xaotong Hou, Roberto Lorusso, Graeme MacLaren, and I-Wen Wang
- Subjects
Pulmonary and Respiratory Medicine ,Adult ,medicine.medical_specialty ,LEFT-VENTRICLE ,medicine.medical_treatment ,Population ,LIFE-SUPPORT ,RESPIRATORY-DISTRESS-SYNDROME ,030204 cardiovascular system & hematology ,extracorporeal life support ,Article ,Hypoxemia ,REFRACTORY CARDIAC-ARREST ,03 medical and health sciences ,0302 clinical medicine ,LONG-TERM OUTCOMES ,Extracorporeal membrane oxygenation ,postoperative complications ,Medicine ,Humans ,Cardiopulmonary resuscitation ,ADULT PATIENTS ,Cardiac Surgical Procedures ,POSTCARDIOTOMY CARDIOGENIC-SHOCK ,Intensive care medicine ,education ,ELDERLY-PATIENTS ,Transplantation ,education.field_of_study ,business.industry ,Cardiogenic shock ,cardiogenic shock ,MECHANICAL CIRCULATORY SUPPORT ,extracorporeal membrane oxygenation ,medicine.disease ,Cardiac surgery ,surgical procedures, operative ,Treatment Outcome ,030228 respiratory system ,Life support ,Surgery ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Cardiotomy ,RIGHT HEART-FAILURE ,cardiac surgery - Abstract
Cardiogenic shock, cardiac arrest, acute respiratory failure, or a combination of such events, are all potential complications after cardiac surgery which lead to high mortality. Use of extracorporeal temporary cardio-circulatory and respiratory support for progressive clinical deterioration can facilitate bridging the patient to recovery or to more durable support. Over the last decade, extracorporeal membrane oxygenation (ECMO) has emerged as the preferred temporary artificial support system in such circumstances. Many factors have contributed to widespread ECMO use, including the relative ease of implantation, effectiveness, versatility, low cost relative to alternative devices, and potential for full, not just partial circulatory support. While there have been numerous publications detailing the short and midterm outcomes of ECMO support, specific reports about post-cardiotomy ECMO (PC-ECMO), are limited, single-center experiences. Etiology of cardiorespiratory failure leading to ECMO implantation, associated ECMO complications, and overall patient outcomes may be unique to the PC-ECMO population. Despite the rise in PC-ECMO use over the past decade, short-term survival has not improved. This report, therefore, aims to present a comprehensive overview of the literature with respect to the prevalence of ECMO use, patient characteristics, ECMO management, and in-hospital and early post-discharge patient outcomes for those treated for post-cardiotomy heart, lung, or heart-lung failure. (C) 2019 International Society for Heart and Lung Transplantation. All rights reserved.
- Published
- 2019
46. Simulation Versus Interactive Mobile Learning for Teaching Extracorporeal Membrane Oxygenation to Clinicians: A Randomized Trial
- Author
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Todd W. Rice, Matthew Bacchetta, Matthew W. Semler, Jonathan D Casey, Meredith E. Pugh, Whitney D. Gannon, John W. Stokes, Clayne Benson, Ashish S. Shah, Ashley Troutt, and Lynne Craig
- Subjects
medicine.medical_specialty ,Academic Medical Centers ,Randomization ,Critical Care ,business.industry ,medicine.medical_treatment ,Clinical performance ,Psychological intervention ,Critical Care and Intensive Care Medicine ,Knowledge retention ,law.invention ,Extracorporeal Membrane Oxygenation ,Randomized controlled trial ,Interquartile range ,law ,Baseline characteristics ,Physical therapy ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Computer Simulation ,business ,Simulation Training ,Retrospective Studies - Abstract
Objectives Extracorporeal membrane oxygenation has become integral to critical care. Data informing optimal extracorporeal membrane oxygenation education modalities are lacking. We aimed to compare the effect of high-fidelity simulation versus interactive mobile learning on extracorporeal membrane oxygenation knowledge acquisition and retention among clinicians. Design Observer-blinded, randomized controlled trial. Setting A single academic medical center. Subjects Forty-four critical care clinicians with limited extracorporeal membrane oxygenation experience. Interventions Participants were randomized to receive: 1) simulation: three high-fidelity training scenarios, 2) QuizTime: 15 total multiple-choice questions delivered over 3 weeks via mobile device, or 3) experiential: no formal training. Participants completed a survey, written knowledge examination, and simulation assessment prior to randomization, immediately following the intervention, and 4 month postintervention. Measurements and main results The primary outcome was knowledge about extracorporeal membrane oxygenation assessed by score on the immediate postintervention written examination. Secondary outcomes included performance in extracorporeal membrane oxygenation simulation postintervention and 4 months later assessed by a rater blinded to group assignment. Clinicians randomized to simulation (n = 15), QuizTime (n = 14), and experiential (n = 15) had similar baseline characteristics. Adjusting for baseline knowledge, postintervention examination scores were higher in the simulation group (90.0%; interquartile range, 85.0-90.0%) than the QuizTime group (70.0%; interquartile range, 65.0-80.0%; p = 0.0003) and the experiential group (75.0%; interquartile range, 65.0-80.0%; p = 0.001). Scores did not differ between the groups at 4 months (p > 0.05 in all analyses). In postintervention extracorporeal membrane oxygenation simulations, the simulation group demonstrated shorter time to critical action compared with QuizTime (80.0 s [interquartile range, 54.0-111.0 s] vs 300.0 s [interquartile range 85.0-300.0 s]; p = 0.02) and compared with both QuizTime (45.0 s [interquartile range, 34.0-92.5 s] vs 255.5 s [interquartile range, 102.0-300.0 s]; p = 0.008) and experiential (300.0 s [interquartile range, 58.0-300.0 s]; p = 0.009) at 4 months. Conclusions Simulation was superior to QuizTime and experiential learning with regard to extracorporeal membrane oxygenation knowledge acquisition. Further studies are needed to ascertain the effect of these interventions on knowledge retention, clinical performance, and patient outcomes.
