Publications by authors named "Clement Eiswirth"

10 Publications

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Preimplant hyponatremia does not predict adverse outcomes in patient with left ventricular assist devices.

Curr Probl Cardiol 2022 May 2:101239. Epub 2022 May 2.

Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.

Background: Hyponatremia is a well-established marker of adverse outcomes in chronic heart failure (HF) but not well studied in patients with left ventricular assist device (LVAD).

Methods: This is a retrospective study, single center study of HM3 [Abbott, USA] LVAD implants. We divided our population based on their sodium prior to LVAD implantation - hyponatremia if <135 mEq/L and normal sodium if 135 - 145 mEq/L. We compared postoperative and long-term outcomes.

Results: A total of 195 patients were included, preimplant hyponatremia was present in 40% with a sodium of 132.1±2.1 vs. 137.8±1.9 mEq/L in the normal sodium group. No differences were observed in the postoperative or long-term outcomes.

Conclusion: Preimplant hyponatremia was not associated with mortality or HF admissions, likely due to adequate left ventricular unloading and resolution of the mechanisms that lead to hyponatremia. These results suggest that optimization of mild hyponatremia may not be critical and should not delay LVAD placement.
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http://dx.doi.org/10.1016/j.cpcardiol.2022.101239DOI Listing
May 2022

Feasibility and Safety of Coronary Angiography via Radial Approach in Cardiac Transplant Recipients: A Single Center Experience.

Curr Probl Cardiol 2021 Jul 24:100935. Epub 2021 Jul 24.

John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA. Electronic address:

Coronary angiography remains the gold standard post-transplant screening test for cardiac allograft vasculopathy. This procedure has traditionally been performed via femoral approach. Data on safety and efficacy of radial approach in cardiac transplant patients remains scarce. Single center retrospective study including all cardiac transplant patients who underwent coronary angiography via transradial approach (TRA) or transfemoral approach (TFA). Safety and efficacy outcomes were compared between the 2 groups. Primary end points included major bleeding, vascular complications, crossover to femoral approach, contrast use and radiation exposure. A total of 201 patients were included. 96 patients (47.8%) underwent angiography via TRA. At baseline, no significant differences with regards to age, gender, or traditional risk factors such as HTN, DM, hyperlipidemia were noted between the 2 groups. Most patients underwent intravascular ultrasound (n = 179, 89%) with no statistically significant differences between the 2 groups (TRA: 90.6% vs TFA: 87.6%, P = 0.5). Additionally, there were no statistically significant differences in radiation exposure, amount of contrast use and fluoroscopy time between the 2 groups. Although there were trends toward increased bleeding among TFA group, these were not statistically significant and were mostly driven by access site hematomas. Use of TRA increased over time and Conversion from TRA to TFA was low (n = 4, 4.2%). Coronary angiography via the radial approach in cardiac transplant recipients is feasible, safe and is associated with low a risk of bleeding with no significant increase in radiation exposure when compared to the traditional femoral approach.
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http://dx.doi.org/10.1016/j.cpcardiol.2021.100935DOI Listing
July 2021

Triple Antithrombotic Therapy in Patients With Left Ventricular Assist Devices.

Curr Probl Cardiol 2021 Jul 24:100940. Epub 2021 Jul 24.

Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.

Data on the efficacy and safety of the combination of warfarin and dual-antiplatelet therapy compared with warfarin and mono-antiplatelet therapy (MAPT) in patients with left ventricular assist devices (LVAD) remains scarce. Single-center study of 130 consecutive patients with durable LVAD. Baseline demographics, antithrombotic and antiplatelet regimen, and outcomes were compared between patients receiving warfarin plus dual-antiplatelet therapy (Group 1) and warfarin plus MAPT (Group 2). Antiplatelet therapy was assessed at hospital discharge post-LVAD implant and included aspirin, clopidogrel and dipyridamole. Outcomes at 1-year were assessed in each group. All patients were on aspirin and warfarin. No significant differences with regards to age, gender or ethnicity were noted at baseline between the two groups. Group 1 was more likely to have higher lactate dehydrogenase LDH levels at discharge and a history of stroke. No significant differences in international normalized ratio INR, hemoglobin or hematocrit were noted at discharge. During the study period, 48 patients had gastrointestinal bleeding events: 28 of 68 (41.2%) in Group 1 vs 20 of 62 (32.2%) in Group 2 (P = 0.293). At 1year, no statistically significant differences were noted in gastrointestinal bleeding (Group 1=27.90% vs Group 2 = 25.80, P = 0.784), ischemic stroke (Group 1 = 8.8% vs group 2 = 6.5%, P = 0.612), hemorrhagic stroke (Group 1 = 4.4% vs group 2 = 3.2%, P = 0.725) or mortality (Group 1 = 5.9% vs Group 2 = 1.6%, P = 0.206). Rates of pump thrombosis however were lower in Group 1 (Group 1 = 0% vs Group 2 = 6.5%, P = 0.033). Our study showed a high prevalence of triple-therapy antithrombotic use in LVAD patients with no significant differences in bleeding, stroke or survival. However, the risk for pump thrombosis was lower at 1-year when compared to patient receiving MAPT.
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http://dx.doi.org/10.1016/j.cpcardiol.2021.100940DOI Listing
July 2021

Use of TandemHeart as Bridge to Recovery for Antibody-Mediated Rejection in a Heart Transplant Patient.

JACC Case Rep 2020 Dec 16;2(15):2358-2362. Epub 2020 Dec 16.

