1
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Duggal NM, Engoren M, Chadderdon SM, Rodriguez E, Morse MA, Vannan MA, Yadav PK, Morcos M, Li F, Reisman M, Garcia-Sayan E, Raghunathan D, Sodhi N, Sorajja P, Chen L, Rogers JH, Calfon MA, Kovach CP, Gill EA, Zahr FE, Chetcuti SJ, Yuan Y, Mentz GB, Lim DS, Ailawadi G. Mortality Associated With Proportionality of Secondary Mitral Regurgitation After Transcatheter Mitral Valve Repair: North American Mitraclip for Functional Mitral Regurgitation Registry. Am J Cardiol 2024; 213:99-105. [PMID: 38110022 DOI: 10.1016/j.amjcard.2023.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/17/2023] [Accepted: 12/09/2023] [Indexed: 12/20/2023]
Abstract
The association, if any, between the effective regurgitant orifice area (EROA) to left ventricular end-diastolic volume (LVEDV) ratio and 1-year mortality is controversial in patients who undergo mitral transcatheter edge-to-edge repair (m-TEER) with the MitraClip system (Abbott Vascular, Santa Clara, CA). This study's objective was to determine the association between EROA/LVEDV and 1-year mortality in patients who undergo m-TEER with MitraClip. In patients with severe secondary (functional) mitral regurgitation (MR), we analyzed registry data from 11 centers using generalized linear models with the generalized estimating equations approach. We studied 525 patients with secondary MR who underwent m-TEER. Most patients were male (63%) and were New York Heart Association class III (61%) or IV (21%). Mitral regurgitation was caused by ischemic cardiomyopathy in 51% of patients. EROA/LVEDV values varied widely, with median = 0.19 mm2/ml, interquartile range [0.12,0.28] mm2/ml, and 187 patients (36%) had values <0.15 mm2/ml. Postprocedural mitral regurgitation severity was substantially alleviated, being 1+ or less in 74%, 2+ in 20%, 3+ in 4%, and 4+ in 2%; 1-year mortality was 22%. After adjustment for confounders, the logarithmic transformation (Ln) of EROA/LVEDV was associated with 1-year mortality (odds ratio 0.600, 95% confidence interval 0.386 to 0.933, p = 0.023). A higher Society of Thoracic Surgeons risk score was also associated with increased mortality. In conclusion, lower values of Ln(EROA/LVEDV) were associated with increased 1-year mortality in this multicenter registry. The slope of the association is steep at low values but gradually flattens as Ln(EROA/LVEDV) increases.
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Affiliation(s)
- Neal M Duggal
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
| | - Milo Engoren
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Scott M Chadderdon
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Evelio Rodriguez
- Department of Cardiothoracic Surgery, Ascension Saint Thomas Heart, Nashville, Tennessee
| | - M Andrew Morse
- Division of Cardiology, Ascension Saint Thomas Heart, Nashville, Tennessee
| | - Mani A Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Pradeep K Yadav
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Michael Morcos
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Flora Li
- Department of Anesthesiology, University of Washington, Seattle, Washington
| | - Mark Reisman
- Division of Cardiology, Weill Cornell Medical Center, New York, New York
| | - Enrique Garcia-Sayan
- Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Deepa Raghunathan
- Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Nishtha Sodhi
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute, Abbott Northwestern Medical Center, Minneapolis, Minnesota
| | - Lily Chen
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California
| | - Jason H Rogers
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California
| | - Marcella A Calfon
- Division of Cardiology, University of California Los Angeles, Los Angeles, California
| | | | - Edward A Gill
- Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Firas E Zahr
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Stanley J Chetcuti
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Yuan Yuan
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Graciela B Mentz
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - D Scott Lim
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
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English CW, Rogers JH, Smith TW. Intracardiac Echocardiographic Guidance for Structural Heart Procedures: Current Utility as Compared to Transesophageal Echocardiography. Interv Cardiol Clin 2024; 13:39-49. [PMID: 37980066 DOI: 10.1016/j.iccl.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Over the past decade, engineering advances in intracardiac echocardiography (ICE) have improved the ability of an imager or interventionalist to guide not only interatrial septal procedures but now commonly left atrial appendage, tricuspid, and mitral procedures. When transesophageal echocardiography (TEE) is not possible because of anatomic limitations, ICE has proved a useful tool to safely complete structural interventions. ICE will play a growing, key role in structural interventions where anatomic factors strongly favor an intracardiac perspective or augment TEE when imaging is suboptimal.
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Affiliation(s)
- Carter W English
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California - Davis Medical Center, 4860 Y Street, Suite 2820, Sacramento, CA 95817, USA
| | - Jason H Rogers
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California - Davis Medical Center, 4860 Y Street, Suite 2820, Sacramento, CA 95817, USA
| | - Thomas W Smith
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California - Davis Medical Center, 4860 Y Street, Suite 2820, Sacramento, CA 95817, USA.
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3
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Rogers JH. Head-to-Head Transcatheter Mitral Edge-to-Edge Repair. JACC Cardiovasc Interv 2023; 16:2817-2819. [PMID: 37902147 DOI: 10.1016/j.jcin.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 10/31/2023]
Affiliation(s)
- Jason H Rogers
- University of California-Davis, Medical Center, Sacramento, California, USA.
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4
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von Bardeleben RS, Mahoney P, Morse MA, Price MJ, Denti P, Maisano F, Rogers JH, Rinaldi M, De Marco F, Rollefson W, Chehab B, Williams M, Leurent G, Asch FM, Rodriguez E. 1-Year Outcomes With Fourth-Generation Mitral Valve Transcatheter Edge-to-Edge Repair From the EXPAND G4 Study. JACC Cardiovasc Interv 2023; 16:2600-2610. [PMID: 37877913 DOI: 10.1016/j.jcin.2023.09.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 08/15/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND The fourth-generation mitral transcatheter edge-to-edge repair (M-TEER) device introduced an improved clip deployment sequence, independent leaflet grasping, and 2 wider clip sizes to tailor the treatment of patients with mitral regurgitation (MR) for a broad range of anatomies. The 30-day safety and effectiveness of the fourth-generation M-TEER device were previously demonstrated. OBJECTIVES The aim of this study was to evaluate 1-year outcomes in a contemporary, real-world cohort of subjects treated with the MitraClip G4 system. METHODS EXPAND G4 is an ongoing prospective, multicenter, international, single-arm study that enrolled subjects with primary and secondary MR. One-year outcomes included MR severity (echocardiographic core laboratory assessed), heart failure hospitalization, all-cause mortality, functional capacity (NYHA functional class), and quality of life (Kansas City Cardiomyopathy Questionnaire). RESULTS A total of 1,164 subjects underwent M-TEER from 2020 to 2022. At 1 year, there was a durable reduction in MR to mild or less in 92.6% and to none or trace in 44.2% (P < 0.0001 vs baseline). Few subjects had major adverse events through 1 year (<2% for myocardial infarction, surgical reintervention, or single-leaflet device attachment). The 1-year Kaplan-Meier estimates for all-cause mortality and heart failure hospitalization were 12.3% and 16.9%. Significant improvements in functional capacity (NYHA functional class I or II in 82%; P < 0.0001 vs baseline) and quality of life (18.5-point Kansas City Cardiomyopathy Questionnaire overall summary score improvement; P < 0.0001) were observed. CONCLUSIONS M-TEER with the fourth-generation M-TEER device was safe and effective at 1 year, with durable reductions in MR severity to ≤1+ in more than 90% of patients and concomitant improvements in functional status and quality of life.