- Published
- 2021
47. Protocol for a randomised controlled trial: reducing reintubation among high-risk cardiac surgery patients with high-flow nasal cannula (I-CAN)
- Author
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Robert E Freundlich, Jonathan P Wanderer, Benjamin French, Ryan P Moore, Antonio Hernandez, Ashish S Shah, Daniel W Byrne, and Pratik P Pandharipande
- Subjects
Adult ,Oxygen ,Intubation, Intratracheal ,Airway Extubation ,Humans ,Cannula ,General Medicine ,Cardiac Surgical Procedures ,Randomized Controlled Trials as Topic - Abstract
IntroductionHeated, humidified, high-flow nasal cannula oxygen therapy has been used as a therapy for hypoxic respiratory failure in numerous clinical settings. To date, limited data exist to guide appropriate use following cardiac surgery, particularly among patients at risk for experiencing reintubation. We hypothesised that postextubation treatment with high-flow nasal cannula would decrease the all-cause reintubation rate within the 48 hours following initial extubation, compared with usual care.Methods and analysisAdult patients undergoing cardiac surgery (open surgery on the heart or thoracic aorta) will be automatically enrolled, randomised and allocated to one of two treatment arms in a pragmatic randomised controlled trial at the time of initial extubation. The two treatment arms are administration of heated, humidified, high-flow nasal cannula oxygen postextubation and usual care (treatment at the discretion of the treating provider). The primary outcome will be all-cause reintubation within 48 hours of initial extubation. Secondary outcomes include all-cause 30-day mortality, hospital length of stay, intensive care unit length of stay and ventilator-free days. Interaction analyses will be conducted to assess the differential impact of the intervention within strata of predicted risk of reintubation, calculated according to our previously published and validated prognostic model.Ethics and disseminationVanderbilt University Medical Center IRB approval, 15 March 2021 with waiver of written informed consent. Plan for publication of study protocol prior to study completion, as well as publication of results.Trial registration numberclinicaltrials.gov,NCT04782817submitted 25 February 2021.Date of protocol29 August 2022. Version 2.0.
- Published
- 2022
48. Commentary: When the data are precise and imperfect
- Author
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Ashish S. Shah
- Subjects
Pulmonary and Respiratory Medicine ,business.industry ,Medicine ,Surgery ,Imperfect ,Cardiology and Cardiovascular Medicine ,business ,Data science - Published
- 2022
49. Commentary: The prodigal son returns
- Author
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Ashish S. Shah
- Subjects
Pulmonary and Respiratory Medicine ,business.industry ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Classics - Published
- 2022
50. Left Ventricular Unloading During Extracorporeal Life Support: Current Practice
- Author
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ANIKET S. RALI, ERIC J. HALL, RAYMOND DIETER, SAGAR RANKA, ANDREW CIVITELLO, MATTHEW D. BACCHETTA, ASHISH S. SHAH, KELLY SCHLENDORF, JOANN LINDENFELD, and SUBHASIS CHATTERJEE
- Subjects
Heart Failure ,Extracorporeal Membrane Oxygenation ,Heart Ventricles ,Hemodynamics ,Shock, Cardiogenic ,Humans ,Cardiology and Cardiovascular Medicine - Abstract
Venoarterial extracorporeal life support (VA-ECLS) is a powerful tool that can provide complete cardiopulmonary support for patients with refractory cardiogenic shock. However, VA-ECLS increases left ventricular (LV) afterload, resulting in greater myocardial oxygen demand, which can impair myocardial recovery and worsen pulmonary edema. These complications can be ameliorated by various LV venting strategies to unload the LV. Evidence suggests that LV venting improves outcomes in VA-ECLS, but there is a paucity of randomized trials to help guide optimal strategy and the timing of venting. In this review, we discuss the available evidence regarding LV venting in VA-ECLS, explain important hemodynamic principles involved, and propose a practical approach to LV venting in VA-ECLS.
- Published
- 2021
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