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Article ; Online: Health System Needs to Establish Cardiac Surgery Centers.

Vervoort, Dominique / Premkumar, Akash / Ghandour, Hiba / Kpodonu, Jacques

2021 Volume 69, Issue 8, Page(s) 729–732

Abstract: Cardiovascular diseases are the leading cause of mortality worldwide, responsible for nearly 18 million deaths each year. More than 80% of these take place in low- and middle-income countries (LMICs), where access to cardiac surgical services is scarce. ... ...

Abstract	Cardiovascular diseases are the leading cause of mortality worldwide, responsible for nearly 18 million deaths each year. More than 80% of these take place in low- and middle-income countries (LMICs), where access to cardiac surgical services is scarce. Approximately 93% of the LMIC population, or six billion people worldwide, are estimated to lack access to safe, timely, and affordable cardiac surgical care as a result of workforce, infrastructure, financial, and quality barriers. Various models have been proposed and attempted to establish cardiac surgery centers in LMICs; however, only some have been successful in achieving sustainable local services. Here, we describe the workforce, infrastructure, financial, and political needs and considerations from a health systems perspective to establish a cardiac surgery center.
MeSH term(s)	Cardiac Surgical Procedures ; Cardiovascular Diseases ; Developing Countries ; Global Health ; Humans ; Treatment Outcome
Language	English
Publishing date	2021-01-09
Publishing country	Germany
Document type	Journal Article
ZDB-ID	800050-5
ISSN	1439-1902 ; 0171-6425 ; 0946-4778 ; 0172-6137
ISSN (online)	1439-1902
ISSN	0171-6425 ; 0946-4778 ; 0172-6137
DOI	10.1055/s-0040-1721395
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Article ; Online: When a Pacemaker Leads to a New Diagnosis.

Paneitz, Dane C / Premkumar, Akash / Stefanescu Schmidt, Ada C / Cameron, Duke E / Bloom, Jordan P

Circulation. Cardiovascular imaging

2022 Volume 15, Issue 7, Page(s) e013995

MeSH term(s)	Heart Defects, Congenital ; Heart Septal Defects, Atrial ; Humans ; Pacemaker, Artificial/adverse effects
Language	English
Publishing date	2022-06-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2435045-X
ISSN	1942-0080 ; 1941-9651
ISSN (online)	1942-0080
ISSN	1941-9651
DOI	10.1161/CIRCIMAGING.122.013995
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Article ; Online: Does Failure to Rescue Drive Race/Ethnicity-based Disparities in Survival After Heart Transplantation?

Abrahim, Orit / Premkumar, Akash / Kubi, Boateng / Wolfe, Stanley B / Paneitz, Dane C / Singh, Ruby / Thomas, Jason / Michel, Eriberto / Osho, Asishana A

Annals of surgery

2023 Volume 279, Issue 2, Page(s) 361–365

Abstract: Objective: The objective was to assess whether race/ethnicity is an independent predictor of failure to rescue (FTR) after orthotopic heart transplantation (OHT).: Summary background data: Outcomes following OHT vary by patient level factors; for ... ...

Abstract	Objective: The objective was to assess whether race/ethnicity is an independent predictor of failure to rescue (FTR) after orthotopic heart transplantation (OHT). Summary background data: Outcomes following OHT vary by patient level factors; for example, non-White patients have worse outcomes than White patients after OHT. Failure to rescue is an important factor associated with cardiac surgery outcomes, but its relationship to demographic factors is unknown. Methods: Using the United Network for Organ Sharing database, we included all adult patients who underwent primary isolated OHT between 1/1/2006 snd 6/30/2021. FTR was defined as the inability to prevent mortality after at least one of the UNOS-designated postoperative complications. Donor, recipient, and transplant characteristics, including complications and FTR, were compared across race/ethnicity. Logistic regression models were created to identify factors associated with complications and FTR. Kaplan Meier and adjusted Cox proportional hazards models evaluated the association between race/ethnicity and posttransplant survival. Results: There were 33,244 adult, isolated heart transplant recipients included: the distribution of race/ethnicity was 66% (n=21,937) White, 21.2% (7,062) Black, 8.3% (2,768) Hispanic, and 3.3% (1,096) Asian. The frequency of complications and FTR differed significantly by race/ethnicity. After adjustment, Hispanic recipients were more likely to experience FTR than White recipients (OR 1.327, 95% CI[1.075-1.639], P =0.02). Black recipients had lower 5-year survival compared with other races/ethnicities (HR 1.276, 95% CI[1.207-1.348], P <0.0001). Conclusions: In the US, Black recipients have an increased risk of mortality after OHT compared with White recipients, without associated differences in FTR. In contrast, Hispanic recipients have an increased likelihood of FTR, but no significant mortality difference compared with White recipients. These findings highlight the need for tailored approaches to addressing race/ethnicity-based health inequities in the practice of heart transplantation.
MeSH term(s)	Adult ; Humans ; Cardiac Surgical Procedures ; Ethnicity ; Heart Transplantation/mortality ; Retrospective Studies ; Tissue Donors ; Racial Groups ; Survival ; Health Status Disparities
Language	English
Publishing date	2023-05-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000005890
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Article: Health System Needs to Establish Cardiac Surgery Centers

