R.K. Cheng

University of Washington Seattle, Seattle, Washington, United States

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Publications (44)278.94 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Mechanical circulatory support for heart failure, including the Total Artificial Heart (TAH, Syncardia, Tucson, AZ, USA) has increased in recent years. This report describes bleeding complications associated with the device. A single institution prospectively maintained quality improvement database was reviewed encompassing the first year of clinical experience with the TAH. Patients who underwent TAH implantation were identified, and a review of complications and outcomes was undertaken. Ten patients underwent TAH implant. Four patients experienced delayed postoperative bleeding. In three patients the manifestation of bleeding was tamponade and evidenced by TAH decreased cardiac output. In two patients, at postoperative days 31 and 137, there was a partial disruption of the aortic anastomosis along the outer curvature with pseudoaneurysm formation. Both were repaired by primary suture closure, without use of cardiopulmonary bypass. There was no mortality attributable to bleeding. TAH patients are at risk for delayed postoperative bleeding, often manifest as an acute decrease in cardiac output. Due to pulsatility and high dP/dT, bleeding from the aortic anastomosis should be considered in the differential of a patient with low flow and/or tamponade. © 2015 Wiley Periodicals, Inc.
    Journal of Cardiac Surgery 08/2015; 30(10). DOI:10.1111/jocs.12601 · 0.89 Impact Factor
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    ABSTRACT: Objective: This study investigates the relationship of periportal fibrosis on postoperative outcomes after ventricular assist device (VAD) implantation. Methods: Between July 2005 and August 2014, a total of 233 patients were implanted with continuous flow VADs. Liver biopsy was performed on 16 patients with concern for liver disease. Survival was evaluated using the Kaplan-Meier method. The effect of fibrosis on length of stay (LOS) in the intensive care unit was modeled using Poisson regression. Adjustments were made for age, profile from the Interagency Registry for Mechanically Assisted Circulatory Support, biopsy, and model for end-stage liver disease score. Results: Fourteen of the 16 patients who underwent biopsy had periportal fibrosis without cirrhosis. One-year survival for the groups with and without biopsy-proven fibrosis was 93% ± 7% and 86% ± 2% (P = .97), respectively. The intensive care unit LOS was not different for those with (median, 7 days; interquartile range: 3-14 days) versus without fibrosis (median, 6 days; interquartile range 4-10 days; P = .65). Fibrosis (P = .42), age (0.95), model for end-stage liver disease excluding internal normalized ratio-XI score (P = .64), performance of a biopsy (P = .28), and Interagency Registry for Mechanically Assisted Circulatory Support class (P = .70) were not associated with intensive care unit LOS. Risk was increased of gastrointestinal bleeding (14% vs 4%; P = .026) in the first year among patients with fibrosis. Conclusions: The presence of periportal fibrosis did not affect survival or outcomes in patients undergoing VAD implantation. These findings suggest that carefully selected patients with advanced heart failure and hepatic fibrosis without cirrhosis may achieve acceptable outcomes with VAD implantation.
    The Journal of thoracic and cardiovascular surgery 08/2015; DOI:10.1016/j.jtcvs.2015.08.073 · 4.17 Impact Factor
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    ABSTRACT: Background: Heart transplant remains the definitive therapy for advanced heart failure patients but is limited by organ availability. We identified a large number of donor hearts from our organ procurement organization (OPO) being exported to other regions. Methods: We engaged a multidisciplinary team including transplant surgeons, cardiologists, and our OPO colleagues to identify opportunities to improve our center-specific organ utilization rate. We performed a retrospective analysis of donor offers before and after institution of a novel review process. Results: Each donor offer made to our program was reviewed on a monthly basis from July 2013 to June 2014 and compared with the previous year. This review process resulted in a transplant utilization rate of 28% for period 1 versus 49% for period 2 (P = .007). Limiting the analysis to offers from our local OPO changed our utilization rate from 46% to 75% (P = .02). Transplant volume increased from 22 to 35 between the 2 study periods. Thirty-day and 1-year mortality were unchanged over the 2 periods. A total of 58 hearts were refused by our center and transplanted at other centers. During period 1, the 30-day and 1-year survival rates for recipients of those organs were 98% and 90%, respectively, comparable with our historical survival data. Conclusions: The simple process of systematically reviewing donor turndown events as a group tended to reduce variability, increase confidence in expanded criteria for donors, and resulted in improved donor organ utilization and transplant volumes.
    The Journal of thoracic and cardiovascular surgery 08/2015; DOI:10.1016/j.jtcvs.2015.08.081 · 4.17 Impact Factor

