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Ueyama HA, Licitra G, Gleason PT, Behbahani-Nejad O, Modi R, Rajagopal D, Byku I, Xie JX, Greenbaum AB, Paone G, Keeling WB, Grubb KJ, Hanzel GS, Devireddy CM, Block PC, Babaliaros VC. Impact of Tricuspid Regurgitation on Outcomes After Transcatheter Mitral Valve Replacement. Am J Cardiol 2024; 220:S0002-9149(24)00238-8. [PMID: 38604492 DOI: 10.1016/j.amjcard.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/27/2024] [Accepted: 03/30/2024] [Indexed: 04/13/2024]
Abstract
Development of functional tricuspid regurgitation (TR) because of chronic mitral disease and subsequent heart failure is common. However, the effect of TR on clinical outcomes after transcatheter mitral valve replacement (TMVR) remains unclear. We aimed to evaluate the impact of baseline TR on outcomes after TMVR. This was a single-center, retrospective analysis of patients who received valve-in-valve or valve-in-ring TMVR between 2012 and 2022. Patients were categorized into none/mild TR and moderate/severe TR based on baseline echocardiography. The primary outcome was 3 years all-cause death and the secondary outcomes were in-hospital events. Of the 135 patients who underwent TMVR, 64 (47%) exhibited none/mild TR at baseline, whereas 71 (53%) demonstrated moderate/severe TR. There were no significant differences in in-hospital events between the groups. At 3 years, the moderate/severe TR group exhibited a significantly increased risk of all-cause death (adjusted hazard ratio 3.37, 95% confidence interval 1.35 to 8.41, p = 0.009). When patients with baseline moderate/severe TR were stratified by echocardiography at 30 days into improved (36%) and nonimproved (64%) TR groups, although limited by small sample size, there was no significant difference in 3-year all-cause mortality (p = 0.48). In conclusion, this study investigating the impact of baseline TR on clinical outcomes revealed that moderate/severe TR is prevalent in those who underwent TMVR and is an independent predictor of 3-year all-cause mortality. Earlier mitral valve intervention before the development of significant TR may play a pivotal role in improving outcomes after TMVR.
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Affiliation(s)
- Hiroki A Ueyama
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Giancarlo Licitra
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Patrick T Gleason
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Omid Behbahani-Nejad
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Roshan Modi
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Dhiren Rajagopal
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Isida Byku
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Joe X Xie
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Adam B Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Gaetano Paone
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - W Brent Keeling
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Kendra J Grubb
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - George S Hanzel
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Chandan M Devireddy
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Peter C Block
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Vasilis C Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia.
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Greenbaum AB, Ueyama HA, Gleason PT, Khan JM, Bruce CG, Halaby RN, Rogers T, Hanzel GS, Xie JX, Byku I, Guyton RA, Grubb KJ, Lisko JC, Shekiladze N, Inci EK, Grier EA, Paone G, McCabe JM, Lederman RJ, Babaliaros VC. Transcatheter Myotomy to Reduce Left Ventricular Outflow Obstruction. J Am Coll Cardiol 2024; 83:1257-1272. [PMID: 38471643 PMCID: PMC10990778 DOI: 10.1016/j.jacc.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Left ventricular outflow tract (LVOT) obstruction is a source of morbidity in hypertrophic cardiomyopathy (HCM) and a life-threatening complication of transcatheter mitral valve replacement (TMVR) and transcatheter aortic valve replacement (TAVR). Available surgical and transcatheter approaches are limited by high surgical risk, unsuitable septal perforators, and heart block requiring permanent pacemakers. OBJECTIVES The authors report the initial experience of a novel transcatheter electrosurgical procedure developed to mimic surgical myotomy. METHODS We used septal scoring along midline endocardium (SESAME) to treat patients, on a compassionate basis, with symptomatic LVOT obstruction or to create space to facilitate TMVR or TAVR. RESULTS In this single-center retrospective study between 2021 and 2023, 76 patients underwent SESAME. In total, 11 (14%) had classic HCM, and the remainder underwent SESAME to facilitate TMVR or TAVR. All had technically successful SESAME myocardial laceration. Measures to predict post-TMVR LVOT significantly improved (neo-LVOT 42 mm2 [Q1-Q3: 7-117 mm2] to 170 mm2 [Q1-Q3: 95-265 mm2]; P < 0.001; skirt-neo-LVOT 169 mm2 [Q1-Q3: 153-193 mm2] to 214 mm2 [Q1-Q3: 180-262 mm2]; P < 0.001). Among patients with HCM, SESAME significantly decreased invasive LVOT gradients (resting: 54 mm Hg [Q1-Q3: 40-70 mm Hg] to 29 mm Hg [Q1-Q3: 12-36 mm Hg]; P = 0.023; provoked 146 mm Hg [Q1-Q3: 100-180 mm Hg] to 85 mm Hg [Q1-Q3: 40-120 mm Hg]; P = 0.076). A total of 74 (97.4%) survived the procedure. Five experienced 3 of 76 (3.9%) iatrogenic ventricular septal defects that did not require repair and 3 of 76 (3.9%) ventricular free wall perforations. Neither occurred in patients treated for HCM. Permanent pacemakers were required in 4 of 76 (5.3%), including 2 after concomitant TAVR. Lacerations were stable and did not propagate after SESAME (remaining septum: 5.9 ± 3.3 mm to 6.1 ± 3.2 mm; P = 0.8). CONCLUSIONS With further experience, SESAME may benefit patients requiring septal reduction therapy for obstructive hypertrophic cardiomyopathy as well as those with LVOT obstruction after heart valve replacement, and/or can help facilitate transcatheter valve implantation.
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Affiliation(s)
- Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA. https://twitter.com/AdamGreenbaumMD
| | - Hiroki A Ueyama
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Patrick T Gleason
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Jaffar M Khan
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health USA, Bethesda, Maryland, USA; St Francis Hospital, Roslyn, New York, USA
| | - Christopher G Bruce
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA; Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health USA, Bethesda, Maryland, USA
| | - Rim N Halaby
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health USA, Bethesda, Maryland, USA
| | - Toby Rogers
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health USA, Bethesda, Maryland, USA; Medstar Washington Hospital Center, Washington, DC, USA
| | - George S Hanzel
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Joe X Xie
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Isida Byku
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Robert A Guyton
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Kendra J Grubb
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - John C Lisko
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Nikoloz Shekiladze
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Errol K Inci
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Elizabeth A Grier
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Gaetano Paone
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | | | - Robert J Lederman
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health USA, Bethesda, Maryland, USA.
| | - Vasilis C Babaliaros
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
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Ueyama HA, Babaliaros VC, Greenbaum AB. Left Ventricular Outflow Tract Modification for Transcatheter Mitral Valve Replacement. Interv Cardiol Clin 2024; 13:217-225. [PMID: 38432764 DOI: 10.1016/j.iccl.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Left ventricular outflow tract (LVOT) obstruction is a life-threatening complication of transcatheter mitral valve replacement. In-depth analysis of pre-procedural computed tomography enables accurate prediction of this risk. Several techniques for LVOT modification, including Laceration of the Anterior Mitral leaflet to Prevent Outflow ObtructioN, preemptive alcohol septal ablation, preemptive radiofrequency ablation, and Septal Scoring Along the Midline Endocardium, have been described as effective strategies to mitigate this risk. This review aims to explore the indications, procedural steps, and outcomes associated with these LVOT modification techniques.
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Affiliation(s)
- Hiroki A Ueyama
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, 550 Peachtree Street, Northeast, Atlanta, GA 30306, USA
| | - Vasilis C Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, 550 Peachtree Street, Northeast, Atlanta, GA 30306, USA
| | - Adam B Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, 550 Peachtree Street, Northeast, Atlanta, GA 30306, USA.
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Halaby RN, Bruce CG, Yildirim DK, Uzun D, Rogers T, Khan JM, Jaimes AE, Grant LP, Babaliaros VC, Greenbaum AB, Lederman RJ. TABERNACL: Temporary Hemodynamic Stabilization In Vivo. Circ Cardiovasc Interv 2024; 17:e013898. [PMID: 38533653 PMCID: PMC11097944 DOI: 10.1161/circinterventions.123.013898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/02/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Acute aortic regurgitation is life-threatening with few nonsurgical options for immediate stabilization. We propose Trans-Aortic Balloon to Ease Regurgitation Applying Counter-Pulsation (TABERNACL), a simple, on-table temporary valve using commercially available equipment to temporize acute severe aortic regurgitation. METHODS We hypothesize that an appropriately sized commercial balloon dilatation catheter-straddling the aortic annulus and connected to a counterpulsation console-can serve as a temporizing valve to restore hemodynamic stability in acute aortic regurgitation. We performed benchtop testing of valvuloplasty, angioplasty, and sizing balloons as counterpulsation balloons. TABERNACL was assessed in vivo in a porcine model of acute aortic regurgitation (n=8). We also tested a static undersized, continuously inflated transvalvular balloon as a spacer intended physically to obstruct the regurgitant orifice. RESULTS Benchtop testing identified that Tyshak II and PTS sizing (NuMed Braun) balloon catheters performed adequately as temporary valves (ie, complete inflation and deflation with each cycle) and resisted fatigue, in contrast to others. When TABERNACL was used in the acute severe regurgitation animals, there was immediate hemodynamic improvement, with a significant 35% increase in diastolic aortic pressure by 16 mm Hg ([95% CI, 7-25] P=0.0056), 34% reduction in left ventricular end-diastolic pressure by -7 mm Hg ([95% CI, -10 to -5] P=0.0006), improvement in the aortic diastolic index by 0.28 ([95% CI, 0.18-0.39] P=0.0009), and reversal of electrocardiographic myocardial ischemia. As an alternative, static balloon inflation across the aortic valve stabilized regurgitation hemodynamics at the expense of a new aortic gradient and caused excessive ectopy from balloon movement in the left ventricular outflow tract. CONCLUSIONS TABERNACL improves hemodynamics and reduces coronary ischemia by electrocardiography in animals with acute severe aortic regurgitation. TABERNACL valves obstruct the diastolic regurgitant orifice without systolic obstruction. This may prove a lifesaving bridge to definitive valve replacement therapy.
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Affiliation(s)
- Rim N. Halaby
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (R.H., K.Y., D.U., A.E.J., L.P.G., R.J.L.)
| | - Christopher G. Bruce
- Department of Cardiology, Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (C.G.B., V.C.B., A.B.G.)
| | - D. Korel Yildirim
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (R.H., K.Y., D.U., A.E.J., L.P.G., R.J.L.)
| | - Dogangun Uzun
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (R.H., K.Y., D.U., A.E.J., L.P.G., R.J.L.)
| | - Toby Rogers
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC (T.R.)
| | - Jaffar M. Khan
- Department of Cardiology, St. Francis Hospital, Roslyn, NY (J.M.K.)
| | - Andi E. Jaimes
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (R.H., K.Y., D.U., A.E.J., L.P.G., R.J.L.)
| | - Laurie P. Grant
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (R.H., K.Y., D.U., A.E.J., L.P.G., R.J.L.)
| | - Vasilis C. Babaliaros
- Department of Cardiology, Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (C.G.B., V.C.B., A.B.G.)
| | - Adam B. Greenbaum
- Department of Cardiology, Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (C.G.B., V.C.B., A.B.G.)
| | - Robert J. Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (R.H., K.Y., D.U., A.E.J., L.P.G., R.J.L.)
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Ueyama HA, Greenbaum AB, Xie JX, Shekiladze N, Gleason PT, Byku I, Devireddy CM, Hanzel GS, Block PC, Babaliaros VC. Transcatheter Paravalvular Leak Closure With Covered Stent Tract and Vascular Plug: Tootsie Roll Technique. JACC Cardiovasc Interv 2024; 17:635-644. [PMID: 38244000 DOI: 10.1016/j.jcin.2023.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/06/2023] [Accepted: 11/17/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Transcatheter closure of transcatheter heart valve (THV)-related paravalvular leak (PVL) is associated with a high failure rate with available devices due to the complex interaction of THV and aortic/mitral annulus. OBJECTIVES This study reports on novel transcatheter techniques to treat PVL after THV. METHODS The authors describe consecutive patients who underwent PVL closure after transcatheter aortic valve replacement (TAVR) or transcatheter mitral valve replacement (TMVR). A covered self-expanding stent (Viabahn) was deployed in the defect to create a seal between the THV and annulus. A vascular plug (Amplatzer Vascular Plug 2 [AVP2] or AVP4) was then deployed inside the covered stent to obliterate PVL. RESULTS Eight patients with THV-related PVL were treated using this method (aortic [3 SAPIEN, 1 Evolut], mitral [2 SAPIEN-in-MAC (mitral annular calcification), 2 M3 TMVR). Various combinations of stents and plugs were used (5 mm × 2.5 cm Viabahn + 6 mm AVP4 [n = 2], 8 mm × 2.5 cm Viabahn + 10 mm AVP2 [n = 5], and 10 mm × 5.0 cm Viabahn + 12 mm AVP2 [n = 1]). All had technical success with immediate elimination of target PVL, without in-hospital complications. None had signs of postprocedure hemolysis. All patients were discharged alive (median 3.5 days [Q1-Q3: 1.0-4.8 days]). No residual PVL was seen at discharge, except for 1 patient with mild regurgitation due to another untreated PVL location. One patient died before 30 days due to complication of valve-in-MAC TMVR. In remaining patients, none had recurrence of PVL at 30 days. Symptoms decreased to NYHA functional class I/II in 6 patients. NYHA functional class III symptoms remained in 1 patient with mitral regurgitation awaiting subsequent valve replacement procedure. CONCLUSIONS The technique of sequential deployment of a covered stent and vascular plug may effectively treat THV-related PVL.
