Mehmet H. Akay

The University of Texas Health Science Center at Houston

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Igor D. Gregorič

The University of Texas Health Science Center at Houston

Biswajit Kar

The University of Texas Health Science Center at Houston

Manish Kumar Patel

Centre for Plant Biotechnology and Genomics

Ismael A. Salas de Armas

The University of Texas Health Science Center at Houston

Bindu Akkanti

The University of Texas Health Science Center at Houston

Sriram Nathan

The University of Texas Health Science Center at Houston

Jayeshkumar Patel

The University of Texas Health Science Center at Houston

Rajko Radovancevic

The University of Texas Health Science Center at Houston

Marwan Jumean

Texas Medical Center

Ismael Salas de Armas

The University of Texas Health Science Center at Houston

Cooperative Institutions

The University of Texas Health Science Center at Houston

131

Memorial Hermann

Texas Medical Center

Cleveland Clinic

Baylor College of Medicine

Society of Thoracic Surgeons

The University of Texas MD Anderson Cancer Center

New York Proton Center

University of Houston

RELX Group (United States)

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Tracheostomy while on Extracorporeal Membrane Oxygenation: A Comparison of Percutaneous and Open Procedures.

Journal of ExtraCorporeal Technology (2020)

Ismael A. Salas de Armas Kha Dinh Bindu Akkanti Pushan Jani Reshma Hussain

Although the ideal timing of tracheostomy for critically ill patients is controversial, transitioning from an endotracheal tube can be beneficial. Concerns arise for patients under extracorporeal membrane oxygenation (ECMO) support. Studies have described percutaneous and open tracheostomy approaches for critically ill patients but, to our knowledge, have not compared the two specifically in ECMO patients. This study analyzed safety and aimed to identify if there was a difference in major bleeding or other tracheostomy-associated complications. A single-center retrospective cohort study of all patients who received tracheostomy while on ECMO from July 2013 to May 2019 was completed. The primary endpoint was a significant difference in the incidence of a major bleeding adverse event at 48 hours. Secondary endpoints included differences in the incidence of complications (e.g., procedure-related mortality, ECMO decannulation, tracheal/esophageal injury, and pneumothorax/pneumomediastinum) and survival to discharge. A secondary analysis separated the groups further by comparing those with bleeding events and those without. The study included 27 ECMO patients: 16 (59%) in the percutaneous arm and 11 in the open arm. The median number of ECMO days before tracheostomy was 10 vs. 13, respectively. There were no statistically significant differences between the two groups for major bleeding events (percutaneous 44% vs. open 27%, p = .45), procedure-related mortality, or procedure-related complications. Both percutaneous and open tracheostomies in patients on ECMO require a multidisciplinary approach to minimize adverse effects. Major bleeding does occur, but there was no statistically significant correlation between bleeding events and the type of the tracheostomy approach. Thus, both open and percutaneous tracheostomy approaches have a favorable safety profile.

Pneumomediastinum

Clinical endpoint

10.1182/ject-2000027

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Citations (3)

Thoracic Compartment Syndrome: A Case Report

The Heart Surgery Forum (2012)

Mehmet H. Akay O.H. Frazier

Thoracic compartment syndrome has been observed after trauma and after mediastinal and cardiac procedures; however, an adult respiratory distress syndrome (ARDS)-like presentation has not been described as a part of thoracic compartment syndrome. We describe the case of an obese patient who underwent coronary artery bypass (his third such procedure) and hiatal hernia reduction during the same operation, followed by transmyocardial laser revascularization and full chest closure the next day. The patient was hypoxic after chest closure. Two days later, his peak airway pressure increased, and his cardiac and urine outputs decreased. Chest radiography findings suggested ARDS without hemodynamic instability. After we reopened the sternal incisions, the patient's symptoms reversed. Although our patient initially appeared to have ARDS, we believe the organ-volume displacement that occurred during the lengthy dual operation produced a thoracic and abdominal compartment syndrome that responded to decompression of the chest.

