Publications by authors named "Nidhi Iyanna"
Article Synopsis
- The UNOS 2018 heart allocation policy prioritizes patients on temporary mechanical circulatory support (tMCS) due to their high risk of mortality while waiting for a heart transplant.
- A study analyzed 27,343 adults on the waitlist and found a significant increase in tMCS use from 7.4% to 22.4% after the policy change.
- Results showed that patients on tMCS had lower waitlist mortality, higher chances of receiving a transplant, and similar one-year mortality rates after transplantation compared to previous trends.
Article Synopsis
- - The study investigates how donor cardiopulmonary resuscitation (CPR) status affects the outcomes of heart transplants from donors after circulatory death (DCD).
- - An analysis of 683 adult DCD heart transplant recipients showed that those who received donor hearts from CPR donors had similar 1-year survival rates (around 92%) as those from non-CPR donors.
- - Results indicate that using DCD hearts from donors who underwent CPR can help increase the availability of donor organs without harming initial post-transplant survival rates.
Background: This study evaluates the impact of the agonal phase and related hemodynamic measures on post-transplant outcomes and heart utilization in donation after circulatory death (DCD) heart transplantation.
Methods: United Network for Organ Sharing registry was queried to analyze adult recipients who underwent isolated DCD heart transplantation between January 1, 2019 and September 30, 2023. The recipients were stratified into 2 groups based on donor agonal period: <30 and ≥30 minutes.
Article Synopsis
- The study aimed to assess how intraoperative neuromonitoring (IONM) affects the risk of stroke and mortality during coronary and valvular heart operations over a period of 11 years.
- Out of 19,299 patients, 589 (3.1%) received IONM, and those patients had higher pre-existing cerebrovascular diseases, resulting in increased rates of operative mortality (5.3% vs 2.5%) and stroke (4.9% vs 1.9%).
- However, after adjusting for patient characteristics, there was no significant difference in stroke or mortality rates between IONM users and non-users, suggesting that IONM may indicate risks rather than directly influence outcomes.
Background: This study evaluates the effects of pre-transplant transpulmonary gradient (TPG) and donor right ventricular mass (RVM) on outcomes following heart transplantation.
Methods: UNOS registry was queried to analyze adult recipients who underwent primary isolated heart transplantation from 1/1/2010 to 12/31/2018. The recipients were dichotomized into 2 groups based on their TPG at the time of transplantation, < 12 and ≥ 12 mmHg.
Article Synopsis
- This study evaluated how mitral regurgitation (MR) affects patient outcomes after undergoing transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS), finding significant survival differences based on MR severity.
- Out of 2250 TAVI patients, those with moderate or greater MR had lower survival rates and a higher chance of heart failure readmissions compared to those with less severe MR.
- The findings suggest the importance of monitoring MR progression after TAVI, as various clinical factors, but not procedural aspects, were linked to the persistence of significant MR, indicating a need for more research on managing combined AS and MR.
Background: This study evaluates the clinical trends and impact of hepatitis C virus-positive (HCV+) donors on waitlist and posttransplant outcomes after heart transplantation.
Methods: The United Network for Organ Sharing registry was queried to identify adult waitlisted and transplanted patients from January 1, 2015, to December 31, 2022. In the waitlist analysis, the candidates were stratified into 2 cohorts based on whether they were willing to accept HCV+ donor offers.
Background: This study evaluates the interaction of donor and recipient age with outcomes following heart transplantation under the 2018 heart allocation system.
Methods: The United Network for Organ Sharing registry was queried to analyze adult primary isolated orthotopic heart transplant recipients and associated donors from August 18, 2018, to June 30, 2021. Both recipient and donor cohorts were grouped according to age: <65 and ≥65 y for recipients and <50 and ≥50 y for donors.
Prior studies assessing the effects of Impella 5.5 support duration on posttransplant outcomes have been limited to single-center case reports and series. This study evaluates the impact of Impella 5.
View Article and Find Full Text PDFBackground: This study evaluates the clinical trends, risk factors, and impact of waitlist blood transfusion on outcomes following isolated heart transplantation.
Methods: The UNOS registry was queried to identify adult recipients from January 1, 2014, to June 30, 2022. The recipients were stratified into two groups depending on whether they received a blood transfusion while on the waitlist.
