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Tang GHL, Zaid S, Hahn RT, Aggarwal V, Alkhouli M, Aman E, Berti S, Chandrashekhar YS, Chadderdon SM, D'Agostino A, Fam NP, Ho EC, Kliger C, Kodali SK, Krishnamoorthy P, Latib A, Lerakis S, Lim DS, Mahadevan VS, Nair DG, Narula J, O'Gara PT, Packer DL, Praz F, Rogers JH, Ruf TF, Sanchez CE, Sharma A, Singh GD, van Mieghem NM, Vannan MA, Yadav PK, Ya'Qoub L, Zahr FE, von Bardeleben RS. Structural Heart Imaging Using 3-Dimensional Intracardiac Echocardiography: JACC Cardiovascular Imaging Position Statement. JACC Cardiovasc Imaging 2024:S1936-878X(24)00202-X. [PMID: 38970594 DOI: 10.1016/j.jcmg.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 07/08/2024]
Abstract
3-dimensional (3D) intracardiac echocardiography (ICE) is emerging as a promising complement and potential alternative to transesophageal echocardiography for imaging guidance in structural heart interventions. To establish standardized practices, our multidisciplinary expert position statement serves as a comprehensive guide for the appropriate indications and utilization of 3D-ICE in various structural heart procedures. The paper covers essential aspects such as the fundamentals of 3D-ICE imaging, basic views, and workflow recommendations specifically tailored for ICE-guided structural heart procedures, such as transeptal puncture, device closure of intracardiac structures, and transcatheter mitral and tricuspid valve interventions. Current challenges, future directions, and training requirements to ensure operator proficiency are also discussed, thereby promoting the safety and efficacy of this innovative imaging modality to support expanding its future clinical applications.
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Affiliation(s)
| | - Syed Zaid
- Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York, New York, USA
| | - Vratika Aggarwal
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Edris Aman
- University of California, Davis Medical Center, Sacramento, California, USA
| | - Sergio Berti
- G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Y S Chandrashekhar
- Minneapolis Veterans Affairs Medical Center, University of Minnesota, Minneapolis, Minnesota, USA
| | | | | | - Neil P Fam
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Edwin C Ho
- Montefiore Medical Center, Bronx, New York, USA
| | - Chad Kliger
- Lenox Hill Hospital, New York, New York, USA
| | - Susheel K Kodali
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Azeem Latib
- Montefiore Medical Center, Bronx, New York, USA
| | | | - D Scott Lim
- University of Virginia, Charlottesville, Virginia, USA
| | - Vaikom S Mahadevan
- University of Massachusetts Chan School of Medicine, Worchester, Massachusetts, USA
| | - Devi G Nair
- St. Bernard's Heart and Vascular Center, Jonesboro, Arkansas, USA
| | - Jagat Narula
- University of Texas Health Houston, Houston, Texas, USA
| | | | | | - Fabien Praz
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jason H Rogers
- University of California, Davis Medical Center, Sacramento, California, USA
| | | | | | - Alok Sharma
- Minneapolis Veterans Affairs Medical Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gagan D Singh
- University of California, Davis Medical Center, Sacramento, California, USA
| | | | | | | | - Lina Ya'Qoub
- University of California, San Francisco Medical Center, San Francisco, California, USA
| | - Firas E Zahr
- Oregon Health and Science University, Portland, Oregon, USA
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2
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Jenab Y, Nourian S, Hosseini Mohammadi NS, Mohseni‐Badalabadi R, Hosseini K, Zakavi S, Ates I. Complications of transcatheter paravalvular leak device closure of mitral valve: An updated review of the literature and a rare case presentation. Clin Cardiol 2024; 47:e24272. [PMID: 38742736 PMCID: PMC11092304 DOI: 10.1002/clc.24272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 04/01/2024] [Accepted: 04/11/2024] [Indexed: 05/16/2024] Open
Abstract
Paravalvular leak (PVL) is an uncommon complication of prosthetic valve implantation, which can lead to infective endocarditis, heart failure, and hemolytic anemia. Surgical reintervention of PVLs is associated with high mortality rates. Transcatheter PVL closure (TPVLc) has emerged as an alternative to surgical reoperation. This method provides a high success rate with a low rate of complications. This article reviews the pathogenesis, clinical manifestation, diagnosis, and management of PVL and complications following TPVLc. Besides, we presented a case of a patient with severe PVL following mitral valve replacement, who experienced complete heart block (CHB) during TPVLc. The first TPVLc procedure failed in our patient due to possible AV-node insult during catheterization. After 1 week of persistent CHB, a permanent pacemaker was implanted. The defect was successfully passed using the previous attempt. Considering the advantages of TPVLc, procedure failure should be regarded as a concern. TPVLc should be performed by experienced medical teams in carefully selected patients.
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Affiliation(s)
- Yaser Jenab
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Saeed Nourian
- Firoozgar Clinical Research and Development CenterIran University of Medical SciencesTehranIran
| | - Negin Sadat Hosseini Mohammadi
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical ScienceTehranIran
| | - Reza Mohseni‐Badalabadi
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical ScienceTehranIran
| | - Sarina Zakavi
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Students' Scientific Research Center (SSRC)Tehran University of Medical ScienceTehranIran
| | - Ismail Ates
- Faculty of HealthscienceBahcesehir UniversityIstanbulTurkey
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Nagasaka T, Patel V, Koren O, Shechter A, Chakravarty T, Cheng W, Ishii H, Jilaihawi H, Nakamura M, Makkar RR. TAVR-in-TAVR with a balloon-expandable valve for paravalvular leak. Front Cardiovasc Med 2024; 11:1374078. [PMID: 38566964 PMCID: PMC10985156 DOI: 10.3389/fcvm.2024.1374078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Paravalvular leak (PVL) is a severe complication of transcatheter aortic valve replacement (TAVR) that can lead to poor outcomes. TAVR-in-TAVR is a promising treatment for PVL; however, reports on its safety or efficacy are limited. In this study, we aimed to investigate the clinical outcomes of TAVR-in-TAVR using balloon-expandable prostheses for PVLs after TAVR. Methods We retrospectively analyzed data from patients who underwent TAVR-in-TAVR using balloon-expandable Sapien prostheses for PVL after an initial TAVR at our institution. The procedural success, in-hospital complications, all-cause mortality, and echocardiographic data for up to 2 years post-surgery were evaluated. Results In total, 31 patients with a mean age of 81.1 ± 7.9 years and mean Society of Thoracic Surgeons score of 8.8 ± 5.4% were identified. The procedural success rate of TAVR-in-TAVR was 96.8% (30/31). No in-hospital deaths, cardiac tamponade, or conversion to sternotomy occurred. Re-intervention was performed in only one patient (3.2%) during hospitalization. The all-cause mortality rates at 30 days and 2 years were 0% and 16.1%, respectively. A significant reduction in the PVL rate was observed at 30 days compared with that at baseline (p < 0.01). Discussion Our findings suggest that TAVR-in-TAVR using balloon-expandable prostheses is safe and effective for PVL after TAVR with low complication rates and acceptable long-term outcomes. Further studies with larger sample sizes are needed to confirm our findings.
