Publications by authors named "Prashant Rao"

49 Publications

Risk Prediction in Cardiogenic Shock: Current State of Knowledge, Challenges and Opportunities.

J Card Fail 2021 Oct;27(10):1099-1110

Cardiovascular Research Foundation, New York, New York.

Cardiogenic shock (CS) is a condition associated with high mortality rates in which prognostication is uncertain for a variety of reasons, including its myriad causes, its rapidly evolving clinical course and the plethora of established and emerging therapies for the condition. A number of validated risk scores are available for CS prognostication; however, many of these are tedious to use, are designed for application in a variety of populations and fail to incorporate contemporary hemodynamic parameters and contemporary mechanical circulatory support interventions that can affect outcomes. It is important to separate patients with CS who may recover with conservative pharmacological therapies from those in who may require advanced therapies to survive; it is equally important to identify quickly those who will succumb despite any therapy. An ideal risk-prediction model would balance incorporation of key hemodynamic parameters while still allowing dynamic use in multiple scenarios, from aiding with early decision making to device weaning. Herein, we discuss currently available CS risk scores, perform a detailed analysis of the variables in each of these scores that are most predictive of CS outcomes and explore a framework for the development of novel risk scores that consider emerging therapies and paradigms for this challenging clinical entity.
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http://dx.doi.org/10.1016/j.cardfail.2021.08.003DOI Listing
October 2021

Exercise, Physical Activity and Cardiometabolic Health: Pathophysiologic Insights.

Cardiol Rev 2021 Sep 15. Epub 2021 Sep 15.

Division of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Cardiovascular Research Center, Beth Israel Deaconess Medical Center, Boston, MA.

Physical activity and its sustained and purposeful performance - exercise - promote a broad and diverse set of metabolic and cardiovascular health benefits. Regular exercise is the most effective way to improve cardiorespiratory fitness, a measure of one's global cardiovascular, pulmonary and metabolic health and one of the strongest predictors of future health risk. Here, we describe how exercise affects individual organ systems related to cardiometabolic health, including the promotion of insulin and glucose homeostasis through improved efficiency in skeletal muscle glucose utilization and enhanced insulin sensitivity; beneficial changes in body composition and adiposity; and improved cardiac mechanics and vascular health. We subsequently identify knowledge gaps that remain in exercise science, including heterogeneity in exercise responsiveness. While the application of molecular profiling technologies in exercise science has begun to illuminate the biochemical pathways that govern exercise-induced health promotion, much of this work has focused on individual organ systems and applied single platforms. New insights into exercise-induced secreted small molecules and proteins that impart their effects in distant organs ("exerkines") highlight the need for an integrated approach towards the study of exercise and its global effects; efforts that are ongoing.
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http://dx.doi.org/10.1097/CRD.0000000000000417DOI Listing
September 2021

Exercise, Physical Activity, and Cardiometabolic Health: Insights into the Prevention and Treatment of Cardiometabolic Diseases.

Cardiol Rev 2021 Sep 15. Epub 2021 Sep 15.

Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Cardiovascular Research Center, Beth Israel Deaconess Medical Center, Boston, MA; Division of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.

Physical activity (PA) and exercise are widely recognized as essential components of primary and secondary cardiovascular disease (CVD) prevention efforts and are emphasized in the health promotion guidelines of numerous professional societies and committees. The protean benefits of PA and exercise extend across the spectrum of CVD, and include the improvement and reduction of risk factors and events for atherosclerotic CVD (ASCVD), cardiometabolic disease, heart failure, and atrial fibrillation, respectively. Here, we highlight recent insights into the salutary effects of PA and exercise on the primary and secondary prevention of ASCVD, including their beneficial effects on both traditional and non-traditional risk mediators; exercise "prescriptions" for ASCVD; the role of PA regular exercise in the prevention and treatment of heart failure; and the relationships between, PA, exercise and atrial fibrillation. While our understanding of the relationship between exercise and CVD has evolved considerably, several key questions remain including the association between extreme volumes of exercise and subclinical ASCVD and its risk; high-intensity exercise and resistance (strength) training as complementary modalities to continuous aerobic exercise; and dose- and intensity-dependent associations between exercise and atrial fibrillation. Recent advances in molecular profiling technologies (i.e., genomics, transcriptomics, proteomics, and metabolomics) have begun to shed light on inter-individual variation in cardiometabolic responses to PA and exercise and may provide new opportunities for clinical prediction in addition to mechanistic insights.
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http://dx.doi.org/10.1097/CRD.0000000000000416DOI Listing
September 2021