  • The Journal of Heart and Lung Transplantation 04/2015; 34(4):S165. DOI:10.1016/j.healun.2015.01.448 · 6.65 Impact Factor

  • The Journal of Heart and Lung Transplantation 04/2015; 34(4):S276. DOI:10.1016/j.healun.2015.01.774 · 6.65 Impact Factor
  • W.C. Levy · C. Mahr · R. Cheng · P. Eckman · K. Leadley · F. Pagani · K. Aaronson ·

    The Journal of Heart and Lung Transplantation 04/2015; 34(4):S164. DOI:10.1016/j.healun.2015.01.445 · 6.65 Impact Factor

  • Journal of the American College of Cardiology 03/2015; 65(10):A890. DOI:10.1016/S0735-1097(15)60890-7 · 16.50 Impact Factor
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    ABSTRACT: Studies on outcomes among patients with heart failure (HF) with preserved left ventricular ejection fraction (HFpEF), borderline left ventricular ejection fraction (HFbEF), and reduced left ventricular ejection fraction (HFrEF) remain limited. We sought to characterize mortality and readmission in patients with HF in the contemporary era. Get With The Guidelines-HF was linked to Medicare data for longitudinal follow-up. Patients were grouped into HFpEF (left ventricular ejection fraction [EF] ≥50%), HFbEF (40% ≤ EF < 50%), and HFrEF (EF <40%). Multivariable models were constructed to examine the relationship between EF and outcomes at 30 days and 1 year and to study trends over time. A total of 40,239 patients from 220 hospitals between 2005 and 2011 were included in the study: 18,897 (47%) had HFpEF, 5,626 (14%) had HFbEF, and 15,716 (39%) had HFrEF. In crude survival analysis, patients with HFrEF had slightly increased mortality compared with HFbEF and HFpEF. After risk adjustment, mortality at 1 year was not significantly different for HFrEF, HFbEF, and HFpEF (HFrEF vs HFpEF, hazard ratio [HR] 1.040 [95% CI 0.998-1.084], and HFbEF vs HFpEF, HR 0.967 [95% CI 0.917-1.020]). Patients with HFpEF had increased risk of all-cause readmission compared with HFrEF. Conversely, risk of cardiovascular and HF readmissions were higher in HFrEF and HFbEF compared with HFpEF. Among patients hospitalized with HF, patients with HFpEF and HFbEF had slightly lower mortality and higher all-cause readmission risk than patients with HFrEF, although the mortality differences did not persist after risk adjustment. Irrespective of EF, these patients experience substantial mortality and readmission highlighting the need for new therapeutic strategies. Copyright © 2014 Elsevier Inc. All rights reserved.
    American Heart Journal 11/2014; 168(5):721-730.e3. DOI:10.1016/j.ahj.2014.07.008 · 4.46 Impact Factor
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    ABSTRACT: Background: The use of left ventricular assist devices has grown rapidly in recent years for patients with end-stage heart failure. A significant proportion of patients require both left- and right-sided support with biventricular assist devices (BiVADs) as a bridge to transplantation. Traditionally, these patients have waited in the hospital until they receive a transplant. Purpose: The aim of this study was to characterize the clinical course of BiVAD patients discharged to home to await heart transplantation. Methods: Between November 2009 and July 2011, 24 adult patients underwent Thoratec paracorporeal BiVAD placement at the University of California Los Angeles, all with an Interagency Registry for Mechanically Assisted Circulatory Support score 1 or 2. The disposition, complications, and rehospitalizations of these subjects were retrospectively reviewed. Results: Fourteen of the 24 patients were successfully discharged to home, with a mean time of 60 +/- 27 days from BiVAD implantation to discharge. Ninety-three percent (13/14) of the patients sent home went on to be transplanted. Eleven of the 14 (79%) came in from home to receive their transplant. The mean time from BiVAD implantation to transplantation was 100 +/- 65 days. Of the 14 patients discharged to home, there were 18 readmissions in 8 patients. Conclusion: In this small single-center review, we found that complex medical patients with BiVADs can be discharged to home and can await a heart transplant from home under the close management of multidisciplinary acute care and outpatient teams. (C) 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
    The Journal of cardiovascular nursing 06/2014; Publish Ahead of Print(4). DOI:10.1097/JCN.0000000000000168 · 2.05 Impact Factor
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    Richard K Cheng · Jamil Aboulhosn · Ali Nsair ·