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Affiliation(s)
- Takashi Nagasaka
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Vivek Patel
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
| | - Ofir Koren
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
- Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Alon Shechter
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tarun Chakravarty
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
| | - Wen Cheng
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hasan Jilaihawi
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
| | - Mamoo Nakamura
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
| | - Raj R. Makkar
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
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4
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Lytra T, Kalogeras K, Pesiridis T, Moldovan C, Vavuranakis MA, Vogiatzi G, Oikonomou E, Dardas P, Chrissoheris M, Ninios V, Vavuranakis M. Correlation of Clinical Outcomes with the Prominent Indication of Transcatheter Paravalvular Leak Closure: A Multicenter Experience. J Clin Med 2023; 12:4047. [PMID: 37373740 DOI: 10.3390/jcm12124047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/07/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND A paravalvular leak (PVL) is a complication following valve replacement, which may lead to heart failure and hemolysis. The aim of this study is to investigate whether the clinical outcome after transcatheter PVL closure differs according to the prominent indication of the procedure (symptoms of heart failure or hemolysis). METHODS The data of consecutive patients who had transcatheter treatment for PVL between July 2011 and September 2022 in five Greek centers were analyzed. The primary endpoint was the technical, and clinical success rates with regards to the prominent indication of paravalvular leak closure. The secondary endpoints included the evaluation and comparison of the clinical and technical success in relation to the type of valve that was treated (aortic or mitral) as well as the survival analysis in relation to the closure indication and type of valve that was treated. RESULTS In total, 60 patients were retrospectively studied (39% men, mean age 69.5 ± 11 years). Regarding the primary outcomes, the technical success in patients mainly suffering from hemolysis was 86.1%, while in those presenting heart failure it was 95.8%, p = 0.387. Furthermore, the clinical success was 72.2% and 87.5% among hemolysis and heart failure patients, respectively, p = 0.210. During the follow-up period, the two-year survival rates were significantly better for patients treated for the aortic valve (78.94%) compared to those in the mitral position (48.78%), p = 0.014. In total, 25 patients died (41.7%) during 24 months of follow-up. CONCLUSIONS Transcatheter paravalvular leak closure can be performed with high technical and clinical success rates without any difference according to the prominent indication of closure.
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Affiliation(s)
- Thekla Lytra
- 3rd Department of Cardiology, University of Athens, Sotiria Hospital, 11527 Athens, Greece
| | - Konstantinos Kalogeras
- 3rd Department of Cardiology, University of Athens, Sotiria Hospital, 11527 Athens, Greece
- 1st Department of Cardiology, University of Athens, Hippokration Hospital, 11527 Athens, Greece
| | - Theodoros Pesiridis
- 3rd Department of Cardiology, University of Athens, Sotiria Hospital, 11527 Athens, Greece
| | - Carmen Moldovan
- 3rd Department of Cardiology, University of Athens, Sotiria Hospital, 11527 Athens, Greece
| | | | - Georgia Vogiatzi
- 3rd Department of Cardiology, University of Athens, Sotiria Hospital, 11527 Athens, Greece
| | - Evaggelos Oikonomou
- 3rd Department of Cardiology, University of Athens, Sotiria Hospital, 11527 Athens, Greece
| | - Petros Dardas
- Cardiology Department, Aghios Loukas Hospital, 55236 Thessaloniki, Greece
| | | | - Vlasis Ninios
- Cardiology Department, Interbalkan Medical Center, 55535 Thessaloniki, Greece
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, University of Athens, Sotiria Hospital, 11527 Athens, Greece
- 1st Department of Cardiology, University of Athens, Hippokration Hospital, 11527 Athens, Greece
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Hatab T, Wessly P, Zaid S, Faza N, Chang SM, Kleiman NS, Little SH, Goel SS. When Echocardiography Is Challenging in Localizing Bioprosthetic Aortic Regurgitation: Dye Don't Lie. JACC Case Rep 2023; 15:101853. [PMID: 37283832 PMCID: PMC10240279 DOI: 10.1016/j.jaccas.2023.101853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 06/08/2023]
Abstract
Transesophageal echocardiography is the main imaging modality for localizing and quantifying prosthetic aortic regurgitation. We describe a case of bioprosthetic aortic paravalvular leak (PVL) where transesophageal echocardiography was inadequate; aortic root angiography and computed tomography fusion were critical in diagnosing and guiding closure. Multimodality imaging can be pivotal in localizing PVL and guiding transcatheter PVL closure. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Taha Hatab
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Priscilla Wessly
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Syed Zaid
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Nadeen Faza
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Su Min Chang
- Department of Cardiology, Houston Methodist Debakey Heart and Vascular Center, Houston, Texas, USA
| | - Neal S. Kleiman
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Stephen H. Little
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sachin S. Goel
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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6
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Alkhouli M, De Backer O, Ellis CR, Nielsen-Kudsk JE, Sievert H, Natale A, Lakkireddy D, Holmes DR. Peridevice Leak After Left Atrial Appendage Occlusion: Incidence, Mechanisms, Clinical Impact, and Management. JACC Cardiovasc Interv 2023; 16:627-642. [PMID: 36990553 DOI: 10.1016/j.jcin.2022.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/11/2022] [Accepted: 12/05/2022] [Indexed: 03/31/2023]
Abstract
Left atrial appendage occlusion is an increasingly adopted stroke prevention strategy in patients with atrial fibrillation. However, peridevice leaks after the procedure are not infrequent and have recently been shown to confer a higher risk for subsequent ischemic events. In this paper, the authors review the available research on the frequency, mechanisms, clinical significance, and management of peridevice leak after percutaneous left atrial appendage occlusion.
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Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiology, Mayo Clinic School of Medicine Rochester, Minnesota, USA.
| | - Ole De Backer
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | | | - David R Holmes
- Department of Cardiology, Mayo Clinic School of Medicine Rochester, Minnesota, USA
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7
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Eng MH, Tandon V, Greenbaum AB, Fang K. Percutaneous Paravalvular Leak Repair. Interv Cardiol Clin 2022; 11:233-243. [PMID: 35710279 DOI: 10.1016/j.iccl.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Paravalvular leaks (PVLs) are challenging lesions that require a comprehensive understanding of surgical and transcatheter heart therapies, multimodality imaging, and transcatheter techniques. Approach to a transcatheter heart valve (THV) or surgical prosthesis for PVL differs in terms of options and varies according to the location (aortic or mitral). A suggested framework for transcatheter PVL repair is defect localization, access planning, defect crossing, sheath delivery. and occluder deployment. Careful planning facilitates success, but operators begin the case with a flexible mindset because many initial strategies may not succeed.
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Affiliation(s)
- Marvin H Eng
- Division of Cardiology, Banner University Medical Center, 755 East McDowell Road, Phoenix, AZ 85006, USA; Structural Heart Program, University of Arizona, Banner University Medical Center, 755 East McDowell Road, Phoenix, AZ 85006, USA.
| | - Varun Tandon
- Division of Cardiology, Banner University Medical Center, 755 East McDowell Road, Phoenix, AZ 85006, USA
| | - Adam B Greenbaum
- Emory Structural Heart and Valve Center, 550 Peachtree Street, NE, Atlanta, GA 30308, USA
| | - Kenith Fang
- Division of Cardiothoracic Surgery, Banner University Medical Center, 1111 East McDowell, Phoneix, AZ 85006, USA
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8
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Güner A, Özkan M, Kalçık M, Gürsoy MO, Gündüz S, Kılıçgedik A, Bayam E, Kalkan S, Kırma C, Türkmen M, Adademir T, Aksüt M, Fedakar A, Kırali K. Serum Levels of Cholesterol and Lipoproteins in Patients With Symptomatic Paravalvular Leaks. Am J Cardiol 2022; 173:112-119. [PMID: 35369933 DOI: 10.1016/j.amjcard.2022.02.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/25/2022]
Abstract
Paravalvular leak (PVL) is a complication of valve replacement surgery which may lead to serious clinical consequences including hemolytic anemia. This study aimed to retrospectively evaluate the effect of successful intervention on serum lipid parameters in patients with PVL. A total of 106 patients (mean age: 57.2 ± 13.6 years, male: 67) who underwent surgical or transcatheter closure for symptomatic PVL were enrolled in this study. During the follow-up period, hemolysis and lipid parameters were evaluated at each clinical visit. This is the first study describing the effects of PVL on lipid metabolism after surgical or transcatheter closure. In the study, 18 patients (17%) had aortic PVL, 84 patients (79%) had mitral PVL, and 4 patients (3.8%) had both aortic and mitral PVL. A total of 59 patients underwent transcatheter closure and 47 patients were treated surgically. Technical success of the procedures was 83%. After successful PVL closure, hemoglobin and haptoglobin levels increased significantly (9.5 ± 1.3 vs 11.9 ± 2.1 g/dl, p <0.001 and 16.6 ± 7.9 vs 34.1 ± 19.9 mg, p <0.001, respectively). A significant increase in total cholesterol (158.9 ± 42.7 vs 209.3 ± 58.7 mg/dl, p <0.001), low-density lipoprotein cholesterol (99.1 ± 33.8 vs 133.9 ± 45.7 mg/dl, p <0.001), and high-density lipoprotein cholesterol (39.8 ± 12.4 vs 44.8 ± 11.7 mg/dl, p <0.001) levels was observed after successful PVL closure. In conclusion, symptomatic patients with PVL had hypocholesterolemia, reflected by low serum lipoprotein levels. After successful PVL closure, an increase in serum lipoprotein levels was observed. The recovery in levels of lipoproteins could be used as a marker of successful PVL closure, and absence of recovery of lipoprotein levels may indicate incomplete closure.
