Jeffrey J Teuteberg

University of Pittsburgh, Pittsburgh, Pennsylvania, United States

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Publications (162)823.86 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: To characterize the worldwide variance in anticoagulation and antiplatelet therapy in patients with continuous- flow mechanical circulatory support (MCS) devices. Background: Anticoagulation in MCS patients dictated by local practice, and therefore uniform standards for management are lacking. Methods: A 42-item survey was created and distributed electronically to MCS practitioners in August 2014. The survey assessed the center-perceived thromboembolic risk (minimal, low, moderate, or high) and characterized the antiplatelet and anticoagulant strategies for the Thoratec HeartMate II (HMII) and HeartWare HVAD. Results: A total of 83/214 centers (39%) responded: North America (60/152), Europe (18/50), Australia (2/4) and Asia (3/8). 60% of centers reported a moderate or high risk perception for the HMII as compared to 49% for HVAD (p=0.72). Although the most common target INR was 2-3 for both devices, significant variability exists. Anticoagulation intensity tended to be lower with the HMII, with more centers targeting INR values of less than 2.5. Aspirin monotherapy was the most common antiplatelet regimen, however the HVAD patients were more likely to be on daily aspirin doses over 100mg. Additionally, parenteral bridging during periods of subtherapeutic INR values was more frequent with the HVAD device. While 43.8% of respondents indicated an increase in the perceived risk of HMII device thrombosis in 2014, intensification of anticoagulation (22%) or antiplatelet (11%) therapy was infrequent. Conclusion: Despite similar perception of thrombotic risk, centers target higher INR values and use larger aspirin doses with the HVAD versus the HMII device. Our findings verify the wide variety of anticoagulation practice patterns between MCS centers.
    The Journal of Heart and Lung Transplantation 04/2015; 34(4):S53–S54. · 5.61 Impact Factor
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    ABSTRACT: The basis for increased mortality after heart transplantation in African Americans and other non-Caucasian racial groups is poorly defined. We hypothesized that increased risk of adverse events is driven by biologic factors. To test this hypothesis in the Invasive Monitoring Attenuation through Gene Expression (IMAGE) study, we determined whether the event rate of the primary outcome of acute rejection, graft dysfunction, death, or retransplantation varied by race as a function of calcineurin inhibitor (CNI) levels and gene expression profile (GEP) scores. We determined the event rate of the primary outcome, comparing racial groups, stratified by time after transplant. Logistic regression was used to compute the relative risk across racial groups, and linear modeling was used to measure the dependence of CNI levels and GEP score on race. In 580 patients monitored for a median of 19 months, the incidence of the primary end point was 18.3% in African Americans, 22.2% in other non-Caucasians, and 8.5% in Caucasians (p < 0.001). There were small but significant correlations of race and tacrolimus trough levels to the GEP score. Tacrolimus levels were similar among the races. Of patients receiving tacrolimus, other non-Caucasians had higher GEP scores than the other racial groups. African American recipients demonstrated a unique decrease in expression of the FLT3 gene in response to higher tacrolimus levels. African Americans and other non-Caucasian heart transplant recipients were 2.5-times to 3-times more likely than Caucasians to experience outcome events in the Invasive Monitoring Attenuation through Gene Expression study. The increased risk of adverse outcomes may be partly due to the biology of the alloimmune response, which is less effectively inhibited at similar tacrolimus levels in minority racial groups. Copyright © 2015 International Society for Heart and Lung Transplantation. All rights reserved.
    The Journal of Heart and Lung Transplantation 02/2015; DOI:10.1016/j.healun.2015.01.987 · 5.61 Impact Factor
  • Jeffrey J. Teuteberg, Marc A. Simon
    The Journal of Heart and Lung Transplantation 11/2014; 34(2). DOI:10.1016/j.healun.2014.11.006 · 5.61 Impact Factor
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    ABSTRACT: Background-Despite low risk of late rejection after heart transplant (HT), surveillance endomyocardial biopsies (EMBs) are often continued for years. We assessed the cost-effectiveness of routine EMB after 12 months post-HT. Methods and Results-Markov model compared the following surveillance EMB strategies to baseline strategy of stopping EMB 12 months post-HT: (1) every 4 months during year 2 post-HT, (2) every 6 months during year 2, (3) every 4 months for years 2 to 3, and (4) every 6 months for years 2 to 3. Patients entered the model 12 months post-HT and were followed until 36 months. In all strategies, patients had EMB with symptoms; in biopsy strategies after 12 months, EMB was also performed as scheduled regardless of symptoms. One-way and Monte Carlo sensitivity analyses were performed. Stopping EMB at 12 months was dominant (more effective, less costly), saving $2884 per patient compared with the next best strategy (every 6 months for year 2) and gaining 0.0011 quality-adjusted life-years. Increasing the annual risk of asymptomatic rejection in years 2 to 3 from previously reported 2.5% to 8.5% resulted in the biopsy every 6 months for year 2 strategy gaining 0.0006 quality-adjusted life-years, but cost $4 913 599 per quality-adjusted life-year gained. EMB for 12 months was also no longer dominant when mortality risk from untreated asymptomatic rejection approached 11%; competing strategies still cost >$200 000 per quality-adjusted life-year as that risk approached 99%. Conclusions-Surveillance EMB for 12 months post-HT is more effective and less costly than EMB performed after 12 months, unless risks of asymptomatic cellular rejection and its mortality are strikingly higher than previously observed.
