Jonathan W Haft

Concordia University–Ann Arbor, Ann Arbor, Michigan, United States

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Publications (92)363.2 Total impact

  • Ming-Sing Si · Francis D. Pagani · Jonathan W. Haft

    No preview · Article · Dec 2015 · The Journal of thoracic and cardiovascular surgery
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    ABSTRACT: Temporary circulatory support (TCS) is used to improve hemodynamics in patients with cardiogenic shock as a bridge to durable VAD (dVAD). Data from dVAD recipients with or without TCS (extracorporeal membranous oxygenation, ECMO, n = 14; TandemHeart, TH, n = 26) were evaluated. Clinical characteristics and hemodynamics were analyzed for patients before and after TCS and compared to Profile 1 (n = 29) or Profile 2 - 3 (n = 269) patients without TCS prior to dVAD. ECMO patients had the highest use of preoperative mechanical ventilation, vasopressors and the highest Heartmate II risk score prior to dVAD (p < 0.01). Patients receiving TCS prior to dVAD implant had hemodynamics comparable to patients in Profiles 2-3 and superior to that of Profile 1 patients without TCS. Operative survival after dVAD was lower in patients receiving ECMO (57%) compared to Profile 1 patients receiving TH (88%), Profile 1 without TCS (82%) or Profile 2-3 patients (97%; all p < 0.01). Despite improved clinical stability with TCS, patients bridged to a dVAD have event-free survival that parallels patients in Profile 1 without TCS. Our data suggests that patients requiring TCS prior to dVAD implant should still be classified INTERMACS Profile 1.
    No preview · Article · Nov 2015 · ASAIO journal (American Society for Artificial Internal Organs: 1992)
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    ABSTRACT: Objective: To examine the outcomes of prolonged (≥14 days) extracorporeal membrane oxygenation (P-ECMO) for adult severe respiratory failure and to assess characteristics associated with survival. Background: The use of ECMO for treatment of severe respiratory adult patients is associated with overall survival rates of 50% to 70% with median ECMO duration of 10 days. No prior multi-institutional studies have examined outcomes of P-ECMO for severe respiratory failure. Methods: Data on all adult (≥18 years) patients who required P-ECMO for severe respiratory failure from 1989 to 2013 were extracted from the Extracorporeal Life Support Organization international multi-institutional registry. We examined outcomes over 23 years and compared the 2 more recent time periods of 1989 to 2006 versus 2007 to 2013. Results: Up to 974 patients, mean age 40.2 (18-83) years, had ECMO duration of mean 25.2 days/median 21.0 days (range: 14-208 days). Venovenous ECMO support was most common (venovenous: 79.5%, venoarterial: 9.9%). Reason for ECMO discontinuation included native lung recovery (54%), organ failure (23.7%), family request (6.7%), hemorrhage (2.7%), and diagnosis incompatible with life (5.6%). Forty patients (4.1%) underwent lung transplant with 50% postoperative in-hospital mortality. Increased prevalence of P-ECMO was noted with 72% (701/974) of all cases reported since 2008. Survival to hospital discharge was 45.4% (443/974) and did not vary with ECMO duration. Multivariate logistic regression analysis confirmed that P-ECMO patients 2007 to 2013 had a lower risk of death [odds ratio (OR): 0.650; 95% confidence interval (CI), 0.454-0.929; P = 0.010] compared with 1989 to 2006. Factors independently associated with survival were younger age (OR: 0.983; 95% CI, 0.974-0.993; P < 0.001) and lower PaCO2 (OR, 0.991; 95% CI, 0.986-0.996; P < 0.001). Conclusions: Prolonged ECMO use for adult respiratory failure was associated with a lower (45.4%) hospital survival rate, compared with prior reported survival rates of short duration ECMO. Prolonged ECMO survival significantly increased in recent years, and increasing ECMO duration did not alter the survival fraction in the 1989 to 2013 study cohort. Although P-ECMO survival rates are less than short ECMO runs, P-ECMO support is justified.
    No preview · Article · Nov 2015 · Annals of Surgery
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    ABSTRACT: To determine how a formula to estimate kinetically changing glomerular filtration rate (keGFR) relates to serum creatinine changes and to compare the discriminatory ability of keGFR to that of perioperative change in serum creatinine to predict acute kidney injury (AKI) and mortality.
    No preview · Article · Nov 2015
  • Jonathan W. Haft

