Publications by authors named "Fayez S Raza"

5 Publications

  • Page 1 of 1

Relation of Vasoplegia in the Absence of Primary Graft Dysfunction to Mortality Following Cardiac Transplantation.

Am J Cardiol 2018 12 8;122(11):1902-1908. Epub 2018 Sep 8.

Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas; Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, Texas. Electronic address:

Vasoplegia following cardiac transplantation is associated with increased morbidity and mortality. Previous studies have not accounted for primary graft dysfunction (PGD). The definition of vasoplegia is based on pressor requirement at 48 hours, many PGD parameters may have normalized after the initial 24 hours on inotropes. We surmised that the purported negative effects of vasoplegia following transplantation may in part be driven by PGD. We reviewed 240 consecutive adult cardiac transplants at our center between 2012 and 2016. The severity of vasoplegia was evaluated as a risk factor for 1-year survival, and the analysis was repeated for the subgroup of 177 patients who did not develop PGD. Overall, 63 (26%) of patients developed mild, moderate, or severe PGD. In those without PGD, vasoplegia was associated with length of stay but not with short- or long-term mortality. Moderate and/or severe vasoplegia occurred in 35 (15%) patients and was associated with higher short-term mortality, length of stay, and PGD. Multivariate logistic regression identified body mass index ≥35 kg/m, left ventricular assist device before transplantation, and use of extracorporeal membrane oxygenation as joint risk factors for vasoplegia. In patients without PGD, only left ventricular assist device before transplantation was associated with vasoplegia. In conclusion, our results show that, in the sizeable subgroup of patients with no signs of PGD, vasoplegia had a much more modest impact on post-transplant morbidity and no significant effect on 1- and 3-year survival. This suggests that PGD may be a confounder when assessing vasoplegia as a risk factor for adverse outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjcard.2018.08.035DOI Listing
December 2018

Determinants and Outcomes of Vasoplegia Following Left Ventricular Assist Device Implantation.

J Am Heart Assoc 2018 05 17;7(11). Epub 2018 May 17.

Department of Cardiology, Baylor University Medical Center, Dallas, TX

Background: Vasoplegia is associated with adverse outcomes following cardiac surgery; however, its impact following left ventricular assist device implantation is largely unexplored.

Methods And Results: In 252 consecutive patients receiving a left ventricular assist device, vasoplegia was defined as the occurrence of normal cardiac function and index but with the need for intravenous vasopressors within 48 hours following surgery for >24 hours to maintain a mean arterial pressure >70 mm Hg. We further categorized vasoplegia as ; , requiring 1 vasopressor (vasopressin, norepinephrine, or high-dose epinephrine [>5 μg/min]); or , requiring ≥2 vasopressors. Predictors of vasoplegia severity were determined using a cumulative logit (ordinal logistic regression) model, and 1-year mortality was evaluated using competing-risks survival analysis. In total, 67 (26.6%) patients developed mild vasoplegia and 57 (22.6%) developed moderate to severe vasoplegia. The multivariable model for vasoplegia severity utilized preoperative Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile, central venous pressure, systolic blood pressure, and intraoperative cardiopulmonary bypass time, which yielded an area under the curve of 0.76. Although no significant differences were noted in stroke or pump thrombosis rates (=0.87 and =0.66, respectively), respiratory failure and major bleeding increased with vasoplegia severity (<0.01). Those with moderate to severe vasoplegia had a significantly higher risk of mortality than those without vasoplegia (adjusted hazard ratio: 2.12; 95% confidence interval, 1.08-4.18; =0.03).

Conclusions: Vasoplegia is predictive of unfavorable outcomes, including mortality. Risk factors for future research include preoperative INTERMACS profile, central venous pressure, systolic blood pressure, and intraoperative cardiopulmonary bypass time.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/JAHA.117.008377DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6015358PMC
May 2018

Usefulness of a left ventricular assist device in patients with left ventricular noncompaction.

Proc (Bayl Univ Med Cent) 2018 Jan 1;31(1):61-63. Epub 2018 Feb 1.

Baylor Heart and Vascular Institute, Baylor Scott and White Research Institute, Dallas, Texas.

Left ventricular noncompaction (LVNC) is a multifactorial structural abnormality of the myocardial wall characterized by prominent trabeculae and deep trabecular recesses. LVNC may present as a congenital or acquired defect characterized by 2 distinct tissue layers: a spongy, noncompacted inner myocardium and a thin, compacted outer myocardium. Patients with LVNC are prone to thromboembolic events, either due to deep trabeculations in the noncompacted myocardium or due to arrhythmias accompanying the defect. There are sparse data concerning treatment options for patients with LVNC who fail medical management. We present 2 such patients with LVNC who, following failed medical management, received a left ventricular assist device (LVAD): one for long-term management and one as a bridge to transplant. Both were managed successfully without thromboembolic events to date. The success of these cases suggests that LVAD placement is a viable therapy in patients with LVNC as a bridge to transplant or as long-term management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08998280.2017.1401342DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903523PMC
January 2018

Use of a MitraClip for severe mitral regurgitation in a cardiac transplant patient.

Proc (Bayl Univ Med Cent) 2017 Apr;30(2):226-227

Baylor Heart and Vascular Hospital, Dallas, Texas.

Severe mitral regurgitation (MR) in patients after cardiac transplant has not been well studied. Traditionally, patients have undergone corrective surgery. We report a 64-year-old man who presented with new heart failure symptoms 6 months after cardiac transplantation. He was found to have severe MR and underwent successful implantation of a MitraClip® with reduction of his MR to mild as well as improvement in his symptoms. Six months later he was still doing well, and a repeat echocardiogram showed good results. We found two previously reported cases using the MitraClip to treat severe MR in adult cardiac transplant patients. The MitraClip is a viable treatment option for MR in cardiac transplant patients despite their distorted anatomy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5349838PMC
http://dx.doi.org/10.1080/08998280.2017.11929597DOI Listing
April 2017

Klebsiella pneumoniae Renal Abscess Syndrome: A Rare Case with Metastatic Involvement of Lungs, Eye, and Brain.

Case Rep Infect Dis 2013 5;2013:685346. Epub 2013 Aug 5.

Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235, USA.

We describe a rare case of Klebsiella pneumoniae renal abscess with metastatic spread leading to endopthalmitis, pulmonary cavitary lesions, and cerebral emboli in a 41-year-old Hispanic female with diabetes mellitus who presented with a four-to-five-day history of fevers, headache, eye pain, and vomiting. She was treated with IV antibiotics and made a gradual but full recovery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2013/685346DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748422PMC
August 2013
-->