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Affiliation(s)
- Hiroki A Ueyama
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Adam B Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Joe X Xie
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Nikoloz Shekiladze
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Patrick T Gleason
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Isida Byku
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Chandan M Devireddy
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - George S Hanzel
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Peter C Block
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Vasilis C Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA.
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Ueyama HA, Xie J, Hanzel GS, Byku I, Paone G, Grubb KJ, Devireddy CM, Greenbaum AB, Babaliaros VC, Gleason PT. Hemodynamic Comparison of Resilia and Sapien 3/Ultra Transcatheter Heart Valves in Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2024; 17:e013325. [PMID: 38047373 DOI: 10.1161/circinterventions.123.013325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Affiliation(s)
- Hiroki A Ueyama
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., J.X., G.S.H., I.B., C.M.D., A.B.G., V.C.B., P.T.G.)
| | - Joe Xie
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., J.X., G.S.H., I.B., C.M.D., A.B.G., V.C.B., P.T.G.)
| | - George S Hanzel
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., J.X., G.S.H., I.B., C.M.D., A.B.G., V.C.B., P.T.G.)
| | - Isida Byku
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., J.X., G.S.H., I.B., C.M.D., A.B.G., V.C.B., P.T.G.)
| | - Gaetano Paone
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (G.P., K.J.G.)
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (G.P., K.J.G.)
| | - Chandan M Devireddy
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., J.X., G.S.H., I.B., C.M.D., A.B.G., V.C.B., P.T.G.)
| | - Adam B Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., J.X., G.S.H., I.B., C.M.D., A.B.G., V.C.B., P.T.G.)
| | - Vasilis C Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., J.X., G.S.H., I.B., C.M.D., A.B.G., V.C.B., P.T.G.)
| | - Patrick T Gleason
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., J.X., G.S.H., I.B., C.M.D., A.B.G., V.C.B., P.T.G.)
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Black GB, Kim JH, Vitter S, Ibrahim R, Lisko JC, Perdoncin E, Shekiladze N, Gleason PT, Grubb KJ, Greenbaum AB, Devireddy CM, Guyton RA, Leshnower B, Merchant FM, El-Chami M, Westerman SB, Shah AD, Leon AR, Lloyd MS, Babaliaros VC, Kiani S. Prospective validation of a risk score to predict pacemaker implantation after transcatheter aortic valve replacement. J Cardiovasc Electrophysiol 2023; 34:2225-2232. [PMID: 37702135 DOI: 10.1111/jce.16061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/25/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION The need for pacemaker is a common complication after transcatheter aortic valve replacement (TAVR). We previously described the Emory Risk Score (ERS) to predict the need for new pacemaker implant (PPM) after TAVR. Metrics included in the score are a history of syncope, pre-existing RBBB, QRS duration ≥140 ms, and prosthesis oversizing ≥16%. To prospectively validate the previously described risk score. METHODS We prospectively evaluated all patients without pre-existing pacemakers, ICD, or pre-existing indications for pacing undergoing TAVR with the Edwards SAPIEN 3 prosthesis at our institution from March 2019 to December 2020 (n = 661). Patients were scored prospectively; however, results were blinded from clinical decision-making. The primary endpoint was PPM at 30 days after TAVR. Performance of the ERS was evaluated using logistic regression, a calibration curve to prior performance, and receiver operating characteristic (ROC) analysis. RESULTS A total of 48 patients (7.3%) had PPM after TAVR. A higher ERS predicted an increased likelihood of PPM (OR 2.61, 95% CI: 2.05-3.25 per point, p < 0.001). There was good correlation between observed and expected values on the calibration curve (slope = 1.04, calibration at large = 0.001). The area under the ROC curve was 0.81 (95% CI [0.74-0.88], p < 0.001). CONCLUSIONS The ERS prospectively predicted the need for PPM in a serial, real-world cohort of patients undergoing TAVR with a balloon-expandable prosthesis, confirming findings previously described in retrospective cohorts. Notably, the prospective performance of the score was comparable with that of the initial cohorts. The risk score could serve as a framework for preprocedural risk stratification for PPM after TAVR.
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Affiliation(s)
- George B Black
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Joshua H Kim
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sophie Vitter
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rand Ibrahim
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John C Lisko
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Emily Perdoncin
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nikoloz Shekiladze
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Patrick T Gleason
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kendra J Grubb
- Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Adam B Greenbaum
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chandan M Devireddy
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert A Guyton
- Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bradley Leshnower
- Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Faisal M Merchant
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mikhael El-Chami
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stacy B Westerman
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anand D Shah
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Angel R Leon
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael S Lloyd
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vasilis C Babaliaros
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Soroosh Kiani
- Department of Medicine, Division of Cardiology, UMass Chan Medical School, Worcester, Massachusetts, USA
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Hoskins MH, Lisko JC, Greenbaum AB, Ueyama HA, Merchant FM, Lloyd MS, Gleason PT, El-Chami MF, Byku I, Block PC, Lederman RJ, Babaliaros VC, Westerman SB. Septal Bipolar Ablation to Prevent Left Ventricular Outflow Tract Obstruction After Transcatheter Mitral Valve Implantation. Circ Cardiovasc Interv 2023; 16:e013333. [PMID: 37712286 PMCID: PMC10592079 DOI: 10.1161/circinterventions.123.013333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Affiliation(s)
- Michael H. Hoskins
- Department of Medicine, Division of Cardiology, Section of Electrophysiology and Pacing, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Cardiology, New Mexico Heart Institute, Albuquerque, New Mexico, USA
| | - John C. Lisko
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Adam B. Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Hiroki A. Ueyama
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Faisal M. Merchant
- Department of Medicine, Division of Cardiology, Section of Electrophysiology and Pacing, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael S. Lloyd
- Department of Medicine, Division of Cardiology, Section of Electrophysiology and Pacing, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Patrick T. Gleason
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Mikhael F. El-Chami
- Department of Medicine, Division of Cardiology, Section of Electrophysiology and Pacing, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Isida Byku
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Peter C. Block
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Robert J. Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Vasilis C. Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Stacy B. Westerman
- Department of Medicine, Division of Cardiology, Section of Electrophysiology and Pacing, Emory University School of Medicine, Atlanta, Georgia, USA
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9
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Ueyama H, Leshnower BG, Inci E, Keeling WB, Tully A, Guyton RA, Xie JX, Gleason PT, Byku I, Devireddy C, Hanzel GS, Block PC, Lederman RJ, Greenbaum AB, Babaliaros VC. Hybrid Closure of Postinfarction Apical Ventricular Septal Defect Using Septal Occluder Device and Right Ventricular Free Wall: The Apical BASSINET Concept. Circ Cardiovasc Interv 2023; 16:e013243. [PMID: 37732604 PMCID: PMC10592084 DOI: 10.1161/circinterventions.123.013243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/28/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Postinfarction ventricular septal defect (VSD) is a catastrophic complication of myocardial infarction. Surgical repair still has poor outcomes. This report describes clinical outcomes after a novel hybrid transcatheter/surgical repair in patients with apical VSD. METHODS Seven patients with postmyocardial infarction apical VSD underwent hybrid transcatheter repair via subxiphoid surgical access. A transcatheter occluder (Amplatzer Septal Occluder) with a trailing premounted suture was deployed through the right ventricular wall and through the ventricular septum into the left ventricular apex. The trailing suture was used to connect an anchor external to the right ventricular wall. Tension on the suture then collapses the right ventricular free wall against the septum and left ventricular occluder, thereby obliterating the VSD. Outcomes were compared with 9 patients who underwent surgical repair using either patch or primary suture closure. RESULTS All patients had significant left-to-right shunt (Qp:Qs 2.5:1; interquartile range [IQR, 2.1-2.6] hybrid repair versus 2.0:1 [IQR, 2.0-2.5] surgical repair), and elevated right ventricular systolic pressure (62 [IQR, 46-71] versus 49 [IQR, 43-54] mm Hg, respectively). All had severely depressed stroke volume index (22 versus 21 mL/m2) with ≈45% in each group requiring mechanical support preprocedurally. The procedure was done 15 (IQR, 10-50) versus 24 (IQR, 10-134) days postmyocardial infarction, respectively. Both groups of patients underwent repair with technical success and without intraprocedural death. One patient in the hybrid group and 4 in the surgical group developed multiorgan failure. The hybrid group had a higher survival at discharge (86% versus 56%) and at 30 days (71% versus 56%), but similar at 1 year (57% versus 56%). During follow-up, 1 patient in each group required reintervention for residual VSD (hybrid: 9 months versus surgical: 5 days). CONCLUSIONS Early intervention with a hybrid transcatheter/surgical repair may be a viable alternative to traditional surgery for postinfarction apical VSD.
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Affiliation(s)
- Hiroki Ueyama
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Bradley G. Leshnower
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Errol Inci
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - W. Brent Keeling
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andy Tully
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert A. Guyton
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Joe X. Xie
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Patrick T. Gleason
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Isida Byku
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Chandan Devireddy
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - George S. Hanzel
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Peter C. Block
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Robert J. Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Adam B. Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Vasilis C. Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
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10
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Sadri V, Kohli K, Ncho B, Inci EK, Perdoncin E, Lisko JC, Lederman R, Greenbaum AB, Babaliaros V, Yoganathan AP. Effect of leaflet laceration on transcatheter aortic valve replacement fluid mechanics and comparison with surgical aortic valve replacement. J Thorac Cardiovasc Surg 2023; 166:e130-e141. [PMID: 37086238 PMCID: PMC10493236 DOI: 10.1016/j.jtcvs.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 02/12/2023] [Accepted: 03/03/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Leaflet thrombosis after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) may be caused by blood flow stagnation in the native and neosinus regions. To date, aortic leaflet laceration has been used to mitigate coronary obstruction following TAVR; however, its influence on the fluid mechanics of the native and neosinus regions is poorly understood. This in vitro study compared the flow velocities and flow patterns in the setting of SAVR vs TAVR with and without aortic leaflet lacerations. METHODS Two valves, (23-mm Perimount and 26-mm SAPIEN 3; Edwards Lifesciences) were studied in a validated mock flow loop under physiologic conditions. Neosinus and native sinus fluid mechanics were quantified using particle image velocimetry in the left and noncoronary cusp, with an increasing number of aortic leaflets lacerated or removed. RESULTS Across all conditions, SAVR had the highest average sinus and neosinus velocities, and this value was used as a reference to compare against the TAVR conditions. With an increasing number of leaflets lacerated or removed with TAVR, the average sinus and neosinus velocities increased from 25% to 70% of SAVR flow (100%). Diastolic velocities were substantially augmented by leaflet laceration. Also, the shorter frame of the SAVR led to higher flow velocities compared with the longer frame of the TAVR, even after complete leaflet removal. CONCLUSIONS Leaflet laceration augmented TAVR native and neosinus flow fields, approaching that of SAVR. These findings may have potential clinical implications for the use of single or multiple leaflet lacerations to reduce leaflet thrombosis and thus potentially improve TAVR durability.
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Affiliation(s)
- Vahid Sadri
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University, Atlanta, Ga
| | - Keshav Kohli
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University, Atlanta, Ga
| | - Beatrice Ncho
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University, Atlanta, Ga
| | - Errol K Inci
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Ga
| | - Emily Perdoncin
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Ga
| | - John C Lisko
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Ga
| | - Robert Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md
| | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Ga
| | - Vasilis Babaliaros
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Ga
| | - Ajit P Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University, Atlanta, Ga.
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Ueyama HA, Greenbaum AB, Leshnower BG, Keeling B, Block PC, Byku I, Ligon RA, Grier E, Shekiladze N, Gleason PT, Xie J, Kim DW, Babaliaros VC, Duwayri Y. Physician-Modified Endograft-Facilitated Transcatheter Pulmonary Valve Replacement in Large Right Ventricular Outflow Tract. Circ Cardiovasc Interv 2023; 16:e013123. [PMID: 37577788 DOI: 10.1161/circinterventions.123.013123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Transcatheter pulmonary valve replacement (TPVR) in patients with a congenital or acquired abnormality resulting in enlarged right ventricular outflow tract (RVOT) is challenging and may preclude treatment with dedicated devices. We describe a technique using a physician-modified endograft to facilitate TPVR. METHODS Six patients underwent physician-modified endograft-facilitated TPVR for severe symptomatic pulmonary insufficiency with enlarged RVOT. The fenestration was created in a commercially available endograft before implantation, which was then deployed from the dominant branch pulmonary artery into the RVOT, with the fenestration aligned with the ostium of the nondominant pulmonary artery. A covered stent was placed through the fenestration into the nondominant branch pulmonary artery, and a transcatheter heart valve was deployed within the endograft at the level of the original pulmonary valve. RESULTS Four patients had tetralogy of Fallot, 1 had pulmonary atresia, and 1 had rheumatic valve disease. The RVOT/main pulmonary artery was severely enlarged (diameter, 44.2 [43.5-50.6] mm). All patients had reduced right ventricular (RV) function and dilated RVs (RV end-diastolic volume, 314 [235-316] mL). Successful endograft, covered stent, and transcatheter heart valve deployment were achieved in all cases without stent/valve embolization, vascular complications, or bleeding complications. At 30 days, 1 patient had mild pulmonary insufficiency, while others had none. The RV size measured by echocardiography was significantly reduced after TPVR (RV area, 34.4 [baseline] versus 29.0 [pre-discharge] versus 25.3 [30 days] cm2; P=0.03). During median follow-up of 221.5 (range, 29-652) days, there were no deaths or need for pulmonary valve reintervention. One patient developed severe tricuspid regurgitation due to entrapment of the anterior tricuspid leaflet by the endograft. The patient underwent successful tricuspid replacement and resection of the offending endograft with preservation of the pulmonary valve prosthesis. CONCLUSIONS Simple fenestration of an off-the-shelf endograft and associated covered stent placement through the fenestration allows TPVR for patients with dysfunctional native or patch-repaired pulmonary valves and RVOT enlargement.
