Radha S Gopalan

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Journals/Publications

• Gopalan, R. S., Arabia, F. A., Noel, P., & Chandrasekaran, K. (2012). Hemolysis from aortic regurgitation mimicking pump thrombosis in a patient with a HeartMate II left ventricular assist device: a case report. ASAIO journal (American Society for Artificial Internal Organs : 1992), 58(3), 278-80.
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  Device-related hemolysis leading to anemia is a recognized chronic complication of a left ventricular assist device (LVAD). With the increased usage of the LVAD in the management of end-stage heart failure, an increased number of complications are being recognized. We present a case where a combination of elevated mean arterial pressure and development of aortic regurgitation resulted in increased hemolysis, power spikes, and anemia, mimicking device thrombus, resulting in a diagnostic dilemma.
• Lahewala, S., Arora, S., Tripathi, B., Panaich, S., Kumar, V., Patel, N., Savani, S., Dave, M., Varma, Y., Badheka, A., Deshmukh, A., Gidwani, U., Gopalan, R., & Briasoulis, A. (2019). Heart failure: Same-hospital vs. different-hospital readmission outcomes. International journal of cardiology, 278, 186-191.
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  Heart Failure (HF) is a major driver of the readmissions/penalties in the US. Although extensive literature on rehospitalization attributed to HF, studies to compare outcomes for same-hospital vs. different-hospital readmissions are sparse.
• Patel, N. J., Verma, D. R., Gopalan, R., Heuser, R. R., & Pershad, A. (2019). Percutaneous Biventricular Mechanical Circulatory Support With Impella CP and Protek Duo Plus TandemHeart. The Journal of invasive cardiology, 31(2), E46.
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  This is the first reported case of full biventricular mechanical circulatory support with the combination of Impella and Protek Duo, which is a dual-lumen cannula inserted via the right internal jugular vein, with its proximal inflow lumen positioned in the right atrium and distal lumen positioned in the main pulmonary artery. These lumens are connected with the paracorporeal TandemHeart pump allowing flows up to 5 L/min. The alternative percutaneous option for right ventricular support is the Impella RP (Abiomed), which has to be placed in the femoral vein, preventing ambulation. The axillary and internal jugular vein positions for devices are probably less prone to infection compared to the femoral area. The combination of an Impella inserted via the axillary artery with the Protek Duo is a viable option, allowing ambulation while providing biventricular support.
• Tripathi, B., Atti, V., Kumar, V., Naraparaju, V., Sharma, P., Arora, S., Wojtaszek, E., Gopalan, R., Siontis, K. C., Gersh, B. J., & Deshmukh, A. (2019). Outcomes and Resource Utilization Associated With Readmissions After Atrial Fibrillation Hospitalizations. Journal of the American Heart Association, 8(19), e013026.
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  Background Atrial fibrillation is the most common arrhythmia worldwide. Data regarding 30-day readmission rates after discharge for atrial fibrillation remain poorly reported. Methods and Results The Nationwide Readmission Database (2010-2014) was queried using the () codes to identify study population. Incidence, etiologies of 30-day readmission and predictors of 30-day readmissions, and cost of care were analyzed. Among 1 723 378 patients who survived to discharge, 249 343 (14.4%) patients were readmitted within 30 days. Compared with the readmitted group, the nonreadmitted group had higher utilization of electrical cardioversion and catheter ablation. Atrial fibrillation was the most common cause of readmission (24.1%). Median time to 30-day readmission was 13 days. Advancing age, female sex, and longer stay during index hospitalization predicted higher 30-day readmissions, whereas private insurance, electrical cardioversion, catheter ablation, higher income, and elective admissions correlated with lower 30-day readmission. Comorbidities such as heart failure, neurological disorder, chronic obstructive pulmonary disease, diabetes mellitus, chronic kidney disease, chronic liver failure, coagulopathy, anemia, peripheral vascular disease, and electrolyte disturbance, correlated with increased 30-day readmissions and cost burden. Trend analysis showed a progressive decline in 30-day readmission rates from 14.7% in 2010 to 14.3% in 2014 ( trend,
• Tripathi, B., Kumar, V., Pitiliya, A., Arora, S., Sharma, P., Shah, M., Atti, V., Ram, P., Patel, B., Patel, N. J., Tripathi, A., Savani, S., Wojtaszek, E., Patel, T., Deshmukh, A., Figueredo, V., & Gopalan, R. (2019). Trends in Incidence and Outcomes of Pregnancy-Related Acute Myocardial Infarction (From a Nationwide Inpatient Sample Database). The American journal of cardiology, 123(8), 1220-1227.