Hippocampal AMPA receptor assemblies and mechanism of allosteric inhibition.

Nature 2021 Jun 12;594(7863):448-453. Epub 2021 May 12.

Vollum Institute, Oregon Health & Science University, Portland, OR, USA.

AMPA-selective glutamate receptors mediate the transduction of signals between the neuronal circuits of the hippocampus. The trafficking, localization, kinetics and pharmacology of AMPA receptors are tuned by an ensemble of auxiliary protein subunits, which are integral membrane proteins that associate with the receptor to yield bona fide receptor signalling complexes. Thus far, extensive studies of recombinant AMPA receptor-auxiliary subunit complexes using engineered protein constructs have not been able to faithfully elucidate the molecular architecture of hippocampal AMPA receptor complexes. Here we obtain mouse hippocampal, calcium-impermeable AMPA receptor complexes using immunoaffinity purification and use single-molecule fluorescence and cryo-electron microscopy experiments to elucidate three major AMPA receptor-auxiliary subunit complexes. The GluA1-GluA2, GluA1-GluA2-GluA3 and GluA2-GluA3 receptors are the predominant assemblies, with the auxiliary subunits TARP-γ8 and CNIH2-SynDIG4 non-stochastically positioned at the B'/D' and A'/C' positions, respectively. We further demonstrate how the receptor-TARP-γ8 stoichiometry explains the mechanism of and submaximal inhibition by a clinically relevant, brain-region-specific allosteric inhibitor.
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http://dx.doi.org/10.1038/s41586-021-03540-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270219PMC
June 2021

Flavonoids in the Treatment of Neuropathic Pain.

Curr Pain Headache Rep 2021 May 7;25(7):43. Epub 2021 May 7.

Department of Anesthesiology, New York-Presbyterian, Weill Cornell Medical College, 525 East 68th Street, Box 124, New York, NY, 10065, USA.

Purpose Of Review: Chronic pain continues to present a large burden to the US healthcare system. Neuropathic pain, a common class of chronic pain, remains particularly difficult to treat despite extensive research efforts. Current pharmacologic regimens exert limited efficacy and wide, potentially dangerous side effect profiles. This review provides a comprehensive, preclinical evaluation of the literature regarding the role of flavonoids in the treatment of neuropathic pain.

Recent Findings: Flavonoids are naturally occurring compounds, found in plants and various dietary sources, which may have potential benefit in neuropathic pain. Numerous animal-model studies have demonstrated this benefit, including reversal of hyperalgesia and allodynia. Flavonoids have also exhibited an anti-inflammatory effect relevant to neuropathic pain, as evidenced by the reduction in multiple pro-inflammatory mediators, such as TNF-α, NF-κB, IL-1β, and IL-6. Flavonoids represent a potentially new treatment modality for neuropathic pain in preclinical models, though human clinical evidence is yet to be explored at this time.
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http://dx.doi.org/10.1007/s11916-021-00959-yDOI Listing
May 2021

First responder cardiac health amid the COVID-19 pandemic.

Resuscitation 2020 11 19;156:120-122. Epub 2020 Sep 19.

University of Texas Southwestern Medical Center, Dallas, TX, United States; Dallas Fire-Rescue Department, Dallas, TX, United States; Parkland BioTel Emergency Medical Services System, Dallas, TX, United States.