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Affiliation(s)
- Hiroki A Ueyama
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., A.B.G., P.C.B., I.B., E.G., N.S., P.T.G., J.X., V.C.B.)
| | - Adam B Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., A.B.G., P.C.B., I.B., E.G., N.S., P.T.G., J.X., V.C.B.)
| | - Bradley G Leshnower
- Division of Cardiothoracic Surgery (B.G.L., B.K.), Emory University School of Medicine, Atlanta, GA
| | - Brent Keeling
- Division of Cardiothoracic Surgery (B.G.L., B.K.), Emory University School of Medicine, Atlanta, GA
| | - Peter C Block
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., A.B.G., P.C.B., I.B., E.G., N.S., P.T.G., J.X., V.C.B.)
| | - Isida Byku
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., A.B.G., P.C.B., I.B., E.G., N.S., P.T.G., J.X., V.C.B.)
| | - R Allen Ligon
- Division of Cardiology, Children's Healthcare of Atlanta (R.A.L., D.W.K.), Emory University School of Medicine, Atlanta, GA
| | - Elizabeth Grier
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., A.B.G., P.C.B., I.B., E.G., N.S., P.T.G., J.X., V.C.B.)
| | - Nikoloz Shekiladze
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., A.B.G., P.C.B., I.B., E.G., N.S., P.T.G., J.X., V.C.B.)
| | - Patrick T Gleason
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., A.B.G., P.C.B., I.B., E.G., N.S., P.T.G., J.X., V.C.B.)
| | - Joe Xie
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., A.B.G., P.C.B., I.B., E.G., N.S., P.T.G., J.X., V.C.B.)
| | - Dennis W Kim
- Division of Cardiology, Children's Healthcare of Atlanta (R.A.L., D.W.K.), Emory University School of Medicine, Atlanta, GA
| | - Vasilis C Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., A.B.G., P.C.B., I.B., E.G., N.S., P.T.G., J.X., V.C.B.)
| | - Yazan Duwayri
- Division of Vascular and Endovascular Therapy (Y.D.), Emory University School of Medicine, Atlanta, GA
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12
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Kamioka N, Greenbaum AB, Lederman RJ, Khan JM, Lisko JC, Byku I, Gleason PT, Grubb KJ, Leshnower B, Block PC, Stewart JP, Babaliaros VC. First Application of the LAMPOON Procedure to a Surgical Mitral Bioprosthesis. Cardiovasc Revasc Med 2023; 53S:S176-S179. [PMID: 35879191 PMCID: PMC9622428 DOI: 10.1016/j.carrev.2022.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 11/26/2022]
Abstract
A cardiogenic shock patient with a history of a surgical mitral valve replacement presented to the hospital with critical mitral stenosis with thickening of prosthetic valve leaflets and thrombus in left atrial appendage. We considered TMVR inside of the degenerated bioprosthetic valve. However, there were two concerns during TMVR based on multimodality imaging assessment: 1) LVOT obstruction due to the surgical bioprosthetic leaflet, 2) stroke due to left atrial appendage thrombus. We performed TMVR with LAMPOON (laceration of the anterior leaflet of the surgical valve to prevent left ventricular outflow tract obstruction) for the bioprosthesis using cerebral protection. While the LAMPOON procedure has developed to prevent LVOT obstruction by the native anterior mitral leaflet during transcatheter mitral valve-in-ring or valve-in-mitral annular calcification, this is the first case that illustrates its use for mitral valve-in-valve replacement.
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Affiliation(s)
- Norihiko Kamioka
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Adam B Greenbaum
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - John C Lisko
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Isida Byku
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Patrick T Gleason
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Kendra J Grubb
- Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Bradley Leshnower
- Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Peter C Block
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - James P Stewart
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Vasilis C Babaliaros
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America.
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13
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Bruce CG, Yildirim DK, Kolandaivelu A, Khan JM, Rogers T, Uzun D, Jaimes AE, Halaby RN, Herzka DA, Babaliaros VC, Greenbaum AB, Lederman RJ. EDEN (Electrocardiographic Radial Depth Navigation): A Novel Approach to Navigate Inside Heart Muscle. JACC Clin Electrophysiol 2023; 9:1741-1754. [PMID: 37354176 PMCID: PMC10524151 DOI: 10.1016/j.jacep.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/04/2023] [Accepted: 04/21/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Intramyocardial guidewire navigation is a novel technique that allows free transcatheter movement within ventricular muscle. Guidewire radial depth, between endocardial and epicardial surfaces, is ambiguous by x-ray and echocardiography. OBJECTIVES The aim of this study was to develop a simple tool, EDEN (Electrocardiographic Radial Depth Navigation), to indicate radial depth during intramyocardial guidewire navigation. Combined with routine imaging, EDEN facilitates a new family of intramyocardial catheter procedures to slice, reshape, pace, and ablate the heart. METHODS We mapped intramyocardial electrograms of left and right ventricular walls and septum during open- and closed-chest swine procedures (N = 53), including MIRTH (Myocardial Intramural Remodeling by Transvenous Tether) ventriculoplasty. We identified radial depth-dependent features on unipolar electrograms. We developed a machine learning-based classifier to indicate categorical position, and modeled the findings in silico to test understanding of the physiology. RESULTS EDEN signatures distinguished 5 depth zones throughout left and right ventricular free walls and interventricular septum. Relative ST-segment elevation magnitude best discriminated position and was maximum (40.1 ± 6.5 mV) in the midmyocardium. Subendocardial positions exhibited dominant Q waves with lower-amplitude ST segments (16.8 ± 5.8 mV), whereas subepicardial positions exhibited dominant R waves with lower-amplitude ST segments (15.7 ± 4.8 mV). EDEN was unaffected by pacing-induced left bundle branch block. ST-segment elevation declined over minutes and reappeared after submillimeter guidewire manipulation. Modeling recapitulated EDEN features. The machine learning-based classifier was 97% accurate. EDEN successfully guided MIRTH ventriculoplasty. CONCLUSIONS EDEN provides a simple and reproducible real-time reflection of categorical guidewire-tip radial depth during intramyocardial guidewire navigation. Used in tandem with x-ray, EDEN enables novel, transcatheter, intramyocardial therapies such as MIRTH, SESAME (Septal Surfing Along Midline Endocardium), and cerclage ventriculoplasty.
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Affiliation(s)
- Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA. https://twitter.com/ChrisGBruce13
| | - D Korel Yildirim
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Aravindan Kolandaivelu
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA; Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA; MedStar Washington Hospital Center, Washington, DC, USA
| | - Dogangun Uzun
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrea E Jaimes
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Rim N Halaby
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Daniel A Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Vasilis C Babaliaros
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
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14
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Ueyama H, Babaliaros VC, Lederman RJ, Greenbaum AB. The 7 Pillars for Transcaval Transcatheter Aortic Valve Replacement. Innovations (Phila) 2023; 18:207-211. [PMID: 37294000 PMCID: PMC10330536 DOI: 10.1177/15569845231173926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Hiroki Ueyama
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Vasilis C. Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Robert J. Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Adam B. Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
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15
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Leshnower BG, Duwayri YM, Nicholson WJ, Ueyama H, Gleason PT, Shekiladze N, Greenbaum AB, Babaliaros V. Endo-Bentall Procedure Using Off-the-Shelf Catheter Devices to Repair an Aorto-Atrial Fistula. Circ Cardiovasc Interv 2023; 16:e012848. [PMID: 37009733 DOI: 10.1161/circinterventions.122.012848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Affiliation(s)
- Bradley G Leshnower
- Division of Cardiothoracic Surgery (B.G.L.), Emory University School of Medicine, Atlanta, GA
| | - Yazan M Duwayri
- Division of Vascular and Endovascular Therapy (Y.M.D.), Emory University School of Medicine, Atlanta, GA
| | - William J Nicholson
- Section of Interventional Cardiology, Division of Cardiovascular Medicine (W.J.N.), Emory University School of Medicine, Atlanta, GA
| | - Hiroki Ueyama
- Division of Cardiovascular Medicine Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.U., P.T.G., N.S., A.B.G., V.B.)
| | - Patrick T Gleason
- Division of Cardiovascular Medicine Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.U., P.T.G., N.S., A.B.G., V.B.)
| | - Nikoloz Shekiladze
- Division of Cardiovascular Medicine Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.U., P.T.G., N.S., A.B.G., V.B.)
| | - Adam B Greenbaum
- Division of Cardiovascular Medicine Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.U., P.T.G., N.S., A.B.G., V.B.)
| | - Vasilis Babaliaros
- Division of Cardiovascular Medicine Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.U., P.T.G., N.S., A.B.G., V.B.)
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16
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Tully A, Babaliaros VC, Devireddy CM, Shekiladze N, Grier E, Ueyama H, O'Brien C, Thobani A, Greenbaum AB, Paone G, Grubb KJ. SHOULD YOU BREAK OR BURN? SHOCKWAVE INTRAVASCULAR LITHOTRIPSY COMPARED TO TRANSCAVAL TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01509-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Bruce CG, Khan JM, Rogers T, Yildirim DK, Babaliaros VC, Greenbaum AB, Lederman RJ. Transcatheter Electrosurgery: A Narrative Review. Circ Cardiovasc Interv 2023; 16:e012019. [PMID: 36799217 PMCID: PMC10108249 DOI: 10.1161/circinterventions.122.012019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/04/2023] [Indexed: 02/18/2023]
Abstract
Transcatheter electrosurgery describes the ability to cut and traverse tissue, at a distance, without an open surgical field and is possible using either purpose-built or off-the-shelf devices. Tissue traversal requires focused delivery of radiofrequency energy to a guidewire tip. Initially employed to cross atretic pulmonary valves, tissue traversal has enabled transcaval aortic access, recanalization of arterial and venous occlusions, transseptal access, and many other techniques. To cut tissue, the selectively denuded inner curvature of a kinked guidewire (the Flying-V) or a single-loop snare is energized during traction. Adjunctive techniques may complement or enable contemporary transcatheter procedures, whereas myocardial slicing or excision of ectopic masses may offer definitive therapy. In this contemporary review we discuss the principles of transcatheter electrosurgery, and through exemplary clinical applications highlight the range of therapeutic options offered by this versatile family of procedures.
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Affiliation(s)
- Christopher G. Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jaffar M. Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- MedStar Washington Hospital Center, Washington, DC, USA
| | - D. Korel Yildirim
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Adam B. Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA, USA
| | - Robert J. Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Khan JM, Kamioka N, Lisko JC, Perdoncin E, Zhang C, Maini A, Chen M, Li Y, Ludwig S, Westermann D, Amat Santos IJ, Kalińczuk Ł, Sinning JM, Kawaguchi T, Fuku Y, Cheema AN, Félix-Oliveira A, Yamamoto M, Kagase A, Codner P, Valle RD, Iyer VS, Kim HS, Lin MS, Maini B, Rodriguez R, Montorfano M, Ancona MB, Tada N, Miyasaka M, Ahmad H, Ruggiero NJ, Torguson R, Ben-Dor I, Shults CC, Weissman G, Lederman RJ, Greenbaum AB, Babaliaros VC, Waksman R, Rogers T. Coronary Obstruction From TAVR in Native Aortic Stenosis: Development and Validation of Multivariate Prediction Model. JACC Cardiovasc Interv 2023; 16:415-425. [PMID: 36858660 PMCID: PMC9991077 DOI: 10.1016/j.jcin.2022.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 03/03/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR)-related coronary artery obstruction prediction remains unsatisfactory despite high mortality and novel preventive therapies. OBJECTIVES This study sought to develop a predictive model for TAVR-related coronary obstruction in native aortic stenosis. METHODS Preprocedure computed tomography and fluoroscopy images of patients in whom TAVR caused coronary artery obstruction were collected. Central laboratories made measurements, which were compared with unobstructed patients from a single-center database. A multivariate model was developed and validated against a 1:1 propensity-matched subselection of the unobstructed cohort. RESULTS Sixty patients with angiographically confirmed coronary obstruction and 1,381 without obstruction were included. In-hospital death was higher in the obstruction cohort (26.7% vs 0.7%; P < 0.001). Annular area and perimeter, coronary height, sinus width, and sinotubular junction height and width were all significantly smaller in the obstructed cohort. Obstruction was most common on the left side (78.3%) and at the level of the coronary artery ostium (92.1%). Coronary artery height and sinus width, but not annulus area, were significant risk factors for obstruction by logistic regression but performed poorly in predicting obstruction. The new multivariate model (coronary obstruction IF cusp height > coronary height, AND virtual valve-to-coronary distance ≤4 mm OR culprit leaflet calcium volume >600 mm3) performed well, with an area under the curve of 0.93 (sensitivity = 0.93, specificity = 0.84) for the left coronary artery and 0.94 (sensitivity = 0.92, specificity = 0.96) for the right. CONCLUSIONS A novel computed tomography-based multivariate prediction model that can be implemented routinely in real-world practice predicted coronary artery obstruction from TAVR in native aortic stenosis.