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  Acute myocardial infarction (AMI) during pregnancy is rare but fatal complication. Recent incidence of pregnancy related AMI and trends in the related outcomes are unknown. The Nationwide Inpatient Sample database was utilized from years 2005 to 2014. International Classification of Disease-Ninth Revision were used to identify pregnancy related admissions and AMI. Primary outcome was incidence and trend of AMI related to pregnancy and Secondary outcomes were trends in mortality, resource utilization, and predictors of AMI during pregnancy. Simple logistic regression model was used to calculate predictors of AMI during pregnancy. p Values for trends were generated by Cochrane-Armitage test for categorical variables and simple linear regression for continuous variables. A total of 43,437,621 pregnancy related hospitalization and 3,786 cases of AMI (86% ante-partum and 14% postpartum) were noted during study period. The incidence of AMI during the study period was 8.7 per 100,000 pregnancies with an overall increase in incidence during the study period (relative increase of 18.9%, p
• Virk, H. U., Tripathi, B., Kumar, V., Lakhter, V., Khan, M. S., Ijaz, S. H., Dean, S., Gupta, S., Sharma, P., Mishra, R., George, J. C., Gopalan, R., Zidar, D., & Janzer, S. (2019). Causes, Trends, and Predictors of 90-Day Readmissions After Spontaneous Coronary Artery Dissection (from A Nationwide Readmission Database). The American journal of cardiology, 124(9), 1333-1339.
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  Spontaneous coronary artery dissection (SCAD) is a frequently missed diagnosis in patients presenting with acute coronary syndrome (ACS). Our aim was to evaluate the causes, trends, and predictors of 90-day hospital readmission in patients presenting with SCAD. The Nationwide Readmissions Database (2013 to 2014) was utilized to identify patients with primary discharge diagnosis of SCAD using the International Classification of Diseases, Ninth Revision, Clinical Modification, diagnostic code 414.12. The primary outcome was 90-day readmission. Among 11,228 patients admitted with the primary diagnosis of SCAD, 2,424 patients (21.6%) were readmitted within 90 days (68% women, 82%
• Kalya, A., Jaroszewski, D., Pajaro, O., Scott, R., Gopalan, R., Kasper, D., & Arabia, F. (2013). 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.
• Sairam, T., Patel, A. N., Subrahmanian, M., Gopalan, R., Pogwizd, S. M., Ramalingam, S., Sankaran, R., & Rajasekaran, N. S. (2018). Evidence for a hyper-reductive redox in a sub-set of heart failure patients. Journal of translational medicine, 16(1), 130.
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  Oxidative stress has been linked to heart failure (HF) in humans. Antioxidant-based treatments are often ineffective. Therefore, we hypothesize that some of the HF patients might have a reductive stress (RS) condition. Investigating RS-related mechanisms will aid in personalized optimization of redox homeostasis for better outcomes among HF patients.
• Tripathi, B., Arora, S., Kumar, V., Abdelrahman, M., Lahewala, S., Dave, M., Shah, M., Tan, B., Savani, S., Badheka, A., Gopalan, R., Shantha, G. P., Viles-Gonzalez, J., & Deshmukh, A. (2018). Temporal trends of in-hospital complications associated with catheter ablation of atrial fibrillation in the United States: An update from Nationwide Inpatient Sample database (2011-2014). Journal of cardiovascular electrophysiology, 29(5), 715-724.
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  Catheter ablation is widely accepted intervention for atrial fibrillation (AF) refractory to antiarrhythmic drugs, but limited data are available regarding contemporary trends in major complications and in-hospital mortality due to the procedure. This study was aimed at exploring the temporal trends of in-hospital mortality, major complications, and impact of hospital volume on frequency of AF ablation-related outcomes.
