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Azizi M, Sharp ASP, Fisher NDL, Weber MA, Lobo MD, Daemen J, Lurz P, Mahfoud F, Schmieder RE, Basile J, Bloch MJ, Saxena M, Wang Y, Sanghvi K, Jenkins JS, Devireddy C, Rader F, Gosse P, Claude L, Augustin DA, McClure CK, Kirtane AJ. Patient-Level Pooled Analysis of Endovascular Ultrasound Renal Denervation or a Sham Procedure 6 Months After Medication Escalation: The RADIANCE Clinical Trial Program. Circulation 2024; 149:747-759. [PMID: 37883784 DOI: 10.1161/circulationaha.123.066941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/24/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND The randomized, sham-controlled RADIANCE-HTN (A Study of the Recor Medical Paradise System in Clinical Hypertension) SOLO, RADIANCE-HTN TRIO, and RADIANCE II (A Study of the Recor Medical Paradise System in Stage II Hypertension) trials independently met their primary end point of a greater reduction in daytime ambulatory systolic blood pressure (SBP) 2 months after ultrasound renal denervation (uRDN) in patients with hypertension. To characterize the longer-term effectiveness and safety of uRDN versus sham at 6 months, after the blinded addition of antihypertensive treatments (AHTs), we pooled individual patient data across these 3 similarly designed trials. METHODS Patients with mild to moderate hypertension who were not on AHT or with hypertension resistant to a standardized combination triple AHT were randomized to uRDN (n=293) versus sham (n=213); they were to remain off of added AHT throughout 2 months of follow-up unless specified blood pressure (BP) criteria were exceeded. In each trial, if monthly home BP was ≥135/85 mm Hg from 2 to 5 months, standardized AHT was sequentially added to target home BP <135/85 mm Hg under blinding to initial treatment assignment. Six-month outcomes included baseline- and AHT-adjusted change in daytime ambulatory, home, and office SBP; change in AHT; and safety. Linear mixed regression models using all BP measurements and change in AHT from baseline through 6 months were used. RESULTS Patients (70% men) were 54.1±9.3 years of age with a baseline daytime ambulatory/home/office SBP of 150.5±9.8/151.0±12.4/155.5±14.4 mm Hg, respectively. From 2 to 6 months, BP decreased in both groups with AHT titration, but fewer uRDN patients were prescribed AHT (P=0.004), and fewer additional AHT were prescribed to uRDN patients versus sham patients (P=0.001). Whereas the unadjusted between-group difference in daytime ambulatory SBP was similar at 6 months, the baseline and medication-adjusted between-group difference at 6 months was -3.0 mm Hg (95% CI, -5.7, -0.2; P=0.033), in favor of uRDN+AHT. For home and office SBP, the adjusted between-group differences in favor of uRDN+AHT over 6 months were -5.4 mm Hg (-6.8, -4.0; P<0.001) and -5.2 mm Hg (-7.1, -3.3; P<0.001), respectively. There was no heterogeneity between trials. Safety outcomes were few and did not differ between groups. CONCLUSIONS This individual patient-data analysis of 506 patients included in the RADIANCE trials demonstrates the maintenance of BP-lowering efficacy of uRDN versus sham at 6 months, with fewer added AHTs. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifiers: NCT02649426 and NCT03614260.
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Affiliation(s)
- Michel Azizi
- Université Paris Cité, France (M.A.)
- AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, Paris, France (M.A.)
- INSERM, Paris, France (M.A.)
| | - Andrew S P Sharp
- University Hospital of Wales and Cardiff University, Cardiff, UK (A.S.P.S.)
| | | | - Michael A Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York (M.A.W., M.S.)
| | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, UK (M.D.L.)
| | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Center Rotterdam, the Netherlands (J.D.)
| | - Philipp Lurz
- Zentrum für Kardiologie, Universitätsmedizin Mainz, Germany (P.L.)
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany (F.M.)
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (F.M.)
| | - Roland E Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany (R.E.S.)
| | - Jan Basile
- Division of Cardiovascular Medicine, Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston (J.B.)
| | - Michael J Bloch
- Department of Medicine, University of Nevada School of Medicine, Vascular Care, Renown Institute of Heart and Vascular Health, Reno (M.J.B.)
| | - Manish Saxena
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York (M.A.W., M.S.)
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (Y.W.)
| | | | | | - Chandan Devireddy
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.D.)
| | - Florian Rader
- Cedars-Sinai Heart Institute, Los Angeles, CA (F.R.)
| | | | - Lisa Claude
- Recor Medical, Inc., Palo Alto, CA (L.C., D.A.A.)
| | | | | | - Ajay J Kirtane
- Columbia University Irving Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY (A.J.K.)
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Ullah W, Sarvepalli D, Kumar A, Zahid S, Saleem S, Muhammadzai HZU, Khattak F, Block PC, Jaber WA, Shishehbor MH, Filby SJ, Devireddy C. Trends and outcomes of combined percutaneous (TAVI+PCI) and surgical approach (SAVR+CABG) for patients with aortic valve and coronary artery disease: A National Readmission Database (NRD) analysis. Catheter Cardiovasc Interv 2023; 102:946-957. [PMID: 37698396 DOI: 10.1002/ccd.30832] [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: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND In patients with severe aortic stenosis (AS) and concomitant severe coronary artery disease (CAD), the relative merits of a combined percutaneous (transcatheter aortic valve implantation [TAVI] and percutaneous coronary intervention [PCI]] versus surgical approach (surgical aortic valve replacement [SAVR] and coronary artery bypass graft [CABG]) remain unknown. AIMS To determine the utility of combined percutaneous versus surgical approaches in patients with severe AS and CAD. METHODS The National Readmission Database (NRD) (2015-2019) was queried to identify all cases of TAVI+PCI and SAVR+CABG. The adjusted odds ratios (aOR) of mortality, stroke, and its composite (major adverse cardiovascular events [MACE]) were calculated using a propensity-score matched (PSM) analysis. RESULTS A total of 89,314 (5358 TAVI+PCI, 83,956 SAVR+CABG) patients were included in the crude analysis. There was a gradual increase in the utilization of TAVI+PCI from 2016 to 2019 by 2%-4% per year. Using PSM, a subset of 11,361 (5358 TAVI+PCI, 6003 SAVR+CABG) patients with a balanced set of demographics and baseline comorbidities was selected. During index hospitalization, the adjusted odds of MACE (aOR 0.72, 95% confidence interval [CI] 0.62-0.83), and all-cause mortality (aOR 0.68, 95% CI 0.57-0.81) were significantly lower in patients undergoing TAVI+PCI compared with SAVR+CABG. However, patients undergoing TAVI+PCI had a higher incidence of MACE (aOR 1.40, 95% CI 1.05-1.87), and mortality (aOR 1.75, 95% CI 1.22-2.50) at 30-days. The risk of index-admission (aOR 0.82, 95% CI 0.62-1.09) and 30-day (aOR 0.88, 95% CI 0.51-1.51) stroke was similar between the two groups. CONCLUSION In selected patients with severe AS and concomitant CAD, a combined percutaneous approach (TAVR+PCI) compared with SAVR+CABG may confer a lower risk of MACE and mortality during index admission but a higher incidence of 30-day complications.
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Affiliation(s)
- Waqas Ullah
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | - Arnav Kumar
- Brigham and Women's Hospital Heart & Vascular Center, Boston, Massachusetts, USA
| | - Salman Zahid
- Rochester General Hospital, Rochester, New York, USA
| | - Sameer Saleem
- University of Kentucky, Bowling Green, Kentucky, USA
| | | | - Furqan Khattak
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Peter C Block
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Wissam A Jaber
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mehdi H Shishehbor
- University Hospitals Harrington Heart and Vascular Institute, Cleveland, Ohio, USA
| | - Steven J Filby
- University Hospitals Harrington Heart and Vascular Institute, Cleveland, Ohio, USA
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Ueyama H, Leshnower BG, Inci E, Keeling WB, Tully A, Guyton RA, Xie JX, Gleason PT, Byku I, Devireddy C, Hanzel GS, Block PC, Lederman RJ, Greenbaum AB, Babaliaros VC. Hybrid Closure of Postinfarction Apical Ventricular Septal Defect Using Septal Occluder Device and Right Ventricular Free Wall: The Apical BASSINET Concept. Circ Cardiovasc Interv 2023; 16:e013243. [PMID: 37732604 PMCID: PMC10592084 DOI: 10.1161/circinterventions.123.013243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/28/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Postinfarction ventricular septal defect (VSD) is a catastrophic complication of myocardial infarction. Surgical repair still has poor outcomes. This report describes clinical outcomes after a novel hybrid transcatheter/surgical repair in patients with apical VSD. METHODS Seven patients with postmyocardial infarction apical VSD underwent hybrid transcatheter repair via subxiphoid surgical access. A transcatheter occluder (Amplatzer Septal Occluder) with a trailing premounted suture was deployed through the right ventricular wall and through the ventricular septum into the left ventricular apex. The trailing suture was used to connect an anchor external to the right ventricular wall. Tension on the suture then collapses the right ventricular free wall against the septum and left ventricular occluder, thereby obliterating the VSD. Outcomes were compared with 9 patients who underwent surgical repair using either patch or primary suture closure. RESULTS All patients had significant left-to-right shunt (Qp:Qs 2.5:1; interquartile range [IQR, 2.1-2.6] hybrid repair versus 2.0:1 [IQR, 2.0-2.5] surgical repair), and elevated right ventricular systolic pressure (62 [IQR, 46-71] versus 49 [IQR, 43-54] mm Hg, respectively). All had severely depressed stroke volume index (22 versus 21 mL/m2) with ≈45% in each group requiring mechanical support preprocedurally. The procedure was done 15 (IQR, 10-50) versus 24 (IQR, 10-134) days postmyocardial infarction, respectively. Both groups of patients underwent repair with technical success and without intraprocedural death. One patient in the hybrid group and 4 in the surgical group developed multiorgan failure. The hybrid group had a higher survival at discharge (86% versus 56%) and at 30 days (71% versus 56%), but similar at 1 year (57% versus 56%). During follow-up, 1 patient in each group required reintervention for residual VSD (hybrid: 9 months versus surgical: 5 days). CONCLUSIONS Early intervention with a hybrid transcatheter/surgical repair may be a viable alternative to traditional surgery for postinfarction apical VSD.
