Publications by authors named "Koji Takeda"

359 Publications

Pulmonary Embolism Response Team utilization during the COVID-19 pandemic.

Vasc Med 2021 Apr 4:1358863X21995896. Epub 2021 Apr 4.

Department of Cardiology, Columbia Irving Medical Center, New York, NY, USA.

Coronavirus disease 2019 (COVID-19) may predispose patients to venous thromboembolism (VTE). Limited data are available on the utilization of the Pulmonary Embolism Response Team (PERT) in the setting of the COVID-19 global pandemic. We performed a single-center study to evaluate treatment, mortality, and bleeding outcomes in patients who received PERT consultations in March and April 2020, compared to historical controls from the same period in 2019. Clinical data were abstracted from the electronic medical record. The primary study endpoints were inpatient mortality and GUSTO moderate-to-severe bleeding. The frequency of PERT utilization was nearly threefold higher during March and April 2020 ( = 74) compared to the same period in 2019 ( = 26). During the COVID-19 pandemic, there was significantly less PERT-guided invasive treatment (5.5% vs 23.1%, = 0.02) with a numerical but not statistically significant trend toward an increase in the use of systemic fibrinolytic therapy (13.5% vs 3.9%, = 0.3). There were nonsignificant trends toward higher in-hospital mortality or moderate-to-severe bleeding in patients receiving PERT consultations during the COVID-19 period compared to historical controls (mortality 14.9% vs 3.9%, = 0.18 and moderate-to-severe bleeding 35.1% vs 19.2%, = 0.13). In conclusion, PERT utilization was nearly threefold higher during the COVID-19 pandemic than during the historical control period. Among patients evaluated by PERT, in-hospital mortality or moderate-to-severe bleeding were not significantly different, despite being numerically higher, while invasive therapy was utilized less frequently during the COVID-19 pandemic.
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http://dx.doi.org/10.1177/1358863X21995896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8047511PMC
April 2021

Criminal victimization of people with epilepsy: Sixteen criminal judgments in Japan between 1990 and 2019.

Epilepsy Behav 2021 Mar 18;118:107912. Epub 2021 Mar 18.

Section of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.

Criminal behavior by people with epilepsy (PWE) has often been discussed. However, there are limited studies on criminal victimization of PWE-in particular, how such victimizations occur. We identified criminal cases involving victims with epilepsy using databases containing criminal judgments and found 16 such cases between 1990 and 2019. Seven were homicide cases, including four filicide cases. In the four filicide cases, all the perpetrators had the intention of homicide-suicide; all the victims had intellectual disabilities or cerebral palsy; two of these victims had acted violently toward the family; and two mothers who perpetrated the crime against the victims had depression. It seemed that the comorbidities and problem behaviors of the victims were more strongly related to serious crimes by family caregivers than the epilepsy itself. To prevent victimization caused by family caregivers, reducing their stress levels is important. Defendants sometimes argued against objective evidence of a crime, claiming that epileptic seizure of PWE caused or was related to the death of victims. Legal and medical professionals involved in determining the manner of death need careful evaluation when sudden deaths of PWE occur.
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http://dx.doi.org/10.1016/j.yebeh.2021.107912DOI Listing
March 2021

Integration of a high-efficiency Mach-Zehnder modulator with a DFB laser using membrane InP-based devices on a Si photonics platform.

Opt Express 2021 Jan;29(2):2431-2441

We demonstrate a wafer-level integration of a distributed feedback laser diode (DFB LD) and high-efficiency Mach-Zehnder modulator (MZM) using InGaAsP phase shifters on Si waveguide circuits. The key to integrating materials with different bandgaps is to combine direct wafer bonding of a multiple quantum well layer for the DFB LD and regrowth of a bulk layer for the phase shifter. Buried regrowth of an InP layer is also employed to define the waveguide cores for the LD and phase shifters on a Si substrate. Both the LD and phase shifters have 230-nm-thick lateral diodes, whose thickness is less than the critical thickness of the III-V compound semiconductor layers on the Si substrate. The fabricated device has a 500-µm-long DFB LD and 500-µm-long carrier-depletion InGaAsP-bulk phase shifters, which provide a total footprint of only 1.9 × 0.31 mm. Thanks to the low losses of the silica-based fiber couplers, InP/Si narrow tapers, and the phase shifters, the fiber-coupled output power of 3.2 mW is achieved with the LD current of 80 mA. The MZM has a VL of around 0.4 Vcm, which overcomes the VL limit of typical carrier-depletion Si MZMs. Thanks to the high modulation efficiency, the device shows an extinction ratio of 5 dB for 50-Gbit/s NRZ signal with a low peak-to-peak voltage of 2.5 V, despite the short phase shifters and single-arm driving.
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http://dx.doi.org/10.1364/OE.411483DOI Listing
January 2021

Predictors of Hemodynamic Response to Intra-Aortic Balloon Pump Therapy in Patients With Acute Decompensated Heart Failure and Cardiogenic Shock.

J Invasive Cardiol 2021 Apr 12;33(4):E275-E280. Epub 2021 Mar 12.

Advanced Heart Failure and Mechanical Circulatory Support, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Boston, MA 02215 USA.

Objectives: There is renewed interest in intra-aortic balloon pump (IABP) use in chronic systolic heart failure (HF) patients with acute decompensation and cardiogenic shock (CS). We sought to identify predictors of early IABP response to guide optimal use in this population.

Methods: We retrospectively analyzed records of chronic systolic HF patients presenting to our center between 2011-2018 with acute decompensated HF who received IABP for CS. An IABP responder was defined as having both an early cardiac output (CO) increase and mean pulmonary artery pressure (MPAP) decrease above the cohort median values.

Results: During this period, a total of 218 chronic systolic HF patients received IABP for acute decompensation with CS. The average CO increase was 0.57 ± 0.85 L/min and MPAP reduction was 5.1 ± 7.6 mm Hg. Fifty-six patients (25.7%) were identified as IABP responders, with mean CO increase of 1.21 ± 0.87 L/min and MPAP reduction of 12.1 ± 5.9 mm Hg. Systemic vascular resistance (SVR) >1300 dynes/sec/cm-5 (odds ratio [OR], 5.04; 95% confidence interval [CI], 1.86-13.6; P<.01) and moderate-severe mitral regurgitation (OR, 2.42; 95% CI, 1.25-4.66; P<.01) predicted robust hemodynamic response.