Article Synopsis
- Both Total Arch Replacement (TAR) and debranching plus Thoracic Endovascular Aortic Repair (TEVAR) are effective treatments for aortic arch pathologies, but it is still uncertain which is the better option.
- A meta-analysis of 11 studies involving 1142 patients revealed no significant difference in overall survival between the two treatments, though TAR showed a significantly lower risk of needing later aortic surgeries.
- Older patients may find debranching plus TEVAR more beneficial, while those with type A aortic dissections might have better outcomes with TAR.
Objectives: The prehospital prediction of the radiographic diagnosis of traumatic brain injury (TBI) in hemorrhagic shock patients has the potential to promote early therapeutic interventions. However, the identification of TBI is often challenging and prehospital tools remain limited. While the Glasgow Coma Scale (GCS) score is frequently used to assess the extent of impaired consciousness after injury, the utility of the GCS scores in the early prehospital phase of care to predict TBI in patients with severe injury and concomitant shock is poorly understood.
View Article and Find Full Text PDFBackground: The reporting of adverse events (AEs) is required and well defined in the execution of clinical trials, but is poorly characterized particularly in prehospital trials focusing on traumatic injury. In the setting of prehospital traumatic injury trials, no literature currently exists analyzing the clinical implications of AEs and their associations with mortality and morbidity. We sought to analyze AEs from three prehospital hemorrhagic shock trials and characterize their time course, incidence, severity, associated clinical outcomes, and relatedness.
View Article and Find Full Text PDFArticle Synopsis
- Tricuspid valve replacement (TVR) using mechanical valves shows better long-term survival rates and lower reoperation risks compared to tissue valves, based on a review of 21 studies involving 7,166 patients.
- Patients with mechanical valves had a lower risk of death (HR 0.77) and gained an average of 2.2 more years of life (12.4 vs 10.2 years).
- While there was no significant difference in reoperation risk within the first 7 years, mechanical valves showed a substantially lower reoperation risk after 7 years (HR 0.24).
Introduction: Thoracic endovascular aortic repair (TEVAR) has gained preference over open surgical repair (OSR) as the intervention of choice for patients with descending thoracic aortic aneurysm (DTA). This study aimed to compare the outcomes of patients with DTA undergoing OSR and TEVAR with contemporary findings.
Evidence Acquisition: A comprehensive search of MEDLINE and EMBASE databases was conducted to identify relevant randomized controlled trials or studies utilizing propensity-score analysis or reporting risk-adjusted outcomes.
Background: Tranexamic acid (TXA) has been hypothesized to mitigate coagulopathy in patients after traumatic injury. Despite previous prehospital clinical trials demonstrating a TXA survival benefit, none have demonstrated correlated changes in thromboelastography (TEG) parameters. We sought to analyze if missing TEG data contributed to this paucity of findings.
View Article and Find Full Text PDFArticle Synopsis
- The study looked at how different types of injuries (blunt vs. penetrating) affect patients in clinical trials for trauma.
- Researchers found that patients with blunt injuries had a higher chance of dying within 30 days compared to those with penetrating injuries (29.7% vs. 14.0%).
- They also noticed that certain markers in the blood, which indicate cell damage, were higher in patients with blunt injuries.
Objective: To evaluate trends and outcomes of lung transplants (LTx) in recipients ≥ 70 years.
Methods: We performed a retrospective analysis of the UNOS database identifying all patients undergoing LTx (May 2005-December 2022). Baseline characteristics and postoperative outcomes were compared by age (<70 years, ≥70 years) and center volume.
Objective: To compare outcomes of patients undergoing valve-in-valve transcatheter aortic valve replacement (ViV TAVR) versus redo surgical aortic valve replacement (SAVR).
Methods: This was a retrospective study using institutional databases of transcatheter (2013-2022) and surgical (2011-2022) aortic valve replacements. Patients who underwent ViV TAVR were compared with patients who underwent redo isolated SAVR.
Autism Spectrum Disorder (ASD) affects about 1 in 44 children and environmental exposures may contribute to disease onset. Air pollution has been associated with adverse neurobehavioral outcomes, yet little research has examined its association with autistic-like behaviors. Therefore, our objective was to examine the association between exposure to air pollution, including NO and PM, during pregnancy and the first year of life to ASD-like behaviors during childhood.
View Article and Find Full Text PDF