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Affiliation(s)
- Hiroki Ueyama
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Bradley G. Leshnower
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Errol Inci
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - W. Brent Keeling
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andy Tully
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert A. Guyton
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Joe X. Xie
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Patrick T. Gleason
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Isida Byku
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Chandan Devireddy
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - George S. Hanzel
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Peter C. Block
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Robert J. Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Adam B. Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Vasilis C. Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
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4
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Kirtane AJ, Sharp ASP, Mahfoud F, Fisher NDL, Schmieder RE, Daemen J, Lobo MD, Lurz P, Basile J, Bloch MJ, Weber MA, Saxena M, Wang Y, Sanghvi K, Jenkins JS, Devireddy C, Rader F, Gosse P, Sapoval M, Barman NC, Claude L, Augustin D, Thackeray L, Mullin CM, Azizi M. Patient-Level Pooled Analysis of Ultrasound Renal Denervation in the Sham-Controlled RADIANCE II, RADIANCE-HTN SOLO, and RADIANCE-HTN TRIO Trials. JAMA Cardiol 2023; 8:464-473. [PMID: 36853627 PMCID: PMC9975919 DOI: 10.1001/jamacardio.2023.0338] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/06/2023] [Indexed: 03/01/2023]
Abstract
Importance Ultrasound renal denervation (uRDN) was shown to lower blood pressure (BP) in patients with uncontrolled hypertension (HTN). Establishing the magnitude and consistency of the uRDN effect across the HTN spectrum is clinically important. Objective To characterize the effectiveness and safety of uRDN vs a sham procedure from individual patient-level pooled data across uRDN trials including either patients with mild to moderate HTN on a background of no medications or with HTN resistant to standardized triple-combination therapy. Data Sources A Study of the ReCor Medical Paradise System in Clinical Hypertension (RADIANCE-HTN SOLO and TRIO) and A Study of the ReCor Medical Paradise System in Stage II Hypertension (RADIANCE II) trials. Study Selection Trials with similar designs, standardized operational implementation (medication standardization and blinding of both patients and physicians to treatment assignment), and follow-up. Data Extraction and Synthesis Pooled analysis using individual patient-level data using linear regression models to compare uRDN with sham across the trials. Main Outcomes and Measures The primary outcome was baseline-adjusted change in 2-month daytime ambulatory systolic BP (dASBP) between groups. Results A total of 506 patients were randomized in the 3 studies (uRDN, 293; sham, 213; mean [SD] age, 54.1 [9.3]; 354 male [70.0%]). After a 1-month medication stabilization period, dASBP was similar between the groups (mean [SD], uRDN, 150.3 [9.2] mm Hg; sham, 150.8 [10.5] mm Hg). At 2 months, dASBP decreased by 8.5 mm Hg to mean (SD) 141.8 (13.8) mm Hg among patients treated with uRDN and by 2.9 mm Hg to 147.9 (14.6) mm Hg among patients treated with a sham procedure (mean difference, -5.9; 95% CI, -8.1 to -3.8 mm Hg; P < .001 in favor of uRDN). BP decreases from baseline with uRDN vs sham were consistent across trials and across BP parameters (office SBP: -10.4 mm Hg vs -3.4 mm Hg; mean difference, -6.4 mm Hg; 95% CI, -9.1 to -3.6 mm Hg; home SBP: -8.4 mm Hg vs -1.4 mm Hg; mean difference, -6.8 mm Hg; 95% CI, -8.7 to -4.9 mm Hg, respectively). The BP reductions with uRDN vs sham were consistent across prespecified subgroups. Independent predictors of a larger BP response to uRDN were higher baseline BP and heart rate and the presence of orthostatic hypertension. No differences in early safety end points were observed between groups. Conclusions and Relevance Results of this patient-level pooled analysis suggest that BP reductions with uRDN were consistent across HTN severity in sham-controlled trials designed with a 2-month primary end point to standardize medications across randomized groups. Trial Registration ClinicalTrials.gov Identifier: NCT02649426 and NCT03614260.
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Affiliation(s)
- Ajay J. Kirtane
- Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York
- Associate Editor, JAMA Cardiology
| | - Andrew S. P. Sharp
- University Hospital of Wales and Cardiff University, Cardiff, United Kingdom
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge
| | | | - Roland E. Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Joost Daemen
- Department of Cardiology, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Melvin D. Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Jan Basile
- Division of Cardiovascular Medicine, Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston
| | - Michael J. Bloch
- Vascular Care, Renown Institute of Heart and Vascular Health, Department of Medicine, University of Nevada School of Medicine, Reno
| | - Michael A. Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York
| | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | | | - Chandan Devireddy
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Florian Rader
- Cedars-Sinai Heart Institute, Los Angeles, California
| | | | - Marc Sapoval
- Université Paris Cité, Paris, France
- AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, Paris, France
- INSERM, CIC1418, Paris, France
| | | | | | | | | | | | - Michel Azizi
- Université Paris Cité, Paris, France
- AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, Paris, France
- INSERM, CIC1418, Paris, France
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5
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Azizi M, Saxena M, Wang Y, Jenkins JS, Devireddy C, Rader F, Fisher NDL, Schmieder RE, Mahfoud F, Lindsey J, Sanghvi K, Todoran TM, Pacella J, Flack J, Daemen J, Sharp ASP, Lurz P, Bloch MJ, Weber MA, Lobo MD, Basile J, Claude L, Reeve-Stoffer H, McClure CK, Kirtane AJ. Endovascular Ultrasound Renal Denervation to Treat Hypertension: The RADIANCE II Randomized Clinical Trial. JAMA 2023; 329:651-661. [PMID: 36853250 PMCID: PMC9975904 DOI: 10.1001/jama.2023.0713] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [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: 11/18/2022] [Accepted: 01/18/2023] [Indexed: 03/01/2023]
Abstract
Importance Two initial sham-controlled trials demonstrated that ultrasound renal denervation decreases blood pressure (BP) in patients with mild to moderate hypertension and hypertension that is resistant to treatment. Objective To study the efficacy and safety of ultrasound renal denervation without the confounding influence of antihypertensive medications in patients with hypertension. Design, Setting, and Participants Sham-controlled, randomized clinical trial with patients and outcome assessors blinded to treatment assignment that was conducted between January 14, 2019, and March 25, 2022, at 37 centers in the US and 24 centers in Europe, with randomization stratified by center. Patients aged 18 years to 75 years with hypertension (seated office systolic BP [SBP] ≥140 mm Hg and diastolic BP [DBP] ≥90 mm Hg despite taking up to 2 antihypertensive medications) were eligible if they had an ambulatory SBP/DBP of 135/85 mm Hg or greater and an SBP/DBP less than 170/105 mm Hg after a 4-week washout of their medications. Patients with an estimated glomerular filtration rate of 40 mL/min/1.73 m2 or greater and with suitable renal artery anatomy were randomized 2:1 to undergo ultrasound renal denervation or a sham procedure. Patients were to abstain from antihypertensive medications until the 2-month follow-up unless prespecified BP criteria were exceeded and were associated with clinical symptoms. Interventions Ultrasound renal denervation vs a sham procedure. Main Outcomes and Measures The primary efficacy outcome was the mean change in daytime ambulatory SBP at 2 months. The primary safety composite outcome of major adverse events included death, kidney failure, and major embolic, vascular, cardiovascular, cerebrovascular, and hypertensive events at 30 days and renal artery stenosis greater than 70% detected at 6 months. The secondary outcomes included mean change in 24-hour ambulatory SBP, home SBP, office SBP, and all DBP parameters at 2 months. Results Among 1038 eligible patients, 150 were randomized to ultrasound renal denervation and 74 to a sham procedure (mean age, 55 years [SD, 9.3 years]; 28.6% female; and 16.1% self-identified as Black or African American). The reduction in daytime ambulatory SBP was greater with ultrasound renal denervation (mean, -7.9 mm Hg [SD, 11.6 mm Hg]) vs the sham procedure (mean, -1.8 mm Hg [SD, 9.5 mm Hg]) (baseline-adjusted between-group difference, -6.3 mm Hg [95% CI, -9.3 to -3.2 mm Hg], P < .001), with a consistent effect of ultrasound renal denervation throughout the 24-hour circadian cycle. Among 7 secondary BP outcomes, 6 were significantly improved with ultrasound renal denervation vs the sham procedure. No major adverse events were reported in either group. Conclusions and Relevance In patients with hypertension, ultrasound renal denervation reduced daytime ambulatory SBP at 2 months in the absence of antihypertensive medications vs a sham procedure without postprocedural major adverse events. Trial Registration ClinicalTrials.gov Identifier: NCT03614260.
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Affiliation(s)
- Michel Azizi
- Université Paris Cité, Paris, France
- AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, Paris, France
- INSERM, CIC1418, Paris, France
| | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, England
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | - Chandan Devireddy
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Florian Rader
- Cedars-Sinai Heart Institute, Los Angeles, California
| | | | - Roland E. Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg, Germany
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge
| | - Jason Lindsey
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | | | - Thomas M. Todoran
- Division of Cardiovascular Medicine, Medical University of South Carolina, Charleston
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - John Pacella
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John Flack
- Springfield Memorial Hospital, Southern Illinois University School of Medicine, Springfield
| | - Joost Daemen
- Erasmus MC, Department of Cardiology, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Andrew S. P. Sharp
- University Hospital of Wales, Cardiff, England
- University of Exeter, Exeter, England
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Michael J. Bloch
- Vascular Care, Renown Institute of Heart and Vascular Health, Department of Medicine, University of Nevada School of Medicine, Reno
| | - Michael A. Weber
- Downstate Medical Center, Division of Cardiovascular Medicine, State University of New York, New York
| | - Melvin D. Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, England
| | - Jan Basile
- Division of Cardiovascular Medicine, Medical University of South Carolina, Charleston
| | | | | | | | - Ajay J. Kirtane
- Columbia University Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York
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6
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Inci EK, Khandhar S, Toma C, Licitra G, Brown MJ, Herzig M, Matthai W, Palevsky H, Schwartz A, Wight JA, McDaniel M, Kumar G, Devireddy C, Baumgartner S, Bashline M, Jaber WA. Mechanical thrombectomy versus catheter directed thrombolysis in patients with pulmonary embolism: A multicenter experience. Catheter Cardiovasc Interv 2023; 101:140-146. [PMID: 36448401 DOI: 10.1002/ccd.30505] [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: 05/24/2022] [Revised: 11/05/2022] [Accepted: 11/19/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVES Compare in-hospital outcomes of patients treated with either mechanical thrombectomy (MT) or catheter directed lysis (CDL) in treatment of acute pulmonary embolism (PE). METHODS This is a multicenter, retrospective cohort study of patients undergoing MT or CDL for acute PE between 2014 and 2021. The primary outcome was the composite of in-hospital death, significant bleed, vascular complication, or need for mechanical support post-procedure. Secondary outcomes included the individual components of the composite outcome in addition to blood transfusions, invasive hemodynamics, echocardiographic data, and intensive care unit (ICU) utilization. RESULTS 458 patients were treated for PE with 266 patients in the CDL arm and 192 patients in the MT arm. The primary composite endpoint was not significantly different between the two groups with CDL 12% versus MT 11% (p = 0.5). There was a significant difference in total length of ICU time required with more in the CDL group versus MT (3.8 ± 2.0 vs. 2.8 ± 3.0 days, p = 0.009). All other secondary end points showed no significant difference between the groups. CONCLUSIONS In patients undergoing catheter directed treatment of PE, there was no difference between MT and CDL in terms of in-hospital mortality, bleeds, catheter-related complications, and hemodynamics.
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Affiliation(s)
- Errol K Inci
- Emory University Hospital, Atlanta, Georgia, USA
| | - Sameer Khandhar
- PENN Presbyterian Medical Center, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsyvlanvia, USA
| | - Catalin Toma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | | | - Matthew Herzig
- PENN Presbyterian Medical Center, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsyvlanvia, USA
| | - William Matthai
- PENN Presbyterian Medical Center, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsyvlanvia, USA
| | - Harold Palevsky
- PENN Presbyterian Medical Center, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsyvlanvia, USA
| | | | - John A Wight
- Emory University Hospital, Atlanta, Georgia, USA
| | | | - Gautam Kumar
- Emory University Hospital, Atlanta, Georgia, USA
| | | | - Scott Baumgartner
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael Bashline
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Koch R, Inci E, Grubb K, Leshnower B, Paone G, Ueyama H, Devireddy C, Gleason P, Xie J, Wei J, Rainer K, Ceretto-Clark B, Byku I, Greenbaum A, Babaliaros V, Perdoncin E. A Comparison of Thirty-Day Clinical and Echocardiographic Outcomes of Patients Undergoing Transcatheter vs. Surgical Aortic Valve Replacement for Native Aortic Insufficiency. Cardiovasc Revasc Med 2023; 46:85-89. [PMID: 35965211 DOI: 10.1016/j.carrev.2022.08.010] [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: 05/04/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES We aim to compare in-hospital and 30-day outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) for native aortic insufficiency (AI). BACKGROUND TAVR is increasingly used off-label in patients with AI deemed high risk for SAVR. There is a paucity of data comparing TAVR and SAVR with current commercially available TAVR devices. METHODS A single-center, retrospective cohort study of patients undergoing TAVR or SAVR for native AI between 2014 and 2020 was performed. Data were obtained from the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database, Transcatheter Valve Therapy (TVT) registry, and chart review. In-hospital and 30-day outcomes are reported. RESULTS Of 125 total patients, 91 underwent SAVR and 34 underwent TAVR. The TAVR group had a higher STS predictive risk of mortality (PROM) (TAVR = 3.96 %, SAVR = 1.25 %, p < 0.0001). In the postoperative period, the SAVR group had higher rates of new-onset atrial fibrillation (20.9 % vs. 0 %, p < 0.001), while the TAVR group had higher rates of complete heart block requiring permanent pacemaker implantation (20.6 % vs. 2.2 %, p < 0.001). There was no difference in in-hospital or 30-day mortality, stroke, myocardial infarction, residual AI, or repeat valve intervention. CONCLUSIONS Despite higher STS PROM and more comorbidities, patients who underwent TAVR for AI had similar in-hospital and 30-day outcomes as patients who underwent SAVR for AI. These results support TAVR in selected high-risk patients with AI, with the knowledge that pacemaker needs may be higher than patients undergoing SAVR.