    JACC Cardiovascular Interventions 05/2014; 7(6). DOI:10.1016/j.jcin.2013.09.015 · 7.35 Impact Factor
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    The Journal of Heart and Lung Transplantation 04/2014; 33(4):S66. DOI:10.1016/j.healun.2014.01.211 · 6.65 Impact Factor
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    Journal of the American College of Cardiology 04/2014; 63(12):A741. DOI:10.1016/S0735-1097(14)60741-5 · 16.50 Impact Factor

  • The Journal of Heart and Lung Transplantation 04/2014; 33(4):S117-S118. DOI:10.1016/j.healun.2014.01.033 · 6.65 Impact Factor
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    ABSTRACT: Cyclin A2 (Ccna2), normally silenced after birth in the mammalian heart, can induce cardiac repair in small-animal models of myocardial infarction. We report that delivery of the Ccna2 gene to infarcted porcine hearts invokes a regenerative response. We used a catheter-based approach to occlude the left anterior descending artery in swine, which resulted in substantial myocardial infarction. A week later, we performed left lateral thoracotomy and injected adenovirus carrying complementary DNA encoding CCNA2 or null adenovirus into peri-infarct myocardium. Six weeks after treatment, we assessed cardiac contractile function using multimodality imaging including magnetic resonance imaging, which demonstrated ~18% increase in ejection fraction of Ccna2-treated pigs and ~4% decrease in control pigs. Histologic studies demonstrate in vivo evidence of increased cardiomyocyte mitoses, increased cardiomyocyte number, and decreased fibrosis in the experimental pigs. Using time-lapse microscopic imaging of cultured adult porcine cardiomyocytes, we also show that Ccna2 elicits cytokinesis of adult porcine cardiomyocytes with preservation of sarcomeric structure. These data provide a compelling framework for the design and development of cardiac regenerative therapies based on cardiomyocyte cell cycle regulation.
    Science translational medicine 02/2014; 6(224):224ra27. DOI:10.1126/scitranslmed.3007668 · 15.84 Impact Factor
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    ABSTRACT: Our insights into different system levels of mechanisms by left ventricular assist device support are increasing and suggest a complex regulatory system of overlapping biological processes. To develop novel decision-making strategies and patient selection criteria, heart failure and reverse cardiac remodeling should be conceptualized and explored by a multifaceted research strategy of transcriptomics, metabolomics, proteomics, molecular biology, and bioinformatics. Knowledge of the molecular mechanisms of reverse cardiac remodeling is in its early stages, and comprehensive reconstruction of the underlying networks is necessary.
    Heart Failure Clinics 01/2014; 10(1 Suppl):S57-62. DOI:10.1016/j.hfc.2013.08.007 · 1.84 Impact Factor