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9
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Onorato EM, Alamanni F, Muratori M, Smolka G, Wojakowski W, Pysz P, Zorinas A, Zakarkaite D, Eltchaninoff H, Litzer PY, Godart F, Calvert P, Christou C, Mussayev A, Missiroli B, Buzaev I, Curello S, Tesorio T, Bartorelli AL. Safety, Efficacy and Long-Term Outcomes of Patients Treated with the Occlutech Paravalvular Leak Device for Significant Paravalvular Regurgitation. J Clin Med 2022; 11:jcm11071978. [PMID: 35407584 PMCID: PMC8999580 DOI: 10.3390/jcm11071978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/26/2022] [Accepted: 03/29/2022] [Indexed: 01/27/2023] Open
Abstract
Between December 2014 and March 2021, 144 patients with aortic (Ao) or mitral (Mi) paravalvular leaks (PVLs) were enrolled at 21 sites in 10 countries. Safety data were available for 137 patients, who were included in the safety analysis fraction (SAF), 93 patients with Mi PVLs and 44 patients with Ao PVLs. The full analysis set (FAS) comprised 112 patients with available stratum (aortic/mitral leak) as well as baseline (BL), 180-day or later assessments (2 years). Procedural success (implantation of the device with a proper closure of the PVL, defined as reduction in paravalvular regurgitation of ≥one grade as assessed by echocardiography post implantation) was achieved in 91.3% of FAS patients with Mi PVLs and in 90.0% of those with Ao PVLs. The proportion of patients suffering from significant or severe heart failure (HF), classified as New York Heart Association (NYHA) class III/IV, decreased from 80% at baseline to 14.1% at 2-year follow-up (FAS). The proportion of FAS patients needing hemolysis-related blood transfusion decreased from 35.5% to 3.8% and from 8.1% to 0% in Mi patients and Ao patients, respectively. In total, 35 serious adverse events (SAEs) were reported in 27 patients (19.7%) of the SAF population. The SAEs considered possibly or probably related to the device included device embolization (three patients), residual leak (two patients) and vascular complication (one patient). During follow-up, 12/137 (8.8%) patients died, but none of the deaths was considered to be device-related. Patients implanted with the Occlutech Paravalvular Leak Device (PLD) showed long-lasting improvements in clinical parameters, including NYHA class and a reduced dependency on hemolysis-related blood transfusions.
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Affiliation(s)
- Eustaquio Maria Onorato
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (F.A.); (M.M.); (A.L.B.)
- Correspondence:
| | - Francesco Alamanni
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (F.A.); (M.M.); (A.L.B.)
| | - Manuela Muratori
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (F.A.); (M.M.); (A.L.B.)
| | - Grzegorz Smolka
- 3rd Division of Cardiology, Medical University of Silesia, 40-055 Katowice, Poland; (G.S.); (W.W.); (P.P.)
| | - Wojtek Wojakowski
- 3rd Division of Cardiology, Medical University of Silesia, 40-055 Katowice, Poland; (G.S.); (W.W.); (P.P.)
| | - Piotr Pysz
- 3rd Division of Cardiology, Medical University of Silesia, 40-055 Katowice, Poland; (G.S.); (W.W.); (P.P.)
| | - Aleksejus Zorinas
- Department of Cardiovascular Medicine, Vilnius University, 01513 Vilnius, Lithuania; (A.Z.); (D.Z.)
| | - Diana Zakarkaite
- Department of Cardiovascular Medicine, Vilnius University, 01513 Vilnius, Lithuania; (A.Z.); (D.Z.)
| | - Hélène Eltchaninoff
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, 76000 Rouen, France; (H.E.); (P.-Y.L.)
| | - Pierre-Yves Litzer
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, 76000 Rouen, France; (H.E.); (P.-Y.L.)
| | - François Godart
- Department of Pediatric Cardiology and Congenital Heart Disease, University of Lille, 59000 Lille, France;
| | - Patrick Calvert
- Department of Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, UK;
| | | | | | - Bindo Missiroli
- Gemelli Molise di Campobasso-Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 86100 Campobasso, Italy;
| | - Igor Buzaev
- Cardiovascular Department, Bashkir State Medical University, 450008 Ufa, Russia;
| | | | - Tullio Tesorio
- Department of Invasive Cardiology, Clinica Montevergine, 83013 Mercogliano, Italy;
| | - Antonio Luca Bartorelli
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (F.A.); (M.M.); (A.L.B.)
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, 20122 Milan, Italy
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10
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Yi K, Ding FH, You T, Li HX, Xu JG, Hou XD, Wang XK, Zhang X. Transcatheter closure of multiple paravalvular leaks by a transapical approach under echocardiographic guidance: A case report. Sci Prog 2021; 104:368504211058554. [PMID: 34851207 PMCID: PMC10450597 DOI: 10.1177/00368504211058554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CASE SUMMARY A patient who underwent mechanical aortic and mitral valve replacement developed three paravalvular leaks 10 months later. We located the tracks by puncturing the apex cordis under transoesophageal echocardiography guidance alone and puncturing the femoral artery guided by fluoroscopy. Three paravalvular leaks were occluded with a hybridization method simultaneously. The patient was followed up for 24 months and maintained a good condition. CONCLUSION Multiple paravalvular leaks after double valve replacement can be occluded in patients by the use of different approaches under echocardiographic guidance alone.
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Affiliation(s)
- Kang Yi
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, China
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, China
| | - Fang-Hui Ding
- The Fifth Department of General Surgery, The First Hospital of Lanzhou University, China
| | - Tao You
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, China
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, China
| | - Hong-Xin Li
- Department of Cardiovascular Surgery, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated with Shandong First Medical University, China
| | - Jian-Guo Xu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, China
| | - Xiao-Dong Hou
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, China
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, China
| | - Xin-Kuan Wang
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, China
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, China
| | - Xin Zhang
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, China
- The First School of Clinical Medical of Gansu University of Chinese Medicine, China
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11
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Garrett HE. Intraoperative repair of mitral paravalvular leak with Amplatzer plug. J Card Surg 2021; 36:2423-2425. [PMID: 33834540 DOI: 10.1111/jocs.15541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/08/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Significant paravalvular leaks may complicate mitral valve replacement (MVR), especially in the setting of mitral annular calcification. Correction has been accomplished postoperatively by endovascular delivery of Amplatzer plugs (Abbott Medical) with good results. Intraoperative delivery of Amplatzer plugs at the index operation may reduce postoperative paravalvular leaks. METHODS A retrospective review of eight patients who underwent placement of Amplatzer plugs for treatment of paravalvular leak during MVR at a single institution is reported. RESULTS Seven patients had ≤1+ residual mitral valve insufficiency and one patient had 1-2+ residual mitral valve insufficiency intraoperatively by transesophageal echocardiogram. At 222 days average follow-up, echocardiogram revealed ≤ 1+ residual mitral valve insufficiency in all surviving patients. CONCLUSION Intraoperative delivery of Amplatzer plugs for treatment of paravalvular leaks during MVR appears to be safe and effective at reducing postoperative mitral valve insufficiency.