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Affiliation(s)
- Rachel Koch
- Department of Internal Medicine, Emory University Hospital, Atlanta, GA, USA
| | - Errol Inci
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Kendra Grubb
- Division of Cardiothoracic Surgery, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Bradley Leshnower
- Division of Cardiothoracic Surgery, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Gaetano Paone
- Division of Cardiothoracic Surgery, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Hiroki Ueyama
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Chandan Devireddy
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Patrick Gleason
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Joe Xie
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Jane Wei
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Isida Byku
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Adam Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Vasilis Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA.
| | - Emily Perdoncin
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA.
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Azizi M, Mahfoud F, Weber MA, Sharp ASP, Schmieder RE, Lurz P, Lobo MD, Fisher NDL, Daemen J, Bloch MJ, Basile J, Sanghvi K, Saxena M, Gosse P, Jenkins JS, Levy T, Persu A, Kably B, Claude L, Reeve-Stoffer H, McClure C, Kirtane AJ, Mullin C, Thackeray L, Chertow G, Kahan T, Dauerman H, Ullery S, Abbott JD, Loening A, Zagoria R, Costello J, Krathan C, Lewis L, McElvarr A, Reilly J, Cash M, Williams S, Jarvis M, Fong P, Laffer C, Gainer J, Robbins M, Crook S, Maddel S, Hsi D, Martin S, Portnay E, Ducey M, Rose S, DelMastro E, Bangalore S, Williams S, Cabos S, Rodriguez Alvarez C, Todoran T, Powers E, Hodskins E, Paladugu V, Tecklenburg A, Devireddy C, Lea J, Wells B, Fiebach A, Merlin C, Rader F, Dohad S, Kim HM, Rashid M, Abraham J, Owan T, Abraham A, Lavasani I, Neilson H, Calhoun D, McElderry T, Maddox W, Oparil S, Kinder S, Radhakrishnan J, Batres C, Edwards S, Garasic J, Drachman D, Zusman R, Rosenfield K, Do D, Khuddus M, Zentko S, O'Meara J, Barb I, Foster A, Boyette A, Wang Y, Jay D, Skeik N, Schwartz R, Peterson R, Goldman JA, Goldman J, Ledley G, Katof N, Potluri S, Biedermann S, Ward J, White M, Mauri L, Sobieszczky P, Smith A, Aseltine L, Stouffer R, Hinderliter A, Pauley E, Wade T, Zidar D, Shishehbor M, Effron B, Costa M, Semenec T, Roongsritong C, Nelson P, Neumann B, Cohen D, Giri J, Neubauer R, Vo T, Chugh AR, Huang PH, Jose P, Flack J, Fishman R, Jones M, Adams T, Bajzer C, Mathur A, Jain A, Balawon A, Zongo O, Bent C, Beckett D, Lakeman N, Kennard S, D’Souza RJ, Statton S, Wilkes L, Anning C, Sayer J, Iyer SG, Robinson N, Sevillano A, Ocampo M, Gerber R, Faris M, Marshall AJ, Sinclair J, Pepper H, Davies J, Chapman N, Burak P, Carvelli P, Jadhav S, Quinn J, Rump LC, Stegbauer J, Schimmöller L, Potthoff S, Schmid C, Roeder S, Weil J, Hafer L, Agdirlioglu T, Köllner T, Böhm M, Ewen S, Kulenthiran S, Wachter A, Koch C, Fengler K, Rommel KP, Trautmann K, Petzold M, Ott C, Schmid A, Uder M, Heinritz U, Fröhlich-Endres K, Genth-Zotz S, Kämpfner D, Grawe A, Höhne J, Kaesberger B, von zur Mühlen C, Wolf D, Welzel M, Heinrichs G, Trabitzsch B, Cremer A, Trillaud H, Papadopoulos P, Maire F, Gaudissard J, Sapoval M, Livrozet M, Lorthioir A, Amar L, Paquet V, Pathak A, Honton B, Cottin M, Petit F, Lantelme P, Berge C, Courand PY, Langevin F, Delsart P, Longere B, Ledieu G, Pontana F, Sommeville C, Bertrand F, Feyz L, Zeijen V, Ruiter A, Huysken E, Blankestijn P, Voskuil M, Rittersma Z, Dolmans H, Kroon A, van Zwam W, Vranken J, de Haan. C, Renkin J, Maes F, Beauloye C, Lengelé JP, Huyberechts D, Bouvie A, Witkowski A, Januszewicz A, Kądziela J, Prejbisj A, Hering D, Ciecwierz D, Jaguszewski MJ, Owczuk R. Effects of Renal Denervation vs Sham in Resistant Hypertension After Medication Escalation: Prespecified Analysis at 6 Months of the RADIANCE-HTN TRIO Randomized Clinical Trial. JAMA Cardiol 2022; 7:1244-1252. [PMID: 36350593 PMCID: PMC9647563 DOI: 10.1001/jamacardio.2022.3904] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 11/10/2022]
Abstract
Importance Although early trials of endovascular renal denervation (RDN) for patients with resistant hypertension (RHTN) reported inconsistent results, ultrasound RDN (uRDN) was found to decrease blood pressure (BP) vs sham at 2 months in patients with RHTN taking stable background medications in the Study of the ReCor Medical Paradise System in Clinical Hypertension (RADIANCE-HTN TRIO) trial. Objectives To report the prespecified analysis of the persistence of the BP effects and safety of uRDN vs sham at 6 months in conjunction with escalating antihypertensive medications. Design, Setting, and Participants This randomized, sham-controlled, clinical trial with outcome assessors and patients blinded to treatment assignment, enrolled patients from March 11, 2016, to March 13, 2020. This was an international, multicenter study conducted in the US and Europe. Participants with daytime ambulatory BP of 135/85 mm Hg or higher after 4 weeks of single-pill triple-combination treatment (angiotensin-receptor blocker, calcium channel blocker, and thiazide diuretic) with estimated glomerular filtration rate (eGFR) of 40 mL/min/1.73 m2 or greater were randomly assigned to uRDN or sham with medications unchanged through 2 months. From 2 to 5 months, if monthly home BP was 135/85 mm Hg or higher, standardized stepped-care antihypertensive treatment starting with aldosterone antagonists was initiated under blinding to treatment assignment. Interventions uRDN vs sham procedure in conjunction with added medications to target BP control. Main Outcomes and Measures Six-month change in medications, change in daytime ambulatory systolic BP, change in home systolic BP adjusted for baseline BP and medications, and safety. Results A total of 65 of 69 participants in the uRDN group and 64 of 67 participants in the sham group (mean [SD] age, 52.4 [8.3] years; 104 male [80.6%]) with a mean (SD) eGFR of 81.5 (22.8) mL/min/1.73 m2 had 6-month daytime ambulatory BP measurements. Fewer medications were added in the uRDN group (mean [SD], 0.7 [1.0] medications) vs sham (mean [SD], 1.1 [1.1] medications; P = .045) and fewer patients in the uRDN group received aldosterone antagonists at 6 months (26 of 65 [40.0%] vs 39 of 64 [60.9%]; P = .02). Despite less intensive standardized stepped-care antihypertensive treatment, mean (SD) daytime ambulatory BP at 6 months was 138.3 (15.1) mm Hg with uRDN vs 139.0 (14.3) mm Hg with sham (additional decreases of -2.4 [16.6] vs -7.0 [16.7] mm Hg from month 2, respectively), whereas home SBP was lowered to a greater extent with uRDN by 4.3 mm Hg (95% CI, 0.5-8.1 mm Hg; P = .03) in a mixed model adjusting for baseline and number of medications. Adverse events were infrequent and similar between groups. Conclusions and Relevance In this study, in patients with RHTN initially randomly assigned to uRDN or a sham procedure and who had persistent elevation of BP at 2 months after the procedure, standardized stepped-care antihypertensive treatment escalation resulted in similar BP reduction in both groups at 6 months, with fewer additional medications required in the uRDN group. Trial Registration ClinicalTrials.gov Identifier: NCT02649426.
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Affiliation(s)
- Michel Azizi
- Université Paris Cité, F-75006 Paris, France,Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, F-75015 Paris, France,INSERM, CIC1418, F-75015 Paris, France
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge
| | - Michael A. Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York
| | - Andrew S. P. Sharp
- University Hospital of Wales, Cardiff and University of Exeter, Exeter, United Kingdom
| | - Roland E. Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Melvin D. Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | | | - Joost Daemen
- Erasmus MC, University Medical Center Rotterdam, Department of Cardiology, Rotterdam, the Netherlands
| | - Michael J. Bloch
- Department of Medicine, University of Nevada School of Medicine, Vascular Care, Renown Institute of Heart and Vascular Health, Reno
| | - Jan Basile
- Division of Cardiovascular Medicine, Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston
| | | | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | | | | | - Terry Levy
- Royal Bournemouth Hospital, Dorset, United Kingdom
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Benjamin Kably
- Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Department of Pharmacology, Paris, France
| | | | | | | | - Ajay J. Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York
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- for the RADIANCE-HTN Investigators
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- for the RADIANCE-HTN Investigators
| | | | - Thu Vo
- for the RADIANCE-HTN Investigators
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Kim J, Black G, perdoncin E, Shekiladze N, Gleason P, Grubb K, Devireddy C, Bhatia NK, Merchant FM, El-Chami MF, Westerman SB, Shah AD, Leon AR, Lloyd MS, Kiani S. PO-620-06 VALIDATION OF RISK SCORE PREDICTING NEED FOR PACEMAKER IMPLANT AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.833] [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: 11/25/2022]
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Barker M, Sathananthan J, Perdoncin E, Devireddy C, Keegan P, Grubb K, Pop AM, Depta JP, Rai D, Abtahian F, Spence MS, Mailey J, Muir DF, Russo MJ, Pineda-Salazar J, Okoh A, Smith M, Dahle TG, Rana M, Alfadhel M, Meier D, Chatfield A, Akodad M, Chuang A, Samuel R, Nestelberger T, McAlister C, Lauck S, Webb JG, Wood DA. Same-Day Discharge Post-Transcatheter Aortic Valve Replacement During the COVID-19 Pandemic: The Multicenter PROTECT TAVR Study. JACC Cardiovasc Interv 2022; 15:590-598. [PMID: 35331450 PMCID: PMC8936029 DOI: 10.1016/j.jcin.2021.12.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 12/23/2022]
Abstract
Objectives The aim of this study was to determine the safety and efficacy of same-day discharge (SDD) after transcatheter aortic valve replacement (TAVR) during the COVID-19 pandemic. Background The COVID-19 pandemic has placed significant stress on health care systems worldwide. SDD in highly selected TAVR patients can facilitate the provision of essential cardiovascular care while managing competing COVID-19 resource demands. Methods Patient selection for SDD was at the discretion of the local multidisciplinary heart team, across 7 international sites. The primary outcome was a composite of cardiovascular death, stroke, myocardial infarction, all-cause readmission, major vascular complications, and new permanent pacemaker (PPM) implantation. Results From March 2020 to August 2021, 124 of 2,100 patients who underwent elective transfemoral TAVR were selected for SDD. The average age was 78.9 ± 7.8 years, the median Society of Thoracic Surgeons score was 2.4 (IQR: 1.4-4.2), and 32.3% (n = 40) had preexisting PPMs. There were no major vascular complications, strokes, or deaths during the index admission. One patient (0.8%) required PPM implantation for complete heart block and was discharged the same day. No patient required a PPM between discharge home and 30-day follow-up. The composite of cardiovascular death, stroke, myocardial infarction, all-cause readmission, major vascular complications, and new PPM at 30 days occurred in 5.7% patients (n = 6 of 106). Conclusions SDD post-TAVR is safe and feasible in selected patients at low risk for adverse clinical events postdischarge. This strategy may have a potential role in highly selected patients even when the COVID-19 pandemic abates.