Section of Cardiomyopathy and Heart Transplantation, Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, The University of Queensland School of Medicine, New Orleans, Louisiana, USA.

Antibody-mediated rejection is a major cause of graft failure, mortality, and morbidity among cardiac transplant recipients. We present the first reported case of TandemHeart (LivaNova, Pittsburgh, Pennsylvania) used in the management of antibody-mediated rejection associated with cardiogenic shock. ().
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http://dx.doi.org/10.1016/j.jaccas.2020.11.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8305082PMC
December 2020

Elusive Diagnosis of Eosinophilic Myocarditis: A Case Series.

Curr Probl Cardiol 2021 Oct 27;46(10):100849. Epub 2021 Mar 27.

John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA.

We present 2 relevant cases of eosinophilic myocarditis (EM) in patients that presented with cardiogenic shock, one of whom received a durable ventricular assist device followed by heart transplantation, with the diagnosis of EM being made based on analysis of the excisional biopsy obtained during implantation of the ventricular assist device. The second patient was initially misdiagnosed with peripartum cardiomyopathy and underwent abortion, to later being diagnosed with EM through endomyocardial biopsy. These two cases highlight the importance of high clinical suspicion for EM based on eosinophilia, comorbidities, and presentation, as well as the value of early diagnosis and therapeutic interventions, including corticosteroids, and advanced heart failure therapies, such as mechanical circulatory support and heart transplantation.
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http://dx.doi.org/10.1016/j.cpcardiol.2021.100849DOI Listing
October 2021

Ruptured hemorrhagic bulla in a patient with a HeartMate 3 treated with an Amplatzer device.

Arch Cardiol Mex 2021 Mar 24. Epub 2021 Mar 24.

Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA, USA; Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA.

A 60-year-old female with underlying emphysema and left ventricular assist device (LVAD) HeartMate 3 presented with progressive hemoptysis, dyspnea, and right chest pain. Baseline hemoglobin was 11.1 g/dL and INR 2.9.
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http://dx.doi.org/10.24875/ACM.20000331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351646PMC
March 2021

Laparoscopic sleeve gastrectomy in obese patients with ventricular assist devices: a data note.

BMC Res Notes 2020 Sep 17;13(1):439. Epub 2020 Sep 17.

The John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.

Objectives: Patients with end-stage heart failure (ESHF) treated with ventricular assist devices (VADs) tend to gain weight after implantation, which is associated with higher complication rates and is a contraindication for heart transplantation (HT). The objective was to analyze the outcomes of obese patients with ESHF and VADs who underwent laparoscopic sleeve gastrectomy (LSG) at Ochsner Medical Center in New Orleans, which is the only program performing VADs and HT in the State of Louisiana, and also one of the largest VAD centers in the USA.

Data Description: This dataset contains detailed baseline, perioperative, and long-term data of patients with VADs undergoing LSG. These variables were collected retrospectively from electronic medical records. Patients who achieved ≥ 50% excess BMI loss, BMI ≤ 35 kg/m, listing for HT, HT, or myocardial recovery were identified and the timing to each of these milestones was documented. These data can be used alone or in combination with other datasets to achieve a larger sample size with more power for further analysis of these variables, which include the most important, standard, and objective bariatric and ESHF outcomes of patients with VADs undergoing LSG. Elaboration of composite outcomes is feasible.
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http://dx.doi.org/10.1186/s13104-020-05272-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7496210PMC
September 2020

Laparoscopic Sleeve Gastrectomy in Patients with Obesity and Ventricular Assist Devices: a Comprehensive Outcome Analysis.

Obes Surg 2021 02 25;31(2):884-890. Epub 2020 Aug 25.

John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.

We analyzed in detail the outcomes of eight patients with ventricular assist devices (VADs) and obesity who underwent laparoscopic sleeve gastrectomy (LSG) at a single heart transplant (HT) center. This comprehensive analysis included body mass index (BMI) trends from VAD implantation to the time of LSG; BMI and percentage of excess BMI lost during follow-up; adverse outcomes; and changes in echocardiographic parameters, fasting lipids, unplanned hospitalizations, and functional status. We also identified the patients who achieved the following outcomes: listing for HT, HT, 50% excess BMI loss, and BMI < 35 kg/m. Laparoscopic sleeve gastrectomy seems to be a reasonable and effective intervention to help patients with VADs and obesity to decrease excess BMI and become candidates for HT.
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http://dx.doi.org/10.1007/s11695-020-04948-9DOI Listing
February 2021

Management of Patients Admitted with Acute Decompensated Heart Failure.

Ochsner J 2015 ;15(3):284-9

Section of Cardiomyopathy and Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.

Background: Hospital admission for the treatment of acute decompensated heart failure is an unfortunate certainty in the vast majority of patients with heart failure. Regardless of the etiology, inpatient treatment for acute decompensated heart failure portends a worsening prognosis.

Methods: This review identifies patients with heart failure who need inpatient therapy and provides an overview of recommended therapies and management of these patients in the hospital setting.

Results: Inpatient therapy for patients with acute decompensated heart failure should be directed at decongestion and symptom improvement. Clinicians should also treat possible precipitating events, identify comorbid conditions that may exacerbate heart failure, evaluate and update current guideline-directed medical therapy, and perform risk stratification for all patients. Finally, efforts should be made to educate patients about the importance of restricting salt and fluid, monitoring daily weights, and adhering to a graded exercise program.

Conclusion: Early discharge follow-up and continued optimization of guideline-directed medical therapy are key to preventing future heart failure readmissions.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4569165PMC
September 2015
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