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Affiliation(s)
- 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, Maryland, USA
| | - Norihiko Kamioka
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA; Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - John C Lisko
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Emily Perdoncin
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Cheng Zhang
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Aneel Maini
- Georgetown University School of Medicine, Washington, DC, USA
| | - Mao Chen
- Department of Cardiology, West China School of Medicine, West China Hospital, Sichuan University, China
| | - Yijian Li
- Department of Cardiology, West China School of Medicine, West China Hospital, Sichuan University, China
| | - Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; Cardiovascular Research Foundation, New York, New York, USA
| | - Dirk Westermann
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Ignacio J Amat Santos
- Department of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | | | - Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Asim N Cheema
- Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Afonso Félix-Oliveira
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Institute of Pharmacology and Neurosciences, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center/Nagoya Heart Center, Nagoya, Japan
| | - Ai Kagase
- Department of Cardiology, Toyohashi Heart Center/Nagoya Heart Center, Nagoya, Japan
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | - Raquel Del Valle
- Interventional Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Vijay S Iyer
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Mao-Shin Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Brijeshwar Maini
- Department of Cardiology, Florida Atlantic University, Boca Raton, Florida, USA
| | - Roberto Rodriguez
- Structural Heart Program, Main Line Health, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Masaki Miyasaka
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Hasan Ahmad
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Nicholas J Ruggiero
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Rebecca Torguson
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Christian C Shults
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Gaby Weissman
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Vasilis C Babaliaros
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, 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, Maryland, USA.
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19
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Ueyama HA, Gleason PT, Babaliaros VC, Greenbaum AB. Transcatheter Mitral Valve Replacement in Failed Bioprosthetic Valve, Ring, and Mitral Annular Calcification Associated Mitral Valve Disease Using Balloon Expandable Transcatheter Heart Valve. Methodist Debakey Cardiovasc J 2023; 19:37-49. [PMID: 37213881 PMCID: PMC10198232 DOI: 10.14797/mdcvj.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/10/2023] [Indexed: 05/23/2023] Open
Abstract
Transcatheter mitral valve replacement (TMVR) using the SAPIEN platform has been performed in failed bioprosthetic valves (valve-in-valve), surgical annuloplasty rings (valve-in-ring), and native valves with mitral annular calcification (MAC) (valve-in-MAC). Experience over the past decade has identified important challenges and solutions to improve clinical outcomes. In this review, we discuss the indication, trend in utilization, unique challenges, procedural planning, and clinical outcomes of valve-in-valve, valve-in-ring, and valve-in-MAC TMVR.
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Affiliation(s)
- Hiroki A. Ueyama
- Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, US
| | - Patrick T. Gleason
- Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, US
| | - Vasilis C. Babaliaros
- Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, US
| | - Adam B. Greenbaum
- Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, US
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20
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Bruce CG, Khan JM, Rogers T, Yildirim DK, Jaimes AE, Seemann F, Chen MY, O’Brien K, Herzka DA, Schenke WH, Eckhaus MA, Potersnak AG, Campbell-Washburn A, Babaliaros VC, Greenbaum AB, Lederman RJ. Reshaping the Ventricle From Within: MIRTH (Myocardial Intramural Remodeling by Transvenous Tether) Ventriculoplasty in Swine. JACC Basic Transl Sci 2022; 8:37-50. [PMID: 36777171 PMCID: PMC9911325 DOI: 10.1016/j.jacbts.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/11/2022]
Abstract
MIRTH (Myocardial Intramural Remodeling by Transvenous Tether) is a transcatheter ventricular remodeling procedure. A transvenous tension element is placed within the walls of the beating left ventricle and shortened to narrow chamber dimensions. MIRTH uses 2 new techniques: controlled intramyocardial guidewire navigation and EDEN (Electrocardiographic Radial Depth Navigation). MIRTH caused a sustained reduction in chamber dimensions in healthy swine. Midventricular implants approximated papillary muscles. MIRTH shortening improved myocardial contractility in cardiomyopathy in a dose-dependent manner up to a threshold beyond which additional shortening reduced performance. MIRTH may help treat dilated cardiomyopathy. Clinical investigation is warranted.
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Key Words
- CMR, cardiac magnetic resonance
- CTO, chronic total occlusion
- EDEN, electrocardiographic radial depth navigation
- EDV, end-diastolic volume
- ESPVR, end-systolic pressure-volume relationship
- ESV, end-systolic volume
- Ees, end-systolic elastance
- LVEDP, left ventricular end-diastolic pressure
- LVESP, left ventricular end systolic pressure
- MIRTH, myocardial intramural remodeling by transvenous tether
- PRSW, preload recruitable stroke work
- PVA, pressure-volume area
- cardiac repair
- cardiomyopathy
- heart failure/etiology/mortality/surgery
- surgical ventricular restoration
- ventricular remodeling
- ventriculoplasty
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Affiliation(s)
- Christopher G. Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jaffar M. Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
- MedStar Washington Hospital Center, Washington, DC, USA
| | - D. Korel Yildirim
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrea E. Jaimes
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Felicia Seemann
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marcus Y. Chen
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kendall O’Brien
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Daniel A. Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - William H. Schenke
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael A. Eckhaus
- Division of Veterinary Resources, National Institutes of Health, Bethesda, Maryland, USA
| | - Amanda G. Potersnak
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Adrienne Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Adam B. Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Robert J. Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
- Address for correspondence: Dr Robert J. Lederman, Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, Maryland 20892-1538, USA. @TheBethesdaLabs@ChrisGBruce13
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21
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Lederman RJ, Rogers T, Babaliaros VC, Greenbaum AB. Reply: Alternative Access Options for Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2022; 15:1685. [PMID: 35981846 PMCID: PMC9599002 DOI: 10.1016/j.jcin.2022.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Robert J. Lederman
- Cardiovascular Branch Division of Intramural
Research National Heart Lung and Blood Institute National Institutes of Health
Building 10, Room 2c713, MSC 1538 Bethesda, Maryland 20892-1538, USA,
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22
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Babaliaros VC, Gleason PT, Xie JX, Khan JM, Bruce CG, Byku I, Grubb K, Paone G, Rogers T, Lederman RJ, Greenbaum AB. Toward Transcatheter Leaflet Removal With the CATHEDRAL Procedure: CATHeter Electrosurgical Debulking and RemovAL. JACC Cardiovasc Interv 2022; 15:1678-1680. [PMID: 35981843 PMCID: PMC9596131 DOI: 10.1016/j.jcin.2022.05.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/18/2022] [Accepted: 05/24/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | - Patrick T. Gleason
- Emory Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA
| | - Joe X. Xie
- Emory Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA
| | - Jaffar M. Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher G. Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Isida Byku
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kendra Grubb
- Emory Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA
| | - Gaetano Paone
- Emory Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Robert J. Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Adam B. Greenbaum
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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23
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Rogers T, Greenbaum AB, Babaliaros VC, Foerst JR, Khan JM, Bruce CG, Stine AM, Satler LF, Perdoncin E, Gleason PT, Lisko JC, Tian X, Miao R, Sachdev V, Chen MY, Lederman RJ. Transcatheter Mitral Cerclage Ventriculoplasty: From Bench to Bedside. JACC Cardiovasc Interv 2022; 15:1249-1263. [PMID: 35738745 DOI: 10.1016/j.jcin.2022.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Transcatheter mitral valve repair is beneficial in patients with mitral regurgitation (MR), left ventricular dysfunction, and persistent symptoms despite maximally tolerated medical therapy. OBJECTIVES The aim of this study was to evaluate the safety and feasibility of transcatheter mitral cerclage ventriculoplasty in patients with MR and either heart failure with reduced ejection fraction or preserved ejection fraction and in subjects with prior edge-to-edge repair but persistent or recurrent symptomatic MR. METHODS The National Heart, Lung, and Blood Institute Division of Intramural Research Transcatheter Mitral Cerclage Ventriculoplasty Early Feasibility Study (NCT03929913) was an investigator-initiated prospective multicenter study. The primary endpoint was technical success measured at exit from the catheterization laboratory. Follow-up included heart failure quality-of-life assessments and serial imaging with echocardiography and cardiac computed tomography. RESULTS Nineteen subjects consented and underwent cerclage, 63% with heart failure with reduced ejection fraction and 37% with heart failure with preserved ejection fraction, with ischemic cardiomyopathy in 26% and nonischemic cardiomyopathy in 74%. There were no procedural deaths, strokes, or transient ischemic attacks or other major cardiovascular adverse events. The primary endpoint was met in 17 subjects. Cerclage induced sustained reductions in mitral regurgitant volume (-41%) and effective orifice area (-33%) after a median of 337 days. Cerclage resulted in improvements in 6-minute walking distance (+78 m) and Kansas City Cardiomyopathy Questionnaire Overall Summary Score (+22 points) at 30 days that were maintained after a median of 265 days. New complete heart block developed in 6 of 17 subjects. Three deaths occurred on postprocedural days 79, 159, and 756, unrelated to cerclage. CONCLUSIONS Transcatheter mitral cerclage ventriculoplasty resulted in significant and sustained improvements in mitral regurgitation and in heart failure quality-of-life assessments.
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Affiliation(s)
- Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA; MedStar Washington Hospital Center, Washington, DC, USA
| | | | | | | | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Annette M Stine
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | | | | | - Xin Tian
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Rui Miao
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Vandana Sachdev
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marcus Y Chen
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
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25
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Kohli K, Wei ZA, Sadri V, Siefert AW, Blanke P, Perdoncin E, Greenbaum AB, Khan JM, Lederman RJ, Babaliaros VC, Yoganathan AP, Oshinski JN. Assessing the Hemodynamic Impact of Anterior Leaflet Laceration in Transcatheter Mitral Valve Replacement: An in silico Study. Front Cardiovasc Med 2022; 9:869259. [PMID: 35811698 PMCID: PMC9261975 DOI: 10.3389/fcvm.2022.869259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/22/2022] [Indexed: 11/20/2022] Open
Abstract
Background A clinical study comparing the hemodynamic outcomes of transcatheter mitral valve replacement (TMVR) with vs. without Laceration of the Anterior Mitral leaflet to Prevent Outflow Obstruction (LAMPOON) has never been designed nor conducted. Aims To quantify the hemodynamic impact of LAMPOON in TMVR using patient-specific computational (in silico) models. Materials Eight subjects from the LAMPOON investigational device exemption trial were included who had acceptable computed tomography (CT) data for analysis. All subjects were anticipated to be at prohibitive risk of left ventricular outflow tract (LVOT) obstruction from TMVR, and underwent successful LAMPOON immediately followed by TMVR. Using post-procedure CT scans, two 3D anatomical models were created for each subject: (1) TMVR with LAMPOON (performed procedure), and (2) TMVR without LAMPOON (virtual control). A validated computational fluid dynamics (CFD) paradigm was then used to simulate the hemodynamic outcomes for each condition. Results LAMPOON exposed on average 2 ± 0.6 transcatheter valve cells (70 ± 20 mm2 total increase in outflow area) which provided an additional pathway for flow into the LVOT. As compared to TMVR without LAMPOON, TMVR with LAMPOON resulted in lower peak LVOT velocity, lower peak LVOT gradient, and higher peak LVOT effective orifice area by 0.4 ± 0.3 m/s (14 ± 7% improvement, p = 0.006), 7.6 ± 10.9 mmHg (31 ± 17% improvement, p = 0.01), and 0.2 ± 0.1 cm2 (17 ± 9% improvement, p = 0.002), respectively. Conclusion This was the first study to permit a quantitative, patient-specific comparison of LVOT hemodynamics following TMVR with and without LAMPOON. The LAMPOON procedure achieved a critical increment in outflow area which was effective for improving LVOT hemodynamics, particularly for subjects with a small neo-left ventricular outflow tract (neo-LVOT).
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Affiliation(s)
- Keshav Kohli
- Wallace H. Coulter Department of Biomedical Engineering at the Georgia Institute of Technology and Emory University, Atlanta, GA, United States
- *Correspondence: Keshav Kohli,
| | - Zhenglun Alan Wei
- Wallace H. Coulter Department of Biomedical Engineering at the Georgia Institute of Technology and Emory University, Atlanta, GA, United States
- Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, MA, United States
| | - Vahid Sadri
- Wallace H. Coulter Department of Biomedical Engineering at the Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Andrew W. Siefert
- Wallace H. Coulter Department of Biomedical Engineering at the Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Philipp Blanke
- Department of Radiology, St. Paul’s Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Emily Perdoncin
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA, United States
| | - Adam B. Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA, United States
| | - Jaffar M. Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Robert J. Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Vasilis C. Babaliaros
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA, United States
| | - Ajit P. Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering at the Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - John N. Oshinski
- Wallace H. Coulter Department of Biomedical Engineering at the Georgia Institute of Technology and Emory University, Atlanta, GA, United States
- Department of Radiology and Imaging Science, Emory University School of Medicine, Atlanta, GA, United States
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Greenbaum AB, Khan JM, Bruce CG, Hanzel GS, Gleason PT, Kohli K, Inci EK, Guyton RA, Paone G, Rogers T, Lederman RJ, Babaliaros VC. Transcatheter Myotomy to Treat Hypertrophic Cardiomyopathy and Enable Transcatheter Mitral Valve Replacement: First-in-Human Report of Septal Scoring Along the Midline Endocardium. Circ Cardiovasc Interv 2022; 15:e012106. [PMID: 35603621 DOI: 10.1161/circinterventions.122.012106] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Adam B Greenbaum
- Emory Structural Heart and Valve Center, Emory University, Atlanta, GA (A.B.G., G.S.H., P.T.G., E.K.I., R.A.G., G.P., V.C.B.)