Conclusions: A subset of chronic systolic HF patients had robust hemodynamic response to IABP with significant CO augmentation and MPAP reduction. Higher SVR and moderate-severe mitral regurgitation predicted early hemodynamic response to IABP.
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April 2021

ECMO as a Bridge to Left Ventricular Assist Device or Heart Transplantation.

JACC Heart Fail 2021 Apr 10;9(4):281-289. Epub 2021 Mar 10.

Milstein Division of Cardiology, Department of Medicine, New York Presbyterian - Columbia University Irving Medical Center, New York, New York, USA. Electronic address:

Objectives: The purpose of this study was to compare outcomes between patients on extracorporeal membrane oxygenation (ECMO) bridged to left ventricular assist device (LVAD) versus heart transplantation (HT) using registry data.

Background: Patients with heart failure supported with ECMO represent the highest priority in the new HT allocation system. For patients on ECMO, bridging to LVAD may be non-inferior compared with bridging to HT.

Methods: Adult patients in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) from 2006 to 2017 and United Network for Organ Sharing (UNOS) database from 2006 to June 2019 requiring ECMO were included. Cause-specific hazard models were created and cumulative incidence functions were calculated with mortality, transplantation, and re-transplantation as competing events.

Results: A total of 906 patients received ECMO as bridge to VAD (n = 587, 64.8%) or as bridge to HT (n = 319, 35.2%). Patients bridged directly to HT were younger (age 46.3 ± 15.4 years vs. 52.1 ± 13.2 years; p < 0.001) and more likely to be female (93 [29.2%] vs. 139 [23.7%]; p = 0.022). Patients bridged directly to HT were more likely to have a nonischemic cardiomyopathy, restrictive physiologies, and allograft failure; (p < 0.05 for all). ECMO use increased over time in both UNOS and INTERMACS. There was no significant difference in mortality between groups (Gray's p = 0.581). This remained true even when the analysis was restricted to transplant-listed or eligible patients as well as patients with dilated phenotypes (excluding patients with congenital heart disease, restrictive phenotypes, and allograft failure).

Conclusions: There was no difference in mortality on pump support compared with posttransplant mortality among those bridged from ECMO to LVAD or HT.
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http://dx.doi.org/10.1016/j.jchf.2020.12.012DOI Listing
April 2021

National outcomes of bridge to multiorgan cardiac transplantation using mechanical circulatory support.

J Thorac Cardiovasc Surg 2021 Feb 5. Epub 2021 Feb 5.

Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY. Electronic address:

Background: Little is known regarding the profile of patients with multiorgan failure listed for simultaneous cardiac transplantation and secondary organ. In addition, few studies have reported how these patients are bridged with mechanical circulatory support (MCS). In this study, we examined national data of patients listed for multiorgan transplantation and their outcomes after bridging with or without MCS.

Methods: United Network for Organ Sharing data were reviewed for adult multiorgan transplantations from 1986 to 2019. Post-transplant patients and total waitlist listings were examined and stratified according to MCS status. Survival was assessed via Cox regression in the post-transplant cohort and Fine-Gray competing risk regression with transplantation as a competing risk in the waitlist cohort.

Results: There were 4534 waitlist patients for multiorgan transplant during the study period, of whom 2117 received multiorgan transplants. There was no significant difference in post-transplant survival between the MCS types and those without MCS in the whole cohort and heart-kidney subgroup. Fine-Gray competing risk regression showed that patients bridged with extracorporeal membrane oxygenation had significantly greater waitlist mortality compared with those without MCS when controlling for preoperative characteristics (subdistribution hazard ratio, 2.27; 95% confidence interval, 1.48-3.47; P < .001), whereas those bridged with a ventricular assist device had a decreased incidence of death compared with those without MCS (subdistribution hazard ratio, 0.78; 95% confidence interval, 0.63-0.96; P = .017).

Conclusions: MCS, as currently applied, does not appear to compromise the survival of multiorgan heart transplant patients. Waitlist data show that extracorporeal membrane oxygenation patients have profoundly worse survival irrespective of preoperative factors including organ type listed. Survival on the waitlist for multiorgan transplant has improved across device eras.
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http://dx.doi.org/10.1016/j.jtcvs.2021.01.114DOI Listing
February 2021

Impact of Ergonomics on Cardiometabolic Risk in Office Workers: Transition to Activity-Based Working With Height-Adjustable Desk.

J Occup Environ Med 2021 Feb 25. Epub 2021 Feb 25.

Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and Welfare, 150 Tobuki, Hachioji, Tokyo 192-0001, Japan (Jindo, Kai, Kitano, Arao) and Okamura Corporation, Tenri Bldg, 1-4-1 Kitasaiwai, Nishi-ku, Yokohama, Kanagawa 220-0004, Japan (Makishima, Takeda).

Objective: Ergonomic office redesigning possibly improves physical activity (PA) and sedentary behavior (SB); however, its impact on cardiometabolic risk has not yet been determined. This study aimed to examine the effect of office relocation on cardiometabolic risk factors.

Methods: Annual health check-up data of 95 office workers from four offices in Tokyo, Japan, who relocated to an office with activity-based working (ABW) and height-adjustable desk (HAD) and a propensity-score matched control-cohort were analyzed. PA and SB on weekdays were measured only in the relocation group before and 10 months after relocation.

Results: Significant interactions were observed for waist circumference, high-density lipoprotein cholesterol, and glycosylated hemoglobin (HbA1c). HbA1c changes showed a significant negative association with moderate-to-vigorous-intensity PA.

Conclusion: An ABW office with HAD improves cardiometabolic risk factors in office workers, possibly through changes in PA and SB.
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http://dx.doi.org/10.1097/JOM.0000000000002175DOI Listing
February 2021

Increased Aortic Stiffness Is Associated With Higher Rates of Stroke, Gastrointestinal Bleeding and Pump Thrombosis in Patients With a Continuous Flow Left Ventricular Assist Device.

J Card Fail 2021 Feb 24. Epub 2021 Feb 24.

