Dipanjan Banerjee MD MS

All Publications

• Multicenter experience with durable biventricular assist devices JOURNAL OF HEART AND LUNG TRANSPLANTATION Shah, P., Ha, R., Singh, R., Cotts, W., Adler, E., Kiernan, M., Brambatti, M., Meehan, K., Phillips, S., Kidambi, S., Macaluso, G. P., Banerjee, D., Mooney, D., Duc Pham, Pretorius, V. D. 2018; 37 (9): 1093–1101

  Abstract

  Severe right ventricular failure necessitating a right ventricular assist device (RVAD) complicates 6% to 11% of left ventricular assist device (LVAD) implants. Patient outcomes for those receiving durable continuous-flow VADs in a biventricular configuration (i.e., BiVAD) have been reported in limited case series.Data from United States centers with ≥ 6 BiVAD implants were collected. Characteristics and outcomes of patients receiving contemporaneous (i.e., same surgery) vs staged implantation of the HVAD as a BiVAD were compared.From 2011 to 2017, 46 patients received durable BiVADs and had the following characteristics: median age, 46 years (interquartile range [IQR], 19-67 years), non-ischemic cardiomyopathy (80%), bridge to transplant (83%), Interagency Registry for Mechanically Assisted Circulatory Support Profile 1 or 2 (92%), use of temporary circulatory support (37%), right atrial pressure 19 mm Hg (IQR, 14-23 mm Hg), and cardiac index of 1.6 liters/min/m2 (IQR, 1.2-2.1 liters/min/m2). Operative mortality was 33%. Equal numbers of patients received a right atrial or right ventricular implant. Contemporaneous BiVAD implantation occurred in 31 patients (67%), and compared with 15 patients (33%) with staged implants, these patients had a shorter intensive care unit length of stay of 12 days (IQR, 7-23 days) vs 42 days (IQR, 28-48 days, p = 0.035) and were more likely to be discharged from the hospital on BiVAD support (61% vs 27%, p = 0.04). RVAD thrombosis developed in 17 patients (37%). Patients with contemporaneous BiVAD implants had a 1-year survival of 74% compared with 40% in staged BiVAD patients (p = 0.11).Patients receiving durable BiVADs represent a critically ill patient population with severe biventricular failure who have high operative mortality and RVAD thrombosis rates. The 1-year survival for patients receiving contemporaneous BiVADs in experienced centers mirrors other contemporary durable biventricular support strategies.

  View details for DOI 10.1016/j.healun.2018.05.001

  View details for Web of Science ID 000444512200008

  View details for PubMedID 30173824

• Incidence of temporary mechanical circulatory support before heart transplantation and impact on post-transplant outcomes. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation Ouyang, D., Gulati, G., Ha, R., Banerjee, D. 2018

  Abstract

  Proposed changes to the United Network for Organ Sharing heart transplant allocation protocol will prioritize patients receiving temporary mechanical circulatory support (tMCS), including extracorporeal membrane oxygenation (ECMO), percutaneous ventricular assist devices (PVADs), and intra-aortic balloon pumps (IABPs). We sought to evaluate contemporary trends in the incidence and outcomes of patients who required tMCS during the hospitalization before heart transplantation.Using the National Inpatient Sample from 1998 to 2014, we identified 6,892 patients who received an orthotopic heart transplant and classified them by pre-transplant ECMO, PVAD, or IABP placement or no pre-transplant tMCS. We compared baseline characteristics and in-hospital outcomes between patients who underwent pre-transplant ECMO, PVAD, or IABP and patients who did not receive tMCS before heart transplantation.Of patients who underwent heart transplantation, 456 (6.6%) received tMCS before transplant. During the study period, the use of tMCS more than doubled, from 17 cases per year from 1998 to 2002 to 40 cases per year from 2012 to 2014 (p < 0.001 for trend). Of patients with tMCS, 341 (74.8%) were supported by IABP, 130 (28.5%) were supported by ECMO, and 21 (4.6%) were supported by PVAD. Before 2007, patients who required tMCS had higher in-hospital mortality than patients who did not require tMCS before transplant (14.3% vs 7.5%, p = 0.05). In the subsequent era (2007 to 2014), mortality was not significantly different (4.7% vs 5.1%, p = 0.9). Hospital mortality improved over time for all patients but most significantly in patients who required tMCS (9.6% absolute risk reduction). However, patients who received tMCS had increased lengths of stays and rates of acute renal, hepatic, and respiratory failure, sepsis, bleeding complications, and surgical reoperations.The use of tMCS before cardiac transplantation is increasing, with no difference in in-patient post-transplant mortality in the recent era between patients who did and did not receive tMCS but with increased complication rates among those who received tMCS. These data support the use of tMCS before cardiac transplantation in appropriately selected patients. Clinicians should balance the above outcomes when making decisions to implant tMCS, given the impending changes to the United Network for Organ Sharing heart allocation protocol.

  View details for DOI 10.1016/j.healun.2018.04.008

  View details for PubMedID 29907499

• Cost-Effectiveness of Left Ventricular Assist Devices in Ambulatory Patients With Advanced Heart Failure. JACC. Heart failure Baras Shreibati, J., Goldhaber-Fiebert, J. D., Banerjee, D., Owens, D. K., Hlatky, M. A. 2017; 5 (2): 110-119

  Abstract

  This study assessed the cost-effectiveness of left ventricular assist devices (LVADs) as destination therapy in ambulatory patients with advanced heart failure.LVADs improve survival and quality of life in inotrope-dependent heart failure, but data are limited as to their value in less severely ill patients.We determined costs of care among Medicare beneficiaries before and after LVAD implantation from 2009 to 2010. We used these costs and efficacy data from published studies in a Markov model to project the incremental cost-effectiveness ratio (ICER) of destination LVAD therapy compared with that of medical management. We discounted costs and benefits at 3% annually and report costs as 2016 U.S. dollars.The mean cost of LVAD implantation was $175,420. The mean cost of readmission was lower before LVAD than after ($12,377 vs. $19,465, respectively; p < 0.001), while monthly outpatient costs were similar ($3,364 vs. $2,974, respectively; p = 0.54). In the lifetime simulation model, LVAD increased quality-adjusted life-years (QALYs) (4.41 vs. 2.67, respectively), readmissions (13.03 vs. 6.35, respectively), and costs ($726,200 vs. $361,800, respectively) compared with medical management, yielding an ICER of $209,400 per QALY gained and $597,400 per life-year gained. These results were sensitive to LVAD readmission rates and outpatient care costs; the ICER would be $86,900 if these parameters were 50% lower.LVADs in non-inotrope-dependent heart failure patients improved quality of life but substantially increased lifetime costs because of frequent readmissions and costly follow-up care. LVADs may provide good value if outpatient costs and adverse events can be reduced.