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (J.M.K., C.G.B., T.R., R.J.L.)
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (J.M.K., C.G.B., T.R., R.J.L.)
| | - George S Hanzel
- Emory Structural Heart and Valve Center, Emory University, Atlanta, GA (A.B.G., G.S.H., P.T.G., E.K.I., R.A.G., G.P., V.C.B.)
| | - Patrick T Gleason
- Emory Structural Heart and Valve Center, Emory University, Atlanta, GA (A.B.G., G.S.H., P.T.G., E.K.I., R.A.G., G.P., V.C.B.)
| | - Keshav Kohli
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University, Atlanta (K.K.)
| | - Errol K Inci
- Emory Structural Heart and Valve Center, Emory University, Atlanta, GA (A.B.G., G.S.H., P.T.G., E.K.I., R.A.G., G.P., V.C.B.)
| | - Robert A Guyton
- Emory Structural Heart and Valve Center, Emory University, Atlanta, GA (A.B.G., G.S.H., P.T.G., E.K.I., R.A.G., G.P., V.C.B.)
| | - Gaetano Paone
- Emory Structural Heart and Valve Center, Emory University, Atlanta, GA (A.B.G., G.S.H., P.T.G., E.K.I., R.A.G., G.P., V.C.B.)
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (J.M.K., C.G.B., T.R., R.J.L.)
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (J.M.K., C.G.B., T.R., R.J.L.)
| | - Vasilis C Babaliaros
- Emory Structural Heart and Valve Center, Emory University, Atlanta, GA (A.B.G., G.S.H., P.T.G., E.K.I., R.A.G., G.P., V.C.B.)
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Khan JM, Bruce CG, Greenbaum AB, Babaliaros VC, Jaimes AE, Schenke WH, Ramasawmy R, Seemann F, Herzka DA, Rogers T, Eckhaus MA, Campbell-Washburn A, Guyton RA, Lederman RJ. Transcatheter Myotomy to Relieve Left Ventricular Outflow Tract Obstruction: The Septal Scoring Along the Midline Endocardium Procedure in Animals. Circ Cardiovasc Interv 2022; 15:e011686. [PMID: 35378990 DOI: 10.1161/circinterventions.121.011686] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Left ventricular outflow tract obstruction complicates hypertrophic cardiomyopathy and transcatheter mitral valve replacement. Septal reduction therapies including surgical myectomy and alcohol septal ablation are limited by surgical morbidity or coronary anatomy and high pacemaker rates, respectively. We developed a novel transcatheter procedure, mimicking surgical myotomy, called Septal Scoring Along the Midline Endocardium (SESAME). METHODS SESAME was performed in 5 naive pigs and 5 pigs with percutaneous aortic banding-induced left ventricular hypertrophy. Fluoroscopy and intracardiac echocardiography guided the procedures. Coronary guiding catheters and guidewires were used to mechanically enter the basal interventricular septum. Imparting a tip bend to the guidewire enabled intramyocardial navigation with multiple df. The guidewire trajectory determined the geometry of SESAME myotomy. The myocardium was lacerated using transcatheter electrosurgery. Cardiac function and tissue characteristics were assessed by cardiac magnetic resonance at baseline, postprocedure, and at 7- or 30-day follow-up. RESULTS SESAME myotomy along the intended trajectory was achieved in all animals. The myocardium splayed after laceration, increasing left ventricular outflow tract area (753 to 854 mm2, P=0.008). Two naive pigs developed ventricular septal defects due to excessively deep lacerations in thin baseline septa. No hypertrophy model pig, with increased septal thickness and left ventricular mass compared with naive pigs, developed ventricular septal defects. One animal developed left axis deviation on ECG but no higher conduction block was seen in any animal. Coronary artery branches were intact on angiography with no infarction on cardiac magnetic resonance late gadolinium imaging. Cardiac magnetic resonance chamber volumes, function, flow, and global strain were preserved. No myocardial edema was evident on cardiac magnetic resonance T1 mapping. CONCLUSIONS This preclinical study demonstrated feasibility of SESAME, a novel transcatheter myotomy to relieve left ventricular outflow tract obstruction. This percutaneous procedure using available devices, with a safe surgical precedent, is readily translatable into patients.
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Affiliation(s)
- Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute (J.M.K., C.G.B., A.E.J., W.H.S., R.R., F.S., D.A.H., T.R., A.C.-W., R.J.L.), NIH, Bethesda, MD
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute (J.M.K., C.G.B., A.E.J., W.H.S., R.R., F.S., D.A.H., T.R., A.C.-W., R.J.L.), NIH, Bethesda, MD
| | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (A.B.G., V.C.B., R.A.G.)
| | - Vasilis C Babaliaros
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (A.B.G., V.C.B., R.A.G.)
| | - Andrea E Jaimes
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute (J.M.K., C.G.B., A.E.J., W.H.S., R.R., F.S., D.A.H., T.R., A.C.-W., R.J.L.), NIH, Bethesda, MD
| | - William H Schenke
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute (J.M.K., C.G.B., A.E.J., W.H.S., R.R., F.S., D.A.H., T.R., A.C.-W., R.J.L.), NIH, Bethesda, MD
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute (J.M.K., C.G.B., A.E.J., W.H.S., R.R., F.S., D.A.H., T.R., A.C.-W., R.J.L.), NIH, Bethesda, MD
| | - Felicia Seemann
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute (J.M.K., C.G.B., A.E.J., W.H.S., R.R., F.S., D.A.H., T.R., A.C.-W., R.J.L.), NIH, Bethesda, MD
| | - Daniel A Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute (J.M.K., C.G.B., A.E.J., W.H.S., R.R., F.S., D.A.H., T.R., A.C.-W., R.J.L.), NIH, Bethesda, MD
| | - Toby Rogers
- MedStar Washington Hospital Center, Washington, DC (T.R.)
| | - Michael A Eckhaus
- Division of Research Services, Office of Research Services (M.A.E.), NIH, Bethesda, MD
| | - Adrienne Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute (J.M.K., C.G.B., A.E.J., W.H.S., R.R., F.S., D.A.H., T.R., A.C.-W., R.J.L.), NIH, Bethesda, MD
| | - Robert A Guyton
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (A.B.G., V.C.B., R.A.G.)
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute (J.M.K., C.G.B., A.E.J., W.H.S., R.R., F.S., D.A.H., T.R., A.C.-W., R.J.L.), NIH, Bethesda, MD
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Lederman RJ, Babaliaros VC, Lisko JC, Rogers T, Mahoney P, Foerst JR, Depta JP, Muhammad KI, McCabe JM, Pop A, Khan JM, Bruce CG, Medranda GA, Wei JW, Binongo JN, Greenbaum AB. Transcaval Versus Transaxillary TAVR in Contemporary Practice: A Propensity-Weighted Analysis. JACC Cardiovasc Interv 2022; 15:965-975. [PMID: 35512920 PMCID: PMC9138050 DOI: 10.1016/j.jcin.2022.03.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to compare transcaval and transaxillary artery access for transcatheter aortic valve replacement (TAVR) at experienced medical centers in contemporary practice. BACKGROUND There are no systematic comparisons of transcaval and transaxillary TAVR access routes. METHODS Eight experienced centers contributed local data collected for the STS/ACC TVT Registry (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry) between 2017 and 2020. Outcomes after transcaval and axillary/subclavian (transaxillary) access were adjusted for baseline imbalances using doubly robust (inverse propensity weighting plus regression) estimation and compared. RESULTS Transcaval access was used in 238 procedures and transaxillary access in 106; for comparison, transfemoral access was used in 7,132 procedures. Risk profiles were higher among patients selected for nonfemoral access but similar among patients requiring transcaval and transaxillary access. Stroke and transient ischemic attack were 5-fold less common after transcaval than transaxillary access (2.5% vs 13.2%; OR: 0.20; 95% CI: 0.06-0.72; P = 0.014) compared with transfemoral access (1.7%). Major and life-threatening bleeding (Valve Academic Research Consortium 3 ≥ type 2) were comparable (10.0% vs 13.2%; OR: 0.66; 95% CI: 0.26-1.66; P = 0.38) compared with transfemoral access (3.5%), as was blood transfusion (19.3% vs 21.7%; OR: 1.07; 95% CI: 0.49-2.33; P = 0.87) compared with transfemoral access (7.1%). Vascular complications, intensive care unit and hospital length of stay, and survival were similar between transcaval and transaxillary access. More patients were discharged directly home and without stroke or transient ischemic attack after transcaval than transaxillary access (87.8% vs 62.3%; OR: 5.19; 95% CI: 2.45-11.0; P < 0.001) compared with transfemoral access (90.3%). CONCLUSIONS Patients undergoing transcaval TAVR had lower rates of stroke and similar bleeding compared with transaxillary access in a contemporary experience from 8 US centers. Both approaches had more complications than transfemoral access. Transcaval TAVR access may offer an attractive option.
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Affiliation(s)
- Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
| | - Vasilis C Babaliaros
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John C Lisko
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Paul Mahoney
- Division of Cardiology, The Sentara Heart Center, Norfolk, Virginia, USA
| | - Jason R Foerst
- Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Jeremiah P Depta
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, New York, USA
| | | | - James M McCabe
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Andrei Pop
- AMITA Health Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Giorgio A Medranda
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Jane W Wei
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jose N Binongo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Adam B Greenbaum
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA. https://twitter.com/AdamGreenbaumMD
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Inci EK, Greenbaum AB, Lederman RJ, Kohli K, Lisko JC, Byku I, Gleason PT, Xie JX, Shekiladze N, Babaliaros VC. Transcatheter Electrosurgical Laceration and Stabilization of Failed MitraClip[s]/SAPIEN M3 for Treatment of Failed MitraClip. Circ Cardiovasc Interv 2022; 15:e012014. [PMID: 35580205 DOI: 10.1161/circinterventions.122.012014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Errol K Inci
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.)
| | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.)
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (R.J.L.)
| | - Keshav Kohli
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University, Atlanta (K.K.)
| | - John C Lisko
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.)
| | - Isida Byku
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.)
| | - Patrick T Gleason
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.)
| | - Joe X Xie
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.)
| | - Nikoloz Shekiladze
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.)
| | - Vasilis C Babaliaros
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.)
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Greenbaum AB, Babaliaros VC, Eng MH. Orthotopic Transcatheter Tricuspid Valve Replacement. Interv Cardiol Clin 2021; 11:87-94. [PMID: 34838300 DOI: 10.1016/j.iccl.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Severe tricuspid regurgitation renders patients frail, and surgical treatment is associated with high mortality. Because most of the tricuspid regurgitation patients are functional and have significant annular dilation, large coaptation gaps are seen. This anatomy is best addressed with transcatheter tricuspid valve replacement (TTVR), and promising therapies are under clinical investigation. Most TTVR devices are in early clinical development with one transcatheter heart valve in pivotal trial; TTVR is expected to significantly affect tricuspid regurgitation and survival.
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Affiliation(s)
- Adam B Greenbaum
- Structural Heart and Valve Center, Department of Internal Medicine-Cardiology, Emory University, 550 Peachtree St Ne Medical, Office Tower, Fl 6, Atlanta, GA 30308, USA
| | - Vasilis C Babaliaros
- Structural Heart and Valve Center, Department of Internal Medicine-Cardiology, Emory University, 550 Peachtree St Ne Medical, Office Tower, Fl 6, Atlanta, GA 30308, USA
| | - Marvin H Eng
- Division of Cardiology, Structural Heart Program, Banner University Medical Center- Phoenix, University of Arizona, 1111 East McDowell Road, Phoenix, AZ 85006, USA.
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31
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Bruce CG, Greenbaum AB, Babaliaros VC, Rogers T, Lederman RJ, Khan JM. Safeguards and pitfalls for Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction during transcatheter aortic valve replacement-the BASILICA technique. Ann Cardiothorac Surg 2021; 10:700-707. [PMID: 34733702 DOI: 10.21037/acs-2021-tviv-26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/06/2021] [Indexed: 11/06/2022]
Abstract
Coronary artery obstruction is a devastating complication of transcatheter aortic valve replacement (TAVR). Bioprosthetic or native Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery Obstruction (BASILICA) is a transcatheter, electrosurgical technique that was developed to prevent obstruction due to sinus effacement or sinus sequestration. BASILICA creates a midline laceration of one (solo) or both (doppio) offending aortic leaflets and has been performed in over 1,000 patients at high risk for obstruction. The procedure has been studied in the prospective BASILICA IDE Trial and data from the International BASILICA Registry of 214 patients supports efficacy and safety; procedural success was achieved in 94.4% and at thirty days 95.3% were free from culprit coronary artery obstruction, all-cause mortality was 2.8% and disabling stroke was reported in only 0.5%. In this review we discuss screening for patients at high risk for coronary artery obstruction, technical details related to performing the BASILICA procedure and how to troubleshoot a BASILICA procedure.