    Circulation Heart Failure 08/2014; 7(5). DOI:10.1161/CIRCHEARTFAILURE.114.001199 · 5.95 Impact Factor
  • Jeffrey J Teuteberg, Josephine C Chou
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    ABSTRACT: Cardiogenic shock remains a leading cause of mortality despite advances in the treatment of myocardial infarction and advanced heart failure. Medical therapy can be inadequate, and patients may need mechanical circulatory support (MCS). The proper application of MCS requires knowledge of the underlying cause of acute heart failure, familiarity with the circulatory support devices, and the potential benefits and limitations of device therapy. This article describes the most commonly used temporary ventricular assist devices and their use in the various causes of cardiogenic shock.
    Critical Care Clinics 07/2014; 30(3):585-606. DOI:10.1016/j.ccc.2014.04.002 · 2.50 Impact Factor
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    ABSTRACT: Background. The malignancy rate after alemtuzumab (C-1H) induction in cardiac transplantation is unknown. Methods. A retrospective analysis from a single center for all patients that underwent cardiac transplantation from January 2000 to January 2011 and that had no history of malignancy before transplantation was performed. Patients induced with alemtuzumab were compared with a group of patients receiving thymoglobulin or no induction and assessed for 4-year cancer-free post-heart transplantation survival. Results. Of 402 patients included, 185 (46.0%) received alemtuzumab, 56 (13.9%) thymoglobulin, and 161 (40.0%) no induction. Baseline characteristics did not differ between groups: mean age 54.0 years, male 77.1%, white 88.6%, ischemic cardiomyopathy 49.0%. The calcineurin inhibitor was tacrolimus in 98.9% of alemtuzumab patients, 98.2% of thymoglobulin patients, and 87.0% of the noninduced (P < .001). The secondary agent was mycophenolate mofetil in all but 16 noninduced patients (9.9%), who received azathioprine. The 4-year cancer-free survival did not differ between groups: 88.1% alemtuzumab, 87.5% thymoglobulin, 88.2% noninduction; P = .088. The 4-year nonskin cancer-free survival was 96.8% for the alemtuzumab group, 96.4% for the thymoglobulin group, and 95.7% for the noninduced; P = .899. Conclusions. Neither the 4-year cancer-free survival nor the 4-year nonskin cancer-free survival differed between the alemtuzumab, thymoglobulin, and noninduced groups.
    Transplantation Proceedings 06/2014; 46(5):1481-8. DOI:10.1016/j.transproceed.2014.04.001 · 0.95 Impact Factor
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    ABSTRACT: Preoperative liver dysfunction may influence haemostasis following ventricular assist device (VAD) implantation. The Model for End-stage Liver Disease (MELD) score was assessed as a predictor of bleeding and levels of haemostatic markers in patients with currently utilized VADs. Sixty-three patients (31 HeartMate II, 15 HeartWare, 17 Thoratec paracorporeal ventricular assist device) implanted 2001-11 were analysed for preoperative liver dysfunction (MELD) and blood product administration. Of these patients, 21 had additional blood drawn to measure haemostatic marker levels. Cohorts were defined based on high (≥18.0, n = 7) and low (<18.0, n = 14) preoperative MELD scores. MELD score was positively correlated with postoperative administration of red blood cell (RBC), platelet, plasma and total blood product units (TBPU) , as well as chest tube drainage and cardiopulmonary bypass time. Age and MELD were preoperative predictors of TBPU by multivariate analysis. The high-MELD cohort had higher administration of TBPU, RBC and platelet units and chest tube drainage postimplant. Similarly, patients who experienced at least one bleeding adverse event were more likely to have had a high preoperative MELD. The high-MELD group exhibited different temporal trends in F1 + 2 levels and platelet counts to postoperative day (POD) 55. D-dimer levels in high-MELD patients became elevated versus those for low-MELD patients on POD 55. Preoperative MELD score predicts postoperative bleeding in contemporary VADs. Preoperative liver dysfunction may also alter postoperative subclinical haemostasis through different temporal trends of thrombin generation and platelet counts, as well as protracted fibrinolysis.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 05/2014; 47(3). DOI:10.1093/ejcts/ezu183 · 2.81 Impact Factor