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Affiliation(s)
| | - Paul Mahoney
- University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | | | - Matthew J Price
- Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California, USA
| | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | | | - Jason H Rogers
- University of California Davis Medical Center, Sacramento, California, USA
| | - Michael Rinaldi
- Sanger Heart and Vascular Institute of Cardiothoracic Surgery, Charlotte, North Carolina, USA
| | | | | | | | - Mathew Williams
- Heart Valve Center, New York University Langone Health, New York, New York, USA
| | | | - Federico M Asch
- Cardiovascular Core Laboratories, MedStar Health Research Institute, Washington, District of Columbia, USA
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Rogers JH, Asch F, Sorajja P, Mahoney P, Price MJ, Maisano F, Denti P, Morse MA, Rinaldi M, Bedogni F, De Marco F, Rollefson W, Chehab B, Williams MR, Leurent G, Morikawa T, Asgar AW, Rodriguez E, von Bardeleben RS, Kar S. Expanding the Spectrum of TEER Suitability: Evidence From the EXPAND G4 Post Approval Study. JACC Cardiovasc Interv 2023; 16:1474-1485. [PMID: 37380229 DOI: 10.1016/j.jcin.2023.05.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 03/21/2023] [Revised: 05/06/2023] [Accepted: 05/09/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Anatomical and clinical criteria to define mitral transcatheter edge-to-edge repair (TEER) "unsuitability" have been proposed on the basis of a Heart Valve Collaboratory consensus opinion from physician experience with early-generation TEER devices but lacked an evidence-based approach. OBJECTIVES The aim of this study was to explore the spectrum of TEER suitability using echocardiographic and clinical outcomes from the EXPAND G4 real-world postapproval study. METHODS EXPAND G4 is a global, prospective, multicenter, single-arm study that enrolled 1,164 subjects with mitral regurgitation (MR) treated with the MitraClip G4 System. Three groups were defined using the Heart Valve Collaboratory TEER unsuitability criteria: 1) risk of stenosis (RoS); 2) risk of inadequate MR reduction (RoIR); and 3) subjects with baseline moderate or less MR (MMR). A TEER-suitable (TS) group was defined by the absence of these characteristics. Endpoints included independent core laboratory-assessed echocardiographic characteristics, procedural outcomes, MR reduction, NYHA functional class, Kansas City Cardiomyopathy Questionnaire score, and major adverse events through 30 days. RESULTS Subjects in the RoS (n = 56), RoIR (n = 54), MMR (n = 326), and TS (n = 303) groups had high 30-day MR reduction rates (≤1+: RoS 97%, MMR 93%, and TS 91%; ≤2+: RoIR 94%). Thirty-day improvements in functional capacity (NYHA functional class I or II at 30 days vs baseline: RoS 94% vs 29%, RoIR 88% vs 30%, MMR 79% vs 26%, and TS 83% vs 33%) and quality of life (change in Kansas City Cardiomyopathy Questionnaire score: RoS +27 ± 26, RoIR +16 ± 26, MMR +19 ± 26, and TS +19 ± 24) were safely achieved in all groups, with low major adverse events (<3%) and all-cause mortality (RoS 1.8%, RoIR 0%, MMR 1.5%, and TS 1.3%). CONCLUSIONS Patients previously deemed TEER unsuitable can be safely and effectively treated with the mitral TEER fourth-generation device.
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Affiliation(s)
- Jason H Rogers
- University of California Davis Medical Center, Sacramento, California, USA.
| | - Federico Asch
- Cardiovascular Core Laboratories, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Paul Sorajja
- Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Paul Mahoney
- Sentara Heart and Valve and Structural Disease Center, Norfolk, Virginia, USA
| | | | | | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | | | | | | | | | | | - Bassem Chehab
- Ascension Via Christi Hospital, University of Kansas, Wichita, Kansas, USA
| | | | | | - Takao Morikawa
- The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Anita W Asgar
- Institut de Cardiologie de Montréal, Montreal, Quebec, Canada
| | | | | | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA
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6
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von Bardeleben RS, Rogers JH, Mahoney P, Price MJ, Denti P, Maisano F, Rinaldi M, Rollefson WA, De Marco F, Chehab B, Williams MR, Asch FM, Rodriguez E. Real-World Outcomes of Fourth-Generation Mitral Transcatheter Repair: 30-Day Results From EXPAND G4. JACC Cardiovasc Interv 2023; 16:1463-1473. [PMID: 37380228 DOI: 10.1016/j.jcin.2023.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/04/2023] [Accepted: 05/09/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND The fourth-generation MitraClip G4 System builds on the previous NTR/XTR system with additional wider clip sizes (NTW and XTW), an independent grasping feature, and an improved clip deployment sequence. OBJECTIVES The primary objective of this study was to assess the safety and performance of the MitraClip G4 System within a contemporary real-world setting. METHODS EXPAND G4 is a prospective, multicenter, international, single-arm, postapproval study that enrolled patients with primary (degenerative) mitral regurgitation (MR) and secondary (functional) MR at 60 centers. Follow-up of the full cohort has been conducted through 30 days. Echocardiograms were analyzed by an echocardiography core laboratory. Study outcomes included MR severity, functional capacity measured by NYHA functional class, quality of life measured using the Kansas City Cardiomyopathy Questionnaire, major adverse event rates, and all-cause mortality. RESULTS In EXPAND G4, 1,141 subjects with primary MR and secondary MR were treated from March 2021 to February 2022. Implantation and acute procedural success rates were 98.0% and 96.2%, respectively, with a mean of 1.4 ± 0.6 clips implanted per subject. MR was significantly reduced at 30 days compared with baseline (98% achieved MR ≤ 2+, and 91% achieved MR ≤ 1+; P < 0.0001). Functional capacity and quality of life were substantially improved, with 83% of patients achieving NYHA functional class I or II. Likewise, an 18-point improvement was observed in Kansas City Cardiomyopathy Questionnaire summary scores compared with baseline. The composite major adverse event rate was 2.7%, and the all-cause death rate was 1.3% at 30 days. CONCLUSIONS This study demonstrates for the first time the effectiveness and safety of MitraClip G4 System at 30 days in a cohort of >1,000 patients with MR in a contemporary, real-world setting.
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Affiliation(s)
| | - Jason H Rogers
- University of California Davis Medical Center, Sacramento, California, USA
| | - Paul Mahoney
- Sentera Heart and Valve and Structural Disease Center, Norfolk, Virginia, USA
| | - Matthew J Price
- Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California, USA
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | | | - Michael Rinaldi
- Sanger Heart and Vascular Institute of Cardiothoracic Surgery, Charlotte, North Carolina, USA
| | | | | | | | - Mathew R Williams
- Heart Valve Center, New York University Langone Health, New York, New York, USA
| | - Federico M Asch
- Cardiovascular Core Laboratories, MedStar Health Research Institute, Washington, District of Columbia, USA
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7
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Wong GX, Kar S, Smith TW, Spangler T, Bolling SF, Rogers JH. Transcatheter Left Atrial Appendage Exclusion: Preclinical and Early Clinical Results With the Laminar Device. JACC Cardiovasc Interv 2023; 16:1347-1357. [PMID: 37294221 DOI: 10.1016/j.jcin.2023.04.028] [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: 03/16/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND The Laminar device rotates and closes the left atrial appendage (LAA) using an integrated ball and lock that excludes and eliminates the LAA pouch. There is a low device surface area, minimizing the risk of peridevice leak (PDL) and device-related thrombus (DRT) formation. OBJECTIVES This study evaluates the safety and efficacy of the Laminar LAA exclusion device in healthy animals and human subjects with nonvalvular atrial fibrillation at risk of ischemic stroke and systemic thromboembolism. METHODS The preclinical study implanted the Laminar device into canine subjects that underwent transesophageal echocardiography (TEE) and fluoroscopic evaluation, followed by necropsy and histological assessment at 45 and 150-days post-implant. The early clinical study implanted the device in human subjects, followed to 12 months postimplantation. Procedural success was defined as device implantation in the intended location without residual LAA leak >5 mm as seen by TEE. Safety endpoints included freedom from stroke, systemic embolism, pericardial effusion, or tamponade, life-threatening/major bleeding, or death. RESULTS The Laminar device was successfully implanted in 10 canines. In all animals at 45 days and 150 days, no PDL or DRT was found, and histological examination showed fully closed LAAs covered with neo-endocardium. The device was successfully implanted in 15 human subjects with no safety events out to 12 months postimplantation. All subjects had successful protocol-defined LAA closure without DRT at 45 days by TEE and computed tomography, which remained stable through 12 months' follow-up. CONCLUSIONS The preclinical and early clinical results demonstrate a promising safety and efficacy profile for the Laminar LAA exclusion device.
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Affiliation(s)
- Gordon X Wong
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, California, USA
| | - Saibal Kar
- Cardiovascular Associates of Los Robles Health System, Thousand Oaks, California, USA
| | - Thomas W Smith
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, California, USA
| | | | - Steven F Bolling
- Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Jason H Rogers
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, California, USA.