  View details for DOI 10.1016/j.jchf.2016.09.008

  View details for PubMedID 28017351

• An informatics-based approach to reducing heart failure all-cause readmissions: the Stanford heart failure dashboard. Journal of the American Medical Informatics Association Banerjee, D., Thompson, C., Kell, C., Shetty, R., Vetteth, Y., Grossman, H., DiBiase, A., Fowler, M. 2016

  Abstract

  Reduction of 30-day all-cause readmissions for heart failure (HF) has become an important quality-of-care metric for health care systems. Many hospitals have implemented quality improvement programs designed to reduce 30-day all-cause readmissions for HF. Electronic medical record (EMR)-based measures have been employed to aid in these efforts, but their use has been largely adjunctive to, rather than integrated with, the overall effort.We hypothesized that a comprehensive EMR-based approach utilizing an HF dashboard in addition to an established HF readmission reduction program would further reduce 30-day all-cause index hospital readmission rates for HF.After establishing a quality improvement program to reduce 30-day HF readmission rates, we instituted EMR-based measures designed to improve cohort identification, intervention tracking, and readmission analysis, the latter 2 supported by an electronic HF dashboard. Our primary outcome measure was the 30-day index hospital readmission rate for HF, with secondary measures including the accuracy of identification of patients with HF and the percentage of patients receiving interventions designed to reduce all-cause readmissions for HF.The HF dashboard facilitated improved penetration of our interventions and reduced readmission rates by allowing the clinical team to easily identify cohorts with high readmission rates and/or low intervention rates. We significantly reduced 30-day index hospital all-cause HF readmission rates from 18.2% at baseline to 14% after implementation of our quality improvement program (P = .045). Implementation of our EMR-based approach further significantly reduced 30-day index hospital readmission rates for HF to 10.1% (P for trend = .0001). Daily time to screen patients decreased from 1 hour to 15 minutes, accuracy of cohort identification improved from 83% to 94.6% (P = .0001), and the percentage of patients receiving our interventions, such as patient education, also improved significantly from 22% to 100% over time (P < .0001).In an institution with a quality improvement program already in place to reduce 30-day readmission rates for HF, an EMR-based approach further significantly reduced 30-day index hospital readmission rates.

  View details for DOI 10.1093/jamia/ocw150

  View details for PubMedID 28011593

• Intra-aortic balloon pump therapy negatively affects flow through a continuous-flow left ventricular assist device. journal of thoracic and cardiovascular surgery Banerjee, D., Choi, C., Ha, R. 2016

  View details for DOI 10.1016/j.jtcvs.2016.09.012

  View details for PubMedID 27717495

• Influence of durable mechanical circulatory support and allosensitization on mortality after heart transplantation JOURNAL OF HEART AND LUNG TRANSPLANTATION Chiu, P., Schaffer, J. M., Oyer, P. E., Pham, M., Banerjee, D., Woo, Y. J., Ha, R. 2016; 35 (6): 731-742

  Abstract

  Allosensitization has been shown to negatively affect post-heart transplant (HTx) survival even with a negative crossmatch. Whether allosensitization related to mechanical circulatory support (MCS) is associated with worse post-HTx survival remains controversial.Adult HTx recipients listed in the United Network for Organ Sharing database (July 2006-December 2012) were identified. Multivariate Cox regression assessed the effect of allosensitization on survival. Propensity matching was performed to compare patients who were and were not allosensitized. Kaplan-Meier survival analysis compared matched and unmatched patients in the MCS and medically managed cohorts.We identified 11,840 HTx recipients, of whom 4,167 had MCS. MCS was associated with allosensitization in multivariate logistic regression. Each different MCS device was associated with worse post-HTx survival in multivariate Cox regression. Allosensitization did not predict post-HTx mortality in MCS patients (hazard ratio, 1.07; 95% confidence interval, 0.89-1.28; p = 0.48. Among patients without MCS, allosensitization was associated with post-HTx mortality (hazard ratio, 1.19; 95% confidence interval, 1.03-1.39; p = 0.02). Kaplan-Meier analysis revealed equivalent survival in unmatched and matched cohorts when MCS patients who were allosensitized were compared with non-allosensitized MCS patients. Among non-MCS patients, allosensitization was associated with worse survival in unmatched and matched analysis.MCS was associated with allosensitization. For MCS patients, allosensitization did not independently predict worse post-HTx outcome. Among non-MCS patients, allosensitization was associated with worse post-HTx survival. Allosensitization appears to be a heterogeneous process influenced by presence of MCS.

  View details for DOI 10.1016/j.healun.2015.12.023

  View details for Web of Science ID 000379367700006

• An Electronic Medical Record Report Improves Identification of Hospitalized Patients With Heart Failure JOURNAL OF CARDIAC FAILURE Banerjee, D., Thompson, C., Bingham, A., Kell, C., Duhon, J., Grossman, H. 2016; 22 (5): 402-405

  Abstract

  Early identification of inpatients with heart failure (HF) may help to reduce readmissions. We found that many patients identified by our coding team as having a primary diagnosis of HF were not identified by our clinical team. We hypothesized that an electronic medical record (EMR)-based report would improve identification of hospitalized patients eventually diagnosed with HF.We constructed an automated EMR-based tool to allow our team to identify patients with HF more quickly and accurately. We selected criteria that could potentially identify the cohort as patients with an exacerbation of HF. We performed monthly reconciliations, comparing the list of patients identified by our coding team as having a primary diagnosis of HF versus the patients identified by our team as having HF. We reduced a baseline 17% discrepancy of patients coded as HF but not identified by our team to 9.5% in the year after implementation of our screening tool (P = .006), and to 5.4% in the next year (P = .03); 56% of patients that were identified as having HF by our CNS team were coded as having HF, versus 49% in the 2 years after implementation (P = .15). Thirty-day readmission rates to our hospital decreased from 16% to 11% (P = .029).An EMR-based approach significantly improved identification of patients discharged with a primary diagnosis of HF. Future investigations should determine whether early identification of inpatients with HF can independently lower readmissions, and whether this strategy can successfully identify outpatients with HF.

