Publications by authors named "Nir Uriel"
Importance: The Aspirin and Hemocompatibility Events With a Left Ventricular Assist Device in Advanced Heart Failure (ARIES-HM3) study demonstrated that aspirin may be safely eliminated from the antithrombotic regimen after HeartMate 3 (HM3 [Abbott Cardiovascular]) left ventricular assist device (LVAD) implantation. This prespecified analysis explored whether conditions requiring aspirin (prior percutaneous coronary intervention [PCI], coronary artery bypass grafting [CABG], stroke, or peripheral vascular disease [PVD]) would influence outcomes differentially with aspirin avoidance.
Objective: To analyze aspirin avoidance on hemocompatibility-related adverse events (HRAEs) at 1 year after implant in patients with a history of CABG, PCI, stroke, or PVD.
Background: Cardiac allograft vasculopathy (CAV) results in impaired blood flow in both epicardial vessels and the microvasculature and is a leading cause of poor outcomes in heart transplant (HT) recipients. Most patients have mild (ISHLT CAV 1) disease. This study examined outcomes amongst those with ISHLT CAV 1 and investigated the value of physiologic assessment via cardiac positron emission tomography/computed tomography (PET/CT) for added risk stratification.
View Article and Find Full Text PDFBackground: Prior analyses have suggested that a smaller left ventricular end-diastolic diameter (LVEDD) is associated with reduced survival following HeartMate 3 left ventricular assist device implantation.
Objectives: In this trial-based comprehensive analysis, the authors sought to examine clinical characteristics and association with the outcome of this specific relationship.
Methods: The authors analyzed the presence of LVEDD <55 mm among 1,921 analyzable HeartMate 3 patients within the MOMENTUM 3 (Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3) trial portfolio, on endpoints of overall survival and adverse events at 2 years.
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 PDFProsthetic valve-related morbidity and mortality in patients with left ventricular assist devices (LVADs) remain unclear. We retrospectively reviewed patients who received a HeartMate II or 3 LVAD at our center between April 2004 and December 2022. Patients with a valve prosthesis in any position were included.
View Article and Find Full Text PDFCardiac allograft vasculopathy (CAV) is a major cause of morbidity and mortality following heart transplantation (HT). Prior studies identified distinct CAV trajectories in the early post-HT period with unique predictors, but the evolution of CAV in later periods is not well-described. This study assessed the prevalence of late CAV progression and associated risk factors in HT recipients with ISHLT CAV 0/1 at 10 years post-HT.
View Article and Find Full Text PDFBackground: Donor-derived cell-free DNA (dd-cfDNA) has emerged as a reliable, noninvasive method for the surveillance of allograft rejection in heart transplantation (HT) patients, but its utility in multi-organ transplants (MOT) is unknown. We describe our experience using dd-cfDNA in simultaneous MOT recipients.
Methods: A single-center retrospective review of all HT recipients between 2018 and 2022 that had at least one measurement of dd-cfDNA collected.
Background: 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.
Article Synopsis
- The study looked at how to manage blood thinners after people got a special heart device called HeartMate 3.
- It compared two methods for checking the right dose of a blood thinner called unfractionated heparin (UFH).
- There were no big differences in bleeding or clotting problems between the two methods, but more research is needed to know which one is better.
Article Synopsis
- This study evaluated the effectiveness and safety of a new procedure called splanchnic nerve ablation for managing fluid volume in patients with heart failure and preserved ejection fraction (HFpEF).* -
- Conducted as a phase 2, double-blind, randomized trial involving 90 patients across 15 centers, the study compared the outcomes of the nerve ablation procedure to a sham control.* -
- Results showed no significant differences in both the primary outcomes (reduction in pulmonary capillary wedge pressure) and safety events between the treatment and control groups, suggesting that the nerve ablation may not provide the expected benefits for these patients.*
Article Synopsis
- A new implantable sensor has been created to measure the area of the inferior vena cava (IVC) to help monitor heart failure (HF) patients daily and predict fluid congestion.
- The study included 15 HF patients and assessed the sensor's safety, effectiveness, and data transmission, finding high accuracy in IVC measurements and excellent patient adherence to using the device.
- Results showed that the sensor was safe and effective, with improvements noted in patients' heart failure classification, indicating a need for further research into remote management of heart failure using this technology.
Article Synopsis
- Cardiomyopathies are a significant cause of cardiovascular issues in the peripartum period, and the study focuses on cases of cardiogenic shock (CS) requiring mechanical circulatory support (MCS).
