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Gogia S, Vahl T, Khalique O, Hamid N, Borden S, Chung C, Ng V, Patel A, George I, Hahn R, Leon M, Kodali S. TCT CONNECT-92 Initial Single-Center Experience With Transfemoral Transcatheter Aortic Valve Replacement in Patients With Symptomatic Severe Aortic Regurgitation. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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52
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Jin G, Mintz G, Ali Z, Kirtane A, Rabbani L, Parikh SA, Leon M, Karmpaliotis D, Moses J, Maehara A. TCT CONNECT-411 IVUS Characteristics of Stent Edge Hematoma Associated With Acute Occlusion. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.434] [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: 11/27/2022]
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53
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Seeger J, Kapadia SR, Kodali S, Linke A, Wöhrle J, Haussig S, Makkar R, Mehran R, Rottbauer W, Leon M. Rate of peri-procedural stroke observed with cerebral embolic protection during transcatheter aortic valve replacement: a patient-level propensity-matched analysis. Eur Heart J 2020; 40:1334-1340. [PMID: 30590554 DOI: 10.1093/eurheartj/ehy847] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/23/2018] [Accepted: 12/05/2018] [Indexed: 12/22/2022] Open
Abstract
AIMS The role of cerebral embolic protection (CEP) in transcatheter aortic valve replacement (TAVR) remains controversial. Randomized trials have not been powered to demonstrate a reduction in stroke rates. The aim of this patient level pooled analysis was to validate the impact of the dual-filter CEP device (Claret Medical Inc., CA, USA) on peri-procedural stroke in a large number of TAVR patients. METHODS AND RESULTS Patients from the SENTINEL US IDE trial were combined with the CLEAN-TAVI and SENTINEL-Ulm study in a patient level pooled analysis (N = 1306). Propensity score matching was performed to adjust for possible confounders. The primary endpoint was procedural stroke within 72 h post-TAVR according to Valve Academic Research Consortium-2 criteria. The secondary endpoint was the combination of all-cause mortality or all-stroke within 72 h after TAVR. In the propensity-matched population, 533 patients underwent TAVR without CEP and 533 patients underwent TAVR with CEP. TAVR patients without vs. with CEP were similar with respect to baseline characteristics, procedural approach, or valve type. In patients undergoing TAVR with dual-filter CEP, procedural all-stroke was significantly lower compared with unprotected procedures [1.88% vs. 5.44%, odds ratio 0.35, 95% confidence interval (CI) 0.17-0.72, relative risk reduction 65%, P = 0.0028]. In addition, all-cause mortality and all-stroke were significantly lower (2.06% vs. 6.00%, odds ratio 0.34, 95% CI 0.17-0.68, relative risk reduction 66%, P = 0.0013). CONCLUSION Our findings suggest that TAVR with the dual-filter CEP device is associated with a significant lower rate of peri-procedural stroke compared with unprotected procedures. However, randomized trials are still needed to clarify this issue.