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Affiliation(s)
- Madeleine Barker
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Perdoncin
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Chandan Devireddy
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Patricia Keegan
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Kendra Grubb
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Andrei M Pop
- AMITA Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Jeremiah P Depta
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, New York, USA
| | - Devesh Rai
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Farhad Abtahian
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, New York, USA
| | - Mark S Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - Jonathan Mailey
- Department of Cardiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - Douglas F Muir
- Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - Mark J Russo
- Division of Cardiac Surgery, Department of Surgery, Rutgers Roger Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jennifer Pineda-Salazar
- Division of Cardiac Surgery, Department of Surgery, Rutgers Roger Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Alexis Okoh
- Division of Cardiac Surgery, Department of Surgery, Rutgers Roger Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Meghan Smith
- Division of Cardiac Surgery, Department of Surgery, Rutgers Roger Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Thom G Dahle
- Department of Cardiology, CentraCare Heart and Vascular Center, St. Cloud, Minnesota, USA
| | - Masud Rana
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mesfer Alfadhel
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Meier
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Chatfield
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mariama Akodad
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Chuang
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rohit Samuel
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Nestelberger
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cameron McAlister
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sandra Lauck
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada.
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Barker M, Sathananthan J, Perdoncin E, Keegan P, Devireddy C, Grubb K, Pop A, Depta J, Rai D, Spence M, Mailey J, Muir D, Russo M, Okoh A, Smith M, Rana M, Lauck S, Webb J, Wood D. TCT-53 Same-Day Discharge Post-Transcatheter Aortic Valve Replacement Using a Standardized Clinical Pathway During the COVID-19 Pandemic: The PROTECT TAVR Study. J Am Coll Cardiol 2021. [PMCID: PMC8559993 DOI: 10.1016/j.jacc.2021.09.903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cubeddu RJ, Garcia S, Pibarot P, Hahn R, Ternacle J, Asher C, Kapadia S, Kodali S, Thourani V, Jaber W, Goessl M, Elmariah S, Makkar R, Webb J, Herrmann H, Lu M, Devireddy C, Malaisrie SC, Smith C, Mack M, Leon M. IMPACT OF ACUTE KIDNEY INJURY AFTER SURGICAL AND TRANSCATHETER AORTIC VALVE REPLACEMENT IN INTERMEDIATE-RISK PATIENTS WITH CHRONIC KIDNEY DISEASE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02497-9] [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: 12/01/2022]
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Koch R, Perdoncin E, Wei JW, Binongo J, Ceretto-Clark B, Rainer K, Greenbaum A, Byku I, Devireddy C, Grubb K, Guyton R, Paone G, Gleason P, Xie J, Babaliaros V. A COMPARISON OF CLINICAL AND ECHOCARDIOGRAPHIC OUTCOMES OF PATIENTS UNDERGOING TRANSCATHETER VS. SURGICAL AORTIC VALVE REPLACEMENT FOR PURE, NATIVE AORTIC INSUFFICIENCY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02489-x] [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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Nogueira R, Etter K, Nguyen T, Ikeme S, Frankel MR, Haussen DC, Del Rio C, McDaniel MC, Sachdeva R, Devireddy C, Al-bayati AR, Mohammaden M, Liberato B, Dinesh D, Bhatt N, Khanna R. Abstract P536: Impact of the Covid-19 Pandemic on the Volumes and Outcomes of Acute Ischemic Stroke and Myocardial Infarction. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The COVID-19 pandemic has wreaked havoc on the presentation, care and outcomes of patients with acute cerebrovascular and cardiovascular conditions. We sought to measure the national impact of COVID-19 on the care for acute ischemic stroke (AIS) and acute myocardial infarction (AMI).
Methods:
In this retrospective, observational study, we used the Premier Healthcare Database to evaluate the changes in the volume of care and hospital outcomes for AIS and AMI in relation to the pandemic. The pandemic months were defined from March 1, 2020- April 30, 2020 and compared to the same period in the year prior. Outcome measures were volumes of hospitalization and reperfusion treatment for AIS and AMI (including intravenous thrombolysis [IVT] and/or mechanical thrombectomy [MT] for AIS and percutaneous coronary interventions [PCI] for AMI) as well as in-hospital mortality, hospital length of stay (LOS) and hospitalization costs were compared across a 2-month period at the height of the pandemic versus the corresponding period in the prior year.
Results:
There were 95,453 AIS patients across 145 hospitals and 19,744 AMI patients across 126 hospitals. There was a significant nation-wide decline in the absolute number of hospitalizations for AIS (-38.94%;95%CI,-34.75% to -40.71%) and AMI (-38.90%;95%CI,-37.03% to -40.81%) as well as IVT (-30.32%;95%CI,-27.02% to -33.83%), MT (-23.54%;95%CI,-19.84% to -27.70%), and PCI (-35.05%;95%CI,-33.04% to -37.12%) during the first two months of the pandemic. This occurred across low-, mid-, and high-volume centers and in all geographic regions. Higher in-hospital mortality was observed in AIS patients (5.7% vs.4.2%, p=0.0037;OR 1.41,95%CI 1.1-1.8) but not
AMI patients. A shift towards an increase in the proportion of admitted AIS and AMI patients receiving reperfusion therapies suggests a greater clinical severity among patients that were hospitalized for these conditions during the pandemic. A shorter length of stay (AIS: -17%, AMI: -20%), and decreased hospitalization costs (AIS: -12%, AMI: -19%) were observed.
Conclusions:
Our findings shed light on the combined health outcomes and economic impact the COVID-19 pandemic has had on acute stroke and cardiac emergency care.
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Affiliation(s)
| | - Katherine Etter
- Global Provider & Payer Value Demonstration, Health Economics and Market Access, Johnson & Johnson, Raynham, MA, Raynham, MA
| | | | - Shelly Ikeme
- Franchise Health Economics and Market Access, Johnson & Johnson, Irvine, CA;, Irrvine, CA
| | | | | | | | | | | | | | | | | | | | | | - Nirav Bhatt
- Emory university Sch of medicine, Atlanta, GA
| | - Rahul Khanna
- Med Device Epidemiology and Real-World Data Sciences, Johnson & Johnson, New Brunswick, NJ, New Brunswick, NJ
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15
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Al-Khadra Y, Sattar Y, Ullah W, Moussa Pacha H, Baibars M, Darmoch F, Abu-Mahfouz M, Afonso L, Devireddy C, Anwaruddin S, Sorajja P, Ajmal R, Kwok CS, Asfour AI, Zehr K, Mamas MA, Alraies MC. Temporal trends and outcomes in utilisation of transcatheter and surgical aortic valve therapies in aortic valve stenosis patients with heart failure. Int J Clin Pract 2021; 75:e13711. [PMID: 32955776 DOI: 10.1111/ijcp.13711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTIONS & AIMS Heart failure (HF) is a common comorbidity in patients undergoing surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). We sought to access the temporal trends and outcomes of TAVR or SAVR in HF patients. METHOD The NIS database from 2011-2014 was queried for patients that underwent TAVR or SAVR and were subsequently diagnosed with HF. Temporal trends in the utilisation of TAVR or SAVR in HF patients were analysed. RESULTS Among 27 982 patients who were diagnosed with HF of whom 17 681 (63.2%) had heart failure with reduced ejection fraction (HFrEF) while 10 301 (36.8%) had heart failure with preserved ejection fraction (HFpEF), 9049 (32.3%) underwent TAVR and 16 933 (76.7%) underwent SAVR. Patients with HFrEF and HFpEF had higher utilisation of TAVR compared with SAVR over the course of the study period (P trend < .001). TAVR was associated with lower mortality [2.8% in 2012 and 1.8% in 2014 (P .013)] compared with SAVR. Similarly, multiple logistic regression showed a statistically significant lower in-hospital mortality in the TAVR group compared with SAVR (aOR 0.634; CI 0.504, 0.798, P < .001). CONCLUSION For patients with severe aortic valve stenosis and heart failure who undergo aortic valve intervention, TAVR is associated with less odds of in-hospital mortality compared with SAVR.
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Affiliation(s)
| | - Yasar Sattar
- Icahn School of Medicine at Mount, Sinai Elmhurst Hospital, Queens, NY, USA
| | - Waqas Ullah
- Abington Jefferson Health, Abington, PA, USA
| | - Homam Moussa Pacha
- McGovern Medical School, Memorial Hermann Heart & Vascular Institute, University of Texas Health Science Center, Houston, TX, USA
| | - Motaz Baibars
- Department of Medicine, John Hopkins University, Baltimore, MD, USA
| | - Fahed Darmoch
- Harvard School of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mohammed Abu-Mahfouz
- Detroit Medical Center, Wayne State University, DMC Heart Hospital, Detroit, MI, USA
| | - Luis Afonso
- Detroit Medical Center, Wayne State University, DMC Heart Hospital, Detroit, MI, USA
| | | | - Saif Anwaruddin
- Department of Cardiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul Sorajja
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Rasikh Ajmal
- Detroit Medical Center, Wayne State University, DMC Heart Hospital, Detroit, MI, USA
| | - Chun Shing Kwok
- Cardiovascular Research Group, Institute for Science & Technology in Medicine, Keel University, Newcastle upon Tyne, UK
| | | | - Kenton Zehr
- Detroit Medical Center, Wayne State University, DMC Heart Hospital, Detroit, MI, USA
| | - Mamas A Mamas
- Department of Cardiology, Keele University, Stoke on Trent, UK
| | - M Chadi Alraies
- Detroit Medical Center, Wayne State University, DMC Heart Hospital, Detroit, MI, USA
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16
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Shekiladze N, Condado JF, Sandesara PB, Kim JH, Devireddy C, McDaniel M, Babaliaros V, Samady H, Kumar G, Jaber WA. A single healthcare experience with Impella RP. Catheter Cardiovasc Interv 2021; 97:E161-E167. [PMID: 32569445 DOI: 10.1002/ccd.28986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/26/2020] [Accepted: 05/06/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To understand the predictors of survival and indications for Impella RP in a single healthcare experience. BACKGROUND The Impella RP can be used to temporarily support patients with right ventricular (RV) dysfunction after left ventricular assist device (LVAD) placement or myocardial infarction (MI). However, recent postmarket approval data have raised concerns of higher than expected mortality with this device. METHODS A retrospective chart review and analysis of all patients that underwent Impella RP placement in the Emory Healthcare system between January 2016 and December 2018 were performed. Patients were classified according to the indication. RESULTS A total of 39 patients underwent Impella RP placement. Six patients were post-LVAD, 9 were implanted for massive pulmonary embolism with persistent shock, 8 for postcardiac surgery RV failure (non-LVAD), 11 for RV failure post-MI, and 5 for new or worsening nonischemic cardiomyopathy. The worst survival was noted in MI-related cardiogenic shock group and in patients who presented with cardiac arrest (3/12). All observed deaths were due to persistent refractory shock. There was no device related death. Survival improved during the last year of experience compared to the first 2 years. CONCLUSION This study supports the selective use of the Impella RP, with a higher than national reported survival rate (49% vs. 28.6%). Indication appears to be an important factor determining survival.