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8
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Singh GD, Aman E, Pham T, Rogers JH, Atsina K, Smith TWR. vICE-Guided T-TEER in a Patient Without TEE Windows. JACC Cardiovasc Interv 2022; 15:e245-e247. [PMID: 36543458 DOI: 10.1016/j.jcin.2022.08.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/30/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Gagan D Singh
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California, USA.
| | - Edris Aman
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California, USA
| | - Tai Pham
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California, USA
| | - Jason H Rogers
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California, USA
| | - Kwame Atsina
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California, USA
| | - Thomas W R Smith
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California, USA
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9
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Bernstein HM, Stripe B, Chen L, Aman E, Smith TWR, Rogers JH, Singh GD. Iatrogenic Atrial Septal Defect Closure Through the Steerable Guide Catheter: Description of Technique and Single-Center Experience. J Invasive Cardiol 2022; 34:E633-E638. [PMID: 35916922] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To introduce a novel method of direct iatrogenic atrial septal defect (iASD) closure through the MitraClip steerable guide catheter (SGC). BACKGROUND MitraClip implantation requires transseptal puncture and the creation of an iASD. There are relatively rare instances, such as hemodynamically significant shunting or concerns for embolus, where iASD must be closed during index procedure. In these instances, it may be beneficial to not give up access to left atrium. METHODS We retrospectively reviewed all iASD closures during MitraClip implantation at our institution from 2015 to 2020. Cases where an ASD occluder was deployed directly through SGC were included. RESULTS Eleven patients had immediate iASD closure through the SGC. Indications for using this method included concern for paradoxical embolus, large defect size and/or significant shunting. Closure device sizes ranged from 8 to 22 mm. Mean time from removal of clip delivery system to occlusion of iASD was 14.6 minutes. There were no procedural complications related to iASD closure using this method. CONCLUSION Closure of iASD intra-procedurally directly through transseptal guide sheath via the method described was safe and allowed for continuous left atrium access.
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10
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Gupta R, Rogers JH, Long X, Aguilar R, Medrano G, Reyes J, Redell M, Goodell MA, Rau RE. Targeting signaling pathways vulnerabilities for the treatment of IKZF1-deleted ph-negative B lymphoblastic leukemia. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7033 Background: Approximately 20% of children diagnosed with B lymphoblastic leukemia (B-ALL) will suffer a relapse, and most adults with B-ALL have a poor prognosis. Genome-wide association studies of B-ALL patients have identified frequent deletions of the gene IKZF1, encoding the master regulator of lymphoid development, IKAROS. These deletions are associated with therapy resistance, increased risk of relapse, and inferior survival. Currently, how loss of IKAROS function contributes to therapy resistance and increased risk of relapse is not fully understood. We used CRISPR-Cas9 genome editing to develop human B-ALL cell lines with various IKZF1 deletions that genetically and phenotypically recapitulate those occurring in patients. Using these isogenic cell lines, we have previously shown IKZF1 deletion results in cell-intrinsic chemoresistance and increased activation of the JAK/STAT signaling pathway (Rogers, Gupta et al. 2021). Methods: Given JAK/STAT is often dysregulated in poor-prognosis leukemia, we investigated the potential mechanisms of aberrant JAK/STAT activation and the therapeutic potential of targeting JAK/STAT in our engineered cell lines. We treated our cells with SH-4-54 (STAT3/5 inhibitor) or tofacitinib (JAK1 inhibitor) alone and in combination with dexamethasone. To elucidate how loss of IKAROS mediates an increase in JAK-STAT activity, we also performed RNAseq of known pathway regulators, comparing IKZF1 wild-type with IKZF1 knockout. Results: The JAK/STAT negative regulator Suppressor of Cytokine Signaling 2 (SOCS2) was significantly downregulated with IKZF1 deletion, validated by RTqPCR and immunoblotting. We further analyzed publicly-available RNAseq data from > 650 pediatric B-ALL samples, finding that SOCS2 expression is significantly lower in patients with low IKZF1expression (likely corresponding to IKZF1 deletion) compared to those with high IKZF1 expression. When we treated our engineered cell lines with tofacitinib or SH-4-54, IKZF1 wild-type cells were sensitive to each compound, suggesting JAK/STAT signaling plays a vital role in cell survival. In contrast, the IKZF1-deleted cells were relatively resistant to JAK/STAT inhibitors alone. However, in combination with dexamethasone, treatment of cells with sub-IC50 levels of SH-4-54 or tofacitinib resulted in re-sensitization to glucocorticoid-induced apoptosis. Conclusions: Our findings support that IKZF1 deletion leads to a targetable upregulation of the JAK/STAT pathway that, when inhibited, results in relative re-sensitization to dexamethasone. JAK/STAT pathway upregulation in IKZF1 deleted cells may be mediated by decreased expression of SOCS2. These results provide initial promise for targeting these vulnerabilities for the treatment of this poor-prognosis disease.
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Affiliation(s)
| | | | - Xin Long
- Texas Children's Hospital, Houston, TX
| | | | | | | | | | | | - Rachel E. Rau
- Texas Children’s Cancer and Hematology Center, Baylor College of Medicine, Houston, TX
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11
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Duncan A, Dahle G, Conradi L, Dumonteil N, Wang J, Shah N, Sun B, Sorajja P, Ailawadi G, Rogers JH, Quarto C, Bethea B. Multicenter Clinical Management Practice to Optimize Outcomes Following Tendyne Transcatheter Mitral Valve Replacement. Struct Heart 2022; 6:100025. [PMID: 37273467 PMCID: PMC10236795 DOI: 10.1016/j.shj.2022.100025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/19/2022] [Accepted: 02/17/2022] [Indexed: 06/06/2023]
Affiliation(s)
- Alison Duncan
- Heart Division, The Royal Brompton Hospital, London, UK
| | - Gry Dahle
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Lenard Conradi
- Department of Cardiothoracic Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Nicholas Dumonteil
- Department of Cardiovascular Medicine, Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - John Wang
- Cardiovascular Intensive Care Unit, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Nimesh Shah
- Cardiovascular Intensive Care Unit, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Benjamin Sun
- Department of Cardiothoracic Surgery, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Department of Cardiothoracic Surgery, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
- Center for Valve and Structural Heart Disease, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Gorav Ailawadi
- Department of Cardiothoracic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jason H. Rogers
- Department of Cardiovascular Medicine, Davis Medical Center, Sacramento, California, USA
| | - Cesare Quarto
- Heart Division, The Royal Brompton Hospital, London, UK
- Department of Cardiothoracic Surgery, The Royal Brompton Hospital, London, UK
| | - Brian Bethea
- Cardiovascular Intensive Care Unit, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
- Department of Cardiothoracic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
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12
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Mahoney PD, Price M, Rinaldi MJ, Rogers JH, Asch FM, Maisano F, Kar S. THE EVOLUTION OF TRANSCATHETER EDGE TO EDGE REPAIR WITH MITRACLIP AND ITS OUTCOMES IN SECONDARY MITRAL REGURGITATION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01569-8] [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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13
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Pearman JL, Wall SL, Chen L, Rogers JH. Intracardiac echocardiographic-guided right-sided cardiac biopsy: Case series and literature review. Catheter Cardiovasc Interv 2021; 98:1000-1005. [PMID: 33002282 DOI: 10.1002/ccd.29302] [Citation(s) in RCA: 6] [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: 04/23/2020] [Revised: 08/26/2020] [Accepted: 09/16/2020] [Indexed: 11/06/2022]
Abstract
Endomyocardial biopsy (EMB) is a common procedure used to aid in the diagnosis of diffuse myocardial diseases and, less commonly, in the diagnosis of cardiac tumors. As cardiac tumors are often found in high-risk locations (ventricular free wall or atria), precision biopsy is paramount, and additional imaging, like transesophageal echocardiography is often required for guidance. The use of intracardiac echocardiography (ICE) to guide biopsy has been described, but there is no consensus on a standardized approach. We report our institutional approach with three cases of ICE-directed EMB performed with the 2.4 mm Jawz bioptome directed with an 8.5-Fr Agilis NxT steerable introducer. All cases were performed under guidance with the AcuNav ICE probe. There were no procedural complications and a definitive diagnosis was obtained in all three cases. We also review the available published cases of ICE-guided EMB in the literature-noting the different procedural approaches, complication rate, and diagnostic yield. There were only two negative biopsies reported among the published cases and no reported complications. Our review of all these cases suggests that ICE-guidance for EMB is superior to other forms of imaging in its ease of use and high definition of right-sided cardiac structures. We also feel that the use of the Agilis steerable sheath allows for more precise directing of the bioptome and is a critical component in performing a successful targeted biopsy.