Columbia University Irving Medical Center, New York, New York; Cardiff School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, UK. Electronic address:

Background: In the general population, increased aortic stiffness is associated with an increased risk of cardiovascular events. Previous studies have demonstrated an increase in aortic stiffness in patients with a continuous flow left ventricular assist device (CF-LVAD). However, the association between aortic stiffness and common adverse events is unknown.

Methods And Results: Forty patients with a HeartMate II (HMII) (51 $ 11 years; 20% female; 25% ischemic) implanted between January 2011 and September 2017 were included. Two-dimensional transthoracic echocardiograms of the ascending aorta, obtained before HMII placement and early after heart transplant, were analyzed to calculate the aortic stiffness index (AO-SI). The study cohort was divided into patients who had an increased vs decreased AO-SI after LVAD support. A composite outcome of gastrointestinal bleeding, stroke, and pump thrombosis was defined as the primary end point and compared between the groups. While median AO-SI increased significantly after HMII support (AO-SI 4.4-6.5, P = .012), 16 patients had a lower AO-SI. Patients with increased (n = 24) AO-SI had a significantly higher rate of the composite end point (58% vs 12%, odds ratio 9.8, P < .01). Similarly, those with increased AO-SI tended to be on LVAD support for a longer duration, had higher LVAD speed and reduced use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers.

Conclusions: Increased aortic stiffness in patients with a HMII is associated with a significantly higher rates of adverse events. Further studies are warranted to determine the causality between aortic stiffness and adverse events, as well as the effect of neurohormonal modulation on the conduit vasculature in patients with a CF-LVAD.
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http://dx.doi.org/10.1016/j.cardfail.2021.02.009DOI Listing
February 2021

Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019: Crisis Standards of Care.

ASAIO J 2021 03;67(3):245-249

From the Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York.

The coronavirus disease 2019 (COVID-19) pandemic has placed extraordinary strain on global healthcare systems. Use of extracorporeal membrane oxygenation (ECMO) for patients with severe respiratory or cardiac failure attributed to COVID-19 has been debated due to uncertain survival benefit and the resources required to safely deliver ECMO support. We retrospectively investigated adult patients supported with ECMO for COVID-19 at our institution during the first 80 days following New York City's declaration of a state of emergency. The primary objective was to evaluate survival outcomes in patients supported with ECMO for COVID-19 and describe the programmatic adaptations made in response to pandemic-related crisis conditions. Twenty-two patients with COVID-19 were placed on ECMO during the study period. Median age was 52 years and 18 (81.8%) were male. Twenty-one patients (95.4%) had severe ARDS and seven (31.8%) had cardiac failure. Fifteen patients (68.1%) were managed with venovenous ECMO while 7 (31.8%) required arterial support. Twelve patients (54.5%) were transported on ECMO from external institutions. Twelve patients were discharged alive from the hospital (54.5%). Extracorporeal membrane oxygenation was used successfully in patients with respiratory and cardiac failure due to COVID-19. The continued use of ECMO, including ECMO transport, during crisis conditions was possible even at the height of the COVID-19 pandemic.
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http://dx.doi.org/10.1097/MAT.0000000000001376DOI Listing
March 2021

Influence of aneurysmal aortic root geometry on mechanical stress to the aortic valve leaflet.

Eur Heart J Cardiovasc Imaging 2021 Feb 21. Epub 2021 Feb 21.

Division of Cardiothoracic Surgery, Department of Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, 707 Fort Washington Avenue, New York, NY 10032, USA.

Aims: While mechanical stress caused by blood flow, e.g. wall shear stress (WSS), and related parameters, e.g. oscillatory shear index (OSI), are increasingly being recognized as key moderators of various cardiovascular diseases, studies on valves have been limited because of a lack of appropriate imaging modalities. We investigated the influence of aortic root geometry on WSS and OSI on the aortic valve (AV) leaflet.

Methods And Results: We applied our novel approach of intraoperative epi-aortic echocardiogram to measure the haemodynamic parameters of WSS and OSI on the AV leaflet. Thirty-six patients were included, which included those who underwent valve-sparing aortic root replacement (VSARR) with no significant aortic regurgitation (n = 17) and coronary artery bypass graft (CABG) with normal AV (n = 19). At baseline, those who underwent VSARR had a higher systolic WSS (0.52 ± 0.12 vs. 0.32 ± 0.08 Pa, respectively, P < 0.001) and a higher OSI (0.37 ± 0.06 vs. 0.29 ± 0.04, respectively, P < 0.001) on the aortic side of the AV leaflet than those who underwent CABG. Multivariate regression analysis revealed that the size of the sinus of Valsalva had a significant association with WSS and OSI. Following VSARR, WSS and OSI values decreased significantly compared with the baseline values (WSS: 0.29 ± 0.12 Pa, P < 0.001; OSI: 0.26 ± 0.09, P < 0.001), and became comparable to the values in those who underwent CABG (WSS, P = 0.42; OSI, P = 0.15).

Conclusions: Mechanical stress on the AV gets altered in correlation with the size of the aortic root. An aneurysmal aortic root may expose the leaflet to abnormal fluid dynamics. The VSARR procedure appeared to reduce these abnormalities.
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http://dx.doi.org/10.1093/ehjci/jeab006DOI Listing
February 2021

Bleeding and Thrombotic Events During Extracorporeal Membrane Oxygenation for Postcardiotomy Shock.

Ann Thorac Surg 2021 Feb 17. Epub 2021 Feb 17.

Department of Surgery, Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York, NY. Electronic address:

Background: Anticoagulation management during veno-arterial extracorporeal membrane oxygenation (ECMO) is particularly difficult in postcardiotomy shock patients given a significant bleeding risk. We sought to determine the effect of anticoagulation on bleeding and thrombosis risk for postcardiotomy shock patients on ECMO.

Methods: We retrospectively reviewed patients who received ECMO for postcardiotomy shock from July 2007 through July 2019. Characteristics of patients who developed bleeding and thrombosis were investigated and risk factors were assessed via multi-level logistic regression.