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http://dx.doi.org/10.1016/j.resuscitation.2020.09.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7501316PMC
November 2020

Reevaluating chronic opioid monitoring during and after the COVID-19 pandemic.

Pain Manag 2020 11 18;10(6):353-358. Epub 2020 Sep 18.

Department of Anesthesiology, NewYork-Presbyterian/Weill Cornell Medical Center, NY 10065, USA.

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http://dx.doi.org/10.2217/pmt-2020-0063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505054PMC
November 2020

The Impact of the COVID-19 Pandemic on Cardiovascular Fellows-in-Training: A National Survey.

J Am Coll Cardiol 2020 08 16;76(7):871-875. Epub 2020 Jun 16.

Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address:

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http://dx.doi.org/10.1016/j.jacc.2020.06.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832440PMC
August 2020

How to Manage Temporary Mechanical Circulatory Support Devices in the Critical Care Setting: Translating Physiology to the Bedside.

Heart Fail Clin 2020 Jul;16(3):283-293

Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

The incidence of cardiogenic shock and the utilization of mechanical circulatory support devices are increasing in the US. In this review we discuss the pathophysiology of cardiogenic shock through basic hemodynamic and myocardial energetic principles. We also explore the commonly used platforms for temporary mechanical circulatory support, their advantages, disadvantages and practical considerations relating to implementation and management. It is through the translation of underlying physiological principles that we can attempt to maximize the clinical utility of circulatory support devices and improve outcomes in cardiogenic shock.
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http://dx.doi.org/10.1016/j.hfc.2020.03.001DOI Listing
July 2020

Physician adherence to 'Seattle' and 'International' ECG criteria in adolescent athletes: An analysis of compliance by specialty, experience, and practice environment.

J Electrocardiol 2020 May - Jun;60:98-101. Epub 2020 Apr 18.

Thomas Jefferson University Hospital, Philadelphia, PA, United States of America.

Background: Screening electrocardiography (ECG) for athletes is both controversial and rapidly evolving. While identifying an abnormal ECG could detect a serious cardiovascular disease, falsely interpreting a benign ECG pattern as abnormal can lead to unnecessary testing, cost, and anxiety. Though recent refinements of athlete screening ECG criteria have significantly improved its accuracy, in clinical practice physician adherence to these criteria may vary.

Methods: We analyzed physician adherence to contemporary athlete ECG criteria in a large, national athlete screening registry. 1577 consecutive screening ECGs were independently re- interpreted to assess for physician adherence to Seattle Criteria or International Criteria, respective to the criteria in place when the screening was performed. We further determined the most common ECG interpretations that deviated from these criteria, and analyzed physician characteristics for independent predictors of adherence to published ECG criteria.

Results: Though overall adherence to contemporary criteria was high, 60.4% of ECGs interpreted as abnormal did not meet athlete ECG criteria for pathology when independently re- read. The most common ECG patterns misinterpreted as abnormal were isolated left ventricular hypertrophy (LVH) and non-pathologic T-wave inversions (TWI). Multivariate regression identified three independent predictors of adherence to athlete ECG criteria: participating in a screening overseen by the organization's medical leadership, electrophysiology specialists and adult cardiologists.

Conclusion: This study highlights the need for quality control measures and continued clinician education in a controversial and rapidly evolving field. Clinician education for athlete screening ECG criteria should emphasize the recent changes in how TWI and LVH voltage criteria should be interpreted in this patient population.
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http://dx.doi.org/10.1016/j.jelectrocard.2020.04.005DOI Listing
June 2021

Parameters of cardiac symptoms in young athletes using the Heartbytes database.

Phys Sportsmed 2021 02 26;49(1):37-44. Epub 2020 Apr 26.

Division of Cardiovascular Medicine, Department of Medicine, Thomas Jefferson University Hospitals , Philadelphia, PA, USA.

