Publications by authors named "Justin A Fried"
Introduction: No clear guidelines exist for unfractionated heparin (UFH) monitoring in adult patients on veno-arterial extracorporeal life support (VA-ECLS) for refractory cardiogenic shock. In this study, we sought to compare outcomes between anti-factor Xa (FXa) and activated partial thromboplastin time (aPTT) strategies for UFH monitoring during VA-ECLS.
Methods: This is a single-center, retrospective review of VA-ECLS patients who received UFH in the cardiothoracic intensive care unit between July 2019 and November 2023.
Elevated Donor-Derived Cell-Free DNA Levels Are Associated With Reduced Myocardial Blood Flow but Not Angiographic Cardiac Allograft Vasculopathy: The EVIDENT Study.
Circ Heart Fail
December 2024
Background: Cardiac allograft vasculopathy (CAV) leads to impaired myocardial blood flow (MBF), increasing the risk of cardiovascular death or retransplant among heart transplantation (HT) recipients. Data on elevation in donor-derived cell-free DNA (dd-cfDNA) and CAV in the absence of rejection are mixed. We sought to test the hypothesis that CAV with reduced MBF (RMBF) is associated with elevated dd-cfDNA.
View Article and Find Full Text PDFBackground: Cancer survivors (CS) comprise a particularly high-risk group for both de-novo and recurrent malignancies after solid organ transplantation.
Case Presentation: We report a case of relapsed melanoma, presented as metastatic disease seven months after heart transplantation in a patient who had an early-stage melanoma resected 25 years prior. Treatment with a combination of dabrafenib, a BRAF inhibitor, and trametinib, a mitogen-activated protein kinase (MEK) inhibitor resulted in a near-complete metabolic response, without major adverse effects.
Feasibility of veno-arterial extracorporeal life support in awake patients with cardiogenic shock.
Interdiscip Cardiovasc Thorac Surg
August 2024
Objectives: This study sought to demonstrate outcomes of veno-arterial extracorporeal life support (VA-ECLS) in non-intubated ('awake') patients with cardiogenic shock, as very few studies have investigated safety and feasibility in this population.
Methods: This was a retrospective review of 394 consecutive VA-ECLS patients at our institution from 2017 to 2021. We excluded patients cannulated for indications definitively associated with intubation.
Article Synopsis
- The HeartMate 3 survival risk score was validated to predict survival chances for patients receiving a HeartMate 3 left ventricular assist device, categorizing them into different survival probability groups.
- A study involving 181 patients revealed that those in the high survival group had a significantly higher two-year survival rate compared to average and low survival groups, with rates of 93.5%, 81.6%, and 82.0%, respectively.
- Although the score's original stratification didn't clearly show survival differences, using a binary cutoff indicated better survival for patients in the high-risk category, demonstrating its potential utility in clinical settings.
Article Synopsis
- The study examined the effects of glucagon-like-peptide 1 receptor agonists (GLP1-RA) on heart transplant recipients dealing with diabetes and obesity, as there has been limited research in this area.
- A total of 74 patients were analyzed, with significant improvements in cardiometabolic parameters such as reduced BMI, lower blood sugar levels (HbA1C), and decreased LDL cholesterol after using GLP1-RA for around 383 days.
- Results indicated that GLP1-RA therapy was effective in managing diabetes and weight in these patients, with minimal impact on their immunosuppression medication adjustments.
Article Synopsis
- Despite advancements in treatment, ST-elevation myocardial infarction (STEMI) still results in high mortality rates, leading to a greater focus on comfort-oriented care for those with poor prognoses.
- In a study of 536 STEMI patients, 11.4% died during hospitalization, with a significant number transitioning to comfort-focused care, especially those on mechanical circulatory support.
- Palliative care consultations were infrequent, occurring in only about 10% of cases, typically late in hospitalization, suggesting a need for earlier integration of comfort care strategies.
