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Sharon Chih - One of the best experts on this subject based on the ideXlab platform.
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Profound Vasoplegia During Sacubitril/Valsartan Treatment After Heart Transplantation.
The Canadian journal of cardiology, 2017Co-Authors: Aws Almufleh, Lisa Mielniczuk, Radoslav Zinoviev, Andrew Moeller, Ross A. Davies, Ellamae Stadnick, Vincent Chan, Sharon ChihAbstract:Vasoplegia occurs in up to 16% of patients who undergo heart transplantation (HT) and is associated with significant morbidity and mortality. We present a case of a 61-year-old man with ischemic cardiomyopathy receiving sacubitril/valsartan (Entresto; Novartis, Cambridge, MA) who developed profound hypotension after HT. He was treated with intravenous methylene blue and high-dose vasopressors, but developed acute kidney injury requiring dialysis and a prolonged stay in the intensive care unit. This case supports a potent vasodilatory effect of sacubitril/valsartan, and if confirmed by other studies, might warrant consideration for withholding treatment while awaiting HT, particularly in patients with risk factors for Vasoplegia.
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profound Vasoplegia during sacubitril valsartan treatment after heart transplantation
Canadian Journal of Cardiology, 2017Co-Authors: Aws Almufleh, Lisa Mielniczuk, Radoslav Zinoviev, Andrew Moeller, Ross A. Davies, Ellamae Stadnick, Vincent Chan, Sharon ChihAbstract:Vasoplegia occurs in up to 16% of patients who undergo heart transplantation (HT) and is associated with significant morbidity and mortality. We present a case of a 61-year-old man with ischemic cardiomyopathy receiving sacubitril/valsartan (Entresto; Novartis, Cambridge, MA) who developed profound hypotension after HT. He was treated with intravenous methylene blue and high-dose vasopressors, but developed acute kidney injury requiring dialysis and a prolonged stay in the intensive care unit. This case supports a potent vasodilatory effect of sacubitril/valsartan, and if confirmed by other studies, might warrant consideration for withholding treatment while awaiting HT, particularly in patients with risk factors for Vasoplegia.
Aws Almufleh - One of the best experts on this subject based on the ideXlab platform.
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Profound Vasoplegia During Sacubitril/Valsartan Treatment After Heart Transplantation.
The Canadian journal of cardiology, 2017Co-Authors: Aws Almufleh, Lisa Mielniczuk, Radoslav Zinoviev, Andrew Moeller, Ross A. Davies, Ellamae Stadnick, Vincent Chan, Sharon ChihAbstract:Vasoplegia occurs in up to 16% of patients who undergo heart transplantation (HT) and is associated with significant morbidity and mortality. We present a case of a 61-year-old man with ischemic cardiomyopathy receiving sacubitril/valsartan (Entresto; Novartis, Cambridge, MA) who developed profound hypotension after HT. He was treated with intravenous methylene blue and high-dose vasopressors, but developed acute kidney injury requiring dialysis and a prolonged stay in the intensive care unit. This case supports a potent vasodilatory effect of sacubitril/valsartan, and if confirmed by other studies, might warrant consideration for withholding treatment while awaiting HT, particularly in patients with risk factors for Vasoplegia.
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profound Vasoplegia during sacubitril valsartan treatment after heart transplantation
Canadian Journal of Cardiology, 2017Co-Authors: Aws Almufleh, Lisa Mielniczuk, Radoslav Zinoviev, Andrew Moeller, Ross A. Davies, Ellamae Stadnick, Vincent Chan, Sharon ChihAbstract:Vasoplegia occurs in up to 16% of patients who undergo heart transplantation (HT) and is associated with significant morbidity and mortality. We present a case of a 61-year-old man with ischemic cardiomyopathy receiving sacubitril/valsartan (Entresto; Novartis, Cambridge, MA) who developed profound hypotension after HT. He was treated with intravenous methylene blue and high-dose vasopressors, but developed acute kidney injury requiring dialysis and a prolonged stay in the intensive care unit. This case supports a potent vasodilatory effect of sacubitril/valsartan, and if confirmed by other studies, might warrant consideration for withholding treatment while awaiting HT, particularly in patients with risk factors for Vasoplegia.
Alfredo L. Clavell - One of the best experts on this subject based on the ideXlab platform.