Abdominal Compartment Syndrome

Hiatal Hernia

Compartment (ship)

10.1532/hsf98.20111071

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Inter-Institutional Collaboration Between Quaternary and Tertiary Hospitals: Cardiac Surgery Impact

The Heart Surgery Forum (2022)

Mehmet H. Akay Ismael Salas de Armas Maria Patarroyo-Aponte Manish Kumar Patel Jayeshkumar Patel

Background: An inter-institutional collaboration between a quaternary hospital (QH) with a high volume of cardiac surgery and a community-based, tertiary hospital (TH) with a newly established cardiac surgery program was established. Methods: We retrospectively reviewed data of patients admitted to the TH between September 2015 and June 2017 for cardiac surgery. The decision to transfer a patient to the QH was based on a Society of Thoracic Surgeon-Predicted Risk of Mortality (STS-PROM) score of ≥ 3%, the potential need for hemodialysis, and other risk factors. The same team of surgeons performed operations at both hospitals. We analyzed the perioperative outcomes of the patients and the referral pattern. Results: A total of 116 patients met eligibility criteria; 105 underwent surgery at the TH, while 11 were transferred to the QH. Among the 11 patients transferred to the QH, eight had a score of 3% (median = 8.2 [IQR 5.7-25.0]). The patients transferred to the QH prior to surgery had a significantly higher STS-PROM score (P = ≤ .001). Overall, the mortality of patients who underwent surgery at the TH was 0.9% (1/105); while surgeries at the QH had a mortality rate of 0% (0/11). Conclusion: The collaborative effort between high-volume cardiac surgery programs and emerging community-based hospitals showed acceptable outcomes in perioperative cardiac surgical mortality. Elevated STS-PROM scores (>3%), previous sternotomy and anticipation of coagulopathy, and low left ventricular ejection fraction or dilated ventricles are factors that influenced the need to transfer from a TH to QH.

Prom

10.1532/hsf.4723

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Left Ventricular Assist Device Outflow Graft Obstruction: A Case Series

ASAIO Journal (2019)

Sriram Nathan Amaninderapal S. Ghotra Keshava Rajagopal Chandni Patel Sachin Kumar

Dysfunction of different components within continuous-flow (CF) left ventricular assist device (LVAD) systems may cause adverse cardiovascular and end-organ sequelae. Outflow graft obstruction is a recognized type of LVAD component dysfunction. Ten patients were admitted and treated for LVAD outflow graft obstruction. Two of these patients subsequently developed recurrent outflow graft obstruction requiring reintervention; however, each reoccurrence was at a different site than the original obstruction. Thus, a total of 12 cases of obstruction were analyzed. The most common reasons for hospital admission were low flow LVAD alarms or decompensated heart failure. Presentation with outflow graft obstruction occurred an average of 3.0 years after LVAD implantation. Patients underwent echocardiographic evaluation at the time of admission. Left ventricular assist device component dysfunction was suspected based on echocardiographic findings, and follow-up contrast studies were used to establish the specific diagnosis of outflow graft stenosis. The majority of stenotic lesions (10/12) were treated percutaneously with balloon angioplasty and stenting with balloon-expandable endovascular prostheses. Postintervention, all patients had significant improvement in LVAD flow rates.

Outflow

10.1097/mat.0000000000001060

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Left Ventricular Rupture After Impella® Placement During High-Risk Percutaneous Coronary Intervention

Cardiovascular revascularization medicine (2019)

Ismael A. Salas de Armas Sachin Kumar Ahmed Almustafa Bindu Akkanti Mehmet H. Akay

Impella

Perforation

10.1016/j.carrev.2019.06.011

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Citations (4)

The use of veno-arterial extracorporeal membrane oxygenation in the octogenarian population: A single-center experience

Perfusion (2022)

Ismael A. Salas de Armas Linda Holifield Lisa Janowiak Mehmet H. Akay Maria Patarroyo

