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Shakweer WME, Krivoruchko AY, Dessouki SM, Khattab AA. A review of transgenic animal techniques and their applications. J Genet Eng Biotechnol 2023; 21:55. [PMID: 37160523 PMCID: PMC10169938 DOI: 10.1186/s43141-023-00502-z] [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: 12/12/2022] [Accepted: 04/20/2023] [Indexed: 05/11/2023]
Abstract
Nowadays, breakthroughs in molecular biology are happening at an unprecedented rate. One of them is the ability to engineer transgenic animals. A transgenic animal is one whose genome has been changed to carry genes from another species or to use techniques for animal genome editing for specific traits. Animal features can be changed by purposefully altering the gene (or genes). A mouse was the first successful transgenic animal. Then pigs, sheep, cattle, and rabbits came a few years later. The foreign-interested genes that will be used in animal transgenic techniques are prepared using a variety of methods. The produced gene of interest is placed into a variety of vectors, including yeast artificial chromosomes, bacterial plasmids, and cosmids. Several techniques, including heat shock, electroporation, viruses, the gene gun, microinjection, and liposomes, are used to deliver the created vector, which includes the interesting gene, into the host cell. Transgenesis can be carried out in the gonads, sperm, fertilized eggs, and embryos through DNA microinjection, retroviruses, stem cells, and cloning. The most effective transgenic marker at the moment is fluorescent protein. Although transgenesis raises a number of ethical concerns, this review concentrates on the fundamentals of animal transgenesis and its usage in industry, medicine, and agriculture. Transgenesis success is confirmed by the integration of an antibiotic resistance gene, western and southern blots, PCR, and ELISA. If technology solves social and ethical problems, it will be the most promising in the future.
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Affiliation(s)
- W M E Shakweer
- Animal Production Department, Agricultural and Biological Research Institute, National Research Centre, 33 El-Buhouth Street, Dokki, Cairo, 12622, Egypt.
| | - A Y Krivoruchko
- Genetic and Biotechnology Department, All-Russian Research Institute of Sheep and Goat Breeding, Stavropol, Russia
| | - Sh M Dessouki
- Department of Animal Production, Faculty of Agriculture, Cairo University, 7 Gamaa Street, Giza, 12613, Egypt
| | - A A Khattab
- Genetics and Cytology Department, Biotechnology Research Institute, National Research Centre, 33 El-Buhouth Street, Dokki, Cairo, 12622, Egypt
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Muntané-Carol G, Taramasso M, Miura M, Gavazzoni M, Pozzoli A, Alessandrini H, Latib A, Attinger-Toller A, Biasco L, Braun D, Brochet E, Connelly KA, de Bruijn S, Denti P, Deuschl F, Lubos E, Ludwig S, Kalbacher D, Estevez-Loureiro R, Fam N, Frerker C, Ho E, Juliard JM, Kaple R, Kodali S, Kreidel F, Harr C, Lauten A, Lurz J, Monivas V, Mehr M, Nazif T, Nickening G, Pedrazzini G, Philippon F, Praz F, Puri R, Schäfer U, Schofer J, Sievert H, Tang GHL, Khattab AA, Andreas M, Russo M, Thiele H, Unterhuber M, Himbert D, Urena M, von Bardeleben RS, Webb JG, Weber M, Windecker S, Winkel M, Zuber M, Hausleiter J, Lurz P, Maisano F, Leon MB, Hahn RT, Rodés-Cabau J. Transcatheter Tricuspid Valve Intervention in Patients With Right Ventricular Dysfunction or Pulmonary Hypertension: Insights From the TriValve Registry. Circ Cardiovasc Interv 2021; 14:e009685. [PMID: 33541097 DOI: 10.1161/circinterventions.120.009685] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Scarce data exist on patients with right ventricular dysfunction (RVD) or pulmonary hypertension (PH) undergoing transcatheter tricuspid valve intervention. This study aimed to determine the early and midterm outcomes and the factors associated with mortality in this group of patients. METHODS This subanalysis of the multicenter TriValve (Transcatheter Tricuspid Valve Therapies) registry included 300 patients with severe tricuspid regurgitation with RVD (n=244), PH (n=127), or both (n=71) undergoing transcatheter tricuspid valve intervention. RVD was defined as a tricuspid annular plane systolic excursion <17 mm, and PH as an estimated pulmonary artery systolic pressure ≥50 mm Hg. RESULTS Mean age of the patients was 77±9 years (54% women). Procedural success was 80.7%, and 9 patients (3%) died during the hospitalization. At a median follow-up of 6 (interquartile range, 2-12) months, 54 patients (18%) died, and the independent associated factors were higher gamma-glutamyl transferase values at baseline (hazard ratio, 1.02 for each increase of 10 u/L [95% CI, 1.002-1.04]), poorer renal function defined as an estimated glomerular filtration rate <45 mL/min (hazard ratio, 2.3 [95% CI, 1.22-4.33]), and the lack of procedural success (hazard ratio, 2.11 [95% CI, 1.17-3.81]). The grade of RVD and the amount of PH at baseline were not found to be predictors of mortality. Most patients alive at follow-up improved their functional class (New York Heart Association I-II in 66% versus 7% at baseline, P<0.001). CONCLUSIONS In patients with severe tricuspid regurgitation and RVD/PH, transcatheter tricuspid valve intervention was associated with high procedural success and a relatively low in-hospital mortality, along with significant improvements in functional status. However, about 1 out of 5 patients died after a median follow-up of 6 months, with hepatic congestion, renal dysfunction, and the lack of procedural success determining an increased risk. These results may improve the clinical evaluation of transcatheter tricuspid valve intervention candidates and would suggest a closer follow-up in those at increased risk. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03416166.
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Affiliation(s)
- Guillem Muntané-Carol
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (G.M.-C., F. Philippon, R.P., J.R.-C.)
| | - Maurizio Taramasso
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Mizuki Miura
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Mara Gavazzoni
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Alberto Pozzoli
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Hannes Alessandrini
- Cardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany (H.A., C.F., C.H.)
| | - Azeem Latib
- Cardiology Department, Montefiore Medical Center, New York, NY (A. Latib, E.H.)
| | | | - Luigi Biasco
- Cardiology Department, Cardiocentro, Lugano, Switzerland (L.B., G.P.)
| | - Daniel Braun
- Cardiology Department, Klinikum der Universität München, Germany (D.B., M. Mehr, J.H.)
| | - Eric Brochet
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France (E.B., J.-M.J., D.H., M.U.)
| | - Kim A Connelly
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Canada (K.A.C., N.F., E.H.)
| | - Sabine de Bruijn
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany (S.d.B., H.S.)
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy (P.D.)
| | - Florian Deuschl
- Cardiology Department, University Heart and Vascular Center Hamburg, Germany (F.D., E.L., S.L., D.K., U.S.)
| | - Edith Lubos
- Cardiology Department, University Heart and Vascular Center Hamburg, Germany (F.D., E.L., S.L., D.K., U.S.)
| | - Sebastian Ludwig
- Cardiology Department, University Heart and Vascular Center Hamburg, Germany (F.D., E.L., S.L., D.K., U.S.)
| | - Daniel Kalbacher
- Cardiology Department, University Heart and Vascular Center Hamburg, Germany (F.D., E.L., S.L., D.K., U.S.)
| | - Rodrigo Estevez-Loureiro
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain (R.E.-L., V.M.)
| | - Neil Fam
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Canada (K.A.C., N.F., E.H.)
| | - Christian Frerker
- Cardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany (H.A., C.F., C.H.)
| | - Edwin Ho
- Cardiology Department, Montefiore Medical Center, New York, NY (A. Latib, E.H.).,Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Canada (K.A.C., N.F., E.H.)
| | - Jean-Michel Juliard
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France (E.B., J.-M.J., D.H., M.U.)
| | - Ryan Kaple
- Cardiology Department, Westchester Medical Center, Valhalla, NY (R.K.)
| | - Susheel Kodali
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY (S.K., T.N., M.B.N., R.T.H.)
| | - Felix Kreidel
- Cardiology Department, Department of Cardiology, University Medical Center Mainz, Germany (F.K., R.S.V.B.)
| | - Claudia Harr
- Cardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany (H.A., C.F., C.H.)
| | - Alexander Lauten
- Cardiology Department, Charité University Hospital, Berlin, Germany (A. Lauten)
| | - Julia Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Germany (J.L., H.T., M.U., P.L.)
| | - Vanessa Monivas
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain (R.E.-L., V.M.)
| | - Michael Mehr
- Cardiology Department, Klinikum der Universität München, Germany (D.B., M. Mehr, J.H.)
| | - Tamin Nazif
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY (S.K., T.N., M.B.N., R.T.H.)
| | - Georg Nickening
- Cardiology Department, Universitatsklinikum Bonn, Germany (G.N., M. Weber)
| | | | - François Philippon
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (G.M.-C., F. Philippon, R.P., J.R.-C.)
| | - Fabien Praz
- Cardiology Department, Inselspital, Bern University Hospital (F. Praz, S.W., M. Winkel), University of Bern, Switzerland
| | - Rishi Puri
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (G.M.-C., F. Philippon, R.P., J.R.-C.)
| | - Ulrich Schäfer
- Cardiology Department, University Heart and Vascular Center Hamburg, Germany (F.D., E.L., S.L., D.K., U.S.)
| | - Joachim Schofer
- Cardiology Department, Albertinen Heart Center, Hamburg, Germany (J.S.)
| | - Horst Sievert
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany (S.d.B., H.S.)
| | - Gilbert H L Tang
- Cardiac Surgery Department, Mount Sinai Hospital, New York, NY (G.H.L.T.)
| | - Ahmed A Khattab
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.).,Cardiology Department (A.A.K.), University of Bern, Switzerland.,Cardiology Department, Cardiance Clinic, Pfäffikon, Switzerland (A.A.K.)
| | - Martin Andreas
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna (M.A., M.R.)
| | - Marco Russo
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna (M.A., M.R.)
| | - Holger Thiele
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Germany (J.L., H.T., M.U., P.L.)
| | - Matthias Unterhuber
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Germany (J.L., H.T., M.U., P.L.)
| | - Dominique Himbert
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France (E.B., J.-M.J., D.H., M.U.)
| | - Marina Urena
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France (E.B., J.-M.J., D.H., M.U.)
| | | | - John G Webb
- Cardiology Department, St. Paul Hospital, Vancouver, Canada (A.A.-T., J.G.W.)
| | - Marcel Weber
- Cardiology Department, Universitatsklinikum Bonn, Germany (G.N., M. Weber)
| | - Stephan Windecker
- Cardiology Department, Inselspital, Bern University Hospital (F. Praz, S.W., M. Winkel), University of Bern, Switzerland
| | - Mirjam Winkel
- Cardiology Department, Inselspital, Bern University Hospital (F. Praz, S.W., M. Winkel), University of Bern, Switzerland
| | - Michel Zuber
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Jörg Hausleiter
- Cardiology Department, Klinikum der Universität München, Germany (D.B., M. Mehr, J.H.)
| | - Philipp Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Germany (J.L., H.T., M.U., P.L.)
| | - Francesco Maisano
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Martin B Leon
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY (S.K., T.N., M.B.N., R.T.H.)
| | - Rebecca T Hahn
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY (S.K., T.N., M.B.N., R.T.H.)
| | - Josep Rodés-Cabau
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (G.M.-C., F. Philippon, R.P., J.R.-C.)
