Melissa C. Smallfield

University Health System

Author Statistics

Papers

Citation

H-Index

i-10 index

Research Trends

Author Order

Document Type

Co-Authors

Keyur B. Shah

Virginia Commonwealth University

Vigneshwar Kasirajan

Virginia Commonwealth University

Mohammed Quader

Virginia Commonwealth University

Daniel Tang

Alaska Heart and Vascular Institute

Salpy V. Pamboukian

University of Washington

Richard H. Cooke

Virginia Commonwealth University

James K. Kirklin

University of Alabama at Birmingham

Inna Tchoukina

Virginia Commonwealth University

José Tallaj

University of Alabama at Birmingham

James F. George

University of Alabama at Birmingham

Cooperative Institutions

Virginia Commonwealth University

University Health System

Virginia Commonwealth University Medical Center

Children's Hospital of Richmond at VCU

Hunter Holmes McGuire VA Medical Center

University of Alabama at Birmingham

University of Michigan–Ann Arbor

University of Richmond

University of Virginia

University of Alabama

Author Statistics

Papers

Citation

H-Index

i-10 index

Research Field

Surveillance Endomyocardial Biopsy in the Modern Era Produces Low Diagnostic Yield for Cardiac Allograft Rejection

Transplantation (2015)

Keyur B. Shah Maureen Flattery Melissa C. Smallfield Grace Merinar Daniel Tang

The changing epidemiology of cardiac allograft rejection has prompted many to question the yield of surveillance endomyocardial biopsy (EMB) in heart transplantation (HT) patients. We sought to determine the yield of EMB in the modern era.We evaluated 2597 EMBs in 182 consecutive HT patients who survived to their first EMB. The EMBs were categorized as asymptomatic or clinically driven and were compared based on era of antiproliferative therapy use at our center (early azathioprine era: 1990-2000 vs modern mycophenolate era: 2000-2011).In the modern era, patients had a higher prevalence of risk factors for developing rejection (≥ International Society of Heart and Lung Transplantation grade 2R); however, the frequency of rejection was decreased at all times (0-6 months: 60.2% vs 21.5%, P < 0.001, 6-12 months: 26.8% vs 1.8%, P < 0.001, 12-36 months: 32.3% vs 10.5%, P = 0.006). The yield of asymptomatic EMB decreased in the modern era between 0 and 6 months (10.9% vs 3.12%), 6 to 12 months (17% vs 0%), and years 2 to 3 (6.1% vs 1.5%). In the early era, the odds ratio of rejection during asymptomatic EMB compared to a clinically driven EMB was 0.47 (95% confidence interval, 0.31-0.71) and was decreased in the modern era (0.17 [0.07-0.42], P = 0.04). The probability of detecting rejection on asymptomatic EMB was significantly reduced in the modern era, even after adjustment for tacrolimus and induction therapy (1% vs 8%, P < 0.001).The clinical yield of surveillance EMB has decreased in the modern era. The EMB in asymptomatic patients longer than 6 months after HT warrants further scrutiny.

Endomyocardial Biopsy

10.1097/tp.0000000000000615

Cite

Citations (35)

Renal Function Recovery with Total Artificial Heart Support

ASAIO Journal (2015)

Mohammed Quader Adam M. Goodreau Keyur B. Shah Gundars Katlaps Richard H. Cooke

Heart failure patients requiring total artificial heart (TAH) support often have concomitant renal insufficiency (RI). We sought to quantify renal function recovery in patients supported with TAH at our institution. Renal function data at 30, 90, and 180 days after TAH implantation were analyzed for patients with RI, defined as hemodialysis supported or an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m. Between January 2008 and December 2013, 20 of the 46 (43.5%) TAH recipients (age 51 ± 9 years, 85% men) had RI, mean preoperative eGFR of 48 ± 7 ml/min/1.73 m. Renal function recovery was noted at each follow-up interval: increment in eGFR (ml/min/1.73 m) at 30, 90, and 180 days was 21 ± 35 (p = 0.1), 16.5 ± 18 (p = 0.05), and 10 ± 9 (p = 0.1), respectively. Six patients (30%) required preoperative dialysis. Of these, four recovered renal function, one remained on dialysis, and one died. Six patients (30%) required new-onset dialysis. Of these, three recovered renal function and three died. Overall, 75% (15 of 20) of patients' renal function improved with TAH support. Total artificial heart support improved renal function in 75% of patients with pre-existing significant RI, including those who required preoperative dialysis.