  View details for DOI 10.1016/j.cardfail.2015.12.006

  View details for Web of Science ID 000375890800015

  View details for PubMedID 26687987

• Pulmonary artery pulsatility index predicts right ventricular failure after left ventricular assist device implantation. journal of heart and lung transplantation Kang, G., Ha, R., Banerjee, D. 2016; 35 (1): 67-73

  Abstract

  Right ventricular failure (RVF) is a major cause of morbidity and mortality after left ventricular assist device (LVAD) implantation. The pulmonary artery pulsatility index (PAPi) is a novel hemodynamic index that predicts RVF in the setting of myocardial infarction, although it has not been shown to predict RVF after LVAD implantation.We performed a retrospective, single-center analysis to examine the utility of the PAPi in predicting RVF and RV assist device (RVAD) implantation in 85 continuous-flow LVAD recipients. We performed a multivariate logistic regression analysis incorporating previously identified predictors of RVF after LVAD placement, including clinical and echocardiographic variables, to determine the independent effect of PAPi in predicting RVF or RVAD after LVAD placement.In this cohort, the mean PAPi was 3.4 with a standard deviation of 2.9. RVF occurred in 33% of patients, and 11% required a RVAD. Multivariate analysis, adjusting for age, blood urea nitrogen (BUN), and Interagency Registry for Mechanically Assisted Circulatory Support profile, revealed that higher PAPi was independently associated with a reduced risk of RVAD placement (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.07-0.89). This relationship did not change significantly when echocardiographic measures were added to the analysis. Stratifying the analysis by the presence of inotropes during catheterization revealed that PAPi was more predictive of RVAD requirement when measured on inotropes (OR, 0.21; 95% CI, 0.02-0.97) than without (OR, 0.49; 95% CI, 0.01-1.94). Furthermore, time from catheterization to LVAD did not significantly affect the predictive value of the PAPi (maximum time, 6 months). Receiver operating characteristic curve analysis revealed that optimal sensitivity and specificity were achieved using a PAPi threshold of 2.0.In LVAD recipients, the PAPi is an independent predictor of RVF and the need for RVAD support after LVAD implantation. This index appears more predictive in patients receiving inotropes and was not affected by time from catheterization to LVAD in our cohort.

  View details for DOI 10.1016/j.healun.2015.06.009

  View details for PubMedID 26212656

• Thalidomide for treatment of gastrointestinal angiodysplasia in patients with left ventricular assist devices: Case series and treatment protocol. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation Draper, K., Kale, P., Martin, B., Kelly Cordero, R., Ha, R., Banerjee, D. 2015; 34 (1): 132–34

  View details for DOI 10.1016/j.healun.2014.09.013

  View details for PubMedID 25447569

• Biventricular VAD versus LVAD for right heart failure. Annals of cardiothoracic surgery Boulate, D., Marques, M. A., Ha, R., Banerjee, D., Haddad, F. 2014; 3 (6): 585-588

  View details for DOI 10.3978/j.issn.2225-319X.2014.08.08

  View details for PubMedID 25512899

• A novel, catheter-based approach to left ventricular assist device deactivation after myocardial recovery. Annals of thoracic surgery Zeigler, S. M., Sheikh, A. Y., Lee, P. H., Desai, J., Banerjee, D., Oyer, P., Dake, M. D., Ha, R. V. 2014; 98 (2): 710-713

  Abstract

  We describe a case of catheter-based embolization and deactivation of a left ventricular assist device using an Amplatzer plug for a patient demonstrating myocardial recovery after diagnosis of nonischemic cardiomyopathy. This procedure can provide a minimally invasive, low morbidity solution for patients wishing to be separated from left ventricular assist device support who want to avoid invasive surgery for device removal.

  View details for DOI 10.1016/j.athoracsur.2013.09.073

  View details for PubMedID 25087798

• Insulin resistance and risk of incident heart failure: cardiovascular health study. Circulation. Heart failure Banerjee, D., Biggs, M. L., Mercer, L., Mukamal, K., Kaplan, R., Barzilay, J., Kuller, L., Kizer, J. R., Djousse, L., Tracy, R., Zieman, S., Lloyd-Jones, D., Siscovick, D., Carnethon, M. 2013; 6 (3): 364-370

  Abstract

  Patients with heart failure (HF) have higher fasting insulin levels and a higher prevalence of insulin resistance as compared with matched controls. Insulin resistance leads to structural abnormalities in the heart, such as increased left atrial size, left ventricular mass, and alterations in transmitral velocity that can precede the diagnosis of HF. It is not known whether insulin resistance precedes the development of HF or whether the relationship between insulin resistance and HF is present among adults with HF caused by nonischemic heart disease.We examined 4425 participants (60% women) from the Cardiovascular Health Study after excluding those with HF, myocardial infarction, or treated diabetes mellitus at baseline. We used Cox proportional hazards models to estimate the relative risk of incident HF associated with fasting insulin measured at study entry. There were 1216 cases of incident HF (1103 without antecedent myocardial infarction) during a median follow-up of 12 years (maximum, 19 years). Fasting insulin levels were positively associated with the risk of incident HF (hazard ratio, 1.10; 95% confidence interval, 1.05-1.15, per SD change) when adjusted for age, sex, race, field center, physical activity, smoking, alcohol intake, high-density lipoprotein-cholesterol, total cholesterol, systolic blood pressure, and waist circumference. The association between fasting insulin levels and incident HF was similar for HF without antecedent myocardial infarction (hazard ratio, 1.10; 95% confidence interval, 1.05-1.15). Measures of left atrial size, left ventricular mass, and peak A velocity at baseline were associated both with fasting insulin levels and with HF; however, additional statistical adjustment for these parameters did not completely attenuate the insulin-HF estimate (hazard ratio, 1.08; 95% confidence interval, 1.03-1.14 per 1-SD increase in fasting insulin).Fasting insulin was positively associated with adverse echocardiographic features and risk of subsequent HF in Cardiovascular Health Study participants, including those without an antecedent myocardial infarction.URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005133.