: To determine clinical parameters that are related to abnormal cardiac symptoms in physically active youth. : We used Simon's Heart Heartbytes National Youth Cardiac Registry to collect data from adolescent athletes in southeastern Pennsylvania. We collected age, race/ethnicity, abnormal cardiac symptoms, medical history, medication use, caffeine intake, and family history. We obtained height, weight, blood pressure, cardiac murmur findings, and ECGs. Echocardiogram was obtained if necessary. Binary logistic regression analysis was performed to identify independent associations between abnormal cardiac symptoms and collected variables. The odds ratio (OR), 95% confidence interval (95% CI), and p-values were used as statistical values. : Of the 887 athletes (543 males and 344 females, age = 16.9 ± 2.1 years, height = 166.9 ± 11.4 cm, weight = 62.0 ± 16.0 kg), 186 (21%) had abnormal cardiac symptoms including chest pain, passing out, difficulty breathing, extreme fatigue, and heart race. There was an independent association between abnormal symptoms and a past medical history (OR: 4.77, 95%CI: 3.18, 7.17, p = 0.001) and medication use (OR: 1.74, 95%CI: 1.08, 2.79, p = 0.022). In medical history, young athletes with asthma showed a greater propensity of abnormal cardiac symptoms (48.9%) compared to young athletes without (14.0%, p = 0.001). Additionally, young athletes with anxiety or depression demonstrated a higher proportion of abnormal cardiac symptoms (48.9%) than those without (19.5%, p = 0.001). Although the association between the presence of abnormal symptoms and African-American race (OR: 2.04, 95%CI: 0.96, 4.35, p = 0.065) and average daily consumption of at least 2 caffeine drinks (OR: 2.08, 95%CI: 0.86, 5.02, p = 0.103) were not significant, there was a trend to reach the a priori significance level. : This study identified several clinical parameters that are associated with symptoms suggestive of abnormal cardiac conditions. Larger studies need to be done to better sort out the clinical history that may contribute to false positives to further reduce false positives at heart screenings.
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http://dx.doi.org/10.1080/00913847.2020.1755908DOI Listing
February 2021

Exercise Recommendations for the Athlete With Coronary Artery Disease.

Curr Treat Options Cardiovasc Med 2019 Dec 9;21(12):82. Epub 2019 Dec 9.

Thomas Jefferson University Hospital, Philadelphia, PA, USA.

Purpose Of The Review: We provide a framework for formulating exercise prescriptions for those with CAD in order to achieve the "optimal" dose of exercise for each individual.

Recent Findings: Multiple epidemiological studies demonstrate that exercise is inversely associated with atherosclerotic coronary artery disease (CAD), yet the risk of an acute coronary event is transiently elevated during vigorous exercise. In turn, CAD is the most common cause of exercise-related sudden cardiac death (SCD) in older athletes. When prescribing exercise recommendations for athletes with CAD, we should maintain equipoise between the benefits derived from sports participation and the risk of an adverse cardiac event. Athletes are not immune from atherosclerotic CAD, and we should perform risk assessments regardless of physical and athletic prowess. Cardiopulmonary exercise testing may be a useful tool to develop individualized exercise regimens for athletes with CAD.
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http://dx.doi.org/10.1007/s11936-019-0795-3DOI Listing
December 2019

Cardiac Arrest in the Cardiac Catheterization Laboratory: Combining Mechanical Chest Compressions and Percutaneous LV Assistance.

JACC Cardiovasc Interv 2019 09;12(18):1840-1849

Department of Medicine, University of Arizona Sarver Heart Center, Tucson, Arizona. Electronic address:

Objectives: The aim of this study was to evaluate the optimal treatment approach for cardiac arrest (CA) occurring in the cardiac catheterization laboratory.

Background: CA can occur in the cath lab during high-risk percutaneous coronary intervention. While attempting to correct the precipitating cause of CA, several options are available to maintain vital organ perfusion. These include manual chest compressions, mechanical chest compressions, or a percutaneous left ventricular assist device.