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Affiliation(s)
- Nikoloz Shekiladze
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jose F Condado
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Pratik B Sandesara
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jeong Hwan Kim
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chandan Devireddy
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael McDaniel
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vasilis Babaliaros
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Habib Samady
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gautam Kumar
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Wissam A Jaber
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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17
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Kumar A, Sammour Y, Reginauld S, Sato K, Agrawal N, Lee JM, Meenakshisundaram C, Ramanan T, Kamioka N, Sawant AC, Mohananey D, Gleason PT, Devireddy C, Krishnaswamy A, Mavromatis K, Grubb K, Svensson LG, Tuzcu EM, Block PC, Iyer V, Babaliaros V, Kapadia S, Samady H. Adverse clinical outcomes in patients undergoing both PCI and TAVR: Analysis from a pooled multi-center registry. Catheter Cardiovasc Interv 2020; 97:529-539. [PMID: 32845036 DOI: 10.1002/ccd.29233] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/02/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is a paucity of data regarding the optimum timing of PCI in relation to TAVR. OBJECTIVE We compared the major adverse cardiovascular and cerebrovascular events (MACCE) rates among patients who underwent percutaneous coronary intervention (PCI) before transcatheter aortic valve replacement (TAVR) with those who received PCI with/after TAVR. METHODS In this multicenter study, we pooled all consecutive patients who underwent TAVR at three high volume centers. RESULTS Among 3,982 patients who underwent TAVR, 327 (8%) patients underwent PCI within 1 year before TAVR, 38 (1%) had PCI the same day as TAVR and 15 (0.5%) had PCI within 2 months after TAVR. Overall, among patients who received both PCI and TAVR (n = 380), history of previous CABG (HR:0.501; p = .001), higher BMI at TAVR (HR:0.970; p = .038), and statin therapy after TAVR (HR:0.660, p = .037) were independently associated with lower MACCE while warfarin therapy after TAVR was associated with a higher risk of MACCE (HR:1.779, p = .017). Patients who received PCI within 1 year before TAVR had similar baseline demographics, STS scores, clinical risk factors when compared to patients receiving PCI with/after TAVR. Both groups were similar in PCI (Syntax Score, ACC/AHA lesion class) and TAVR (valve types, access) related variables. There were no significant differences in terms of MACCE (log rank p = .550), all-cause mortality (log rank p = .433), strokes (log rank p = .153), and repeat PCI (log rank p = .054) in patients who underwent PCI with/after TAVR when compared to patients who received PCI before TAVR. CONCLUSION Among patients who underwent both PCI and TAVR, history of CABG, higher BMI, and statin therapy had lower, while those discharged on warfarin, had higher adverse event rates. Adverse events rates were similar regardless of timing of PCI.
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Affiliation(s)
- Arnav Kumar
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Yasser Sammour
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Shawn Reginauld
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Kimi Sato
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nikhil Agrawal
- Department of Medicine Division of Cardiology, State University of New York at Buffalo, Buffalo, New York
| | - Joo Myung Lee
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | | | - Thammi Ramanan
- Department of Medicine Division of Cardiology, State University of New York at Buffalo, Buffalo, New York
| | - Norihiko Kamioka
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Abhishek C Sawant
- Department of Medicine Division of Cardiology, State University of New York at Buffalo, Buffalo, New York
| | | | - Patrick T Gleason
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Chandan Devireddy
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Amar Krishnaswamy
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Kreton Mavromatis
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Kendra Grubb
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Lars G Svensson
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - E Murat Tuzcu
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Peter C Block
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Vijay Iyer
- Department of Medicine Division of Cardiology, State University of New York at Buffalo, Buffalo, New York
| | - Vasilis Babaliaros
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Samir Kapadia
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Habib Samady
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
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18
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Naidu SS, Coylewright M, Hawkins BM, Meraj P, Morray BH, Devireddy C, Ing F, Klein AJ, Seto AH, Grines CL, Henry TD, Rao SV, Duffy PL, Amin Z, Aronow HD, Box LC, Caputo RP, Cigarroa JE, Cox DA, Daniels MJ, Elmariah S, Fagan TE, Feldman DN, Forbes TJ, Hermiller JB, Herrmann HC, Hijazi ZM, Jeremias A, Kavinsky CJ, Latif F, Parikh SA, Reilly J, Rosenfield K, Swaminathan RV, Szerlip M, Yakubov SJ, Zahn EM, Mahmud E, Bhavsar SS, Blumenthal T, Boutin E, Camp CA, Cromer AE, Dineen D, Dunham D, Emanuele S, Ferguson R, Govender D, Haaf J, Hite D, Hughes T, Laschinger J, Leigh SM, Lombardi L, McCoy P, McLean F, Meikle J, Nicolosi M, O'Brien J, Palmer RJ, Patarca R, Pierce V, Polk B, Prince B, Rangwala N, Roman D, Ryder K, Tolve MH, Vang E, Venditto J, Verderber P, Watson N, White S, Williams DM. Hot topics in interventional cardiology: Proceedings from the society for cardiovascular angiography and interventions 2020 think tank. Catheter Cardiovasc Interv 2020; 96:1258-1265. [PMID: 32840956 DOI: 10.1002/ccd.29197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/29/2020] [Accepted: 08/01/2020] [Indexed: 11/05/2022]
Abstract
The society for cardiovascular angiography and interventions (SCAI) think tank is a collaborative venture that brings together interventional cardiologists, administrative partners, and select members of the cardiovascular industry community for high-level field-wide discussions. The 2020 think tank was organized into four parallel sessions reflective of the field of interventional cardiology: (a) coronary intervention, (b) endovascular medicine, (c) structural heart disease, and (d) congenital heart disease (CHD). Each session was moderated by a senior content expert and co-moderated by a member of SCAI's emerging leader mentorship program. This document presents the proceedings to the wider cardiovascular community in order to enhance participation in this discussion, create additional dialogue from a broader base, and thereby aid SCAI and the industry community in developing specific action items to move these areas forward.
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Affiliation(s)
- Srihari S Naidu
- Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | | | - Beau M Hawkins
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | | | | | - Frank Ing
- UC Davis Medical Center, Los Angeles, California, USA
| | | | - Arnold H Seto
- Long Beach VA Health Care System, Long Beach, California, USA
| | - Cindy L Grines
- Northside Cardiovascular Institute, Atlanta, Georgia, USA
| | | | - Sunil V Rao
- Duke University Hospital, Durham, North Carolina, USA
| | - Peter L Duffy
- First Health Cardiology-Pinehurst, Pinehurst, North Carolina, USA
| | - Zahid Amin
- Children's Hospital of Georgia, Augusta, Georgia, USA
| | - Herbert D Aronow
- Lifespan Cardiovascular Institute/Brown Medical School, Providence, Rhode Island, USA
| | - Lyndon C Box
- West Valley Medical Center, Caldwell, Idaho, USA
| | | | | | - David A Cox
- Cardiovascular Associates, Birmingham, Alabama, USA
| | | | - Sammy Elmariah
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas E Fagan
- Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | | | | | - James B Hermiller
- The St. Vincent Medical Group at The Heart Center, Indianapolis, Indiana, USA
| | - Howard C Herrmann
- University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Ziyad M Hijazi
- Weill Cornell Medical College, New York, NY. Sidra Medical and Research Center, Doha, Qatar
| | - Allen Jeremias
- St. Francis Hospital, The Heart Hospital, Roslyn, New York, USA
| | | | - Faisal Latif
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Sahil A Parikh
- New York Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - John Reilly
- Stony Brook University Hospital, Stony Brook, New York, USA
| | | | | | | | - Steve J Yakubov
- OhioHealth Heart & Vascular Physicians, Coshocton, Ohio, USA
| | - Evan M Zahn
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ehtisham Mahmud
- University of California, San Diego Sulpizio Cardiovascular Center, San Diego, California, USA
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- Philips Healthcare, San Diego, California, USA
| | | | - Tico Blumenthal
- Cordis, A Cardinal Health Company, Santa Clara, California, USA
| | | | | | | | | | | | | | | | | | - Joel Haaf
- Philips Healthcare, San Diego, California, USA
| | - Denise Hite
- Cordis, A Cardinal Health Company, Santa Clara, California, USA
| | | | | | | | | | | | | | | | | | | | | | - Roberto Patarca
- Cordis, A Cardinal Health Company, Santa Clara, California, USA
| | | | - Bucky Polk
- Philips Healthcare, San Diego, California, USA
| | | | | | - Dana Roman
- Janssen Pharmaceuticals, Raritan, New Jersey, USA
| | - Ken Ryder
- Abiomed, Danvers, Massachusetts, USA
| | | | - Eric Vang
- Medtronic, Minneapolis, Minnesota, USA
| | | | - Paula Verderber
- Cordis, A Cardinal Health Company, Santa Clara, California, USA
| | - Nancy Watson
- Cordis, A Cardinal Health Company, Santa Clara, California, USA
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19
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Keegan P, Lisko JC, Kamioka N, Maidman S, Binongo JN, Wei J, Vadlamudi R, Edwards JK, Vatsa N, Maini A, Reginauld S, Gleason P, Stewart J, Devireddy C, Block PC, Greenbaum A, Guyton RA, Babaliaros VC. Nurse Led Sedation: The Clinical and Echocardiographic Outcomes of the 5-Year Emory Experience. Structural Heart 2020. [DOI: 10.1080/24748706.2020.1773591] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Patricia Keegan
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John C. Lisko
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Norihiko Kamioka
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Samuel Maidman
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jose N. Binongo
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jane Wei
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ratna Vadlamudi
- Division of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - J. Kirk Edwards
- Division of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Aneesha Maini
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shawn Reginauld
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Patrick Gleason
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - James Stewart
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chandan Devireddy
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Peter C. Block
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Adam Greenbaum
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert A. Guyton
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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20
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Di Mario C, Goodwin M, Ristalli F, Ravani M, Meucci F, Stolcova M, Sardella G, Salvi N, Bedogni F, Berti S, Babaliaros VC, Pop A, Caparrelli D, Stewart J, Devireddy C. A Prospective Registry of Intravascular Lithotripsy-Enabled Vascular Access for Transfemoral Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2020; 12:502-504. [PMID: 30846091 DOI: 10.1016/j.jcin.2019.01.211] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 01/04/2019] [Indexed: 11/28/2022]
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21
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Maidman SD, Lisko JC, Kamioka N, Chen EP, Mavromatis K, Halkos M, Stewart JP, Lattouf OM, Keeling WB, Gleason P, Sommerfeld AJ, Maini A, Ibrahim AW, Grubb KJ, Leshnower BG, Guyton R, Greenbaum AB, Block PC, Babaliaros VC, Devireddy C. Outcomes Following Shock Aortic Valve Replacement: Transcatheter Versus Surgical Approaches. Cardiovasc Revasc Med 2020; 21:1313-1318. [PMID: 32305316 DOI: 10.1016/j.carrev.2020.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/12/2020] [Accepted: 03/12/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To compare transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) for patients in shock. BACKGROUND There are minimal data on the clinical and echocardiographic outcomes for patients in shock that undergo TAVR and no data comparing these outcomes to similar patients undergoing SAVR. METHODS This is a single center, retrospective cohort study of patients having Society of Thoracic Surgeons (STS)-defined urgent or emergent AVR for aortic stenosis with clinical signs and symptoms of shock. Inclusion criteria were based on the Society of Cardiovascular Angiography & Interventions (SCAI) shock consensus statement and included: the need for inotropic or vasopressor agents, mechanical ventilation, continuous renal replacement therapy or newly initiated hemodialysis, and/or utilization of mechanical hemodynamic support. Clinical and echocardiographic outcomes for TAVR and SAVR were compared. RESULTS Thirty-seven patients met the inclusion criteria for this study (17 TAVR, 20 SAVR). TAVR patients had a higher STS Predicted Risk of Mortality (PROM) score of 22.3% compared to 11.8% for SAVR patients (p = 0.001). No significant differences were found in baseline echocardiographic results. TAVR procedures required less procedure room time (185.9 min TAVR, 348.5 min SAVR, p < 0.001) and fewer intraoperative packed red blood cell (pRBC) transfusions (0.2 units TAVR, 3.4 units SAVR, p < 0.001). TAVR patients also had lower rates of prolonged postoperative ventilation compared to SAVR patients (38.5% TAVR, 75.0% SAVR, p = 0.047). TAVR and SAVR had similar rates of mortality at discharge (2 TAVR, 1 SAVR, p = 0.584), 30-days (2 TAVR, 1 SAVR, p = 0.584), and 1-year (8 TAVR, 5 SAVR, p = 0.149). CONCLUSIONS Despite a higher risk TAVR group, patients in shock undergoing either TAVR or SAVR have similar 30-day mortality. At one year, SAVR patients have a numerically better, though not statistically significant, survival. These findings support the use of TAVR for patients in shock with aortic stenosis.