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Guerrero M, Wang DD, Pursnani A, Eleid M, Khalique O, Urena M, Salinger M, Kodali S, Kaptzan T, Lewis B, Kato N, Cajigas HM, Wendler O, Holzhey D, Pershad A, Witzke C, Alnasser S, Tang GH, Grubb K, Reisman M, Blanke P, Leipsic J, Williamson E, Pellikka PA, Pislaru S, Crestanello J, Himbert D, Vahanian A, Webb J, Hahn RT, Leon M, George I, Bapat V, O’Neill W, Rihal C. A Cardiac Computed Tomography–Based Score to Categorize Mitral Annular Calcification Severity and Predict Valve Embolization. JACC Cardiovasc Imaging 2020; 13:1945-1957. [DOI: 10.1016/j.jcmg.2020.03.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/02/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
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Sathananthan J, Green P, Finn M, Wood DA, Lauck S, Crowley A, Alu M, Arnold SV, Cohen D, Kapadia S, Mack M, Thourani VH, Kodali S, Leon M, Webb JG. Prognostic implications of baseline 6‐min walk test performance in intermediate risk patients undergoing transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2020; 97:E154-E160. [DOI: 10.1002/ccd.28981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 11/09/2022]
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Fried JA, Ramasubbu K, Bhatt R, Topkara VK, Clerkin KJ, Horn E, Rabbani L, Brodie D, Jain SS, Kirtane AJ, Masoumi A, Takeda K, Kumaraiah D, Burkhoff D, Leon M, Schwartz A, Uriel N, Sayer G. The Variety of Cardiovascular Presentations of COVID-19. Circulation 2020; 141:1930-1936. [PMID: 32243205 PMCID: PMC7314498 DOI: 10.1161/circulationaha.120.047164] [Citation(s) in RCA: 434] [Impact Index Per Article: 108.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
MESH Headings
- Acute Coronary Syndrome/diagnosis
- Adult
- COVID-19
- Cardiac Catheterization
- Cardiovascular Agents/therapeutic use
- Cardiovascular Diseases/diagnosis
- Cardiovascular Diseases/etiology
- Combined Modality Therapy
- Coronavirus Infections/complications
- Coronavirus Infections/diagnosis
- Coronavirus Infections/drug therapy
- Diabetes Mellitus, Type 2/complications
- Diagnosis, Differential
- Extracorporeal Membrane Oxygenation/methods
- Female
- Heart Failure/diagnosis
- Heart Failure/drug therapy
- Heart Failure/etiology
- Heart Failure/therapy
- Heart Transplantation
- Humans
- Hyperlipidemias/complications
- Hypertension/complications
- Hypertrophy, Left Ventricular/complications
- Immunosuppressive Agents/adverse effects
- Intra-Aortic Balloon Pumping
- Kidney Transplantation
- Male
- Middle Aged
- Pandemics
- Pericarditis/diagnosis
- Pneumonia, Viral/complications
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/drug therapy
- Postoperative Complications/diagnosis
- Postoperative Complications/etiology
- Respiration, Artificial
- Respiratory Distress Syndrome/etiology
- Respiratory Distress Syndrome/therapy
- Shock, Cardiogenic/diagnosis
- Shock, Cardiogenic/etiology
- Shock, Cardiogenic/therapy
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Bettonville M, Leon M, Margaux J, Urbin-Choffray D, Theunissen E, Besse-Hammer T, Fortems Y, Verlinden S, Godeaux O, Delmarcelle AS, Kaux JF. FRI0400 EFFICACY AND SAFETY OF AN INTRA-ARTICULAR INJECTION OF JTA-004, A NOVEL ENHANCED PROTEIN SOLUTION, IN KNEE OSTEOARTHRITIS PAIN: A RANDOMISED, DOUBLE-BLIND CONTROLLED PHASE II/III STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Osteoarthritis (OA) is a degenerative, chronic, and progressive joint disease. It is associated with chronic pain, joint function impairments and disabilities, causing a poorer quality of life with physical and/or mental co-morbidity. Along with population ageing and increasing obesity, the incidence of OA is rising and there is an urgent need for new treatment options.Objectives:JTA-004 is a novel protein solution in development for the treatment of knee OA pain. Supplemented with hyaluronic acid and clonidine, it is designed to provide a fast-acting and long-lasting pain relief. To evaluate efficacy and safety and to select the most effective formulation, single intra-articular administration of 3 JTA-004 formulations were tested and compared to Hylan G-F 20 during a 6-month period.Methods:In this prospective, multicentre, double-blind phase II/III trial (NCT02740231), eligible participants were 50-79-year-old men and women with primary knee OA classified with Kellgren-Lawrence grade II or III and a body mass index (BMI) under 35. 