Methods: Eighty swine (58 ± 10 kg) were studied. The left main or proximal left anterior descending artery was occluded. Ventricular fibrillation (VFCA) was induced and circulatory support was provided with 1 of 4 techniques: either manual chest compressions (frequently interrupted), mechanical chest compressions with a piston device (LUCAS-2), an Impella 2.5 L percutaneously placed LVAD, or the combination of mechanical chest compressions and the percutaneous left ventricular assist device. The study protocol included 12 min of left main coronary occlusion, reperfusion, with defibrillation attempted after 15 min of VFCA. Primary outcome was favorable neurological function (CPC 1 or 2) at 24 h, while secondary outcomes included return of spontaneous circulation and hemodynamics.

Results: Manual chest compressions provided fewer neurologically intact surviving animals than the combination of a mechanical chest compressor and a percutaneous LVAD device (0% vs. 56%; p < 0.01), while no difference was found between the 2 mechanical approaches (28% vs. 35%: p = 0.75). Comparing integrated coronary perfusion pressure showed sequential improvement in hemodynamic support with mechanical devices (401 ± 230 vs. 1,337 ± 905 mm Hg/s; p = 0.06).

Conclusions: Combining 2 mechanical devices provided superior 24-h survival with favorable neurological recovery compared with manual compressions during moderate duration VFCA associated with an acute coronary occlusion in the animal catheterization laboratory.
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http://dx.doi.org/10.1016/j.jcin.2019.05.016DOI Listing
September 2019

The Reply.

Am J Med 2019 03 11;132(3):e529-e530. Epub 2019 Jan 11.

Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Mass.

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http://dx.doi.org/10.1016/j.amjmed.2018.12.012DOI Listing
March 2019

Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock and Cardiac Arrest.

Circ Heart Fail 2018 09;11(9):e004905

Advanced Heart Failure and Mechanical Circulatory Support Program, University of Massachusetts Memorial Medical Center, Worcester (R.D.K.).

Venoarterial extracorporeal membrane oxygenation (VA-ECMO)-also referred to as extracorporeal life support-is a form of temporary mechanical circulatory support and simultaneous extracorporeal gas exchange. The initiation of VA-ECMO has emerged as a salvage intervention in patients with cardiogenic shock, even cardiac arrest refractory to standard therapies. Analogous to veno-venous ECMO for acute respiratory failure, VA-ECMO provides circulatory support and allows time for other treatments to promote recovery or may be a bridge to a more durable mechanical solution in the setting of acute or acute on chronic cardiopulmonary failure. In this review, we provide a brief overview of VA-ECMO, the attendant physiological considerations of peripheral VA-ECMO, and its complications, namely that of left ventricular distention, bleeding, heightened systemic inflammatory response syndrome, thrombosis and thromboembolism, and extremity ischemia or necrosis.
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http://dx.doi.org/10.1161/CIRCHEARTFAILURE.118.004905DOI Listing
September 2018

Regenerative concepts in cardiovascular research: novel hybrid therapy for remodeling ischemic cardiomyopathy.

J Thorac Dis 2018 Jun;10(Suppl 15):S1819-S1824

Department of Surgery, Division of Cardiothoracic Surgery, University of Arizona, Tucson, AZ, USA.

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http://dx.doi.org/10.21037/jtd.2018.01.83DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6035946PMC
June 2018

The Limits of Cardiac Performance: Can Too Much Exercise Damage the Heart?

Am J Med 2018 11 26;131(11):1279-1284. Epub 2018 Jun 26.

Cardiovascular Performance Program, Massachusetts General Hospital, Boston.

Routine moderate-intensity physical activity confers numerous cardiovascular benefits and reduces all-cause mortality. However, the health impact of exercise doses that exceed contemporary physical activity guidelines remains incompletely understood, and an emerging body of literature suggests that high levels of exercise may have the capacity to damage the cardiovascular system. This review focuses on the contemporary controversies regarding high-dose exercise and cardiovascular morbidity and mortality. We discuss the limitations of available studies, explore potential mechanisms that may mediate exercise-related cardiac injury, and highlight the gaps in knowledge for future research.
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http://dx.doi.org/10.1016/j.amjmed.2018.05.037DOI Listing
November 2018

Preconception Counseling for Patients With Thoracic Aortic Aneurysms.