Vervoort, Dominique / Premkumar, Akash / Ghandour, Hiba / Kpodonu, Jacques

The Thoracic and Cardiovascular Surgeon

2021 Volume 69, Issue 08, Page(s) 729–732

Abstract	Cardiovascular diseases are the leading cause of mortality worldwide, responsible for nearly 18 million deaths each year. More than 80% of these take place in low- and middle-income countries (LMICs), where access to cardiac surgical services is scarce. Approximately 93% of the LMIC population, or six billion people worldwide, are estimated to lack access to safe, timely, and affordable cardiac surgical care as a result of workforce, infrastructure, financial, and quality barriers. Various models have been proposed and attempted to establish cardiac surgery centers in LMICs; however, only some have been successful in achieving sustainable local services. Here, we describe the workforce, infrastructure, financial, and political needs and considerations from a health systems perspective to establish a cardiac surgery center.
Keywords	health system ; cardiac surgery ; health policies
Language	English
Publishing date	2021-01-09
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	800050-5
ISSN	1439-1902 ; 0171-6425 ; 0946-4778 ; 0172-6137
ISSN (online)	1439-1902
ISSN	0171-6425 ; 0946-4778 ; 0172-6137
DOI	10.1055/s-0040-1721395
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Article ; Online: Textbook outcome: A novel metric in heart transplantation outcomes.

Zakko, Jason / Premkumar, Akash / Logan, April J / Sneddon, Jeffrey M / Brock, Guy N / Pawlik, Timothy M / Mokadam, Nahush A / Whitson, Bryan A / Lampert, Brent C / Washburn, William K / Osho, Asishana A / Ganapathi, Asvin M / Schenk, Austin D

The Journal of thoracic and cardiovascular surgery

2023 Volume 167, Issue 3, Page(s) 1077–1087.e13

Abstract: Objective: Assessing heart transplant program quality using short-term survival is insufficient. We define and validate the composite metric textbook outcome and examine its association with overall survival.: Methods: We identified all primary, ... ...

Abstract	Objective: Assessing heart transplant program quality using short-term survival is insufficient. We define and validate the composite metric textbook outcome and examine its association with overall survival. Methods: We identified all primary, isolated adult heart transplants in the United Network for Organ Sharing/Organ Procurement and Transplantation Network Standard Transplant Analysis and Research files from May 1, 2005, to December 31, 2017. Textbook outcome was defined as length of stay 30 days or less; ejection fraction greater than 50% during 1-year follow-up; functional status 80% to 100% at 1 year; freedom from acute rejection, dialysis, and stroke during the index hospitalization; and freedom from graft failure, dialysis, rejection, retransplantation, and mortality during the first year post-transplant. Univariate and multivariate analyses were performed. Factors independently associated with textbook outcome were used to create a predictive nomogram. Conditional survival at 1 year was measured. Results: A total of 24,620 patients were identified with 11,169 (45.4%, 95% confidence interval, 44.7-46.0) experiencing textbook outcome. Patients with textbook outcome were more likely free from preoperative mechanical support (odds ratio, 3.504, 95% confidence interval, 2.766 to 4.439, P < .001), free from preoperative dialysis (odds ratio, 2.295, 95% confidence interval, 1.868-2.819, P < .001), to be not hospitalized (odds ratio, 1.264, 95% confidence interval, 1.183-1.349, P < .001), to be nondiabetic (odds ratio, 1.187, 95% confidence interval, 1.113-1.266, P < .001), and to be nonsmokers (odds ratio, 1.160, 95% confidence interval,1.097-1.228, P < .001). Patients with textbook outcome have improved long-term survival relative to patients without textbook outcome who survive at least 1 year (hazard ratio for death, 0.547, 95% confidence interval, 0.504-0.593, P < .001). Conclusions: Textbook outcome is an alternative means of examining heart transplant outcomes and is associated with long-term survival. The use of textbook outcome as an adjunctive metric provides a holistic view of patient and center outcomes.
MeSH term(s)	Adult ; Humans ; Treatment Outcome ; Renal Dialysis ; Heart Transplantation/adverse effects ; Proportional Hazards Models ; Multivariate Analysis ; Graft Survival ; Retrospective Studies
Language	English
Publishing date	2023-02-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2023.02.019
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Article ; Online: Reoperative Mitral Surgery Versus Transcatheter Mitral Valve Replacement: A Systematic Review.