164 patients were randomly assigned to one of the three JTA-004 formulations or the reference treatment (Hylan G-F 20) in a 1:1:1:1 ratio. The three JTA-004 formulations differed in their clonidine concentration (50 or 100 µg/ml) and/or their volume of injection (2 or 4 ml) (Table 1). Patients were evaluated using Western Ontario McMaster Universities (WOMAC®) scores and Short-Form health survey (SF-12). The primary efficacy endpoint was the change from baseline at 6 months in WOMAC®VA3.1 Pain Subscale. Safety was assessed by monitoring and reporting vital signs, physical examination, adverse events and concomitant medications throughout the study.Table 1.Description of the three JTA-004 formulations administeredJTA-004 formulationPlasma proteinsolutionClonidineHAVolume ofConcentrationAmountConcentrationAmountConcentrationAmountinjectionJTA-100/21.02 g/ml2.04 g50 µg/ml100 µg10 mg/ml20 mg2 mlJTA-200/21.02 g/ml2.04 g100 µg/ml200 µg10 mg/ml20 mg2 mlJTA-200/41.02 g/ml4.08 g50 µg/ml200 µg10 mg/ml40 mg4 mlResults:At 6 months, patients in the three JTA-004 groups showed a better improvement in pain compared to patients in the reference group. The between-group difference (between each JTA-004 test group and reference group) in adjusted (adapted to difference in baseline values) mean change in WOMAC®Pain Subscale Score from baseline ranged between -9.49 mm and -11.63 mm at 6 months post-injection. Statistical superiority of each JTA-004 formulation over Hylan G-F 20 was however not demonstrated (p-value between 0.052 and 0.141) (Figure 1,JTA 200/2, 100/2 and 200/4). As the three JTA-004 formulations had a similar efficacy in terms of pain reduction, apost hocanalysis was subsequently performed between the pooled JTA-004-treated patients and the reference group. This analysis showed a 26.1 ± 2.4 (adjusted mean ± SE) mm improvement in pain in the pooled JTA-004 group vs. 15.6 ± 4.1 mm in the reference group at 6 months, demonstrating a statistically significant superiority of JTA-004 over the reference (between-group difference = -10.57; p = 0.030) (Figure 1,pooled JTA).Figure 1.Main and post hoc analyses.All JTA-004 formulations were shown to be well tolerated and had a clinically acceptable safety profile. There was a trend for fewer treatment-related events in the JTA-100/2 group, notably no cases of post-injection mild and transient hypotension.Conclusion:This study provides a first evidence of efficacy and safety of JTA-004 in the treatment of knee OA pain.Disclosure of Interests:Marie Bettonville Employee of: Bone Therapeutics, Marc Leon: None declared, Joëlle Margaux: None declared, Didier Urbin-Choffray: None declared, Emilie Theunissen: None declared, Tatiana Besse-Hammer: None declared, Yves Fortems: None declared, Séverine Verlinden: None declared, Olivier Godeaux Consultant of: Bone Therapeutics, Anne-Sophie Delmarcelle Employee of: Bone Therapeutics, Jean-François Kaux Consultant of: Bone Therapeutics
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Chen S, Redfors B, Crowley A, Ben‐Yehuda O, Summers M, Hahn RT, Jaber WA, Pibarot P, Alu MC, Chau KH, Kapadia S, Nazif T, Vahl TP, Thourani V, Kodali S, Leon M. Impact of recent heart failure hospitalization on clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement: an analysis from the
PARTNER
2 trial and registries. Eur J Heart Fail 2020; 22:1866-1874. [DOI: 10.1002/ejhf.1841] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/31/2020] [Accepted: 04/13/2020] [Indexed: 11/06/2022] Open
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Messika‐Zeitoun D, Verta P, Gregson J, Pocock SJ, Boero I, Feldman TE, Abraham WT, Lindenfeld J, Bax J, Leon M, Enriquez‐Sarano M. Impact of tricuspid regurgitation on survival in patients with heart failure: a large electronic health record patient‐level database analysis. Eur J Heart Fail 2020; 22:1803-1813. [DOI: 10.1002/ejhf.1830] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/06/2020] [Indexed: 01/09/2023] Open
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60