Curr Treat Options Cardiovasc Med 2018 May 10;20(6):50. Epub 2018 May 10.

Massachusetts General Hospital, 55 Fruit St., YAW-5800, Boston, MA, 02114, USA.

Purpose Of The Review: Acute aortic dissection is a potentially catastrophic cardiovascular emergency that is associated with a high mortality rate. Pregnancy, with its attendant hormonal and physiological changes, increases the risk of dissection in women with known thoracic aortic aneurysms. In this review, we highlight the importance of preconception counseling to help women with known thoracic aortic aneurysms better understand their risk of dissection and the heritable nature of thoracic aortic disease and its associated syndromes.

Recent Findings: The risk of aortic dissection during pregnancy differs according to the underlying etiology of thoracic aortic aneurysm and the degree of aortic dilatation at baseline. Guideline-specific management of women with thoracic aortic aneurysms in pregnancy reduces their risk of dissection. Management of pregnant women with thoracic aortic aneurysms requires an intensive multidisciplinary approach to maximize the chances of a successful outcome for both the mother and fetus. Preconception counseling provides an opportunity to optimize patients medically and to consider potential prophylactic aortic repair prior to pregnancy.
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http://dx.doi.org/10.1007/s11936-018-0640-0DOI Listing
May 2018

Improving Community Survival Rates from Out-of-Hospital Cardiac Arrest.

Curr Cardiol Rev 2018 ;14(2):79-84

University of Arizona, College of Medicine, Sarver Heart Center, Tucson, Arizona, United States.

Out of hospital cardiac arrest affects 350,000 Americans yearly and is associated with a high mortality rate. Improving survival rates in this population rests on the prompt and effective implementation of four key principles. These include 1) early recognition of cardiac arrest 2) early use of chest compressions 3) early defibrillation, which in turn emphasizes the importance of public access defibrillation programs and potential for drone technology to allow for early defibrillation in private or rural settings 4) early and aggressive post-arrest care including the consideration of therapeutic hypothermia, early coronary angiography +/- percutaneous coronary intervention and a hyper-invasive approach to out-of-hospital refractory cardiac arrest.
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http://dx.doi.org/10.2174/1573403X14666180507160555DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6088442PMC
September 2018

Total artificial heart implantation in a young Marfan syndrome patient.

Int J Artif Organs 2018 Mar 20;41(3):175-177. Epub 2018 Feb 20.

2 Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA.

Introduction: Cardiovascular complications represent the leading cause of morbidity and mortality in patients with Marfan syndrome. Here, we describe a unique case where a total artificial heart was implanted in a young Marfan syndrome woman.

Methods: A 22-year-old postpartum African American female with Marfan syndrome developed multiple severe valve dysfunction and biventricular failure that was refractory to medical management. She previously had a Bentall procedure for Type A aortic dissection and repair of a Type B dissection.

Results: We implanted a total artificial heart with a good outcome.

Conclusion: Total artificial heart is a durable option for severe biventricular failure and multiple valvular dysfunction as a bridge to transplant in a young patient with Marfan syndrome.
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http://dx.doi.org/10.1177/0391398817752297DOI Listing
March 2018

Peripheral VA-ECMO with direct biventricular decompression for refractory cardiogenic shock.

Perfusion 2018 09 21;33(6):493-495. Epub 2018 Feb 21.

3 Department of Perfusion and Artificial Heart Programs, Banner University Medical Center, Tucson, Arizona.

Cardiogenic shock and cardiac arrest are life-threatening emergencies that result in high mortality rates. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) via peripheral cannulation is an option for patients who do not respond to conventional therapies. Left ventricular (LV) distention is a major limitation with peripheral VA-ECMO and is thought to contribute to poor recovery and the inability to wean off VA-ECMO. We report on a novel technique that combines peripheral VA-ECMO with off-pump insertion of a trans-apical LV venting cannula and a right ventricular decompression cannula.
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http://dx.doi.org/10.1177/0267659118761558DOI Listing
September 2018

Potential Impact of the Proposed Revised UNOS Thoracic Organ Allocation System.

