Anantharam V Kalya

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• Yerasi, C., Roy, S. B., Olson, M., Elnahas, S., Kang, P., Hashimi, A. S., Huang, J., Abdelrazek, H., Patel, V., Omar, A., Bremner, R. M., Smith, M., Walia, R., Bhattacharya, S., & Kalya, A. (2018). Outcomes of lung transplant recipients with preoperative atrial fibrillation. Asian cardiovascular & thoracic annals, 26(2), 127-132.
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  Background Preoperative atrial fibrillation is associated with poor outcomes after cardiac surgery, but its effect on lung transplantation outcomes remains unknown. Methods We retrospectively reviewed the charts of 235 patients who underwent lung transplantation in our institution from 2013 to 2015, analyzing demographics, length of stay, survival, readmissions, and cardiac events. Mean recipient age was 59 ± 11 years, and 142 (60.4%) were men. Patients were grouped according to pre-transplantation atrial fibrillation status (atrial fibrillation/no atrial fibrillation). Results The atrial fibrillation group ( n = 38; 16.2%) was significantly older with a longer ischemic time, more postoperative atrial arrhythmias (73.7% vs. 20.8%, p = 0.01), and a longer median postoperative length of stay (16 vs. 13 days, p = 0.02). The median total hospital stay in the first postoperative year was also higher in the atrial fibrillation group (27 vs. 21 days, p = 0.25). Short-term survival and survival during follow-up did not differ significantly between groups. Conclusions Lung transplant recipients with preoperative atrial fibrillation are at increased risk of adverse cardiovascular outcomes and longer hospital stay. Preoperative atrial fibrillation may portend adverse events after lung transplantation.
• Kalya, A., Jaroszewski, D., Pajaro, O., Scott, R., Gopalan, R., Kasper, D., & Arabia, F. (2014). Role of total artificial heart in the management of heart transplant rejection and retransplantation: case report and review. Clinical transplantation, 27(4), E348-50.
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  Cardiac allograft rejection and failure may require mechanical circulatory support as bridge-to-retransplantation. Prognosis in this patient group is poor and implantable ventricular assist devices have had limited success due to organ failure associated with the high dose immunosuppression required to treat ongoing rejection. We present a case from our institution and the world-wide experience utilizing the SynCardia CardioWest Total Artificial Heart (TAH-t; SynCardia Systems, Inc., Tucson, AZ, USA) for replacement of the failing graft, recovery of patient and end-organ failure with ultimate bridge to retransplantation. We present our experience and review of world-wide experience for use of TAH-t in this type patient.
• Mookadam, F., Kendall, C. B., Wong, R. K., Kalya, A., Warsame, T., Arabia, F. A., Lusk, J., Moustafa, S., Steidley, E., Quader, N., & Chandrasekaran, K. (2012). Left ventricular assist devices: physiologic assessment using echocardiography for management and optimization. Ultrasound in medicine & biology, 38(2), 335-45.
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  Left ventricular assist devices (LVAD) are being deployed increasingly in patients with severe left ventricular dysfunction and medically refractory congestive heart failure of any etiology. The United States Food and Drug Administration (FDA) recently approved the use of the Thoratec Heartmate II (Thoratec Corporation, Pleasanton, CA, USA) for outpatient use. Echocardiography is fundamental during each stage of patient management, pre-LVAD placement, during LVAD placement, for postoperative LVAD optimization and long-term follow-up. We present a pragmatic and systematic echocardiographic approach that serves as a guide for the management of left ventricular assist devices.
• Pajaro, O. E., Jaroszewski, D. E., Scott, R. L., Kalya, A. V., Tazelaar, H. D., & Arabia, F. A. (2011). Antibody-mediated rejection in heart transplantation: case presentation with a review of current international guidelines. Journal of transplantation, 2011, 351950.
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  Antibody-mediated rejection (AMR) (humoral rejection) of cardiac allografts remains difficult to diagnose and treat. Interest in AMR of cardiac allografts has increased over the last decade as it has become apparent that untreated humoral rejection threatens graft and patient survival. An international and multidisciplinary consensus group has formulated guidelines for the diagnosis and treatment of AMR and established that identification of circulating or donor-specific antibodies is not required and that asymptomatic AMR, that is, biopsy-proven AMR without cardiac dysfunction is a real entity with worsened prognosis. Strict criteria for the diagnosis of cardiac AMR have not been firmly established, although the diagnosis relies heavily on tissue pathological findings. Therapy remains largely empirical. We review an unfortunate experience with one of our patients and summarize recommended criteria for the diagnosis of AMR and potential treatment schemes with a focus on current limitations and the need for future research and innovation.
