Perin A. Kothari

All Publications

• Beating Heart Transplants-Overview and Implications for Anesthesiologists. Journal of cardiothoracic and vascular anesthesia Kothari, P., Kiwakyou, L. M., Guenthart, B. A., Vanneman, M. 2023

  Abstract

  As the demand for heart allografts for transplantation continues to rise, ex vivo organ perfusion strategies are playing an increasingly important role in the preservation of organs from donation after circulatory death and extended-criteria donors. One such method uses the Organ Care System (TransMedics, Andover, MA). Traditionally, this technique of preservation requires 2 periods of warm ischemia and subsequent cardioplegic arrest. In a novel surgical technique pioneered at the authors' institution, heart allograft implantation no longer requires a second cardioplegic arrest. This article discusses the surgical approach for this procedure, the advantages and disadvantages of this approach, and analogs to current clinical practice to theorize what impact this may have on cardiac transplantation volumes in the future.

  View details for DOI 10.1053/j.jvca.2023.12.031

  View details for PubMedID 38228423

• Highlights and Perioperative Implications from the 2022 American College of Cardiology and American Heart Association Guidelines for Diagnosis and Management of Aortic Disease. Journal of cardiothoracic and vascular anesthesia Kothari, P., Bodmer, N. J., Ellis, S., Kiwakyou, L. M., Choi, C. 2023

  Abstract

  As the understanding of aortic diseases and their complications grow, increasing importance of uniformity in diagnosis and management is crucial for optimal care of this patient population. The 2022 American College of Cardiology and American Heart Association Guidelines for Diagnosis and Management of Aortic Disease discusses these considerations in detail. The purpose of this review is to highlight essential recommendations that are of relevance to the perioperative physician who manages these patients. A few notable points include, shared decision-making with patients, creation of multidisciplinary aortic teams, lower diameter thresholds for surgery in certain situations, and increased testing for patients with heritable aortic diseases. In addition to briefly reviewing basics of aortic diseases, the authors discuss changes to guidelines that are especially relevant to perioperative care.

  View details for DOI 10.1053/j.jvca.2023.05.037

  View details for PubMedID 37353422

• The Year in Graduate Medical Education: Selected Highlights From 2022. Journal of cardiothoracic and vascular anesthesia Patel, S. J., Notarianni, A. P., Martin, A. K., Tsai, A., Pulton, D. A., Linganna, R., Patel, P. A., Waldron, N. H., Nimma, S. R., Bodmer, N. J., Kothari, P., Jackson, E., Gupta, R. G., Roberts, M. L., Feinman, J. W. 2023

  View details for DOI 10.1053/j.jvca.2023.04.040

  View details for PubMedID 37210326

• Staying Virtual: A Survey Study of the Virtual Lecture Experience in Academic Medicine. Anesthesia and analgesia Rayaz, H., Yedavalli, V., Sair, H., Sharma, G., Rowan, N., Tackett, S., Infosino, A., Nabipour, S., Kothari, P., Levine, R., Ishii, M., Yousem, D., Agrawal, Y., Skarupski, K., Faraday, N., Lee, J. K., Brady, M. 2023