  View details for DOI 10.1161/CIRCHEARTFAILURE.112.000022

  View details for PubMedID 23575256

  View details for PubMedCentralID PMC3888807

• Lack of Improvement in Outpatient Management of Congestive Heart Failure in the United States ARCHIVES OF INTERNAL MEDICINE Banerjee, D., Stafford, R. S. 2010; 170 (15): 1399-1400

  View details for Web of Science ID 000280651500020

  View details for PubMedID 20696970

• Correlation of a [C-13]Glucose Breath Test With Surrogate Markers of Insulin Resistance in Urban and Rural Asian Indians METABOLIC SYNDROME AND RELATED DISORDERS Banerjee, D., Vikram, N., Mishra, P., Bhatt, R., Prakash, S., Misra, A. 2009; 7 (3): 215-219

  Abstract

  High rates of insulin resistance (IR), which contribute to a high prevalence of cardiovascular disease (CVD), have been noted in Asian Indians. Rapid, effective measures of IR could identify individuals at risk for CVD in this population. A [(13)C]glucose breath test has been shown to correlate significantly with invasive measures of IR in a Caucasian cohort. We hypothesized that the breath test would correlate significantly with surrogate measures of IR in Asian Indians.A total of 49 urban and 49 rural Asian Indian subjects underwent the (13)C breath test and 2-hour oral glucose tolerance testing. Correlations were performed between the breath test results and surrogate measures of IR including the homeostasis model of insulin resistance (HOMA). These two indices were also correlated with body mass index (BMI).In the overall cohort, the breath test correlated significantly with HOMA (r = -0.40; P < 0.0001), waist circumference (WC) (r = -0.70; P < 0.0001), and BMI (r = -0.59; P < 0.0001). The breath test correlated significantly with BMI in the urban and rural cohorts (r = -0.65; P < 0.0001 and r = -0.36; P = 0.01) and with HOMA (r = -0.55; P = 0.0001) in the urban cohort. There was no significant correlation between the breath test and HOMA (r = -0.07; P = 0.61) in the rural cohort. When corrected for WC and BMI, the correlation between the breath test and HOMA in the urban cohort was no longer significant (r = -0.08; P = 0.57).The (13)C breath test correlated significantly with HOMA values in urban but not in more insulin-sensitive rural subjects and yielded no incremental information over BMI. Further refinement of the [(13)C]glucose breath test is necessary prior to its use as a screening test for IR in Asian Indians.

  View details for DOI 10.1089/met.2008.0075

  View details for Web of Science ID 000266159900008

  View details for PubMedID 19284316

• Planned Concomitant Left and Right Ventricular Assist Device Insertion to Avoid Long-term Biventricular Mechanical Support: Bridge to Right Ventricular Recovery. The heart surgery forum Salna, M., Shudo, Y., Teuteberg, J. J., Banerjee, D., Ha, R. V., Woo, Y. J., Hiesinger, W. 2018; 21 (5): E412–E414

  Abstract

  INTRODUCTION: The planned use of a temporary right ventricular assist device (RVAD) at the time of left ventricular assist device (LVAD) implantation may prevent the need for a permanent biventricular assist device (BiVAD). Herein we describe our RVAD weaning protocol that was effectively employed in 4 patients to prevent the need for permanent BiVAD.METHODS: Four patients in refractory cardiogenic shock underwent planned RVAD insertion during LVAD implantation due to severely depressed right ventricular function with dilation preoperatively. A standardized RVAD weaning protocol was employed in these 4 patients in preparation for decannulation.RESULTS: Temporary RVADs were successfully placed in all 4 patients at the time of LVAD implantation. All patients survived to RVAD decannulation and discharge and were alive at the time of most recent follow-up (range, 528-742 days post-RVAD decannulation).CONCLUSION: Planned implantation of a temporary RVAD in high risk patients may avoid the need for biventricular mechanical support in the future.

  View details for DOI 10.1532/hsf.2035

  View details for PubMedID 30311895

• Applying Cardiopulmonary Exercise Testing to the Evaluation of Left Ventricular Function for Patients Ventricular Assist Device Therapy American College of Sports Medicine Christle, J. W., Moneghetti , K. J., Haddad, F., Banerjee, D., Myers, J., : 533

  View details for DOI 10.1249/01.mss.0000518376.31161.d1

• RIGHT VENTRICULAR LOAD ADAPTABILITY IN PATIENTS UNDERGOING CONTINUOUS-FLOW LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION Amsallem, M., Aymami, M., Hiesinger, W., Zeigler, S., Moneghetti, K., Marques, M., Wheeler, M., Teuteberg, J., Ha, R., Banerjee, D., Haddad, F. ELSEVIER SCIENCE INC. 2018: 1624

  View details for DOI 10.1016/S0735-1097(18)32165-X

  View details for Web of Science ID 000429659703274

• RIGHT HEART MALADAPTIVE PHENOTYPES AND PREDICTION OF RIGHT HEART FAILURE FOLLOWING CONTINUOUS-FLOW LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION Aymami, M., Haddad, F., Amsallem, M., Wheeler, M., Moneghetti, K., Adams, J., Verhoye, J., Sallam, K., Woo, Y., Ha, R., Banerjee, D. ELSEVIER SCIENCE INC. 2018: 652

  View details for DOI 10.1016/S0735-1097(18)31193-8

  View details for Web of Science ID 000429659701502

• Prolonged veno-arterial extracorporeal life support for cardiac failure. The International journal of artificial organs Guenther, S. P., Shudo, Y., Hiesinger, W., Banerjee, D. 2018: 391398818777359