Results: Of the 152 patients who received ECMO for postcardiotomy shock, 33 (23%) developed 40 thrombotic events and 64 (45%) developed 86 bleeding events. Predictors of bleeding were intraoperative packed red blood cell transfusion (OR 1.05, 95% CI [1.01-1.09]), platelet transfusion (OR 1.10, 95% CI [1.05-1.16]), international normalized ratio (OR 1.18, 95% CI [1.02-1.37]), and activated partial thromboplastin time (aPTT) greater than 60 seconds (OR 2.32, 95% CI [1.14-4.73]). Predictors of thrombosis were anticoagulation use (OR 0.39, 95% CI [0.19-0.79]), surgical venting (OR 3.07, 95% CI [1.29-7.31]), hemoglobin (OR 1.38, 95% CI [1.06-1.79]), and central cannulation (OR 2.06, 95% CI [1.03-4.11]). The daily predicted probability of thrombosis was between 0.075 and 0.038 in those who did not receive anticoagulation and decreased to between 0.030 and 0.013 in those who received anticoagulation at aPTTs between 25 and 80 seconds.

Conclusions: Anticoagulation can reduce thromboembolic events in postcardiotomy shock patients on ECMO, but bleeding risk may outweigh this benefit at aPTTs greater than 60 seconds.
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http://dx.doi.org/10.1016/j.athoracsur.2021.02.008DOI Listing
February 2021

Safety of reduced anti-thrombotic strategy in patients with HeartMate 3 left ventricular assist device.

J Heart Lung Transplant 2021 Apr 19;40(4):237-240. Epub 2021 Jan 19.

Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York. Electronic address:

There are limited safety data on reduced anti-thrombotic therapy (RT) in patients with HeartMate 3 (HM3) left ventricular assist device (LVAD). We conducted a single-center, retrospective study of patients with HM3 managed with RT from November 2014 through January 2020. We analyzed baseline characteristics, RT indications, and bleeding and thrombotic complications. We found that 50 of 161 patients with HM3 (31.1%) received RT starting at a median time of 90.5 days after LVAD implantation. Patients on RT were older and more likely to have ischemic heart failure than patients on standard anti-thrombotic therapy (ST). The most common indication for RT was gastrointestinal bleeding (29 patients [58.0%]). At 1-year follow-up, 5.0% of patients on RT developed a thrombotic event. Switching patients from ST to RT reduced the occurrence of major bleeding from 1.252 to 0.324 events per patient-year (p = 0.006). In our population of patients with HM3 LVAD, RT reduces bleeding without increasing the incidence of thrombosis. Our retrospective study suggests that an upfront RT strategy in patients with HM3 may be beneficial and should be prospectively studied.
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http://dx.doi.org/10.1016/j.healun.2021.01.012DOI Listing
April 2021

C-Reactive Protein Levels Predict Outcomes in Continuous-Flow Left Ventricular Assist Device Patients: An INTERMACS Analysis.

ASAIO J 2021 Jan 28. Epub 2021 Jan 28.

From the Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

CRP is an established inflammatory biomarker with prognostic value in patients with chronic heart failure, yet its role in continuous-flow left ventricular assist device (LVAD) patients is largely unknown. 5,183 patients from the INTERMACS registry who underwent durable LVAD between 2008 and 2017 and had preimplant CRP levels were included. The sample was stratified into two groups based on preimplant CRP levels: CRP of 0-10 mg/L (low) and >10 mg/L (high). Kaplan-Meier survival estimates were used to assess outcomes at 2 years after LVAD implantation, with log-rank testing used to compare groups. Cox proportional hazard models were used for multivariable adjustment. Patients with high preimplant CRP were younger, more likely to be INTERMACS class I, and had a higher need for temporary mechanical circulatory support before LVAD implant compared to those with lower CRP levels (all P < 0.001). The high CRP group had higher WBC counts and BNP levels (all P < 0.001). After adjustment, higher CRP (>10 mg/L) was associated with greater risk of mortality, RV failure, and stroke postimplant (P < 0.001). In addition, elevated postimplant CRP level at 3 months was associated with increased mortality and stroke on LVAD support (P < 0.001). CRP is a predictor of death and complications on LVAD support. Future studies are necessary to explore the mechanisms underlying this finding and the potential role of antiinflammatory therapies in this population.
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http://dx.doi.org/10.1097/MAT.0000000000001327DOI Listing
January 2021

Serial assessment of HeartMate 3 pump position and inflow angle and effects on adverse events.

Eur J Cardiothorac Surg 2021 Feb 1. Epub 2021 Feb 1.

Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA.

Objectives: This study analyses the position of the HeartMate 3 left ventricular assist device on serial radiographs to assess positional change and possible correlation with adverse events.

Methods: We retrospectively analysed 59 left ventricular assist device recipients who had serial chest radiographs at 1 month, 6 months and 12 months post-implantation between November 2014 and June 2018. We measured pump angle, pump-spine distance and pump-diaphragm depth and investigated their relationship to a composite outcome of heart failure readmission, low flow alarms, stroke or inflow/outflow occlusion requiring surgical repositioning through recurrent event survival modelling.

Results: Between 1 and 6 months, the absolute pump-spine distance changed by 10.00 mm (P < 0.01) and the absolute pump-diaphragm depth changed by 18.80 mm (P < 0.01). These parameters did not change significantly between 6 and 12 months post-implantation. Pump angle did not change significantly over any period. Twenty-six patients experienced the composite outcome; in these patients, the median 1-month pump angle was 66.2° (interquartile range 54.5-78.0) as compared to 59.0° (interquartile range 47.0-65.0) in the 33 patients who did not have adverse events (P = 0.04). Pump depth and pump-spine distance at 1 month were not associated with the composite outcome. Change in pump depth between 1 and 6 months [hazard ratio (HR) 1.019; 95% confidence interval (CI) 1.000-1.039] and between 6 and 12 months (HR 1.020; 95% CI 1.000-1.040) were weakly associated with the composite outcome.

Conclusions: Larger pump angles are associated with the composite outcome of position-related adverse events. Pump depth movement is weakly associated with the composite outcome.
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http://dx.doi.org/10.1093/ejcts/ezaa475DOI Listing
February 2021

Phase 2 Study of Nimotuzumab in Combination With Concurrent Chemoradiotherapy in Patients With Locally Advanced Non-Small-Cell Lung Cancer.

Clin Lung Cancer 2021 Mar 26;22(2):134-141. Epub 2020 Dec 26.

Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka, Japan.