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    ABSTRACT: Objectives A post-approval (PA) study for destination therapy (DT) was required by the Food and Drug Administration (FDA) to determine whether results with the HeartMate (HM) II (Thoratec, Pleasanton, California) left ventricular assist device (LVAD) in a commercial setting were comparable to results during the DT multicenter pivotal clinical trial. Background New device technology developed in the clinical research setting requires validation in a real-world setting. Methods The PA study was a prospective evaluation of the first 247 HM II patients identified pre-operatively as eligible for DT in the national INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) registry. Patients were enrolled from January to September 2010 at 61 U. S. centers and followed for 2 years. A historical comparison group included patients (n = 133 at 34 centers) enrolled in the primary data cohort in the DT pivotal trial (TR). Survival rates and adverse events for the PA group were obtained from the INTERMACS registry. Results Baseline characteristics were similar for PA versus TR. Forty-five percent of PA patients were in INTERMACS profiles 1 to 2 and 28% were in profile 3. Adverse events in the PA group were similar or lower than those in the TR group, including improvements in device-related infection (0.22 vs. 0.47) and post-operative bleeding requiring surgery (0.09 vs. 0.23) events per patient-year. Kaplan-Meier survival at 2 years was 62% (PA group) versus 58% (TR group). PA group survival at 1 and 2 years was 82 +/- 5% and 69 +/- 6% for INTERMACS profiles 4 to 7 (n = 63) versus 72 +/- 3% and 60 +/- 4% for profiles 1 to 3 (n = 184). The median length of stay after surgery was reduced by 6 days in the PA group versus the TR group. Conclusions Results in a commercial patient care setting for the DT population supported the original pivotal clinical trial findings regarding the efficacy and risk profile of the HM II LVAD. Survival was best in patients who were not inotrope-dependent (INTERMACS profiles 4 to 7). (C) 2014 by the American College of Cardiology Foundation
    Journal of the American College of Cardiology 05/2014; 63(17):1751-1757. DOI:10.1016/j.jacc.2014.01.053 · 15.34 Impact Factor
  • The Journal of Heart and Lung Transplantation 04/2014; 33(4):S31. DOI:10.1016/j.healun.2014.01.112 · 5.61 Impact Factor
  • The Journal of Heart and Lung Transplantation 04/2014; 33(4):S178-S179. DOI:10.1016/j.healun.2014.01.482 · 5.61 Impact Factor
  • The Journal of Heart and Lung Transplantation 04/2014; 33(4):S237. DOI:10.1016/j.healun.2014.01.617 · 5.61 Impact Factor
  • The Journal of Heart and Lung Transplantation 04/2014; 33(4):S247. DOI:10.1016/j.healun.2014.01.646 · 5.61 Impact Factor
  • The Journal of Heart and Lung Transplantation 04/2014; 33(4):S36-S37. DOI:10.1016/j.healun.2014.01.127 · 5.61 Impact Factor
  • The Journal of Heart and Lung Transplantation 04/2014; 33(4):S128. DOI:10.1016/j.healun.2014.01.344 · 5.61 Impact Factor
  • The Journal of Heart and Lung Transplantation 04/2014; 33(4):S226-S227. DOI:10.1016/j.healun.2014.01.589 · 5.61 Impact Factor
  • The Journal of Heart and Lung Transplantation 04/2014; 33(4):S175. DOI:10.1016/j.healun.2014.01.472 · 5.61 Impact Factor
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    ABSTRACT: Gene expression profiling test scores have primarily been used to identify heart transplant recipients who have a low probability of rejection at the time of surveillance testing. We hypothesized that the variability of gene expression profiling test scores within a patient may predict risk of future events of allograft dysfunction or death. Patients from the IMAGE study with rejection surveillance gene expression profiling tests performed at 1- to 6-month intervals were selected for this cohort study. Gene expression profiling score variability was defined as the standard deviation of an individual's cumulative test scores. Gene expression profiling ordinal score (range, 0-39), threshold score (binary value=1 if ordinal score ≥34), and score variability were studied in multivariate Cox regression models to predict future clinical events. Race, age at time of transplantation, and time posttransplantation were significantly associated with future events in the univariate analysis. In the multivariate analyses, gene expression profiling score variability, but not ordinal scores or scores over threshold, was independently associated with future clinical events. The regression coefficient P values were <0.001, 0.46, and 0.773, for gene expression profiling variability, ordinal, and threshold scores, respectively. The hazard ratio for a 1 unit increase in variability was 1.76 (95% CI, 1.4-2.3). The variability of a heart recipient's gene expression profiling test scores over time may provide prognostic utility. This information is independent of the probability of acute cellular rejection at the time of testing that is rendered from a single ordinal gene-expression profiling test score.