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A. Khattab A, H. Gouda S, Y. El-Okby AEW. ORAL VERSUS TOPICAL PROPRANOLOL IN MANAGEMENT OF INFANTILE HEMANGIOMA. Al-Azhar Medical Journal 2021; 50:133-142. [DOI: 10.21608/amj.2021.139696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Taramasso M, Gavazzoni M, Pozzoli A, Alessandrini H, Latib A, Attinger-Toller A, Biasco L, Braun D, Brochet E, Connelly KA, de Bruijn S, Denti P, Deuschl F, Estevez-Louriero R, Fam N, Frerker C, Ho E, Juliard JM, Kaple R, Kodali S, Kreidel F, Kuck KH, Lauten A, Lurz J, Monivas V, Mehr M, Nazif T, Nickening G, Pedrazzini G, Praz F, Puri R, Rodés-Cabau J, Schäfer U, Schofer J, Sievert H, Tang GHL, Khattab AA, Thiele H, Unterhuber M, Vahanian A, Von Bardeleben RS, Webb JG, Weber M, Windecker S, Winkel M, Zuber M, Hausleiter J, Lurz P, Maisano F, Leon MB, Hahn RT. Outcomes of TTVI in Patients With Pacemaker or Defibrillator Leads: Data From the TriValve Registry. JACC Cardiovasc Interv 2020; 13:554-564. [PMID: 31954676 DOI: 10.1016/j.jcin.2019.10.058] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 07/29/2019] [Revised: 09/30/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The interference of a transtricuspid cardiac implantable electronic device (CIED) lead with tricuspid valve function may contribute to the mechanism of tricuspid regurgitation (TR) and poses specific therapeutic challenges during transcatheter tricuspid valve intervention (TTVI). Feasibility and efficacy of TTVI in presence of a CIED is unclear. BACKGROUND Feasibility of TTVI in presence of a CIED lead has never been proven on a large basis. METHODS The study population consisted of 470 patients with severe symptomatic TR from the TriValve (Transcatheter Tricuspid Valve Therapies) registry who underwent TTVI at 21 centers between 2015 and 2018. The association of CIED and outcomes were assessed. RESULTS Pre-procedural CIED was present in 121 of 470 (25.7%) patients. The most frequent location of the CIED lead was the posteroseptal commissure (44.0%). As compared with patients without a transvalvular lead (no-CIED group), patients having a tricuspid lead (CIED group) were more symptomatic (New York Heart Association functional class III to IV in 95.9% vs. 92.3%; p = 0.02) and more frequently had previous episodes of right heart failure (87.8% vs. 69.0%; p = 0.002). No-CIED patients had more severe TR (effective regurgitant orifice area 0.7 ± 0.6 cm2 vs. 0.6 ± 0.3 cm2; p = 0.02), but significantly better right ventricular function (tricuspid annular plane systolic excursion = 16.7 ± 5.0 mm vs. 15.9 ± 4.0 mm; p = 0.04). Overall, 373 patients (79%) were treated with the MitraClip (Abbott Vascular, Santa Clara, California) (106 [87.0%] in the CIED group). Among them, 154 (33%) patients had concomitant transcatheter mitral repair (55 [46.0%] in the CIED group, all MitraClip). Procedural success was achieved in 80.0% of no-CIED patients and in 78.6% of CIED patients (p = 0.74), with an in-hospital mortality of 2.9% and 3.7%, respectively (p = 0.70). At 30 days, residual TR ≤2+ was observed in 70.8% of no-CIED and in 73.7% of CIED patients (p = 0.6). Symptomatic improvement was observed in both groups (NYHA functional class I to II at 30 days: 66.0% vs. 65.0%; p = 0.30). Survival at 12 months was 80.7 ± 3.0% in the no-CIED patients and 73.6 ± 5.0% in the CIED patients (p = 0.30). CONCLUSIONS TTVI is feasible in selected patients with CIED leads and acute procedural success and short-term clinical outcomes are comparable to those observed in patients without a transtricuspid lead.
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Affiliation(s)
- Maurizio Taramasso
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
| | - Mara Gavazzoni
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Alberto Pozzoli
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | | | - Azeem Latib
- Cardiology Department, Montefiore Medical Center, New York, New York
| | | | - Luigi Biasco
- Cardiology Department, Cardiocentro, Lugano, Switzerland
| | - Daniel Braun
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Eric Brochet
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | - Kim A Connelly
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Canada
| | - Sabine de Bruijn
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Florian Deuschl
- Cardiology Department, University Heart Center Hamburg, Hamburg, Germany
| | - Rodrigo Estevez-Louriero
- Cardiology Department, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Neil Fam
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Canada
| | | | - Edwin Ho
- Cardiology Department, Montefiore Medical Center, New York, New York; Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, Canada
| | | | - Ryan Kaple
- Cardiology Department, Westchester Medical Center, Valhalla, New York
| | - Susheel Kodali
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Felix Kreidel
- Cardiology Department, Department of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Karl-Heinz Kuck
- Cardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Alexander Lauten
- Cardiology Department, Charité University Hospital, Berlin, Germany
| | - Julia Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Vanessa Monivas
- Cardiology Department, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Michael Mehr
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Tamin Nazif
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Georg Nickening
- Cardiology Department, Universitatsklinikum Bonn, Bonn, Germany
| | | | - Fabien Praz
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rishi Puri
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Josep Rodés-Cabau
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Ulrich Schäfer
- Cardiology Department, University Heart Center Hamburg, Hamburg, Germany
| | - Joachim Schofer
- Cardiology Department, Albertinen Heart Center, Hamburg, Germany
| | - Horst Sievert
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Gilbert H L Tang
- Cardiac Surgery Department, Mount Sinai Hospital, New York, New York
| | - Ahmed A Khattab
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland; Cardiology Department, Cardiance Clinic, Pfäffikon, Switzerland; Cardiology Department, University of Bern, Bern, Switzerland
| | - Holger Thiele
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Matthias Unterhuber
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Alec Vahanian
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | | | - John G Webb
- Cardiology Department, St. Paul Hospital, Vancouver, Canada
| | - Marcel Weber
- Cardiology Department, Universitatsklinikum Bonn, Bonn, Germany
| | - Stephan Windecker
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirjam Winkel
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michel Zuber
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Jörg Hausleiter
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Philipp Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
| | - Francesco Maisano
- Cardiology Department, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Martin B Leon
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Rebecca T Hahn
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
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Khattab AA, El-Mekkawy MS, Shehata AM, Whdan NA. Clinical study of serum interleukin-6 in children with community-acquired pneumonia. Egyptian Pediatric Association Gazette 2018. [DOI: 10.1016/j.epag.2018.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Kolandaivelu K, Bailey L, Buzzi S, Zucker A, Milleret V, Ziogas A, Ehrbar M, Khattab AA, Stanley JRL, Wong GK, Zani B, Markham PM, Tzafriri AR, Bhatt DL, Edelman ER. Ultra-hydrophilic stent platforms promote early vascular healing and minimise late tissue response: a potential alternative to second-generation drug-eluting stents. EUROINTERVENTION 2017; 12:2148-2156. [PMID: 27993749 DOI: 10.4244/eij-d-15-00497] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Simple surface modifications can enhance coronary stent performance. Ultra-hydrophilic surface (UHS) treatment of contemporary bare metal stents (BMS) was assessed in vivo to verify whether such stents can provide long-term efficacy comparable to second-generation drug-eluting stents (DES) while promoting healing comparably to BMS. METHODS AND RESULTS UHS-treated BMS, untreated BMS and corresponding DES were tested for three commercial platforms. A thirty-day and a 90-day porcine coronary model were used to characterise late tissue response. Three-day porcine coronary and seven-day rabbit iliac models were used for early healing assessment. In porcine coronary arteries, hydrophilic treatment reduced intimal hyperplasia relative to the BMS and corresponding DES platforms (1.5-fold to threefold reduction in 30-day angiographic and histological stenosis; p<0.04). Endothelialisation was similar on UHS-treated BMS and untreated BMS, both in swine and rabbit models, and lower on DES. Elevation in thrombotic indices was infrequent (never observed with UHS, rare with BMS, most often with DES), but, when present, correlated with reduced endothelialisation (p<0.01). CONCLUSIONS Ultra-hydrophilic surface treatment of contemporary stents conferred good healing while moderating neointimal and thrombotic responses. Such surfaces may offer safe alternatives to DES, particularly when rapid healing and short dual antiplatelet therapy (DAPT) are crucial.
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Affiliation(s)
- Kumaran Kolandaivelu
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
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Helaly FM, El-Sawy SM, Hashem AI, Khattab AA, Mourad RM. Synthesis and characterization of nanosilver-silicone hydrogel composites for inhibition of bacteria growth. Cont Lens Anterior Eye 2016; 40:59-66. [PMID: 27693238 DOI: 10.1016/j.clae.2016.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 06/11/2016] [Revised: 09/17/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Nanosilver-silicone hydrogel (NAgSiH) composites for contact lenses were synthesized to asses the antimicrobial effects. METHODS Silicone hydrogel (SiH) films were synthesized followed by impregnation in silver nitrate solutions (10, 20, 30, 40, 60, 80ppm) and in-situ chemical reduction of silver ions using sodium borohydride (NaBH4). The silver nano particles (AgNPS) were identified by UV-vis absorption spectroscopy, Energy-dispersive X-ray spectroscopy (EDX) mapping and EDX spectrum. Physico-mechanical and chemical properties of NAgSIH films were studied. The antimicrobial effect of the hydrogels against Escherichia coli, Pseudomonas aeruginosa, Bacillus subtilis and Staphylococcus aureus was evaluated. The numbers of viable bacterial cells on NAgSiH surface or in solution compared to control SiH were examined. RESULTS The NAgSiH films were successfully synthesized. FTIR results indicated that AgNPS had no effect on the bulk structure of the prepared SiH films. From TGA analysis, NAgSiH(R80) and SiH(R0) films had the same maximum decomposition temperature (404°C). UV-vis absorption spectroscopy and EDX mapping and spectrum emphasized that AgNPS were in spherical shape. The maximum absorption wavelength of NAgSiH films were around 400nm. The light transmittance decreased as the concentration of AgNPS increased, but still greater than 90% at wavelength around 555nm. The Young's modulus increased gradually from 1.06MPa of SiH(R0) to highest value 1.38MPa of NAgSiH(R80). AgNPS incorporated into SiH films reduced the bacterial cell growth and prevented colonization. Groups NAgSiH(R60,R80) demonstrated an excellent reduction in bacterial viability in solution and on the SiH surface. CONCLUSIONS NAgSiH composites were successfully synthesized and possessed an excellent antimicrobial effects.
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Affiliation(s)
- F M Helaly
- Department of polymers and Pigments, Division of Chemical Industries, National Research Centre, Dokki, Cairo, Egypt
| | - S M El-Sawy
- Department of polymers and Pigments, Division of Chemical Industries, National Research Centre, Dokki, Cairo, Egypt
| | - A I Hashem
- Department of Chemistry, Faculty of Science, Ain Shams University, Abbasiya, Cairo, Egypt
| | - A A Khattab
- Department of Genetics and Cytology, Division of Genetic Engineering and Biotechnology, National Research Centre, Dokki, Cairo, Egypt
| | - R M Mourad
- Department of polymers and Pigments, Division of Chemical Industries, National Research Centre, Dokki, Cairo, Egypt.
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Verheye S, Khattab AA, Carrie D, Stella P, Slagboom T, Bartunek J, Onuma Y, Serruys PW. Direct implantation of rapamycin-eluting stents with bioresorbable drug carrier technology utilising the Svelte coronary stent-on-a-wire: the DIRECT II study. EUROINTERVENTION 2016; 12:e615-22. [DOI: 10.4244/eijv12i5a101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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9
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O'Sullivan CJ, Wenaweser P, Ceylan O, Rat-Wirtzler J, Stortecky S, Heg D, Spitzer E, Zanchin T, Praz F, Tüller D, Huber C, Pilgrim T, Nietlispach F, Khattab AA, Carrel T, Meier B, Windecker S, Buellesfeld L. Effect of Pulmonary Hypertension Hemodynamic Presentation on Clinical Outcomes in Patients With Severe Symptomatic Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation: Insights From the New Proposed Pulmonary Hypertension Classification. Circ Cardiovasc Interv 2016; 8:e002358. [PMID: 26156149 DOI: 10.1161/circinterventions.114.002358] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) frequently coexists with severe aortic stenosis, and PH severity has been shown to predict outcomes after transcatheter aortic valve implantation (TAVI). The effect of PH hemodynamic presentation on clinical outcomes after TAVI is unknown. METHODS AND RESULTS Of 606 consecutive patients undergoing TAVI, 433 (71.4%) patients with severe aortic stenosis and a preprocedural right heart catheterization were assessed. Patients were dichotomized according to whether PH was present (mean pulmonary artery pressure, ≥25 mm Hg; n=325) or not (n=108). Patients with PH were further dichotomized by left ventricular end-diastolic pressure into postcapillary (left ventricular end-diastolic pressure, >15 mm Hg; n=269) and precapillary groups (left ventricular end-diastolic pressure, ≤15 mm Hg; n=56). Finally, patients with postcapillary PH were divided into isolated (n=220) and combined (n=49) subgroups according to whether the diastolic pressure difference (diastolic pulmonary artery pressure-left ventricular end-diastolic pressure) was normal (<7 mm Hg) or elevated (≥7 mm Hg). Primary end point was mortality at 1 year. PH was present in 325 of 433 (75%) patients and was predominantly postcapillary (n=269/325; 82%). Compared with baseline, systolic pulmonary artery pressure immediately improved after TAVI in patients with postcapillary combined (57.8±14.1 versus 50.4±17.3 mm Hg; P=0.015) but not in those with precapillary (49.0±12.6 versus 51.6±14.3; P=0.36). When compared with no PH, a higher 1-year mortality rate was observed in both precapillary (hazard ratio, 2.30; 95% confidence interval, 1.02-5.22; P=0.046) and combined (hazard ratio, 3.15; 95% confidence interval, 1.43-6.93; P=0.004) but not isolated PH patients (P=0.11). After adjustment, combined PH remained a strong predictor of 1-year mortality after TAVI (hazard ratio, 3.28; P=0.005). CONCLUSIONS Invasive stratification of PH according to hemodynamic presentation predicts acute response to treatment and 1-year mortality after TAVI.