Sengupta, Aditya / Yazdchi, Farhang / Alexis, Sophia L / Percy, Edward / Premkumar, Akash / Hirji, Sameer / Bapat, Vinayak N / Bhatt, Deepak L / Kaneko, Tsuyoshi / Tang, Gilbert H L

Journal of the American Heart Association

2021 Volume 10, Issue 6, Page(s) e019854

Abstract: Bioprosthetic mitral structural valve degeneration and failed mitral valve repair (MVr) have traditionally been treated with reoperative mitral valve surgery. Transcatheter mitral valve-in-valve (MVIV) and valve-in-ring (MVIR) replacement are now ... ...

Abstract	Bioprosthetic mitral structural valve degeneration and failed mitral valve repair (MVr) have traditionally been treated with reoperative mitral valve surgery. Transcatheter mitral valve-in-valve (MVIV) and valve-in-ring (MVIR) replacement are now feasible, but data comparing these approaches are lacking. We sought to compare the outcomes of (1) reoperative mitral valve replacement (redo-MVR) and MVIV for structural valve degeneration, and (2) reoperative mitral valve repair (redo-MVr) or MVR and MVIR for failed MVr. A literature search of PubMed, Embase, and the Cochrane Library was conducted up to July 31, 2020. Thirty-two studies involving 25 832 patients were included. Redo-MVR was required in ≈35% of patients after index surgery at 10 years, with 5% to 15% 30-day mortality. MVIV resulted in >95% procedural success with 30-day and 1-year mortality of 0% to 8% and 11% to 16%, respectively. Recognized complications included left ventricular outflow tract obstruction (0%-6%), valve migration (0%-9%), and residual regurgitation (0%-6%). Comparisons of redo-MVR and MVIV showed no statistically significant differences in mortality (11.3% versus 11.9% at 1 year,
MeSH term(s)	Cardiac Catheterization/methods ; Heart Valve Diseases/surgery ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation/methods ; Humans ; Mitral Valve/surgery ; Reoperation
Language	English
Publishing date	2021-03-09
Publishing country	England
Document type	Journal Article ; Systematic Review
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.120.019854
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Article ; Online: Management and outcomes of esophageal perforation.

Axtell, Andrea L / Gaissert, Henning A / Morse, Christopher R / Premkumar, Akash / Schumacher, Lana / Muniappan, Ashok / Ott, Harald / Allan, James S / Lanuti, Michael / Mathisen, Douglas J / Wright, Cameron D

Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus

2021 Volume 35, Issue 1

Abstract: Background: Esophageal perforation is a morbid condition and remains a therapeutic challenge. We report the outcomes of a large institutional experience with esophageal perforation and identify risk factors for morbidity and mortality.: Methods: A ... ...