  • Heart Failure Clinics 01/2014; 10(1):S57–S62. · 1.84 Impact Factor
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    ABSTRACT: Heart failure (HF) and obesity are commonly seen in the USA. Although obesity is associated with traditional cardiovascular disease, its relationship with HF is complex. Obesity is an accepted risk factor for incident HF. However, in patients with established HF, there exists a paradoxical correlation, with escalating BMI incrementally protective against adverse outcomes. Despite this relationship, patients with HF may desire to lose weight to reduce comorbidities or to improve quality of life. Thus far, studies have shown that intentional weight loss in obese patients with HF does not increase risk, with strategies including dietary modification, physical activity, pharmacotherapy, and/or surgical intervention.
    Expert Review of Cardiovascular Therapy 08/2013; 11(9). DOI:10.1586/14779072.2013.824691
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    ABSTRACT: We sought to characterize the ACHD HT experience at a single referral institute.Methods and MaterialsWe analyzed our HT database. All OHT patients aged ≥ 18 years from 2001-2011 were included. Longitudinal survival was examined with Kaplan-Meier & adjusted Cox PH regression. Follow-up time was censored at 1 year. Data from UNOS registry (2001-2011) was compared.ResultsIn our institution, 728 HT patients were identified, with 699 non-ACHD & 29 ACHD. Overall, 34.6% were ischemic & 65.4% were non-ischemic. Overall age was 52.4 ± 13.8 years, with ACHD younger than non-ACHD (34.9 ± 14.6 versus 53.1 ± 13.3, p < 0.001). Survival at 30-, 60-, & 365 days was 93.1%, 89.7%, 86.2% in ACHD, & 98.4%, 97.9%, 91.2% in non-ACHD, respectively (Figure 1a). After adjusting for age, ACHD had worse survival at 30 days [OR 5.3 (95% CI 1.0-28.7), p = 0.05], 60 days [5.7 (1.4-22.7), 0.015], & 6 months [3.9 (1.3-12.1), 0.017]. This difference resolved at 1 year [1.8 (0.6-5.3), 0.277]. In UNOS, there were 465 ACHD HT-only from 2001-2011. When comparing our experience to UNOS (Figure 1b), there was no significant difference, but an apparent trend toward improved survival in our ACHD cohort (30-, 60- & 365-day survival of 84.2%, 81.9%, & 77.4%).Conclusions Management of ACHD patients with heart failure remains challenging with OHT as a viable strategy for end-stage disease. In our experience, ACHD patients have increased mortality early post-transplant that persists to 6 months. However, ACHD patients have similar survival by 1 year. When compared to UNOS ACHD, there was no significant difference in survival for 2001-2011, although a trend toward improved survival existed despite a complex referral base.
    The Journal of Heart and Lung Transplantation 04/2013; 32(4):S206. DOI:10.1016/j.healun.2013.01.511 · 6.65 Impact Factor
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    ABSTRACT: MOD is a major cause of mortality after MCSD implantation in heart failure patients. We hypothesized that WGCNA can model the MOD inflammatory response.Methods and MaterialsWe analyzed peripheral blood mononuclear cell gene expression of 29 MCSD patients between 3/2010 and 3/2011, and 8 age matched controls. MOD was defined by SOFA score obtained at median 8 days (25-75% IQR 7 - 14) postoperatively. SOFA risk was defined as low (≤ 4), medium (5-11) and high (≥12). Purified total RNA was amplified and hybridized on Illumina Whole Transcriptome microarrays. Statistical analysis was conducted on GeneSpring GX 12 using Kruskal-Wallis and adjusted for multiple testing (FDR <0.05, fold change 1.5). Network analysis was done using WGCNA R software.ResultsMean age was 57±15 years. 