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Affiliation(s)
- Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Adam B Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Vasilis C Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.,Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Perdoncin E, Bruce CG, Babaliaros VC, Yildirim DK, Depta JP, McCabe JM, Gleason PT, Xie J, Grubb KJ, Paone G, Kohli K, Kamioka N, Khan JM, Rogers T, Lederman RJ, Greenbaum AB. Balloon-Augmented Leaflet Modification With Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction and Laceration of the Anterior Mitral Leaflet to Prevent Outflow Obstruction: Benchtop Validation and First In-Man Experience. Circ Cardiovasc Interv 2021; 14:e011028. [PMID: 34674556 DOI: 10.1161/circinterventions.121.011028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) and laceration of the anterior mitral leaflet to prevent outflow obstruction (LAMPOON) reduce the risk of coronary and left ventricular outflow obstruction obstruction during transcatheter aortic valve replacement and transcatheter mitral valve replacement. Despite successful laceration, BASILICA or LAMPOON may fail to prevent obstruction caused by inadequate leaflet splay in patients having challenging anatomy such as very small valve-to-coronary distance, diffusely calcified, rigid leaflets, or undergoing transcatheter aortic valve replacement inside existing transcatheter aortic valve replacement. We describe a novel technique of balloon-augmented (BA) leaflet laceration to enhance leaflet splay. METHODS We measured the incremental leaflet splay from BA-BASILICA in vitro. From November 2019 to March 2021, 16 patients underwent BA-BASILICA and 4 BA-LAMPOON at 3 centers. RESULTS BA-BASILICA increased benchtop leaflet tip splay 17%, maximum splay angle 30%, and splay area 23%, resulting in a more rounded apex and larger effective area. Sixteen patients at risk for inadequate BASILICA leaflet splay, including 4 transcatheter aortic valve replacement inside existing transcatheter aortic valve replacement, underwent BA-BASILICA. All had successful leaflet laceration. One had coronary obstruction requiring immediate orthotopic stenting. Two underwent elective orthotopic coronary stenting through the transcatheter valve cells for leaflet prolapse without coronary ischemia. There were no deaths during the procedure or at 30 days. Four patients at risk for inadequate anterior mitral leaflet splay underwent BA-LAMPOON. All had successful target leaflet laceration without left ventricular outflow obstruction obstruction or procedural death. One died within 30 days. CONCLUSIONS BA leaflet laceration enhances leaflet splay in vitro and may allow transcatheter aortic valve replacement and transcatheter mitral valve replacement in patients otherwise ineligible for traditional BASILICA or LAMPOON due to challenging anatomy. Graphic Abstract: A graphic abstract is available for this article.
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Affiliation(s)
- Emily Perdoncin
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (E.P., V.C.B., P.T.G., J.X., K.J.G., G.P., N.K., A.B.G.)
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.G.B., D.K.Y., J.M.K., T.R., R.J.L.)
| | - Vasilis C Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (E.P., V.C.B., P.T.G., J.X., K.J.G., G.P., N.K., A.B.G.)
| | - Dursun Korel Yildirim
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.G.B., D.K.Y., J.M.K., T.R., R.J.L.)
| | - Jeremiah P Depta
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, NY (J.P.D.)
| | - James M McCabe
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.G.B., D.K.Y., J.M.K., T.R., R.J.L.).,Division of Cardiology, University of Washington, Seattle (J.M.M.)
| | - Patrick T Gleason
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (E.P., V.C.B., P.T.G., J.X., K.J.G., G.P., N.K., A.B.G.)
| | - Joe Xie
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (E.P., V.C.B., P.T.G., J.X., K.J.G., G.P., N.K., A.B.G.)
| | - Kendra J Grubb
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (E.P., V.C.B., P.T.G., J.X., K.J.G., G.P., N.K., A.B.G.)
| | - Gaetano Paone
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (E.P., V.C.B., P.T.G., J.X., K.J.G., G.P., N.K., A.B.G.)
| | - Keshav Kohli
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University, Atlanta (K.K.)
| | - Norihiko Kamioka
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (E.P., V.C.B., P.T.G., J.X., K.J.G., G.P., N.K., A.B.G.)
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.G.B., D.K.Y., J.M.K., T.R., R.J.L.)
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.G.B., D.K.Y., J.M.K., T.R., R.J.L.)
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.G.B., D.K.Y., J.M.K., T.R., R.J.L.)
| | - Adam B Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (E.P., V.C.B., P.T.G., J.X., K.J.G., G.P., N.K., A.B.G.)
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Greenbaum AB, Lisko JC, Gleason PT, Kamioka N, Metcalf DP, Greenbaum MA, Paone G, Grubb KJ, Lederman RJ, Babaliaros VC. Annular-to-Apical "Emory Angle" to Ensure Coaxial Mitral Implantation of the SAPIEN 3 Valve. JACC Cardiovasc Interv 2021; 13:2447-2450. [PMID: 33092718 DOI: 10.1016/j.jcin.2020.07.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/01/2020] [Accepted: 07/21/2020] [Indexed: 11/27/2022]
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Kamioka N, Babaliaros VC, Lisko JC, Sahu A, Shashidharan S, Carazo MR, Jokhadar M, Rodriguez FH, Book WM, Gleason PT, Keeling WB, Jaber W, Block PC, Lederman RJ, Greenbaum AB, Kim DW. Single-Barrel, Double-Barrel, and Fenestrated Endografts to Facilitate Transcatheter Pulmonary Valve Replacement in Large RVOT. JACC Cardiovasc Interv 2021; 13:2755-2765. [PMID: 33303113 DOI: 10.1016/j.jcin.2020.08.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/10/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to test the hypothesis that narrowing the landing zone using commercially available endografts would enable transcatheter pulmonary valve replacement (TPVR) using commercially available transcatheter heart valves. BACKGROUND TPVR is challenging in an outsized native or patch-repaired right ventricular outflow tract (RVOT). Downsizing the RVOT for TPVR is currently possible only using investigational devices. In patients ineligible because of excessive RVOT size, TPVR landing zones were created using commercially available endografts. METHODS Consecutive patients with native or patch-repaired RVOTs and high or prohibitive surgical risk were reviewed, and this report describes the authors' experience with endograft-facilitated TPVR (EF-TPVR) offered to patients ineligible for investigational or commercial devices. All EF-TPVR patients were surgery ineligible, with symptomatic, severe pulmonary insufficiency, enlarged RVOTs, and severe right ventricular (RV) enlargement (>150 ml/m2). TPVR and surgical pulmonary valve replacement (SPVR) were compared in patients with less severe RV enlargement. RESULTS Fourteen patients had large RVOTs unsuitable for conventional TPVR; 6 patients (1 surgery ineligible) received investigational devices, and 8 otherwise ineligible patients underwent compassionate EF-TPVR (n = 5 with tetralogy of Fallot). Three strategies were applied on the basis of progressively larger RVOT size: single-barrel, in situ fenestrated, and double-barrel endografts as required to anchor 1 (single-barrel and fenestrated) or 2 (double-barrel) transcatheter heart valves. All were technically successful, without procedure-related, 30-day, or in-hospital deaths. Two late complications (stent obstruction and embolization) were treated percutaneously. One patient died of ventricular tachycardia 36 days after EF-TPVR. Compared with 48 SPVRs, RV enlargement was greater, but 30-day and 1-year mortality and readmission were no different. The mean transvalvular pressure gradient was lower after EF-TPVR (3.8 ± 0.8 mm Hg vs. 10.7 ± 4.1 mm Hg; p < 0.001; 30 days). More than mild pulmonary insufficiency was equivalent in both (EF-TPVR 0.0% [n = 0 of 8] vs. SPVR 4.3% [n = 1 of 43]; p = 1.00; 30 days). CONCLUSIONS EF-TPVR may be an alternative for patients with pulmonic insufficiency and enlarged RVOTs ineligible for other therapies.
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Affiliation(s)
- Norihiko Kamioka
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vasilis C Babaliaros
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John C Lisko
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anurag Sahu
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Matthew R Carazo
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Maan Jokhadar
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Fred H Rodriguez
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Wendy M Book
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Patrick T Gleason
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - William B Keeling
- Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Wissam Jaber
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Peter C Block
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Adam B Greenbaum
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dennis W Kim
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA; Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
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Westermann D, Ludwig S, Kalbacher D, Spink C, Linder M, Bhadra OD, Nikorowitsch J, Waldschmidt L, Demal T, Voigtländer L, Schaefer A, Seiffert M, Pecha S, Schofer N, Greenbaum AB, Reichenspurner H, Blankenberg S, Conradi L, Schirmer J. Prevention of coronary obstruction in patients at risk undergoing transcatheter aortic valve implantation: the Hamburg BASILICA experience. Clin Res Cardiol 2021; 110:1900-1911. [PMID: 34156524 PMCID: PMC8639537 DOI: 10.1007/s00392-021-01881-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/26/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed to assess the clinical outcome of the bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary obstruction (BASILICA) technique in a single-center patient cohort considered at high or prohibitive risk of transcatheter aortic valve implantation (TAVI)-induced coronary obstruction. METHODS Between October 2019 and January 2021, a total of 15 consecutive patients (age 81.0 [78.1, 84.4] years; 53.3% female; EuroSCORE II 10.6 [6.3, 14.8] %) underwent BASILICA procedure prior to TAVI at our institution. Indications for TAVI were degeneration of stented (n = 12, 80.0%) or stentless (n = 1, 6.7%) bioprosthetic aortic valves, or calcific stenosis of native aortic valves (n = 2, 13.3%), respectively. Individual risk of TAVI-induced coronary obstruction was assessed by pre-procedural computed tomography analysis. Procedural and 30-day outcomes were documented in accordance with Valve Academic Research Consortium (VARC)-2 criteria. RESULTS BASILICA was attempted for single left coronary cusp in 12 patients (80.0%), for single right coronary cusp in 2 patients (13.3%), and for both cusps in 1 patient (6.7%), respectively. The procedure was feasible in 13 patients (86.7%) resulting in effective prevention of coronary obstruction, whilst TAVI was performed without prior successful bioprosthetic leaflet laceration in two patients (13.3%). In one of these patients (6.7%), additional chimney stenting immediately after TAVI was performed. No all-cause deaths or strokes were documented after 30 days. CONCLUSION The BASILICA technique appears to be a feasible, safe and effective concept to avoid iatrogenic coronary artery obstruction during TAVI in both native and bioprosthetic valves of patients at high or prohibitive risk. ClinicalTrials.gov Identifier: NCT04227002 (Hamburg AoRtic Valve cOhoRt).
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Affiliation(s)
- Dirk Westermann
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Hamburg, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Hamburg, Germany.
| | - Daniel Kalbacher
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Hamburg, Germany
| | - Clemens Spink
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Linder
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Oliver D Bhadra
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Julius Nikorowitsch
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Lara Waldschmidt
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Till Demal
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Lisa Voigtländer
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Hamburg, Germany
| | - Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Moritz Seiffert
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Hamburg, Germany
| | - Simon Pecha
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Hamburg, Germany.,Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Niklas Schofer
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA, USA
| | - Hermann Reichenspurner
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Hamburg, Germany.,Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Hamburg, Germany
| | - Lenard Conradi
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Luebeck/Kiel, Hamburg, Germany.,Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Johannes Schirmer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
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Eng MH, Kargoli F, Wang DD, Frisoli TM, Lee JC, Villablanca PS, Nemeh H, Greenbaum AB, Guerrero M, O'Neill BP, Wyman J, O'Neill W. Short- and mid-term outcomes in percutaneous mitral valve replacement using balloon expandable valves. Catheter Cardiovasc Interv 2021; 98:1193-1203. [PMID: 34106514 DOI: 10.1002/ccd.29783] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/02/2021] [Accepted: 05/16/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Due to elevated surgical risk, transcatheter mitral valve replacement (TMVR) is used as an alternative for treating failed bioprosthetic valves, annuloplasty repairs and mitral annular calcification (MAC). We report the procedural and longitudinal outcomes for each subtype: Mitral valve-in-valve (MVIV), mitral valve-in-ring (MViR), and valve-in-MAC (ViMAC). METHODS Consecutive patients undergoing TMVR from October 2013 to December 2019 were assessed. Patients at high risk for left ventricular outflow tract obstruction had either alcohol septal ablation or intentional laceration of the anterior leaflet (LAMPOON). RESULTS Eight-eight patients underwent TMVR; 38 MViV, 31 MViR, and 19 ViMAC procedures were performed. The median Society of Thoracic Surgery 30-day predicted risk of mortality was 8.2% (IQR 5.2, 19.9) for all. Sapien 3 (78%) and transseptal access (98%) were utilized in most cases. All-cause in-hospital mortality, technical, and procedural success were 8%, 83%, and 66% respectively. Median follow up was 1.4 years (IQR 0.5-2.9 years) and overall survival was 40% at 4 years. Differential survival rates were observed with MViV doing the best, followed by MViR and ViMAC having a <20% survival at 4 years. After adjusting for co-variates, MViV procedure was the strongest predictor of survival (HR 0.24 [95% CI 0.079-0.7]). CONCLUSION TMVR is performed in at high-risk patients with attenuated long-term survival. MViV has the best success and survival rate, but long-term survival in MViR and ViMAC is guarded.