  Abstract

  In intractable cardiogenic shock, extracorporeal life support frequently is the last treatment option. Outcomes of prolonged veno-arterial extracorporeal life support for cardiac failure are poorly defined.We retrospectively analyzed 10 patients (4 females, age = 36 ± 16 years) who underwent prolonged extracorporeal life support (≥7 days) from December 2015 to March 2017 for cardiogenic shock. The primary endpoint was survival to hospital discharge.Etiologies included ischemic cardiomyopathy with non ST-segment elevation myocardial infarction (n = 1), dilated (n = 3), hypertrophic (n = 1), postpartum cardiomyopathy (n = 1), and others (n = 4). Heart failure was left or biventricular in 80.0% (left ventricular ejection fraction = 15.6 ± 5.5%). Among the 10 patients, 80.0% underwent femoral and 20.0% central cannulation, 40.0% required changes in the cannulation strategy, and 80.0% underwent left ventricular venting. No technical malfunctions occurred, but 50.0% required circuit exchanges for thrombus formation. 80.0% suffered from infections. 60.0% could be decannulated after 717 ± 830 (168-2301) h of support, and survival to hospital discharge was 40.0%. Longest follow-up available is 160 ± 175 (12-409) days after discharge, with 30.0% alive and in satisfying functional condition.Prolonged veno-arterial extracorporeal life support for cardiac failure is feasible with low technical complication rates. Survival rates are acceptable, yet inferior to short-term support. We observed a shift from initial shock-related complications to infections during prolonged support. Since recovery and thus weaning is rather unlikely after a prolonged need for extracorporeal life support, this form of support should be limited to centers offering the full spectrum of interdisciplinary cardiac care including ventricular assist device implantation and transplantation.

  View details for DOI 10.1177/0391398818777359

  View details for PubMedID 29896993

• Optimal timing of same-admission orthotopic heart transplantation after left ventricular assist device implantation. World journal of cardiology Gulati, G., Ouyang, D., Ha, R., Banerjee, D. 2017; 9 (2): 154-161

  Abstract

  To investigate the impact of timing of same-admission orthotopic heart transplant (OHT) after left ventricular assist device (LVAD) implantation on in-hospital mortality and post-transplant length of stay.Using data from the Nationwide Inpatient Sample from 1998 to 2011, we identified patients 18 years of age or older who underwent implantation of a LVAD and for whom the procedure date was available. We calculated in-hospital mortality for those patients who underwent OHT during the same admission as a function of time from LVAD to OHT, adjusting for age, sex, race, household income, and number of comorbid diagnoses. Finally, we analyzed the effect of time to OHT after LVAD implantation on the length of hospital stay post-transplant.Two thousand and two hundred patients underwent implantation of a LVAD in this cohort. One hundred and sixty-four (7.5%) patients also underwent OHT during the same admission, which occurred on average 32 d (IQR 7.75-66 d) after LVAD implantation. Of patients who underwent OHT, patients who underwent transplantation within 7 d of LVAD implantation ("early") experienced increased in-hospital mortality (26.8% vs 12.2%, P = 0.0483) compared to patients who underwent transplant after 8 d ("late"). There was no statistically significant difference in age, sex, race, household income, or number of comorbid diagnoses between the early and late groups. Post-transplant length of stay after LVAD implantation was also not significantly different between patients who underwent early vs late OHT.In this cohort of patients who received LVADs, the rate of in-hospital mortality after OHT was lower for patients who underwent late OHT (at least 8 d after LVAD implantation) compared to patients who underwent early OHT. Delayed timing of OHT after LVAD implantation did not correlate with longer hospital stays post-transplant.

  View details for DOI 10.4330/wjc.v9.i2.154

  View details for PubMedID 28289529

  View details for PubMedCentralID PMC5329742

• Neprilysin Inhibitors in Cardiovascular Disease. Current cardiology reports Kang, G., Banerjee, D. 2017; 19 (2): 16-?

  Abstract

  Mortality from heart failure remains high despite advances in medical therapy over the last three decades. Angiotensin receptor-neprilysin inhibitor (ARNI) combinations are the latest addition to the heart failure medical armamentarium, which is built on the cornerstone regimen of beta blockers, angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers, and aldosterone antagonists. Recent trial data have shown a significant mortality benefit from ARNIs, which, as of May 2016, have now received a class I recommendation for use in patients with heart failure and reduced ejection fraction from the major American and European cardiology societies.

  View details for DOI 10.1007/s11886-017-0827-0

  View details for PubMedID 28185171

• Simultaneous ramp right heart catheterization and echocardiography in a ReliantHeart left ventricular assist device. World journal of cardiology Banerjee, D., Dutt, D., Duclos, S., Sallam, K., Wheeler, M., Ha, R. 2017; 9 (1): 55-59

  Abstract

  Many clinicians caring for patients with continuous flow left ventricular assist devices (CF-LVAD) use ramp right heart catheterization (RHC) studies to optimize pump speed and also to troubleshoot CF-LVAD malfunction. An investigational device, the ReliantHeart Heart Assist 5 (Houston, TX), provides the added benefit of an ultrasonic flow probe on the outflow graft that directly measures flow through the CF-LVAD. We performed a simultaneous ramp RHC and echocardiogram on a patient who received the above CF-LVAD to optimize pump parameters and investigate elevated flow through the CF-LVAD as measured by the flow probe. We found that the patient's hemodynamics were optimized at their baseline pump speed, and that the measured cardiac output via the Fick principle was lower than that measured by the flow probe. Right heart catheterization may be useful to investigate discrepancies between flow measured by a CF-LVAD and a patient's clinical presentation, particularly in investigational devices where little clinical experience exists. More data is needed to elucidate the correlation between the flow measured by an ultrasonic probe and cardiac output as measured by RHC.

