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Sharma D, Ramsewak A, Manoharan G, Spence MS. Efficacy of RADPAD® protection drape in reducing radiation exposure to the primary operator during Transcatheter Aortic Valve Implantation (TAVI). Minerva Cardioangiol 2016; 64:41-46. [PMID: 25900558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The efficacy of RADPAD® (a sterile, lead-free drape) has been demonstrated to reduce the scatter radiation to the primary operator during fluoroscopic procedures. However, the use of the RADPAD® during TAVI procedures has not been studied. Transcatheter aortic valve implantation (TAVI) is now an established treatment for patients with symptomatic severe aortic stenosis who are deemed inoperable or at high risk for conventional surgical aortic valve replacement (AVR). Consequently the radiation exposure to the patient and the interventional team from this procedure has become a matter of interest and importance. Methods to reduce radiation exposure to the interventional team during this procedure should be actively investigated. In this single center prospective study, we determined the radiation dose during this procedure and the efficacy of RADPAD® in reducing the radiation dose to the primary operator. METHODS Fifty consecutive patients due to undergo elective TAVI procedures were identified. Patients were randomly assigned to undergo the procedure with or without the use of a RADPAD® drape. There were 25 patients in each group and dosimetry was performed at the left eye level of the primary operator. The dosimeter was commenced at the start of the procedure, and the dose was recorded immediately after the end of the procedure. Fluoroscopy times and DAP were also recorded prospectively. RESULTS Twenty-five patients underwent transfemoral TAVI using a RADPAD® and 25 with no-RADPAD®. The mean primary operator radiation dose was significantly lower in the RADPAD group at 14.8 mSv vs. 24.3 mSv in the no-RADPAD group (P=0.008). There was no significant difference in fluoroscopy times or dose-area products between the two patient groups. The dose to the primary operator relative to fluoroscopy time (RADPAD: slope=0.325; no RADPAD: slope=1.148; analysis of covariance F=7.47, P=0.009) and dose area product (RADPAD: slope=0.0007; no RADPAD: slope=0.002; analysis of covariance F=7.38; P=0.009) was smaller in the RADPAD group compared to no-RADPAD group. CONCLUSIONS Use of a RADPAD® significantly reduces radiation exposure to the primary operator during TAVI procedures.
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Rampat R, Khawaja MZ, Byrne J, MacCarthy P, Blackman DJ, Krishnamurthy A, Gunarathne A, Kovac J, Banning A, Kharbanda R, Firoozi S, Brecker S, Redwood S, Bapat V, Mullen M, Aggarwal S, Manoharan G, Spence MS, Khogali S, Dooley M, Cockburn J, de Belder A, Trivedi U, Hildick-Smith D. Transcatheter Aortic Valve Replacement Using the Repositionable LOTUS Valve. JACC Cardiovasc Interv 2016; 9:367-372. [DOI: 10.1016/j.jcin.2015.12.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/24/2015] [Accepted: 12/03/2015] [Indexed: 02/07/2023]
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Booth K, Beattie R, McBride M, Manoharan G, Spence M, Jones JM. High Risk Aortic Valve Replacement - The Challenges of Multiple Treatment Strategies with an Evolving Technology. THE ULSTER MEDICAL JOURNAL 2016; 85:18-22. [PMID: 27158160 PMCID: PMC4847840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Deciding on the optimal treatment strategy for high risk aortic valve replacement is challenging. Transcatheter Aortic Valve implantation (TAVI) has been available in our centre as an alternative treatment modality for patients since 2008. We present our early experience of TAVI and SAVR (surgical Aortic Valve Replacement) in high risk patients who required SAVR because TAVI could not be performed. METHODS The database for Surgical aortic valve and Transcatheter aortic valve replacement referrals was interrogated to identify relevant patients. RESULTS Survival to hospital discharge was 95.5% in the forty five patients who had SAVR when TAVI was deemed technically unsuitable. One year survival was 86%. CONCLUSION Defining who is appropriate for TAVI or high risk SAVR is challenging and multidisciplinary team discussion has never been more prudent in this field of evolving technology with ever decreasing risks of surgery. The introduction of TAVI at our institution has seen a rise in our surgical caseload by approximately by 25%. Overall, the option of aortic valve intervention is being offered to more patients in general which is a substantial benefit in the treatment of aortic valve disease.