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Affiliation(s)
- Joseph L Pearman
- Internal Medicine, UC Davis Medical Center, Sacramento, California
| | - Stephen L Wall
- Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, California
| | - Lily Chen
- Internal Medicine, UC Davis Medical Center, Sacramento, California.,Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, California
| | - Jason H Rogers
- Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, California
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14
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Rogers JH, Sorajja P, Thourani VH, Sharma RP, Chehab B, Cowger J, Heimansohn D, Badhwar V, Guerrero M, Ailawadi G. Randomized Trials Are Needed for Transcatheter Mitral Valve Replacement. JACC Cardiovasc Interv 2021; 14:2039-2046. [PMID: 34556279 DOI: 10.1016/j.jcin.2021.06.014] [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: 05/11/2021] [Accepted: 06/08/2021] [Indexed: 10/20/2022]
Abstract
Transcatheter mitral valve replacement (TMVR) is a new therapy for treating symptomatic mitral regurgitation (MR) and stenosis. The proposed benefit of TMVR is the predictable, complete elimination of MR, which is less certain with transcatheter repair technologies such as TEER (transcatheter edge-to-edge repair). The potential benefit of MR elimination with TMVR needs to be rigorously evaluated against its risks which include relative procedural invasiveness, need for anticoagulation, and chronic structural valve deterioration. Randomized controlled trials (RCTs) are a powerful method for evaluating the safety and effectiveness of TMVR against current standard of care transcatheter therapies, such as TEER. RCTs not only help with the assessment of benefits and risks, but also with policies for determining operator or institutional requirements, resource utilization, and reimbursement. In this paper, the authors provide recommendations and considerations for designing pivotal RCTs for first-in-class TMVR devices.
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Affiliation(s)
- Jason H Rogers
- University of California-Davis, Medical Center, Davis, California, USA.
| | - Paul Sorajja
- Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Vinod H Thourani
- Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | | | | | | | | | - Vinay Badhwar
- West Virginia University, Morgantown, West Virginia, USA
| | | | - Gorav Ailawadi
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
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15
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Kosmidou I, Lindenfeld J, Abraham WT, Rinaldi MJ, Kapadia SR, Rajagopal V, Sarembock IJ, Brieke A, Gaba P, Rogers JH, Shahim B, Redfors B, Zhang Z, Mack MJ, Stone GW. Sex-Specific Outcomes of Transcatheter Mitral-Valve Repair and Medical Therapy for Mitral Regurgitation in Heart Failure. JACC Heart Fail 2021; 9:674-683. [PMID: 34391744 DOI: 10.1016/j.jchf.2021.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/19/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES This study sought to assess the sex-specific outcomes in patients with heart failure (HF) with 3+ and 4+ secondary mitral regurgitation (SMR) treated with transcatheter mitral valve repair (TMVr) plus guideline-directed medical therapy (GDMT) versus GDMT alone in the COAPT trial. BACKGROUND The impact of sex in patients with HF and severe SMR treated with TMVr with the MitraClip compared with GDMT alone is unknown. METHODS Patients were randomized 1:1 to TMVr versus GDMT alone. Two-year outcomes were examined according to sex. RESULTS Among 614 patients, 221 (36.0%) were women. Women were younger than men and had fewer comorbidities, but reduced quality of life and functional capacity at baseline. In a joint frailty model accounting for the competing risk of death, the 2-year cumulative incidence of the primary endpoint of all HF hospitalizations (HFH) was higher in men compared with women treated with GDMT alone. However, the relative reduction in HFHs with TMVr was greater in men (HR: 0.43; 95% CI: 0.34-0.54) than women (HR: 0.78; 95% CI: 0.57-1.05) (Pinteraction = 0.002). A significant interaction between TMVr versus GDMT alone treatment and time was present for all HFHs in women (HR: 0.57; 95% CI: 0.39-0.84, and HR: 1.39; 95% CI: 0.83-2.33 between 0-1 year and 1-2 years after randomization, respectively, Pinteraction = 0.007) but not in men (HR: 0.48; 95% CI: 0.36-0.64, and HR: 0.33; 95% CI: 0.21-0.51; Pinteraction = 0.16). Female sex was independently associated with a lower adjusted risk of death at 2 years (HR: 0.64; 95% CI: 0.46-0.90; P = 0.011). TMVr consistently reduced 2-year mortality compared with GDMT alone, irrespective of sex (Pinteraction = 0.99). CONCLUSIONS In the COAPT trial, TMVr with the MitraClip resulted in improved clinical outcomes compared with GDMT alone, irrespective of sex. However, the impact of TMVr in reducing HFH was less pronounced in women compared with men beyond the first year after treatment. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Tria] [COAPT]; NCT01626079).
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Affiliation(s)
- Ioanna Kosmidou
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Michael J Rinaldi
- Sanger Heart & Vascular Institute/Atrium Health, Charlotte, North Carolina, USA
| | | | | | - Ian J Sarembock
- The Christ Hospital and Lindner Clinical Research Center, Cincinnati, Ohio, USA
| | | | - Prakriti Gaba
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | | | - Bahira Shahim
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Björn Redfors
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Zixuan Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | | | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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16
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Kar S, Mack MJ, Lindenfeld J, Abraham WT, Asch FM, Weissman NJ, Enriquez-Sarano M, Lim DS, Mishell JM, Whisenant BK, Rogers JH, Arnold SV, Cohen DJ, Grayburn PA, Stone GW. Relationship Between Residual Mitral Regurgitation and Clinical and Quality-of-Life Outcomes After Transcatheter and Medical Treatments in Heart Failure: COAPT Trial. Circulation 2021; 144:426-437. [PMID: 34039025 DOI: 10.1161/circulationaha.120.053061] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the randomized COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation), among 614 patients with heart failure with 3+ or 4+ secondary mitral regurgitation (MR), transcatheter mitral valve repair (TMVr) with the MitraClip reduced MR, heart failure hospitalizations, and mortality and improved quality of life compared with guideline-directed medical therapy (GDMT) alone. We aimed to examine the prognostic relationship between MR reduction and outcomes after TMVr and GDMT alone. METHODS Outcomes in COAPT between 30 days and 2 years were examined on the basis of the severity of residual MR at 30 days. RESULTS TMVr-treated patients had less severe residual MR at 30 days than GDMT-treated patients (0/1+, 2+, and 3+/4+: 72.9%, 19.9%, and 7.2% versus 8.2%, 26.1%, and 65.8%, respectively [P<0.0001]). The rate of composite death or heart failure hospitalizations between 30 days and 2 years was lower in patients with 30-day residual MR of 0/1+ and 2+ compared with patients with 30-day residual MR of 3+/4+ (37.7% versus 49.5% versus 72.2%, respectively [P<0.0001]). This relationship was consistent in the TMVr and GDMT arms (Pinteraction=0.92). The improvement in Kansas City Cardiomyopathy Questionnaire score from baseline to 30 days was maintained between 30 days and 2 years in patients with 30-day MR ≤2+ but deteriorated in those with 30-day MR 3+/4+ (-0.3±1.7 versus -9.4±4.6 [P=0.0008]) consistently in both groups (Pinteraction=0.95). CONCLUSIONS In the COAPT trial, reduced MR at 30 days was associated with greater freedom from death or heart failure hospitalizations and improved quality of life through 2-year follow-up whether the MR reduction was achieved by TMVr or GDMT. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01626079.
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Affiliation(s)
- Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, CA (S.K.).,Bakersfield Heart Hospital, CA (S.K.)
| | | | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.)
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus (W.T.A.)
| | - Federico M Asch
- MedStar Health Research Institute, Washington, DC (F.M.A., N.J.W.).,Georgetown University, Washington, DC (F.M.A., N.J.W.)
| | - Neil J Weissman
- MedStar Health Research Institute, Washington, DC (F.M.A., N.J.W.).,Georgetown University, Washington, DC (F.M.A., N.J.W.)
| | | | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville (D.S.L.)
| | | | | | - Jason H Rogers
- University of California Davis Medical Center, Sacramento (J.H.R.)
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A.)
| | - David J Cohen
- University of Missouri-Kansas City School of Medicine (S.V.A.).,St Francis Hospital, Roslyn, NY (D.J.C.)
| | - Paul A Grayburn
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, TX (P.A.G.)