Semin Thorac Cardiovasc Surg 2018 2;30(2):129-133. Epub 2018 Feb 2.

Department of Cardiothoracic Surgery, University of Arizona, Tucson, Arizona. Electronic address:

The current United States heart allocation system faces 2 main challenges: an evolving landscape of device therapy in advanced heart failure and a rapidly increasing transplant waiting list. The proposed new heart allocation system involves expansion of the 3 tiers and enables greater distinction between different types of mechanical circulatory support devices. In this review, we discuss how the proposed revision reconciles key concerns of the current system to create a more fair and equitable allocation of hearts in the United States.
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http://dx.doi.org/10.1053/j.semtcvs.2018.01.001DOI Listing
November 2018

Assessment of Proliferative Potential of Odontogenic Keratocyst and Dentigerous Cyst using Podoplanin: An Immunohistochemical Study.

J Contemp Dent Pract 2017 Dec 1;18(12):1173-1176. Epub 2017 Dec 1.

Department of Public Health Dentistry, Maharaja Agrasen Institute of Management Studies, New Delhi, India.

Introduction: Odontogenic cysts are commonly encountered lesions among head and neck pathologies. Odontogenic keratocyst (OKC) has unique features of recurrence and local aggressiveness. Podoplanin (PDP) is a lymphatic endothelial marker and is shown to be expressed in a variety of tissues. Hence, we planned to assess the significance of PDP in OKC and dentigerous cyst (DC).

Materials And Methods: The present study included assessment of immunoexpression of PDP in OKC and DC. Twenty specimens each of OKC and DC were included in the present study and were stained with D2-40 antibody. All the sections were analyzed and were categorized as negative staining, weakly positive staining, and strongly positive staining. All the results were analyzed by Statistical Package for the Social Sciences (SPSS) software.

Results: We detected PDP-positive staining in the cell membrane and cytoplasm of the cells of basal cell layer and supra-basal cell layers. In DC cases, we observed positive staining only in cases associated with inflammation.

Conclusion: Podoplanin does play a significant role in enhancing the local invasive and neoplastic properties of OKC.

Clinical Significance: Podoplanin expression in OKC is potentially associated with moderate invasive nature of the neighboring structures.
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http://dx.doi.org/10.5005/jp-journals-10024-2194DOI Listing
December 2017

Ambulatory central VA-ECMO with biventricular decompression for acute cardiogenic shock.

Catheter Cardiovasc Interv 2018 11 4;92(5):1002-1004. Epub 2017 Dec 4.

Department of Cardiothoracic Surgery, University of Arizona, Tucson, Arizona.

We describe the off-pump insertion of a biventricular assist device with extra-corporeal membrane oxygenation (ECMO): a novel technique that allows for ambulatory central veno-arterial (VA) ECMO with direct biventricular decompression.
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http://dx.doi.org/10.1002/ccd.27428DOI Listing
November 2018

Intraoperative thermographic imaging to assess myocardial distribution of Del Nido cardioplegia.

J Card Surg 2017 Dec 3;32(12):812-815. Epub 2017 Dec 3.

Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona.

We describe the intraoperative non-invasive use of an infrared (IR) camera to monitor Del Nido cardioplegia delivery in patients undergoing cardiac surgery. Thermal pictures were taken pre- and post-cardioplegia and at timed points after arrest, and compared to readings from a transseptal temperature probe. There was good concordance between the transseptal probe and the IR camera temperature readings. This non-invasive technique, which assesses cardioplegic distribution, may help to determine when additional doses of Del Nido cardioplegia are required during periods of cardioplegic arrest.
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http://dx.doi.org/10.1111/jocs.13258DOI Listing
December 2017

Poor cough flow in acute stroke patients is associated with reduced functional residual capacity and low cough inspired volume.