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Belardi J, Manoharan G, Albertal M, Widimský P, Neumann FJ, Silber S, Leon MB, Saito S. The influence of age on clinical outcomes in patients treated with the resolute zotarolimus-eluting stent. Catheter Cardiovasc Interv 2015; 87:253-61. [DOI: 10.1002/ccd.25334] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/15/2015] [Accepted: 11/27/2015] [Indexed: 11/10/2022]
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van Nunen LX, Zimmermann FM, Tonino PAL, Barbato E, Baumbach A, Engstrøm T, Klauss V, MacCarthy PA, Manoharan G, Oldroyd KG, Ver Lee PN, Van't Veer M, Fearon WF, De Bruyne B, Pijls NHJ. Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial. Lancet 2015; 386:1853-60. [PMID: 26333474 DOI: 10.1016/s0140-6736(15)00057-4] [Citation(s) in RCA: 381] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In the Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) study, fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) improved outcome compared with angiography-guided PCI for up to 2 years of follow-up. The aim in this study was to investigate whether the favourable clinical outcome with the FFR-guided PCI in the FAME study persisted over a 5-year follow-up. METHODS The FAME study was a multicentre trial done in Belgium, Denmark, Germany, the Netherlands, Sweden, the UK, and the USA. Patients (aged ≥ 18 years) with multivessel coronary artery disease were randomly assigned to undergo angiography-guided PCI or FFR-guided PCI. Before randomisation, stenoses requiring PCI were identified on the angiogram. Patients allocated to angiography-guided PCI had revascularisation of all identified stenoses. Patients allocated to FFR-guided PCI had FFR measurements of all stenotic arteries and PCI was done only if FFR was 0·80 or less. No one was masked to treatment assignment. The primary endpoint was major adverse cardiac events at 1 year, and the data for the 5-year follow-up are reported here. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00267774. FINDINGS After 5 years, major adverse cardiac events occurred in 31% of patients (154 of 496) in the angiography-guided group versus 28% (143 of 509 patients) in the FFR-guided group (relative risk 0·91, 95% CI 0·75-1·10; p=0·31). The number of stents placed per patient was significantly higher in the angiography-guided group than in the FFR-guided group (mean 2·7 [SD 1·2] vs 1·9 [1·3], p<0·0001). INTERPRETATION The results confirm the long-term safety of FFR-guided PCI in patients with multivessel disease. A strategy of FFR-guided PCI resulted in a significant decrease of major adverse cardiac events for up to 2 years after the index procedure. From 2 years to 5 years, the risks for both groups developed similarly. This clinical outcome in the FFR-guided group was achieved with a lower number of stented arteries and less resource use. These results indicate that FFR guidance of multivessel PCI should be the standard of care in most patients. FUNDING St Jude Medical, Friends of the Heart Foundation, and Medtronic.