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Affiliation(s)
- Crochan J O'Sullivan
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Peter Wenaweser
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Osman Ceylan
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Julie Rat-Wirtzler
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Stefan Stortecky
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Dik Heg
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Ernest Spitzer
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Thomas Zanchin
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Fabien Praz
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - David Tüller
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Christoph Huber
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Thomas Pilgrim
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Fabian Nietlispach
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Ahmed A Khattab
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Thierry Carrel
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Bernhard Meier
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Stephan Windecker
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Lutz Buellesfeld
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.).
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O'Sullivan CJ, Englberger L, Hosek N, Heg D, Cao D, Stefanini GG, Stortecky S, Gloekler S, Spitzer E, Tüller D, Huber C, Pilgrim T, Praz F, Buellesfeld L, Khattab AA, Carrel T, Meier B, Windecker S, Wenaweser P. Clinical outcomes and revascularization strategies in patients with low-flow, low-gradient severe aortic valve stenosis according to the assigned treatment modality. JACC Cardiovasc Interv 2016; 8:704-17. [PMID: 25946444 DOI: 10.1016/j.jcin.2014.11.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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: 09/05/2014] [Revised: 10/27/2014] [Accepted: 11/03/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study compared clinical outcomes and revascularization strategies among patients presenting with low ejection fraction, low-gradient (LEF-LG) severe aortic stenosis (AS) according to the assigned treatment modality. BACKGROUND The optimal treatment modality for patients with LEF-LG severe AS and concomitant coronary artery disease (CAD) requiring revascularization is unknown. METHODS Of 1,551 patients, 204 with LEF-LG severe AS (aortic valve area <1.0 cm(2), ejection fraction <50%, and mean gradient <40 mm Hg) were allocated to medical therapy (MT) (n = 44), surgical aortic valve replacement (SAVR) (n = 52), or transcatheter aortic valve replacement (TAVR) (n = 108). CAD complexity was assessed using the SYNTAX score (SS) in 187 of 204 patients (92%). The primary endpoint was mortality at 1 year. RESULTS LEF-LG severe AS patients undergoing SAVR were more likely to undergo complete revascularization (17 of 52, 35%) compared with TAVR (8 of 108, 8%) and MT (0 of 44, 0%) patients (p < 0.001). Compared with MT, both SAVR (adjusted hazard ratio [adj HR]: 0.16; 95% confidence interval [CI]: 0.07 to 0.38; p < 0.001) and TAVR (adj HR: 0.30; 95% CI: 0.18 to 0.52; p < 0.001) improved survival at 1 year. In TAVR and SAVR patients, CAD severity was associated with higher rates of cardiovascular death (no CAD: 12.2% vs. low SS [0 to 22], 15.3% vs. high SS [>22], 31.5%; p = 0.037) at 1 year. Compared with no CAD/complete revascularization, TAVR and SAVR patients undergoing incomplete revascularization had significantly higher 1-year cardiovascular death rates (adj HR: 2.80; 95% CI: 1.07 to 7.36; p = 0.037). CONCLUSIONS Among LEF-LG severe AS patients, SAVR and TAVR improved survival compared with MT. CAD severity was associated with worse outcomes and incomplete revascularization predicted 1-year cardiovascular mortality among TAVR and SAVR patients.
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Affiliation(s)
- Crochan J O'Sullivan
- Department of Cardiology, Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland
| | - Lars Englberger
- Department of Cardiovascular Surgery, Bern University Hospital, Bern, Switzerland
| | - Nicola Hosek
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Dik Heg
- Clinical Trials Unit, Bern University Hospital, Bern, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Davide Cao
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | | | - Stefan Stortecky
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Steffen Gloekler
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Ernest Spitzer
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - David Tüller
- Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland
| | - Christoph Huber
- Department of Cardiovascular Surgery, Bern University Hospital, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Lutz Buellesfeld
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Ahmed A Khattab
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Thierry Carrel
- Department of Cardiovascular Surgery, Bern University Hospital, Bern, Switzerland
| | - Bernhard Meier
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland; Clinical Trials Unit, Bern University Hospital, Bern, Switzerland
| | - Peter Wenaweser
- Department of Cardiology, Bern University Hospital, Bern, Switzerland.
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de Waha S, Allali A, Büttner HJ, Toelg R, Geist V, Neumann FJ, Khattab AA, Richardt G, Abdel-Wahab M. Rotational atherectomy before paclitaxel-eluting stent implantation in complex calcified coronary lesions: Two-year clinical outcome of the randomized ROTAXUS trial. Catheter Cardiovasc Interv 2015; 87:691-700. [PMID: 26525804 DOI: 10.1002/ccd.26290] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [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: 06/03/2015] [Revised: 07/29/2015] [Accepted: 10/03/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND In the randomized ROTAXUS trial, routine lesion preparation of complex calcified coronary lesions using rotational atherectomy (RA) prior to paclitaxel-eluting stent implantation did not reduce the primary endpoint of angiographic late lumen loss at 9 months compared to stenting without RA. So far, no long-term data of prospective head-to-head comparisons between both treatment strategies have been reported. METHODS AND RESULTS ROTAXUS randomly assigned patients with complex calcified coronary lesions to RA followed by stenting (n = 120) or stenting without RA (n = 120). The primary endpoint of the current analysis was the occurrence of major adverse cardiac events (MACE) at 2-year follow-up defined as the composite of death, myocardial infarction, and target vessel revascularization (TVR). At 2 years, MACE occurred in 32 patients in the RA group and 37 patients in the standard therapy group (29.4% vs. 34.3%, P = 0.47). The rates of death (8.3% vs. 7.4%, P = 1.00), myocardial infarction (8.3% vs. 6.5%, P = 0.80), target lesion revascularization (TLR, 13.8% vs. 16.7%, P = 0.58), and TVR (19.3% vs. 22.2%, P = 0.62) were similar in both groups. CONCLUSION Despite high rates of initial angiographic success, nearly one third of patients enrolled in ROTAXUS experienced MACE within 2-year follow-up, with no differences between patients treated with or without RA.
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Affiliation(s)
- Suzanne de Waha
- Department of Cardiology and Angiology, Segeberger Kliniken - Heart Centre, Bad Segeberg, Germany
| | - Abdelhakim Allali
- Department of Cardiology and Angiology, Segeberger Kliniken - Heart Centre, Bad Segeberg, Germany
| | - Heinz-Joachim Büttner
- Department of Cardiology, University Heart Centre Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Ralph Toelg
- Department of Cardiology and Angiology, Segeberger Kliniken - Heart Centre, Bad Segeberg, Germany
| | - Volker Geist
- Department of Cardiology and Angiology, Segeberger Kliniken - Heart Centre, Bad Segeberg, Germany
| | - Franz-Josef Neumann
- Department of Cardiology, University Heart Centre Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Ahmed A Khattab
- Department of Cardiology, University of Bern, Bern, Switzerland
| | - Gert Richardt
- Department of Cardiology and Angiology, Segeberger Kliniken - Heart Centre, Bad Segeberg, Germany
| | - Mohamed Abdel-Wahab
- Department of Cardiology and Angiology, Segeberger Kliniken - Heart Centre, Bad Segeberg, Germany
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Meier B, Blaauw Y, Khattab AA, Lewalter T, Sievert H, Tondo C, Glikson M. EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion. EUROINTERVENTION 2015; 10:1109-25. [PMID: 25169595 DOI: 10.4244/eijy14m08_18] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Bernhard Meier
- Cardiology, Bern University Hospital, 3010 Bern, Switzerland
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13
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Stortecky S, Stefanini GG, Pilgrim T, Heg D, Praz F, Luterbacher F, Piccolo R, Khattab AA, Räber L, Langhammer B, Huber C, Meier B, Jüni P, Wenaweser P, Windecker S. Validation of the Valve Academic Research Consortium Bleeding Definition in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation. J Am Heart Assoc 2015; 4:e002135. [PMID: 26408014 PMCID: PMC4845126 DOI: 10.1161/jaha.115.002135] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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] [Indexed: 11/30/2022]
Abstract
Background The Valve Academic Research Consortium (VARC) has proposed a standardized definition of bleeding in patients undergoing transcatheter aortic valve interventions (TAVI). The VARC bleeding definition has not been validated or compared to other established bleeding definitions so far. Thus, we aimed to investigate the impact of bleeding and compare the predictivity of VARC bleeding events with established bleeding definitions. Methods and Results Between August 2007 and April 2012, 489 consecutive patients with severe aortic stenosis were included into the Bern‐TAVI‐Registry. Every bleeding complication was adjudicated according to the definitions of VARC, BARC, TIMI, and GUSTO. Periprocedural blood loss was added to the definition of VARC, providing a modified VARC definition. A total of 152 bleeding events were observed during the index hospitalization. Bleeding severity according to VARC was associated with a gradual increase in mortality, which was comparable to the BARC, TIMI, GUSTO, and the modified VARC classifications. The predictive precision of a multivariable model for mortality at 30 days was significantly improved by adding the most serious bleeding of VARC (area under the curve [AUC], 0.773; 95% confidence interval [CI], 0.706 to 0.839), BARC (AUC, 0.776; 95% CI, 0.694 to 0.857), TIMI (AUC, 0.768; 95% CI, 0.692 to 0.844), and GUSTO (AUC, 0.791; 95% CI, 0.714 to 0.869), with the modified VARC definition resulting in the best predictivity (AUC, 0.814; 95% CI, 0.759 to 0.870). Conclusions The VARC bleeding definition offers a severity stratification that is associated with a gradual increase in mortality and prognostic information comparable to established bleeding definitions. Adding the information of periprocedural blood loss to VARC may increase the sensitivity and the predictive power of this classification.
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Affiliation(s)
- Stefan Stortecky
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland (S.S., G.G.S., T.P., F.P., F.L., R.P., A.A.K., L., B.M., P.W., S.W.)
| | - Giulio G Stefanini
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland (S.S., G.G.S., T.P., F.P., F.L., R.P., A.A.K., L., B.M., P.W., S.W.)
| | - Thomas Pilgrim
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland (S.S., G.G.S., T.P., F.P., F.L., R.P., A.A.K., L., B.M., P.W., S.W.)
| | - Dik Heg
- Department of Clinical Research, Clinical Trials Unit, Bern, Switzerland (D.H., S.W.)
| | - Fabien Praz
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland (S.S., G.G.S., T.P., F.P., F.L., R.P., A.A.K., L., B.M., P.W., S.W.)
| | - Fabienne Luterbacher
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland (S.S., G.G.S., T.P., F.P., F.L., R.P., A.A.K., L., B.M., P.W., S.W.)
| | - Raffaele Piccolo
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland (S.S., G.G.S., T.P., F.P., F.L., R.P., A.A.K., L., B.M., P.W., S.W.)
| | - Ahmed A Khattab
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland (S.S., G.G.S., T.P., F.P., F.L., R.P., A.A.K., L., B.M., P.W., S.W.)
| | - Lorenz Räber
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland (S.S., G.G.S., T.P., F.P., F.L., R.P., A.A.K., L., B.M., P.W., S.W.)
| | - Bettina Langhammer
- Department of Cardiovascular Surgery, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland (B.L., C.H.)
| | - Christoph Huber
- Department of Cardiovascular Surgery, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland (B.L., C.H.)
| | - Bernhard Meier
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland (S.S., G.G.S., T.P., F.P., F.L., R.P., A.A.K., L., B.M., P.W., S.W.)
| | - Peter Jüni
- Institute of Primary Health Care, University of Bern, Switzerland (P.)
| | - Peter Wenaweser
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland (S.S., G.G.S., T.P., F.P., F.L., R.P., A.A.K., L., B.M., P.W., S.W.)
| | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland (S.S., G.G.S., T.P., F.P., F.L., R.P., A.A.K., L., B.M., P.W., S.W.) Department of Clinical Research, Clinical Trials Unit, Bern, Switzerland (D.H., S.W.)