BMJ Open Respir Res 2017 26;4(1):e000230. Epub 2017 Oct 26.

Division of Asthma Allergy and Lung Biology, Respiratory Medicine, King's College London, London, London, UK.

Introduction: Each year 7 million people die of stroke worldwide; most deaths are caused by chest infections. Patients with acute stroke have impaired voluntary cough flow, associated with increased risk of chest infections. Reduced functional residual capacity (FRC) could lead to impaired cough flow. We therefore compared FRC in acute hemiparetic stroke patients and controls and explored its relationship with volume inspired before cough and voluntary cough peak flow.

Methods: 21 patients within 2 weeks of first-ever middle cerebral artery territory (MCA) infarct (mean (SD) age 68 (11) years, 10 females) and 30 controls (58 (11) years, 15 females) underwent FRC and voluntary cough testing (cough inspired volume and peak flow) while semirecumbent. FRC was expressed as % predicted; cough inspired volume was expressed as % predicted VC and cough peak flow as % predicted PEF. A clinician scored stroke severity using the National Institutes of Health Stroke Scale (NIHSS).

Results: Patients' reclined FRC, voluntary cough peak flowand cough inspired volume were reduced compared with controls (p<0.01 for all): patients' median (IQR) FRC 76 (67-90) % predicted, mean (SD) cough inspired volume 64 (20) % predicted and mean (SD) peak cough flow 61 (32) % predicted despite them having only mild stroke-related impairments: median NIHSS score 4 (IQR 2-6). Univariate linear regression analyses showed FRC predicted cough inspired volume (adjusted R=0.45) and cough inspired volume predicted cough flow (adjusted R=0.56); p<0.01 for both. Sitting patients upright increased their FRC by median 0.210 L.

Conclusions: FRC and cough inspired volume in the reclined position are significantly reduced in acute hemiparetic stroke patients with mild impairments; both factors are associated with poor voluntary cough peak flow.
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http://dx.doi.org/10.1136/bmjresp-2017-000230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5663270PMC
October 2017

Cryo-EM Structures Reveal Mechanism and Inhibition of DNA Targeting by a CRISPR-Cas Surveillance Complex.

Cell 2017 Oct;171(2):414-426.e12

Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD 20892, USA; Center for Molecular Microscopy, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD 20892, USA. Electronic address:

Prokaryotic cells possess CRISPR-mediated adaptive immune systems that protect them from foreign genetic elements, such as invading viruses. A central element of this immune system is an RNA-guided surveillance complex capable of targeting non-self DNA or RNA for degradation in a sequence- and site-specific manner analogous to RNA interference. Although the complexes display considerable diversity in their composition and architecture, many basic mechanisms underlying target recognition and cleavage are highly conserved. Using cryoelectron microscopy (cryo-EM), we show that the binding of target double-stranded DNA (dsDNA) to a type I-F CRISPR system yersinia (Csy) surveillance complex leads to large quaternary and tertiary structural changes in the complex that are likely necessary in the pathway leading to target dsDNA degradation by a trans-acting helicase-nuclease. Comparison of the structure of the surveillance complex before and after dsDNA binding, or in complex with three virally encoded anti-CRISPR suppressors that inhibit dsDNA binding, reveals mechanistic details underlying target recognition and inhibition.
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http://dx.doi.org/10.1016/j.cell.2017.09.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683424PMC
October 2017

Minimally invasive insertion of off-pump central extracorporeal membrane oxygenation.

J Card Surg 2017 Nov 13;32(11):738-740. Epub 2017 Sep 13.

Department of Sugery, Divison of Cardiothoracic Sugery, Banner-University Medical Center Tucson, University of Arizona, Tucson, Arizona.

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http://dx.doi.org/10.1111/jocs.13208DOI Listing
November 2017
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