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Manoharan G, Walton A, Brecker S, Pasupati S, Blackman DJ, Meredith IT. TCT-98 Clinical Outcomes at 1 Year with a Repositionable Self-Expanding Transcatheter Aortic Valve. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Manoharan G, Linke A, Moellmann H, Frerker C, van Boven A, Worthley SG, Redwood S, Kovac J, Butter C, Sondergaard L, Schymik G, Walther T. TCT-638 Rhythm Changes And Pacemaker Incidence Associated With a Repositionable Self Expanding TAVI System: A Prospective Multicenter Analysis. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Alnasser S, Dvir D, Walther T, Kim WK, Bedogni F, Testa L, Amrane H, van Boven A, Pelletier M, Rodes-Cabau J, Del Trigo M, Van Mieghem NM, De Jaegere P, Frerker C, Manoharan G, Spence MS, Worthley SG, Asgar AW, Ibrahim R, Sgroi C, Pilato G, Stub D, John W, Cheema A. TCT-665 Safety and Efficacy of Second Generation Self Expanding Portico® Valve System for the Treatment of Failed Aortic Bioprosthesis: Results from an International Multicenter Valve-in-Valve Registry. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Linke A, Manoharan G, Moellmann H, Schäfer U, Kovac J, Kuck KH, Holzhey DM, Walther T. TCT-693 Multicentre clinical study evaluating a novel resheathable self-expanding transcatheter aortic valve system. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Howe A, Spence M, Manoharan G, Johnston N, Owens C, Dixon L, Onyekwelu N, Jeganathan R, Smith B, McEvoy M. 59 Real world TAVI outcome and prognostication: a retrospective review of a single centre experience. BRITISH HEART JOURNAL 2015. [DOI: 10.1136/heartjnl-2015-308621.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rammohan A, Sathyanesan J, Palaniappan R, Manoharan G. Macronodular tuberculosis of the liver: a tumour masquerade. ACTA ACUST UNITED AC 2015; 35:180-2. [PMID: 26012323 DOI: 10.7869/tg.207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Noad RL, Johnston N, McKinley A, Dougherty M, Nzewi O, Jeganathan R, Manoharan G, Spence MS. A pathway to earlier discharge following TAVI: Assessment of safety and resource utilization. Catheter Cardiovasc Interv 2015; 87:134-42. [DOI: 10.1002/ccd.26005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 04/01/2015] [Accepted: 04/11/2015] [Indexed: 11/11/2022]
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Sharma D, Ramsewak A, O'Conaire S, Manoharan G, Spence MS. Reducing radiation exposure during transcatheter aortic valve implantation (TAVI). Catheter Cardiovasc Interv 2015; 85:1256-61. [DOI: 10.1002/ccd.25363] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 12/21/2013] [Indexed: 11/08/2022]
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Meredith I, Walton A, Brecker S, Pasupati S, Blackman D, Manoharan G. Early results following transcatheter aortic valve implantation with a repositionable self-expanding bioprosthesis. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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De Bruyne B, Fearon WF, Pijls NHJ, Barbato E, Tonino P, Piroth Z, Jagic N, Mobius-Winckler S, Rioufol G, Witt N, Kala P, MacCarthy P, Engström T, Oldroyd K, Mavromatis K, Manoharan G, Verlee P, Frobert O, Curzen N, Johnson JB, Limacher A, Nüesch E, Jüni P. Fractional flow reserve-guided PCI for stable coronary artery disease. N Engl J Med 2014; 371:1208-17. [PMID: 25176289 DOI: 10.1056/nejmoa1408758] [Citation(s) in RCA: 781] [Impact Index Per Article: 78.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND We hypothesized that in patients with stable coronary artery disease and stenosis, percutaneous coronary intervention (PCI) performed on the basis of the fractional flow reserve (FFR) would be superior to medical therapy. METHODS In 1220 patients with stable coronary artery disease, we assessed the FFR in all stenoses that were visible on angiography. Patients who had at least one stenosis with an FFR of 0.80 or less were randomly assigned to undergo FFR-guided PCI plus medical therapy or to receive medical therapy alone. Patients in whom all stenoses had an FFR of more than 0.80 received medical therapy alone and were included in a registry. The primary end point was a composite of death from any cause, nonfatal myocardial infarction, or urgent revascularization within 2 years. RESULTS The rate of the primary end point was significantly lower in the PCI group than in the medical-therapy group (8.1% vs. 19.5%; hazard ratio, 0.39; 95% confidence interval [CI], 0.26 to 0.57; P<0.001). This reduction was driven by a lower rate of urgent revascularization in the PCI group (4.0% vs. 16.3%; hazard ratio, 0.23; 95% CI, 0.14 to 0.38; P<0.001), with no significant between-group differences in the rates of death and myocardial infarction. Urgent revascularizations that were triggered by myocardial infarction or ischemic changes on electrocardiography were less frequent in the PCI group (3.4% vs. 7.0%, P=0.01). In a landmark analysis, the rate of death or myocardial infarction from 8 days to 2 years was lower in the PCI group than in the medical-therapy group (4.6% vs. 8.0%, P=0.04). Among registry patients, the rate of the primary end point was 9.0% at 2 years. CONCLUSIONS In patients with stable coronary artery disease, FFR-guided PCI, as compared with medical therapy alone, improved the outcome. Patients without ischemia had a favorable outcome with medical therapy alone. (Funded by St. Jude Medical; FAME 2 ClinicalTrials.gov number, NCT01132495.).
