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Ashish S Shah

Publications and source records attributed to Ashish S Shah.

10 recordsLinked to original sources
PubMed2006

Marginal cardiac allografts do not have increased primary graft dysfunction in alternate list transplantation.

BACKGROUND: Clinical success with modern heart transplantation (HT) has led to the development of an alternate list (AL) HT strategy, matching marginal cardiac allografts with recipients who do not meet standard criteria for HT. Marginal allografts may be at an increased risk for primary graft dysfunction (PGD), the leading cause of early mortality after HT.(1) The incidence of PGD in AL HT relative to standard list (SL) HT has not been evaluated, and may contribute to the greater mortality associated with AL HT.(2) The objective of this study was to determine the incidence of and predictors for PGD. METHODS AND RESULTS: A retrospective analysis was performed on 260 consecutive adult patients undergoing either SL HT (n=207) or AL HT (n=53) at our institution from 1/2000 to 1/2005. PGD was defined by requirement for mechanical circulatory support immediately post-HT or more broadly as the need for either mechanical support or high-dose inotrope (epinephrine > or = 0.07 microg/kg/min). Donor hearts allocated to AL recipients were turned down for SL HT for reasons that included coronary disease, left ventricular dysfunction or hypertrophy, and high-dose inotropic requirement. AL HT recipients were significantly older, with a higher proportion of diabetes mellitus and ischemic cardiomyopathy. Both groups experienced a similar incidence of significant rejection, but overall mortality was higher in the AL HT group. (2) The incidence of PGD did not differ between AL and SL HT recipients. Pre-transplant VAD and prolonged total ischemic times (> or = 4.5 hours) were independent predictors of PGD. CONCLUSIONS: Select marginal donor hearts used in AL HT do not have an increased incidence of PGD. Pre-transplant VAD and prolonged ischemic times are more important determinants of PGD. These data support continued aggressive utilization of marginal donor hearts in AL HT.

Adult↗
PubMed2006

Invited commentary.

Explore the source record for details and available documents.

Adrenergic beta-Agonists↗
PubMed2005

Isolated mitral valve repair in patients with depressed left ventricular function.

BACKGROUND: The utility of mitral valve repair (MV repair) has been well documented in patients with normal left ventricular function. Few studies, however, have specifically examined outcomes of isolated MV repair in patients with decreased left ventricular function. The purpose of the present study is to review a modern experience with isolated MV repair in patients with depressed left ventricular function and to examine intermediate outcomes. METHODS: A retrospective review of patients who underwent MV repair from 1996 to 2003 was performed to identify consecutive patients who had isolated MV repair. Preoperative studies were reviewed to further identify patients with an ejection fraction less than 0.45. Clinical operative data were collected from the medical record, and survival was determined with the Social Security Death Index. Further end points of reoperation and transplantation were also noted. RESULTS: A total of 101 patients were identified with a mean follow-up of 1,124 days. Mean ejection fraction and age was 0.34 +/- 0.09 and 56 +/- 14 years, respectively. Thirty-day mortality was 2.9%. One- and 5-year survival was 94% +/- 2% and 70% +/- 6%, respectively. There was no statistically significant difference in actuarial survival for functional versus primary mitral disease, or for ejection fraction less than 0.35 versus greater than 0.35. Six patients required transplantation. Five-year freedom from reoperation, transplantation, and death was 61% +/- 11% and 54% +/- 8% for patients with primary and secondary mitral valve disease, respectively (p = 0.279). Minimally invasive MV repair was performed in 57 patients with a mean ejection fraction of 0.369 +/- 0.07 and a 30-day mortality of 1.7%. CONCLUSIONS: In patients with isolated MV regurgitation and depressed left ventricular function, MV repair can be achieved with low operative mortality, but there remains a persistent risk of death, reoperation, or transplantation irrespective of valve disease. Minimally invasive MV repair was safe in this group.

Cardiac Surgical Procedures↗
PubMed2004

Reducing hospital morbidity and mortality following esophagectomy.

BACKGROUND: Esophagogastrectomy (EG) is a formidable operation with significant morbidity and mortality rates. Risk factor analyses have been performed, but few studies have produced strategies that have improved operative results. This study was performed in order to identify prognostic variables that might be used to develop a strategy for optimizing outcomes after EG. METHODS: The records of all patients (n = 379) who underwent EG patients at a tertiary medical center between 1996 and 2002 were retrospectively reviewed. Thirty-day morbidity and mortality were determined, and multivariable logistical regression analysis assessed the effect of preoperative and postoperative variables on early mortality. RESULTS: Operations included Ivor Lewis (n = 179), transhiatal (n = 130), and other approaches (n = 70). Operative mortality was 5.8%; 64% experienced complications, including respiratory complications (28.5%), anastamotic strictures (25%), and leak (14%). Increasing age, anastomotic leak, Charlson comorbidity index 3, worse swallowing scores, and pneumonia were associated with increased risk of mortality by univariate analysis. However, only age (p = 0.002) and pneumonia (p = 0.0008) were independently associated with mortality by multivariable analysis. Pneumonia was associated with a 20% incidence of death. Patients with pneumonia had significantly worse deglutition and anastomotic integrity on barium esophagogram compared with patients without pneumonia (p < 0.001, Mann-Whitney rank sum test). CONCLUSIONS: Morbidity and mortality of EG are significant, but most complications, including anastomotic leak, are not independent predictors of mortality. The most important complication after EG is pneumonia. Strategies to decrease postoperative mortality should include careful assessment of swallowing abnormalities and predisposition to aspiration by cineradiography or fiberoptic endoscopy. After EG, acceptable pharyngeal function and airway protection should be verified before resuming oral intake.