• Dieter, R. S., Kalya, A., Pacanowski, J. P., Migrino, R., Gaines, T. E., & Dieter, R. A. (2005). Acute aortic syndromes: aortic dissections, penetrating aortic ulcers and intramural aortic hematomas. Expert review of cardiovascular therapy, 3(3), 423-31.
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  Acute aortic syndromes, including dissections, intramural hematomas and penetrating aortic ulcers, are a catastrophic clinical entity that are relatively uncommon. A high index of clinical suspicion along with proper imaging modalities are critical in making a prompt and accurate diagnosis for immediate management and to improve survival of the patient.
• Kalya, A. V., Tector, A. J., Crouch, J. D., Downey, F. X., McDonald, M. L., Anderson, A. J., Bartoszewski, C. J., & Hosenpud, J. D. (2005). Comparison of Novacor and HeartMate vented electric left ventricular assist devices in a single institution. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 24(11), 1973-5.
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  We compared the survival outcomes, left ventricular assist device (LVAD)-related hospitalization, stroke, infection, panel reactive antibody, and blood product use data among 13 Novacor and 51 HeartMate system recipients. Stroke was significantly higher in Novacor patients, as was blood product use at the time of heart transplantation, likely due to long-term anti-coagulation, while the LVAD-related hospitalization and infections did not differ between the 2 groups. A positive panel reactive antibody was seen more among the HeartMate patients, but did not have a significant clinical impact and may not represent a true allosensitization.
• Qiu, Y., Tang, X. L., Park, S. W., Sun, J. Z., Kalya, A., & Bolli, R. (1997). The early and late phases of ischemic preconditioning: a comparative analysis of their effects on infarct size, myocardial stunning, and arrhythmias in conscious pigs undergoing a 40-minute coronary occlusion. Circulation research, 80(5), 730-42.
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  The effectiveness of the late phase of ischemic preconditioning (PC) in protecting against myocardial infarction and the concomitant contractile dysfunction after sustained ischemia remains unclear. The early and late phases of PC have not been compared using the same protocol in the same experimental model; furthermore, the late phase of PC has not been assessed in the conscious state in a large animal preparation. The goal of this study was to directly compare the effects of early and late PC on myocardial infarct size and postischemic dysfunction in chronically instrumented, conscious pigs. Four groups of pigs were subjected to a 40-minute coronary occlusion followed by 3 days of reperfusion. Group 1 (n=7) served as control. Group 2 (n=6) was subjected to ten 2-minute occlusion/2-minute reperfusion cycles 25 minutes before the 40-minute occlusion (early PC). Groups 3 (n=7) and 4 (n=4) were subjected to 10 and 25 cycles, respectively, of 2-minute occlusion/2-minute reperfusion 24 hours before the 40-minute occlusion (late PC). Infarct size averaged 45.1+/-5.9% of the region at risk in control pigs, was reduced by 79% (to 9.4+/-3.2%) in group 2, but did not differ in groups 3 (33.3+/-4.8%) and 4 (38.8+/-8.2%) versus group 1. Power analysis demonstrated that there was an 80% probability of detecting a 40% decrease in infarct size in groups 3 and 4 versus group 1. The recovery of systolic wall thickening (measured with ultrasonic crystals) after the 40-minute occlusion was poor in groups 1, 3, and 4 but markedly enhanced in group 2 throughout the 3 days of reperfusion; this beneficial effect could have been due to limitation of infarct size, alleviation of stunning, or both. Thus, a series of ten 2-minute coronary occlusions had a profound (approximately 80%) early infarct-limiting effect, which was associated with a marked functional benefit. This protection, however, disappeared 24 hours later and could not be reinstituted by increasing the number of PC coronary occlusions to 25. The incidence and duration of ventricular tachycardia after reperfusion was not changed by either early or late PC; no conclusions could be drawn regarding ventricular fibrillation or ischemia-induced ventricular tachycardia, since these arrhythmias did not occur in control animals. Taken together, the present results demonstrate striking differences between the early and late effects of PC: In conscious swine subjected to a sustained coronary occlusion, a PC protocol that induces powerful protection during the early phase of PC fails to induce any protection during the late phase, indicating either that a late protective effect of PC does not exist or that, if it exists, it must be weaker than the early protective effect.