    No preview · Article · Oct 2015 · The Journal of thoracic and cardiovascular surgery
  • Jonathan W. Haft

    No preview · Article · Jun 2015 · The Journal of thoracic and cardiovascular surgery
  • Daniel E Mazur · Robert H Bartlett · Jonathan W Haft

    No preview · Article · Jun 2015 · The Annals of thoracic surgery
  • Daniel E. Mazur · Robert H. Bartlett · Jonathan W. Haft

    No preview · Article · Jun 2015 · The Annals of Thoracic Surgery
  • Jonathan W Haft

    No preview · Article · May 2015 · Journal of Surgical Research
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    ABSTRACT: Centrifugal pumps are increasingly used for extracorporeal membrane oxygenation (ECMO) rather than roller pumps. However, shear forces induced by these types of continuous flow pumps are associated with acquired von Willebrand Factor deficiency and bleeding complications. This study was undertaken to compare adverse bleeding complications with use of centrifugal and roller pumps in patients on prolonged ECMO support. The records of all adult ECMO patients from June 2002 to 2013 were retrospectively reviewed using the University of Michigan Health System database and the Extracorporeal Life Support Organization registry, focusing on patients supported for at least 5 days. Ninety-five ECMO patients met criteria for inclusion (48 roller vs. 47 centrifugal pump). Indications included pulmonary (79%), cardiac (15%), and extracorporeal cardiopulmonary resuscitation (6%), without significant difference between the two groups. Despite lower heparin anticoagulation (10.9 vs. 13.7 IU/kg/hr) with centrifugal pumps, there was a higher incidence of non-surgical bleeding (gastrointestinal, pulmonary, and neurological) in centrifugal pump patients (26.1 vs. 9.0 events/1000 patient-days, p = 0.024). In conclusion, in our historical comparison, despite reduced anti-coagulation, ECMO support using centrifugal pumps was associated with a higher incidence of non-surgical bleeding. The mechanisms behind this are multifactorial and require further investigation.
    No preview · Article · Apr 2015 · ASAIO journal (American Society for Artificial Internal Organs: 1992)

  • No preview · Article · Apr 2015 · The Journal of Heart and Lung Transplantation
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    ABSTRACT: Inhaled nitric oxide (iNO) is a rescue treatment for severe hypoxemia in the intensive care unit setting. To evaluate the effectiveness and safety of iNO in adult patients with severe hypoxemia before and during transport to a tertiary care center. Prospective data were examined in a retrospective cohort study. Patients with severe hypoxemia and cardiopulmonary failure (n=139) at referring hospitals in whom conventional therapy was unsuccessful were treated with iNO in the intensive care units in anticipation of transfer to a tertiary center. Treatment wih iNO was initiated by the critical care transport team in 114 patients and continued in 25 patients. Arterial blood gas analysis was done before and after iNO treatment. Patients treated with iNO had significant improvement in oxygenation: mean (SD) for PaO2 increased from 60.7 (20.2) to 72.3 (40.6) mm Hg (P=.008), and mean (SD) for ratio of PaO2 to fraction of inspired oxygen (P:F) increased from 62.4 (26.1) to 73.1 (42.6) (P= .03). Use of iNO was continued through transport in 102 patients, all of whom were transported without complication. The P:F continued to improve, with a mean (SD) of 109.7 (73.8) from 6 to 8 hours after arrival at the tertiary center (P< .001 relative to values both before and after treatment). Among patients treated with iNO, 60.2% survived to discharge. In 35 nonresponders, iNO was discontinued, and 15 patients could not be transferred owing to life-threatening hypoxemia; 2 were later transferred on extracorporeal membrane oxygenation. Of 18 patients transported without iNO, 9 (50%) survived. Use of iNO significantly improves oxygenation of patients with severe hypoxemia and allows safe transfer to a tertiary care center. (American Journal of Critical Care. 2015; 24:110-117). ©2015 American Association of Critical-Care Nurses.
    No preview · Article · Mar 2015 · American Journal of Critical Care
  • Jonathan W Haft