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14
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O'Sullivan CJ, Stortecky S, Bütikofer A, Heg D, Zanchin T, Huber C, Pilgrim T, Praz F, Buellesfeld L, Khattab AA, Blöchlinger S, Carrel T, Meier B, Zbinden S, Wenaweser P, Windecker S. Impact of mitral regurgitation on clinical outcomes of patients with low-ejection fraction, low-gradient severe aortic stenosis undergoing transcatheter aortic valve implantation. Circ Cardiovasc Interv 2015; 8:e001895. [PMID: 25657315 DOI: 10.1161/circinterventions.114.001895] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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 Up to 1 in 6 patients undergoing transcatheter aortic valve implantation (TAVI) present with low-ejection fraction, low-gradient (LEF-LG) severe aortic stenosis and concomitant relevant mitral regurgitation (MR) is present in 30% to 55% of these patients. The effect of MR on clinical outcomes of LEF-LG patients undergoing TAVI is unknown. METHODS AND RESULTS Of 606 consecutive patients undergoing TAVI, 113 (18.7%) patients with LEF-LG severe aortic stenosis (mean gradient ≤40 mm Hg, aortic valve area <1.0 cm(2), left ventricular ejection fraction <50%) were analyzed. LEF-LG patients were dichotomized into ≤mild MR (n=52) and ≥moderate MR (n=61). Primary end point was all-cause mortality at 1 year. No differences in mortality were observed at 30 days (P=0.76). At 1 year, LEF-LG patients with ≥moderate MR had an adjusted 3-fold higher rate of all-cause mortality (11.5% versus 38.1%; adjusted hazard ratio, 3.27 [95% confidence interval, 1.31-8.15]; P=0.011), as compared with LEF-LG patients with ≤mild MR. Mortality was mainly driven by cardiac death (adjusted hazard ratio, 4.62; P=0.005). As compared with LEF-LG patients with ≥moderate MR assigned to medical therapy, LEF-LG patients with ≥moderate MR undergoing TAVI had significantly lower all-cause mortality (hazard ratio, 0.38; 95% confidence interval, 0.019-0.75) at 1 year. CONCLUSIONS Moderate or severe MR is a strong independent predictor of late mortality in LEF-LG patients undergoing TAVI. However, LEF-LG patients assigned to medical therapy have a dismal prognosis independent of MR severity suggesting that TAVI should not be withheld from symptomatic patients with LEF-LG severe aortic stenosis even in the presence of moderate or severe MR.
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Affiliation(s)
- Crochan J O'Sullivan
- From the Department of Cardiology (C.J.O., S.S., A.B., T.Z., T.P., F.P., L.B., A.A.K., S.B., B.M., S.Z., P.W., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), and Clinical Trials Unit (D.H.), Bern University Hospital, Bern, Switzerland; and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland (D.H.)
| | - Stefan Stortecky
- From the Department of Cardiology (C.J.O., S.S., A.B., T.Z., T.P., F.P., L.B., A.A.K., S.B., B.M., S.Z., P.W., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), and Clinical Trials Unit (D.H.), Bern University Hospital, Bern, Switzerland; and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland (D.H.)
| | - Anne Bütikofer
- From the Department of Cardiology (C.J.O., S.S., A.B., T.Z., T.P., F.P., L.B., A.A.K., S.B., B.M., S.Z., P.W., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), and Clinical Trials Unit (D.H.), Bern University Hospital, Bern, Switzerland; and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland (D.H.)
| | - Dik Heg
- From the Department of Cardiology (C.J.O., S.S., A.B., T.Z., T.P., F.P., L.B., A.A.K., S.B., B.M., S.Z., P.W., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), and Clinical Trials Unit (D.H.), Bern University Hospital, Bern, Switzerland; and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland (D.H.)
| | - Thomas Zanchin
- From the Department of Cardiology (C.J.O., S.S., A.B., T.Z., T.P., F.P., L.B., A.A.K., S.B., B.M., S.Z., P.W., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), and Clinical Trials Unit (D.H.), Bern University Hospital, Bern, Switzerland; and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland (D.H.)
| | - Christoph Huber
- From the Department of Cardiology (C.J.O., S.S., A.B., T.Z., T.P., F.P., L.B., A.A.K., S.B., B.M., S.Z., P.W., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), and Clinical Trials Unit (D.H.), Bern University Hospital, Bern, Switzerland; and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland (D.H.)
| | - Thomas Pilgrim
- From the Department of Cardiology (C.J.O., S.S., A.B., T.Z., T.P., F.P., L.B., A.A.K., S.B., B.M., S.Z., P.W., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), and Clinical Trials Unit (D.H.), Bern University Hospital, Bern, Switzerland; and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland (D.H.)
| | - Fabien Praz
- From the Department of Cardiology (C.J.O., S.S., A.B., T.Z., T.P., F.P., L.B., A.A.K., S.B., B.M., S.Z., P.W., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), and Clinical Trials Unit (D.H.), Bern University Hospital, Bern, Switzerland; and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland (D.H.)
| | - Lutz Buellesfeld
- From the Department of Cardiology (C.J.O., S.S., A.B., T.Z., T.P., F.P., L.B., A.A.K., S.B., B.M., S.Z., P.W., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), and Clinical Trials Unit (D.H.), Bern University Hospital, Bern, Switzerland; and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland (D.H.)
| | - Ahmed A Khattab
- From the Department of Cardiology (C.J.O., S.S., A.B., T.Z., T.P., F.P., L.B., A.A.K., S.B., B.M., S.Z., P.W., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), and Clinical Trials Unit (D.H.), Bern University Hospital, Bern, Switzerland; and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland (D.H.)
| | - Stefan Blöchlinger
- From the Department of Cardiology (C.J.O., S.S., A.B., T.Z., T.P., F.P., L.B., A.A.K., S.B., B.M., S.Z., P.W., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), and Clinical Trials Unit (D.H.), Bern University Hospital, Bern, Switzerland; and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland (D.H.)
| | - Thierry Carrel
- From the Department of Cardiology (C.J.O., S.S., A.B., T.Z., T.P., F.P., L.B., A.A.K., S.B., B.M., S.Z., P.W., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), and Clinical Trials Unit (D.H.), Bern University Hospital, Bern, Switzerland; and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland (D.H.)
| | - Bernhard Meier
- From the Department of Cardiology (C.J.O., S.S., A.B., T.Z., T.P., F.P., L.B., A.A.K., S.B., B.M., S.Z., P.W., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), and Clinical Trials Unit (D.H.), Bern University Hospital, Bern, Switzerland; and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland (D.H.)
| | - Stephan Zbinden
- From the Department of Cardiology (C.J.O., S.S., A.B., T.Z., T.P., F.P., L.B., A.A.K., S.B., B.M., S.Z., P.W., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), and Clinical Trials Unit (D.H.), Bern University Hospital, Bern, Switzerland; and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland (D.H.)
| | - Peter Wenaweser
- From the Department of Cardiology (C.J.O., S.S., A.B., T.Z., T.P., F.P., L.B., A.A.K., S.B., B.M., S.Z., P.W., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), and Clinical Trials Unit (D.H.), Bern University Hospital, Bern, Switzerland; and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland (D.H.)
| | - Stephan Windecker
- From the Department of Cardiology (C.J.O., S.S., A.B., T.Z., T.P., F.P., L.B., A.A.K., S.B., B.M., S.Z., P.W., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), and Clinical Trials Unit (D.H.), Bern University Hospital, Bern, Switzerland; and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland (D.H.).
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15
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O’Sullivan CJ, Wenaweser P, Ceylan O, Stortecky S, Spitzer E, Zanchin T, Praz F, Pilgrim T, Khattab AA, Meier B, Windecker S, Buellesfeld L, Tüller D, Rat-Wirtzler J, Heg D, Huber C, Carrel T, Nietlispach F. Response To Letter Regarding Article, “Effect of Pulmonary Hypertension Hemodynamic Presentation on Clinical Outcomes in Patients With Severe Symptomatic Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation: Insights From the New Proposed Pulmonary Hypertension Classification”. Circ Cardiovasc Interv 2015; 8:e003064. [DOI: 10.1161/circinterventions.115.003064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Peter Wenaweser
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Osman Ceylan
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Ernest Spitzer
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Thomas Zanchin
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Ahmed A. Khattab
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Bernhard Meier
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Lutz Buellesfeld
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - David Tüller
- Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland
| | - Julie Rat-Wirtzler
- Department of Epidemiology, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Dik Heg
- Department of Epidemiology, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Christoph Huber
- Department of Cardiovascular Surgery, Bern University Hospital, Bern, Switzerland
| | - Thierry Carrel
- Department of Cardiovascular Surgery, Bern University Hospital, Bern, Switzerland
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16
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Koskinas KC, Räber L, Zanchin T, Wenaweser P, Stortecky S, Moschovitis A, Khattab AA, Pilgrim T, Blöchlinger S, Moro C, Jüni P, Meier B, Heg D, Windecker S. Clinical Impact of Gastrointestinal Bleeding in Patients Undergoing Percutaneous Coronary Interventions. Circ Cardiovasc Interv 2015; 8:CIRCINTERVENTIONS.114.002053. [DOI: 10.1161/circinterventions.114.002053] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The risk factors and clinical sequelae of gastrointestinal bleeding (GIB) in the current era of drug-eluting stents, prolonged dual antiplatelet therapy, and potent P2Y
12
inhibitors are not well established. We determined the frequency, predictors, and clinical impact of GIB after percutaneous coronary interventions (PCIs) in a contemporary cohort of consecutive patients treated with unrestricted use of drug-eluting stents.
Methods and Results—
Between 2009 and 2012, all consecutive patients undergoing PCI were prospectively included in the Bern PCI Registry. Bleeding Academic Research Consortium (BARC) GIB and cardiovascular outcomes were recorded within 1 year of follow-up. Among 6212 patients, 84.1% received new-generation drug-eluting stents and 19.5% received prasugrel. At 1 year, GIB had occurred in 65 patients (1.04%); 70.8% of all events and 84.4% of BARC ≥3B events were recorded >30 days after PCI. The majority of events (64.4%) were related to upper GIB with a more delayed time course compared with lower GIB. Increasing age, previous GIB, history of malignancy, smoking, and triple antithrombotic therapy (ie, oral anticoagulation plus dual antiplatelet therapy) were independent predictors of GIB in multivariable analysis. GIB was associated with increased all-cause mortality (adjusted hazard ratio, 3.40; 95% confidence interval, 1.67–6.92;
P
=0.001) and the composite of death, myocardial infarction, or stroke (adjusted hazard ratio, 3.75; 95% confidence interval, 1.99–7.07;
P
<0.001) and was an independent predictor of all-cause mortality during 1 year.
Conclusions—
Among unselected patients undergoing PCI, GIB has a profound effect on prognosis. Triple antithrombotic therapy emerged as the single drug-related predictor of GIB in addition to patient-related risk factors within 1 year of PCI.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT02241291.