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (D.J.C., G.W.S.).,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (G.W.S.)
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17
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Malhotra P, Yap J, Aman E, Rogers JH. The Yin-Yang Sign of Severe Mitral Regurgitation. J Invasive Cardiol 2021; 33:E314. [PMID: 33794480] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In select patients with severe, eccentric mitral regurgitation, we have observed that the regurgitant jet may entrain blood along the left atrial wall to produce a Chinese yin-yang symbol on color Doppler. This clinical imaging series demonstrates this unique phenomenon in an 81-year-old woman with symptomatic, severe, functional mitral regurgitation secondary to non-ischemic cardiomyopathy who was referred for transcatheter mitral valve repair. The yin-yang symbol resolved on transthoracic echocardiography after placement of 2 MitraClip NTR devices.
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Affiliation(s)
| | | | | | - Jason H Rogers
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, CA 95817 USA.
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18
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Mack MJ, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, Whisenant BK, Grayburn PA, Rinaldi MJ, Kapadia SR, Rajagopal V, Sarembock IJ, Brieke A, Rogers JH, Marx SO, Cohen DJ, Weissman NJ, Stone GW. 3-Year Outcomes of Transcatheter Mitral Valve Repair in Patients With Heart Failure. J Am Coll Cardiol 2021; 77:1029-1040. [PMID: 33632476 DOI: 10.1016/j.jacc.2020.12.047] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [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: 07/08/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial, transcatheter mitral valve repair (TMVr) resulted in fewer heart failure hospitalizations (HFHs) and lower mortality at 24 months in patients with heart failure (HF) with mitral regurgitation (MR) secondary to left ventricular dysfunction compared with guideline-directed medical therapy (GDMT) alone. OBJECTIVES This study determined if these benefits persisted to 36 months and if control subjects who were allowed to cross over at 24 months derived similar benefit. METHODS This study randomized 614 patients with HF with moderate-to-severe or severe secondary MR, who remained symptomatic despite maximally tolerated GDMT, to TMVr plus GDMT versus GDMT alone. The primary effectiveness endpoint was all HFHs through 24-month follow-up. Patients have now been followed for 36 months. RESULTS The annualized rates of HFHs per patient-year were 35.5% with TMVr and 68.8% with GDMT alone (hazard ratio [HR]: 0.49; 95% confidence interval [CI]: 0.37 to 0.63; p < 0.001; number needed to treat (NNT) = 3.0; 95% CI: 2.4 to 4.0). Mortality occurred in 42.8% of the device group versus 55.5% of control group (HR: 0.67; 95% CI: 0.52 to 0.85; p = 0.001; NNT = 7.9; 95% CI: 4.6 to 26.1). Patients who underwent TMVr also had sustained 3-year improvements in MR severity, quality-of-life measures, and functional capacity. Among 58 patients assigned to GDMT alone who crossed over and were treated with TMVr, the subsequent composite rate of mortality or HFH was reduced compared with those who continued on GDMT alone (adjusted HR: 0.43; 95% CI: 0.24 to 0.78; p = 0.006). CONCLUSIONS Among patients with HF and moderate-to-severe or severe secondary MR who remained symptomatic despite GDMT, TMVr was safe, provided a durable reduction in MR, reduced the rate of HFH, and improved survival, quality of life, and functional capacity compared with GDMT alone through 36 months. Surviving patients who crossed over to device treatment had a prognosis comparable to those originally assigned to transcatheter therapy. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation [COAPT]; NCT01626079).
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Affiliation(s)
- Michael J Mack
- Baylor Scott & White Heart Hospital Plano, Plano, Texas, USA.
| | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA
| | - William T Abraham
- Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart & Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA; Bakersfield Heart Hospital, Bakersfield, California, USA
| | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, Virginia, USA
| | - Jacob M Mishell
- Kaiser Permanente-San Francisco Hospital, San Francisco, California, USA
| | | | - Paul A Grayburn
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, Texas, USA
| | - Michael J Rinaldi
- Sanger Heart & Vascular Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Ian J Sarembock
- The Christ Hospital and Lindner Clinical Research Center, Cincinnati, Ohio, USA
| | | | - Jason H Rogers
- University of California Davis Medical Center, Sacramento, California, USA
| | - Steven O Marx
- Columbia University Irving Medical Center, New York, New York, USA
| | - David J Cohen
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Neil J Weissman
- MedStar Health Research Institute, Washington, DC, USA; Georgetown University, Washington, DC, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai and Cardiovascular Research Foundation, New York, New York, USA. https://twitter.com/GreggWStone
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19
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Abstract
Annuloplasty is a fundamental component of surgical mitral valve repair, and is employed in nearly 100% of repair operations for both primary and secondary mitral regurgitation (SMR). Developing transcatheter techniques to replicate surgical annuloplasty has been the focus of significant innovation and development in recent years. Since many patients are not offered surgery due to high perceived surgical risk, transcatheter approaches will provide new treatment options. In this manuscript, we review technologies which allow transseptal and transcatheter mitral valve (MV) annuloplasty.
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Affiliation(s)
- Jason H Rogers
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Steven F Bolling
- Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, MI, USA
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20
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Abstract
Chordal replacement is a fundamental technique used in the surgical repair of primary mitral regurgitation, and can be an effective means of preserving the native valve without leaflet resection. Surgical chordal replacement can be challenging since it is performed on an open, non-beating heart, and choosing the correct chord length to restore the zone of coaptation requires both intuition and skill. Developing transcatheter, transfemoral, and transseptal approaches to mitral valve chordal replacement presents the opportunity for safer and potentially earlier treatment of patients with primary mitral regurgitation. In particular, transcatheter methods will allow adjustment of chordal length and position real-time on a beating heart under echocardiographic guidance. In this manuscript, we review the current transcatheter transseptal technologies in development and discuss the various issues related to device design, efficacy, durability, and clinical trial design.
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Affiliation(s)
- Jason H Rogers
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Steven F Bolling
- Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, MI, USA
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21
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Singh GD, Rogers JH, Saw J. Watchman FLX: Early "Real World" Experience in Search for the Perfect Closure. JACC Cardiovasc Interv 2020; 13:2742-2744. [PMID: 33189646 DOI: 10.1016/j.jcin.2020.07.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Gagan D Singh
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California, USA.
| | - Jason H Rogers
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California, USA
| | - Jacqueline Saw
- Division of Cardiovascular Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
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22
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Hernandez AA, Foster GA, Soderberg SR, Fernandez A, Reynolds MB, Orser MK, Bailey KA, Rogers JH, Singh GD, Wu H, Passerini AG, Simon SI. An Allosteric Shift in CD11c Affinity Activates a Proatherogenic State in Arrested Intermediate Monocytes. J Immunol 2020; 205:2806-2820. [PMID: 33055281 DOI: 10.4049/jimmunol.2000485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/10/2020] [Indexed: 11/19/2022]
Abstract
Intermediate monocytes (iMo; CD14+CD16+) increase in number in the circulation of patients with unstable coronary artery disease (CAD), and their recruitment to inflamed arteries is implicated in events leading to mortality following MI. Monocyte recruitment to inflamed coronary arteries is initiated by high affinity β2-integrin (CD11c/CD18) that activates β1-integrin (VLA-4) to bind endothelial VCAM-1. How integrin binding under shear stress mechanosignals a functional shift in iMo toward an inflammatory phenotype associated with CAD progression is unknown. Whole blood samples from patients treated for symptomatic CAD including non-ST elevation MI, along with healthy age-matched subjects, were collected to assess chemokine and integrin receptor levels on monocytes. Recruitment on inflamed human aortic endothelium or rVCAM-1 under fluid shear stress was assessed using a microfluidic-based artery on a chip (A-Chip). Membrane upregulation of high affinity CD11c correlated with concomitant activation of VLA-4 within focal adhesive contacts was required for arrest and diapedesis across inflamed arterial endothelium to a greater extent in non-ST elevation MI compared with stable CAD patients. The subsequent conversion of CD11c from a high to low affinity state under fluid shear activated phospho-Syk- and ADAM17-mediated proteolytic cleavage of CD16. This marked the conversion of iMo to an inflammatory phenotype associated with nuclear translocation of NF-κB and production of IL-1β+ We conclude that CD11c functions as a mechanoregulator that activates an inflammatory state preferentially in a majority of iMo from cardiac patients but not healthy patients.