Background: We evaluated the tolerability and efficacy of nimotuzumab, a humanized IgG1 monoclonal anti-epidermal growth factor receptor antibody, with concurrent chemoradiotherapy in patients with unresectable locally advanced non-small-cell lung cancer.

Patients And Methods: In this multicenter, single-arm, open-label, phase 2 trial conducted in Japan (JapicCTI-090825), patients received thoracic radiotherapy (60 Gy, 2 Gy per fraction, 6 weeks) and four 4-week cycles of chemotherapy (day 1, cisplatin 80 mg/m; days 1 and 8, vinorelbine 20 mg/m). Nimotuzumab 200 mg was administrated weekly for 16 weeks. The primary endpoint was treatment completion rate, defined as the percentage of patients completing 60 Gy of radiotherapy within 8 weeks, 2 cycles of chemotherapy, and at least 75% of the required nimotuzumab dose during the initial 2-cycle concurrent chemoradiotherapy period.

Results: Of 40 patients enrolled, 39 received the study treatment, which was well tolerated, with a completion rate of 87.2%. Thirty-eight patients completed 60 Gy of radiotherapy within 8 weeks. Infusion reaction, grade 3 or higher rash, grade 3 or higher radiation pneumonitis, or grade 4 or higher nonhematologic toxicity were not observed. The objective response rate was 69.2%. The median progression-free survival (PFS) and 5-year PFS rate were 508 days and 29.0%, respectively. The 5-year PFS rate in patients with non-squamous cell carcinoma (n = 23) was 13.7% and in patients with squamous cell carcinoma (n = 16) was 50.0%. The 5-year overall survival rate was 58.4%.

Conclusion: Addition of nimotuzumab to the concurrent chemoradiotherapy regimen was well tolerated and showed potential for treating patients with locally advanced non-small-cell lung cancer, particularly squamous cell carcinoma.
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http://dx.doi.org/10.1016/j.cllc.2020.12.012DOI Listing
March 2021

Sex differences in patients with cardiogenic shock requiring extracorporeal membrane oxygenation.

J Thorac Cardiovasc Surg 2020 Dec 23. Epub 2020 Dec 23.

Division of Cardiac Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, NY. Electronic address:

Objective: Our study assesses differences between male and female patients placed on venoarterial extracorporeal membrane oxygenation for cardiogenic shock.

Method: We retrospectively analyzed 574 adult patients placed on venoarterial extracorporeal membrane oxygenation for cardiogenic shock at our institution between January 2007 and December 2018. Baseline characteristics and outcomes were assessed. Propensity score matching was used to compare outcomes. The primary end point was in-hospital mortality. Secondary outcomes include limb ischemia, limb ischemia interventions, distal perfusion cannula placement, stroke, bleeding, and continuous venovenous hemofiltration initiation.

Results: There were 394 male patients (69%) and 180 female patients (31%). After adjusting for baseline differences, propensity score matching compared 171 male patients with 171 female patients. No difference was seen between men and women in in-hospital mortality (60.2% vs 56.7%; P = .59), limb ischemia (47.4% vs 45.6%; P = .83), limb ischemia surgery (15.2% vs 12.9%; P = .64), bleeding (49.7% vs 49.1%; P = 1), continuous venovenous hemofiltration initiation (39.2% vs 32.7%; P = .26), and stroke (8.2% vs 9.4%; P = .85). Multivariable logistic regression showed that female patients who died were more likely to have had chronic kidney disease (odds ratio [OR], 2.67; 95% confidence interval [CI], 1.09-6.53; P = .032) than surviving women. Male patients who died were more likely to have had coronary artery disease (OR, 2.25; 95% CI, 1.34-3.78; P = .002) and higher lactate levels (OR, 1.14; 95% CI, 1.08-1.21; P < .001) than surviving men. Women with cardiac transplant primary graft dysfunction were more likely to survive (OR, 0.04; 95% CI, 0.01-0.27; P = .001), whereas men with cardiac transplant primary graft dysfunction were less likely to survive (OR, 0.28; 95% CI, 0.11-0.71; P = .007), than patients with other shock etiologies.

Conclusions: After adjusting for baseline difference, there was no difference in outcomes between male and female patients despite differing risk profiles for in-hospital mortality. (supplementary video).
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http://dx.doi.org/10.1016/j.jtcvs.2020.12.044DOI Listing
December 2020

Prognostic impact of geriatric assessment in elderly patients with non-small cell lung cancer: an integrated analysis of two randomized phase III trials (JCOG1115-A).

Jpn J Clin Oncol 2021 Jan 22. Epub 2021 Jan 22.

Department of Medical Oncology, Osaka City General Hospital, Osaka, Japan.

Objective: Patients' actual age and performance status do not always accurately identify the 'fit elderly' for chemotherapy. This study aimed to determine whether four geriatric assessment tools could predict prognosis.

Methods: This study were analyzed using the data of two randomized phase III trials (JCOG0207 and JCOG0803/WJOG4307L) for elderly patients with advanced non-small cell lung cancer and included all eligible patients who were assessed before treatment with four geriatric assessment tools: the Barthel activities of daily living index, Lawton instrumental activities of daily living scale, Mini-Mental State Examination, and Geriatric Depression Scale-15. Univariable and multivariable analyses for overall survival, adjusted for baseline factors, were performed using a stratified Cox regression model with treatment regimen as strata.

Results: This analysis included 330 patients aged 70-74, 75-79 or 80 or more (n = 95/181/54), with a performance status of 0 or 1 (n = 119/211). Patients were divided into three groups based on Mini-Mental State Examination and two groups based on Geriatric Depression Scale, but over 80% of patients had perfect scores for both activities of daily living and instrumental activities of daily living. In overall survival subgroup analyses by GA tool, only Mini-Mental State Examination scores were associated with substantial outcome differences (median survival times: 21.2, 13.5 and 12.2 months for scores 30, 29-24 and ≤23). After adjusting for baseline factors, the Mini-Mental State Examination, sex and performance status were tended to be worse overall survival.

Conclusion: MMSE scores, performance status and sex, but not chronological age, effectively predicted the prognosis of elderly patients. Further studies should confirm that the Mini-Mental State Examination is useful for determining the indication of chemotherapy in elderly patients with advanced non-small cell lung cancer.
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http://dx.doi.org/10.1093/jjco/hyaa257DOI Listing
January 2021

Cardiac transplantation in adult congenital heart disease with prior sternotomy.