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Gupta A, Wang Y, Kodali SK, George I, Vahl T, Mori M, Kirtane A, Leon M, Krumholz HM. TRENDS IN TRANSCATHETER AND SURGICAL AORTIC VALVE REPLACEMENT AMONG MEDICARE BENEFICIARIES IN THE UNITED STATES, 2012-2017. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32067-2] [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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61
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Varunok N, Madhavan M, Redfors B, Diamond J, Smits P, von Birgelen C, Liu M, Serruys P, Ben-Yehuda O, Kirtane A, Leon M, Stone G. LONG-TERM ADVERSE ISCHEMIC OUTCOMES AFTER PERCUTANEOUS CORONARY INTERVENTION AMONG PATIENTS BY PRIOR CORONARY ARTERY BYPASS GRAFTING STATUS: ANALYSIS FROM 19 RANDOMIZED TRIALS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32030-1] [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: 11/16/2022]
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62
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Gupta A, Wang Y, Kodali SK, Vahl T, Mori M, George I, Kirtane A, Leon M, Krumholz HM. SEX- AND RACE-BASED DIFFERENCES AMONG MEDICARE BENEFICIARIES UNDERGOING TRANSCATHETER AND SURGICAL AORTIC VALVE REPLACEMENT IN THE UNITED STATES, 2012-2017. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32068-4] [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: 11/28/2022]
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63
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Alexis S, Alzahrani T, Khalique OK, Kini AS, Sharma SK, Dangas GD, Hahn RT, Kodali SK, Leon M, Adams D, George I, Tang G. CHARACTERIZING AND QUANTIFYING MITRAL ANNULAR CALCIFICATION FOR PATIENT-PREDICTIVE MODELING IN THE ERA OF TMVR. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31740-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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64
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Alexis S, Malik A, George I, El-Eshmawi A, Kodali SK, Hahn RT, Khalique OK, Zaid S, Guerrero M, Bapat V, Leon M, Adams D, Tang G. SURGICAL AND TRANSCATHETER MITRAL VALVE REPLACEMENT IN MITRAL ANNULAR CALCIFICATION- A SYSTEMATIC REVIEW. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31848-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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65
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Yadav M, Brener SJ, Mintz G, Kirtane A, Genereux P, Madhavan M, Redfors B, Liu M, Smits P, von Birgelen C, Serruys P, Leon M, Stone G. LONG-TERM OUTCOMES FOLLOWING STENT IMPLANTATION IN PATIENTS WITH VERSUS WITHOUT PRIOR PCI: AN INDIVIDUAL PATIENT-DATA POOLED ANALYSIS OF 20 RANDOMIZED CONTROLLED TRIALS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32024-6] [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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Madhavan M, Redfors B, Ali Z, Prasad M, Shahim B, Smits P, von Birgelen C, Zhang Z, Mehran R, Serruys P, Maehara A, Leon M, Kirtane A, Stone G. LONG-TERM OUTCOMES AFTER REVASCULARIZATION FOR STABLE ISCHEMIC HEART DISEASE: AN INDIVIDUAL PATIENT-LEVEL POOLED ANALYSIS OF 19 RANDOMIZED CORONARY STENT TRIALS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30631-8] [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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Marquis-Gravel G, Urban PM, Copt S, Slama SS, Stoll HP, Mehran R, Capodanno D, Leon M, Rao S, Pocock S, Morice M, Krucoff M. EVALUATION OF THE ACADEMIC RESEARCH CONSORTIUM HIGH BLEEDING RISK DEFINITION IN PATIENTS TREATED WITH DRUG-COATED STENTS AND BARE-METAL STENTS FROM THE LEADERS FREE I & II TRIALS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32129-x] [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: 11/30/2022]