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Affiliation(s)
- Samuel D Maidman
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - John C Lisko
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Norihiko Kamioka
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Edward P Chen
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Kreton Mavromatis
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Michael Halkos
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States of America
| | - James P Stewart
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Omar M Lattouf
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States of America
| | - W Brent Keeling
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Patrick Gleason
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Alex J Sommerfeld
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Aneesha Maini
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Akram W Ibrahim
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Bradley G Leshnower
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Robert Guyton
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Adam B Greenbaum
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Peter C Block
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Vasilis C Babaliaros
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America.
| | - Chandan Devireddy
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
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22
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Jadue A, Lisko JC, Contreras JFC, Kamioka N, Babaliaros V, Greenbaum A, Paone G, Byku I, Guyton R, Maini A, Devireddy C, Grubb K. TRANSCATHETER AORTIC VALVE REPLACEMENT OUTCOMES IN PATIENTS WITH NATIVE AORTIC VALVE INSUFFICENCY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32748-0] [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: 11/26/2022]
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Gibson CM, Kumar V, Gopalakrishnan L, Singh P, Guo J, Kazziha S, Devireddy C, Pinto D, Marshall JJ, Stouffer GA, Mavromatis K, Grip L, Bainey KR. Feasibility and Safety of Low-Dose Intra-Coronary Tenecteplase During Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction (ICE T-TIMI 49). Am J Cardiol 2020; 125:485-490. [PMID: 31870492 DOI: 10.1016/j.amjcard.2019.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 11/25/2022]
Abstract
Following primary percutaneous coronary intervention (PPCI) for ST segment elevation myocardial infarction, microvascular perfusion is often impaired secondary to thrombotic embolization. Intracoronary (IC) fibrinolytic administration may reduce thrombotic burden and distal embolization. The ICE-T-TIMI-49 study evaluated the feasibility and safety of low-dose IC tenecteplase (TNK) during PPCI. The study randomized 40 PPCI patients to a volume matched bolus of IC TNK (4 mg) (n = 20) or IC saline placebo (n = 20) before and following PPCI. The primary end point was percent diameter stenosis of the culprit lesion following first bolus. The primary end point did not differ between IC placebo (median 100%, interquartile range [IQR] 83.0,100.0) and IC TNK (median 100% stenosis, IQR 91.0,100.0; p = 0.522). However, the proportion of patients with reduction in thrombus following first bolus tended to be greater with IC TNK (placebo: 12.5% vs IC TNK: 40.0%, p = 0.133). Following PPCI, the corrected Thrombolysis In Myocardial Infarction (TIMI) frame count (cTFC) was lower (faster) with placebo (16.0 frames [IQR 12.0,24.0] vs 24.0 frames [22.0,32.0], p = 0.045) due to a trend towards greater frequency of hyperemia (cTFC <14), a marker of distal embolization (50.0% vs 8.3%, p = 0.056). There was no difference in TIMI major bleeds and no intracranial hemorrhage. In conclusion, treatment with low-dose IC TNK appears safe and well tolerated during PPCI. Although IC TNK administration did not improve percent stenosis, a trend towards reduced thrombus burden was demonstrated with less hyperemia (a marker of distal embolization). Our findings provide support for a large randomized study.
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Kumar A, Sammour Y, Reginauld S, Sato K, Agrawal N, Meenakshisundaram C, Kamioka N, Sawant AC, Devireddy C, Krishnaswamy A, Greenbaum AB, Mavromatis K, Grubb K, Byku I, Svensson L, Tuzcu M, Block PC, Iyer V, Kapadia S, Babaliaros V. CRT-600.08 A Comparison of Clinical Outcomes According to the Timing of PCI and TAVR: A Pooled Analysis From a Multicenter Registry. JACC Cardiovasc Interv 2020. [DOI: 10.1016/j.jcin.2020.01.155] [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: 11/16/2022]
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Kiani S, Stebbins A, Thourani VH, Forcillo J, Vemulapalli S, Kosinski AS, Babaliaros V, Cohen D, Kodali SK, Kirtane AJ, Hermiller JB, Stewart J, Lowenstern A, Mack MJ, Guyton RA, Devireddy C. The Effect and Relationship of Frailty Indices on Survival After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2020; 13:219-231. [DOI: 10.1016/j.jcin.2019.08.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/31/2019] [Accepted: 08/07/2019] [Indexed: 11/26/2022]
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Kiani S, Kamioka N, Caughron H, Dong A, Patel H, Lisko J, Gleason P, Stewart J, Grubb K, Greenbaum A, Devireddy C, Guyton R, Leshnower B, Babaliaros V, Hoskins M. P1019Validation of a risk score to predict the need for pacemaker implantation after transcatheter aortic valve replacement. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
New conduction abnormalities necessitating pacemaker implantation (PMI) is a common occurrence after TAVR. There is an increased rate of PMI in the those receiving the most contemporary implanted valve, the Edwards Sapien-3 (S3), compared to prior generation balloon expandable valves. We previously described predictors of PMI in a large cohort. Herein we sought to validate these predictors of PMI in a subsequent validation cohort.
Methods
We evaluated all patients undergoing first time elective TAVR with S3 at our institution (n=326). We developed a risk score based on a predictive model we have previously described. Patients received one point for each of the following: history of syncope, oversizing of the valve >16%, baseline right bundle branch block morphology, and two points for a QRS duration >115 ms. We performed regression analysis of the risk score and need for PMI. We also evaluated the performance of the risk score using ROC analysis.
Results
Thirty patients (8%) of the total cohort had need for PMI after S3 implantation. Those with PMI had a higher rate of pre-existing infra-nodal conduction system disease – including QRS duration >115ms (57% vs. 20%, p<0.001) and right bundle branch block (RBBB) morphology (47% vs. 10%, p<0.001) - as well as more frequent valve oversizing >15.7% (47% vs. 23%, p<0.01). There was no significant difference in a history of syncope (10% vs. 8%, p=0.72) between groups. The PMI risk score had an area under the curve of 0.753 on ROC analysis. The PMI risk score was significantly associated with PMI (OR 2.37; 95% CI [1.64–3.34], p<0.001).
Rate of PMI Stratified by Risk Score
Conclusions
The PMI risk score was strongly predictive of the need for PMI after implantation of the S3 valve in a large validation cohort. The PMI risk score performed well in sensitivity analysis. This PMI risk score represents a simple tool to help further risk stratify patients being considered for TAVR.
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Affiliation(s)
- S Kiani
- Emory University School of Medicine, Atlanta, United States of America
| | - N Kamioka
- Emory University School of Medicine, Cardiology, Atlanta, United States of America
| | - H Caughron
- Emory University School of Medicine, Atlanta, United States of America
| | - A Dong
- Emory University School of Medicine, Atlanta, United States of America
| | - H Patel
- Emory University School of Medicine, Atlanta, United States of America
| | - J Lisko
- Emory University School of Medicine, Cardiology, Atlanta, United States of America
| | - P Gleason
- Emory University School of Medicine, Cardiology, Atlanta, United States of America
| | - J Stewart
- Emory University School of Medicine, Cardiology, Atlanta, United States of America
| | - K Grubb
- Emory University School of Medicine, Atlanta, United States of America
| | - A Greenbaum
- Emory University School of Medicine, Cardiology, Atlanta, United States of America
| | - C Devireddy
- Emory University School of Medicine, Cardiology, Atlanta, United States of America
| | - R Guyton
- Emory University School of Medicine, Atlanta, United States of America
| | - B Leshnower
- Emory University School of Medicine, Atlanta, United States of America
| | - V Babaliaros
- Emory University School of Medicine, Cardiology, Atlanta, United States of America
| | - M Hoskins
- Emory University School of Medicine, Cardiology, Atlanta, United States of America
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Lisko J, Maidman S, Kamioka N, Guyton R, Gleason P, Alvarez L, Byku I, Grubb K, Shekiladze N, Bakhtadze B, Brown M, Ho A, Parihar S, Khan J, Devireddy C, Rogers T, Babaliaros V. TCT-426 TAVR Versus SAVR for Bicuspid Aortic Valve. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.517] [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: 10/25/2022]
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Byku I, Lisko J, Khan J, Guyton R, Gleason P, Maidman S, Alvarez L, Grubb K, Kamioka N, Devireddy C, Rogers T, Lederman R, Babaliaros V. TCT-92 Antegrade LAMPOON (Intentional Percutaneous Laceration of the Anterior Mitral Leaflet to Prevent Outflow Obstruction): A Novel Modification of the Previously Described Retrograde LAMPOON, is a Technically Feasible, Reproducible, Effective, and Safe Modification of This Procedure. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.134] [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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Maidman S, Lisko J, Kamioka N, Byku I, Gleason P, Alvarez L, Grubb K, Rogers T, Khan J, Guyton R, Babaliaros V, Devireddy C. TCT-703 Outcomes Following Aortic Valve Replacement for Cardiogenic Shock: Transcatheter Versus Surgical Approaches. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.833] [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: 11/24/2022]
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Naidu SS, Daniels MJ, Elmariah S, Garcia S, Klein AJ, Feldman DN, Ing FF, Kavinsky CJ, Devireddy C, Mahmud E, Grines CL, Henry TD, Duffy PL, Amin ZC, Aronow HD, Banerjee S, Brilakis ES, Herrmann HC, Hijazi ZM, Jaffer FA, Latif F, Messenger JC, Parikh SA, Poulin M, Reilly JP, Rosenfield K, Szerlip M, Vincent RN, Cox DA, Baker D, Bhalla N, Bowen R, Camp C, Govender D, Haggstrom K, Hargus N, Hite D, Meikle J, Mylor B, Pierce V, Prince B, Roach J, Rudy J, Schludi B, Struck J, Tochterman A, Tolve M, William DM, Yowe S. Hot topics in interventional cardiology: Proceedings from the Society for Cardiovascular Angiography and Interventions (SCAI) 2019 Think Tank. Catheter Cardiovasc Interv 2019; 94:598-606. [DOI: 10.1002/ccd.28449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Srihari S. Naidu
- Westchester Medical Center and New York Medical College Valhalla New York
| | | | | | - Santiago Garcia
- Minneapolis Heart Institute at Abbott Northwestern Hospital Minneapolis Minnesota
| | | | | | | | | | | | - Ehtisham Mahmud
- University of California, San Diego Sulpizio Cardiovascular Center San Diego California
| | | | | | - Peter L. Duffy
- FirstHealth Cardiology‐Pinehurst Pinehurst North Carolina
| | | | - Herbert D. Aronow
- Cardiovascular Institute/Brown Medical School Providence Rhode Island
| | | | | | | | | | | | - Faisal Latif
- University of Oklahoma Health Sciences Center Oklahoma City Oklahoma
| | | | | | - Marie‐France Poulin
- Beth Israel Deaconess Medical Center/Harvard Medical School Boston Massachusetts
| | - John P. Reilly
- SUNY Stony Brook University Hospital Southampton New York
| | | | | | | | | | | | | | | | | | | | - Kurt Haggstrom
- Cordis, A Cardinal Health Company Santa Clara California
| | - Nick Hargus
- Cardiovascular Systems, Inc. Saint Paul Minnesota
| | - Denise Hite
- Cordis, A Cardinal Health Company Santa Clara California
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Azizi M, Schmieder RE, Mahfoud F, Weber MA, Daemen J, Lobo MD, Sharp AS, Bloch MJ, Basile J, Wang Y, Saxena M, Lurz P, Rader F, Sayer J, Fisher ND, Fouassier D, Barman NC, Reeve-Stoffer H, McClure C, Kirtane AJ, Jay D, Skeik N, Schwartz R, Dohad S, Victor R, Sanghvi K, Costello J, Walsh C, Abraham J, Owan T, Abraham A, Mauri L, Sobieszczky P, Williams J, Roongsritong C, Todoran T, Powers E, Hodskins E, Fong P, Laffer C, Gainer J, Robbins M, Reilly J, Cash M, Goldman J, Aggarwal S, Ledley G, His D, Martin S, Portnay E, Calhoun D, McElderry T, Maddox W, Oparil S, Huang PH, Jose P, Khuddus M, Zentko S, O’Meara J, Barb I, Garasic J, Drachman D, Zusman R, Rosenfield K, Devireddy C, Lea J, Wells B, Stouffer R, Hinderliter A, Pauley E, Potluri S, Biedermann S, Bangalore S, Williams S, Zidar D, Shishehbor M, Effron B, Costa M, Radhakrishnan J, Mathur A, Jain A, Iyer SG, Robinson N, Edroos SA, Levy T, Patel A, Beckett D, Bent C, Davies J, Chapman N, Shin MS, Howard J, Joseph A, D’Souza R, Gerber R, Faris M, Marshall AJ, Elorz C, Höllriegel R, Fengler K, Rommel KP, Böhm M, Ewen S, Lucic J, Ott C, Schmid A, Uder M, Rump C, Stegbauer J, Kröpil P, Sapoval M, Cornu E, Lorthioir A, Gosse P, Cremer A, Trillaud H, Papadopoulos P, Pathak A, Honton B, Lantelme P, Berge C, Courand PY, Feyz L, Blankestijn P, Voskuil M, Rittersma Z, Kroon A, van Zwam W, Persu A, Renkin J. Six-Month Results of Treatment-Blinded Medication Titration for Hypertension Control After Randomization to Endovascular Ultrasound Renal Denervation or a Sham Procedure in the RADIANCE-HTN SOLO Trial. Circulation 2019; 139:2542-2553. [PMID: 30880441 DOI: 10.1161/circulationaha.119.040451] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND The multicenter, international, randomized, blinded, sham-controlled RADIANCE-HTN SOLO trial (A Study of the ReCor Medical Paradise System in Clinical Hypertension) demonstrated a 6.3 mm Hg greater reduction in daytime ambulatory systolic blood pressure (BP) at 2 months by endovascular ultrasound renal denervation (RDN) compared with a sham procedure among patients not treated with antihypertensive medications. We report 6-month results after the addition of a recommended standardized stepped-care antihypertensive treatment to the randomized endovascular procedure under continued blinding to initial treatment. METHODS Patients with a daytime ambulatory BP ≥135/85 mm Hg and <170/105 mm Hg after a 4-week discontinuation of up to 2 antihypertensive medications, and a suitable renal artery anatomy, were randomized to RDN (n=74) or sham (n=72). Patients were to remain off antihypertensive medications throughout the first 2 months of follow-up unless safety BP criteria were exceeded. Between 2 and 5 months, if monthly measured home BP was ≥135/85 mm Hg, a standardized stepped-care antihypertensive treatment was recommended consisting of the sequential addition of amlodipine (5 mg/d), a standard dose of an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and hydrochlorothiazide (12.5 mg/d), followed by the sequential uptitration of hydrochlorothiazide (25 mg/d) and amlodipine (10 mg/d). Outcomes included the 6-month (1) change in daytime ambulatory systolic BP adjusted for medications and baseline systolic BP, (2) medication burden, and (3) safety. RESULTS A total of 69/74 RDN patients and 71/72 sham patients completed the 6-month ambulatory BP measurement. At 6 months, 65.2% of patients in the RDN group were treated with the standardized stepped-care antihypertensive treatment versus 84.5% in the sham group (P=0.008), and the average number of antihypertensive medications and defined daily dose were less in the RDN group than in the sham group (0.9±0.9 versus 1.3±0.9, P=0.010 and 1.4±1.5 versus 2.0±1.8, P=0.018; respectively). Despite less intensive standardized stepped-care antihypertensive treatment, RDN reduced daytime ambulatory systolic BP to a greater extent than sham (-18.1±12.2 versus -15.6±13.2 mm Hg, respectively; difference adjusted for baseline BP and number of medications: -4.3 mm Hg, 95% confidence interval, -7.9 to -0.6, P=0.024). There were no major adverse events in either group through 6 months. CONCLUSIONS The BP-lowering effect of endovascular ultrasound RDN was maintained at 6 months with less prescribed antihypertensive medications compared with a sham control. CLINICAL TRIAL REGISTRATION URL: https://www. CLINICALTRIALS gov. Unique identifier: NCT02649426.