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Manoharan G, De Bruyne B. TCT-108 Multi-Vessel Versus Single-Vessel Treatment with Resolute Zotarolimus Eluting Stent in the RESOLUTE Global Clinical Program. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Meredith I, Walters D, Dumonteil N, Worthley S, Tchetche D, Manoharan G, Blackman DJ, Rioufol G, Hildick-Smith D, Whitbourn R, Lefevre T, Lange R, Mueller R, Redwood S, Allocco DJ, Dawkins K. RESULTS OF THE REPOSITIONABLE PERCUTANEOUS REPLACEMENT OF STENOTIC AORTIC VALVE WITH THE LOTUS™ VALVE SYSTEM – EVALUATION OF SAFETY AND PERFORMANCE (REPRISE II) STUDY: 3-MONTH OUTCOMES IN HIGH-RISK SURGICAL PATIENTS. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61960-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Daly MJ, Blair PH, Modine T, Donnelly PM, Jeganathan R, Manoharan G, Spence MS. Carotid-Access Transcatheter Aortic Valve Replacement in a Patient with a Previous Mitral Valve Replacement. J Card Surg 2014; 30:256-9. [DOI: 10.1111/jocs.12324] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sharma D, Manoharan G, Parissis H. Double patch repair for a double ventricular rupture. Asian Cardiovasc Thorac Ann 2014; 21:470-2. [PMID: 24570535 DOI: 10.1177/0218492312458266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe the case of a 77-year-old woman with recent acute myocardial infarction complicated by ventricular septal defect and formation of a pseudoaneurysm, which were successfully treated surgically with a double patch repair. This case highlights the importance of early recognition of this serious complication, using clinical and echocardiographic examinations, and the various challenges encountered in surgical repair.
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Jeger RV, Manoharan G, Kaiser CA. First-in-man Portico® transcatheter aortic valve-in-valve implantation in a degenerated 19 mm Mitroflow® aortic pericardial heart valve. EUROINTERVENTION 2014; 9:1368. [DOI: 10.4244/eijv9i11a229] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cockburn JA, de Belder A, Hildick-Smith D, Hutchinson N, Manoharan G, Spence MS, Trivedi U. TCT-713 A Minimalist Approach to Trans-Catheter Aortic Valve Implantation, With Limited Use of Computerised Tomography, Transoesophageal Echocardiography and General Anaesthesia - In-Hospital, 30 Day and One Year Outcomes. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Holroyd EW, Poliacikova P, Simms A, Manoharan G, Spence MS, Levy R, Blackman DJ, Hildick-Smith D, Khogali S. TCT-762 Is a high pacing rate post TAVI associated with appropriate pacemaker utilisation? A real-world multi-centre retrospective analysis of pacemaker utilisation in patients paced following TAVI. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ribeiro HB, Webb JG, Makkar RR, Cohen MG, Kapadia SR, Kodali S, Tamburino C, Barbanti M, Chakravarty T, Jilaihawi H, Paradis JM, de Brito FS, Cánovas SJ, Cheema AN, de Jaegere PP, del Valle R, Chiam PTL, Moreno R, Pradas G, Ruel M, Salgado-Fernández J, Sarmento-Leite R, Toeg HD, Velianou JL, Zajarias A, Babaliaros V, Cura F, Dager AE, Manoharan G, Lerakis S, Pichard AD, Radhakrishnan S, Perin MA, Dumont E, Larose E, Pasian SG, Nombela-Franco L, Urena M, Tuzcu EM, Leon MB, Amat-Santos IJ, Leipsic J, Rodés-Cabau J. Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: insights from a large multicenter registry. J Am Coll Cardiol 2013; 62:1552-62. [PMID: 23954337 DOI: 10.1016/j.jacc.2013.07.040] [Citation(s) in RCA: 409] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/15/2013] [Accepted: 07/23/2013] [Indexed: 01/14/2023]
Abstract