    No preview · Article · Dec 2014 · Journal of Thoracic and Cardiovascular Surgery
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    ABSTRACT: The usual duration of ECMO in patients with severe acute respiratory distress syndrome (ARDS) is 7-10 days. Prolonged duration ECMO (defined as > 14 days) is increasingly being documented with native lung recovery or as a bridge to lung transplantation. We report a case of prolonged duration ECMO (6,364 hours, 265 days) requiring no complete circuit exchange. As critical care improves, prolonged ECMO will continue to pose unique technological and ethical challenges that test our expectations of this treatment modality. There is a critical need for diagnostic modalities to provide objective assessment of native lung recovery in patients requiring prolonged duration ECMO.
    No preview · Article · Nov 2014 · ASAIO journal (American Society for Artificial Internal Organs: 1992)
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    ABSTRACT: This is a review of the University of Michigan experience with extracorporeal life support (ECLS) also known as extracorporeal membrane oxygenation (ECMO). Two thousand patients were managed with ECMO from 1973-2010. The first thousand were reported previously.Of the 2000 patients, 74% and were weaned from ECLS, and 64% survived to hospital discharge In patients with respiratory failure, survival to hospital discharge was 84% in 799 neonates, 76% in 239 children, and 50% in 353 adults. Survival in patients with cardiac failure was 45% in 361 children, and 38% in 119 adults. ECLS during cardiac arrest (ECPR) was performed in 129 patients, with 41% surviving to discharge. Survival decreased from 74% to 55% between the first and second thousand patients. The most common complication was bleeding at sites other than the head, with an incidence of 39%, and the least frequent complication was pump malfunction, with a 2% incidence. Intracranial bleeding or infarction occurred in 8% of patients, with a 43% survival rate. This is the largest series of ECLS at one institution reported in the world to date. Our experience has shown that ECLS saves lives of moribund patients with acute pulmonary and cardiac failure in all age groups.
    No preview · Article · Sep 2014 · ASAIO journal (American Society for Artificial Internal Organs: 1992)
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    ABSTRACT: Background: Interfacility transport of patients on extracorporeal membrane oxygenation (ECMO) has been performed in large numbers at only a few programs. Limited data are available on outcomes after ECMO transport to justify expanding or discontinuing these programs. Methods: This was a retrospective review of a 20-year, single-institution experience with interhospital ECMO transport as well as a systematic review of reports of transfers of patients on ECMO. Results of both were compared with historical data from the international registry of the Extracorporeal Life Support Organization (ELSO). Results: Between 1990 and 2012, ECMO was used to facilitate transport of 221 patients to our institution, and 135 (62%) survived to discharge. Review of an additional 27 case series describing ECMO transport of 643 patients showed an overall survival of 61%. After stratifying by age and primary indication for ECMO, survival of transported patients was not significantly different compared with all ECMO patients in the ELSO registry, with the exception of pediatric patients treated for respiratory failure (transported patients in this category had higher survival than those in the ELSO registry). Conclusions: Interfacility transport on ECMO is feasible and can be accomplished safely in the critically ill. Survival of transported patients is comparable to age-matched and treatment-matched ECMO patients at large.
    No preview · Article · Aug 2014 · The Annals of Thoracic Surgery
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    ABSTRACT: Abstract BACKGROUND: Centrifugal pumps are used increasingly for temporary mechanical support for the treatment of cardiogenic shock. However, centrifugal pumps can generate excessive negative pressure and are afterload sensitive. A previously developed modified roller pump mitigates these limitations both in vitro and in preliminary animal experiments. We report the results of intermediate-term testing of our evolving pump technology, known as the BioVAD. METHODS: The BioVAD was implanted in 6 adult male sheep (62.5 ± 3.9 kg), with drainage from the left atrium and reinfusion into the descending aorta. The sheep were monitored for 5 days. Heparin was given during the initial implantation, but no additional anticoagulants were given. Data collected included hemodynamic status, pump flow and pressures, laboratory values to monitor end-organ function and hemolysis, pathologic specimens to evaluate for thromboembolic events and organ ischemia, and