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Affiliation(s)
- Michel Azizi
- Université Paris-Descartes, France (M.A., D.F.)
- AP-HP, Department of Hypertension, Hôpital Européen Georges-Pompidou, Paris, France (M.A., D.F.)
- INSERM, CIC1418, Paris, France (M.A., D.F.)
| | - Roland E. Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Germany (R.E.S.)
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany (F.M.)
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (F.M.)
| | - Michael A. Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York (M.A.W.)
| | - Joost Daemen
- Erasmus MC, University Medical Center Rotterdam, Department of Cardiology, Rotterdam, The Netherlands (J.D.)
| | - Melvin D. Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, United Kingdom (M.D.L., M.S.)
| | - Andrew S.P. Sharp
- Royal Devon and Exeter NHS Foundation Trust, United Kingdom (A.S.P.S.)
| | - Michael J. Bloch
- Department of Medicine, University of Nevada School of Medicine, Vascular Care, Renown Institute of Heart and Vascular Health, Reno, NV (M.J.B.)
| | - Jan Basile
- Seinsheimer Cardiovascular Health Program, Medical University of South Carolina, Ralph H Johnson VA Medical Center, Charleston (J.B.)
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis (Y.W.)
| | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, United Kingdom (M.D.L., M.S.)
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Germany (P.L.)
| | - Florian Rader
- Cedars-Sinai Heart Institute, Los Angeles, CA (F.R.)
| | - Jeremy Sayer
- The Essex Cardiothoracic Centre, United Kingdom (J.S.)
| | | | - David Fouassier
- Université Paris-Descartes, France (M.A., D.F.)
- AP-HP, Department of Hypertension, Hôpital Européen Georges-Pompidou, Paris, France (M.A., D.F.)
- INSERM, CIC1418, Paris, France (M.A., D.F.)
| | | | | | | | - Ajay J. Kirtane
- Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, NY (A.J.K.)
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Kiani S, Kamioka N, Lisko J, Mengistu A, Stewart J, Gleason P, Grubb K, Greenbaum AB, Devireddy C, Guyton R, Leshnower B, Babaliaros V, Hoskins M. PREDICTORS FOR THE NEED FOR NEW PERMANENT PACEMAKER IMPLANTATION, AND HIGH PACING BURDEN ON FOLLOW-UP AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT WITH THE EDWARDS-SAPIEN 3 VALVE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31094-0] [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: 10/27/2022]
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Kamioka N, Caughron H, Lisko J, Binongo J, Almuwaqqat Z, Keegan P, Gleason P, Byku I, Alvarez L, Reginauld S, Maini A, Grubb K, Devireddy C, Mavromatis K, Leshnower B, Stewart J, Guyton R, Block P, Greenbaum AB, Babaliaros V. IMPACT OF HEMODIALYSIS ON EARLY DEGENERATION OF BIOPROSTHESIS AND CLINICAL OUTCOME AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31703-6] [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: 10/27/2022]
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Kamioka N, Caughron H, Lisko J, Keegan P, Binongo J, Wei J, Byku I, Alvarez L, Reginauld S, Patel H, Maini A, Leshnower B, Devireddy C, Mavromatis K, Stewart J, Block P, Guyton R, Grubb K, Greenbaum AB, Babaliaros V. IMPACT OF OBESITY ON THE OUTCOMES AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31702-4] [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: 10/27/2022]
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Giri JS, Szerlip M, Devireddy C, Cox DA, Kavinsky C, Genereux P, Naidu SS, Bruner C, Struck J, Kurz J, Dunham J. SCAI 2018 Think Tank Proceedings: "What should the role of the surgeon be in TAVR, both as a co-operator and in-patient evaluation for TAVR? Catheter Cardiovasc Interv 2019; 93:178-179. [PMID: 30358059 DOI: 10.1002/ccd.27901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Jay S Giri
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - David A Cox
- Cardiovascular Associates, Brookwood Baptist Health, Birmingham, AL, USA
| | | | | | | | | | | | | | | | - Jeff Dunham
- Terumo Interventional Systems, Somerset, NJ, USA
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Kamioka N, Keegan P, Lerakis S, Binongo J, Caughron H, Reginauld S, Patel H, Maini A, Yousef A, Gleason P, Leshnower B, Devireddy C, Mavromatis K, Stewart J, Block P, Thourani V, Guyton R, Babaliaros V. TCT-259 1000 Minimalist TAVR: Sapien through Sapien-3. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Khan J, Lederman R, Guyton R, Devireddy C, Kamioka N, Yousef A, Gleason P, Babaliaros V. TCT-860 LAMPOON to Facilitate Tendyne Transcatheter Mitral Valve Replacement: From Animal Model to First-in-Human. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.2110] [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: 10/28/2022]
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Cubeddu RJ, Asher C, Lowry A, Blackstone EH, Kapadia S, Beohar N, Thourani V, Mack M, Kodali S, Herrmann H, Forcillo J, Babaliaros V, Devireddy C, Malaisrie S, Davidson C, Jaber W, Leon M, Svensson L. TCT-839 Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis is More Likely to Improve than Worsen CKD Stage: Analysis of the PARTNER 1, 2A, and S3 Trials. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.2083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Macedo LG, Kosmidou I, Alu M, Praz F, Nazif T, Kodali S, Thourani V, Szeto WY, Devireddy C, Kapadia S, Makkar R, Leon M. TCT-477 Prevalence and Clinical Impact of Baseline QRS Duration in Patients With Severe Aortic Stenosis Two Years After Aortic Valve Replacement in the PARTNER II Trial. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1650] [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: 11/29/2022]
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Kamioka N, Caughron H, Lerakis S, Yousef A, Gleason P, Stewart J, Devireddy C, Leshnower B, Guyton RA, Block P, Babaliaros V. OUTCOMES AFTER TRANSCATHETER TRICUSPID VALVE-IN-VALVE THERAPY VERSUS RE-DO ISOLATED SURGICAL TVR IN PATIENTS WITH PREVIOUS TRICUSPID BIOPROSTHETIC VALVES. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31920-x] [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: 10/17/2022]
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Kiani S, Stebbins A, Thourani VH, Forcillo J, Vemulapalli S, Kosinski A, Babaliaros V, Cohen D, Kodali SK, Kirtane A, Hermiller J, Stewart J, Lowenstern A, Mavromatis K, Mack MJ, Guyton RA, Devireddy C. THE EFFECT AND RELATIONSHIP OF AGE AND FRAILTY ON SURVIVAL IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31533-x] [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: 11/25/2022]
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Forcillo J, Condado JF, Ko YA, Yuan M, Binongo JN, Ndubisi NM, Kelly JJ, Babaliaros V, Guyton RA, Devireddy C, Leshnower BG, Stewart JP, Perrault LP, Khairy P, Thourani VH. Assessment of Commonly Used Frailty Markers for High- and Extreme-Risk Patients Undergoing Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2017; 104:1939-1946. [DOI: 10.1016/j.athoracsur.2017.05.067] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/17/2017] [Accepted: 05/19/2017] [Indexed: 11/26/2022]
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Kamioka N, Babaliaros V, Morse M, Frisoli T, Iturbe JM, Corrigan F, Forcillo J, Caughron H, Dong A, Devireddy C, O'Neill W, Paone G, Wang DD, Thourani V, Greenbaum A. TCT-501 Echocardiographic Findings of Transcatheter Mitral Valve-in-Valve Therapy VS. Re-do Surgical MVR in Patients with Previous Mitral Prosthetic Valves. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.615] [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: 10/18/2022]
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Spiering W, Van Der Heyden J, Van Kleef M, Kroon A, Devireddy C, Foster Iii M, Ghali M, Mendelsohn F, Reuter H, Reilly J, Bates M. 2219Efficacy and safety results of endovascular baroreflex amplification (EBA) for resistant hypertension (CALM-FIM studies): a safety and proof-of-principle cohort study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.2219] [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: 11/13/2022] Open
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Condado JF, Corrigan FE, Lerakis S, Parastatidis I, Stillman AE, Binongo JN, Stewart J, Mavromatis K, Devireddy C, Leshnower B, Guyton R, Forcillo J, Patel A, Thourani VH, Block PC, Babaliaros V. Anatomical risk models for paravalvular leak and landing zone complications for balloon-expandable transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2017; 90:690-700. [PMID: 28471092 DOI: 10.1002/ccd.26987] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/16/2016] [Accepted: 01/22/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Though several anatomical characteristics have been reported separately as risk factors for paravalvular leak (PVL) and landing zone (LZ) complications after transcatheter aortic valve replacement (TAVR), multivariate risk models are needed. METHODS Patients that underwent balloon-expandable TAVR with multidetector cardiac computed tomography (MDCT) sizing were studied. MDCT images were analyzed and the association between anatomical factors and ≥mild PVL, ≥moderate PVL, and LZ complications (annular rupture, requirement of new permanent pacemaker, and coronary obstruction) was determined, and subsequently competing predictive models were developed and validated. RESULTS A total of 316 consecutive TAVR patients were included. Median age was 82.0 years (74.0-87.0) and STS score was 8.3% (5.4-10.9). Factors associated with ≥mild PVL included TAVR with Sapien/Sapien XT vs. Sapien 3 (OR = 2.50, 95% CI = 1.24-5.07), LVOT nontubularity (OR = 1.02, 95% CI = 1.01-1.04), LZ calcification (OR = 1.01, 95% CI = 1.00-1.01), and low cover index (OR = 0.94, 95% CI = 0.91-0.96). Factors associated with LZ complications included LZ calcification (OR = 1.01, 95% CI 1.00-1.01), leaflet asymmetry (OR = 1.01, 95% CI 1.01-1.02), and cover index (OR = 1.09, 95% CI 1.03-1.14). Predictive models for ≥mild PVL (AUC = 0.71, 95% CI = 0.66-0.77), ≥moderate PVL (AUC = 0.75, 95% CI = 0.65-0.84), and LZ complications (AUC = 0.77, 95% CI = 0.67-0.87) were created using procedural details and anatomical data from the MDCT. Clinical variables were not included as they were poorly correlated with the occurrence of PVL and LZ complications. For each outcome, the area under the curve (AUC) of the multivariate model was superior to the model consisting only of individual factors. CONCLUSIONS A model using procedural/anatomical characteristics derived from MDCT predicts ≥mild PVL, ≥moderate PVL, and LZ complications post-TAVR. Incorporation of anatomical risks into clinical practice may help stratify patients before TAVR. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Jose F Condado
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Frank E Corrigan
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Stamatios Lerakis
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Ioannis Parastatidis
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Arthur E Stillman