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Affiliation(s)
- H Edward Garrett
- Department of Surgery, Baptist Memorial Hospital - Memphis, Memphis, Tennessee, USA.,Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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12
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Kalogeras K, Ntalekou K, Aggeli K, Moldovan C, Katsianos E, Kalantzis C, Bei E, Mourmouris C, Spargias K, Chrissoheris M, Dardas P, Aznaouridis K, Tzifa A, Theofilogiannakos E, Siasos G, Tousoulis D, Vavuranakis M. Transcatheter closure of paravalvular leak: Multicenter experience and follow-up. Hellenic J Cardiol 2021; 62:416-422. [PMID: 33617960 DOI: 10.1016/j.hjc.2021.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/22/2020] [Accepted: 02/12/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Paravalvular leak (PVL) is a common complication following valve replacement, which leads to heart failure and hemolysis. Transcatheter PVL closure has emerged as a reliable alternative with promising results. We quote the combined three-center experience of PVL patients treated percutaneously. METHODS Consecutive patients treated percutaneously for PVL were retrospectively studied. Procedural characteristics, inhospital, and long-term clinical outcomes were assessed. Technical (successful deployment) and clinical (NYHA and/or hemolysis improvement) success were evaluated. RESULTS In total, 39 patients treated for PVL in either the aortic (12 patients) or the mitral (27 patients) position were studied. Amplatzer Vascular Plug III was the most commonly used device among the 45 devices totally implanted. Postprocedurally, the rates of at least moderate PVL (87.5% preprocedurally vs 10.5% at discharge) and functional status (mean NYHA class 2.8 ± 0.7 on admission vs 1.5 ± 0.8 at follow-up) were statistically significantly improved. Total population technical success rate was 89.7%, being comparable between patients treated for mitral or aortic valve PVLs (92.6% vs 83.3%, respectively). Clinical success was achieved in 82.1% of patient cohort without statistical difference among those with isolated aortic or mitral PVL or among those with PVL closure an indication of heart failure or hemolysis. During a mean follow-up of 33.5 months, five patients died, including one periprocedural death. CONCLUSIONS This multicenter recorded experience confirms that percutaneous PVL closure can be performed with high technical and clinical success rates and limited complications that lead to significant PVL reduction and functional status improvement.
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Affiliation(s)
- Konstantinos Kalogeras
- 1(st) Department of Cardiology, University of Athens, 'Hippokration' Hospital, Athens, Greece; 3(rd) Department of Cardiology, University of Athens, 'Sotiria' Hospital, Athens, Greece.
| | - Konstantina Ntalekou
- 1(st) Department of Cardiology, University of Athens, 'Hippokration' Hospital, Athens, Greece
| | - Konstantina Aggeli
- 1(st) Department of Cardiology, University of Athens, 'Hippokration' Hospital, Athens, Greece
| | - Carmen Moldovan
- 1(st) Department of Cardiology, University of Athens, 'Hippokration' Hospital, Athens, Greece
| | - Efstratios Katsianos
- 1(st) Department of Cardiology, University of Athens, 'Hippokration' Hospital, Athens, Greece; 3(rd) Department of Cardiology, University of Athens, 'Sotiria' Hospital, Athens, Greece
| | - Charalambos Kalantzis
- 1(st) Department of Cardiology, University of Athens, 'Hippokration' Hospital, Athens, Greece
| | - Evelina Bei
- 1(st) Department of Cardiology, University of Athens, 'Hippokration' Hospital, Athens, Greece
| | | | | | | | - Petros Dardas
- Cardiology Department, 'Aghios Loukas' Hospital, Thessaloniki, Greece
| | | | - Afroditi Tzifa
- Cardiology Department, 'Hygeia' Hospital, Athens, Greece
| | | | - Gerasimos Siasos
- 1(st) Department of Cardiology, University of Athens, 'Hippokration' Hospital, Athens, Greece; 3(rd) Department of Cardiology, University of Athens, 'Sotiria' Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- 1(st) Department of Cardiology, University of Athens, 'Hippokration' Hospital, Athens, Greece
| | - Manolis Vavuranakis
- 1(st) Department of Cardiology, University of Athens, 'Hippokration' Hospital, Athens, Greece; 3(rd) Department of Cardiology, University of Athens, 'Sotiria' Hospital, Athens, Greece
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13
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Jang SJ, Truong QA, Bergman G, Wong SC, Mosadegh B. Percutaneous Closure of Aortic and Mitral Paravalvular Leaks—Diagnostic and Therapeutic Considerations. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-020-00896-w] [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: 11/29/2022]
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14
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Vogt JC, Michelena HI, Nishimura RA, Nkomo VT, Pislaru SV, Reeder GS, Rihal CS, Eleid MF. Diastolic blood pressure predicts outcomes after aortic paravalvular leak closure. Catheter Cardiovasc Interv 2021; 97:E79-E87. [PMID: 32259389 DOI: 10.1002/ccd.28890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/14/2020] [Accepted: 03/25/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We sought to determine hemodynamic effects of aortic paravalvular leak (PVL) and predictors of clinical outcomes after aortic PVL closure. BACKGROUND The significance of hemodynamic alterations in PVL and relation to severity, procedural success of percutaneous closure and clinical outcomes have not been defined. METHODS Patients undergoing percutaneous PVL closure between July 21, 2004 and September 10, 2018 were included. PVL severity was assessed by echocardiography and aortic angiography. Hemodynamics were assessed by intra-arterial pressure tracings before and after PVL closure. The primary outcome was a composite of mortality, redo aortic valve replacement (AVR) and redo PVL closure. RESULTS One hundred and seventeen patients (mean age 70.3 ± 14.9 years, 79% surgical and 21% transcatheter prostheses) underwent PVL closure with 94% technical success. PVL was moderate or greater in 106 (91%) at baseline and 11 (11%) post-procedure. Diastolic BP for those with moderate or greater PVL was lower than for those with less PVL (50.3 ± 11.7 vs. 56.5 ± 12.4 mmHg, p < .001). Pulse pressure was similar between these groups (69.9 ± 20.3 vs. 67.4 ± 21.2 mmHg, p = .39). 35 patients (34%) had 40 events during a mean follow-up of 1.6 ± 1.9 years (23 deaths, 12 redo AVR, and five redo PVL closures). In a multivariate model, final diastolic BP <47 mmHg (HR 3.27 [1.45-7.36], p = .007) was a significant predictor of the composite endpoint. CONCLUSIONS Diastolic BP was significantly associated with aortic PVL severity and clinical outcomes after PVL closure. In contrast, pulse pressure did not correlate with PVL severity or outcomes. These findings have implications for clinical management of patients with aortic PVL.
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Affiliation(s)
- Joshua C Vogt
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Guy S Reeder
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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15
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Jabbar AA, Hasan M, Jenkins JS, Collins T, Ramee S. Elective Percutaneous Paravalvular Leak Closure Under Conscious Sedation: Procedural Techniques and Clinical Outcomes. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1291-1298. [PMID: 33246555 DOI: 10.1016/j.carrev.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Paravalvular leaks (PVLs) are a well-recognized complication of prosthetic valves that are detected up to 18% of all implanted surgical valves. Perioperative morbidity is thought to be lower in percutaneous compared to surgical PVL repair. However, a direct comparison of PVL closure techniques has never been performed. Our study is the first to demonstrate that elective PVL closure with monitored anesthesia care can be achieved with high success and low complications rates resulting in short hospital stays. METHODS This is a retrospective cohort of patients admitted electively for catheter-based treatment of symptomatic prosthetic paravalvular regurgitation from Jan 2013 to April 2018. Both mitral and aortic PVLs were included. Patients' demographics, risk factors, procedural outcomes, In-hospital and thirty-day mortality were all reported. We followed the Valve Academic Research Consortium (VARC) criteria to define device and procedural technical success. In-hospital and 30- day outcomes were assessed by retrospective chart review. RESULTS A total of 54 PVLs in thirty-seven patients were repaired (65% aortic & 35% mitral). The mean-age in the mitral cohort was lower than the aortic cohort (61 vs 72years, P<0.0001) but the two groups shared similar clinical risk factors (P>0.05). Average hospital stay was 1-2days (<1.5days overall cohort) which was significantly lower in the aortic compared to the mitral cohort (P=0.009). All procedures were guided by TEE under conscious sedation with monitored anesthesia care. Procedural technical success defined as any significant residual shunt was 81% in the overall cohort and 88% in the aortic group. No procedural deaths were reported. Short-term mortality during the first 30days was 5.4% (two patients). CONCLUSION Elective catheter-based repair of symptomatic prosthetic paravalvular regurgitation appears to be safe and effective. The use of conscious sedation with monitored anesthesia care resulted in short hospital stay.