2444 gene transcripts were differentially expressed between controls and SOFA risk groups. Unsupervised WGCNA (Figure) identified major gene expression modules (Fig 1A) with different degrees of correlation to SOFA score. Comparison of module-characteristic eigengenes (Fig 1B) showed SOFA score was best correlated with the black module, composed of 125 genes (entities). Gene ontology and pathway analysis revealed α-defensins (DEFA1, DEFA3, DEFA4) as the most relevant members of this module, which are multifunctional mediators of innate and adaptive immunity.ConclusionsWCGNA can facilitate identification of key biomarkers of the immune response triggered by MCSD implantation, including a close association between α-defensin pathways and MOD.
    The Journal of Heart and Lung Transplantation 04/2013; 32(4):S223. DOI:10.1016/j.healun.2013.01.565 · 6.65 Impact Factor
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    ABSTRACT: CKD is common in pts awaiting HT & may be associated with worse outcomes post-HT. CKD stage threshold where H+K is beneficial compared to HT-only is not well defined.Methods and Materials30424 HT-only & 563 H+K pts were identified from UNOS(1987-2011) & stratified by CKD stage using the MDRD formula. Exclusions(41%):<18y), re-HT & follow-up (FU) loss. Survival was censored at 12y & multivariate Cox proportional hazard regression models were adjusted for age, sex, DM, race, ischemic time, dialysis, etiology, life support, wait time & HLA mismatch.ResultsCKD 2 (39%) & 3(36%) were most prevalent compared to CKD 1(19%), 4(3%) & 5(3%) in HT-only pts. Amongst H+K pts, CKD 3 (20%), 4(18%) & 5(56%) were most prevalent. FU began at time of HT (mean 65 ± 57 months). 12688 pts died (41% HT & 31% HK, p<0.001). Crude survival is shown (Figure). Unadjusted HR for all-cause mortality (compared to CKD 3 HT) in H+K showed:CKD 3[0.68 (0.44-1.03)]; CKD 4[1.11 (0.78-1.57)]; CKD 5[1.05 (0.86-1.26)]. After adjustment: CKD 3[0.66 (0.42-1.04)]; CKD 4[1.07 (0.75-1.53)]; CKD 5(0.94 (0.73-1.21)]. Comparing HT vs H+K in each stage individually: CKD 3[1.67 (1.10-2.54)] vs [0.60 (0.39-0.91)]; CKD 4[1.50 (1.05-2.15)] vs [0.66 (0.46-0.95)]; CKD 5[1.83 (1.48-2.27)] vs [0.54 (0.44-0.67)].ConclusionsHT-only survival is significantly diminished in CKD 3-5 compared to CKD 1-2. However, H+K appears protective for CKD stages 3-5, with similar mortality compared to HT-only with normal renal function In each individual stage 3, 4, & 5, HT-only has increased mortality compared to H+K. These results suggest CKD stages 3-5 should undergo H+K rather than HT-only. Prospective study is warranted to verify these results.
    The Journal of Heart and Lung Transplantation 04/2013; 32(4):S144. DOI:10.1016/j.healun.2013.01.325 · 6.65 Impact Factor

Publication Stats

232 Citations
278.94 Total Impact Points


  • 2014-2015
    • University of Washington Seattle
      • Division of General Internal Medicine
      Seattle, Washington, United States
    • CSU Mentor
      Long Beach, California, United States
  • 2013
    • Harbor-UCLA Medical Center
      Torrance, California, United States
    • Università degli Studi di Torino
      Torino, Piedmont, Italy
    • University of Toronto
      • Faculty of Medicine
      Toronto, Ontario, Canada
  • 2012-2013
    • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
      Torrance, California, United States
  • 2009-2013
    • University of California, Los Angeles
      • • Division of Cardiology
      • • Department of Medicine
      Los Ángeles, California, United States
  • 2006-2007
    • Columbia University
      • Department of Biomedical Engineering
      New York, New York, United States