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Affiliation(s)
- Alfredo A Hernandez
- Department of Biomedical Engineering, University of California, Davis, Davis, CA 95616
| | - Greg A Foster
- Department of Biomedical Engineering, University of California, Davis, Davis, CA 95616
| | - Stephanie R Soderberg
- Department of Biomedical Engineering, University of California, Davis, Davis, CA 95616
| | - Andrea Fernandez
- Department of Biomedical Engineering, University of California, Davis, Davis, CA 95616
| | - Mack B Reynolds
- Department of Biomedical Engineering, University of California, Davis, Davis, CA 95616
| | - Mable K Orser
- Department of Biomedical Engineering, University of California, Davis, Davis, CA 95616
| | - Keith A Bailey
- Department of Biomedical Engineering, University of California, Davis, Davis, CA 95616
| | - Jason H Rogers
- Department of Cardiovascular and Internal Medicine, University of California, Davis Medical Center, Sacramento, CA 95817; and
| | - Gagan D Singh
- Department of Cardiovascular and Internal Medicine, University of California, Davis Medical Center, Sacramento, CA 95817; and
| | - Huaizhu Wu
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX 77030
| | - Anthony G Passerini
- Department of Biomedical Engineering, University of California, Davis, Davis, CA 95616
| | - Scott I Simon
- Department of Biomedical Engineering, University of California, Davis, Davis, CA 95616;
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23
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Singh GD, Rogers JH, Chen S, Yap J, Smith TWR, Fan D, Stripe B, Aman E. Adjunctive use of fluoroscopy during MitraClip implantation reduces procedural complexity: The parallax technique. Catheter Cardiovasc Interv 2020; 97:745-754. [PMID: 33045138 DOI: 10.1002/ccd.29323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/21/2020] [Accepted: 09/28/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND During MitraClip implantation sub-valvular correction of trajectory and/or alignment may increase adverse clip or leaflet events. With systematic adjunctive use of fluoroscopy ("Parallax technique"), we aimed to assess parameters that minimize the need for corrective measures and help increase procedural efficiency. METHODS We retrospectively analyzed 30 patients without (Fl-) and 39 patients utilizing adjunctive fluoroscopy (Fl+) during MitraClip implantation. After establishing trajectory and supra-valvular alignment, the Parallax technique was utilized. Trajectory and alignment are maintained during advancement. RESULTS All patients had 3 or 4+ MR. There were no differences in baseline demographics. The average number of clips (Fl- vs Fl+) was 1.72 ± 0.8 vs 1.59 ± 0.5, p = .57. For the first clip, the need for sub-valvular alignment (80% vs. 36%, p = .0001), eversion with retraction back to left atrium (23% vs. 10%, p = .001) and the number of grasps (2.3 ± 1.2 vs 1.4 ± 0.9) was reduced. The time from transseptal puncture to first clip deployment (71 ± 21 vs 44 ± 16 min, p = .01) was reduced. Procedural success was achieved in all but one patient in the Fl- group (p = ns). There were no differences noted for in-hospital or 30-day outcomes. CONCLUSIONS Systematic use of a simple and easy to implement "Parallax technique" was associated with reduced need for sub-valvular manipulation and was associated with improved procedural times. Further larger scale studies are needed to assess the applicability of the technique.
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Affiliation(s)
- Gagan D Singh
- Division of Cardiovascular Medicine, University of California Davis, Davis, California, USA
| | - Jason H Rogers
- Division of Cardiovascular Medicine, University of California Davis, Davis, California, USA
| | - Sarah Chen
- Division of Cardiothoracic Surgery, University of California Davis, Davis, California, USA
| | - Jonathan Yap
- Division of Cardiovascular Medicine, University of California Davis, Davis, California, USA
| | - Thomas W R Smith
- Division of Cardiovascular Medicine, University of California Davis, Davis, California, USA
| | - Dali Fan
- Division of Cardiovascular Medicine, University of California Davis, Davis, California, USA
| | - Benjamin Stripe
- Division of Cardiovascular Medicine, University of California Davis, Davis, California, USA
| | - Edris Aman
- Division of Cardiovascular Medicine, University of California Davis, Davis, California, USA
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Yap J, Chen S, Smith TWR, Rogers JH, Singh GD. Transjugular mitral valve repair with the MitraClip: A step-by-step guide. Catheter Cardiovasc Interv 2020; 96:699-705. [PMID: 32259371 DOI: 10.1002/ccd.28902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 11/08/2022]
Abstract
The MitraClip procedure is carried out almost exclusively via the transfemoral approach. However, in some patients transfemoral delivery of MitraClip is not technically feasible (e.g., occluded inferior vena cava or tortuous/obstructive iliofemoral venous anatomy). The technical considerations and challenges of the MitraClip procedure are amplified when an alternate route is considered. We describe a successful case of MitraClip performed via the right internal jugular (IJ) approach in a patient with a flail A3 scallop and previous mitral valve repair. We reviewed prior cases in the literature and discuss step-by-step the pertinent clinical and technical considerations for performing this procedure via the transjugular route. In summary, the right IJ access site provides a reasonable alternative to perform the MitraClip procedure in cases where femoral access is contraindicated or prohibitive. A thorough understanding of the technical considerations is crucial in improving procedural success rates.
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Affiliation(s)
- Jonathan Yap
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California, USA.,Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Sarah Chen
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California, USA
| | - Thomas W R Smith
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California, USA
| | - Jason H Rogers
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California, USA
| | - Gagan D Singh
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California, USA
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Westcott SK, Wung W, Glassy M, Singh GD, Smith TW, Fan D, Rogers JH. A novel clock‐face method for characterizing peridevice leaks after left atrial appendage occlusion. Catheter Cardiovasc Interv 2020; 96:E387-E392. [DOI: 10.1002/ccd.28796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/10/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Sarah K. Westcott
- Division of Cardiovascular MedicineUniversity of California Davis Medical Center Sacramento California
| | - William Wung
- Division of Cardiovascular MedicineUniversity of California Davis Medical Center Sacramento California
| | - Matthew Glassy
- Division of Cardiovascular MedicineUniversity of California Davis Medical Center Sacramento California
| | - Gagan D. Singh
- Division of Cardiovascular MedicineUniversity of California Davis Medical Center Sacramento California
| | - Thomas W. Smith
- Division of Cardiovascular MedicineUniversity of California Davis Medical Center Sacramento California
| | - Dali Fan
- Division of Cardiovascular MedicineUniversity of California Davis Medical Center Sacramento California
| | - Jason H. Rogers
- Division of Cardiovascular MedicineUniversity of California Davis Medical Center Sacramento California
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Rogers JH, Boyd WD, Smith TW, Bolling SF. Novel Intra-Annular Mitral Valve Imaging With Intracardiac Echocardiography for Direct Transcatheter Mitral Annuloplasty. JACC Cardiovasc Interv 2020; 12:2443-2445. [PMID: 31806231 DOI: 10.1016/j.jcin.2019.09.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/24/2019] [Indexed: 11/25/2022]
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Yap J, Chen S, Stripe BR, Smith TWR, Rogers JH, Singh GD. Transseptal access for left heart structural interventions in the setting of prior atrial septal defect closure. Catheter Cardiovasc Interv 2020; 95:414-419. [PMID: 31638326 DOI: 10.1002/ccd.28548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/05/2019] [Indexed: 11/09/2022]
Abstract
A transseptal puncture is critical for "left-sided" structural heart interventions. Procedures such as transcatheter edge-to-edge repair (MitraClip) and left atrial appendage (LAA) closure (Watchman) require precise puncture of the interatrial septum (IAS), and the presence of a prior atrial septal defect (ASD) closure device poses a challenge. We aim to present a successfully completed case of MitraClip and Watchman in the presence of ASD closure device in two different patients. A review of the literature will be reported, and pertinent clinical and technical considerations will be discussed in depth to achieve procedural success. In summary, transseptal puncture for left heart structural interventions is feasible in the presence of a prior ASD/patent foramen ovale closure device. A detailed understanding of the anatomical considerations as well as the use of multimodality imaging to evaluate the IAS will aid in improving procedural success rates.