Adenocarcinoma↗
PubMed2004

Right ventricular targeted gene transfer of a beta-adrenergic receptor kinase inhibitor improves ventricular performance after pulmonary artery banding.

OBJECTIVE: Abrupt increases in right ventricular afterload occur after cardiac transplantation and pulmonary artery banding, which can result in right ventricular hypertrophy and dilatation. Right ventricular dysfunction is also accompanied by beta-adrenergic receptor desensitization. We sought to determine whether selective right ventricular expression of a transgene encoding a beta-adrenergic receptor kinase inhibitor can improve right ventricular remodeling early after pulmonary artery banding. METHODS: Rabbits underwent pulmonary artery banding 3 days after percutaneous right coronary artery injection of empty adenovirus (n = 19), a control adenovirus containing the beta-galactosidase transgene (n = 10), or an adenovirus containing the beta-adrenergic receptor kinase inhibitor transgene (n = 14). Sham-operated animals (n = 7) underwent instrumentation without deployment of the pulmonary artery band. Right ventricular function was assessed in each rabbit before and 7 days after pulmonary artery banding. Right ventricular mass and dimensions (surface area and volume) were obtained, and biochemical analysis was performed to confirm transgene expression and to characterize beta-adrenergic receptor signaling. RESULTS: Right ventricular mass was increased in animals treated with adenovirus containing the beta-adrenergic receptor kinase inhibitor transgene, adenovirus containing the beta-galactosidase transgene, and empty adenovirus after banding when compared with results in sham-operated animals. However, right ventricular volume and surface area, as measures of dilatation, were significantly lower in pulmonary artery banded rabbits pretreated with adenovirus containing the beta-adrenergic receptor kinase inhibitor transgene when compared with those treated with empty adenovirus or adenovirus containing the beta-galactosidase transgene. Right ventricular contractility and defective beta-adrenergic receptor signaling were significantly enhanced in rabbits expressing the beta-adrenergic receptor kinase inhibitor after pulmonary artery banding. CONCLUSIONS: Right ventricular preconditioning with the beta-adrenergic receptor kinase inhibitor transgene can attenuate the early right ventricular dilatation and dysfunction associated with pulmonary artery banding. Thus beta-adrenergic receptor kinase inhibition might represent a novel target for limiting ventricular remodeling after increased right ventricular afterload.

Adenoviridae↗
PubMed2003

Real-time three-dimensional echocardiography to construct clinically ready, load-independent indices of myocardial contractile performance.

BACKGROUND: Real-time 3-dimensional echocardiography (RT3DE) reliably determines intracardiac chamber volumes without left ventricular (LV) geometric assumptions, yet clinical assessment of contractile performance is often on the basis of potentially inaccurate, load-dependent indices such as ejection fraction. METHODS: In 6 chronically instrumented dogs, RT3DE estimated LV volumes at various loading conditions. Preload recruitable stroke work and end-systolic pressure-volume relationships were constructed. RT3DE-derived indices were compared with similar relationships determined by sonomicrometry. RESULTS: Highly linear preload recruitable stroke work and end-systolic pressure-volume relationships were constructed by RT3DE and sonomicrometry. Mean preload recruitable stroke work slopes correlated between methods, but volume intercepts differed as a result of geometric assumptions of sonomicrometry. Conversely, RT3DE-derived end-systolic pressure-volume relationships did not correlate well with sonomicrometry. CONCLUSIONS: These data are unique in reporting load-independent measures of LV performance using RT3DE. These techniques would strengthen evaluation of LV function after myocardial ischemia or cardiac operation, in which frequent changes in ventricular geometry or loading conditions confound functional assessment by more traditional methods.

Animals↗
PubMed2003

Catheter-based intracoronary myocardial adenoviral gene delivery: importance of intraluminal seal and infusion flow rate.

Although percutaneous, adenoviral-mediated intracoronary gene delivery to the heart has been demonstrated in some species, consistent and safe methodology is needed before clinical applicability is possible. In this study, we examine the effects of altering intracoronary flow rate and obtaining an adequate seal between the catheter and the coronary lumen on successful cardiac gene delivery and myocardial injury in both piglets and adult rabbits. To study the efficacy of in vivo myocardial gene transfer, we utilized adenoviral vectors containing either the beta(2)-adrenergic receptor or beta-galactosidase. The left circumflex coronary artery of piglets and the right coronary artery of rabbits were catheterized under fluoroscopic guidance and adenovirus solutions were injected using varying flow rates with or without balloon inflation. Successful transgene delivery to the heart was determined approximately 1 week after coronary infusions. Histologic analysis was also performed in all animals to determine the extent of myocardial injury. Our results indicate that efficient and reproducible cardiac transgene expression utilizing intracoronary delivery is dependent upon the infusion flow rate and, in larger animals, requires an intraluminal seal. Excessive flow rate is associated with greater myocardial injury. Thus, conditions can be established and controlled to improve future investigational and clinical application of catheter-based intracoronary myocardial gene therapy.

Adenoviridae↗