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Affiliation(s)
- Ali Abdul Jabbar
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Mohanad Hasan
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - J Stephen Jenkins
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Tyrone Collins
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA, United States of America
| | - Stephen Ramee
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America.
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16
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Use of Railway TM Dilator as a Novel Technique to Cross Prosthetic Aortic and Mitral Paravalvular Leak. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 28S:109-113. [PMID: 32900643 DOI: 10.1016/j.carrev.2020.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 11/21/2022]
Abstract
Percutaneous endovascular repair of prosthetic paravalvular leaks (PVLs) has emerged as a safer, and less invasive option preferred for many patients. Crossing the PVL with a guide catheter (GC), or guide sheath is one of the challenging aspects of this technique and at times require arteriovenous (AV) rail creation. AV rail creation requires additional arterial access, snaring, and externalizing of a wire, all of which are associated with unique challenges and complications risk. Despite using these techniques, nearly 8% of the PVL closure procedures are unsuccessful. We report two cases with a novel technique of using a 0.035″ dilator from the Railway™, a radial sheathless access system, to successfully cross a guide catheter (GC) through difficult PVL when the traditional telescoping technique failed.
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17
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Subramanyam P, Legasto AC, Al'Aref SJ, Wong SC, Truong QA. Potential impact of dynamic automated CT aortic annular measurements on outcomes for transcatheter aortic valve replacement sizing. Int J Cardiovasc Imaging 2020; 36:2291-2297. [PMID: 32621038 DOI: 10.1007/s10554-020-01928-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/25/2020] [Indexed: 11/30/2022]
Abstract
To determine the potential impact of automated computed tomography (CT) software used for aortic annular sizing for transcatheter aortic valve replacement (TAVR) on paravalvular leak (PVL) and major adverse cardiovascular events (MACE) as compared to standard CT manual measurement. In 60 TAVR patients (84 ± 7 years, 60% male), we evaluated the preprocedural CT scans. For the standard manual measurement, we measured the perimeter and area from a single cardiac phase deemed to be of maximum systolic opening. Valve type and size were determined by a multidisciplinary TAVR team per clinical routine. From the dynamic automated software, we determined the aortic annular perimeter and area as the maximum value from an entire cardiac cycle. Valve size was readjudicated by a blinded interventional cardiologist who was provided with valve type and automated values. Clinical endpoints were adjudicated for presence of at least mild PVL and MACE at 30 days. There were 16 (28%) patients with PVL and 4 (7%) with 30-day MACE. When reclassifying valve size using dynamic automated values, 12 (20%) patients were undersized and 3 (5%) patients were oversized. Undersized patients were more likely to have mild-to-moderate PVL at 30 days (27% vs 4%, p = 0.04) than those not undersized. Of the 5 (45%) undersized patients with at least mild PVL, all were balloon-expandable valves. Automated dynamic CT annular measurements have the potential to reclassify patients with PVL with larger TAVR valve size, particularly balloon-expandable valves.
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Affiliation(s)
- Pritha Subramanyam
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, NY, USA
| | - Alan C Legasto
- Department of Radiology, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, NY, USA
| | - Subhi J Al'Aref
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, NY, USA.,Department of Radiology, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, NY, USA
| | - Shing Chiu Wong
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, NY, USA
| | - Quynh A Truong
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, NY, USA. .,Department of Radiology, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, NY, USA.
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Abstract
Structural heart disease (SHD) emergencies include acute deterioration of a stable lesion or development of a new critical lesion. Structural heart disease emergencies can produce heart failure and cardiogenic shock despite preserved systolic function that may not respond to standard medical therapy and typically necessitate surgical or percutaneous intervention. Comprehensive Doppler echocardiography is the initial diagnostic modality of choice to determine the cause and severity of the underlying SHD lesion. Patients with chronic SHD lesions which deteriorate due to intercurrent illness (eg, infection or arrhythmia) may not require urgent intervention, whereas patients with an acute SHD lesion often require definitive therapy. Medical stabilization prior to definitive intervention differs substantially between stenotic lesions (aortic stenosis, mitral stenosis, left ventricular outflow tract obstruction) and regurgitant lesions (aortic regurgitation, mitral regurgitation, ventricular septal defect). Patients with regurgitant lesions typically require aggressive afterload reduction and inotropic support, whereas patients with stenotic lesions may paradoxically require β-blockade and vasoconstrictors. Emergent cardiac surgery for patients with decompensated heart failure or cardiogenic shock carries a substantial mortality risk but may be necessary for patients who are not eligible for catheter-based percutaneous SHD intervention. This review explores initial medical stabilization and subsequent definitive therapy for patients with SHD emergencies.
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Affiliation(s)
- Jacob C Jentzer
- Department of Cardiovascular Medicine, 4352Mayo Clinic Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, 4352Mayo Clinic Rochester, MN, USA
| | - Bradley Ternus
- Division of Cardiovascular Medicine, 5228University of Wisconsin, Madison, WI, USA
| | - Mackram Eleid
- Department of Cardiovascular Medicine, 4352Mayo Clinic Rochester, MN, USA
| | - Charanjit Rihal
- Department of Cardiovascular Medicine, 4352Mayo Clinic Rochester, MN, USA
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19
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Onorato EM, Muratori M, Smolka G, Malczewska M, Zorinas A, Zakarkaite D, Mussayev A, Christos CP, Bauer F, Gandet T, Martinelli GL, Costante AM, Bartorelli AL. Midterm procedural and clinical outcomes of percutaneous paravalvular leak closure with the Occlutech Paravalvular Leak Device. EUROINTERVENTION 2020; 15:1251-1259. [DOI: 10.4244/eij-d-19-00517] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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20
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Edelman JJ, Khan JM, Rogers T, Shults C, Satler LF, Ben-Dor II, Waksman R, Thourani VH. Valve-in-Valve TAVR: State-of-the-Art Review. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:299-310. [DOI: 10.1177/1556984519858020] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An increasing number of surgically implanted bioprostheses will require re-intervention for structural valve deterioration. Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) has become an alternative to reoperative surgery, currently approved for high-risk and inoperable patients. Challenges to the technique include higher rates of prosthesis–patient mismatch and coronary obstruction, compared to native valve TAVR. Herein, we review results of ViV TAVR and novel techniques to overcome the aforementioned challenges.
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Affiliation(s)
- J. James Edelman
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC, USA
| | - Jaffar M. Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christian Shults
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC, USA
| | - Lowell F. Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - I. Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Vinod H. Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC, USA
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21
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Alkhouli M, Farooq A, Go RS, Balla S, Berzingi C. Cardiac prostheses-related hemolytic anemia. Clin Cardiol 2019; 42:692-700. [PMID: 31039274 PMCID: PMC6605004 DOI: 10.1002/clc.23191] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/16/2019] [Accepted: 04/28/2019] [Indexed: 11/28/2022] Open
Abstract
Hemolysis is an unintended sequel of temporary or permanent intracardiac devices. However, limited data exist on the characteristics and treatment of hemolysis in patients with cardiac prostheses. This entity, albeit uncommon, often poses significant diagnostic and management challenges to the clinical cardiologist. In this article, we aim to provide a contemporary overview of the incidence, mechanisms, diagnosis, and management of cardiac prosthesis‐related hemolysis.