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Green P, Chung C, Murphy S, Al-Ghusain A, Mollenkopf S, Feldman T, Davidson C, Eleid M, Kipperman R, Smith R, Lim S, Zahr F, Gray WA, Greenbaum A, Leon M, Kodali SK. IMPACT OF TRANSCATHETER TRICUSPID VALVE REPAIR ON DAILY PHYSICAL ACTIVITY: AN ANALYSIS OF WEARABLE ACTIVITY MONITORING IN THE CLASP TR EARLY FEASIBILITY STUDY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31836-2] [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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Tang GHL, Zaid S, Fuchs A, Yamabe T, Yazdchi F, Gupta E, Ahmad H, Kofoed K, Goldberg J, Undemir C, Kaple R, Shah P, Lansman S, Dangas GD, Lerakis S, Sharma SK, Kini AS, Khalique OK, Hahn RT, Sondergaard L, George I, Kodali SK, De Backer O, Leon M, Bapat V. THE ALIGNMENT OF TRANSCATHETER AORTIC VALVE NEO-COMMISSURES (ALIGN TAVR) STUDY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31737-x] [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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Guerrero M, Vemulapalli S, Xiang Q, Wang DD, Eleid M, Cabalka AK, Sandhu G, Salinger M, Russell H, Greenbaum A, Kodali S, George I, Dvir D, Whisenant B, Russo MJ, Pershad A, Fang K, Coylewright M, Shah P, Babaliaros V, Khan JM, Tommaso C, Saucedo J, Kar S, Makkar R, Mack M, Holmes D, Leon M, Bapat V, Thourani VH, Rihal C, O’Neill W, Feldman T. Thirty-Day Outcomes of Transcatheter Mitral Valve Replacement for Degenerated Mitral Bioprostheses (Valve-in-Valve), Failed Surgical Rings (Valve-in-Ring), and Native Valve With Severe Mitral Annular Calcification (Valve-in-Mitral Annular Calcification) in the United States. Circ Cardiovasc Interv 2020; 13:e008425. [DOI: 10.1161/circinterventions.119.008425] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Transcatheter mitral valve replacement using aortic transcatheter heart valves has recently become an alternative for patients with degenerated mitral bioprostheses, failed surgical repairs with annuloplasty rings or severe mitral annular calcification who are poor surgical candidates. Outcomes of these procedures are collected in the Society of Thoracic Surgeons/American College of Cardiology/Transcatheter Valve Therapy Registry. A comprehensive analysis of mitral valve-in-valve (MViV), mitral valve-in-ring (MViR), and valve-in-mitral annular calcification (ViMAC) outcomes has not been performed. We sought to evaluate short-term outcomes of early experience with MViV, MViR, and ViMAC in the United States.
Methods:
Retrospective analysis of data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.
Results:
Nine hundred three high-risk patients (median Society of Thoracic Surgeons score 10%) underwent MViV (n=680), MViR (n=123), or ViMAC (n=100) between March 2013 and June 2017 at 172 hospitals. Median age was 75 years, 59.2% female. Technical and procedural success were higher in MViV. Left ventricular outflow tract obstruction occurred more frequently with ViMAC (ViMAC=10%, MViR=4.9%, MViV=0.7%;
P
<0.001). In-hospital mortality (MViV=6.3%, MViR=9%, ViMAC=18%;
P
=0.004) and 30-day mortality (MViV=8.1%, MViR=11.5%, ViMAC=21.8%;
P
=0.003) were higher in ViMAC. At 30-day follow-up, median mean mitral valve gradient was 7 mm Hg, most patients (96.7%) had mitral regurgitation grade ≤1 (+) and were in New York Heart Association class I to II (81.7%).
Conclusions:
MViV using aortic balloon-expandable transcatheter heart valves is associated with a low complication rate, a 30-day mortality lower than predicted by the Society of Thoracic Surgeons score, and superior short-term outcomes than MViR and ViMAC. At 30 days, patients in all groups experienced improvement of symptoms, and valve performance remained stable.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02245763.
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Faroux L, Chen S, Muntané-Carol G, Regueiro A, Philippon F, Sondergaard L, Jørgensen TH, Lopez-Aguilera J, Kodali S, Leon M, Nazif T, Rodés-Cabau J. Clinical impact of conduction disturbances in transcatheter aortic valve replacement recipients: a systematic review and meta-analysis. Eur Heart J 2020; 41:2771-2781. [DOI: 10.1093/eurheartj/ehz924] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/26/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
The clinical impact of new-onset persistent left bundle branch block (NOP-LBBB) and permanent pacemaker implantation (PPI) on transcatheter aortic valve replacement (TAVR) recipients remains controversial. We aimed to evaluate the impact of (i) periprocedural NOP-LBBB and PPI post-TAVR on 1-year all-cause death, cardiac death, and heart failure hospitalization and (ii) NOP-LBBB on the need for PPI at 1-year follow-up.