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Affiliation(s)
- Jonathan Yap
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California.,Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Sarah Chen
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
| | - Benjamin R Stripe
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
| | - Thomas W R Smith
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
| | - Jason H Rogers
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
| | - Gagan D Singh
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
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Rogers JH, Ebner AA, Boyd WD, Lim S, Reardon MJ, Smith TW, Bolling SF. First-in-Human Transfemoral Transseptal Mitral Valve Chordal Repair. JACC Cardiovasc Interv 2020; 13:1383-1385. [PMID: 32061611 DOI: 10.1016/j.jcin.2019.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
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Affiliation(s)
- Jason H Rogers
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, CA, USA.
| | - Walter D Boyd
- Division of Cardiac Surgery, East Carolina University, Greenville, NC, USA
| | - Steven F Bolling
- Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, MI, USA
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Stripe BR, Singh GD, Smith T, Rogers JH. Retrieval of a MitraClip from the left atrium using a two-snare technique: Case report and review of the literature. Catheter Cardiovasc Interv 2019; 96:210-214. [PMID: 31617308 DOI: 10.1002/ccd.28538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/01/2019] [Indexed: 11/05/2022]
Abstract
MitraClip is used for reduction of mitral insufficiency in patients who are not good surgical candidates, but with expanding indications, the use of MitraClip and the number of complications will increase. Here is presented a case of a single leaflet device attachment that worsened the patient's mitral insufficiency, as well as the technique for stabilizing the valve followed by retrieval of the device. A special focus is placed on removing the using a two-snare technique to avoid the need for a surgical cutdown and repair.
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Affiliation(s)
- Benjamin R Stripe
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, California
| | - Gagan D Singh
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, California
| | - Thomas Smith
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, California
| | - Jason H Rogers
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, California
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Glassy MS, Wung W, Westcott S, Smith TW, Fan D, Rogers JH, Singh GD. Watchman Occlusion in Long-Standing Persistent Atrial Fibrillation. JACC Cardiovasc Interv 2019; 12:1018-1026. [DOI: 10.1016/j.jcin.2019.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/05/2019] [Accepted: 04/02/2019] [Indexed: 11/24/2022]
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Erglis A, Narbute I, Poupineau M, Hovasse T, Kamzola G, Zvaigzne L, Erglis M, Erglis K, Greene S, Rogers JH. Treatment of Secondary Mitral Regurgitation in Chronic Heart Failure. J Am Coll Cardiol 2019; 70:2834-2835. [PMID: 29191334 DOI: 10.1016/j.jacc.2017.09.1110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/30/2017] [Accepted: 09/22/2017] [Indexed: 11/26/2022]
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Beri N, Singh GD, Smith TW, Fan D, Boyd WD, Rogers JH. Iatrogenic atrial septal defect closure after transseptal mitral valve interventions: Indications and outcomes. Catheter Cardiovasc Interv 2019; 94:829-836. [DOI: 10.1002/ccd.28294] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 04/04/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Neil Beri
- Division of Cardiovascular MedicineUC Davis Medical Center Sacramento California
| | - Gagan D. Singh
- Division of Cardiovascular MedicineUC Davis Medical Center Sacramento California
| | - Thomas W. Smith
- Division of Cardiovascular MedicineUC Davis Medical Center Sacramento California
| | - Dali Fan
- Division of Cardiovascular MedicineUC Davis Medical Center Sacramento California
| | - Walter D. Boyd
- Division of Cardiothoracic SurgeryUC Davis Medical Center Sacramento California
| | - Jason H. Rogers
- Division of Cardiovascular MedicineUC Davis Medical Center Sacramento California
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Rogers JH, Boyd WD, Smith TWR, Ebner AA, Bolling SF. Combined MitraClip Edge-to-Edge Repair With Millipede IRIS Mitral Annuloplasty. JACC Cardiovasc Interv 2019; 11:323-324. [PMID: 29413250 DOI: 10.1016/j.jcin.2017.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 10/30/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
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Abstract
Mitral valve ring annuloplasty is a surgical gold standard and is used routinely during surgical mitral valve repair of primary or secondary mitral regurgitation. The Millipede IRIS annuloplasty ring is the first transcatheter, transfemoral, transseptal, semirigid, complete annuloplasty ring to be delivered to the mitral valve annulus. Initial results in humans demonstrate that the Millipede IRIS ring is safe, and can effectively reduce the mitral annular diameter leading to a clinically significant reduction or elimination of mitral regurgitation.
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Affiliation(s)
- Jason H Rogers
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, 4860 Y Street, Suite 2820, Sacramento, CA 95817, USA.
| | - Walter D Boyd
- Division of Cardiothoracic Surgery, University of California, Davis Medical Center, 2221 Stockton Boulevard, Suite 2112, Sacramento, CA 95817, USA
| | - Thomas W Smith
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, 4860 Y Street, Suite 2820, Sacramento, CA 95817, USA
| | - Steven F Bolling
- Department of Cardiac Surgery, University of Michigan Health System, Floor 3 Reception C, 1500 E Medical Center Dr SPC 5856, Ann Arbor, MI 48109-5856, USA
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Glassy MS, Sharma G, Singh GD, Smith TWR, Fan D, Rogers JH. Usable implantation depth for watchman left atrial appendage occlusion is greater with appendage angiography than transesophageal echocardiography. Catheter Cardiovasc Interv 2019; 93:E311-E317. [PMID: 30311343 DOI: 10.1002/ccd.27916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 07/09/2018] [Accepted: 09/09/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To compare left atrial appendage (LAA) angiography to transesophageal echocardiography (TEE) for assessing usable LAA depth. BACKGROUND TEE is typically employed for procedural measurement of LAA ostial diameter and depth. Since angiography enhances distal LAA anatomy, we sought to compare angiography to TEE for determining usable LAA depth. METHODS Seventy five Watchman device cases were retrospectively evaluated. Two independent cardiologists measured intraoperative LAA ostial diameter and depth at standard 0°, 45°, 90°, and 135° TEE omniplane views and in the right anterior oblique (RAO) 30°, caudal (CAUD) 30° angiographic view. RESULTS The average age and CHA2 DS2 VASc score were 74 (±7.2) years and 4.6 (±1.3), respectively. The average ostial diameter and depth (mm) by TEE were 0°: 19.6 and 26.5; 45°: 17.5 and 26.6; 90°: 18.3 and 25.1; 135°: 19.5 and 23.3. The ostial diameter and depth (mm) by RAO 30° CAUD 30° angiography were 21.1 and 29.7. This angiographic view corresponds to a TEE view between 90° and 135°. In comparison to angiography, TEE 90° underestimated the LAA ostial diameter by 2.9 ± 3.7 mm (P < 0.001) and by 1.9 ± 4.0 mm at TEE 135° (P < 0.01); Pearson's r 0.53 angiography/TEE 90° and 0.50 angiography/TEE 135°. More importantly, TEE 90° underestimated the true usable LAA depth by 5.4 ± 5.8 mm (P < 0.001) and by 7.3 ± 6.1 mm at TEE 135° (P < 0.001); Pearson's r 0.39 angiography/TEE 90° and 0.30 angiography/TEE 135°. CONCLUSIONS Compared to TEE, LAA angiography provides additional depth information and may be particularly valuable when patients have insufficient depth for Watchman by TEE measures.