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Combined Heart-Kidney Transplantation: Vasoplegia is Associated with Poorer Post-Kidney Transplant Outcomes
The Journal of Heart and Lung Transplantation, 2020Co-Authors: J. A. Steadman, Shannon M. Dunlay, John M. Stulak, Naveen L. Pereira, Alfredo L. Clavell, Sudhir S. Kushwaha, Brooks S. Edwards, John A. Schirger, Robert P. Frantz, Byron H. SmithAbstract:Purpose Candidate selection for multi-organ transplants should consider the chances of good function and benefit of all transplanted organs. Risk factors for early renal graft dysfunction after combined heart-kidney transplant (CHKTx) may include Vasoplegia and vasopressor need in spite of good cardiac graft function. We aimed to identify risk factors for Vasoplegia after CHKTx and its impact on postoperative and renal allograft outcomes. Methods A retrospective review was conducted on 58 consecutive patients who underwent CHKTx at a single center between 1996 and 2019. Baseline characteristics, perioperative complications including post-transplant Vasoplegia, graft function, and survival were assessed. Vasoplegia was defined as needing vasopressors to maintain a MAP >70 mmHg with either an ejection fraction >55% or a cardiac index ≥2.0 L/min/m2 within 48 hours of transplantation. Results The mean transplant age was 53.6 years (± 11.3 SD). Pre-transplant, 17 (29.3%) patients had a left ventricular assist device (VAD) and 1 (1.7%) had a right VAD. The operative mortality rate was 5.2% (3 patients). Seventeen (32.1%) patients experienced Vasoplegia; of these, 10 (58.8%) had a VAD pre-transplant, 9 (52.9%) had delayed renal graft function (DGF), and 3 (17.6%) had permanent renal graft failure (PGF). All 3 patients with PGF had Vasoplegia and 9 (50.0%) with DGF had Vasoplegia. Eight (66.7%) of the patients with either DGF or PGF and Vasoplegia had a VAD. Further survival analyses shown in table 1. Conclusion Vasoplegia is associated with a higher risk of renal allograft dysfunction following CHKTx, and is frequently associated with LVAD as a bridge to transplant. Identifying further risk factors associated with poor post-CHKTx renal graft function could help define patients for whom CHKTx is appropriate. A review of the CHKTx allocation process in high risk patient groups is warranted.
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predictors and clinical outcomes of Vasoplegia in patients bridged to heart transplantation with continuous flow left ventricular assist devices
Journal of the American College of Cardiology, 2019Co-Authors: Rabea Asleh, Hilmi Alnsasra, Sarah Schettle, Riad Taher, Shannon M. Dunlay, John M. Stulak, Richard C. Daly, Atta Behfar, Naveen L. Pereira, Alfredo L. ClavellAbstract:Vasoplegia has been implicated in adverse outcomes after heart transplantation (HT). Although left ventricular assist device (LVAD) is associated with increased risk of Vasoplegia, pre-operative predictors of Vasoplegia in this population and its impact on survival after HT are unknown. In this
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Predictors and Clinical Outcomes of Vasoplegia in Patients Bridged to Heart Transplantation with Continuous Flow Left Ventricular Assist Devices
The Journal of Heart and Lung Transplantation, 2019Co-Authors: Rabea Asleh, Hilmi Alnsasra, Sarah Schettle, Riad Taher, Shannon M. Dunlay, John M. Stulak, Richard C. Daly, Atta Behfar, Naveen L. Pereira, Alfredo L. ClavellAbstract:Purpose Vasoplegia has been implicated in adverse outcomes after heart transplantation (HT). Although left ventricular assist device (LVAD) is associated with increased risk of Vasoplegia, pre-operative predictors of Vasoplegia in this population and its impact on survival after HT are unknown. In this study, we sought to examine predictors and outcomes of patients who develop Vasoplegia after HT following bridging therapy with continuous flow LVAD. Methods We retrospectively analyzed 94 patients who underwent HT after bridging with LVAD between July, 2008 and June, 2018 at a large institution. Vasoplegia was defined as persistent low vascular resistance requiring ≥2 intravenous vasopressors within 48 hours post HT for >24 hours to maintain a mean arterial pressure >70 mm Hg. Logistic regression was used to examine predictors of Vasoplegia and the association with survival was examined using Cox proportional hazard regression. Results Overall, 44 (46.8%) patients with LVAD developed Vasoplegia after HT. Patients with and without Vasoplegia had similar pre-operative LVAD, echocardiographic, and hemodynamic parameters. Patients with Vasoplegia were significantly older, had longer LVAD support, higher pre-operative creatinine, cardiopulmonary bypass time (CBT), and Charlson comorbidity index, and had higher rates of hypothyroidism and sustained ventricular tachycardia (VT) (all p Conclusion Longer LVAD support, impaired renal function, sustained VT, and prolonged intra-operative CBT are independent predictors of Vasoplegia in patients undergoing HT after LVAD bridging. Vasoplegia is associated with poor prognosis; hence, detailed assessment of these predictors can be clinically important.