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Affiliation(s)
- Konstantinos C. Koskinas
- From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland
| | - Lorenz Räber
- From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland
| | - Thomas Zanchin
- From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland
| | - Peter Wenaweser
- From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland
| | - Aris Moschovitis
- From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland
| | - Ahmed A. Khattab
- From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland
| | - Stefan Blöchlinger
- From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland
| | - Christina Moro
- From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland
| | - Peter Jüni
- From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland
| | - Bernhard Meier
- From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland
| | - Dik Heg
- From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland
| | - Stephan Windecker
- From the Department of Cardiology, Bern University Hospital, Bern, Switzerland (K.C.K., L.R., T.Z., P.W., S.S., A.M., A.A.K., T.P., S.B., C.M., B.M., S.W.); and Institute of Primary Health Care (P.J.), Institute of Social and Preventive Medicine (D.H.), and Clinical Trials Unit, Department of Clinical Research (S.W.), University of Bern, Bern, Switzerland
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17
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Gloekler S, Shakir S, Doblies J, Khattab AA, Praz F, Guerios Ê, Koermendy D, Stortecky S, Pilgrim T, Buellesfeld L, Wenaweser P, Windecker S, Moschovitis A, Jaguszewski M, Landmesser U, Nietlispach F, Meier B. Early results of first versus second generation Amplatzer occluders for left atrial appendage closure in patients with atrial fibrillation. Clin Res Cardiol 2015; 104:656-65. [PMID: 25736061 DOI: 10.1007/s00392-015-0828-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/17/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Transcatheter left atrial appendage (LAA) occlusion has been proven to be an effective treatment for stroke prophylaxis in patients with atrial fibrillation. For this purpose, the Amplatzer cardiac plug (ACP) was introduced. Its second generation, the Amulet, was developed for easier delivery, better coverage, and reduction of complications. AIM To investigate the safety and efficacy of first generation versus second generation Amplatzer occluders for LAA occlusion. METHODS Retrospective analysis of prospectively collected data from the LAA occlusion registries of the Bern and Zurich university hospitals. Comparison of the last consecutive 50 ACP cases versus the first consecutive 50 Amulet cases in patients with non-valvular atrial fibrillation. For safety, a periprocedural combined endpoint, which is composed of death, stroke, cardiac tamponade, and bailout by surgery was predefined. For efficacy, the endpoint was procedural success. RESULTS There were no differences between the two groups in baseline characteristics. The percentage of associated interventions during LAA occlusion was high in (78% with ACP vs. 70% with Amulet p = ns). Procedural success was similar in both groups (98 vs. 94%, p = 0.61). The combined safety endpoint for severe adverse events was reached by a similar rate of patients in both groups (6 vs. 8%, p = 0.7). Overall complication rate was insignificantly higher in the ACP group, which was mainly driven by clinically irrelevant pericardial effusions (24 vs. 14%, p = 0.31). Death, stroke, or tamponade were similar between the groups (0 vs. 2%, 0 vs. 0%, or 6 vs. 6%, p = ns). CONCLUSION Transcatheter LAA occlusion for stroke prophylaxis in patients with atrial fibrillation can be performed with similarly high success rates with first and second generations of Amplatzer occluders. According to this early experience, the Amulet has failed to improve results of LAA occlusion. The risk for major procedural adverse events is acceptable but has to be taken into account when selecting patients for LAA occlusion, a preventive procedure.
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Affiliation(s)
- Steffen Gloekler
- Cardiology, Cardiovascular Department, Bern University Hospital, Bern, Switzerland
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Kolandaivelu K, Bailey L, Buzzi S, Zucker A, Ziogas A, Milleret V, Ehrbar M, Khattab AA, Stanley JR, Wong GK, Zani B, Markham PK, Tzafriri AR, Bhatt DL, Edelman ER. CRT-704 Ultra-Hydrophilic Stents Promote Early Healing and Minimize Late Tissue Response: A Potential Alternative to Second-Generation Drug Eluting Stents. JACC Cardiovasc Interv 2015. [DOI: 10.1016/j.jcin.2014.12.174] [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: 11/27/2022]
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Meier B, Blaauw Y, Khattab AA, Lewalter T, Sievert H, Tondo C, Glikson M. EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion. EUROINTERVENTION 2015. [DOI: 10.4244/eijy14m09_18] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Khattab AA, Gloekler S, Sprecher B, Shakir S, Guerios E, Stortecky S, O'Sullivan CJ, Nietlispach F, Moschovitis A, Pilgrim T, Buellesfeld L, Wenaweser P, Windecker S, Meier B. Feasibility and outcomes of combined transcatheter aortic valve replacement with other structural heart interventions in a single session: a matched cohort study. Open Heart 2014; 1:e000014. [PMID: 25332781 PMCID: PMC4195934 DOI: 10.1136/openhrt-2013-000014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 05/08/2014] [Accepted: 05/28/2014] [Indexed: 11/30/2022] Open
Abstract
Background Concurrent cardiac diseases are frequent among elderly patients and invite simultaneous treatment to ensure an overall favourable patient outcome. Aim To investigate the feasibility of combined single-session percutaneous cardiac interventions in the era of transcatheter aortic valve implantation (TAVI). Methods This prospective, case–control study included 10 consecutive patients treated with TAVI, left atrial appendage occlusion and percutaneous coronary interventions. Some in addition had patent foramen ovale or atrial septal defect closure in the same session. The patients were matched in a 1:10 manner with TAVI-only cases treated within the same time period at the same institution regarding their baseline factors. The outcome was validated according to the Valve Academic Research Consortium (VARC) criteria. Results Procedural time (126±42 vs 83±40 min, p=0.0016), radiation time (34±8 vs 22±12 min, p=0.0001) and contrast dye (397±89 vs 250±105 mL, p<0.0001) were higher in the combined intervention group than in the TAVI-only group. Despite these drawbacks, no difference in the VARC endpoints was evident during the in-hospital period and after 30 days (VARC combined safety endpoint 32% for TAVI only and 20% for combined intervention, p=1.0). Conclusions Transcatheter treatment of combined cardiac diseases is feasible even in a single session in a high-volume centre with experienced operators.
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Affiliation(s)
- Ahmed A Khattab
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| | - Steffen Gloekler
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| | - Beate Sprecher
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| | - Samera Shakir
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| | - Enio Guerios
- Centro de Cardiopatias Congênitas e Estruturais do Paraná , Curitiba, Paraná , Brazil
| | - Stefan Stortecky
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| | - Crochan J O'Sullivan
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| | - Fabian Nietlispach
- Department of Cardiology , Zurich University Hospital , Zürich , Switzerland
| | - Aris Moschovitis
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| | - Thomas Pilgrim
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| | - Lutz Buellesfeld
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| | - Peter Wenaweser
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| | - Stephan Windecker
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| | - Bernhard Meier
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
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O'Sullivan CJ, Stefanini GG, Räber L, Heg D, Taniwaki M, Kalesan B, Pilgrim T, Zanchin T, Moschovitis A, Büllesfeld L, Khattab AA, Meier B, Wenaweser P, Jüni P, Windecker S. Impact of stent overlap on long-term clinical outcomes in patients treated with newer-generation drug-eluting stents. EUROINTERVENTION 2014; 9:1076-84. [PMID: 24064474 DOI: 10.4244/eijv9i9a182] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Early-generation drug-eluting stent (DES) overlap (OL) is associated with impaired long-term clinical outcomes whereas the impact of OL with newer-generation DES is unknown. Our aim was to assess the impact of OL on long-term clinical outcomes among patients treated with newer-generation DES. METHODS AND RESULTS We analysed the three-year clinical outcomes of 3,133 patients included in a prospective DES registry according to stent type (sirolimus-eluting stents [SES; N=1,532] versus everolimus-eluting stents [EES; N=1,601]), and the presence or absence of OL. The primary outcome was a composite of death, myocardial infarction (MI), and target vessel revascularisation (TVR). The primary endpoint was more common in patients with OL (25.1%) than in those with multiple DES without OL (20.8%, adj HR=1.46, 95% CI: 1.03-2.09) and patients with a single DES (18.8%, adj HR=1.74, 95% CI: 1.34-2.25, p<0.001) at three years. A stratified analysis by stent type showed a higher risk of the primary outcome in SES with OL (28.7%) compared to other SES groups (without OL: 22.6%, p=0.04; single DES: 17.6%, p<0.001), but not between EES with OL (22.3%) and other EES groups (without OL: 18.5%, p=0.30; single DES: 20.4%, p=0.20). CONCLUSIONS DES overlap is associated with impaired clinical outcomes during long-term follow-up. Compared with SES, EES provide similar clinical outcomes irrespective of DES overlap status.
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Meier B, Blaauw Y, Khattab AA, Lewalter T, Sievert H, Tondo C, Glikson M, Lip GYH, Lopez-Minguez J, Roffi M, Israel C, Dudek D, Savelieva I. EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion. ACTA ACUST UNITED AC 2014; 16:1397-416. [DOI: 10.1093/europace/euu174] [Citation(s) in RCA: 194] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Bernhard Meier
- Cardiology, Bern University Hospital, 3010 Bern, Switzerland
| | - Yuri Blaauw
- Department of Cardiology, Maastricht University Medical Center, 6281 Maastricht, The Netherlands
| | | | | | - Horst Sievert
- Cardiovascular Center Frankfurt, 60389 Frankfurt, Germany
| | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
| | - Michael Glikson
- Davidai Arrhythmia Center, Sheba Medical Center, 52621 Tel Hashomer, Israel
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Khattab AA, Nijhoff F, Schofer J, Berland J, Meier B, Nietlispach F, Agostoni P, Brucks S, Stella P. Svelte integrated delivery system performance examined through diagnostic catheter delivery: The SPEED registry. Catheter Cardiovasc Interv 2014; 85:E23-31. [DOI: 10.1002/ccd.25621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 01/28/2014] [Accepted: 07/26/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Ahmed A. Khattab
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Freek Nijhoff
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Joachim Schofer
- Medical Care Center Prof Mathey; Prof Schofer, Hamburg University Cardiovascular Center; Hamburg Germany
| | - Jacques Berland
- Department of Cardiology; Clinique Saint-Hilaire; Rouen France
| | - Bernhard Meier
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | | | | | - Steffen Brucks
- Medical Care Center Prof Mathey; Prof Schofer, Hamburg University Cardiovascular Center; Hamburg Germany
| | - Pieter Stella
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
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Akin I, Khattab AA, Büttner HJ, Toelg R, Geist V, Neumann FJ, Richardt G, Abdel-Wahab M. Comparison of bivalirudin and heparin in patients undergoing rotational atherectomy: a subanalysis of the randomised ROTAXUS trial. EUROINTERVENTION 2014; 10:458-65. [DOI: 10.4244/eijv10i4a79] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Stefanini GG, Stortecky S, Cao D, Rat-Wirtzler J, O'Sullivan CJ, Gloekler S, Buellesfeld L, Khattab AA, Nietlispach F, Pilgrim T, Huber C, Carrel T, Meier B, Jüni P, Wenaweser P, Windecker S. Coronary artery disease severity and aortic stenosis: clinical outcomes according to SYNTAX score in patients undergoing transcatheter aortic valve implantation. Eur Heart J 2014; 35:2530-40. [PMID: 24682843 DOI: 10.1093/eurheartj/ehu074] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [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] [Indexed: 01/03/2023] Open
Abstract
AIM The aim of this study was to evaluate whether coronary artery disease (CAD) severity exerts a gradient of risk in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS A total of 445 patients with severe AS undergoing TAVI were included into a prospective registry between 2007 and 2012. The preoperative SYNTAX score (SS) was determined from baseline coronary angiograms. In case of revascularization prior to TAVI, residual SS (rSS) was also determined. Clinical outcomes were compared between patients without CAD (n = 158), patients with low SS (0-22, n = 207), and patients with high SS (SS > 22, n = 80). The pre-specified primary endpoint was the composite of cardiovascular death, stroke, or myocardial infarction (MI). At 1 year, CAD severity was associated with higher rates of the primary endpoint (no CAD: 12.5%, low SS: 16.1%, high SS: 29.6%; P = 0.016). This was driven by differences in cardiovascular mortality (no CAD: 8.6%, low SS: 13.6%, high SS: 20.4%; P = 0.029), whereas the risk of stroke (no CAD: 5.1%, low SS: 3.3%, high SS: 6.7%; P = 0.79) and MI (no CAD: 1.5%, low SS: 1.1%, high SS: 4.0%; P = 0.54) was similar across the three groups. Patients with high SS received less complete revascularization as indicated by a higher rSS (21.2 ± 12.0 vs. 4.0 ± 4.4, P < 0.001) compared with patients with low SS. High rSS tertile (> 14) was associated with higher rates of the primary endpoint at 1 year (no CAD:12.5%, low rSS: 16.5%, high rSS: 26.3%, P = 0.043). CONCLUSIONS Severity of CAD appears to be associated with impaired clinical outcomes at 1 year after TAVI. Patients with SS > 22 receive less complete revascularization and have a higher risk of cardiovascular death, stroke, or MI than patients without CAD or low SS.
