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Harmouch W, Karnkowska B, Thakker R, Rasmussen P, Shalaby M, Khalife W, Alwash H, Motiwala A, Kumfa P, Gilani S, Jneid H, Rangasetty U. Cerebral Embolic Protection in Transcatheter Aortic Valve Implantation Using the Sentinel Cerebral Protection System: A Systematic Review and Meta-Analysis. Cardiol Ther 2024:10.1007/s40119-024-00359-4. [PMID: 38340292 DOI: 10.1007/s40119-024-00359-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) plays a vital role in patients with symptomatic aortic stenosis. Despite the mortality benefit of TAVI, embolic stroke remains a feared complication. As a result, transcatheter cerebral embolic protection (TCEP) devices have been developed to reduce this risk. Given the ongoing debate of TCEP in TAVI, we performed a systematic review and meta-analysis of all randomized controlled trials to date to identify outcomes of periprocedural stroke using the Sentinel™ cerebral protection system (CPS). METHODS MEDLINE, Cochrane, and Scopus databases were utilized from inception until 12/2023. PRISMA criteria was utilized. Keywords included "cerebral embolic protection", "sentinel cerebral protection system", "transcatheter aortic valve implantation", and "transcatheter aortic valve replacement". Primary outcome was periprocedural stroke. Secondary outcomes included periprocedural disabling and non-disabling stroke, all-cause mortality, transient ischemic attack, delirium, acute kidney injury, vascular complications, bleeding, and pacemaker implantation. Risk ratios (RR) were measured via Mantel-Haenszel method with fixed analysis. Heterogeneity was assessed via chi-squared and Higgin's I2 test. RESULTS Four trials with 3528 patients were assessed. SAPIEN 3 was the most common bioprosthetic valve used. The average age was 79.4 years with 41.9% of the sample size being females. The most prevalent comorbidities were hypertension, diabetes mellitus, and coronary artery disease. There was no difference in periprocedural stroke in patients who underwent TAVI with the Sentinel™ CPS compared to no TCEP (RR 0.75, P = 0.12). Periprocedural disabling strokes were less likely in those who underwent TAVI with the Sentinel™ CPS compared to no TCEP (RR 0.41, P = 0.02) with a number needed to treat (NNT) of 123. All other outcomes did not reach statistical significance. CONCLUSIONS In our analysis, there was no difference between TAVI with the Sentinel™ CPS compared to TAVI without TCEP in regard to risk of periprocedural stroke; however, it was associated with a decreased risk of periprocedural disabling stroke.
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Affiliation(s)
- Wissam Harmouch
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Barbara Karnkowska
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Ravi Thakker
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Peter Rasmussen
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Mostafa Shalaby
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Wissam Khalife
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Haider Alwash
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Afaq Motiwala
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Paul Kumfa
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Syed Gilani
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Hani Jneid
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Umamahesh Rangasetty
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
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Albaeni A, Chatila KF, Thakker RA, Kumfa P, Alwash H, Elsherbiny A, Gilani S, Khalife WI, Jneid H, Motiwala A, Motiwala A. In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions in Heart failure patients. Curr Probl Cardiol 2023; 48:101458. [PMID: 36261103 DOI: 10.1016/j.cpcardiol.2022.101458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/13/2022] [Indexed: 01/04/2023]
Abstract
In-hospital outcomes of chronic total occlusion Percutaneous Coronary Interventions (CTO PCI) in heart failure patients has not been evaluated on a national base and was the focus of this investigation. We used the Nationwide Inpatient Sample database from 2008 to 2014 to identify adults with single vessel CTO PCI for stable ischemic heart disease (SIHD). Patients were divided into 3 groups: patients without heart failure, heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Clinical characteristics and in-hospital outcomes were studied using relevant statistics. Multiple logistic regression models were performed to assess in-hospital mortality, acute renal failure, and the use of mechanical support devices. Of 112,061 inpatients with SIHD from 2008 to 2014 undergoing CTO PCI, 21,185 (19%) had HFrEF and 3309 (3%) had HFpEF. Compared to patients without heart failure, HFrEF and HFpEF patients were older (mean age 69.2 vs 66.3, 70.3 vs 66.3 respectively, P < 0.001), had more comorbidities and higher acute in-hospital complications. HFrEF patients had higher adjusted in-hospital mortality [AOR 1.73, 95% CI (1.21-2.48)], acute renal failure [AOR 2.68, 95% CI (2.34-3.06)], and need for mechanical support [AOR 2.76, 95% CI (2.17-3.51)]. Compared to patients without heart failure, HFpEF patients had similar mortality and need for mechanical support, but higher incidence of acute renal failure. Older age was significantly associated with increased in-hospital mortality. chronic total occlusion PCI in patients with heart failure is associated with higher in-hospital morbidity and mortality and warrants further investigation to optimize health care delivery.
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Affiliation(s)
- Aiham Albaeni
- Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX.
| | - Khaled F Chatila
- Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX
| | - Ravi A Thakker
- Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX
| | - Paul Kumfa
- Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX
| | - Haider Alwash
- Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX
| | - Ahmed Elsherbiny
- Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX
| | - Syed Gilani
- Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX
| | - Wissam I Khalife
- Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX
| | - Hani Jneid
- Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX
| | - Afaq Motiwala
- Department of Medicine, Division of Cardiology, University of Texas Medical branch, Galveston, TX
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Toodayan N, Alwash H. Sir Victor Horsley's (1857-1916) memorial wall inscription at the Amarah War Cemetery. J Hist Neurosci 2019; 28:443-444. [PMID: 31039078 DOI: 10.1080/0964704x.2019.1593575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Nadeem Toodayan
- University of Queensland School of Medicine , Brisbane , Australia
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Choudhry MW, Mazhar M, Virk F, Alwash H, Sharma M, Rejjal L, Rangasetty U. PROFOUND ANEMIA, ACUTE KIDNEY INJURY AND “HEMATURIA” FOLLOWING PERIPHERAL ANGIOPLASTY AND STENTING: WHAT IS YOUR DIFFERENTIAL DIAGNOSIS? J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)33035-9] [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: 11/15/2022]
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Rejjal L, Al-Taweel O, Alwash H, Choudhry M, Alghrouz M, Khalife W, Morsy M, Al-Taweel A, Chatila K, Gilani S. STENT MIGRATION DURING ENDOVASCULAR STENTING IN SUPERIOR VENA CAVA SYNDROME IN A PATIENT WITH RECENT HEART TRANSPLANTATION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)33347-9] [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: 10/27/2022]
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Alwash H, Lee J, Reddy S, Kalynych A, Polsani V, Rinehart S. INFERIOR VENA CAVA FILTER STRUT FRACTURE WITH RIGHT VENTRICULAR IMPLANTATION. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60698-2] [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: 10/23/2022]
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