Clin Transplant 2021 Jan 21:e14229. Epub 2021 Jan 21.

Department of Cardiovascular Surgery, Columbia University Medical Center, New York, NY, USA.

Background: Adult congenital heart disease (ACHD) patients who require orthotopic heart transplantation are surgically complex due to anatomical abnormalities and multiple prior surgeries. In this study, we investigated these patients' outcomes using our institutional database.

Methods: ACHD patients who had prior intracardiac repair and subsequent heart transplant were included (2008-2018). Adult patients without ACHD were extracted as a control. A comparison of patients with functional single ventricular (SV) and biventricular (BV) hearts was performed.

Results: There were 9 SV and 24 BV patients. The SV group had higher central venous pressure/pulmonary capillary wedge pressure (P = .028), hemoglobin concentration (P = .010), alkaline phosphatase (P = .022), and were more likely to have liver congestion (P = .006). Major complications included infection in 16 (48.5%), temporary dialysis in 12 (36.4%), and graft dysfunction requiring perioperative mechanical support in 7 (21.2%). Overall in-hospital mortality was 15.2%. Kaplan-Meier analysis showed a higher, but not statistically significant, survival after 10 years between the ACHD and control groups (ACHD 84.9% vs. control 67.5%, P = .429). There was no significant difference in 10-year survival between SV and BV groups (78% vs. 88%, P = .467).

Conclusions: Complex ACHD cardiac transplant recipients have a high incidence of early morbidities after transplantation. However, long-term outcomes were acceptable.
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http://dx.doi.org/10.1111/ctr.14229DOI Listing
January 2021

The Society of Thoracic Surgeons Intermacs 2020 Annual Report.

Ann Thorac Surg 2021 03 16;111(3):778-792. Epub 2021 Jan 16.

Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan. Electronic address:

The Society of Thoracic Surgeons (STS)-Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) 2020 Annual Report reviews outcomes on 25,551 patients undergoing primary isolated continuous-flow left ventricular assist device (LVAD) implantation between 2010 and 2019. In 2019, 3198 primary LVADs were implanted, which is the highest annual volume in Intermacs history. Compared with the previous era (2010-2014), patients who received an LVAD in the most recent era (2015-2019) were more likely to be African American (26.8% vs 22.9%, P < .0001) and more likely to be bridged to durable LVAD with temporary mechanical support devices (36.8% vs 26.0%, P < .0001). In 2019, 50% of patients were INTERMACS Profile 1 or 2 before durable LVAD, and 73% received an LVAD as destination therapy. Magnetic levitation technology has become the predominant design, accounting for 77% of devices in 2019. The 1- and 2-year survival in the most recent era has improved compared with 2010 to 2014 (82.3% and 73.1% vs 80.5% and 69.1%, respectively; P < .0001). Major bleeding and infection continue to be the leading adverse events. Incident stroke has declined in the current era to 12.7% at 1 year. STS-Intermacs research publications are highlighted, and the new quality initiatives are introduced.
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http://dx.doi.org/10.1016/j.athoracsur.2020.12.038DOI Listing
March 2021

Temporary surgical ventricular assist device for treatment of acute myocardial infarction and refractory cardiogenic shock in the percutaneous device era.

J Artif Organs 2021 Jan 18. Epub 2021 Jan 18.

Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA.

Background: Acute myocardial infarction with refractory cardiogenic shock (AMI-RCS) is associated with poor outcomes. Several percutaneous mechanical circulatory support devices exist; however, limitations exist regarding long-term use. Herein, we describe our experience with the temporary surgical CentriMag VAD.

Methods: We reviewed 74 patients with AMI-RCS who underwent CentriMag VAD insertion as bridge-to-decision device from 2007 to 2020. Patients were divided into groups based on introduction of the "shock team" model: Era 1 (2007-2014, n = 51) and Era 2 (2015-2020, n = 23).

Results: Era 2 had higher proportion of patients with INTERMACS Profile I. The use of percutaneous MCS as bridge to VAD and the use of minimally invasive VAD were higher in Era 2. There were fewer postoperative bleeding events in Era 2 (80% vs 61%, p = .07). Thirty-day mortality was 23% and 1-year survival was 55%, which were no differences between eras. Destinations after CentriMag VAD included myocardial recovery (39%), durable LVAD (27%), and transplantation (5%).

Conclusion: CentriMag VAD device represents a viable bridge-to-decision device with acceptable short- and long-term outcomes for patients with AMI-RCS. Stable outcomes in a progressively sicker population may be related to changes in practice patterns as well as introduction of the "shock team" concept.
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http://dx.doi.org/10.1007/s10047-020-01236-2DOI Listing
January 2021

Influence of Atrial Fibrillation on Functional Tricuspid Regurgitation in Patients With HeartMate 3.

J Am Heart Assoc 2021 Feb 8;10(3):e018334. Epub 2021 Jan 8.

Division of Cardiothoracic Surgery Department of Surgery Columbia University Medical Center New York NY.

Background Functional tricuspid regurgitation (TR) can occur secondary to atrial fibrillation (AF). The impact of AF on functional TR and cardiovascular events is uncertain in patients with left ventricular assist devices. This study aimed to investigate the effect of AF on functional TR and cardiovascular events in patients with a HeartMate 3 left ventricular assist device. Methods and Results We retrospectively reviewed 133 patients who underwent HeartMate 3 implantation at our center between November 2014 and November 2018. We excluded patients who had undergone previous or concomitant tricuspid valve procedures and those whose echocardiographic images were of insufficient quality. The primary end point was death and the presence of a cardiovascular event at 1 year. We defined cardiovascular event as a composite of death, stroke, and hospital readmission due to recurrent heart failure and significant residual TR as vena contracta width ≥3 mm. In total, 110 patients were included in this analysis. Patients were divided into 3 groups: no AF (n=51), paroxysmal AF (n=40), and persistent AF (PeAF) (n=19). Kaplan-Meier analysis showed that patients with PeAF had the worst survival (no AF 98%, paroxysmal AF 98%, PeAF 84%, log-rank =0.038) and event-free rate (no AF 93%, paroxysmal AF 89%, PeAF 72%, log-rank =0.048) at 1 year. Thirty-one (28%) patients had residual TR 1 month after left ventricular assist device implantation. Patients with residual TR had a significantly poor prognosis compared with those without residual TR (log-rank =0.014). Conclusions PeAF was associated with increased mortality, cardiovascular events, and residual TR compared with no AF and paroxysmal AF.
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http://dx.doi.org/10.1161/JAHA.120.018334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955423PMC
February 2021

Contemporary Use of Venoarterial Extracorporeal Membrane Oxygenation: Insights from the Multicenter RESCUE Registry.