Abstract	Background: Esophageal perforation is a morbid condition and remains a therapeutic challenge. We report the outcomes of a large institutional experience with esophageal perforation and identify risk factors for morbidity and mortality. Methods: A retrospective analysis was conducted on 142 patients who presented with a thoracic or gastroesophageal junction esophageal perforation from 1995 to 2020. Baseline characteristics, operative or interventional strategies, and outcomes were analyzed by etiology of the perforation and management approach. Multivariable cox and logistic regression models were constructed to identify predictors of mortality and morbidity. Results: Overall, 109 (77%) patients underwent operative intervention, including 80 primary reinforced repairs and 21 esophagectomies and 33 (23%) underwent esophageal stenting. Stenting was more common in iatrogenic (27%) and malignant (64%) perforations. Patients who presented with a postemetic or iatrogenic perforation had similar 90-day mortality (16% and 16%) and composite morbidity (51% and 45%), whereas patients who presented with a malignant perforation had a 45% 90-day mortality and 45% composite morbidity. Risk factors for mortality included age >65 years (hazard ratio [HR] 1.89 [1.02-3.26], P = 0.044) and a malignant perforation (HR 4.80 [1.31-17.48], P = 0.017). Risk factors for composite morbidity included pleural contamination (odds ratio [OR] 2.06 [1.39-4.43], P = 0.046) and sepsis (OR 3.26 [1.44-7.36], P = 0.005). Of the 33 patients who underwent stent placement, 67% were successfully managed with stenting alone and 30% required stent repositioning. Conclusions: Risk factors for morbidity and mortality after esophageal perforation include advanced age, pleural contamination, septic physiology, and malignant perforation. Primary reinforced repair remains a reasonable strategy for patients with an esophageal perforation from a benign etiology.
MeSH term(s)	Aged ; Esophageal Perforation/etiology ; Esophageal Perforation/surgery ; Esophagectomy/adverse effects ; Humans ; Retrospective Studies ; Stents ; Treatment Outcome
Language	English
Publishing date	2021-07-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	639470-x
ISSN	1442-2050 ; 1120-8694
ISSN (online)	1442-2050
ISSN	1120-8694
DOI	10.1093/dote/doab039
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Article ; Online: Quantifying the impact of surgical decompression on quality of life and identification of factors associated with outcomes in patients with symptomatic metastatic spinal cord compression.

Lak, Asad M / Rahimi, Amina / Abunimer, Abdullah M / Tafel, Ian / Devi, Sharmila / Premkumar, Akash / Ida, Fidelia / Lu, Yi / Chi, John H / Tanguturi, Shyam / Groff, Michael W / Zaidi, Hasan A

Journal of neurosurgery. Spine

2020 Volume 33, Issue 2, Page(s) 237–244

Abstract: Objective: Metastatic spinal cord compression (MSCC) imposes significant impairment on patient quality of life and often requires immediate surgical intervention. In this study the authors sought to estimate the impact of surgical intervention on ... ...

Abstract	Objective: Metastatic spinal cord compression (MSCC) imposes significant impairment on patient quality of life and often requires immediate surgical intervention. In this study the authors sought to estimate the impact of surgical intervention on patient quality of life in the form of mean quality-adjusted life years (QALY) gained and identify factors associated with positive outcomes. Methods: The authors performed a retrospective chart review and collected data for patients who had neurological symptoms resulting from radiologically and histologically confirmed MSCC and were treated with surgical decompression during the last 12 years. Results: A total of 151 patients were included in this study (mean age 60.4 years, 57.6% males). The 5 most common metastatic tumor types were lung, multiple myeloma, renal, breast, and prostate cancer. The majority of patients had radioresistant tumors (82.7%) and had an active primary site at presentation (67.5%). The median time from tumor diagnosis to cord compression was 12 months and the median time from identification of cord compression to death was 4 months. Preoperative presenting symptoms included motor weakness (70.8%), pain (70.1%), sensory disturbances (47.6%), and bowel or bladder disturbance (31.1%). The median estimated blood loss was 500 mL and the average length of hospital stay was 10.3 days. About 18% of patients had postoperative complications and the mean follow-up was 7 months. The mean pre- and postoperative ECOG (Eastern Cooperative Oncology Group) performance status grades were 3.2 and 2.4, respectively. At follow-up, 58.3% of patients had improved status, 31.5% had no improvement, and 10.0% had worsening of functional status. The mean QALY gained per year in the entire cohort was 0.55. The mean QALY gained in the first 6 months was 0.1 and in the first year was 0.4. For patients who lived 1-2, 2-3, 3-4, or 4-5 years, the mean QALY gained were 0.8, 1.4, 1.7, and 2.3, respectively. Preoperative motor weakness, bowel dysfunction, bladder dysfunction, and ASA (American Society of Anesthesiologists) class were identified as independent predictors inversely associated with good outcome. Conclusions: The mean QALY gained from surgical decompression in the first 6 months and first year equals 1.2 months and 5 months of life in perfect health, respectively. These findings suggest that surgery might also be beneficial to patients with life expectancy < 6 months.
Language	English
Publishing date	2020-04-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2158643-3
ISSN	1547-5646 ; 1547-5654
ISSN (online)	1547-5646
ISSN	1547-5654
DOI	10.3171/2020.1.SPINE191326
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