Stanford University School of Medicine M.D. '25
University of Cambridge MPhil in Epidemiology '21
Harvard College A.B. with Honors in Human Evolutionary Biology, Minor in Chemistry '20
Education & Certifications
Bachelor of Arts, Harvard University, UG Human Biology (2020)
MPhil, University of Cambridge, Epidemiology (2021)
A.B., Harvard College, Human Evolutionary Biology, Minor in Chemistry (2020)
Four Decades of Progress in Heart-Lung Transplantation: 271 Cases at a Single Institution.
The Journal of thoracic and cardiovascular surgery
OBJECTIVE: The objective of this study is to evaluate survival for combined heart-lung transplant (HLTx) recipients across four decades at a single institution. We aim to summarize our contemporary practice based upon more than 271 HLTx over 40 years.METHODS: Data were collected from a departmental database and the United Network for Organ Sharing (UNOS). Recipients <18y, those undergoing redo HLTx , or triple-organ system transplantation were excluded, leaving 271 patients for analysis. The Pioneering Era was defined by date of transplant between 1981-2000 (N=155), and the Modern Era between 2001-2022 (N=116). Survival analysis was performed using cardinality matching of populations based on donor and recipient age, donor and recipient sex, ischemic time, and sex-matching.RESULTS: Between 1981-2022, 271 HLTx were performed at a single institution. Recipients in the Modern Era were older (42 vs 34y, P<0.001) and had shorter waitlist times (78 vs 234d, P<0.001). Allografts from female donors were more common in the Modern Era (59% vs 39%, P=0.002). In the matched survival analysis, 30-day survival (97% vs 84%, P=0.005), 1-year survival (89% vs 77%, P=0.041), and 10-year survival (53% vs 26%, P=0.012) significantly improved in the Modern Era relative to the Pioneering Era, respectively.CONCLUSIONS: Long-term survival in HLTx is achievable with institutional experience and may continue to improve in the coming decades. Advances in mechanical circulatory support, improved maintenance immunosuppression, and early recognition and management of acute complications such as primary graft dysfunction and acute rejection have dramatically improved the prognosis for HLTx recipients in our contemporary institutional experience.
View details for DOI 10.1016/j.jtcvs.2024.01.042
View details for PubMedID 38320627
Biomechanics and clinical outcomes of various conduit configurations in valve sparing aortic root replacement.
Annals of cardiothoracic surgery
2023; 12 (4): 326-337
Several conduit configurations, such as straight graft (SG), Valsalva graft (VG), anticommissural plication (ACP), and the Stanford modification (SMOD) technique, have been described for the valve-sparing aortic root replacement (VSARR) procedure. Prior ex vivo studies have evaluated the impact of conduit configurations on root biomechanics, but the mock coronary artery circuits used could not replicate the physical properties of native coronary arteries. Moreover, the individual leaflet's biomechanics, including the fluttering phenomenon, were unclear.Porcine aortic roots with coronary arteries were explanted (n=5) and underwent VSARR using SG, VG, ACP, and SMOD for evaluation in an ex vivo left heart flow loop simulator. Additionally, 762 patients who underwent VSARR from 1993 through 2022 at our center were retrospectively reviewed. Analysis of variance was performed to evaluate differences between different conduit configurations, with post hoc Tukey's correction for pairwise testing.SG demonstrated lower rapid leaflet opening velocity compared with VG (P=0.001) and SMOD (P=0.045) in the left coronary cusp (LCC), lower rapid leaflet closing velocity compared with VG (P=0.04) in the right coronary cusp (RCC), and lower relative opening force compared with ACP (P=0.04) in the RCC. The flutter frequency was lower in baseline compared with VG (P=0.02) and in VG compared with ACP (P=0.03) in the LCC. Left coronary artery mean flow was higher in SG compared with SMOD (P=0.02) and ACP (P=0.05). Clinically, operations using SG compared with sinus-containing graft was associated with shorter aortic cross-clamp and cardiopulmonary bypass time (P<0.001, <0.001).SG demonstrated hemodynamics and biomechanics most closely recapitulating those from the native root with significantly shorter intraoperative times compared with repair using sinus-containing graft. Future in vivo validation studies as well as correlation with comprehensive, comparative clinical study outcomes may provide additional invaluable insights regarding strategies to further enhance repair durability.
View details for DOI 10.21037/acs-2023-avs2-0068
View details for PubMedID 37554719
View details for PubMedCentralID PMC10405339
Galectin-3 and HFpEF: Clarifying an Emerging Relationship.