J Card Fail 2021 Mar 13;27(3):327-337. Epub 2021 Jan 13.

Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.

Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as a life-saving therapy for patients with cardiovascular collapse, but identifying patients unlikely to benefit remains a challenge.

Methods And Results: We created the RESCUE registry, a retrospective, observational registry of adult patients treated with VA-ECMO between January 2007 and June 2017 at 3 high-volume centers (Columbia University, Duke University, and Washington University) to describe short-term patient outcomes. In 723 patients treated with VA-ECMO, the most common indications for deployment were postcardiotomy shock (31%), cardiomyopathy (including acute heart failure) (26%), and myocardial infarction (17%). Patients frequently suffered in-hospital complications, including acute renal dysfunction (45%), major bleeding (41%), and infection (33%). Only 40% of patients (n = 290) survived to discharge, with a minority receiving durable cardiac support (left ventricular assist device [n = 48] or heart transplantation [n = 7]). Multivariable regression analysis identified risk factors for mortality on ECMO as older age (odds ratio [OR], 1.26; 95% confidence interval [CI], 1.12-1.42) and female sex (OR, 1.44; 95% CI, 1.02-2.02) and risk factors for mortality after decannulation as higher body mass index (OR 1.17; 95% CI, 1.01-1.35) and major bleeding while on ECMO support (OR, 1.92; 95% CI, 1.23-2.99).

Conclusions: Despite contemporary care at high-volume centers, patients treated with VA-ECMO continue to have significant in-hospital morbidity and mortality. The optimization of outcomes will require refinements in patient selection and improvement of care delivery.
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http://dx.doi.org/10.1016/j.cardfail.2020.11.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008981PMC
March 2021

Impella percutaneous left ventricular assist device as mechanical circulatory support for cardiogenic shock: A retrospective analysis from a tertiary academic medical center.

Catheter Cardiovasc Interv 2020 Dec 16. Epub 2020 Dec 16.

Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.

Objectives: To describe hemodynamic efficacy and clinical outcomes of Impella percutaneous left ventricular assist device (pLVAD) in patients with cardiogenic shock (CS).

Background: Percutaneous LVADs are increasingly used in CS management. However, device-related outcomes and optimal utilization remain active areas of investigation.

Methods: All CS patients receiving pLVAD as mechanical circulatory support (MCS) between 2011 and 2017 were identified. Clinical characteristics and outcomes were analyzed. A multivariable logistic regression model was created to predict MCS escalation despite pLVAD. Outcomes were compared between early and late implantation.

Results: A total of 115 CS patients (mean age 63.6 ± 13.8 years; 69.6% male) receiving pLVAD as MCS were identified, the majority with CS secondary to acute myocardial infarction (AMI; 67.0%). Patients experienced significant cardiac output improvement (median 3.39 L/min to 3.90 L/min, p = .002) and pharmacological support reduction (median vasoactive-inotropic score [VIS] 25.4 to 16.4, p = .049). Placement of extracorporeal membrane oxygenation (ECMO) occurred in 48 (41.7%) of patients. Higher pre-pLVAD VIS was associated with subsequent MCS escalation in the entire cohort and AMI subgroup (OR 1.27 [95% CI 1.02-1.58], p = .034 and OR 1.72 [95% CI 1.04-2.86], p = .035, respectively). Complications were predominantly access site related (bleeding [9.6%], vascular injury [5.2%], and limb ischemia [2.6%]). In-hospital mortality was 57.4%, numerically greater survival was noted with earlier device implantation.

Conclusions: Treatment with pLVAD for CS improved hemodynamic status but did not uniformly obviate MCS escalation. Mortality in CS remains high, though earlier device placement for appropriately selected patients may be beneficial.
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http://dx.doi.org/10.1002/ccd.29434DOI Listing
December 2020

Commentary: The role of mechanical circulatory support in heart retransplantation.

J Thorac Cardiovasc Surg 2020 Jul 18. Epub 2020 Jul 18.

Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2020.07.047DOI Listing
July 2020

The Perspective of Forensic Inpatients With Psychotic Disorders on Protective Factors Against Risk of Violent Behavior.

Front Psychiatry 2020 5;11:575529. Epub 2020 Nov 5.

Department of Forensic Psychiatry, National Center of Neurology and Psychiatry, National Center Hospital, Tokyo, Japan.

Little is known about the opinions of forensic inpatients with psychotic disorders like schizophrenia on factors likely to prevent or decrease future violent behavior. To understand the perspectives of forensic inpatients with psychotic disorders on protective factors against risk of violent behavior and compare them to factors identified by professional staff. Using the Structured Assessment of Protective Factors (SAPROF) checklist for self-appraisal of violence risk, we conducted semi-structured interviews with 32 inpatients of the Medical Treatment and Supervision Act Ward and compared the results with those of professionals. Inpatients scored higher in the SAPROF total score, the motivational factors of "life goals" and "motivation for treatment," and the protective level in general. Inpatients scored themselves lower in risk level than professionals. The degree of agreement between service users' and professionals' evaluations was low for all categories except external factors. Inpatients prioritized "life goals," "self-control," and "medication" as the top three key strengths currently preventing violent behavior, whereas the professionals selected "life goals" less often. The top three important future goals for preventing future violence selected by inpatients were "work," "intimate relationships," and "life goals," with the former two being selected significantly less often by the professionals. This is the first study to shed light on Japanese forensic inpatients' perspectives about preventing future violent behavior. Despite professionals' underestimation, inpatients viewed themselves as having high motivation for treatment and positive life goals. Inpatients prioritized personal values such as life goals, work, and intimate relationships, whereas professionals prioritized understanding, treating, and observing the disease. Our findings are consistent with past reports on patients' and clinicians' perspectives. Awareness of such gaps in perceptions can help build fruitful therapeutic alliances. We discuss the implications in terms of treatment, how to address the gap therapeutically, and how to design treatment accordingly. Directions for future research are also discussed.
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http://dx.doi.org/10.3389/fpsyt.2020.575529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678485PMC
November 2020

Orthotopic heart transplantation and concomitant aortic arch replacement in an adult Fontan patient with hypoplastic left heart syndrome.

