Publications by authors named "Jacob N Schroder"
Objective: Recently, normothermic regional perfusion (NRP) and direct procurement and perfusion (DPP) have allowed for heart transplantation following donation after circulatory death (DCD). This study aimed to characterize utilization and variation of NRP and DPP in the United States.
Methods: Heart transplants from 12/1/19-3/31/24 were identified from the United Network for Organ Sharing Database.
Objective: Randomized data support transplantation of hearts from donors after circulatory death. This may lead to a sizeable increase in the donor pool. Regional variations in donors after circulatory death heart use were examined to help elucidate barriers to donor pool expansion.
View Article and Find Full Text PDFArticle Synopsis
- * Researchers explored ex vivo perfusion using the TransMedics Organ Care System (OCS) and reported on 8 pediatric patients who received OCS-perfused hearts between 2020 and 2024.
- * Results showed that all patients had normal left ventricular function after transplant and no fatalities during a median follow-up of nearly 12 months, indicating promising outcomes with this technique.
Background: We previously reported that concurrent tricuspid valve surgery (TVS) was not associated with a lower incidence of early right heart failure (RHF) in patients undergoing durable left ventricular assist device (LVAD) implantation. This follow-up analysis aimed to further define the clinical impact of concurrent TVS after 2 months of follow-up.
Methods: Patients with moderate or severe tricuspid regurgitation (TR) on preoperative echocardiography (n = 71) were randomized to LVAD implantation either alone (no TVS group; n = 34) or with concurrent TVS (TVS group; n = 37).
Background: Heart transplantation following donation after circulatory death (DCD HT) has short-term survival outcomes comparable to donation after brain death and has led to a significant increase in transplantation volume. The U.S.
View Article and Find Full Text PDFBackground: Patients with obesity and advanced heart failure requiring left ventricular assist device (LVAD) support are more likely to experience LVAD complications and may be disproportionately Black and/or female when compared to patients without obesity. Among these patients, obesity may represent a barrier to transplant eligibility and a marker of inequity in heart transplantation and health outcomes in advanced heart failure.
Methods: To better understand this issue at our institution, we examined our active LVAD cohort and found that almost one-third of all patients had severe obesity with BMI ≥ 35 kg/m.
This study identified 26 late invasive primary surgical site infection (IP-SSI) within 4-12 months of transplantation among 2073 SOT recipients at Duke University Hospital over the period 2015-2019. Thoracic organ transplants accounted for 25 late IP-SSI. Surveillance for late IP-SSI should be maintained for at least one year following transplant.
View Article and Find Full Text PDFBackground: Heart transplant (HT) in recipients with left ventricular assist devices (LVADs) is associated with poor early post-HT outcomes, including primary graft dysfunction (PGD). As complicated heart explants in recipients with LVADs may produce longer ischemic times, innovations in donor heart preservation may yield improved post-HT outcomes. The SherpaPak Cardiac Transport System is an organ preservation technology that maintains donor heart temperatures between 4 °C and 8 °C, which may minimize ischemic and cold-induced graft injuries.
View Article and Find Full Text PDFBackground: The aims of the study were to assess the performance of a clinically available cell-free DNA (cfDNA) assay in a large cohort of pediatric and adult heart transplant recipients and to evaluate performance at specific cut points in detection of rejection.
Methods: Observational, non-interventional, prospective study enrolled pediatric and adult heart transplant recipients from seven centers. Biopsy-associated plasma samples were used for cfDNA measurements.
Article Synopsis
- Extended criteria donor (ECD) hearts from donation after brain death (DBD) are often underused for transplants due to cold storage issues; this study explored the impact of an extracorporeal perfusion system on their utilization and outcomes.
- In a multicenter study with adult recipients, 173 ECD DBD hearts were perfused, achieving an 87% transplantation success rate, with 30-day survival at 97% and only 6.7% experiencing severe primary graft dysfunction (PGD).