explanted pump evaluation results. RESULTS: All animals survived the planned experimental duration and there were no pump malfunctions. Mean BioVAD flow was 3.57 ± 0.30 L/min (57.1 mL/kg/min) and mean inlet pressure was -30.51 ± 4.25 mm Hg. Laboratory values, including plasma free hemoglobin, creatinine, lactate, and bilirubin levels, remained normal. Three animals had small renal cortical infarcts, but there were no additional thromboembolic events or other abnormalities seen on pathologic examination. No thrombus was identified in the BioVAD blood flow path. CONCLUSIONS: The BioVAD performed well for 5 days in this animal model of temporary left ventricular assistance. Its potential advantages over centrifugal pumps may make it applicable for short-term mechanical circulatory support.
    No preview · Article · Jul 2014 · The Annals of Thoracic Surgery
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    ABSTRACT: Background Although left ventricular assist device (LVAD) management strategies are undertaken to reduce The development of aortic insufficiency (AI), The effect of AI on patient morbidity and mortality is not known. Methods Patients undergoing HeartMate II (Thoratec, Pleasanton, CA) implant were prospectively monitored with serial echocardiograms. Kaplan-Meier methods and log-rank testing were used to estimate and compare mortality and freedom from moderate or worser right ventricular hypokinesis (RVHK), moderate or worse mitral regurgitation (MR), and hemolysis according to AI severity. Mixed modelling was used to examine for correlates of AI development in The pre-operative and post-operative setting and to investigate The effect of AI on post-operative MR and RVHK. Results There were 930 echocardiograms completed in 166 patients. During 291 person-years of follow-up, mild-moderate or worse AI developed in 70 (0.38 persons per year [PPY]), moderate or worse AI in 36 (0.17 PPY), moderate-severe AI in 11 (0.039 PPY), and severe AI in 2 (0.0069 PPY). Overall 2-year survival and 2-year survival after onset of moderate or worse AI was 87% ± 6.2% and 65% ± 11%, respectively, compared with 76% ± 5.1% and 76% ± 5.1%, respectively, in those with less AI (p = 0.57). Patients with moderate AI were not more likely to develop MR, hemolysis events, or worsening RVHK, but patients with pre-existing RVHK appeared to be less tolerant of AI. Three of 35 deaths were directly attributed to AI. No reoperations were performed solely for AI. Conclusions AI is common after LVAD implant but did not affect survival in this cohort. Except in those with significant RV dysfunction, this calls into question need for echocardiogram-guided device settings to ensure aortic valve opening. © 2014 International Society for Heart and Lung Transplantation.
    No preview · Article · Jun 2014 · The Journal of Heart and Lung Transplantation
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    ABSTRACT: Postcardiotomy shock affects 0.5% to 6% of cardiac operations and is associated with a high mortality. Many of these patients had their procedures performed at lower-volume cardiac surgery centers with limited resources. The objective of this study was to determine the outcomes in patients in postcardiotomy shock who were transferred to a tertiary care center for escalated care. We performed a retrospective review of 104 postcardiotomy shock patients transferred to our institution between 2004 and 2012. Univariable and multivariable analyses were performed to determine predictors of in-hospital and overall survival. Seventy-eight percent of patients were receiving temporary mechanical support. The in-hospital mortality in our series was 46%. Multivariable predictors of in-hospital mortality included higher initial creatinine level on arrival and a history of known heart failure. Multivariable predictors of overall mortality included higher initial creatinine and lactate levels, lower initial ejection fraction, and a history of heart failure and hypertension. The Kaplan-Meier estimation of 5-year survival was 39% in all patients and 72% in patients who survived to hospital discharge. Patients with postcardiotomy cardiac failure transported to a tertiary care center for advanced cardiac support had a nearly 50% survival, with excellent long-term survival of those discharged alive. Preservation of end-organ function, often with mechanical support, can improve survival.
    No preview · Article · May 2014 · The Annals of thoracic surgery
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    Full-text · Article · Apr 2014 · European Heart Journal

Publication Stats

967 Citations
363.20 Total Impact Points


  • 2002-2015
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
    • University of Michigan
      • • Department of Surgery
      • • Department of Cardiac Surgery
      • • Department of Biomedical Engineering
      Ann Arbor, Michigan, United States