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Affiliation(s)
- Mohamad Alkhouli
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Ali Farooq
- Division of Cardiology, Department of Medicine, West Virginia University, Charleston, West Virginia
| | - Ronald S Go
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sudarshan Balla
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Chalak Berzingi
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, West Virginia
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22
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Kinno M, Raissi SR, Olson KA, Rigolin VH. Three-dimensional echocardiography in the evaluation and management of paravalvular regurgitation. Echocardiography 2018; 35:2056-2070. [DOI: 10.1111/echo.14194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- Menhel Kinno
- Division of Cardiology; Department of Medicine; Feinberg School of Medicine; Northwestern University; Chicago Illionis
| | - Sasan R. Raissi
- Division of Cardiology; Department of Medicine; Feinberg School of Medicine; Northwestern University; Chicago Illionis
| | - Kristoff A. Olson
- Division of Cardiology; Department of Medicine; Feinberg School of Medicine; Northwestern University; Chicago Illionis
| | - Vera H. Rigolin
- Division of Cardiology; Department of Medicine; Feinberg School of Medicine; Northwestern University; Chicago Illionis
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23
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Intracardiac Echocardiography in Structural Heart Disease Interventions. JACC Cardiovasc Interv 2018; 11:2133-2147. [DOI: 10.1016/j.jcin.2018.06.056] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/17/2018] [Accepted: 06/05/2018] [Indexed: 01/17/2023]
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24
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Panaich SS, Maor E, Reddy G, Raphael CE, Cabalka A, Hagler DJ, Reeder GS, Rihal CS, Eleid MF. Effect of percutaneous paravalvular leak closure on hemolysis. Catheter Cardiovasc Interv 2018; 93:713-719. [DOI: 10.1002/ccd.27917] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/13/2018] [Accepted: 09/09/2018] [Indexed: 11/10/2022]
Affiliation(s)
| | - Elad Maor
- Department of Cardiovascular Diseases. Mayo Clinic, Rochester Minnesota
| | - Gautam Reddy
- Department of Cardiovascular Diseases. Mayo Clinic, Rochester Minnesota
| | - Claire E. Raphael
- Department of Cardiovascular Diseases. Mayo Clinic, Rochester Minnesota
| | - Allison Cabalka
- Department of Cardiovascular Diseases. Mayo Clinic, Rochester Minnesota
| | - Donald J. Hagler
- Department of Cardiovascular Diseases. Mayo Clinic, Rochester Minnesota
| | - Guy S. Reeder
- Department of Cardiovascular Diseases. Mayo Clinic, Rochester Minnesota
| | | | - Mackram F. Eleid
- Department of Cardiovascular Diseases. Mayo Clinic, Rochester Minnesota
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25
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Joseph TA, Lane CE, Fender EA, Zack CJ, Rihal CS. Catheter-based closure of aortic and mitral paravalvular leaks: existing techniques and new frontiers. Expert Rev Med Devices 2018; 15:653-663. [DOI: 10.1080/17434440.2018.1514257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Timothy A. Joseph
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Colleen E. Lane
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Erin A. Fender
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Chad J. Zack
- Department of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Charanjit S. Rihal
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
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26
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Busu T, Alqahtani F, Badhwar V, Cook CC, Rihal CS, Alkhouli M. Meta-analysis Comparing Transcatheter and Surgical Treatments of Paravalvular Leaks. Am J Cardiol 2018; 122:302-309. [PMID: 29779588 DOI: 10.1016/j.amjcard.2018.03.360] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 11/26/2022]
Abstract
Percutaneous paravalvular leak (PVL) closure has emerged as a feasible alternative to redo valve surgery. However, comparative data on percutaneous and surgical treatment of PVL are scarce. We performed a systematic review and a meta-analysis of studies on percutaneous and surgical treatments of PVL. Of the 2,267 studies screened, 22 eligible studies were analyzed. Primary end points were technical success, 30-day mortality, stroke, and length of stay. Secondary end points were 1-year mortality, readmission for heart failure, reoperation, and symptomatic improvement at follow-up. A total of 2,373 patients were included, of whom 1,511 (63.7%) underwent percutaneous closure. Technical success was higher with surgery (96.7% vs 72.1%, odds ratio [OR] 9.7, p <0.001) but at the cost of higher 30-day mortality (8.6% vs 6.8%, OR 1.90, p <0.001), a trend toward higher stroke (3.3% vs 1.4%, OR 1.94, p = 0.069), and longer hospitalizations. However, surgery was associated with similar 1-year mortality (17.3% vs 17.2%, OR 1.07, p = 0.67), reoperation (9.1% vs 9.9%, OR 0.72, p = 0.1), readmission for heart failure (13.3% vs 26.4%, OR 0.51, p = 0.29), and improvement in New York Heart Association classification (67.4% vs 56%, OR 1.37, p = 0.74), compared with percutaneous closure. A sensitivity analysis including comparative studies only yielded similar results. Surgical treatment of PVL achieves higher technical success rates but is associated with higher early morbidity and mortality compared with percutaneous closure. Nevertheless, mortality rates and clinical efficacy parameters were similar at midterm with both procedures. Further studies are warranted to identify the ideal management approach to patients with symptomatic PVL.
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Alkhouli M, Winkler L, Tallaksen RJ. Computed Tomography Assessment for Transcatheter Aortic Valve Replacement. Interv Cardiol Clin 2018; 7:301-313. [PMID: 29983143 DOI: 10.1016/j.iccl.2018.03.004] [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: 10/28/2022]
Abstract
Transcatheter aortic valve replacement has become a mainstream therapeutic option for patients with severe aortic stenosis who are at intermediate risk or high risk for surgical valve replacement. Computed tomography (CT) is now the standard imaging modality for preoperative vascular access planning an aortic annular sizing. This article reviews the established and potential future roles of CT in transcatheter aortic valve replacement.
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Affiliation(s)
- Mohamad Alkhouli
- Division of Cardiovascular Disease, Structural Heart Interventions, West Virginia University School of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505-8059, USA.
| | - Lana Winkler
- Department of Radiology, West Virginia University, 1 medical drive, Morgantown, WV 26505, USA
| | - Robert J Tallaksen
- Department of Radiology, West Virginia University, 1 medical drive, Morgantown, WV 26505, USA
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Gilbert ON, Choi CH, Franzil JL, Caughey M, Qureshi W, Stacey RB, Pu M, Applegate RJ, Gandhi SK, Zhao DXM. Comparison of paravalvular aortic leak characteristics in the Medtronic CoreValve versus Edwards Sapien Valve: Paravalvular aortic leak characteristics. Catheter Cardiovasc Interv 2018; 92:972-980. [DOI: 10.1002/ccd.27643] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/02/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Olivia N. Gilbert
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard; Winston-Salem North Carolina
| | - Charles H. Choi
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard; Winston-Salem North Carolina
| | - Jodie L. Franzil
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard; Winston-Salem North Carolina
| | - Melissa Caughey
- Division of Cardiology, Department of Medicine; University of North Carolina Medical Center; Chapel Hill North Carolina
| | - Waqas Qureshi
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard; Winston-Salem North Carolina
| | - R. Brandon Stacey
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard; Winston-Salem North Carolina
| | - Min Pu
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard; Winston-Salem North Carolina
| | - Robert J. Applegate
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard; Winston-Salem North Carolina
| | - Sanjay K. Gandhi
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard; Winston-Salem North Carolina
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Zhou X, Vannan MA, Qian Z. 3D printing for trans-catheter aortic valve replacement: Integrating anatomy and physiology to plan, predict and optimize procedural outcomes. Int J Cardiol 2018; 258:334-335. [DOI: 10.1016/j.ijcard.2018.01.125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/29/2018] [Indexed: 11/25/2022]
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Alkhouli M, Zack CJ, Sarraf M, Eleid MF, Cabalka AK, Reeder GS, Hagler DJ, Maalouf JF, Nkomo VT, Rihal CS. Successful Percutaneous Mitral Paravalvular Leak Closure Is Associated With Improved Midterm Survival. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005730. [DOI: 10.1161/circinterventions.117.005730] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 11/16/2017] [Indexed: 11/16/2022]
Abstract
Background—
Percutaneous closure of prosthetic mitral valve paravalvular leak (PVL) has emerged as an alternative to surgical treatment in high-risk patients. Limited data exist on the impact of successful percutaneous PVL closure on midterm outcomes.