Article Synopsis
- A study analyzed data from 7,070 patients with cardiogenic shock (CS), finding that 5.6% developed acute limb ischemia (ALI), particularly among women and those with peripheral arterial disease.* -
- ALI incidence increased with the severity of CS, with highest rates among patients using advanced support devices like VA-ECMO and balloon pumps, yet less than half used distal perfusion catheters.* -
- Mortality rates were significantly higher for patients with ALI (57.4%) compared to those without (38.0%), highlighting ALI's severe impact on survival in CS patients.*
Article Synopsis
- This study explores the challenges faced by pediatric heart transplant (HT) recipients when transitioning to adult care, focusing on identifying risk factors for poor health outcomes.
- Researchers analyzed data from 72 patients who made this transition between 2011 and 2021, noting key factors such as medication adherence, psychiatric history, and age at transition.
- The findings emphasize the need for structured transition plans tailored to high-risk individuals to improve adherence and outcomes in adult HT care.
Article Synopsis
- Belatacept (BTC) is a fusion protein that inhibits T-cell activation and has primarily been used for immunosuppression in kidney transplants, but its effectiveness for heart transplant patients remains less understood.
- A retrospective study analyzed 21 heart transplant recipients who received BTC between 2017 and 2021, focusing on their health outcomes, including rejection rates and kidney function over a follow-up period that extended to December 2023.
- Results indicated that BTC treatment had a low rejection rate (4.8%) and stable graft function, with a slight improvement in kidney health for the majority of the patients, though a significant portion of them discontinued the treatment within the study period.
Article Synopsis
- Patients with HeartMate 3 LVADs show improved hemodynamics through pump speed adjustments, particularly during hemodynamic ramp tests conducted from 2015 to 2022.
- Out of 60 studied patients, only 58% had optimized filling pressures at baseline, but after speed adjustments, 65% achieved optimized measurements.
- Those who attained optimized pressures experienced significantly lower readmission rates over 6 and 12 months, mainly due to reduced cardiac-related hospitalizations, compared to nonoptimized patients.
Article Synopsis
- This study examined how interactions between the ventricles affect right ventricular (RV) size and function in patients with left ventricular assist devices (LVADs) during hemodynamic tests by varying the device speed.
- Researchers found that faster LVAD speeds led to an increase in RV end-diastolic volume and stroke volume, while RV end-systolic volumes remained stable.
- The results suggest that these interventricular interactions actually improve RV compliance and decrease afterload without impairing RV contractility, challenging the common belief that these interactions negatively affect RV function.
Background: This study examines the role of extracorporeal life support flow in the development of acute kidney injury in cardiogenic shock.
Methods: We performed a retrospective analysis of 465 patients placed on extracorporeal life support at our institution between January 2015 and December 2020 for cardiogenic shock. Flow index was calculated by dividing mean flow by body surface.
Article Synopsis
- * Out of 10 documented pregnancies during LVAD support, 8 resulted in successful births, while 1 case involved maternal and fetal mortality and another was a spontaneous abortion.
- * The study emphasizes the importance of a collaborative care approach, proper medication management, and understanding the physiological changes during pregnancy to support maternal and fetal health while on LVAD.
Dual circulation is a common but underrecognized physiological occurrence associated with peripheral venoarterial extracorporeal membrane oxygenation (ECMO). Competitive flow will develop between blood ejected from the heart and blood travelling retrograde within the aorta from the ECMO reinfusion cannula. The intersection of these two competitive flows is referred to as the "mixing point".
View Article and Find Full Text PDFPurpose: Venoarterial extracorporeal membrane oxygenation (V-A ECMO) can be used to support severely ill patients with cardiogenic shock. While age is commonly used in patient selection, little is known regarding its association with outcomes in this population. We sought to evaluate the association between increasing age and outcomes following V-A ECMO.
View Article and Find Full Text PDFArticle Synopsis
- Aortic root thrombosis (ART) is a complication from using the HeartMate 3 (HM3) left ventricular assist device, and this study investigates its incidence and complications.