Ellamae Stadnick - One of the best experts on this subject based on the ideXlab platform.
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Profound Vasoplegia During Sacubitril/Valsartan Treatment After Heart Transplantation.
The Canadian journal of cardiology, 2017Co-Authors: Aws Almufleh, Lisa Mielniczuk, Radoslav Zinoviev, Andrew Moeller, Ross A. Davies, Ellamae Stadnick, Vincent Chan, Sharon ChihAbstract:Vasoplegia occurs in up to 16% of patients who undergo heart transplantation (HT) and is associated with significant morbidity and mortality. We present a case of a 61-year-old man with ischemic cardiomyopathy receiving sacubitril/valsartan (Entresto; Novartis, Cambridge, MA) who developed profound hypotension after HT. He was treated with intravenous methylene blue and high-dose vasopressors, but developed acute kidney injury requiring dialysis and a prolonged stay in the intensive care unit. This case supports a potent vasodilatory effect of sacubitril/valsartan, and if confirmed by other studies, might warrant consideration for withholding treatment while awaiting HT, particularly in patients with risk factors for Vasoplegia.
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profound Vasoplegia during sacubitril valsartan treatment after heart transplantation
Canadian Journal of Cardiology, 2017Co-Authors: Aws Almufleh, Lisa Mielniczuk, Radoslav Zinoviev, Andrew Moeller, Ross A. Davies, Ellamae Stadnick, Vincent Chan, Sharon ChihAbstract:Vasoplegia occurs in up to 16% of patients who undergo heart transplantation (HT) and is associated with significant morbidity and mortality. We present a case of a 61-year-old man with ischemic cardiomyopathy receiving sacubitril/valsartan (Entresto; Novartis, Cambridge, MA) who developed profound hypotension after HT. He was treated with intravenous methylene blue and high-dose vasopressors, but developed acute kidney injury requiring dialysis and a prolonged stay in the intensive care unit. This case supports a potent vasodilatory effect of sacubitril/valsartan, and if confirmed by other studies, might warrant consideration for withholding treatment while awaiting HT, particularly in patients with risk factors for Vasoplegia.
Vincent Chan - One of the best experts on this subject based on the ideXlab platform.
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Profound Vasoplegia During Sacubitril/Valsartan Treatment After Heart Transplantation.
The Canadian journal of cardiology, 2017Co-Authors: Aws Almufleh, Lisa Mielniczuk, Radoslav Zinoviev, Andrew Moeller, Ross A. Davies, Ellamae Stadnick, Vincent Chan, Sharon ChihAbstract:Vasoplegia occurs in up to 16% of patients who undergo heart transplantation (HT) and is associated with significant morbidity and mortality. We present a case of a 61-year-old man with ischemic cardiomyopathy receiving sacubitril/valsartan (Entresto; Novartis, Cambridge, MA) who developed profound hypotension after HT. He was treated with intravenous methylene blue and high-dose vasopressors, but developed acute kidney injury requiring dialysis and a prolonged stay in the intensive care unit. This case supports a potent vasodilatory effect of sacubitril/valsartan, and if confirmed by other studies, might warrant consideration for withholding treatment while awaiting HT, particularly in patients with risk factors for Vasoplegia.
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profound Vasoplegia during sacubitril valsartan treatment after heart transplantation
Canadian Journal of Cardiology, 2017Co-Authors: Aws Almufleh, Lisa Mielniczuk, Radoslav Zinoviev, Andrew Moeller, Ross A. Davies, Ellamae Stadnick, Vincent Chan, Sharon ChihAbstract:Vasoplegia occurs in up to 16% of patients who undergo heart transplantation (HT) and is associated with significant morbidity and mortality. We present a case of a 61-year-old man with ischemic cardiomyopathy receiving sacubitril/valsartan (Entresto; Novartis, Cambridge, MA) who developed profound hypotension after HT. He was treated with intravenous methylene blue and high-dose vasopressors, but developed acute kidney injury requiring dialysis and a prolonged stay in the intensive care unit. This case supports a potent vasodilatory effect of sacubitril/valsartan, and if confirmed by other studies, might warrant consideration for withholding treatment while awaiting HT, particularly in patients with risk factors for Vasoplegia.