Methods and Results—
We examined consecutive patients who underwent percutaneous mitral PVL closure at Mayo Clinic, Rochester, MN, between January 2006 and January 2017. Procedural success, in-hospital outcomes, and midterm mortality were assessed. A total of 231 patients underwent percutaneous mitral PVL repair at a mean age of 67±12 years. Mean time from mitral valve replacement to percutaneous PVL repair was 1.25 (0.31–7.25) years. One hundred sixty-two patients (70%) had ≤mild PVL after the procedure. Compared with those who had >mild residual PVL, patients with ≤mild residual PVL had lower rates of repeat surgical interventions (6% versus 17%;
P
=0.004) and lower all-cause mortality at 30 days (1% versus 14%;
P
<0.001) and 1 year (15% versus 39%;
P
<0.001). Survival at 3 years was 61% in patients who had ≤mild residual leak and 47% in patients with higher grade of residual PVL (
P
=0.002).
Conclusions—
In a large consecutive cohort of patients undergoing percutaneous mitral PVL closure, successful percutaneous reduction of the PVL to mild or less was associated with significant midterm survival benefit.
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Affiliation(s)
- Mohamad Alkhouli
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., M.F.E., G.S.R., J.F.M., V.T.N., C.S.R.), Division of Pediatrics (A.K.C.), and Division of Pediatric Cardiology, Department of Cardiovascular Diseases (D.J.H.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, West Virginia University, Morgantown (M.A.)
| | - Chad J. Zack
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., M.F.E., G.S.R., J.F.M., V.T.N., C.S.R.), Division of Pediatrics (A.K.C.), and Division of Pediatric Cardiology, Department of Cardiovascular Diseases (D.J.H.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, West Virginia University, Morgantown (M.A.)
| | - Mohammad Sarraf
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., M.F.E., G.S.R., J.F.M., V.T.N., C.S.R.), Division of Pediatrics (A.K.C.), and Division of Pediatric Cardiology, Department of Cardiovascular Diseases (D.J.H.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, West Virginia University, Morgantown (M.A.)
| | - Mackram F. Eleid
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., M.F.E., G.S.R., J.F.M., V.T.N., C.S.R.), Division of Pediatrics (A.K.C.), and Division of Pediatric Cardiology, Department of Cardiovascular Diseases (D.J.H.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, West Virginia University, Morgantown (M.A.)
| | - Allison K. Cabalka
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., M.F.E., G.S.R., J.F.M., V.T.N., C.S.R.), Division of Pediatrics (A.K.C.), and Division of Pediatric Cardiology, Department of Cardiovascular Diseases (D.J.H.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, West Virginia University, Morgantown (M.A.)
| | - Guy S. Reeder
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., M.F.E., G.S.R., J.F.M., V.T.N., C.S.R.), Division of Pediatrics (A.K.C.), and Division of Pediatric Cardiology, Department of Cardiovascular Diseases (D.J.H.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, West Virginia University, Morgantown (M.A.)
| | - Donald J. Hagler
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., M.F.E., G.S.R., J.F.M., V.T.N., C.S.R.), Division of Pediatrics (A.K.C.), and Division of Pediatric Cardiology, Department of Cardiovascular Diseases (D.J.H.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, West Virginia University, Morgantown (M.A.)
| | - Joseph F. Maalouf
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., M.F.E., G.S.R., J.F.M., V.T.N., C.S.R.), Division of Pediatrics (A.K.C.), and Division of Pediatric Cardiology, Department of Cardiovascular Diseases (D.J.H.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, West Virginia University, Morgantown (M.A.)
| | - Vuyisile T. Nkomo
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., M.F.E., G.S.R., J.F.M., V.T.N., C.S.R.), Division of Pediatrics (A.K.C.), and Division of Pediatric Cardiology, Department of Cardiovascular Diseases (D.J.H.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, West Virginia University, Morgantown (M.A.)
| | - Charanjit S. Rihal
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., M.F.E., G.S.R., J.F.M., V.T.N., C.S.R.), Division of Pediatrics (A.K.C.), and Division of Pediatric Cardiology, Department of Cardiovascular Diseases (D.J.H.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, West Virginia University, Morgantown (M.A.)
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Raphael CE, Alkhouli M, Maor E, Panaich SS, Alli O, Coylewright M, Reeder GS, Sandhu G, Holmes DR, Nishimura R, Malouf J, Cabalka A, Eleid MF, Rihal CS. Building Blocks of Structural Intervention. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005686. [DOI: 10.1161/circinterventions.117.005686] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Claire E. Raphael
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Mohamad Alkhouli
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Elad Maor
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Sidakpal S. Panaich
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Oluseun Alli
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Megan Coylewright
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Guy S. Reeder
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Gurpreet Sandhu
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - David R. Holmes
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Rick Nishimura
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Joseph Malouf
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Allison Cabalka
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Mackram F. Eleid
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Charanjit S. Rihal
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
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Saitto G, Nardi P, Ussia GP, Sergi D, Prati P, Russo M, Romeo F, Ruvolo G. Percutaneous aortic leak closure in a small and frail annulus after double heart valve replacement. J Cardiovasc Med (Hagerstown) 2017; 18:916-919. [PMID: 28914661 DOI: 10.2459/jcm.0000000000000571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: Paravalvular leak (PVL) is an uncommon but serious complication associated with the implantation of prosthetic valves. Following aortic valve replacement, up to 5% of patients affected by PVL develop clinical symptoms of heart failure, hemolysis or both. Percutaneous treatment of PVL has emerged instead of conventional surgery, as a well tolerated and less invasive procedure but remains a challenge. We present the case of a young woman with mechanical aortic and mitral prostheses, who presented surgical aortic PVL caused by a serious frailty of native annulus, became symptomatic after 5 months and was successfully percutaneously treated with an Amplatzer Duct Occluder device.
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Affiliation(s)
- Guglielmo Saitto
- aCardiac Surgery Unit bCardiology Unit cCardiac Anesthesia Division, Tor Vergata University Policlinic, Rome, Italy
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Landes U, Kornowski R. Transcatheter Valve Implantation in Degenerated Bioprosthetic Surgical Valves (ViV) in Aortic, Mitral, and Tricuspid Positions: A Review. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2017. [DOI: 10.1080/24748706.2017.1372649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Uri Landes
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Waterbury TM, Reeder GS, Pislaru SV, Cabalka AK, Rihal CS, Eleid MF. Techniques and outcomes of paravalvular leak repair after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2017; 90:870-877. [PMID: 28766839 DOI: 10.1002/ccd.27224] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/15/2017] [Accepted: 07/05/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To investigate the feasibility, procedural success, and outcomes of paravalvular leak (PVL) closure in patients with prior transcatheter aortic valve replacement (TAVR). BACKGROUND PVL after TAVR is associated with adverse patient outcomes and increased mortality. Percutaneous PVL closure has emerged as a therapeutic strategy for addressing this issue, but data for transcatheter PVL repair after TAVR remains limited. METHODS This is a single center retrospective review of PVL closure after TAVR. Patients with balloon-expandable or self-expanding prostheses were included. Baseline patient demographics, procedural characteristics, complications, and clinical outcomes were reviewed. RESULTS A total of 18 patients with clinically significant PVL after TAVR referred for PVL closure were identified during the study period. Procedural success resulting in successful transcatheter occluder plug delivery was 78% (14 cases). Balloon postdilatation (2/4) and valve-in-valve (2/4) were used effectively in the remaining patients after an unsuccessful PVL closure attempt. PVL grading by echocardiography decreased from moderate or severe to < moderate in 13 patients (72%). Adverse events including cardiac tamponade and acute kidney injury occurred in 1 case each. One-month all-cause mortality was 11%. CONCLUSION In selected patients, percutaneous PVL repair following TAVR is feasible and effective for both balloon-expandable and self-expanding prostheses. Most patients undergoing PVL closure after TAVR require a single occluder plug placement for reduction in PVL to mild or less.