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Affiliation(s)
- Giulio G Stefanini
- Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland
| | - Davide Cao
- Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland
| | - Julie Rat-Wirtzler
- CTU Bern, Department of Clinical Research, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | | | - Steffen Gloekler
- Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland
| | - Lutz Buellesfeld
- Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland
| | - Ahmed A Khattab
- Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland
| | - Fabian Nietlispach
- Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland
| | - Christoph Huber
- Department of Cardiovascular Surgery, Bern University Hospital, Bern, Switzerland
| | - Thierry Carrel
- Department of Cardiovascular Surgery, Bern University Hospital, Bern, Switzerland
| | - Bernhard Meier
- Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland
| | - Peter Jüni
- CTU Bern, Department of Clinical Research, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Peter Wenaweser
- Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern 3010, Switzerland
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Koermendy D, Nietlispach F, Shakir S, Gloekler S, Wenaweser P, Windecker S, Khattab AA, Meier B. Amplatzer left atrial appendage occlusion through a patent foramen ovale. Catheter Cardiovasc Interv 2014; 84:1190-6. [DOI: 10.1002/ccd.25354] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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: 06/24/2013] [Revised: 10/28/2013] [Accepted: 12/30/2013] [Indexed: 12/17/2022]
Affiliation(s)
- Dezsoe Koermendy
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | | | - Samera Shakir
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Steffen Gloekler
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Peter Wenaweser
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Stephan Windecker
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Ahmed A. Khattab
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Bernhard Meier
- Department of Cardiology; Bern University Hospital; Bern Switzerland
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Abstract
Microembolic signals (MES) can be detected in many recipients of mechanical aortic valve prostheses by transcranial Doppler ultrasound. The nature and etiology of these MES have remained unclear for a long time. The solid and gaseous nature of MES are discussed, as well as whether or not MES may reflect artifacts. Recently, the gaseous nature of these MES has been widely established. To understand the physics of bubble formation related to mechanical heart valve prostheses, it is necessary to discuss the different types of cavitation occurring at the prostheses and the conditions leading to the degassing of blood. We describe the history of transcranial Doppler ultrasound-techniques and the current techniques in the measurement of these signals. Furthermore, the possible clinical impact of MES, as well as strategies for the design of new prostheses and surgical alternatives to diminish their load are discussed.
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Affiliation(s)
- Axel Nötzold
- Segeberger Kliniken GmbH, Department for Cardiac and Vascular Surgery, Am Kurpark 1, 23795 Bad Segeberg, Germany.
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O'Sullivan CJ, Stortecky S, Heg D, Pilgrim T, Hosek N, Buellesfeld L, Khattab AA, Nietlispach F, Moschovitis A, Zanchin T, Meier B, Windecker S, Wenaweser P. Clinical outcomes of patients with low-flow, low-gradient, severe aortic stenosis and either preserved or reduced ejection fraction undergoing transcatheter aortic valve implantation. Eur Heart J 2013; 34:3437-50. [DOI: 10.1093/eurheartj/eht408] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Khattab AA, O'Sullivan CJ, Stefanini GG, Räber L, Paquin M, Windecker S, Meier B. New approach to direct stenting using a novel "all-in-one" coronary stent system via 5 French diagnostic catheters: a pilot study. Catheter Cardiovasc Interv 2013; 82:E403-10. [PMID: 23378279 DOI: 10.1002/ccd.24860] [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: 11/01/2012] [Revised: 01/22/2013] [Accepted: 01/27/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We sought to evaluate the strategy success and short term clinical outcomes of direct stenting via 5 French (F) diagnostic catheters using a novel bare metal stent with integrated delivery system (IDS) (Svelte Medical Systems, New Providence, NJ) and compare the results to a conventionally treated matched group. METHODS Fifteen consecutive patients with lesions deemed suitable for direct stenting using a bare metal stent were included. The primary endpoint was the strategy success defined as the ability to successfully treat a target lesion via a 5 F diagnostic catheter with a good angiographic result (TIMI III flow, residual stenosis ≤20%). Procedure and fluoroscopy times, contrast agent use, cost, and short-term clinical outcomes were compared to a matched group treated via conventional stenting. RESULTS The primary endpoint was reached in 14/15 patients (93%). There were no significant differences in procedural (58.6 min ± 12.7 vs. 57.4 min ± 14.2) or fluoroscopy times (10.0 min ± 4.3 vs.10.1 min ± 3.9) or contrast agent use (193.7 ml ± 54.8 vs. 181.4 ml ± 35.6). However, there were significant reductions in materials used in the study group compared to the control group equating to cost savings of almost US $600 per case (US $212.44 ± 258.09 vs. US $804.69 ± 468.11; P = 0.001). CONCLUSIONS Direct stenting using a novel bare metal stent with an IDS via 5 F diagnostic catheters is a viable alternative to conventional stenting in selected patients and is associated with significant cost savings.
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Affiliation(s)
- Ahmed A Khattab
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
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Khattab AA, Stieger S, Kamat PJ, Vandenberghe S, Bongoni A, Stone GW, Seiler C, Meier B, Hess OM, Rieben R. Effect of pressure-controlled intermittent coronary sinus occlusion (PICSO) on myocardial ischaemia and reperfusion in a closed-chest porcine model. EUROINTERVENTION 2013; 9:398-406. [DOI: 10.4244/eijv9i3a63] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ruder TD, Ebert LC, Khattab AA, Rieben R, Thali MJ, Kamat P. Edema is a sign of early acute myocardial infarction on post-mortem magnetic resonance imaging. Forensic Sci Med Pathol 2013; 9:501-5. [DOI: 10.1007/s12024-013-9459-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2013] [Indexed: 03/25/2023]
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Nietlispach F, Gloekler S, Krause R, Shakir S, Schmid M, Khattab AA, Wenaweser P, Windecker S, Meier B. Amplatzer left atrial appendage occlusion: single center 10-year experience. Catheter Cardiovasc Interv 2013; 82:283-9. [PMID: 23412815 DOI: 10.1002/ccd.24872] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [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: 10/08/2012] [Revised: 01/04/2013] [Accepted: 02/09/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To report a 10-year single center experience with Amplatzer devices for left atrial appendage (LAA) occlusion. BACKGROUND Intermediate-term outcome data following LAA occlusion are scarce. METHODS Short- and intermediate-term outcomes of patients who underwent LAA occlusion were assessed. All procedures were performed under local aesthesia without transesophageal echocardiography. Patients were discharged on acetylsalicylic acid and clopidogrel for 1-6 months. RESULTS LAA occlusion was attempted in 152 patients (105 males, age 72 ± 10 years, CHA2 DS2 -Vasc-score 3.4 ± 1.7, HAS-BLED-score 2.4 ± 1.2). Nondedicated devices were used in 32 patients (21%, ND group) and dedicated Amplatzer Cardiac Plugs were used in 120 patients (79%, ACP group). A patent foramen ovale or atrial septal defect was used for left atrial access and closed at the end of LAA occlusion in 40 patients. The short-term safety endpoints (procedural complications, bleeds) occurred in 15 (9.8%) and the efficacy endpoints (death, stroke, systemic embolization) in 0 patients. Device embolization occurred more frequently in the ND as compared to the ACP group (5 patients or 12% vs. 2 patients or 2%). Mean intermediate-term follow up of the study population was 32 months (range 1-120). Late deaths occurred in 15 patients (5 cardiovascular, 7 noncardiac, 3 unexplained). Neurologic events occurred in 2, peripheral embolism in 1, and major bleeding in 4 patients. The composite efficacy and safety endpoint occurred in 7% and 12% of patients. CONCLUSION LAA closure may be a good alternative to oral anticoagulation. This hypothesis needs to be tested in a randomized clinical trial to ensure that all potential biases of this observational study are accounted for.
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Meier B, Kalesan B, Mattle HP, Khattab AA, Hildick-Smith D, Dudek D, Andersen G, Ibrahim R, Schuler G, Walton AS, Wahl A, Windecker S, Jüni P. Percutaneous closure of patent foramen ovale in cryptogenic embolism. N Engl J Med 2013; 368:1083-91. [PMID: 23514285 DOI: 10.1056/nejmoa1211716] [Citation(s) in RCA: 597] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The options for secondary prevention of cryptogenic embolism in patients with patent foramen ovale are administration of antithrombotic medications or percutaneous closure of the patent foramen ovale. We investigated whether closure is superior to medical therapy. METHODS We performed a multicenter, superiority trial in 29 centers in Europe, Canada, Brazil, and Australia in which the assessors of end points were unaware of the study-group assignments. Patients with a patent foramen ovale and ischemic stroke, transient ischemic attack (TIA), or a peripheral thromboembolic event were randomly assigned to undergo closure of the patent foramen ovale with the Amplatzer PFO Occluder or to receive medical therapy. The primary end point was a composite of death, nonfatal stroke, TIA, or peripheral embolism. Analysis was performed on data for the intention-to-treat population. RESULTS The mean duration of follow-up was 4.1 years in the closure group and 4.0 years in the medical-therapy group. The primary end point occurred in 7 of the 204 patients (3.4%) in the closure group and in 11 of the 210 patients (5.2%) in the medical-therapy group (hazard ratio for closure vs. medical therapy, 0.63; 95% confidence interval [CI], 0.24 to 1.62; P=0.34). Nonfatal stroke occurred in 1 patient (0.5%) in the closure group and 5 patients (2.4%) in the medical-therapy group (hazard ratio, 0.20; 95% CI, 0.02 to 1.72; P=0.14), and TIA occurred in 5 patients (2.5%) and 7 patients (3.3%), respectively (hazard ratio, 0.71; 95% CI, 0.23 to 2.24; P=0.56). CONCLUSIONS Closure of a patent foramen ovale for secondary prevention of cryptogenic embolism did not result in a significant reduction in the risk of recurrent embolic events or death as compared with medical therapy. (Funded by St. Jude Medical; ClinicalTrials.gov number, NCT00166257.).
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Affiliation(s)
- Bernhard Meier
- Department of Cardiology, Bern University Hospital, Bern, Switzerland.
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Pilgrim T, Meier B, Khattab AA. Death by patent foramen ovale in a soccer player. J Invasive Cardiol 2013; 25:162-164. [PMID: 23468450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 34-year-old male patient was referred for primary percutaneous coronary intervention for ST-segment elevation myocardial infarction with cardiogenic shock and was found to have embolic left coronary artery occlusion and subsegmental pulmonary artery emboli as a consequence of venous thrombosis to trauma to the thigh in the presence of a patent foramen ovale.
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Affiliation(s)
- Thomas Pilgrim
- Swiss Cardiovascular Center Bern, Bern University Hospital, 3010 Bern, Switzerland
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Stortecky S, Buellesfeld L, Wenaweser P, Heg D, Pilgrim T, Khattab AA, Gloekler S, Huber C, Nietlispach F, Meier B, Jüni P, Windecker S. Atrial fibrillation and aortic stenosis: impact on clinical outcomes among patients undergoing transcatheter aortic valve implantation. Circ Cardiovasc Interv 2013; 6:77-84. [PMID: 23386662 DOI: 10.1161/circinterventions.112.000124] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is an important risk factor for stroke and is common among elderly patients undergoing transcatheter aortic valve implantation. The aim of this study was to assess the impact of AF on clinical outcomes among patients undergoing transcatheter aortic valve implantation. METHODS AND RESULTS Between August 2007 and October 2011, a total of 389 high-risk patients undergoing transcatheter aortic valve implantation were included into a prospective registry. AF was recorded in 131 patients (33.7%) with a mean CHA(2)DS(2)-VASC score of 4.5±1.2 and was paroxysmal in 26 (25.0%), persistent in 8 (7.7%), and permanent in 70 patients (67.3%). Patients with and without AF had similar baseline characteristics except for fewer revascularization procedures (coronary artery bypass grafting: 12% versus 22%; P=0.03) among AF patients. At 1 year, all-cause mortality was higher among patients with AF (30.9%) compared with those without AF (13.9%; hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.43-3.90; P=0.0008). This was observed irrespective of the type of AF (permanent, HR, 2.47; 95% CI, 1.40-4.38; persistent, HR, 3.60; 95% CI, 1.10-11.78; paroxysmal, HR, 2.88; 95% CI, 1.37-6.05). Mortality gradually increased with higher CHA(2)DS(2)-VASC scores (score 1-3: HR, 2.20; 95% CI, 0.92-5.27; score 6-8: HR, 4.12; 95% CI, 2.07-8.20). The risks of stroke (3.9% versus 5.1%; HR, 0.76; 95% CI, 0.23-1.96; P=0.47) and life-threatening bleeding (19.8% versus 14.7%; HR, 1.37; 95% CI, 0.86-2.19; P=0.19) were similar among patients with and without AF. CONCLUSIONS AF is common among high-risk patients with severe aortic stenosis undergoing transcatheter aortic valve implantation and is associated with a >2-fold increased risk of all-cause and cardiovascular mortality, irrespective of the type of AF. The gradient of risk directly correlates with the CHA(2)DS(2)-VASC score.
