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Senguttuvan NB, Srinivasan NV, Panchanatham M, Abdulkader RS, Anandaram A, Polareddy DR, Ramesh S, Singh H, Yallanki H, Kaliyamoorthi D, Chidambaram S, Ramalingam V, Rajendran R, Muralidharan TR, Rao R, Seth A, Claessen B, Krishnamoorthy P. Systematic review and meta-analysis of early aortic valve replacement versus conservative therapy in patients with asymptomatic aortic valve stenosis with preserved left ventricle systolic function. Open Heart 2024; 11:e002511. [PMID: 38191233 PMCID: PMC10806528 DOI: 10.1136/openhrt-2023-002511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/14/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND A quarter of patients with severe aortic stenosis (AS) were asymptomatic, and only a third of them survived at the end of 4 years. Only a select subset of these patients was recommended for aortic valve replacement (AVR) by the current American College of Cardiology/American Heart Association guidelines. We intended to study the effect of early AVR (eAVR) in this subset of asymptomatic patients with preserved left ventricle function. METHODS AND RESULTS We searched PubMed and Embase for randomised and observational studies comparing the effect of eAVR versus conservative therapy in patients with severe, asymptomatic AS and normal left ventricular function. The primary outcome was all-cause mortality. The secondary outcomes were composite major adverse cardiac events (MACE) (study defined), myocardial infarction (MI), stroke, cardiac death, sudden death, the development of symptoms, heart failure hospitalisations and major bleeding. We used GRADEPro to assess the certainty of the evidence. In the randomised controlled trial (RCT) only analysis, we found no significant difference in all-cause mortality between the early aortic intervention group versus the conservative arm (CA) (incidence rate ratio, IRR (CI): 0.5 (0.2 to 1.1), I2=31%, p=0.09). However, in the overall cohort, we found mortality benefit for eAVR over CA (IRR (CI): 0.4 (0.3 to 0.7), I2=84%, p<0.01). There were significantly lower MACE, cardiac death, sudden death, development of symptoms and heart failure hospitalisations in the eAVR group. We noticed no difference in MI, stroke and major bleeding. CONCLUSION We conclude that there is no reduction in all-cause mortality in the eAVR arm in patients with asymptomatic AS with preserved ejection fraction. However, eAVR reduces heart failure related hospitalisations and death or heart failure hospitalisations. PROSPERO REGISTRATION NUMBER CRD42022306132.
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Affiliation(s)
| | | | - Manokar Panchanatham
- Department of Cardiology, SRIHER (Deemed to be University), Chennai, Tamil Nadu, India
| | | | - Asuwin Anandaram
- Department of Clinical Research, SRIHER (Deemed to be University), Chennai, Tamil Nadu, India
| | | | - Sankaran Ramesh
- Department of Cardiology, SRIHER (Deemed to be University), Chennai, Tamil Nadu, India
| | - Harsimran Singh
- Department of Cardiology, SRIHER (Deemed to be University), Chennai, Tamil Nadu, India
| | - Hanumath Yallanki
- Department of Medicine, SRIHER (Deemed to be University), Chennai, Tamil Nadu, India
| | | | | | - Vadivelu Ramalingam
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | | | | | - Ravindar Rao
- Department of Cardiology, Rajasthan University of Health Sciences, Jaipur, Rajasthan, India
| | - Ashok Seth
- Department of Cardiology, Fortis Escorts Heart Institute and Research Centre, New Delhi, Delhi, India
| | - Bimmer Claessen
- Department of Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Parasuram Krishnamoorthy
- Cardiology, Icahn School of Medicine at Mount Sinai Zena and Michael A Wiener Cardiovascular Institute, New York, New York, USA
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Ramakumar V, Thakur A, Abdulkader RS, Claessen B, Anandaram A, Palraj R, Aravamudan VM, Thoddi Ramamurthy M, Dangas G, Senguttuvan NB. Coronary Stent Infections - A Systematic Review and Meta-Analysis. Cardiovasc Revasc Med 2023; 54:16-24. [PMID: 36906449 DOI: 10.1016/j.carrev.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Coronary stent infection (CSI) represents a rare but potentially fatal complication of percutaneous coronary interventions (PCI). A systematic review and meta-analysis of published reports was performed to profile CSI and its management strategies. METHODS Online database searches were performed using MeSH and keywords. The primary outcome of the study was in-hospital mortality. A unique Artificial Intelligence-based predictive model was developed for need for delayed surgery and probability of survival on medical therapy alone. RESULTS A total of 79 subjects were included in the study. Twenty eight (35.0 %) patients had type 2 diabetes mellitus. Subjects most commonly reported symptoms within the first week of the procedure (43 %). Fever was the most common initial symptom (72 %). Thirty eight percent of patients presented with acute coronary syndrome. The presence of mycotic aneurysms was described in 62 % of patients. Staphylococcus species were the most common (65 %) isolated organism. The primary outcome of in-hospital mortality was seen in a total of 24 patients out of 79 (30.3 %). A comparative univariate analysis comparing those encountering in-hospital mortality versus otherwise revealed the presence of structural heart disease (83 % mortality vs 17 % survival, p = 0.009), and the presence of non ST elevation acute coronary syndrome (11 % mortality vs 88 % survival, p = 0.03), to be a statistically significant factor predicting in-hospital mortality. In an analysis between patients with successful versus failed initial medical therapy, patients from private teaching hospitals (80.0 % vs 20.0 %; p = 0.01, n = 10) had a higher survival with medical therapy alone. CONCLUSION CSI is a highly under-studied disease entity with largely unknown risk factors and clinical outcomes. Larger studies are needed to further define the characteristics of CSI. (PROSPERO ID CRD42021216031).