  View details for DOI 10.4330/wjc.v9.i1.55

  View details for PubMedID 28163837

  View details for PubMedCentralID PMC5253195

• Efficacy of Video Capsule Endoscopy in the Management of Suspected Small Bowel Bleeding in Patients With Continuous Flow Left Ventricular Assist Devices. Gastroenterology research Zikos, T. A., Pan, J., Limketkai, B., Banerjee, D., Fernandez-Becker, N. 2017; 10 (5): 280–87

  Abstract

  Continuous flow left ventricular assist device (CF-LVAD) patients have a high prevalence of gastrointestinal bleeding from the small bowel. Video capsule endoscopy (VCE) is often used for diagnosis in these patients, but efficacy has yet to be determined. In this study, we evaluated the efficacy of VCE in the management of CF-LVAD patients with suspected small bowel bleeding by comparing to a non-VCE CF-LVAD control group.We retrospectively reviewed the charts of all patients with CF-LVADs implanted at Stanford Hospital from January 2010 to October 2015. Patients were included in the study if there was a clinical suspicion of small bowel bleeding and either a negative upper endoscopy or colonoscopy.A total of 26 patients met inclusion criteria for a total of 15 encounters where VCE was done, and 25 where VCE was not done. There were no statistical differences when comparing these groups in terms of medical therapy use (thalidomide or octreotide), enteroscopy use (double-balloon or push), intervention on lesions, or any 30-day outcomes. There was no advantage to VCE with regard to the composite endpoint time to re-bleed or death related to re-bleeding (median 114 vs. 161 days, P = 0.15) after removing patients who did not get a VCE due to death or critical illness.We did not find VCE changed management or outcomes in CF-LVAD patients with suspected small bowel bleeding at our institution when compared to a non-VCE control group. Our experience is small and single center, and larger, multi-center studies could further elucidate the utility of VCE in this patient population.

  View details for DOI 10.14740/gr908w

  View details for PubMedID 29118868

  View details for PubMedCentralID PMC5667693

• Management of Patients After Percutaneous LVAD Deactivation. The Annals of thoracic surgery Banerjee, D., Ha, R. 2017; 104 (4): 1440

  View details for DOI 10.1016/j.athoracsur.2017.01.005

  View details for PubMedID 28935321

• Dealing with a left ventricular pseudoaneurysm during assist device implant. Asian cardiovascular & thoracic annals Ha, R. V., Chiu, P., Banerjee, D., Sheikh, A. Y. 2016; 24 (5): 477-479

  Abstract

  Despite increasing use of left ventricular devices for the surgical treatment of heart failure, there is limited experience with implantation of devices in the setting of challenging left apical anatomy. We report the case of a 68-year-old man with a chronic post-infarction calcified apical pseudoaneurysm, who underwent pseudoaneurysmectomy, ventricular myoplasty, and left ventricular assist device implantation. A review of the literature and operative strategies are presented.

  View details for DOI 10.1177/0218492315579555

  View details for PubMedID 25834125

• The Evolution of Temporary Percutaneous Mechanical Circulatory Support Devices: a Review of the Options and Evidence in Cardiogenic Shock CURRENT CARDIOLOGY REPORTS Abnousi, F., Yong, C. M., Fearon, W., Banerjee, D. 2015; 17 (6)

  View details for DOI 10.1007/s11886-015-0594-8

  View details for Web of Science ID 000353514800004

  View details for PubMedID 25899658

• Continuous flow left ventricular assist device placement complicated by aortic valve thrombus and myocardial infarction INTERNATIONAL JOURNAL OF CARDIOLOGY Kim, J. B., Rhee, J., Brenner, D. A., Ha, R., Banerjee, D., Yeung, A. C., Tremmel, J. A. 2014; 176 (3): E102-E103

  View details for DOI 10.1016/j.ijcard.2014.07.248

  View details for Web of Science ID 000343893300011

• Significantly higher rates of gastrointestinal bleeding and thromboembolic events with left ventricular assist devices. Clinical gastroenterology and hepatology Shrode, C. W., Draper, K. V., Huang, R. J., Kennedy, J. L., Godsey, A. C., Morrison, C. C., Shami, V. M., Wang, A. Y., Kern, J. A., Bergin, J. D., Ailawadi, G., Banerjee, D., Gerson, L. B., Sauer, B. G. 2014; 12 (9): 1461-1467

  Abstract

  The risk of gastrointestinal (GI) bleeding (GIB) and thromboembolic events may increase with continuous-flow left ventricular assist devices (CF-LVADs). We aimed to characterize GIB and thromboembolic events that occurred in patients with CF-LVADs and compare them with patients receiving anticoagulation therapy.We performed a retrospective analysis of 159 patients who underwent CF-LVAD placement at 2 large academic medical centers (mean age, 55 ± 13 y). We identified and characterized episodes of GIB and thromboembolic events through chart review; data were collected from a time period of 292 ± 281 days. We compared the rates of GIB and thromboembolic events between patients who underwent CF-LVAD placement and a control group of 159 patients (mean age, 64 ± 15 y) who received a cardiac valve replacement and were discharged with anticoagulation therapy.Bleeding events occurred in 29 patients on CF-LVAD support (18%; 45 events total). Sixteen rebleeding events were identified among 10 patients (range, 1-3 rebleeding episodes/patient). There were 34 thrombotic events among 27 patients (17%). The most common source of bleeding was GI angiodysplastic lesions (n = 20; 44%). GIB and thromboembolic events were more common in patients on CF-LVAD support than controls; these included initial GIB (18% vs 4%, P < .001), rebleeding (6% vs none, P = .001), and thromboembolic events (17% vs 8%, P = .01).Patients with CF-LVADS receiving anticoagulants have a significantly higher risk of GIB and thromboembolic events than patients receiving anticoagulants after cardiac valve replacement surgery. GI angiodysplastic lesions are the most common source of bleeding.

  View details for DOI 10.1016/j.cgh.2014.01.027

  View details for PubMedID 24480675

• Fatal acanthamoeba encephalitis in a patient with a total artificial heart (syncardia) device. Open forum infectious diseases Tan, S. K., Gajurel, K., Tung, C., Albers, G., Deresinski, S., Montoya, J. G., Sheikh, A. Y., Banerjee, D., Ha, R. 2014; 1 (2): ofu057-?

  Abstract

  Acanthamoeba encephalitis is an uncommon but often fatal infection complication. Here we report the first case of Acanthamoeba encephalitis in a patient with a Total Artificial Heart device.

  View details for DOI 10.1093/ofid/ofu057

  View details for PubMedID 25734127

• The Presence of Air Bubbles in the Aorta of a Patient with a HeartMate II Left Ventricular Assist Device: A Novel Sign of Outflow Graft Obstruction. ASAIO journal Davis, M. K., Ha, R., Banerjee, D. 2014; 60 (5): 600-602

  Abstract

  Microbubbles formed by cavitation have been frequently reported in patients with mechanical heart valves (MHVs), but have not previously been described in patients with continuous-flow left ventricular assist devices (LVADs). Obstruction of the LVAD circuit by thrombus, outflow graft kinking, or cannula malposition may cause high pressure gradients and turbulent flow, often resulting in hemolysis. Here, we describe for the first time the presence of microbubbles in the ascending aorta of a patient with severe LVAD-associated hemolysis. We propose that these bubbles were formed by cavitation in the presence of a high pressure gradient due to LVAD outflow graft obstruction, and suggest that this may be a novel imaging sign of LVAD obstruction in patients with continuous-flow LVADs.