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Affiliation(s)
- Stefan Stortecky
- Departments of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
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Stoller M, Traupe T, Khattab AA, de Marchi SF, Steck H, Seiler C. Effects of coronary sinus occlusion on myocardial ischaemia in humans: role of coronary collateral function. Heart 2013; 99:548-55. [DOI: 10.1136/heartjnl-2012-303305] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Abdel-Wahab M, Richardt G, Joachim Büttner H, Toelg R, Geist V, Meinertz T, Schofer J, King L, Neumann FJ, Khattab AA. High-Speed Rotational Atherectomy Before Paclitaxel-Eluting Stent Implantation in Complex Calcified Coronary Lesions. JACC Cardiovasc Interv 2013; 6:10-9. [DOI: 10.1016/j.jcin.2012.07.017] [Citation(s) in RCA: 298] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 07/04/2012] [Indexed: 12/13/2022]
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Buellesfeld L, Stortecky S, Kalesan B, Gloekler S, Khattab AA, Nietlispach F, Delfine V, Huber C, Eberle B, Meier B, Wenaweser P, Windecker S. Aortic Root Dimensions Among Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2013; 6:72-83. [PMID: 23347864 DOI: 10.1016/j.jcin.2012.09.007] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 08/24/2012] [Accepted: 09/06/2012] [Indexed: 02/06/2023]
Affiliation(s)
- Lutz Buellesfeld
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Freiburgstrasse, Bern, Switzerland.
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Pilgrim T, Kalesan B, Wenaweser P, Huber C, Stortecky S, Buellesfeld L, Khattab AA, Eberle B, Gloekler S, Gsponer T, Meier B, Jüni P, Carrel T, Windecker S. Predictors of Clinical Outcomes in Patients With Severe Aortic Stenosis Undergoing TAVI. Circ Cardiovasc Interv 2012; 5:856-61. [DOI: 10.1161/circinterventions.112.974899] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background—
Patients with severe aortic stenosis at increased surgical risk continue to experience compromised long-term survival despite successful transcatheter aortic valve implantation. We used time-related pathways in a multistate analysis to identify predictors of adverse long-term outcome in patients who underwent transcatheter aortic valve implantation.
Methods and Results—
In a cohort of 389 patients with a mean age of 82.4±5.8 years and a STS score of 6.8±5.3 undergoing transcatheter aortic valve implantation between 2007 and 2011, multistate analysis was used to estimate mortality and stroke taking into account intercurrent events including kidney injury and the composite of access site and bleeding complications (ABC). Transapical access emerged as a predictor of kidney injury (hazard ratio [HR], 2.12; 95% confidence interval [CI] 1.00–4.47) and ABC (HR, 1.78; 95% CI, 1.07–2.96), but had no impact on the risk of stroke or death. Body mass index ≤20 kg/m
2
increased the risk of stroke or death (HR, 2.64; 95% CI, 1.25–5.54). Age >80 years (HR, 3.15; 95% CI, 1.11–8.92), body mass index ≤20 kg/m
2
(HR, 4.11; 95% CI, 1.33–12.70), prior stroke (HR, 16.42; 95% CI, 3.63–74.21), and presence of atrial fibrillation at baseline (HR, 4.12; 95% CI, 1.87–9.97) increased the risk of stroke and death after an intercurrent event of ABC.
Conclusions—
A body mass index ≤20 kg/m
2
was identified as a primary predictor of stroke and death after transcatheter aortic valve implantation during long-term follow-up, whereas transapical access emerged as a predictor of kidney injury and ABC. Age >80 years, body mass index ≤20 kg/m
2
, prior stroke, and presence of atrial fibrillation at baseline increased the risk of stroke and death after an intercurrent event of ABC.
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Affiliation(s)
- Thomas Pilgrim
- From the Departments of Cardiology (T.P., B.K., P.W., S.S., L.B., A.A.K., S.G., B.M., S.W.) and Cardiovascular Surgery (C.H., T.C.), Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland (B.K., T.G., P.J.); and Department of Anesthesiology, Bern University Hospital, Bern, Switzerland (B.E.)
| | - Bindu Kalesan
- From the Departments of Cardiology (T.P., B.K., P.W., S.S., L.B., A.A.K., S.G., B.M., S.W.) and Cardiovascular Surgery (C.H., T.C.), Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland (B.K., T.G., P.J.); and Department of Anesthesiology, Bern University Hospital, Bern, Switzerland (B.E.)
| | - Peter Wenaweser
- From the Departments of Cardiology (T.P., B.K., P.W., S.S., L.B., A.A.K., S.G., B.M., S.W.) and Cardiovascular Surgery (C.H., T.C.), Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland (B.K., T.G., P.J.); and Department of Anesthesiology, Bern University Hospital, Bern, Switzerland (B.E.)
| | - Christoph Huber
- From the Departments of Cardiology (T.P., B.K., P.W., S.S., L.B., A.A.K., S.G., B.M., S.W.) and Cardiovascular Surgery (C.H., T.C.), Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland (B.K., T.G., P.J.); and Department of Anesthesiology, Bern University Hospital, Bern, Switzerland (B.E.)
| | - Stefan Stortecky
- From the Departments of Cardiology (T.P., B.K., P.W., S.S., L.B., A.A.K., S.G., B.M., S.W.) and Cardiovascular Surgery (C.H., T.C.), Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland (B.K., T.G., P.J.); and Department of Anesthesiology, Bern University Hospital, Bern, Switzerland (B.E.)
| | - Lutz Buellesfeld
- From the Departments of Cardiology (T.P., B.K., P.W., S.S., L.B., A.A.K., S.G., B.M., S.W.) and Cardiovascular Surgery (C.H., T.C.), Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland (B.K., T.G., P.J.); and Department of Anesthesiology, Bern University Hospital, Bern, Switzerland (B.E.)
| | - Ahmed A. Khattab
- From the Departments of Cardiology (T.P., B.K., P.W., S.S., L.B., A.A.K., S.G., B.M., S.W.) and Cardiovascular Surgery (C.H., T.C.), Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland (B.K., T.G., P.J.); and Department of Anesthesiology, Bern University Hospital, Bern, Switzerland (B.E.)
| | - Balthasar Eberle
- From the Departments of Cardiology (T.P., B.K., P.W., S.S., L.B., A.A.K., S.G., B.M., S.W.) and Cardiovascular Surgery (C.H., T.C.), Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland (B.K., T.G., P.J.); and Department of Anesthesiology, Bern University Hospital, Bern, Switzerland (B.E.)
| | - Steffen Gloekler
- From the Departments of Cardiology (T.P., B.K., P.W., S.S., L.B., A.A.K., S.G., B.M., S.W.) and Cardiovascular Surgery (C.H., T.C.), Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland (B.K., T.G., P.J.); and Department of Anesthesiology, Bern University Hospital, Bern, Switzerland (B.E.)
| | - Thomas Gsponer
- From the Departments of Cardiology (T.P., B.K., P.W., S.S., L.B., A.A.K., S.G., B.M., S.W.) and Cardiovascular Surgery (C.H., T.C.), Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland (B.K., T.G., P.J.); and Department of Anesthesiology, Bern University Hospital, Bern, Switzerland (B.E.)
| | - Bernhard Meier
- From the Departments of Cardiology (T.P., B.K., P.W., S.S., L.B., A.A.K., S.G., B.M., S.W.) and Cardiovascular Surgery (C.H., T.C.), Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland (B.K., T.G., P.J.); and Department of Anesthesiology, Bern University Hospital, Bern, Switzerland (B.E.)
| | - Peter Jüni
- From the Departments of Cardiology (T.P., B.K., P.W., S.S., L.B., A.A.K., S.G., B.M., S.W.) and Cardiovascular Surgery (C.H., T.C.), Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland (B.K., T.G., P.J.); and Department of Anesthesiology, Bern University Hospital, Bern, Switzerland (B.E.)
| | - Thierry Carrel
- From the Departments of Cardiology (T.P., B.K., P.W., S.S., L.B., A.A.K., S.G., B.M., S.W.) and Cardiovascular Surgery (C.H., T.C.), Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland (B.K., T.G., P.J.); and Department of Anesthesiology, Bern University Hospital, Bern, Switzerland (B.E.)
| | - Stephan Windecker
- From the Departments of Cardiology (T.P., B.K., P.W., S.S., L.B., A.A.K., S.G., B.M., S.W.) and Cardiovascular Surgery (C.H., T.C.), Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; Institute of Social and Preventive Medicine and Clinical Trials Unit, Bern University Hospital, Bern, Switzerland (B.K., T.G., P.J.); and Department of Anesthesiology, Bern University Hospital, Bern, Switzerland (B.E.)
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Stortecky S, Wenaweser P, Diehm N, Pilgrim T, Huber C, Rosskopf AB, Khattab AA, Buellesfeld L, Gloekler S, Eberle B, Schmidli J, Carrel T, Meier B, Windecker S. Percutaneous management of vascular complications in patients undergoing transcatheter aortic valve implantation. JACC Cardiovasc Interv 2012; 5:515-524. [PMID: 22625190 DOI: 10.1016/j.jcin.2012.01.021] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 12/02/2011] [Accepted: 01/11/2012] [Indexed: 12/29/2022]
Abstract
OBJECTIVES This study sought to investigate the feasibility and safety of percutaneous management of vascular complications after transcatheter aortic valve implantation (TAVI). BACKGROUND Vascular complications after TAVI are frequent and outcomes after percutaneous management of these adverse events not well established. METHODS Between August 2007 and July 2010, 149 patients underwent transfemoral TAVI using a percutaneous approach. We compared outcomes of patients undergoing percutaneous management of vascular complications with patients free from vascular complications and performed duplex ultrasonography, fluoroscopy, and multislice computed tomography during follow-up. RESULTS A total of 27 patients (18%) experienced vascular complications consisting of incomplete arteriotomy closure (n = 19, 70%), dissection (n = 3, 11%), arterial perforation (n = 3, 11%), arterial occlusion (n = 1, 4%), and pseudoaneurysm (n = 1, 4%). Percutaneous stent graft implantation was successful in 21 of 23 (91%) patients, whereas 2 patients were treated by manual compression, 2 patients underwent urgent surgery, and 2 patients required delayed surgery. Rates of major adverse cardiac events at 30 days were similar among patients undergoing percutaneous management of vascular complications and those without vascular complications (9% vs. 8%, p = 1.00). After a median follow-up of 10.9 months, imaging showed no evidence of hemodynamically significant stenosis (mean peak velocity ratio: 1.2 ± 0.4). Stent fractures were observed in 4 stents (22%, type I [6%], type II [16%]) and were clinically silent in all cases. CONCLUSIONS Vascular complications after TAVI can be treated percutaneously as a bailout procedure with a high rate of technical success, and clinical outcomes are comparable to patients without vascular complications. Stent patency is high during follow-up, although stent fractures require careful scrutiny.
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Affiliation(s)
- Stefan Stortecky
- Department of Cardiology, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland
| | - Peter Wenaweser
- Department of Cardiology, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland.
| | - Nicolas Diehm
- Department of Clinical, Interventional Angiology, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland
| | - Christoph Huber
- Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland
| | - Andrea Bianca Rosskopf
- Department of Diagnostic, Interventional, and Pediatric Radiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ahmed A Khattab
- Department of Cardiology, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland
| | - Lutz Buellesfeld
- Department of Cardiology, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland
| | - Steffen Gloekler
- Department of Cardiology, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland
| | - Balthasar Eberle
- Department of Anesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jürg Schmidli
- Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland
| | - Thierry Carrel
- Department of Cardiovascular Surgery, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland
| | - Bernhard Meier
- Department of Cardiology, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center Bern, University of Bern, Bern, Switzerland
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Guérios ÊE, Gloekler S, Pilgrim T, Stortecky S, Büllesfeld L, Khattab AA, Huber C, Meier B, Windecker S, Wenaweser P. Second valve implantation for the treatment of a malpositioned transcatheter aortic valve. J Invasive Cardiol 2012; 24:457-462. [PMID: 22954566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Unfavorable immediate or delayed results after transcatheter aortic valve implantation (TAVI) may be a consequence of bioprosthesis malfunctioning, malpositioning, embolization, or degeneration. Deployment of a second valve within the first one implanted (TAVI-in-TAV) may be a potentially helpful therapeutic strategy. METHODS Six out of 412 patients undergoing TAVI had TAVI-in-TAV implantation for the treatment of a too high (n = 4) or too low position (n = 2) of the first implanted valve. RESULTS All TAVI-in-TAV procedures were successfully performed. The calculated valve area after second valve implantation was 1.6 ± 0.3 cm(2) with a mean gradient of 7.3 ± 2.2 mm Hg. Residual aortic regurgitation (AR) was mild in 5 patients and moderate in 1. At mid-term follow-up (30-724 days) neither the mean valve area (1.47 ± 0.31 cm(2)), the mean gradient (7.5 ± 3.6 mm Hg; 3.0-13.0 mm Hg) nor the degree of AR had changed significantly. CONCLUSION TAVI-in-TAV for correction of malpositioned or embolized valves is technically feasible and leads to favorable functional results during mid-term follow-up.