Artificial kidney

Concomitant

10.1097/mat.0000000000000288

Cite

Citations (11)

Mechanical Circulatory Support Devices in the ICU

CHEST Journal (2014)

Keyur B. Shah Melissa C. Smallfield Daniel Tang Rajiv Malhotra Richard H. Cooke

10.1378/chest.13-2645

Cite

Citations (8)

259: Ibutilide is safe and efficatious in heart transplant recipients

The Journal of Heart and Lung Transplantation (2007)

Verónica Franco José Tallaj Barry K. Rayburn Salpy V. Pamboukian Raymond L. Benza

Ibutilide

Supraventricular Tachycardia

Paroxysmal supraventricular tachycardia

10.1016/j.healun.2006.11.278

Cite

Citations (1)

Novel Lipoprotein Markers Remain Elevated Despite Statin Therapy After Heart Transplant

The Journal of Heart and Lung Transplantation (2014)

Sanah Christopher M.T. Hassanein Maureen Flattery Melissa C. Smallfield Richard H. Cooke

10.1016/j.healun.2014.01.759

Cite

Citations (0)

Improvement in 2-year survival for ventricular assist device patients after implementation of an intensive surveillance protocol

The Journal of Heart and Lung Transplantation (2011)

Salpy V. Pamboukian José Tallaj Robert N. Brown William L. Holman Margaret S. Blood

10.1016/j.healun.2011.03.001

Cite

Citations (34)

Percutaneous approach to left ventricular assist device decommissioning

Catheterization and Cardiovascular Interventions (2022)

Francesco Moroni Keyur B. Shah Mohammed Quader Katherine M. Klein Melissa C. Smallfield

To assess the outcomes of a single-center experience with percutaneous left ventricular assist device (LVAD) decommissioning.Patients with LVADs may eventually require their removal, either due to recovery of left ventricular function or recurrent complications. Traditionally, withdrawal of LVAD support has been managed with surgical device explantation, which carries significant procedural risks. Transcatheter LVAD decommissioning, with outflow graft occlusion and driveline transection, has recently been described as an alternative to surgical removal.Here, we report on a retrospective cohort of five consecutive cases treated with transcatheter LVAD decommissioning.The procedure was effective in all cases, and no patient experienced procedure-related complications. At midterm follow-up, the three patients who had myocardial function recovery were alive and had not experienced heart failure-related symptoms or complications.Percutaneous LVAD decommissioning appears to be a safe and effective approach to LVAD treatment discontinuation.

Nuclear decommissioning

Discontinuation

10.1002/ccd.30230

Cite

Citations (4)

Gastrointestinal Bleeding in Patients with Ventricular Assist Devices is Highest Immediately After Implantation

The American Journal of Gastroenterology (2012)

Joshua B. French George Smallfield Salpy V. Pamboukian José Tallaj Robert N. Brown

Purpose: The Ventricular Assist Device (VAD) has been used as a bridge to transplantation and more recently as destination therapy in patients with refractory heart failure. While VAD implantation is associated with gastrointestinal bleeding (GIB), outcomes in terms of initial and repeat GIB risk, severity, location of lesions and endoscopic interventions need to be better defined. Methods: Consecutive patients from a prospective database of adult patients with VADs implanted between January 1, 2000 and December 31, 2010 at a single center were reviewed and followed through May 31, 2011. The GIB events were further classified by severity (transfusion requirements < 4U vs. > 4U of pRBC), location (Proximal, Mid, or Distal Bowel) and type (Mucosal, Vascular or Abnormal Growth). Hazard analysis models were calculated for the time to first GIB, as well as freedom from subsequent GIB events. Results: Of 166 patients with a VAD, 38 patients experienced 84 GIB events (Range 1 - 9 events per person; IQR = 1.00 - 2.25) of which 51 were minor, 28 were major, and 5 were not characterized due to incomplete outside records. Seventeen patients experienced 2 or more GIB events. Maximal hazard for the first bleeding event was 2.23 events/ patient-year at 21 days and declined to the constant hazard by 71 days post-implantation (Figure). The hazard for recurrent GIB was highest immediately following the first GIB event. The relative risk of a GIB event was 1.8 for ages 45 vs. 65 years at implant (p=.04). Most GIB events (68%) were located in the proximal bowel compared to the mid or distal bowel. While mucosal lesions were the most common cause of bleeding of the initial GIB events (44%), vascular abnormalities were the predominant cause when considering all GIB events (46%). When various mechanical and cauterization endoscopic intervention techniques were compared, no single technique appeared to be superior over another in terms of preventing future GIB events.Figure: No Caption available.Conclusion: The actuarial risk of initial GIB events peaks in the first 3 months following VAD implantation followed by a stable lower risk of bleeding. The hazard for recurrent GIB events is substantially increased immediately after the initial GIB.

Destination therapy

Gastrointestinal bleeding

Refractory (planetary science)

10.14309/00000434-201210001-01426

Cite

Citations (0)

Device Management and Flow Optimization on Left Ventricular Assist Device Support

Critical Care Clinics (2018)

Inna Tchoukina Melissa C. Smallfield Keyur B. Shah

Artificial heart

10.1016/j.ccc.2018.03.002

Cite