OBJECTIVES This study sought to evaluate the main baseline and procedural characteristics, management, and clinical outcomes of patients from a large cohort of patients undergoing transcatheter aortic valve implantation (TAVI) who suffered coronary obstruction (CO). BACKGROUND Very little data exist on CO following TAVI. METHODS This multicenter registry included 44 patients who suffered symptomatic CO following TAVI of 6,688 patients (0.66%). Pre-TAVI computed tomography data was available in 28 CO patients and in a control group of 345 patients (comparisons were performed including all patients and a cohort matched 1:1 by age, sex, previous coronary artery bypass graft, transcatheter valve type, and size). RESULTS Baseline and procedural variables associated with CO were older age (p < 0.001), female sex (p < 0.001), no previous coronary artery bypass graft (p = 0.043), the use of a balloon-expandable valve (p = 0.023), and previous surgical aortic bioprosthesis (p = 0.045). The left coronary artery was the most commonly involved (88.6%). The mean left coronary artery ostia height and sinus of Valsalva diameters were lower in patients with obstruction than in control subjects (10.6 ± 2.1 mm vs. 13.4 ± 2.1 mm, p < 0.001; 28.1 ± 3.8 mm vs. 31.9 ± 4.1 mm, p < 0.001). Differences between groups remained significant after the case-matched analysis (p < 0.001 for coronary height; p = 0.01 for sinus of Valsalva diameter). Most patients presented with persistent severe hypotension (68.2%) and electrocardiographic changes (56.8%). Percutaneous coronary intervention was attempted in 75% of the cases and was successful in 81.8%. Thirty-day mortality was 40.9%. After a median follow-up of 12 (2 to 18) months, the cumulative mortality rate was 45.5%, and there were no cases of stent thrombosis or reintervention. CONCLUSIONS Symptomatic CO following TAVI was a rare but life-threatening complication that occurred more frequently in women, in patients receiving a balloon-expandable valve, and in those with a previous surgical bioprosthesis. Lower-lying coronary ostium and shallow sinus of Valsalva were associated anatomic factors, and despite successful treatment, acute and late mortality remained very high, highlighting the importance of anticipating and preventing the occurrence of this complication.
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Fairley SL, Jeganathan R, Manoharan G, Spence MS. Early experience of implantation of the new CoreValve(®) Evolut(™) in degenerated bioprosthetic aortic valves. Catheter Cardiovasc Interv 2013; 83:485-92. [PMID: 23857751 DOI: 10.1002/ccd.25125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/20/2013] [Accepted: 07/07/2013] [Indexed: 11/10/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis in high-risk patients. The PARTNER trial demonstrated equivalent 1-year survival rates between patients randomized to TAVI versus conventional surgery (Leon et al., N Engl J Med 2010;363:1597-1607), with sustained benefit up to 2 years (Makkar et al., NEJM 2012;366:1696-1704). Recently, the ADVANCE registry cited all-cause mortality rates of 4.5%, 12.8%, and 17.9% at 30-days, 6 months, and 1-year following TAVI in 1,015 high-risk patients (Linke, TCT 2012, 2012). In addition, TAVI was demonstrated to be a feasible treatment for severe native valve regurgitation in a series of 31 high-risk patients. The all-cause 30-day mortality rate was 6.4%, with a 30-day major stroke rate of 6.4%. At 1-year, the all-cause mortality rate was 12.5% (Roy et al., J Am Coll Cardiol 2012;60(17S):B264). We report the successful transcatheter implantation of the new CoreValve(®) Evolut(™) in two patients with regurgitant aortic bioprostheses.
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Raja K, Chandrasekar C, Krishnarajasekhar OR, Manoharan G. Zero CD4 count: a case of discordant CD4 response in a patient with well suppressed viral load. Indian J Med Microbiol 2013; 31:298-302. [PMID: 23883722 DOI: 10.4103/0255-0857.115658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Human immunodeficiency virus (HIV) positive patients continue to have raise in CD4 cell for several years after initiation of anti-retroviral therapy (ART). The discordant response of static or fall in CD4 cells in presence of well-suppressed viral load is an unusual finding. In this communication, we present a case report of an HIV patient in whom the repeated CD4 enumerations consistently showed zero/nil CD4 counts before and after the start of ART in spite of maximum viral suppression.
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