phosphorus-31-magnetic-resonance-spectroscopy-for-serial-measurements

Phosphorus-31 Magnetic Resonance Spectroscopy for Serial Measurements of Cardiac Energetics During Temperature-Controlled Heart Preservation

Reliable organ preservation is critical to increasing donor availability and improving transplant outcomes. While static storage remains the standard for ...

Johns Hopkins University School of Medicine

Racial disparities persist in health care. Our study objective was to evaluate racial disparity in cardiac surgery in Maryland.

Racial Disparity in Cardiac Surgery Risk and Outcome: Report From a Statewide Quality Initiative.

Adding Mitral Valve Translocation to the Tool Kit for Treatment of Secondary Mitral Regurgitation.

Mitral valve translocation (MVT) is a novel procedure that was developed to treat patients with severe, symptomatic, secondary mitral regurgitation (MR). MVT enhances leaflet coaptation by insertion of an autologous pericardial patch interposed between the mitral annulus and the native mitral leaflets. The patch substantially increases total leaflet surface area and creates supranormal coaptation. In addition, it relieves leaflet tethering by transposing the native valve deeper into the ventricle and decreases the circumference of the annulus. The enhanced coaptation produced by MVT may protect against recurrent MR in patients with continued adverse left ventricular remodeling. The procedural steps include detachment of the intact native mitral valve at the annulus, placement of interrupted pledgeted sutures around the annulus to secure the proximal aspect of the patch, and attachment of the native valve to the distal aspect of the patch using running suture. Follow-up of patients who have undergoing MVT is ongoing, with satisfactory short-term results, including sustained MR grades of ≤mild and 14 mm coaptation at 12 months.

How To Do It: Mitral Valve Translocation.

Mitral Valve Translocation: A Novel Approach to Repair Secondary Mitral Regurgitation.

The redundant leaflet tissue and annular pathology of Barlow disease can make surgical repair challenging. We examined perioperative and late outcomes of a large cohort of patients with Barlow disease undergoing surgical repair.

Non-resectional cordal repair for Barlow mitral valve disease.

A 4-h preservation time threshold for cardiac allografts is the current standard in heart transplantation, but novel technologies are proposed to decrease the morbidity associated with prolonged allograft storage. This study examined adult heart transplant recipients from 2000-2015 and 2020-2023 in the United States, stratified into an early (2000-2015) and modern era (2020-2023), then into standard (≤ 4 h) and prolonged (≥ 5 h) preservation time groups within each era. This study reinforced the 4-h threshold in the early era, where prolonged preservation significantly increased one-year mortality (HR 1.60, 95% CI 1.36-1.90). However, this association was no longer significant in the modern era (HR 1.14, 95% CI 0.85-1.50). A sub-analysis showed that using machine perfusion devices for allograft storage was not associated with one-year mortality (HR 1.15, 95% CI 0.79-1.70). Spline analysis demonstrated possible inflection points between 4 and 5 h and 8-9 h in the modern era, and further analysis found that 5-8 h of preservation did not increase one-year mortality (HR 1.09, 95% CI 0.80-1.47) relative to the ≤ 4 h group. In conclusion, the association between cardiac allograft preservation duration and morbidity has decreased in the modern era. Today, a 4-h preservation duration threshold may be too restrictive.

Understanding preservation time thresholds in the modern era of heart transplantation.

The safety of using teenage donor hearts for adult recipients is unclear. Moreover, the appropriateness of predicted heart mass ratio as a size metric for teenage donors is unknown.

Outcomes of teenage donor hearts transplanted into adult heart transplant recipients: A United Network for Organ Sharing analysis.

Rare but Necessary: A Defense of Organ Allocation Out of Sequence in Heart Transplantation.

PurposeExtracorporeal membrane oxygenation (ECMO) patients have increased risk for limb acute compartment syndrome (ACS), but diagnosis remains difficult given the lack of subjective and pulsatility assessments in this patient population. This exploratory study characterized ECMO patients who developed ACS and investigated laboratory measures that can aid diagnosis.MethodsWe reviewed records of adult patients placed on ECMO between 2016 and 2022 at our single center, collecting clinical, laboratory, and survival data upon cannulation. We performed comparisons of baseline and laboratory data between ACS and No ACS patients. Threshold regression was then used to develop laboratory cutoffs for ACS diagnosis and logistic regression to characterize predictors of ACS. Survival analysis relied on Cox proportional hazards modeling.Results278 ECMO patients were included, of which 14 (5%) developed ACS. ACS patients had a higher amputation rate (21.4% vs 1.9%,  < 0.001) and mortality risk (HR 2.35,  = 0.03); only 1 (7%) ACS patient had amputation-free survival. The most sensitive threshold cutoffs included maximum INR >1.95 (sensitivity 0.91), baseline lactate >7.85 (0.88), and 24-h lactate >3.75 (0.88). The most specific were baseline CpK >3765.5 (specificity 0.91), maximum K >5.95 (0.88), and maximum CpK >6362.0 (0.85). Laboratory values, namely CpK and lactate, predicted ACS with promising diagnostic sensitivity and specificity.ConclusionsACS remains associated with increased mortality and morbidity, most often occurring within 24 h after cannulation. Laboratory values, namely CpK and lactate values, independently predicted ACS development with promising sensitivity and specificity. These exploratory findings may help guide decision-making surrounding ACS in the ECMO setting.

Article	Year
Racial Disparity in Cardiac Surgery Risk and Outcome: Report From a Statewide Quality Initiative. The Annals of thoracic surgery\| PubMed ID: 31962111	2020
Adding Mitral Valve Translocation to the Tool Kit for Treatment of Secondary Mitral Regurgitation. The Annals of thoracic surgery\| PubMed ID: 35339446	2022
How To Do It: Mitral Valve Translocation. Innovations (Philadelphia, Pa.)\| PubMed ID: 36988265	2023
Mitral Valve Translocation: A Novel Approach to Repair Secondary Mitral Regurgitation. Innovations (Philadelphia, Pa.)\| PubMed ID: 36988277	2023
Non-resectional cordal repair for Barlow mitral valve disease. The Journal of cardiovascular surgery\| PubMed ID: 38511306	2024
Understanding preservation time thresholds in the modern era of heart transplantation. Scientific reports\| PubMed ID: 40240451	2025
Outcomes of teenage donor hearts transplanted into adult heart transplant recipients: A United Network for Organ Sharing analysis. The Journal of thoracic and cardiovascular surgery\| PubMed ID: 40490214	2025
Rare but Necessary: A Defense of Organ Allocation Out of Sequence in Heart Transplantation. The American journal of bioethics : AJOB\| PubMed ID: 41533119	2026
Laboratory factors and diagnostic aids for compartment syndrome in extracorporeal membrane oxygenation: An exploratory single-center study. Perfusion\| PubMed ID: 41575012	2026

Chetan Pasrija

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