Current cardiology reviews
HFpEF is a leading cause of death whose burden is projected to increase in the coming decades. The aim of this paper is to interrogate the relationship between levels of circulating galectin-3, an emerging risk factor for cardiovascular disease, and the clinical diagnosis of HFpEF.The authors reviewed peer-reviewed literature and 18 studies met inclusion criteria. Study characteristics, study outcome definitions, assay characteristics, main findings, and measures of association were tabulated and summarized.Five studies found significant associations between galectin-3 and HFpEF diagnosis compared to healthy controls, and one did not. Five studies found significant associations between levels of circulating galectin-3 and severity of diastolic dysfunction. Three studies found significant associations between galectin-3 and all-cause mortality or rehospitalization. Two studies found levels of circulating galectin-3 to be a statistically significant predictor of later HFpEF onset. Finally, two studies examined whether galectin-3 was associated with incident HFpEF, one found a significant association and the other did not.Given the paucity of effective therapeutics for HFpEF, galectin-3 shows promise as a possible HFpEF-linked biomarker that may, with further study, inform and predict treatment course to reduce morbidity and mortality.
View details for DOI 10.2174/1573403X19666230320165821
View details for PubMedID 36959138
Galectin-3 is Associated with Heart Failure Incidence: A Meta-Analysis.
Current cardiology reviews
INTRODUCTION: Heart failure (HF) is a leading cause of death worldwide. The global prevalence of heart failure is projected to increase rapidly in the coming decades, and significant attention has turned to improve biomarker-based risk prediction of incident HF. This paper aimed to qualitatively and quantitatively evaluate the evidence associating levels of galectin-3 with the risk of incident HF.METHODS: A review of PUBMED-indexed peer-reviewed literature was performed. Nine studies met the inclusion criteria, and all nine had data eligible for conversion and pooling. A random-effects meta-analysis was performed using hazard ratios and 95% confidence intervals from a minimally adjusted model, a further adjusted model, and from subgroups within the further-adjusted model.RESULTS: The minimally-adjusted model provided an HR of 1.97 (95% CI 1.74-2.23) when comparing the top quartile of log-gal-3 to the bottom quartile. The further-adjusted model provided an HR of 1.32 (95% CI 1.21-1.44) for the same comparison. The positive, significant association was conserved during sensitivity analysis.CONCLUSION: There is a significant positive association between circulating galectin-3 and the risk of incident heart failure. Given the complex mechanistic relationship between galectin-3 and cardiovascular pathophysiology, further investigation is recommended for the possible implementation of galectin-3 into clinical risk prediction models.
View details for DOI 10.2174/1573403X19666221117122012
View details for PubMedID 36397629
- Did giraffe cardiovascular evolution solve the problem of heart failure with preserved ejection fraction? EVOLUTION MEDICINE AND PUBLIC HEALTH 2021; 9 (1): 248-255
Complete and Partial Aortic Occlusion for the Treatment of Hemorrhagic Shock in Swine.
Journal of visualized experiments : JoVE
Hemorrhage remains the leading cause of preventable deaths in trauma. Endovascular management of non-compressible torso hemorrhage has been at the forefront of trauma care in recent years. Since complete aortic occlusion presents serious concerns, the concept of partial aortic occlusion has gained a growing attention. Here, we present a large animal model of hemorrhagic shock to investigate the effects of a novel partial aortic balloon occlusion catheter and compare it with a catheter that works on the principles of complete aortic occlusion. Swine are anesthetized and instrumented in order to conduct controlled fixed-volume hemorrhage, and hemodynamic and physiological parameters are monitored. Following hemorrhage, aortic balloon occlusion catheters are inserted and inflated in the supraceliac aorta for 60 min, during which the animals receive whole-blood resuscitation as 20% of the total blood volume (TBV). Following balloon deflation, the animals are monitored in a critical care setting for 4 h, during which they receive fluid resuscitation and vasopressors as needed. The partial aortic balloon occlusion demonstrated improved distal mean arterial pressures (MAPs) during the balloon inflation, decreased markers of ischemia, and decreased fluid resuscitation and vasopressor use. As swine physiology and homeostatic responses following hemorrhage have been well-documented and are like those in humans, a swine hemorrhagic shock model can be used to test various treatment strategies. In addition to treating hemorrhage, aortic balloon occlusion catheters have become popular for their role in cardiac arrest, cardiac and vascular surgery, and other high-risk elective surgical procedures.
View details for DOI 10.3791/58284
View details for PubMedID 30199035
View details for PubMedCentralID PMC6231876