• Maldonado, ., Talley, . D., Mayfield-Stokes, ., Leesar, ., Shih, ., & Kalya, . (1996). Exogenous Fibronectin to Prevent Neointimal Hyperplasia after Balloon Angioplasty. The Journal of invasive cardiology, 8(2), 107-112.
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  This study examined the effect of fibronectin to prevent restenosis in a microswine model after balloon angioplasty of the right iliac artery. Immediately following angioplasty, fourteen hypercholesterolemic microswines were randomized to receive fibronectin (223.5 mg, n = 8) or saline containing albumin (75.6 mg, n = 6). At 60-days post-angioplasty, the angioplasty-injured and intact contralateral arteries were examined with angiography and histopathology. With angiography, there was no significant difference in the luminal diameters of angioplasty arteries compared with the intact contralateral vessels. Histological examination of angioplasty-injured vessels showed neointimal hyperplasia. The intimal areas of angioplasty-injured vessels, in the placebo and fibronectin groups, were much larger than the areas of their contralateral vessels (fibronectin 287 +/- 160 vs. 138 +/- 88 µm2, p = 0.018; and the placebo (1,245 +/- 1,567 vs. 248 +/- 219 µm2, p = 0.041). Mean total cholesterol levels of both groups were maintained at levels > 400 mg/dl throughout the study period. CONCLUSION: At sixty days after balloon angioplasty injury: 1) fibronectin did not only not prevent neointimal hyperplasia, in some animals, it increased neointimal growth; and 2) angiographic results were not sensitive enough to quantify changes observed in histologic findings.
• Tang, X. L., Qiu, Y., Park, S. W., Sun, J. Z., Kalya, A., & Bolli, R. (1996). Time course of late preconditioning against myocardial stunning in conscious pigs. Circulation research, 79(3), 424-34.
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  We have recently found in conscious pigs that a sequence of brief coronary occlusions induces severe myocardial stunning, but when the same sequence is repeated 24 hours later, the severity of stunning is markedly reduced (approximately 50%) ("late preconditioning against stunning"). As an initial step toward elucidating the mechanism and potential clinical significance of this powerful cardioprotective response, the present study was conducted to define the time course of late preconditioning against myocardial stunning. Conscious pigs underwent a sequence of ten 2-minute coronary occlusion/2-minute reperfusion cycles and then a second identical sequence at 6 hours (group I, n = 7), 12 hours (group II, n = 6), 24 hours (group III, n = 10), 3 days (group IV, n = 10), or 6 days (group V, n = 11) after the first. Systolic wall thickening (WTh) in the ischemic/reperfused region remained significantly depressed for at least 3 hours after the 10th reperfusion of the first sequence, indicating myocardial stunning. When the second sequence of coronary occlusions was performed 6 hours after the first (group I), the recovery of WTh was similar to the first. In contrast, when the second sequence was repeated 12 hours after the first (group II), the recovery of WTh was improved, though not consistently, and the total deficit of WTh decreased by 41% (P < .05) compared with the first sequence. When the second sequence was repeated 24 hours (group III) and 3 days (group IV) after the first, the recovery of WTh was substantially enhanced, with 52% and 49% reductions in the total deficit of WTh, respectively (P < .01 versus the first sequence). When the second sequence was repeated 6 days later (group V), the recovery of WTh was indistinguishable from the first sequence. Thus, late preconditioning against myocardial stunning requires > 6 hours to develop, lasts for at least 60 hours after its appearance (with the most effective protection present at 24 hours and 3 days), and disappears within 6 days after the preconditioning ischemia, a time course that is consistent with the synthesis and degradation of cardioprotective proteins. In view of its sustained duration, this endogenous cardioprotective mechanism is of potential clinical importance.
• Kalya, A. V., & Ahearn, D. G. (1995). Increased resistance to antifungal antibiotics of Candida spp. adhered to silicone. Journal of industrial microbiology, 14(6), 451-5.
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  The minimal inhibitory concentrations (MICs) and minimal fungicidal concentrations (MFCs) of amphotericin B, miconazole, ketoconazole, fluconazole, and itraconazole were determined for non-adhered cells and cells adhered to sections of a silicone urinary catheter. The densities of adhered cells were established with cells radiolabeled with tritiated leucine. Well defined MICs and MFCs were established for amphotericin B for representative adhered strains. In contrast, the azoles, especially fluconazole, did not give clear end points and the MICs and MFCs were arbitrarily determined. MFCs for the adhered cells generally were 2- to 5-fold higher than those of non-adhered cells. Techniques that include adhered-cell susceptibilities may be necessary before antifungal regimens for prosthetic device-associated yeast infections are appropriately defined.