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jose N Binongo
- Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - James Stewart
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Kreton Mavromatis
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Chandan Devireddy
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Bradley Leshnower
- Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Robert Guyton
- Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Jessica Forcillo
- Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Ateet Patel
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Vinod H Thourani
- Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Peter C Block
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Vasilis Babaliaros
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
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Forcillo J, Condado JF, Binongo JN, Lasanajak Y, Caughron H, Babaliaros V, Devireddy C, Leshnower B, Guyton RA, Block PC, Simone A, Keegan P, Khairy P, Thourani VH. Readmission rates after transcatheter aortic valve replacement in high- and extreme-risk patients with severe aortic stenosis. J Thorac Cardiovasc Surg 2017; 154:445-452. [PMID: 28532575 DOI: 10.1016/j.jtcvs.2017.03.144] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 03/03/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE In high- or extreme-risk patients undergoing transcatheter aortic valve replacement, readmissions have not been adequately studied and are the subject of increased scrutiny by healthcare systems. The objectives of this study were to determine the incidence of 30-day and 1-year cardiac and noncardiac readmissions, identify predictors of readmission, and assess the association between readmission and 1-year mortality. METHODS A retrospective review was performed on 714 patients who underwent transcatheter aortic valve replacement from September 2007 to January 2015 at Emory University. RESULTS Patients' median age was 83 years, and 46.6% were female. Early all-cause readmission for the cohort was 10.5%, and late readmission was 18.8%. Anemia was related to both early all-cause (hazard ratio [HR], 0.74) and cardiovascular-related readmission (HR, 0.60). A 23-mm valve implanted was associated with early all-cause readmission (HR, 1.73). Length of hospital stay was related to late all-cause (HR, 1.14) and cardiovascular-related readmission (HR, 1.21). Postoperative permanent stroke had an impact on late cardiovascular-related readmission (HR, 3.60; 95% confidence interval, 1.13-11.49). Multivariable analysis identified anemia as being associated with 30-day all-cause readmission, and anemia and postoperative stroke were associated with 30-day cardiovascular-related readmission. Readmissions seemed to be related to 1-year mortality (HR, 2.04; 95% confidence interval, 1.33-3.12). CONCLUSIONS We show some baseline comorbidities and procedural complications that are directly associated with early and late readmissions, and anemia and postoperative stroke were associated with an increase in mortality. Moreover, we found that readmission was associated with double the hazard of death within 1 year. Whether treatment of identified risk factors could decrease readmission rates and mortality warrants further investigation.
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Affiliation(s)
- Jessica Forcillo
- Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Emory University, Atlanta, Ga; Cardiology Department, Université de Montréal, Montréal, Québec, Canada
| | - Jose F Condado
- Division of Cardiology, Structural Heart and Valve Center, Emory University, Atlanta, Ga
| | - Jose N Binongo
- Department of Biostatistics, School of Public Health, Emory University, Atlanta, Ga
| | - Yi Lasanajak
- Department of Biostatistics, School of Public Health, Emory University, Atlanta, Ga
| | - Hope Caughron
- Division of Cardiology, Structural Heart and Valve Center, Emory University, Atlanta, Ga
| | - Vasilis Babaliaros
- Division of Cardiology, Structural Heart and Valve Center, Emory University, Atlanta, Ga
| | - Chandan Devireddy
- Division of Cardiology, Structural Heart and Valve Center, Emory University, Atlanta, Ga
| | - Bradley Leshnower
- Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Emory University, Atlanta, Ga
| | - Robert A Guyton
- Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Emory University, Atlanta, Ga
| | - Peter C Block
- Division of Cardiology, Structural Heart and Valve Center, Emory University, Atlanta, Ga
| | - Amy Simone
- Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Emory University, Atlanta, Ga
| | - Patricia Keegan
- Division of Cardiology, Structural Heart and Valve Center, Emory University, Atlanta, Ga
| | - Paul Khairy
- Cardiology Department, Université de Montréal, Montréal, Québec, Canada
| | - Vinod H Thourani
- Division of Cardiothoracic Surgery, Structural Heart and Valve Center, Emory University, Atlanta, Ga.
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Condado JF, Maini A, Leshnower B, Thourani V, Forcillo J, Devireddy C, Mavromatis K, Sarin EL, Stewart J, Guyton R, Simone A, Keegan P, Lerakis S, Block PC, Babaliaros V. End-stage renal disease and severe aortic stenosis: Does valve replacement improve one-year outcomes? Catheter Cardiovasc Interv 2017; 89:1109-1115. [DOI: 10.1002/ccd.26875] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 01/11/2016] [Revised: 10/08/2016] [Accepted: 11/06/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Jose F. Condado
- Structural Heart and Valve Center; Divisions of Cardiology, Emory University School of Medicine; Atlanta Georgia
| | - Aneel Maini
- Structural Heart and Valve Center; Divisions of Cardiology, Emory University School of Medicine; Atlanta Georgia
| | - Bradley Leshnower
- Divisions of Cardiothoracic Surgery; Emory University School of Medicine; Atlanta Georgia
| | - Vinod Thourani
- Divisions of Cardiothoracic Surgery; Emory University School of Medicine; Atlanta Georgia
| | - Jessica Forcillo
- Divisions of Cardiothoracic Surgery; Emory University School of Medicine; Atlanta Georgia
| | - Chandan Devireddy
- Structural Heart and Valve Center; Divisions of Cardiology, Emory University School of Medicine; Atlanta Georgia
| | - Kreton Mavromatis
- Structural Heart and Valve Center; Divisions of Cardiology, Emory University School of Medicine; Atlanta Georgia
| | - Eric L. Sarin
- Divisions of Cardiothoracic Surgery; Emory University School of Medicine; Atlanta Georgia
| | - James Stewart
- Structural Heart and Valve Center; Divisions of Cardiology, Emory University School of Medicine; Atlanta Georgia
| | - Robert Guyton
- Divisions of Cardiothoracic Surgery; Emory University School of Medicine; Atlanta Georgia
| | - Amy Simone
- Divisions of Cardiothoracic Surgery; Emory University School of Medicine; Atlanta Georgia
| | - Patricia Keegan
- Structural Heart and Valve Center; Divisions of Cardiology, Emory University School of Medicine; Atlanta Georgia
| | - Stamatios Lerakis
- Structural Heart and Valve Center; Divisions of Cardiology, Emory University School of Medicine; Atlanta Georgia
| | - Peter C. Block
- Structural Heart and Valve Center; Divisions of Cardiology, Emory University School of Medicine; Atlanta Georgia
| | - Vasilis Babaliaros
- Structural Heart and Valve Center; Divisions of Cardiology, Emory University School of Medicine; Atlanta Georgia
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Kapadia SR, Kodali S, Makkar R, Mehran R, Lazar RM, Zivadinov R, Dwyer MG, Jilaihawi H, Virmani R, Anwaruddin S, Thourani VH, Nazif T, Mangner N, Woitek F, Krishnaswamy A, Mick S, Chakravarty T, Nakamura M, McCabe JM, Satler L, Zajarias A, Szeto WY, Svensson L, Alu MC, White RM, Kraemer C, Parhizgar A, Leon MB, Linke A, Makkar R, Al-Jilaihawi H, Kapadia S, Krishnaswamy A, Tuzcu EM, Mick S, Kodali S, Nazif T, Thourani V, Babaliaros V, Devireddy C, Mavromatis K, Waksman R, Satler L, Pichard A, Szeto W, Anwaruddin S, Vallabhajosyula P, Giri J, Herrmann H, Zajarias A, Lasala J, Greenbaum A, O’Neill W, Eng M, Rovin J, Lin L, Spriggs D, Wong SC, Bergman G, Salemi A, Smalling R, Kar B, Loyalka P, Lim DS, Ragosta M, Reisman M, McCabe J, Don C, Sharma S, Kini A, Dangas G, Mahoney P, Morse A, Stankewicz M, Rodriguez E, Linke A, Mangner N, Woitek F, Frerker C, Cohen D. Protection Against Cerebral Embolism During Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2017; 69:367-377. [DOI: 10.1016/j.jacc.2016.10.023] [Citation(s) in RCA: 265] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 10/21/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022]
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50
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Condado JF, Haider MN, Lerakis S, Keegan P, Caughron H, Thourani VH, Devireddy C, Leshnower B, Mavromatis K, Sarin EL, Stewart J, Guyton R, Forcillo J, Patel A, Simone A, Block PC, Babaliaros V. Does minimalist transfemoral transcatheter aortic valve replacement produce better survival in patients with severe chronic obstructive pulmonary disease? Catheter Cardiovasc Interv 2016; 89:775-780. [DOI: 10.1002/ccd.26683] [Citation(s) in RCA: 24] [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: 02/05/2016] [Accepted: 07/02/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Jose F. Condado
- Structural Heart and Valve Center, Divisions of Cardiology; Emory University; Atlanta Georgia
| | | | - Stamatios Lerakis
- Structural Heart and Valve Center, Divisions of Cardiology; Emory University; Atlanta Georgia
| | - Patricia Keegan
- Structural Heart and Valve Center, Divisions of Cardiology; Emory University; Atlanta Georgia
| | - Hope Caughron
- Structural Heart and Valve Center, Divisions of Cardiology; Emory University; Atlanta Georgia
| | - Vinod H. Thourani
- Department of Cardiothoracic Surgery; Emory University; Atlanta Georgia
| | - Chandan Devireddy
- Structural Heart and Valve Center, Divisions of Cardiology; Emory University; Atlanta Georgia
| | - Bradley Leshnower
- Department of Cardiothoracic Surgery; Emory University; Atlanta Georgia
| | - Kreton Mavromatis
- Structural Heart and Valve Center, Divisions of Cardiology; Emory University; Atlanta Georgia
| | - Eric L. Sarin
- Department of Cardiothoracic Surgery; Emory University; Atlanta Georgia
| | - James Stewart
- Structural Heart and Valve Center, Divisions of Cardiology; Emory University; Atlanta Georgia
| | - Robert Guyton
- Department of Cardiothoracic Surgery; Emory University; Atlanta Georgia
| | - Jessica Forcillo
- Department of Cardiothoracic Surgery; Emory University; Atlanta Georgia
| | - Ateet Patel
- Structural Heart and Valve Center, Divisions of Cardiology; Emory University; Atlanta Georgia
| | - Amy Simone
- Department of Cardiothoracic Surgery; Emory University; Atlanta Georgia
| | - Peter C. Block
- Structural Heart and Valve Center, Divisions of Cardiology; Emory University; Atlanta Georgia
| | - Vasilis Babaliaros
- Structural Heart and Valve Center, Divisions of Cardiology; Emory University; Atlanta Georgia
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