Interact Cardiovasc Thorac Surg 2021 Jan;32(2):325-327

Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA.

Heart failure and neoaortic dilation are common long-term complications in patients with hypoplastic left heart syndrome after single-ventricle palliation. Orthotopic heart transplantation and concomitant transverse aortic arch replacement can be performed safely and effectively. The addition of preoperative three-dimensional modelling can supplement operative planning, facilitate intraoperative execution, and optimize clinical outcomes.
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http://dx.doi.org/10.1093/icvts/ivaa243DOI Listing
January 2021

Handicap theory is applied to females but not males in relation to mate choice in the stalk-eyed fly Sphyracephala detrahens.

Sci Rep 2020 11 12;10(1):19684. Epub 2020 Nov 12.

Department of Life Science, Faculty of Science, Gakushuin University, 1-5-1 Mejiro, Toshima-ku, Tokyo, 171-8588, Japan.

Handicap theory explains that exaggeratedly developed sexual traits become handicaps but serve as honest signals of quality. Because very weak signals are less likely to provide benefits than to simply incur costs, it is interesting to elucidate how sexual traits are generated and developed during evolution. Many stalk-eyed fly species belonging to tribe Diopsini exhibit marked sexual dimorphism in their eye spans, and males with larger eye spans have larger bodies and reproductive capacities, which are more advantageous in terms of contests between males and acceptance for mating by females. In this study, we investigated the role of eye span in a more primitive species, Sphyracephala detrahens, in tribe Sphyracephalini with less pronounced sexual dimorphism. Male-male, female-female, and male-female pairs showed similar contests influenced by eye span, which was correlated with nutrition and reproductive ability in both sexes. During mating, males did not distinguish between sexes and chose individuals with larger eye spans, whereas females did not choose males. However, males with larger eye spans copulated repeatedly. These results indicate that, in this species, eye span with a small sexual difference does not function in sex recognition but affects contest and reproductive outcomes, suggesting the primitive state of sexual dimorphism.
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http://dx.doi.org/10.1038/s41598-020-76649-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7661502PMC
November 2020

The Role of Palliative Care in Withdrawal of Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock.

J Pain Symptom Manage 2020 Nov 1. Epub 2020 Nov 1.

Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA; Adult Palliative Care Services, Columbia University Irving Medical Center, New York, New York, USA. Electronic address:

Context: As the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) increases, decisions regarding withdrawal from VA-ECMO increase.

Objectives: To evaluate the clinical characteristics of patients withdrawn from VA-ECMO and the role of palliative care consultation in the decision.

Methods: We retrospectively reviewed adult patients with cardiogenic shock requiring VA-ECMO at our institution, who were withdrawn from VA-ECMO between January 1, 2014 and May 31, 2019. The relationship between clinical characteristics and palliative care visits was assessed, and documented reasons for withdrawal were identified.

Results: Of 460 patients who received VA-ECMO, 91 deceased patients (19.8%) were included. Forty-two patients (44.8%) had a palliative care consultation. The median duration on VA-ECMO was 4.0 days (interquartile range 8.8), and it was significantly longer for patients with palliative care consultation than those without (8.8 days vs. 2.0 days, P < 0.001). Among those with palliative care consultation, those with early consultation (within three days) had significantly shorter duration of VA-ECMO compared with those with late consultation (7.6 days vs. 13.5 days, t = 2.022, P = 0.008). Twenty-two (24.2%) had evidence of brain injury, which was significantly associated with patient age, number of comorbidities, duration of VA-ECMO, number of life-sustaining therapies, and number of palliative care visits (Wilks lambda 0.8925, DF 5,121, P = 0.016). Presence of brain injury was associated with fewer palliative care visits (t = 2.82, P = 0.006).

Conclusion: Shorter duration of VA-ECMO support and presence of brain injury were associated with fewer palliative care visits. Decisions around withdrawal of VA-ECMO support might be less complicated when patient's medical conditions deteriorate quickly or when neurological prognosis seems poor.
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http://dx.doi.org/10.1016/j.jpainsymman.2020.10.027DOI Listing
November 2020

Commentary: A pandemic blueprint for planning your act and acting your plan.

J Thorac Cardiovasc Surg 2020 Sep 18. Epub 2020 Sep 18.

Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2020.09.057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500271PMC
September 2020

Comparing outcomes for infiltrative and restrictive cardiomyopathies under the new heart transplant allocation system.

Clin Transplant 2020 12 28;34(12):e14109. Epub 2020 Oct 28.

Milstein Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.

The new heart transplantation (HT) allocation policy was introduced on 10/18/2018. Using the UNOS registry, we examined early outcomes following HT for restrictive cardiomyopathy, hypertrophic cardiomyopathy, cardiac sarcoidosis, or cardiac amyloidosis compared to the old system. Those listed who had an event (transplant, death, or waitlist removal) prior to 10/17/2018 were in Era 1, and those listed on or after 10/18/2018 were in Era 2. The primary endpoint was death on the waitlist or delisting due to clinical deterioration. A total of 1232 HT candidates were included, 855 (69.4%) in Era 1 and 377 (30.6%) in Era 2. In Era 2, there was a significant increase in the use of temporary mechanical circulatory support and a reduction in the primary endpoint, (20.9 events per 100 PY (Era 1) vs. 18.6 events per 100 PY (Era 2), OR 1.98, p = .005). Median waitlist time decreased (91 vs. 58 days, p < .001), and transplantation rate increased (119.0 to 204.7 transplants/100 PY for Era 1 vs Era 2). Under the new policy, there has been a decrease in waitlist time and waitlist mortality/delisting due to clinical deterioration, and an increase in transplantation rates for patients with infiltrative, hypertrophic, and restrictive cardiomyopathies without any effect on post-transplant 6-month survival.
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http://dx.doi.org/10.1111/ctr.14109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755228PMC
December 2020