- In a cohort of 197 HM3 patients, 9.6% developed ART, and 7.6% experienced moderate or greater aortic insufficiency (AI) over an average follow-up period of 17.5 months.
- ART was linked to higher risks of severe outcomes, including death, stroke, and the need for aortic valve interventions, emphasizing the importance of monitoring for this complication in HM3 patients.
Article Synopsis
- Aortic regurgitation (AR) is a common issue after left ventricular assist device (LVAD) implantation, specifically in patients with HeartMate 3 (HM3).
- In a study of 62 stable patients, nearly half had at least mild AR at baseline, but hemodynamic measures did not differ significantly between those with and without AR at the start.
- While AR did not impact one-year mortality or hospitalization rates, it was associated with increased rates of worsening AR and right ventricular failure over time.
New system, old problem: Increased wait time for high-priority transplant candidates.
J Heart Lung Transplant
November 2023
Article Synopsis
- The 2018 heart allocation policy aimed to enhance risk assessment and minimize waitlist deaths for critically ill patients awaiting transplants.
- A study analyzing wait times from 2018 to 2022 found no significant changes in the median wait time for the highest priority patients (status 1), while wait times for status 2 patients increased by an average of 4.2 days with each subsequent period after the policy change.
- Blood type O candidates experienced the longest wait times, and despite regional variations, wait times rose across all regions during the study period.
Article Synopsis
- Significant weight loss (≥10%) before a heart transplant is linked to lower 1-year survival rates post-surgery, with a study showing survival rates at 86.9% for those who lost weight compared to 91.0% for those who didn't.
- The study analyzed data from nearly 6,000 adult heart transplant recipients, confirming that preoperative weight loss serves as an independent mortality predictor even when accounting for other health factors like hospitalization status and obesity.
- The findings suggest that implementing nutritional interventions prior to transplant could help improve survival outcomes for patients experiencing significant weight loss.
The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) following acute myocardial infarction with cardiogenic shock (AMI-CS) is increasing, but the ability to predict favorable outcomes with support remains limited. We retrospectively reviewed all patients with AMI-CS supported with VA-ECMO between December 2008 and June 2018. One hundred twenty-six patients received VA-ECMO for AMI-CS during the study period; of these, 39 (31.
View Article and Find Full Text PDFBackground: In patients with the HeartMate 3 (HM3, Abbott) left ventricular (LV) assist device (LVAD), outflow graft narrowing has been reported as a result of accumulation of biodebris either internal or external to the graft. This study describes the prevalence, imaging findings, and clinical outcomes associated with HM3 LVAD outflow graft narrowing.
Methods: A single-center retrospective cohort study was performed in patients who received an HM3 LVAD between November 2014 and July 2019.
Objectives: This analysis sought to investigate the waitlist and post-transplant outcomes of individuals bridged to transplantation by using temporary percutaneous endovascular mechanical circulatory support (tMCS) through a status 2 designation (cardiogenic shock and exception).
Background: The 2018 donor heart allocation policy change granted a status 2 designation to patients supported with tMCS.
Methods: Adult patients in the United Network for Organ Sharing registry after October 18, 2018 who received a status 2 designation for tMCS were included and grouped by their status 2 criteria: cardiogenic shock with hemodynamic criteria (CS-HD), cardiogenic shock without hemodynamic criteria before tMCS (CS-woHD), and exception.
Article Synopsis
- Heart transplantation is a viable treatment for advanced transthyretin cardiac amyloidosis (ATTR-CA), but the effects of ongoing amyloid deposition post-transplant are unclear.
- A study included 12 patients who underwent heart transplant for ATTR-CA, finding that over 50% showed signs of continued or new ATTR symptoms, affecting their quality of life.
- The results indicate a need for better monitoring and disease-modifying treatments for TTR to enhance quality of life after heart transplantation.