  View details for DOI 10.1097/MAT.0000000000000102

  View details for PubMedID 24814838

• Treatment of Left Ventricular Assist Device-Associated Arteriovenous Malformations with Thalidomide ASAIO JOURNAL Ray, R., Kale, P. P., Ha, R., Banerjee, D. 2014; 60 (4): 482-483

  View details for DOI 10.1097/MAT.0000000000000087

  View details for Web of Science ID 000338777600021

• Underdiagnosis of Hypertension Using Electronic Health Records AMERICAN JOURNAL OF HYPERTENSION Banerjee, D., Chung, S., Wong, E. C., Wang, E. J., Stafford, R. S., Palaniappan, L. P. 2012; 25 (1): 97-102

  Abstract

  Hypertension is highly prevalent and contributes to cardiovascular morbidity and mortality. Appropriate identification of hypertension is fundamental for its management. The rates of appropriate hypertension diagnosis in outpatient settings using an electronic health record (EHR) have not been well studied. We sought to identify prevalent and incident hypertension cases in a large outpatient healthcare system, examine the diagnosis rates of prevalent and incident hypertension, and identify clinical and demographic factors associated with appropriate hypertension diagnosis.We analyzed a 3-year, cross-sectional sample of 251,590 patients aged ≥18 years using patient EHRs. Underlying hypertension was defined as two or more abnormal blood pressure (ABP) readings ≥140/90 mm Hg and/or pharmaceutical treatment. Appropriate hypertension diagnosis was defined by the reporting of ICD-9 codes (401.0-401.9). Factors associated with hypertension diagnosis were assessed through multivariate analyses of patient clinical and demographic characteristics.The prevalence of hypertension was 28.7%, and the diagnosis rate was 62.9%. The incidence of hypertension was 13.3%, with a diagnosis rate of 19.9%. Predictors of diagnosis for prevalent hypertension included older age, Asian, African American, higher body mass index (BMI), and increased number of ABP readings. Predictors for incident hypertension diagnosis were similar. In patients with two or more ABP readings, hypertension diagnosis was associated with significantly higher medication treatment rates (92.6% vs. 15.8%, P < 0.0001).Outpatient EHR diagnosis rates are suboptimal, yet EHR diagnosis of hypertension is strongly associated with treatment. Targeted efforts to improve diagnosis should be a priority.

  View details for DOI 10.1038/ajh.2011.179

  View details for Web of Science ID 000298264800019

  View details for PubMedID 22031453

• Preliminary Results from BCG and ECG Measurements in the Heart Failure Clinic 34th Annual International Conference of the IEEE Engineering-in-Medicine-and-Biology-Society (EMBS) Giovangrandi, L., Inan, O. T., Banerjee, D., Kovacs, G. T. IEEE. 2012: 3780–3783

  Abstract

  We report on the preliminary deployment of a bathroom scale-based ballistocardiogram (BCG) system for the in-hospital monitoring of patients with heart failure. These early trials provided valuable insights into the challenges and opportunities for such monitoring. In particular, the need for robust algorithms and adapted BCG metric is suggested. The system was designed to be robust and user-friendly, with dual ballistocardiogram (BCG) and electrocardiogram (ECG) capabilities. The BCG was measured from a modified bathroom scale, while the ECG (used as timing reference) was measured using dry handlebar electrodes. The signal conditioning and digitization circuits were USB-powered, and data acquisition performed using a netbook. Four patients with a NYHA class III at admission were measured daily for the duration of their treatment at Stanford hospital. A measure of BCG quality, in essence a quantitative implementation of the BCG classes originally defined in the 1950s, is proposed as a practical parameter.

  View details for Web of Science ID 000313296504002

  View details for PubMedID 23366751

• Racial and Ethnic Variation in Lipoprotein (a) Levels among Asian Indian and Chinese Patients. Journal of lipids Banerjee, D., Wong, E. C., Shin, J., Fortmann, S. P., Palaniappan, L. 2011; 2011: 291954-?

  Abstract

  Background. Lipoprotein (a) [Lp(a)] is an independent risk factor for cardiovascular disease (CVD) in Non-Hispanic Whites (NHW). There are known racial/ethnic differences in Lp(a) levels, and the association of Lp(a) with CVD outcomes has not been examined in Asian Americans in the USA. Objective. We hypothesized that Lp(a) levels would differ in Asian Indians and Chinese Americans when compared to NHW and that the relationship between Lp(a) and CVD outcomes would be different in these Asian racial/ethnic subgroups when compared to NHW. Methods. We studied the outpatient electronic health records of 2022 NHW, 295 Asian Indians, and 151 Chinese adults age ≥18 y in Northern California in whom Lp(a) levels were assessed during routine clinical care from 2001 to 2008, excluding those who had received prescriptions for niacin (14.6%). Nonparametric methods were used to compare median Lp(a) levels. Significance was assessed at the P < .0001 level to account for multiple comparisons. CVD outcomes were defined as ischemic heart disease (IHD) (265 events), stroke (122), or peripheral vascular disease (PVD) (87). We used logistic regression to determine the relationship between Lp(a) and CVD outcomes. Results. Both Asian Indians (36 nmol/L) and NHW (29 nmol/L) had higher median Lp(a) levels than Chinese (22 nmol/L, P ≤ .0001 and P = .0032). When stratified by sex, the differences in median Lp(a) between these groups persisted in the 1761 men (AI v CH: P = .001, NHW v CH: P = .0018) but were not statistically significant in the 1130 women (AI v CH: P = .0402, NHW v CH: P = .0761). Asian Indians (OR = 2.0) and Chinese (OR = 4.8) exhibited a trend towards greater risk of IHD with high Lp(a) levels than NHW (OR = 1.4), but no relationship was statistically significant. Conclusion. Asian Indian and NHW men have higher Lp(a) values than Chinese men, with a trend toward, similar associations in women. High Lp(a) may be more strongly associated with IHD in Asian Indians and Chinese, although we did not have a sufficient number of outcomes to confirm this. Further studies should strive to elucidate the relationship between Lp(a) levels, CVD, and race/ethnicity among Asian subgroups in the USA.