    Transplantation 03/2014; 97(6):708-14. DOI:10.1097/01.TP.0000443897.29951.cf · 3.78 Impact Factor
  • Echocardiography 03/2014; 31(3). DOI:10.1111/echo.12587 · 1.25 Impact Factor
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    ABSTRACT: Background The malignancy rate after alemtuzumab (C-1H) induction in cardiac transplantation is unknown. Methods A retrospective analysis from a single center for all patients that underwent cardiac transplantation from January 2000 to January 2011 and that had no history of malignancy before transplantation was performed. Patients induced with alemtuzumab were compared with a group of patients receiving thymoglobulin or no induction and assessed for 4-year cancer-free post–heart transplantation survival. Results Of 402 patients included, 185 (46.0%) received alemtuzumab, 56 (13.9%) thymoglobulin, and 161 (40.0%) no induction. Baseline characteristics did not differ between groups: mean age 54.0 years, male 77.1%, white 88.6%, ischemic cardiomyopathy 49.0%. The calcineurin inhibitor was tacrolimus in 98.9% of alemtuzumab patients, 98.2% of thymoglobulin patients, and 87.0% of the noninduced (P < .001). The secondary agent was mycophenolate mofetil in all but 16 noninduced patients (9.9%), who received azathioprine. The 4-year cancer-free survival did not differ between groups: 88.1% alemtuzumab, 87.5% thymoglobulin, 88.2% noninduction; P = .088. The 4-year nonskin cancer–free survival was 96.8% for the alemtuzumab group, 96.4% for the thymoglobulin group, and 95.7% for the noninduced; P = .899. Conclusions Neither the 4-year cancer-free survival nor the 4-year nonskin cancer–free survival differed between the alemtuzumab, thymoglobulin, and noninduced groups.
    Transplantation Proceedings 01/2014; 46(5):1481–1488. · 0.95 Impact Factor
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    ABSTRACT: Objectives A post approval (PA) study for destination therapy (DT) was required by FDA to determine whether results with the HeartMate (HM) II Left Ventricular Assist Device (LVAD) in a commercial setting are comparable to results during the DT multicenter pivotal clinical trial. Background New device technology developed in the clinical research setting requires validation in a real world setting Methods The PA study was a prospective evaluation of the first 247 HM II patients identified pre-operatively as DT in the national INTERMACS registry. Patients were enrolled from Jan - Sep 2010 at 61 US centers and followed for two years. A historical comparison group included patients (n=133 at 34 centers) enrolled in the primary data cohort in the DT pivotal trial (TR). Survival rates and adverse events for PA were obtained in the INTERMACS registry. Results Baseline characteristics were similar for PA vs TR. PA patients were 45% INTERMACS profile 1-2 and 28% profile 3. Adverse events in the PA group were similar or lower than TR, including improvements in device-related infection (0.22 vs 0.47) and post-operative bleeding requiring surgery (0.09 vs 0.23) events/pt-yr. Kaplan Meier survival at 2 years was 62% (PA) vs 58% (TR). PA survival at 1 and 2 years was 82±5% and 69±6% for INTERMACS profiles 4-7 (n=63) vs 72±3% and 60±4% for profiles 1-3 (n=184). The median length of stay after surgery was reduced by 6 days in PA vs TR. Conclusions Results in a commercial patient care setting for the DT population support the original pivotal clinical trial findings regarding the efficacy and risk profile of the HM II LVAD. Survival was best in patients not yet inotrope dependent (INTERMACS 4-7).
    Journal of the American College of Cardiology 01/2014; 31(4):S10. DOI:10.1016/j.healun.2012.01.004 · 15.34 Impact Factor

Publication Stats

1k Citations
823.86 Total Impact Points

Institutions

  • 2005–2014
    • University of Pittsburgh
      • Division of Cardiothoracic Surgery
      Pittsburgh, Pennsylvania, United States
  • 2012
    • University of Pennsylvania
      • Division of Cardiothoracic Surgery
      Philadelphia, PA, United States
  • 2011
    • Imperial College London
      Londinium, England, United Kingdom
    • University of Alabama at Birmingham
      • Department of Medicine
      Birmingham, Alabama, United States
  • 2008
    • Hospital of the University of Pennsylvania
      • Department of Medicine
      Philadelphia, Pennsylvania, United States
  • 2007
    • Harvard Medical School
      • Department of Medicine
      Boston, Massachusetts, United States
  • 2006
    • University of Maryland, Baltimore
      Baltimore, Maryland, United States
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
  • 2004
    • Brigham and Women's Hospital
      • Department of Medicine
      Boston, Massachusetts, United States