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Affiliation(s)
- Marvin H Eng
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Faraj Kargoli
- Division of Cardiology, Montiefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Tiberio M Frisoli
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - James C Lee
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Pedro S Villablanca
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Hassan Nemeh
- Division of Cardiothoracic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Adam B Greenbaum
- Emory Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA
| | - Mayra Guerrero
- Division of Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian P O'Neill
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Janet Wyman
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - William O'Neill
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
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Khan JM, Greenbaum AB, Babaliaros VC, Dvir D, Reisman M, McCabe JM, Satler L, Waksman R, Eng MH, Paone G, Chen MY, Bruce CG, Stine AM, Tian X, Rogers T, Lederman RJ. BASILICA Trial: One-Year Outcomes of Transcatheter Electrosurgical Leaflet Laceration to Prevent TAVR Coronary Obstruction. Circ Cardiovasc Interv 2021; 14:e010238. [PMID: 34003670 DOI: 10.1161/circinterventions.120.010238] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (J.M.K., M.Y.C., C.G.B., A.M.S., X.T., T.R., R.J.L.)
| | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (A.B.G., V.C.B., G.P.)
| | - Vasilis C Babaliaros
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (A.B.G., V.C.B., G.P.)
| | | | | | | | - Lowell Satler
- University of Washington, Seattle (D.D., M.R., J.M.M.). Medstar Washington Hospital Center, Washington, DC (L.S., R.W., T.R.)
| | - Ron Waksman
- University of Washington, Seattle (D.D., M.R., J.M.M.). Medstar Washington Hospital Center, Washington, DC (L.S., R.W., T.R.)
| | - Marvin H Eng
- Center for Structural Heart Disease, Division of Cardiology, and Division of Cardiac Surgery, Henry Ford Health System, Detroit, MI (M.H.E.)
| | - Gaetano Paone
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (A.B.G., V.C.B., G.P.)
| | - Marcus Y Chen
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (J.M.K., M.Y.C., C.G.B., A.M.S., X.T., T.R., R.J.L.)
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (J.M.K., M.Y.C., C.G.B., A.M.S., X.T., T.R., R.J.L.)
| | - Annette M Stine
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (J.M.K., M.Y.C., C.G.B., A.M.S., X.T., T.R., R.J.L.)
| | - Xin Tian
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (J.M.K., M.Y.C., C.G.B., A.M.S., X.T., T.R., R.J.L.)
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (J.M.K., M.Y.C., C.G.B., A.M.S., X.T., T.R., R.J.L.).,University of Washington, Seattle (D.D., M.R., J.M.M.). Medstar Washington Hospital Center, Washington, DC (L.S., R.W., T.R.)
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (J.M.K., M.Y.C., C.G.B., A.M.S., X.T., T.R., R.J.L.)
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Kohli K, Wei ZA, Sadri V, Khan JM, Lisko JC, Netto T, Greenbaum AB, Blanke P, Oshinski JN, Lederman RJ, Yoganathan AP, Babaliaros VC. Dynamic nature of the LVOT following transcatheter mitral valve replacement with LAMPOON: new insights from post-procedure imaging. Eur Heart J Cardiovasc Imaging 2021; 23:650-662. [PMID: 34009283 DOI: 10.1093/ehjci/jeab074] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS To characterize the dynamic nature of the left ventricular outflow tract (LVOT) geometry and flow rate in patients following transcatheter mitral valve replacement (TMVR) with anterior leaflet laceration (LAMPOON) and derive insights to help guide future patient selection. METHODS AND RESULTS Time-resolved LVOT geometry and haemodynamics were analysed with post-procedure computed tomography and echocardiography in subjects (N = 19) from the LAMPOON investigational device exemption trial. A novel post hoc definition for LVOT obstruction was employed to account for systolic flow rate and quality of life improvement [obstruction was defined as LVOT gradient >30 mmHg or LVOT effective orifice area (EOA) ≤1.15 cm2]. The neo-LVOT and skirt neo-LVOT were observed to vary substantially in area throughout systole (64 ± 27% and 25 ± 14% change in area, respectively). The peak systolic flow rate occurred most commonly just prior to mid-systole, while minimum neo-LVOT (and skirt neo-LVOT) area occurred most commonly in early-diastole. Subjects with LVOT obstruction (n = 5) had smaller skirt neo-LVOT values across systole. Optimal thresholds for skirt neo-LVOT area were phase-specific (260, 210, 200, and 180 mm2 for early-systole, peak flow, mid-systole, and end-systole, respectively). CONCLUSION The LVOT geometry and flow rate exhibit dynamic characteristics following TMVR with LAMPOON. Subjects with LVOT obstruction had smaller skirt neo-LVOT areas across systole. The authors recommend the use of phase-specific threshold values for skirt neo-LVOT area to guide future patient selection for this procedure. LVOT EOA is a 'flow-independent' metric which has the potential to aid in characterizing LVOT obstruction severity.
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Affiliation(s)
- Keshav Kohli
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Suite 200, 387 Technology Circle, Atlanta, GA 30313-2412, USA
| | - Zhenglun Alan Wei
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Suite 200, 387 Technology Circle, Atlanta, GA 30313-2412, USA.,Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, MA, USA
| | - Vahid Sadri
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Suite 200, 387 Technology Circle, Atlanta, GA 30313-2412, USA
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - John C Lisko
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA, USA
| | - Tiffany Netto
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Suite 200, 387 Technology Circle, Atlanta, GA 30313-2412, USA
| | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA, USA
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, CA
| | - John N Oshinski
- Department of Radiology and Imaging Science, Emory University School of Medicine, Atlanta, GA, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ajit P Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Suite 200, 387 Technology Circle, Atlanta, GA 30313-2412, USA
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Khan JM, Babaliaros VC, Greenbaum AB, Spies C, Daniels D, Depta JP, Oldemeyer JB, Whisenant B, McCabe JM, Muhammad KI, George I, Mahoney P, Lanz J, Laham RJ, Shah PB, Chhatriwalla A, Yazdani S, Hanzel G, Pershad A, Leonardi RA, Khalil R, Tang GHL, Herrmann HC, Agarwal S, Fail PS, Zhang M, Pop A, Lisko J, Perdoncin E, Koch RL, Ben-Dor I, Satler LF, Zhang C, Cohen JE, Lederman RJ, Waksman R, Rogers T. Preventing Coronary Obstruction During Transcatheter Aortic Valve Replacement: Results From the Multicenter International BASILICA Registry. JACC Cardiovasc Interv 2021; 14:941-948. [PMID: 33958168 DOI: 10.1016/j.jcin.2021.02.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study sought to determine the safety of the BASILICA (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction) procedure. BACKGROUND Transcatheter aortic valve replacement causes coronary artery obstruction in 0.7% of cases, with 40% to 50% mortality. BASILICA is a procedure to prevent coronary obstruction. Safety and feasibility in a large patient cohort is lacking. METHODS The international BASILICA registry was a retrospective, multicenter, real-world registry of patients at risk of coronary artery obstruction undergoing BASILICA and transcatheter aortic valve replacement. Valve Academic Research Consortium-2 definitions were used to adjudicate events. RESULTS Between June 2017 and December 2020, 214 patients were included from 25 centers in North America and Europe; 72.8% had bioprosthetic aortic valves and 78.5% underwent solo BASILICA. Leaflet traversal was successful in 94.9% and leaflet laceration in 94.4%. Partial or complete coronary artery obstruction was seen in 4.7%. Procedure success, defined as successful BASILICA traversal and laceration without mortality, coronary obstruction, or emergency intervention, was achieved in 86.9%. Thirty-day mortality was 2.8% and stroke was 2.8%, with 0.5% disabling stroke. Thirty-day death and disabling stroke were seen in 3.4%. Valve Academic Research Consortium-2 composite safety was achieved in 82.8%. One-year survival was 83.9%. Outcomes were similar between solo and doppio BASILICA, between native and bioprosthetic valves, and with the use of cerebral embolic protection. CONCLUSIONS BASILICA is safe, with low reported rates of stroke and death. BASILICA is feasible in the real-world setting, with a high procedure success rate and low rates of coronary artery obstruction.
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Affiliation(s)
- Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Vasilis C Babaliaros
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Christian Spies
- Burlingame Center, BASH-Sutter Health, San Francisco, California, USA
| | - David Daniels
- Burlingame Center, BASH-Sutter Health, San Francisco, California, USA
| | - Jeremiah P Depta
- Sands Constellation Heart Institute, Rochester Regional Health, Rochester, New York, USA
| | - J Bradley Oldemeyer
- UC Health Heart and Vascular Clinic, Medical Center of the Rockies, Loveland, Colorado, USA
| | - Brian Whisenant
- Department of Cardiology, Intermountain Medical Center, Salt Lake City, Utah, USA
| | - James M McCabe
- Section of Interventional Cardiology, University of Washington, Seattle, Washington, USA
| | - Kamran I Muhammad
- Section of Interventional Cardiology, Oklahoma Heart Institute, Tulsa, Oklahoma, USA
| | - Isaac George
- Department of Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Paul Mahoney
- Structural Heart Center, Sentara Heart Hospital, Norfolk, Virginia, USA
| | - Jonas Lanz
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Roger J Laham
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Pinak B Shah
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Adnan Chhatriwalla
- St. Luke's Mid America Heart Institute, St. Luke's Hospital of Kansas City, Kansas City, Missouri, USA
| | - Shahram Yazdani
- Section of Structural Heart Disease, Carient Heart and Vascular, Manassas, Virginia, USA
| | - George Hanzel
- Department of Cardiology, Beaumont Hospital, Royal Oak, Michigan, USA
| | - Ashish Pershad
- Section of Interventional Cardiology, Banner University Medical Center, Phoenix, Arizona, USA
| | - Robert A Leonardi
- Lexington Heart and Vascular Center, Lexington Medical Center, West Columbia, South Carolina, USA
| | - Ramzi Khalil
- Department of Cardiology, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, New York, USA
| | - Howard C Herrmann
- Section of Interventional Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shikhar Agarwal
- Geisinger Heart Institute, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Peter S Fail
- Section of Interventional Cardiology, Cardiovascular Center of the South, Houma, Louisiana, USA
| | - Ming Zhang
- Department of Cardiovascular Services, Swedish Medical Center, Seattle, Washington, USA
| | - Andrei Pop
- AMITA Health Medical Group Heart and Vascular, Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - John Lisko
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Emily Perdoncin
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Rachel L Koch
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Cheng Zhang
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Jeffrey E Cohen
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
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Lisko JC, Babaliaros VC, Khan JM, Kamioka N, Gleason PT, Paone G, Byku I, Tiwana J, McCabe JM, Cherukuri K, Khalil R, Lasorda D, Goel SS, Kleiman NS, Reardon MJ, Daniels DV, Spies C, Mahoney P, Case BC, Whisenant BK, Yadav PK, Condado JF, Koch R, Grubb KJ, Bruce CG, Rogers T, Lederman RJ, Greenbaum AB. Tip-to-Base LAMPOON for Transcatheter Mitral Valve Replacement With a Protected Mitral Annulus. JACC Cardiovasc Interv 2021; 14:541-550. [PMID: 33663781 DOI: 10.1016/j.jcin.2020.11.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate tip-to-base intentional laceration of the anterior mitral leaflet to prevent left ventricular outflow tract obstruction (LAMPOON) in patients undergoing transcatheter mitral valve replacement (TMVR) in annuloplasty rings or surgical mitral valves. BACKGROUND LAMPOON is an effective adjunct to TMVR that prevents left ventricular outflow tract obstruction (LVOTO). Laceration is typically performed from the base to the tip of the anterior mitral leaflet. A modified laceration technique from leaflet tip to base may be effective in patients with a prosthesis that protects the aortomitral curtain. METHODS This is a multicenter, 21-patient, consecutive retrospective observational cohort. Patients underwent tip-to-base LAMPOON to prevent LVOTO and leaflet overhang, or therapeutically to lacerate a long anterior mitral leaflet risking or causing LVOTO. Outcomes were compared with findings from patients in the LAMPOON investigational device exemption trial with a prior mitral annuloplasty. RESULTS Twenty-one patients with a annuloplasty or valve prosthesis-protected mitral annulus underwent tip-to-base LAMPOON (19 preventive, 2 rescue). Leaflet laceration was successful in all and successfully prevented or treated LVOTO in all patients. No patients had significant LVOTO upon discharge. There were 2 cases of unintentional aortic valve injury (1 patient underwent emergency transcatheter aortic valve replacement and 1 patient underwent urgent surgical aortic valve replacement). In both cases, the patients had a supra-annular ring annuloplasty, and the retrograde aortic guiding catheter failed to insulate the guidewire lacerating surface from the aortic root. All patients survived to 30 days. Compared with classic retrograde LAMPOON, there was a trend toward shorter procedure time. CONCLUSIONS Tip-to-base laceration is a simple, effective, and safe LAMPOON variant applicable to patients with an appropriately positioned mitral annular ring or bioprosthetic valve. Operators should take care to insulate the lacerating surface from adjacent structures.
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Affiliation(s)
- John C Lisko
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vasilis C Babaliaros
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA.
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Norihiko Kamioka
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Patrick T Gleason
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gaetano Paone
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Isida Byku
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jasleen Tiwana
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - James M McCabe
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Krishna Cherukuri
- Division of Cardiology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Ramzi Khalil
- Division of Cardiology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - David Lasorda
- Division of Cardiology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Sachin S Goel
- Division of Cardiology, Houston Methodist, Houston, Texas, USA
| | - Neal S Kleiman
- Division of Cardiology, Houston Methodist, Houston, Texas, USA
| | | | - David V Daniels
- Division of Cardiology, Palo Alto Medical Foundation, San Francisco, California, USA
| | - Christian Spies
- Division of Cardiology, Palo Alto Medical Foundation, San Francisco, California, USA
| | - Paul Mahoney
- Division of Cardiology, Sentara Heart Center, Norfolk, Virginia, USA
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Pradeep K Yadav
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Jose F Condado
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rachel Koch
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kendra J Grubb
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Adam B Greenbaum
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
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Khan JM, Rogers T, Greenbaum AB, Babaliaros VC, Lisko JC, Yildirim DK, Bruce CG, Herzka DA, Ratnayaka K, Lederman RJ. Advances in Transcatheter Electrosurgery for Treating Valvular Heart Disease. US Cardiology Review 2021. [DOI: 10.15420/usc.2020.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Delivery of electrosurgery energy through catheters and guidewires enables interventionists to ‘cut’ through obstructive intravascular lesions or across cardiac chambers. A novel application of transcatheter electrosurgery is to make controlled lacerations in heart valve leaflets. This review describes three applications of transcatheter electrosurgery of aortic and mitral valve leaflets to enable transcatheter heart valve implantation. Intentional laceration of the anterior mitral leaflet to prevent left ventricular outflow obstruction splits and splays the anterior mitral valve and enables transcatheter mitral valve replacement without left ventricular outflow tract obstruction. Technique modifications and novel applications are described. Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction enables transcatheter aortic valve replacement without coronary artery obstruction. The technique is described and novel uses, especially in the setting of repeat transcatheter aortic valve replacement, are discussed. Finally, electrosurgical laceration and stabilization of mitral valve clip devices (ELASTA-Clip) enables transcatheter mitral valve replacement after MitraClip implantation. In conclusion, transcatheter electrosurgery is an important and versatile new tool in structural heart intervention.