Advanced age is a known risk factor for poor outcomes after veno-arterial extracorporeal membrane oxygenation (V-A ECMO) for cardiac support. The use of ECMO support in patients over the age of 80 is controversial, and sometimes its use is contraindicated. We aimed to assess the use of ECMO in octogenarian patients to determine survival and complication rates.A single-center, retrospective analysis was completed at a large, urban academic medical center. Patients requiring V-A ECMO support between December of 2012 and November of 2019 were included as long as the patient was at least 80 years of age at the time of cannulation. Post cardiotomy shock patients were excluded.A total of 46 patients met eligibility criteria; all received V-A ECMO support. Overall, the majority of patients (71.7%; 33/46) survived to decannulation, and 43.5% (20/46) survived to discharge. Patients who were previously rescued from percutaneous interventions tend to have a better survival than other patients (p = .06). The most common complications were renal and hemorrhagic.We demonstrated that advanced age alone should not disqualify patients from cannulating and supporting with V-A ECMO.

Cardiotomy

Single Center

Contraindication

10.1177/02676591221111506

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Citations (4)

Kardiyopulmoner Bypass ve Destek Cihazları Uygulamaları

Turkiye Klinikleri Cardiovascular Surgery - Special Topics (2013)

Mehmet H. Akay

Source

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Impella CP to Impella 5.5 Uninterrupted Upgrade Using a Double Device Technique

ASAIO Journal (2021)

Ismael Salas de Armas Manish Kumar Patel Mehmet H. Akay Jayeshkumar Patel Branislav Stojkovic

For the first time, we present a novel technique that enables the exchange of the Impella CP (Abiomed Inc., Danvers, Massachusetts, USA) to the Impella 5.5 (Abiomed Inc.) with no interruption of mechanical support in patients with minimal left ventricular reserve. Specifically, the aortic valve is crossed with the Impella 5.5 whereas the Impella CP is still functioning within the left ventricle. The Impella 5.5 is then initiated, and the Impella CP is weaned. Finally, the Impella CP is pulled out into the descending aorta. This exchange provides continuous support with no hemodynamic disarrangement.

Impella

10.1097/mat.0000000000001587

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Use of Antihypertensive Medications in Left Ventricular Assist Device Patients Who Undergo Sleeve Gastrectomy

The Journal of Heart and Lung Transplantation (2020)

Marwan Jumean Aashini R Patel Sriram Nathan Sachin Kumar Mehmet H. Akay

Concomitant

Sleeve gastrectomy

Morbidly obese

Demographics

10.1016/j.healun.2020.01.398

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Use of Percutaneous Left Ventricular Assist Device Before Durable Device Implantation in Patients With Cardiac Cachexia: Case Series

ASAIO Journal (2023)

Ismael A. Salas de Armas Amanda Bergeron Bindu Akkanti Mehmet H. Akay Alison Scovell

Frailty and malnutrition in patients with heart failure are barriers to durable left ventricular assist device (D-LVAD) support and heart transplantation. Moreover, cachexia in patients with advanced heart failure carries a high mortality risk. There are no guidelines for these patients other than increased caloric intake and rehabilitation. Patients suffering from cardiac cachexia and heart failure may benefit from temporary, percutaneous assist device support to improve the underlying heart disease and reverse the catabolic state. We retrospectively reviewed patients from January 2017 to January 2022. All patients who received Impella support (5.0 or 5.5, Abiomed) before D-LVAD implantation were screened. Those who met the criteria for cardiac cachexia were included. Patient demographics, nutritional and biochemical markers, and survival data were collected. A total of 14 patients were included. The majority of patients were male (85.7%) with ischemic cardiomyopathy (64.3%). Caloric intake, physical strength, and ambulation improved. Prealbumin levels improved from a median of 13.7–18.0 mg/dl ( p < 0.006) while on Impella 5.0 or 5.5 support. All patients survived to discharge and the 6 month follow-up. In conclusion, use of the Impella device improves cardiogenic shock symptoms and, consequently, may improve cachexia status prior to D-LVAD implantation.

Impella

10.1097/mat.0000000000001902

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Citations (7)