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Affiliation(s)
- Thomas M Waterbury
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Guy S Reeder
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Sorin V Pislaru
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Allison K Cabalka
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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Alkhouli M, Sengupta PP. 3-Dimensional-Printed Models for TAVR Planning: Why Guess When You Can See? JACC Cardiovasc Imaging 2017; 10:732-734. [PMID: 28683948 DOI: 10.1016/j.jcmg.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 05/11/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Mohamad Alkhouli
- West Virginia University Heart and Vascular Institute, Morgantown, West Virginia.
| | - Partho P Sengupta
- West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
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Alkhouli M, Alqahtani F, Aljohani S. Transcatheter mitral valve replacement: an evolution of a revolution. J Thorac Dis 2017; 9:S668-S672. [PMID: 28740722 DOI: 10.21037/jtd.2017.05.60] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Mohamad Alkhouli
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Fahad Alqahtani
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Sami Aljohani
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
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Alqahtani F, Bhirud A, Aljohani S, Mills J, Kawsara A, Runkana A, Alkhouli M. Intracardiac versus transesophageal echocardiography to guide transcatheter closure of interatrial communications: Nationwide trend and comparative analysis. J Interv Cardiol 2017; 30:234-241. [PMID: 28439973 DOI: 10.1111/joic.12382] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 03/25/2017] [Accepted: 03/29/2017] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES This study aimed to assess current temporal trends in utilization of ICE versus TEE guided closure of interatrial communications, and to compare periprocedural complications and resource utilization between the two imaging modalities. BACKGROUND While transesophageal echocardiography (TEE) has historically been used to guide percutaneous structural heart interventions, intracardiac echocardiography (ICE) is being increasingly utilized to guide many of these procedures such as closure of interatrial communications. METHODS Using the Nationwide Inpatient Sample, all patients aged >18 years, who underwent ASD or PFO closure with either ICE or TEE guidance between 2003 and 2014 were included. Comparative analysis of outcomes and resource utilization was performed using a propensity score-matching model. RESULTS ICE guidance for interatrial communication closure increased from 9.7% in 2003 to 50.6% in 2014. In the matched model, the primary endpoint of major adverse cardiovascular events occurred less frequently in the ICE group versus the TEE group (11.1% vs 14.3%, respectively, P = 0.008), mainly driven by less vascular complications in the ICE group (0.5% vs 1.3%, P = 0.045). Length of stay was shorter in the ICE group (3 ± 4 vs 4 ± 4 days, P < 0.0001). Cost was similar in the two groups 18 454 ± 17 035$ in the TEE group vs 18 278 ± 15 780$ in the ICE group (P = 0.75). CONCLUSIONS Intracardiac echocardiogram utilization to guide closure of interatrial communications has plateaued after a rapid rise throughout the 2000s. When utilized to guide interatrial communication closure procedure, ICE is as safe as TEE and does not increase cost or prolonged hospitalizations.
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Affiliation(s)
- Fahad Alqahtani
- Division of Cardiovascular Disease, West Virginia University, Morgantown, West Virginia
| | - Ashwin Bhirud
- Division of Cardiovascular Disease, West Virginia University, Morgantown, West Virginia
| | - Sami Aljohani
- Division of Cardiovascular Disease, West Virginia University, Morgantown, West Virginia
| | - James Mills
- Division of Cardiovascular Disease, West Virginia University, Morgantown, West Virginia
| | - Akram Kawsara
- Division of Cardiovascular Disease, West Virginia University, Morgantown, West Virginia
| | - Ashok Runkana
- Division of Cardiovascular Disease, West Virginia University, Morgantown, West Virginia
| | - Mohamad Alkhouli
- Division of Cardiovascular Disease, West Virginia University, Morgantown, West Virginia
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39
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Ruiz CE, Hahn RT, Berrebi A, Borer JS, Cutlip DE, Fontana G, Gerosa G, Ibrahim R, Jelnin V, Jilaihawi H, Jolicoeur EM, Kliger C, Kronzon I, Leipsic J, Maisano F, Millan X, Nataf P, O'Gara PT, Pibarot P, Ramee SR, Rihal CS, Rodes-Cabau J, Sorajja P, Suri R, Swain JA, Turi ZG, Tuzcu EM, Weissman NJ, Zamorano JL, Serruys PW, Leon MB. Clinical Trial Principles and Endpoint Definitions for Paravalvular Leaks in Surgical Prosthesis. Eur Heart J 2017; 39:1224-1245. [DOI: 10.1093/eurheartj/ehx211] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/15/2017] [Indexed: 12/18/2022] Open
Affiliation(s)
- Carlos E Ruiz
- Hackensack University Medical Center, Structural and Congenital Heart Center, Hackensack, New Jersey
| | - Rebecca T Hahn
- Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York
| | | | - Jeffrey S Borer
- State University of New York Downstate Medical Center and College of Medicine, New York, New York
| | | | - Greg Fontana
- Cedars Sinai Medical Center, Los Angeles, California
| | | | - Reda Ibrahim
- Montreal Heart Institute, Montreal, Quebec, Canada
| | - Vladimir Jelnin
- Hackensack University Medical Center, Structural and Congenital Heart Center, Hackensack, New Jersey
| | | | | | - Chad Kliger
- Lenox Hill Heart and Vascular Institute-North Shore LIJ Health System, New York, New York
| | - Itzhak Kronzon
- Lenox Hill Heart and Vascular Institute-North Shore LIJ Health System, New York, New York
| | - Jonathon Leipsic
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Patrick Nataf
- AP-HP Hôpital Bichat Service de Cardiologie, Paris, France
| | | | | | | | | | | | - Paul Sorajja
- Minneapolis Heart Institute and Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | | | - Zoltan G Turi
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | | | | | | | - Martin B Leon
- Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York
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40
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Ruiz CE, Hahn RT, Berrebi A, Borer JS, Cutlip DE, Fontana G, Gerosa G, Ibrahim R, Jelnin V, Jilaihawi H, Jolicoeur EM, Kliger C, Kronzon I, Leipsic J, Maisano F, Millan X, Nataf P, O'Gara PT, Pibarot P, Ramee SR, Rihal CS, Rodes-Cabau J, Sorajja P, Suri R, Swain JA, Turi ZG, Tuzcu EM, Weissman NJ, Zamorano JL, Serruys PW, Leon MB. Clinical Trial Principles and Endpoint Definitions for Paravalvular Leaks in Surgical Prosthesis. J Am Coll Cardiol 2017; 69:2067-2087. [DOI: 10.1016/j.jacc.2017.02.038] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/09/2017] [Accepted: 02/15/2017] [Indexed: 01/05/2023]
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41
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Alkhouli M, Almustafa A, Kawsara A, Tarabishy A. Transcatheter closure of an aortoatrial fistula following a surgical aortic valve replacement. J Card Surg 2017; 32:186-189. [PMID: 28247471 DOI: 10.1111/jocs.13113] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Mohamad Alkhouli
- West Virginia University Heart and Vascular Institute; Morgantown; West Virginia
| | - Ahmed Almustafa
- West Virginia University Heart and Vascular Institute; Morgantown; West Virginia
| | - Akram Kawsara
- West Virginia University Heart and Vascular Institute; Morgantown; West Virginia
| | - Abdul Tarabishy
- West Virginia University Heart and Vascular Institute; Morgantown; West Virginia
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42
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Ruiz CE, Mathur AP. Paravalvular Leak Closure: Time to Standardize Clinical Endpoints? JACC Cardiovasc Interv 2016; 9:2427-2428. [PMID: 27931594 DOI: 10.1016/j.jcin.2016.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 09/22/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Carlos E Ruiz
- Structural and Congenital Heart Center, Hackensack University Medical Center and the Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey.
| | - Atish P Mathur
- Structural and Congenital Heart Center, Hackensack University Medical Center and the Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey
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