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Affiliation(s)
- Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC
| | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA
| | | | - John C Lisko
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA
| | - Dursun Korel Yildirim
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Daniel A Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Kanishka Ratnayaka
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD; UCSD Rady Children’s Hospital, San Diego, CA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD
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42
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Case BC, Lisko JC, Babaliaros VC, Greenbaum AB, Satler L, Ben-Dor I, Forrestal BJ, Yerasi C, Kamioka N, Rogers T, Waksman R, Lederman RJ, Khan JM. LAMPOON techniques to prevent or manage left ventricular outflow tract obstruction in transcatheter mitral valve replacement. Ann Cardiothorac Surg 2021; 10:172-179. [PMID: 33575191 DOI: 10.21037/acs-2020-mv-25] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Transcatheter mitral valve replacement (TMVR) is a therapeutic option for patients with severe mitral disease who are deemed inoperable due to their overall surgical risk. The close relationships between the left ventricular outflow tract (LVOT) and the anterior mitral valve leaflet can lead to LVOT obstruction, a common complication with high mortality. Predicting and preventing LVOT obstruction is therefore essential, prior to TMVR. Laceration of the Anterior Mitral leaflet to Prevent Outflow ObtructioN (LAMPOON) is a transcatheter electrosurgical technique to split the anterior mitral valve leaflet immediately prior to TMVR. The technique has been studied in a prospective clinical trial and has evolved with many iterations for specific anatomies. In this review, we discuss the different LAMPOON techniques to prevent and treat LVOT obstruction.
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Affiliation(s)
- Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - John C Lisko
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA, USA
| | | | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA, USA
| | - Lowell Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Brian J Forrestal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Charan Yerasi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Norihiko Kamioka
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA, 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
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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43
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Perdoncin E, Greenbaum AB, Grubb KJ, Babaliaros VC, Keegan P, Ceretto‐Clark B, Wei J, Guyton RA, Paone G, Byku I, Gleason PT, Biven K, Mathew P, Mortorano C, Inci EK, Faaborg‐Andersen C, Mitchell R, Devireddy CM. Safety of same‐day discharge after uncomplicated, minimalist transcatheter aortic valve replacement in the COVID‐19 era. Catheter Cardiovasc Interv 2020; 97:940-947. [DOI: 10.1002/ccd.29453] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/10/2020] [Accepted: 12/13/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Emily Perdoncin
- Division of Cardiology, Emory Structural Heart and Valve Center Emory University Hospital Midtown Atlanta Georgia USA
| | - Adam B. Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center Emory University Hospital Midtown Atlanta Georgia USA
| | - Kendra J. Grubb
- Division of Cardiothoracic Surgery, Emory Structural Heart and Valve Center Emory University Hospital Midtown Atlanta Georgia USA
| | - Vasilis C. Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center Emory University Hospital Midtown Atlanta Georgia USA
| | - Patricia Keegan
- Division of Cardiology, Emory Structural Heart and Valve Center Emory University Hospital Midtown Atlanta Georgia USA
| | | | - Jane Wei
- Rollins School of Public Health Emory University Atlanta Georgia USA
| | - Robert A. Guyton
- Division of Cardiothoracic Surgery, Emory Structural Heart and Valve Center Emory University Hospital Midtown Atlanta Georgia USA
| | - Gaetano Paone
- Division of Cardiothoracic Surgery, Emory Structural Heart and Valve Center Emory University Hospital Midtown Atlanta Georgia USA
| | - Isida Byku
- Division of Cardiology, Emory Structural Heart and Valve Center Emory University Hospital Midtown Atlanta Georgia USA
| | - Patrick T. Gleason
- Division of Cardiology, Emory Structural Heart and Valve Center Emory University Hospital Midtown Atlanta Georgia USA
| | - Kelby Biven
- Division of Cardiology, Emory Structural Heart and Valve Center Emory University Hospital Midtown Atlanta Georgia USA
| | - Preethy Mathew
- Division of Cardiology, Emory Structural Heart and Valve Center Emory University Hospital Midtown Atlanta Georgia USA
| | - Cecilia Mortorano
- Emory Healthcare Emory University Hospital Midtown Atlanta Georgia USA
| | - Errol K. Inci
- Division of Cardiology, Emory Structural Heart and Valve Center Emory University Hospital Midtown Atlanta Georgia USA
| | - Christian Faaborg‐Andersen
- Division of Cardiology, Emory Structural Heart and Valve Center Emory University Hospital Midtown Atlanta Georgia USA
| | - Rae Mitchell
- Emory Healthcare Emory University Hospital Midtown Atlanta Georgia USA
| | - Chandan M. Devireddy
- Division of Cardiology, Emory Structural Heart and Valve Center Emory University Hospital Midtown Atlanta Georgia USA
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Abstract
Ventricular septal rupture and hemopericardium are rare postinfarction complications. Contrast[HYPHEN]enhanced echocardiography can help identify pericardial effusion etiologies. Transcaval percutaneous ventricular assist device implantation is a viable strategy.
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Affiliation(s)
- Samuel D Maidman
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Logan M Eberly
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Adam B Greenbaum
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Robert A Guyton
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Bryan J Wells
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
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Byku I, Kamioka N, Greenbaum AB, Gleason P, Babaliaros VC, Grubb KJ. Master of cardiothoracic surgery: transcaval transcatheter aortic valve replacement. Ann Cardiothorac Surg 2020; 9:531-533. [PMID: 33312918 DOI: 10.21037/acs-2020-av-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Isida Byku
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Norihiko Kamioka
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Adam B Greenbaum
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Patrick Gleason
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Vasilis C Babaliaros
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Kendra J Grubb
- Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Lisko JC, Greenbaum AB, Guyton RA, Kamioka N, Grubb KJ, Gleason PT, Byku I, Condado JF, Jadue A, Paone G, Block PC, Alvarez L, Xie J, Khan JM, Rogers T, Lederman RJ, Babaliaros VC. Electrosurgical Detachment of MitraClips From the Anterior Mitral Leaflet Prior to Transcatheter Mitral Valve Implantation. JACC Cardiovasc Interv 2020; 13:2361-2370. [PMID: 33011144 PMCID: PMC7584767 DOI: 10.1016/j.jcin.2020.06.047] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/20/2020] [Accepted: 06/18/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this study was to test the hypothesis that transcatheter electrosurgery might allow intentional detachment of previously placed MitraClip(s) from the anterior leaflet to recreate a single mitral orifice for transcatheter mitral valve implantation (TMVI), leaving the retained MitraClip(s) securely fastened to the posterior leaflet and without interfering with the mitral bioprosthesis. BACKGROUND Patients with severe mitral regurgitation or stenosis despite edge-to-edge mitral repair with the MitraClip typically have few therapeutic options because the resultant double orifice precludes TMVI. Transcatheter electrosurgery may allow detachment of failed MitraClip(s) from the anterior leaflet to recreate a single orifice for TMVI. METHODS This was a single-center, 5-patient, consecutive, retrospective observational cohort. Patients underwent transcatheter electrosurgical laceration and stabilization of failed MitraClip(s) to recreate a single orifice, leaving the MitraClip(s) securely fastened to the posterior leaflet. Subsequently, patients underwent TMVI with an investigational device, the Tendyne mitral bioprosthesis, on a compassionate basis. Patients were followed up to 30 days. RESULTS MitraClip detachment from the anterior leaflet and Tendyne implantation were successful in all patients. All patients survived to discharge. All patients were discharged with grade 0 central mitral regurgitation. Two patients had moderate perivalvular mitral regurgitation that did not require reintervention. During the follow-up period of 30 days, there were no deaths, cases of valve dysfunction, or reintervention. There was no evidence of erosion or bioprosthetic valve dysfunction attributable to the retained MitraClip(s) still attached to the posterior leaflet. CONCLUSIONS Transcatheter electrosurgical detachment of failed MitraClips from the anterior leaflet followed by TMVI is technically feasible and safe at 30 days. Longer term study is needed to determine the clinical benefit of this approach and new algorithms for TMVI sizing following electrosurgical laceration and stabilization of a failed MitraClip to avoid perivalvular leak.
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Affiliation(s)
- John C Lisko
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Adam B Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Robert A Guyton
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Norihiko Kamioka
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Kendra J Grubb
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Patrick T Gleason
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Isida Byku
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Jose F Condado
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Andres Jadue
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Gaetano Paone
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Peter C Block
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Lucia Alvarez
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Joe Xie
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Vasilis C Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia.
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47
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Khan JM, Bruce CG, Babaliaros VC, Greenbaum AB, Rogers T, Lederman RJ. TAVR Roulette: Caution Regarding BASILICA Laceration for TAVR-in-TAVR. JACC Cardiovasc Interv 2020; 13:787-789. [PMID: 32192701 DOI: 10.1016/j.jcin.2019.10.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/24/2019] [Accepted: 10/03/2019] [Indexed: 11/19/2022]
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Afana M, Altawil M, Basir M, Alqarqaz M, Alaswad K, Eng M, O'Neill WW, Lederman RJ, Greenbaum AB. Transcaval access for the emergency delivery of 5.0 liters per minute mechanical circulatory support in cardiogenic shock. Catheter Cardiovasc Interv 2020; 97:555-564. [PMID: 32902101 DOI: 10.1002/ccd.29235] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/02/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The purpose of this study was to describe the feasibility and early outcomes of transcaval access for delivery of emergency mechanical circulatory support (MCS) in cardiogenic shock. BACKGROUND Vascular access for implantation of MCS in patients with cardiogenic shock is often challenging due to peripheral arterial disease and vasoconstriction. Transcaval delivery of MCS may be an alternative. We describe a series of patients we implanted an Impella 5.0 device, on-table without CT planning, through a percutaneous transcaval access route. METHODS Ten patients with progressive or refractory cardiogenic shock underwent Impella 5.0 implantation via transcaval access. Demographic, clinical and procedural variables and in-hospital outcomes were collected. RESULTS All ten underwent emergency implantation of the 7 mm diameter Impella 5.0 device via transcaval access. Six were women, with median age of 55.5 years (range, 29-69). Cardiogenic shock was attributed to idiopathic nonischemic cardiomyopathy (n = 4), myocarditis (n = 2), ischemic cardiomyopathy (n = 2), heart transplant rejection (n = 1), and unknown etiology (n = 1). Median duration of support was 92.1 hr (range, 21.2-165.4). Seven (70%) survived to device explant, with six (60%) surviving to access port closure and discharge. Among survivors, five recovered heart function and one received destination therapy left ventricular assist device. CONCLUSIONS Transcaval access is feasible for emergency nonsurgical implantation of the Impella 5.0 device in cardiogenic shock with small or diseased iliofemoral arteries. This allows early institution of higher-flow MCS than conventional femoral artery implantation of the 3.5 L Impella CP device, and enables a bridge-to-recovery or bridge-to-destination strategy.
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Affiliation(s)
- Majed Afana
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Mahmoud Altawil
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Mir Basir
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Mohammad Alqarqaz
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Khaldoon Alaswad
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Marvin Eng
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA.,Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - William W O'Neill
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA.,Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA
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Rogers T, Khan JM, Satler LF, Greenbaum AB, Lederman RJ. TAVR-in-TAVR?: Don't Bank on It! J Am Coll Cardiol 2020; 76:1003. [PMID: 32819458 DOI: 10.1016/j.jacc.2020.05.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 11/17/2022]
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50
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Kohli K, Wei ZA, Sadri V, Easley TF, Pierce EL, Zhang YN, Wang DD, Greenbaum AB, Lisko JC, Khan JM, Lederman RJ, Blanke P, Oshinski JN, Babaliaros V, Yoganathan AP. Framework for Planning TMVR using 3-D Imaging, In Silico Modeling, and Virtual Reality. Structural Heart 2020. [DOI: 10.1080/24748706.2020.1762268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Keshav Kohli
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University
| | - Zhenglun Alan Wei
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University
| | - Vahid Sadri
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University
| | - Thomas F. Easley
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University
| | - Eric L. Pierce
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University
| | - Yingnan Nancy Zhang
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University
| | - Dee Dee Wang
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Adam B. Greenbaum
- Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA
| | - John C. Lisko
- Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA
| | - Jaffar M. Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health
| | - Robert J. Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health
| | | | - John N. Oshinski
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University
- Department of Radiology and Imaging Science, Emory University, Atlanta, Georgia, USA
| | - Vasilis Babaliaros
- Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA
| | - Ajit P. Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University
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