  View details for DOI 10.1155/2011/291954

  View details for PubMedID 21660301

• Right ventricular failure: a novel era of targeted therapy. Current heart failure reports Banerjee, D., Haddad, F., Zamanian, R. T., Nagendran, J. 2010; 7 (4): 202-211

  Abstract

  There now is strong evidence to recognize the pivotal role of the right ventricle (RV) in heart disease and to establish it as a unique and separate entity than the left ventricle (LV). Here, we summarize the differences between the two ventricles, the diagnosis of RV failure, and the management of acute and chronic RV failure. We review the indices derived by echocardiography used to measure RV function, and novel biomarkers that may play a role diagnosing and prognosticating in RV-specific disease. There are new novel therapies that specifically target the RV in disease. For example, phosphodiesterase type 5 inhibitors improve contractility of the hypertrophied RV while sparing the normal LV in pulmonary arterial hypertension. The metabolism of the hypertrophied RV is another area for therapeutic exploitation by metabolic modulation. We also suggest future potential molecular targets that may be unique to the RV because they are upregulated in RV hypertrophy greater than in LV hypertrophy.

  View details for DOI 10.1007/s11897-010-0031-7

  View details for PubMedID 20890792

• Understanding and Identifying Bias and Confounding in the Medical Literature SOUTHERN MEDICAL JOURNAL Hsu, J. L., Banerjee, D., Kuschner, W. G. 2008; 101 (12): 1240-1245

  Abstract

  Bias and confounding are types of error that may be encountered in the collection, analysis, or interpretation of research data. Bias and confounding may result in erroneous research conclusions with adverse consequences for patients and health care providers. In this article, we provide clinician-friendly descriptions and examples of bias (including surveillance, information, selection, lead, length, and publication) and confounding. The purpose of the article is to help clinicians to recognize two important sources of error in research and in turn to help clinicians to assess the validity and generalizability of a research report.

  View details for Web of Science ID 000261778000015

  View details for PubMedID 19005435

• Does using ethnic specific criteria improve the usefulness of the term metabolic syndrome? controversies and suggestions INTERNATIONAL JOURNAL OF OBESITY Banerjee, D., Misra, A. 2007; 31 (9): 1340-1349

  Abstract

  The metabolic syndrome (MetS) is an important tool that identifies populations at increased risk for cardiovascular disease (CVD) and type 2 diabetes, targeting them for preventive measures. The criteria for the identification of the MetS were initially constructed from data in Caucasian populations. Recent research suggests that the current criteria for the MetS may not accurately characterize disease risk in non-Caucasian populations, either over or underestimating the risk in certain ethnic groups. Altering the criteria for each population by making ethnic-specific cutoffs as has been done with waist circumference will help in more accurate characterization. Using different combinations of the MetS criteria for different ethnic groups based CVD risk and factor analysis needs consideration. With better characterizations of patient populations, the ultimate goal would be to make MetS more accurate for predicting CVD risk while retaining the ease of screening afforded by the MetS. The proposed alterations of definition and criteria of the MetS would ensure its continued viability and sustainability.

  View details for DOI 10.1038/sj.ijo.0803619

  View details for Web of Science ID 000249090000002

  View details for PubMedID 17438559

• Principles and procedures of medical ethics case consultation BRITISH JOURNAL OF HOSPITAL MEDICINE Banerjee, D., Kuschner, W. G. 2007; 68 (3): 140-144

  Abstract

  Ethical conflicts are common in hospital medicine. This article reviews core medical ethics principles, describes models for conducting hospital-based ethics case consultations, and highlights the contributions of hospital ethics committees to high quality patient care.

  View details for Web of Science ID 000245198000005

  View details for PubMedID 17419461

• The metabolic syndrome in South Asians: Continuing escalation & possible solutions INDIAN JOURNAL OF MEDICAL RESEARCH Misra, A., Misra, R., Wijesuriya, M., Banerjee, D. 2007; 125 (3): 345-354

  Abstract

  The metabolic syndrome is a crucial factor in causation of type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD) in South Asians. Approximately 20-25 per cent of urban South Asians have evidence of the metabolic syndrome. Furthermore, insulin resistance was reported to be present in nearly 30 per cent of children and adolescents in India, more so in girls. At the same time many young individuals have clustering of other risk factors/conditions related to insulin resistance (e.g., non-alcoholic fatty liver disease, obstructive sleep apnoea, etc.). Rapid nutritional and lifestyle transition in urbanized areas in various countries in South Asia are prime reasons for increasing prevalence of obesity and the metabolic syndrome. It is particularly important to effectively implement and strengthen population-based primary prevention strategies for the prevention of 'epidemic' of obesity and the metabolic syndrome. The lifestyle factor modification to prevent the metabolic syndrome and T2DM in South Asians should start in early childhood. Finally, there is an urgent need to conduct research studies regarding the correct definitions of the metabolic syndrome and genetic and perinatal factors related to insulin resistance in South Asians.

  View details for Web of Science ID 000246871300012

  View details for PubMedID 17496360

• Normal chest radiograph in terminal respiratory failure due to amyotrophic lateral sclerosis SOUTHERN MEDICAL JOURNAL Won, C., Banerjee, D., Stark, P., Kuschner, W. G. 2006; 99 (5): 551-552

  View details for Web of Science ID 000241315500029

  View details for PubMedID 16711329

• Diagnosing occupational lung disease: a practical guide to the occupational pulmonary history for the primary care practitioner. Comprehensive therapy Banerjee, D., Kuschner, W. G. 2005; 31 (1): 2-11

  Abstract

  A well-executed occupational pulmonary history should be part of the evaluation of workers presenting with respiratory illnesses or symptoms. In this article, we review the scope of occupational lung disease and detail the essential elements of the occupational pulmonary history.

  View details for PubMedID 15793319