  Abstract

  Increasing clinical demands can adversely impact academic advancement, including the ability to deliver lectures and disseminate scholarly work. The virtual lecture platform became mainstream during the height of the coronavirus-19 pandemic. Lessons learned from this period may offer insight into supporting academic productivity among physicians who must balance multiple demands, including high clinical workloads and family care responsibilities. We evaluated perceptions on delivering virtual lectures to determine whether virtual venues merit continuation beyond the pandemic's initial phase and whether these perceptions differ by gender and rank.In a survey study, faculty who spoke in 1 of 3 virtual lecture programs in the Departments of Anesthesiology and Critical Care Medicine, Otolaryngology, and Radiology at a university hospital in 2020 to 2022 were queried about their experience. Speakers' motivations to lecture virtually and the perceived advantages and disadvantages of virtual and in-person lectures were analyzed using descriptive statistics and qualitative analyses.Seventy-two of 95 (76%) faculty members responded (40% women, 38% men, and 22% gender undisclosed). Virtual lectures supported the speakers "a lot" to "extremely" with the following goals: enhancing one's reputation and credibility (76%), networking (70%), receiving feedback (63%), and advancing prospects for promotion (59%). Virtual programs also increased the speakers' sense of accomplishment (70%) and professional optimism (61%) by at least "a lot," including instructors and assistant professors who previously had difficulty obtaining invitations to speak outside their institution. Many respondents had declined prior invitations to speak in-person due to clinical workload (66%) and family care responsibilities (58%). Previous opportunities to lecture in-person were also refused due to finances (39%), teaching (26%), and research (19%) requirements, personal medical conditions or disabilities (9%), and religious obligations (5%). Promotion was a stronger motivating factor to lecture virtually for instructors and assistant professors than for associate and full professors. By contrast, disseminating work and ideas was a stronger motivator for associate and full professors. Associate and full professors also reported greater improvement in work-related well-being than earlier career faculty from the virtual lecture experience. Very few differences were found by gender.Virtual lecture programs support faculty who might not otherwise have the opportunity to lecture in-person due to multiple constraints. To increase the dissemination of scholarly work and expand opportunities to all faculty, virtual lectures should continue even as in-person venues are reestablished.

  View details for DOI 10.1213/ANE.0000000000006490

  View details for PubMedID 37115722

• The Year in Perioperative Echocardiography: Selected Highlights From 2022. Journal of cardiothoracic and vascular anesthesia Khoche, S., Ellis, J., Poorsattar, S. P., Kothari, P., Oliver, A., Whyte, A., Maus, T. M. 2023

  Abstract

  THIS SPECIAL article is part of an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor-in-chief, Dr. Kaplan, and the Editorial Board for the opportunity to continue this series, which focuses on the past year's research highlights that pertain to perioperative echocardiography in relation to cardiothoracic and vascular anesthesia. The major selected themes for 2022 include (1) updates on mitral valve assessments and interventions, (2) training and simulation updates, (3) outcomes and complications of transesophageal echocardiography, and (4) point-of-care cardiac ultrasound. The themes selected for this special article are just a sample of the advances in perioperative echocardiography during 2022. An appreciation and understanding of these highlights will help to ensure and improve the perioperative outcomes for patients with cardiovascular disease undergoing cardiac surgery.

  View details for DOI 10.1053/j.jvca.2023.04.023

  View details for PubMedID 37208207

• Ex-Vivo Preservation of Heart Allografts-An Overview of the Current State. Journal of cardiovascular development and disease Kothari, P. 2023; 10 (3)

  Abstract

  As heart transplantation continues to be the gold-standard therapy for end-stage heart failure, the supply-demand imbalance of available organs worsens. Until recently, there have been no advances in increasing the donor pool, as prolonged cold ischemic time excludes the use of certain donors. The TransMedics Organ Care System (OCS) allows for ex-vivo normothermic perfusion, which allows for a reduction of cold ischemic time and allows for long-distance procurements. Furthermore, the OCS allows for real-time monitoring and assessment of allograft quality, which can be crucial for extended-criteria donors or donation after cardiac death (DCD) donors. Conversely, the XVIVO device allows for hypothermic perfusion to preserve allografts. Despite their limitations, these devices have the potential to alleviate the supply-demand imbalance in donor availability.

  View details for DOI 10.3390/jcdd10030105

  View details for PubMedID 36975869

• The Year in Graduate Medical Education: Selected Highlights From 2021. Journal of cardiothoracic and vascular anesthesia Patel, S. J., Patel, P. A., Martin, A. K., Tsai, A., Linganna, R. E., Ghofaily, L. A., Notarianni, A. P., Allen, W. L., Buric, D. M., Bodmer, N. J., Kothari, P., Jackson, E., Feinman, J. W. 2022

  Abstract

  This special article is the first in a planned annual series for the Journal of Cardiothoracic and Vascular Anesthesia that will highlight significant literature from the world of graduate medical education (GME) that was published over the past year. The major themes selected for this inaugural review are the educational value of simulation and training workshops, the expanding role of social media and other information technologies in GME and recruitment, the state of residency and fellowship training before the COVID-19 pandemic, and the inevitable effects COVID-19 has had on graduate medical education. The authors would like to thank the editorial board for allowing us to shine a light on a small subset of the writing and research produced in this field, so that educators may understand how best to educate and train the next generation of anesthesiologists.