• Tripathi, B., Arora, S., Kumar, V., Thakur, K., Lahewala, S., Patel, N., Dave, M., Shah, M., Savani, S., Sharma, P., Bandyopadhyay, D., Shantha, G. P., Egbe, A., Chatterjee, S., Patel, N. K., Gopalan, R., Figueredo, V. M., & Deshmukh, A. (2018). Hospital Complications and Causes of 90-Day Readmissions After Implantation of Left Ventricular Assist Devices. The American journal of cardiology, 122(3), 420-430.
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  Left ventricular assist devices (LVADs) have emerged as an attractive option in patients with advance heart failure. Nationwide readmission database 2013 to 2014 was utilized to identify LVAD recipients using ICD-9 procedure code 37.66. The primary outcome was 90-day readmission. Readmission causes were identified using ICD-9 codes in primary diagnosis field. The secondary outcomes were LVAD associated with hospital complications. Hierarchic 2-level logistic models were used to evaluate study outcomes. We identified 4,693 LVAD recipients (mean age 57 years, 76.2% males). Of which 53.9% were readmitted in first 90 days of discharge. Cardiac causes (33.3%), bleeding (21.3%), and infections (12.4%) were leading etiologies of 90-day readmissions. Significant predictors (odds ratio, 95% confidence interval, p value) of readmission were disposition to nursing facilities (1.33, 1.09 to 1.63, p = 0.01) and longer length of stay (1.01, 1.00 to 1.01, p
• Arora, S., Lahewala, S., Hassan Virk, H. U., Setareh-Shenas, S., Patel, P., Kumar, V., Tripathi, B., Shah, H., Patel, V., Gidwani, U., Deshmukh, A., Badheka, A., & Gopalan, R. (2017). Etiologies, Trends, and Predictors of 30-Day Readmissions in Patients With Diastolic Heart Failure. The American journal of cardiology, 120(4), 616-624.
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  An estimated half of all heart failure (HF) populations has been categorized to have diastolic HF (DHF), but sparse data are available describing etiologies and predictors of 30-day readmission in DHF population. The study cohort was derived from the National Readmission Database 2013 to 2014, a subset of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality. DHF was identified using International Classification of Diseases, 9th Revision code 428.3x in primary diagnosis field. Readmission etiologies were identified by International Classification of Diseases, 9th Revision code in primary diagnosis field. The primary outcome was 30-day readmission. Hierarchical multivariable logistic regression was used to adjust for confounders. In total, 192,394 patients with DHF were included, of which 40,927 (21.27%) patients were readmitted with total readmissions of 47,056 within 30 days. Predictors of increased readmissions were age (odds ratio [OR] 1.002, 95% confidence interval [CI] 1.001 to 1.0003, p
• Arora, S., Patel, P., Lahewala, S., Patel, N., Patel, N. J., Thakore, K., Amin, A., Tripathi, B., Kumar, V., Shah, H., Shah, M., Panaich, S., Deshmukh, A., Badheka, A., Gidwani, U., & Gopalan, R. (2017). Etiologies, Trends, and Predictors of 30-Day Readmission in Patients With Heart Failure. The American journal of cardiology, 119(5), 760-769.
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  Heart failure (HF) is the most common discharge diagnosis across the United States, and these patients are particularly vulnerable to readmissions, increasing attention to potential ways to address the problem. The study cohort was derived from the Healthcare Cost and Utilization Project's National Readmission Data 2013, sponsored by the Agency for Healthcare Research and Quality. HF was identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification codes. Readmission was defined as a subsequent hospital admission within 30 days after discharge day of index admission. Readmission causes were identified using International Classification of Diseases, Ninth Revision, codes in primary diagnosis filed. The primary outcome was 30-day readmission. Hierarchical 2-level logistic models were used to evaluate study outcomes. From a total 301,892 principal admissions (73.4% age ≥65 years and 50.6% men), 55,857 (18.5%) patients were readmitted with a total of 64,264 readmissions during the study year. Among the etiologies of readmission, cardiac causes (49.8%) were most common (HF being most common followed by coronary artery disease and arrhythmias), whereas pulmonary causes were responsible for 13.1% and renal causes for 8.9% of the readmissions. Significant predictors of increased 30-day readmission included diabetes (odds ratio, 95% confidence interval, p value: 1.06, 1.03 to 1.08, p
• Tripathi, B., Arora, S., Mishra, A., Kundoor, V. R., Lahewala, S., Kumar, V., Shah, M., Lakhani, D., Shah, H., Patel, N. V., Patel, N. J., Dave, M., Deshmukh, A., Sudhakar, S., & Gopalan, R. (2017). Short-term outcomes of atrial flutter ablation. Journal of cardiovascular electrophysiology, 28(11), 1275-1284.