Methods and results
We performed a systematic search from PubMed and EMBASE databases for studies reporting raw data on 1-year clinical impact of NOP-LBBB or periprocedural PPI post-TAVR. Data from 30 studies, including 7792 patients (12 studies) and 42 927 patients (21 studies) for the evaluation of the impact of NOP-LBBB and PPI after TAVR were sourced, respectively. NOP-LBBB was associated with an increased risk of all-cause death [risk ratio (RR) 1.32, 95% confidence interval (CI) 1.17–1.49; P < 0.001], cardiac death (RR 1.46, 95% CI 1.20–1.78; P < 0.001), heart failure hospitalization (RR 1.35, 95% CI 1.05–1.72; P = 0.02), and PPI (RR 1.89, 95% CI 1.58–2.27; P < 0.001) at 1-year follow-up. Periprocedural PPI after TAVR was associated with a higher risk of all-cause death (RR 1.17, 95% CI 1.11–1.25; P < 0.001) and heart failure hospitalization (RR 1.18, 95% CI 1.03–1.36; P = 0.02). Permanent pacemaker implantation was not associated with an increased risk of cardiac death (RR 0.84, 95% CI 0.67–1.05; P = 0.13).
Conclusion
NOP-LBBB and PPI after TAVR are associated with an increased risk of all-cause death and heart failure hospitalization at 1-year follow-up. Periprocedural NOP-LBBB also increased the risk of cardiac death and PPI within the year following the procedure. Further studies are urgently warranted to enhance preventive measures and optimize the management of conduction disturbances post-TAVR.
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Landes U, Iakobishvili Z, Vronsky D, Zusman O, Barsheshet A, Jaffe R, Jubran A, Yoon SH, Makkar RR, Taramasso M, Russo M, Maisano F, Sinning JM, Shamekhi J, Biasco L, Pedrazzini G, Moccetti M, Latib A, Pagnesi M, Colombo A, Tamburino C, D' Arrigo P, Windecker S, Pilgrim T, Tchetche D, De Biase C, Guerrero M, Iftikhar O, Bosmans J, Bedzra E, Dvir D, Mylotte D, Sievert H, Watanabe Y, Søndergaard L, Dagnegård H, Codner P, Kodali S, Leon M, Kornowski R. Transcatheter Aortic Valve Replacement in Oncology Patients With Severe Aortic Stenosis. JACC Cardiovasc Interv 2019; 12:78-86. [PMID: 30621982 DOI: 10.1016/j.jcin.2018.10.026] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/08/2018] [Accepted: 10/15/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The authors sought to collect data on contemporary practice and outcome of transcatheter aortic valve replacement (TAVR) in oncology patients with severe aortic stenosis (AS). BACKGROUND Oncology patients with severe AS are often denied valve replacement. TAVR may be an emerging treatment option. METHODS A worldwide registry was designed to collect data on patients who undergo TAVR while having active malignancy. Data from 222 cancer patients from 18 TAVR centers were compared versus 2,522 "no-cancer" patients from 5 participating centers. Propensity-score matching was performed to further adjust for bias. RESULTS Cancer patients' age was 78.8 ± 7.5 years, STS score 4.9 ± 3.4%, 62% men. Most frequent cancers were gastrointestinal (22%), prostate (16%), breast (15%), hematologic (15%), and lung (11%). At the time of TAVR, 40% had stage 4 cancer. Periprocedural complications were comparable between the groups. Although 30-day mortality was similar, 1-year mortality was higher in cancer patients (15% vs. 9%; p < 0.001); one-half of the deaths were due to neoplasm. Among patients who survived 1 year after the TAVR, one-third were in remission/cured from cancer. Progressive malignancy (stage III to IV) was a strong mortality predictor (hazard ratio: 2.37; 95% confidence interval: 1.74 to 3.23; p < 0.001), whereas stage I to II cancer was not associated with higher mortality compared with no-cancer patients. CONCLUSIONS TAVR in cancer patients is associated with similar short-term but worse long-term prognosis compared with patients without cancer. Among this cohort, mortality is largely driven by cancer, and progressive malignancy is a strong mortality predictor. Importantly, 85% of the patients were alive at 1 year, one-third were in remission/cured from cancer. (Outcomes of Transcatheter Aortic Valve Implantation in Oncology Patients With Severe Aortic Stenosis [TOP-AS]; NCT03181997).