  View details for DOI 10.1053/j.jvca.2022.05.013

  View details for PubMedID 35662516

• The Year in Perioperative Echocardiography: Selected Highlights From 2021. Journal of cardiothoracic and vascular anesthesia Khoche, S., Choi, C., Kothari, P., Hamm, K., Poorsattar, S. P., Maus, T. M. 2022

  Abstract

  This article is the sixth of an annual series reviewing the research highlights of the year pertaining to the subspecialty of perioperative echocardiography for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor-in-chief, Dr. Kaplan, and the editorial board for the opportunity to continue this series. In most cases, these were research articles that were targeted at the perioperative echocardiography diagnosis and treatment of patients after cardiothoracic surgery; but, in some cases, these articles targeted the use of perioperative echocardiography in general.

  View details for DOI 10.1053/j.jvca.2022.04.002

  View details for PubMedID 35680493

• The Year in Electrophysiology: Selected Highlights from 2021. Journal of cardiothoracic and vascular anesthesia Vanneman, M., Kothari, P., Bodmer, N. J., Convissar, D., Desai, G. A., Kumar, N., Iyer, M. H., Neuburger, P. J., Essandoh, M. K., Cronin, B., Dalia, A. A. 2022

  View details for DOI 10.1053/j.jvca.2022.01.045

  View details for PubMedID 35248433

• The Year in Electrophysiology: Selected Highlights From 2020. Journal of cardiothoracic and vascular anesthesia Kothari, P. n., Poorsattar, S. P., Graul, T. n., Cody, J. n., Steinhorn, R. n., Choi, C. n., Essandoh, M. K., Cronin, B. n., Dalia, A. n. 2021

  Abstract

  This article is the third in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the Editor-in-Chief Dr. Kaplan, the Associate Editor-in-Chief Dr. Augoustides, and the editorial board for the opportunity to continue this series; namely, the highlights of the year that pertain to electrophysiology in relation to cardiothoracic and vascular anesthesia. This third article focuses on the convergent procedure, His-bundle pacing, a comparison of subcutaneous and transvenous defibrillator therapies, the 2020 practice advisory update for the perioperative management of patients with cardiac implantable electronic devices, and a technology update regarding the Micra AV (Medtronic, Moundsview, MN), the EMPOWER leadless pacemaker (Boston Scientific, Marlborough, MA), WiSE-CRT (EBR Systems, Sunnyvale, CA), the Extravascular Implantable Cardioverter Defibrillator (Medtronic, Moundsview, MN), and the BAROSTIM NEO (CVRx Inc, Minneapolis, MN).

  View details for DOI 10.1053/j.jvca.2021.01.044

  View details for PubMedID 33602638

• Gradually Progressive Dyspnea and Exercise Intolerance in an Otherwise Active Middle-Aged Woman: Why Was the Presentation of Congenital Heart Disease Delayed? Journal of cardiothoracic and vascular anesthesia Kothari, P., Nguyen, Q., Pagel, P. S., Choi, C. 2020

  Abstract

  Patients with congenital heart disease (CHD) increasingly are surviving into adulthood. In the United States alone, there are more than one million adult patients living with CHD with the number increasing about 5% each year. With more than 85% of infants with CHD surviving into adulthood with their disease, encounters with these patients in the operating room for cardiac and noncardiac operative procedures is becoming more commonplace. Most of these patients receive corrective surgery early in life, although some may live with uncorrected CHD with no-to-relatively mild symptoms and present at a later time in life with symptoms of heart failure or pulmonary hypertension. The authors present an adult patient with uncorrected CHD presenting with late onset of heart failure symptoms. The authors also review the patient's complex congenital heart lesion, transesophageal echocardiography findings, and intraoperative management.

  View details for DOI 10.1053/j.jvca.2020.11.055

  View details for PubMedID 33376067