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Affiliation(s)
- Ênio E Guérios
- Department of Cardiology, Cardiovascular Center Bern, University Hospital Bern, Bern, Switzerland
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Khattab K, Khattab AA, Ortak J, Richardt G, Bonnemeier H. Iyengar yoga increases cardiac parasympathetic nervous modulation among healthy yoga practitioners. Evid Based Complement Alternat Med 2012; 4:511-7. [PMID: 18227919 PMCID: PMC2176143 DOI: 10.1093/ecam/nem087] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2006] [Accepted: 04/23/2007] [Indexed: 11/19/2022]
Abstract
Relaxation techniques are established in managing of cardiac patients during rehabilitation aiming to reduce future adverse cardiac events. It has been hypothesized that relaxation-training programs may significantly improve cardiac autonomic nervous tone. However, this has not been proven for all available relaxation techniques. We tested this assumption by investigating cardiac vagal modulation during yoga.We examined 11 healthy yoga practitioners (7 women and 4 men, mean age: 43 ± 11; range: 26–58 years). Each individual was subjected to training units of 90 min once a week over five successive weeks. During two sessions, they practiced a yoga program developed for cardiac patients by B.K.S. Iyengar. On three sessions, they practiced a placebo program of relaxation. On each training day they underwent ambulatory 24 h Holter monitoring. The group of yoga practitioners was compared to a matched group of healthy individuals not practicing any relaxation techniques. Parameters of heart rate variability (HRV) were determined hourly by a blinded observer. Mean RR interval (interval between two R-waves of the ECG) was significantly higher during the time of yoga intervention compared to placebo and to control (P < 0.001 for both). The increase in HRV parameters was significantly higher during yoga exercise than during placebo and control especially for the parameters associated with vagal tone, i.e. mean standard deviation of NN (Normal Beat to Normal Beat of the ECG) intervals for all 5-min intervals (SDNNi, P < 0.001 for both) and root mean square successive difference (rMSSD, P < 0.01 for both). In conclusion, relaxation by yoga training is associated with a significant increase of cardiac vagal modulation. Since this method is easy to apply with no side effects, it could be a suitable intervention in cardiac rehabilitation programs.
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Affiliation(s)
- Kerstin Khattab
- Herz-Kreislauf-Zentrum Segeberger Kliniken GmbH, Bad Segeberg and Medizinische Klinik II, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Germany
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Brugger N, Saguner AM, Zbinden S, Khattab AA. LAD dissection following parachute belt trauma during BASE jumping. Int J Cardiol 2012; 159:e25-6. [PMID: 22204851 DOI: 10.1016/j.ijcard.2011.11.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 11/26/2011] [Indexed: 10/14/2022]
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Räber L, Kelbæk H, Ostojic M, Baumbach A, Heg D, Tüller D, von Birgelen C, Roffi M, Moschovitis A, Khattab AA, Wenaweser P, Bonvini R, Pedrazzini G, Kornowski R, Weber K, Trelle S, Lüscher TF, Taniwaki M, Matter CM, Meier B, Jüni P, Windecker S. Effect of biolimus-eluting stents with biodegradable polymer vs bare-metal stents on cardiovascular events among patients with acute myocardial infarction: the COMFORTABLE AMI randomized trial. JAMA 2012; 308:777-87. [PMID: 22910755 DOI: 10.1001/jama.2012.10065] [Citation(s) in RCA: 246] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
CONTEXT The efficacy and safety of drug-eluting stents compared with bare-metal stents remains controversial in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). OBJECTIVE To compare stents eluting biolimus from a biodegradable polymer with bare-metal stents in primary PCI. DESIGN, SETTING, AND PATIENTS A prospective, randomized, single-blinded, controlled trial of 1161 patients presenting with STEMI at 11 sites in Europe and Israel between September 19, 2009, and January 25, 2011. Clinical follow-up was performed at 1 and 12 months. INTERVENTION Patients were randomized 1:1 to receive the biolimus-eluting stent (n = 575) or the bare-metal stent (n = 582). MAIN OUTCOME MEASURES Primary end point was the rate of major adverse cardiac events, a composite of cardiac death, target vessel-related reinfarction, and ischemia-driven target-lesion revascularization at 1 year. RESULTS Major adverse cardiac events at 1 year occurred in 24 patients (4.3%) receiving biolimus-eluting stents with biodegradable polymer and 49 patients (8.7%) receiving bare-metal stents (hazard ratio [HR], 0.49; 95% CI, 0.30-0.80; P = .004). The difference was driven by a lower risk of target vessel-related reinfarction (3 [0.5%] vs 15 [2.7%]; HR, 0.20; 95% CI, 0.06-0.69; P = .01) and ischemia-driven target-lesion revascularization (9 [1.6%] vs 32 [5.7%]; HR, 0.28; 95% CI, 0.13-0.59; P < .001) in patients receiving biolimus-eluting stents compared with those receiving bare-metal stents. Rates of cardiac death were not significantly different (16 [2.9%] vs 20 [3.5%], P = .53). Definite stent thrombosis occurred in 5 patients (0.9%) treated with biolimus-eluting stents and 12 patients (2.1%; HR, 0.42; 95% CI, 0.15-1.19; P = .10) treated with bare-metal stents. CONCLUSION Compared with a bare-metal stent, the use of biolimus-eluting stents with a biodegradable polymer resulted in a lower rate of the composite of major adverse cardiac events at 1 year among patients with STEMI undergoing primary PCI. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00962416.
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Affiliation(s)
- Lorenz Räber
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
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Stortecky S, Schmid V, Windecker S, Kadner A, Pilgrim T, Buellesfeld L, Khattab AA, Wenaweser P. Improvement of physical and mental health after transfemoral transcatheter aortic valve implantation. EUROINTERVENTION 2012; 8:437-43. [DOI: 10.4244/eijv8i4a69] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kalesan B, Stefanini GG, Räber L, Schmutz M, Baumgartner S, Hitz S, Baldinger SH, Pilgrim T, Moschovitis A, Wenaweser P, Büllesfeld L, Khattab AA, Meier B, Jüni P, Windecker S. Long-term comparison of everolimus- and sirolimus-eluting stents in patients with acute coronary syndromes. JACC Cardiovasc Interv 2012; 5:145-54. [PMID: 22361598 DOI: 10.1016/j.jcin.2011.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 09/22/2011] [Accepted: 11/18/2011] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The goal of this study was to compare the long-term clinical outcome between everolimus-eluting stent (EES) and sirolimus-eluting stent (SES) in patients with acute coronary syndromes (ACS). BACKGROUND EES have not been directly compared with SES in ACS patients to date. METHODS Between 2004 and 2009, 1,746 consecutive ACS patients (ST-segment elevation ACS [STE-ACS]: 33.5%; non-ST-segment elevation ACS [NSTE-ACS]: 66.5%) were treated with EES (n=903) or SES (n=843). Using propensity score matching, clinical outcome was compared among 705 matched pairs of ACS patients treated with EES and SES. RESULTS Through 3 years, the primary endpoint-the composite of death, myocardial infarction (MI), and target vessel revascularization (TVR)-occurred in 13.8% of EES- and 17.7% of SES-treated ACS patients (hazard ratio [HR]: 0.72, 95% confidence interval [CI]: 0.54 to 0.95, p=0.02). The difference in favor of EES was driven by a lower risk of TVR (5.7% vs. 8.8%, HR: 0.65, 95% CI: 0.43 to 0.98, p=0.04) and a trend toward a lower risk of MI (2.1% vs. 3.3%, HR: 0.56, 95% CI: 0.29 to 1.12, p=0.10). The risk of death (7.2% vs. 8.8%, HR: 0.75, 95% CI: 0.50 to 1.10, p=0.14) showed no difference between EES and SES. The treatment effect in favor of EES for the primary endpoint was similar for patients with STE-ACS (16.4% vs. 18.5%, HR: 0.80, 95% CI: 0.50 to 1.27) and NSTE-ACS (12.4% vs. 17.3%; HR: 0.67, 95% CI: 0.47 to 0.96; pfor interaction=0.56) and across major subgroups. Definite (0.4% vs. 1.8%, p=0.03), and definite or probable stent thrombosis (3.4% vs. 6.1%, p=0.02) were less frequent among EES- than SES-treated ACS patients. CONCLUSIONS Among patients with ACS, the unrestricted use of EES is associated with improved clinical outcome compared with SES during long-term follow-up to 3 years. Notably, the risk of stent thrombosis was lower among EES-treated ACS patients.
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Affiliation(s)
- Bindu Kalesan
- Institute of Social and Preventive Medicine, University of Bern, and Clinical Trials Unit, Department of Cardiology, Bern University Hospital, Bern, Switzerland
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Guérios EE, Schmid M, Gloekler S, Khattab AA, Wenaweser PM, Windecker S, Meier B. Left atrial appendage closure with the Amplatzer cardiac plug in patients with atrial fibrillation. Arq Bras Cardiol 2012; 98:528-36. [PMID: 22584492 DOI: 10.1590/s0066-782x2012005000044] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 12/26/2011] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Percutaneous left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation (OA) for prevention of thromboembolic stroke in patients with non-valvular atrial fibrillation (NVAF). OBJECTIVE To describe the immediate results and short- to medium-term clinical follow-up (FU) of patients that underwent LAAC with Amplatzer Cardiac Plug (ACP) implantation in a single reference center. METHODS Eighty-six consecutive patients with NVAF, contraindication to OA, and CHADS2 score=2.6 ± 1.2 underwent LAAC with ACP implantation. Clinical and echocardiographic FU was performed at least four months after the procedure. RESULTS All implants were guided by angiography alone. Procedural success was 99% (one patient suffered a cardiac tamponade requiring pericardiocentesis, and the procedure was waived). There were four major complications (the already mentioned cardiac tamponade, two transient ischemic attacks and one device embolization with percutaneous retrieval) and two minor complications (one pericardial effusion without clinical significance and one non-significant ASD evidenced at FU). There was one in-hospital death after six days, unrelated to the procedure. All other patients were discharged without OA. After 25.9 patient-years of FU (69 patients), there were no strokes and no late device embolization. The LAA was completely closed in 97% of the cases. Six patients showed evidence of thrombus formation on the device, which resolved after three months of OA. CONCLUSION LAAC is associated with high success, acceptable complication rates, and promising FU results, and may be considered a valuable alternative or complement to OA for stroke prevention in patients with NVAF.
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Abdel-Wahab M, Baev R, Dieker P, Kassner G, Khattab AA, Toelg R, Sulimov D, Geist V, Richardt G. Long-term clinical outcome of rotational atherectomy followed by drug-eluting stent implantation in complex calcified coronary lesions. Catheter Cardiovasc Interv 2012; 81:285-91. [DOI: 10.1002/ccd.24367] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [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: 10/24/2011] [Revised: 01/01/2012] [Accepted: 02/12/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Mohamed Abdel-Wahab
- Department of Cardiology; Heart Center; Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg); Bad Segeberg; Germany
| | - Radoy Baev
- Department of Cardiology; Heart Center; Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg); Bad Segeberg; Germany
| | - Patrick Dieker
- Department of Cardiology; Heart Center; Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg); Bad Segeberg; Germany
| | - Guido Kassner
- Department of Cardiology; Heart Center; Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg); Bad Segeberg; Germany
| | - Ahmed A. Khattab
- Department of Cardiology; Heart Center; Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg); Bad Segeberg; Germany
| | - Ralph Toelg
- Department of Cardiology; Heart Center; Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg); Bad Segeberg; Germany
| | - Dmitriy Sulimov
- Department of Cardiology; Heart Center; Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg); Bad Segeberg; Germany
| | - Volker Geist
- Department of Cardiology; Heart Center; Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg); Bad Segeberg; Germany
| | - Gert Richardt
- Department of Cardiology; Heart Center; Segeberger Kliniken GmbH (Academic Teaching Hospital of the Universities of Kiel and Hamburg); Bad Segeberg; Germany
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Stortecky S, Windecker S, Pilgrim T, Heg D, Buellesfeld L, Khattab AA, Huber C, Gloekler S, Nietlispach F, Mattle H, Jüni P, Wenaweser P. Cerebrovascular accidents complicating transcatheter aortic valve implantation: frequency, timing and impact on outcomes. EUROINTERVENTION 2012; 8:62-70. [DOI: 10.4244/eijv8i1a11] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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