- The retrospective analysis included 11 cases, with a majority of patients experiencing shock after delivery and many treated with various MCS devices like intra-aortic balloon pumps and ECMO.
- Outcomes showed a high recovery rate of 63.6% over a median follow-up of 4.5 years, suggesting that MCS could be a viable option before considering heart transplants.
Article Synopsis
- Donation after circulatory death heart transplantation may expand donor options, particularly benefiting patients with lower urgency status who are using durable left ventricular assist devices (LVADs).
- A study analyzed data from the United Network for Organ Sharing between 2019 and 2022, comparing outcomes of heart transplant recipients with LVADs to those receiving other bridging support, focusing on one-year mortality and several medical complications.
- While the one-year mortality rates showed no significant difference, patients with LVADs experienced higher rates of acute rejection, suggesting the need for careful monitoring and management post-transplant.
Article Synopsis
- This study analyzed the outcomes of 774 adult patients who received simultaneous heart-kidney transplants (SHK) under the revised UNOS heart allocation policy, focusing on 50 patients who were supported by veno-arterial extracorporeal life support (VA-ECLS) compared to 724 without.
- Results showed that VA-ECLS patients were younger and had better kidney function before transplant but faced higher rates of temporary dialysis and lower survival rates after the procedure, with significant differences in early mortality and cardiac allograft failure.
- The findings indicate that while VA-ECLS patients have similar renal outcomes post-transplant, they experience greater risks for early mortality and complications related to heart trans
Article Synopsis
- The increasing demand for organ transplants and advancements in LVAD technology have made LVADs a key option for patients awaiting heart transplants.
- The text discusses the current processes involved in LVAD implantation, focusing on patient selection, preparation before the device is implanted, and outcomes after transplantation.
- A recent policy change in the US has decreased the use of LVADs for transplantation, prompting suggestions to adjust allocation criteria to improve implantation rates.
Article Synopsis
- Cardiac hybrid PET/CT is used to assess cardiac allograft vasculopathy (CAV) in heart transplant patients and visually estimated coronary artery calcium (VECAC) from CT scans can help predict cardiovascular outcomes.
- A study of 430 heart transplant patients found that higher VECAC scores (specifically 10-99 and 100+) were linked to a significantly greater risk of death or retransplantation during a median follow-up of 4.2 years.
- The findings suggest that VECAC can be a valuable independent marker for predicting adverse outcomes post-heart transplant and should be considered in patient evaluations.
Article Synopsis
- Preoperative assessment of pectoralis muscle area, which estimates sarcopenia, is linked to increased risks in LVAD patients, including higher postoperative mortality and gastrointestinal bleeding.
- A study involving 254 LVAD patients found that those with low pectoralis muscle area (low-PMI cohort) exhibited significantly elevated inflammation and endotoxemia markers compared to others.
- Patients with low pectoralis muscle area experienced longer hospital stays and a greater likelihood of readmissions within 90 days and one year after surgery.
Article Synopsis
- This study compares two methods of estimating kidney function (eGFRcysC and eGFRsCr) in heart transplant recipients, focusing on how body mass index (BMI), steroid use, and muscle mass affect accuracy.
- Significant differences between the two eGFRs were noted, especially early after transplantation, with eGFRcysC showing more stability over time compared to eGFRsCr.
- Using eGFRcysC can impact dosing for the medication valganciclovir, suggesting that 46% of patients would have required dosage adjustments, mostly reductions, highlighting the importance of accurate kidney function assessment.
Article Synopsis
- Hemocompatibility issues post-left ventricular assist device (LVAD) implantation lead to complications like gastrointestinal bleeding, stroke, or death, but predicting these risks is challenging.* -
- A secondary analysis of the MOMENTUM 3 trial utilized a multistate model to evaluate 2,056 LVAD patients, revealing a 2-year incidence rate of 25.6% for gastrointestinal bleeding, 6.0% for stroke, and 12.3% for death.* -
- The multistate model, which includes 39 variables, provides a tool for stratifying risk and predicting adverse events in ambulatory LVAD patients, potentially improving clinical decision-making.*
Article Synopsis
- Organ allocation for non-US citizen, non-US resident transplant patients is debated in the U.S., with a lack of data on stakeholder views.
- A survey conducted at an urban transplant institute included responses from 209 providers and 119 patients, revealing varied awareness of eligibility for organ transplantation.
- While most patients favor eligibility for non-US citizen transplants, providers prioritize legal statuses differently, indicating a need for more comprehensive research to inform policy.
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.