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Affiliation(s)
| | - Abhishek Thakur
- Department of Cardiology, National Cardiac Centre, Kathmandu, Nepal
| | | | | | - Asuwin Anandaram
- Department of Clinical Research, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Raj Palraj
- Mayo Clinic College of Medicine, Rochester, USA
| | | | | | - George Dangas
- Icahn School of Medicine, Mount Sinai, New York, USA
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Senguttuvan NB, Singh H, Kumar BV, Kongara RC, Abdulkader RS, Anandaram A, Krishnamurthy P, Balasubramaniyan JV, Sadhanandham S, Ramesh S, Manokar P, Muralidharan TR, Murthy JSN, Thanikachalam S. Safety and Efficacy of OPN Balloon in Patients With Calcified Coronary Artery Disease. Cardiovasc Revasc Med 2023; 54:25-30. [PMID: 36842933 DOI: 10.1016/j.carrev.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/14/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Patients with symptomatic calcified coronary lesions have poor outcomes. Such lesions require additional atherectomy devices for bed preparation. AIM To assess the safety and efficacy of OPN balloon in patients with calcified coronary lesions. METHODS This is an investigator-initiated, prospective, observational study. The primary outcome of the study was a procedural success. RESULTS We studied 71 patients (133 lesions). Maximum lesions were located in LAD [46.6 %]. The OPN balloon was used for pre-dilatation alone in 28.6 % (Pre-stent OPN group), post-dilatation alone in 63.2 % of lesions (Post-stent OPN group), and in both situations in 8.3 % of lesions with procedural success in 98.5 % of patients. Further dilatation with different NC balloons was required in both groups (30 %). The median (IQR) OPN balloon diameter in the pre- and post-stent OPN group were 2.5 (2.5, 3.0) and 3.0 (3.0,3.0) mm (p = 0.001), respectively. The difference between the diameter of the stent and OPN balloon used in pre-stent OPN group was 0.5 (0.2, 0.5) mm while it was 0.0 (0.0,0.2) mm in the post-stent OPN group (p < 0.001). Eight complications and two deaths occured. Distal shaft rupture was also noticed. CONCLUSION OPN balloon is safe, and effective in treating calcified coronary lesions. We propose to undersize the balloon by 0.5 mm for pre-dilatation followed by 0.25 mm larger NC balloon if needed. In the post-dilatation group, use a 1:1 size balloon in a non-tortuous straight segment. Use imaging especially when (1) the pressure taken more than the rated burst pressure, (2) an OPN balloon size is ≥3 mm (3) using 1:1 size OPN balloon in a tortuous segment.
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Affiliation(s)
- Nagendra Boopathy Senguttuvan
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India.
| | - Harsimran Singh
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Balakrishnan Vinod Kumar
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Rahul Chowdary Kongara
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | | | - Asuwin Anandaram
- Department of Clinical Research, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Preetam Krishnamurthy
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Jayanthy Venkata Balasubramaniyan
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Shanmugasundram Sadhanandham
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Sankaran Ramesh
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Panchanatham Manokar
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Thoddi Ramamurthy Muralidharan
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Jayanthy S N Murthy
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
| | - Sadagopan Thanikachalam
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India
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