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  Understanding the factors associated with early readmissions following atrial flutter (AFL) ablation is critical to reduce the cost and improving the quality of life in AFL patients.
• Trivieri, M. G., Dweck, M. R., Abgral, R., Robson, P. M., Karakatsanis, N. A., Lala, A., Contreras, J., Sahni, G., Gopalan, R., Gorevic, P., Fuster, V., Narula, J., & Fayad, Z. A. (2016). F-Sodium Fluoride PET/MR for the Assessment of Cardiac Amyloidosis. Journal of the American College of Cardiology, 68(24), 2712-2714.
• Fine, N. M., Gopalan, R. S., Arabia, F. A., Kushwaha, S. S., & Chandrasekaran, K. (2014). Intraoperative transesophageal echocardiographic guidance of total artificial heart implantation. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 33(4), 454-7.
• Gopalan, R., Scott, R., Arabia, F., & Chandrasekaran, K. (2011). Electro-acupuncture therapy in a patient with a total artificial heart. Acupuncture in medicine : journal of the British Medical Acupuncture Society, 29(4), 302-3.
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  Interaction between the electrical system of implanted cardiovascular devices and electrical stimulation of acupuncture points (electro-acupuncture) can be life-threatening. As a result, there is reluctance to use this modality in patients who have been implanted with any cardiac device. A patient with a total artificial heart was successfully treated with electro-acupuncture for inflammatory arthritis without any adverse events. This case illustrates the safety of electro-acupuncture in patients with a total artificial heart.
• Vinales, K. L., Gopalan, R. S., Lanza, L. A., Lester, S. J., & Chaliki, H. P. (2010). Unusual case of nonbacterial thrombotic endocarditis attributable to primary antiphospholipid syndrome. Circulation, 122(12), e459-60.
• Jaroszewski, D. E., Pierce, C. C., Staley, L. L., Wong, R., Scott, R. R., Steidley, E. E., Gopalan, R. S., DeValeria, P., Lanza, L., Mulligan, D., & Arabia, F. A. (2009). Simultaneous heart and kidney transplantation after bridging with the CardioWest total artificial heart. The Annals of thoracic surgery, 88(4), 1324-6.
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  End-stage renal failure is often considered a relative contraindication for total artificial heart implantation due to the increased risk of mortality after transplantation. We report the successful treatment of a patient having heart and renal failure with the CardioWest (SynCardia Inc, Tucson, AZ) total artificial heart for bridge-to-cardiac transplantation of a heart and kidney.
• Samuels, L. E., Holmes, E. C., Hagan, K., Gopalan, R., Droogan, C., & Ferdinand, F. (2006). The Thoratec Implantable Ventricular Assist Device (IVAD): initial clinical experience. The heart surgery forum, 9(4), E690-2.
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  The Thoratec Implantable Ventricular Assist Device (IVAD) is the only FDA-approved intracorporeal biventricular cardiac assist device. It is a titanium-coated version of its predecessor, the Paracorporeal Ventricular Assist Device (PVAD). The blood pump is compatible with the portable TLC-II driver, making home discharge feasible.
• Rajput, F. S., Gnanasekeram, H., Satwani, S., Davenport, J. D., Gracely, E. J., Gopalan, R., & Narula, J. (2003). Choosing metoprolol or carvedilol in heart failure (a pre-COMET commentary). The American journal of cardiology, 92(2), 218-21.