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McConkey H, Modine T, Latib A, Jüni P, Windecker S, Leon M. Will the PARTNER 3 Low Risk Trial change my practice? EUROINTERVENTION 2019; 15:e1077-e1080. [DOI: 10.4244/eij-d-19-00847] [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: 11/23/2022]
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Regueiro A, Linke A, Latib A, Ihlemann N, Urena M, Walther T, Husser O, Herrmann H, Nombela-Franco L, Cheema A, Le Breton H, Stortecky S, Kapadia S, Bartorelli A, Sinning JM, Amat-Santos I, Munoz-Garcia A, Lerakis S, Gutíerrez-Ibanes E, Abdel-Wahab M, Tchetche D, Testa L, Eltchaninoff H, Livi U, Castillo JC, Jilaihawi H, Webb J, Barbanti M, Kodali S, de Brito Jr F, Ribeiro H, Miceli A, Fiorina C, Actis Dato GM, Rosato F, Serra V, Masson JB, Wijeysundera H, Mangione J, Ferreira MC, Lima V, Carvalho L, Abizaid A, Marino M, Esteves V, Andrea J, Messika-Zeitoun D, Himbert D, Kim WK, Pellegrini C, Auffret V, Nietlispach F, Pilgrim T, Durand E, Lisko J, Makkar R, Lemos P, Leon M, Puri R, San Roman A, Vahanian A, Søndergaard L, Mangner N, Rodés-Cabau J. Infective Endocarditis Following Transcatheter Aortic Valve Replacement: Comparison of Balloon- Versus Self-Expandable Valves. Circ Cardiovasc Interv 2019; 12:e007938. [PMID: 31694412 DOI: 10.1161/circinterventions.119.007938] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND No data exist about the characteristics of infective endocarditis (IE) post-transcatheter aortic valve replacement (TAVR) according to transcatheter valve type. We aimed to determine the incidence, clinical characteristics, and outcomes of patients with IE post-TAVR treated with balloon-expandable valve (BEV) versus self-expanding valve (SEV) systems. METHODS Data from the multicenter Infectious Endocarditis After TAVR International Registry was used to compare IE patients with BEV versus SEV. RESULTS A total of 245 patients with IE post-TAVR were included (SEV, 47%; BEV, 53%). The timing between TAVR and IE was similar between groups (SEV, 5.5 [1.2-15] months versus BEV, 5.3 [1.7-11.4] months; P=0.89). Enterococcal IE was more frequent in the SEV group (36.5% versus 15.4%; P<0.01), and vegetation location differed according to valve type (stent frame, SEV, 18.6%; BEV, 6.9%; P=0.01; valve leaflet, SEV, 23.9%; BEV, 38.5%; P=0.01). BEV recipients had a higher rate of stroke/systemic embolism (20.0% versus 8.7%, adjusted OR: 2.46, 95% CI: 1.04-5.82, P=0.04). Surgical explant of the transcatheter valve (SEV, 8.7%; BEV, 13.8%; P=0.21), and in-hospital death at the time of IE episode (SEV, 35.6%; BEV, 37.7%; P=0.74) were similar between groups. After a mean follow-up of 13±12 months, 59.1% and 54.6% of the SEV and BEV recipients, respectively, had died (P=0.66). CONCLUSIONS The characteristics of IE post-TAVR, including microorganism type, vegetation location, and embolic complications but not early or late mortality, differed according to valve type. These results may help to guide the diagnosis and management of IE and inform future research studies in the field.
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Zhang M, Maehara A, Zhang Z, Leon M, Moses JW, Mintz G, Stone G. TCT-299 The Impact of Left Ventricular Ejection Fraction on Long-Term Outcomes in Patients Undergoing PCI: Analysis From a Large Pooled Randomized Trial Dataset. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.374] [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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