- The outcomes demonstrated that using this perfusion system not only reduced severe PGD but also supported good patient survival rates through two years, suggesting a way to significantly increase heart transplant availability for patients in need.
Objective: We developed a hybrid technique for repairing post-myocardial infarction (MI) ventricular septal defect (VSD) that combines infarct exclusion with patch and a nitinol-mesh septal occluder device (SOD) to provide a scaffold to support the damaged septal wall. Here, we compare outcomes of patients with post-MI VSD repaired using patch only or hybrid patch/SOD.
Methods: Patients undergoing post-MI VSD repair at our institution from 2013 to 2022 who received patch alone or patch/SOD repair were analyzed.
Article Synopsis
- Heart transplantation (HT) has traditionally used cold storage for preserving donor hearts, which poses risks like ischemic damage and poor outcomes after the transplant.
- New preservation methods, such as the SherpaPak Cardiac Transport System and Transmedics Organ Care System, are being implemented and allow for better heart preservation, expanding donor options and geographic reach for procurement.
- The paper discusses emerging evidence linking these new techniques to better outcomes post-transplant and recommends best practices for choosing between different preservation methods.
Objectives: The Impella 5.5 has been successfully used in the adult population; however, safety and efficacy data in patients aged less than 18 years are limited.
Methods: Six pediatric patients, aged 13 to 16 years and weighing 45 to 113 kg, underwent axillary artery graft placement and attempted placement of the Impella 5.
Article Synopsis
- Improved survival rates after heart transplantation (HT) have led more recipients to consider pregnancy, but there is limited data on the associated outcomes.
- In a study analyzing over 19 million deliveries in the U.S., HT recipients were found to have significantly higher risks for severe maternal morbidity (SMM), preterm birth, and readmission within one year after delivery compared to non-HT recipients.
- The findings indicate that women with a history of HT face 16 to 38 times greater odds of suffering from various complications during and after pregnancy, highlighting the need for careful counseling for these patients.
Traditional ice storage has been the historic standard for preserving donor's hearts. However, this approach provides variability in cooling, increasing risks of freezing injury. To date, no preservation technology has been reported to improve survival after transplantation.
View Article and Find Full Text PDFObjectives: To investigate whether recipient administration of thyroid hormone (liothyronine [T3]) is associated with reduced rates of primary graft dysfunction (PGD) after orthotopic heart transplantation.
Design: Retrospective cohort study.
Setting: Single-center, university hospital.
Background: Right ventricular failure (RVF) is a leading driver of morbidity and death after major cardiac surgery for advanced heart failure, including orthotopic heart transplantation and left ventricular assist device implantation. Inhaled pulmonary-selective vasodilators, such as inhaled epoprostenol (iEPO) and nitric oxide (iNO), are essential therapeutics for the prevention and medical management of postoperative RVF. However, there is limited evidence from clinical trials to guide agent selection despite the significant cost considerations of iNO therapy.
View Article and Find Full Text PDFIntroduction: The advent of new technologies to reduce primary graft dysfunction (PGD) and improve outcomes after heart transplantation are costly. Adoption of these technologies requires a better understanding of health care utilization, specifically the costs related to PGD.
Methods: Records were examined from all adult patients who underwent orthotopic heart transplantation (OHT) between July 1, 2013 and July 30, 2019 at a single institution.
Background: Data showing the efficacy and safety of the transplantation of hearts obtained from donors after circulatory death as compared with hearts obtained from donors after brain death are limited.
Methods: We conducted a randomized, noninferiority trial in which adult candidates for heart transplantation were assigned in a 3:1 ratio to receive a heart after the circulatory death of the donor or a heart from a donor after brain death if that heart was available first (circulatory-death group) or to receive only a heart that had been preserved with the use of traditional cold storage after the brain death of the donor (brain-death group). The primary end point was the risk-adjusted survival at 6 months in the as-treated circulatory-death group as compared with the brain-death group.