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Affiliation(s)
- Matthew S Glassy
- Division of Cardiovascular Medicine, University of California Davis Medical Center, California
| | - Gaurav Sharma
- Division of Cardiovascular Medicine, University of California Davis Medical Center, California
| | - Gagan D Singh
- Division of Cardiovascular Medicine, University of California Davis Medical Center, California
| | - Thomas W R Smith
- Division of Cardiovascular Medicine, University of California Davis Medical Center, California
| | - Dali Fan
- Division of Cardiovascular Medicine, University of California Davis Medical Center, California
| | - Jason H Rogers
- Division of Cardiovascular Medicine, University of California Davis Medical Center, California
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Chen L, Mantri N, Eng ML, Wung W, Smith TWR, Stripe BR, Fan D, Boyd WD, Low RI, Rogers JH, Singh GD. Intraprocedural direct left atrial and wedge pressure correlation during transcatheter mitral valve repair: Results from a single center registry. Catheter Cardiovasc Interv 2018; 94:165-170. [DOI: 10.1002/ccd.28035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/10/2018] [Accepted: 12/02/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Lily Chen
- Division of Cardiovascular Medicine; UC Davis Medical Center; Sacramento California
| | - Neha Mantri
- Division of Cardiovascular Medicine; Kaiser Permanente; San Francisco California
| | - Maia L. Eng
- Division of Cardiovascular Medicine; UC Davis Medical Center; Sacramento California
| | - William Wung
- Division of Cardiovascular Medicine; UC Davis Medical Center; Sacramento California
| | - Thomas W. R. Smith
- Division of Cardiovascular Medicine; UC Davis Medical Center; Sacramento California
| | - Benjamin R. Stripe
- Division of Cardiovascular Medicine; UC Davis Medical Center; Sacramento California
| | - Dali Fan
- Division of Cardiovascular Medicine; UC Davis Medical Center; Sacramento California
| | - Walter D. Boyd
- Division of Cardiothoracic Surgery; UC Davis Medical Center; Sacramento California
| | - Reginald I. Low
- Division of Cardiovascular Medicine; UC Davis Medical Center; Sacramento California
| | - Jason H. Rogers
- Division of Cardiovascular Medicine; UC Davis Medical Center; Sacramento California
| | - Gagan D. Singh
- Division of Cardiovascular Medicine; UC Davis Medical Center; Sacramento California
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Abstract
Transcatheter mitral valve replacement is an emerging technology for the treatment of mitral valve regurgitation. Numerous devices are in development and in various stages of clinical investigation. The Tendyne system (Tendyne Holdings, LLC, a subsidiary of Abbott Vascular, Roseville, Minnesota) is a fully repositionable and retrievable, transapical transcatheter mitral valve replacement platform. The results of the early feasibility studies in the U.S. are highly encouraging and a pivotal randomized trial is underway. The Tendyne transcatheter mitral valve replacement valve may prove to be a safe, less invasive approach to treatment of mitral valve disease.
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Affiliation(s)
- Jared P Beller
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Jason H Rogers
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis, Sacramento, CA, USA
| | - Vinod H Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute and Georgetown University, Washington, DC, USA
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
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Abstract
The IRIS mitral annuloplasty ring is a transcatheter, transfemoral and transseptal-delivered complete, semi-rigid annuloplasty ring. The IRIS system mimics surgical annuloplasty by reducing the mitral septal-lateral dimension and improving leaflet coaptation. We report the early experience with the IRIS system in seven patients. These patients had 3-4+ mitral regurgitation (MR) with annular dilation and were symptomatic NYHA II-IV with LV end systolic dimensions ≤65 mm. Patients were excluded for LVEF <20%, aortic valve disease, right-sided heart failure and PA systolic pressure >70 mmHg. Baseline and 30-day transthoracic echocardiography and CT imaging was performed. In phase 1, 4 patients had surgical IRIS mitral ring implantation. In phase 2, 3 patients had transfemoral, transseptal delivery of the IRIS mitral ring. There was no procedural death, or MI. The mitral SL diameter was reduced from 38.0±4.1 to 25.9±4.9 mm at 30 days (31.8% SL reduction, n=7). MR was reduced from baseline 3-4+ to 0-1+ in all patients at 30 days. There were improvements in NYHA class and there was a decrease in diastolic LV volumes from 182.4±54.3 to 115.3±98.8 mL at 30 days (36.8% reduction). Based on these initial positive findings, ongoing clinical trials are underway to further evaluate the safety and efficacy of the IRIS ring.
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Affiliation(s)
- Jason H Rogers
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Walter D Boyd
- Division of Cardiothoracic Surgery, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Thomas W Smith
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Steven F Bolling
- Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, MI, USA
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Rogers JH, Stripe BR, Singh GD, Boyd WD, Fan D, Smith TW. Initial clinical experience with the FlexPoint Steerable Transseptal Needle in left-sided structural heart procedures. Catheter Cardiovasc Interv 2018; 92:792-796. [DOI: 10.1002/ccd.27685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 02/25/2018] [Revised: 03/26/2018] [Accepted: 05/15/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Jason H. Rogers
- Division of Cardiovascular Medicine; University of California, Davis Medical Center; Sacramento California 95817
| | - Benjamin R. Stripe
- Division of Cardiovascular Medicine; University of California, Davis Medical Center; Sacramento California 95817
| | - Gagan D. Singh
- Division of Cardiovascular Medicine; University of California, Davis Medical Center; Sacramento California 95817
| | - Walter D. Boyd
- Division of Cardiovascular Medicine; University of California, Davis Medical Center; Sacramento California 95817
| | - Dali Fan
- Division of Cardiovascular Medicine; University of California, Davis Medical Center; Sacramento California 95817
| | - Thomas W.R. Smith
- Division of Cardiovascular Medicine; University of California, Davis Medical Center; Sacramento California 95817
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Glassy M, Sharma G, Singh G, Smith T, Fan D, Rogers JH. LEFT ATRIAL APPENDAGE ANGIOGRAPHY MORE ACCURATELY DEFINES APPENDAGE DEPTH THAN TRANSESOPHAGEAL ECHOCARDIOGRAPHY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31628-0] [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: 10/17/2022]
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Bommer WJ, Kishiyama M, Ram S, Hoegh H, Rogers JH. FROM PILOT TRIAL TO REAL-WORLD EXPERIENCE: THE SAFETY OF OFFSITE PERCUTANEOUS CORONARY INTERVENTIONS IN CALIFORNIA. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)30797-6] [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: 11/16/2022]
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Abstract
The tricuspid valve was ignored for a long time. The prevalence of severe tricuspid regurgitation is not negligible, however, and is associated with poor prognosis. In cases of primary tricuspid regurgitation, surgical options are limited by a high risk of mortality and morbidity. New percutaneous approaches are becoming available to meet this consistent unmet clinical need. This review presents the current available devices that reproduce both the complete and uncomplete surgical annuloplasty techniques.
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Affiliation(s)
- Antonio Mangieri
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy.
| | - Scott Lim
- Department of Cardiology, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA
| | - Jason H Rogers
- Division of Cardiovascular Medicine, UC Davis Medical Center, 2315 Stockton Boulevard, Sacramento, CA 95817, USA
| | - Azeem Latib
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy
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45
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Rogers JH, Boyd WD, Smith TWR, Ebner AA, Grube E, Bolling SF. Transcatheter Annuloplasty for Mitral Regurgitation with an Adjustable Semi-Rigid Complete Ring: Initial Experience with the Millipede IRIS Device. Structural Heart 2017. [DOI: 10.1080/24748706.2017.1385879] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jason H. Rogers
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, California, USA
| | - Walter D. Boyd
- Division of Cardiac Surgery, University of California, Davis Medical Center, Sacramento, California, USA
| | - Thomas W. R. Smith
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, California, USA
| | - Adrian A. Ebner
- Cardiovascular Department, Italian Hospital, Asuncion, Paraguay
| | - Eberhard Grube
- Department of Cardiology, University Hospital Bonn, Bonn, Germany
| | - Steven F. Bolling
- Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
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Shafi NA, Singh GD, Smith TW, Rogers JH. Sizing of patent ductus arteriosus in adults for transcatheter closure using the balloon pull-through technique. Catheter Cardiovasc Interv 2017; 91:1159-1163. [DOI: 10.1002/ccd.27303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 03/06/2017] [Revised: 06/14/2017] [Accepted: 08/04/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Nabil A. Shafi
- Division of Cardiovascular Medicine; University of California, Davis Medical Center; Sacramento California
| | - Gagan D. Singh
- Division of Cardiovascular Medicine; University of California, Davis Medical Center; Sacramento California
| | - Thomas W. Smith
- Division of Cardiovascular Medicine; University of California, Davis Medical Center; Sacramento California
| | - Jason H. Rogers
- Division of Cardiovascular Medicine; University of California, Davis Medical Center; Sacramento California
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48
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Affiliation(s)
- Jason H Rogers
- Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, California.
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49
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Singh GD, Smith TW, Rogers JH. Mitral stenosis due to dynamic clip-leaflet interaction during the MitraClip procedure: Case report and review of current knowledge. Cardiovasc Revasc Med 2017; 18:287-294. [PMID: 28063811 DOI: 10.1016/j.carrev.2016.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 11/22/2016] [Accepted: 12/08/2016] [Indexed: 11/16/2022]
Abstract
The goal of MitraClip therapy is to achieve mitral regurgitation reduction without iatrogenic creation of clinically significant MS. In some series, up to 35% of patients are left with mild MS. There are many contributors to the final transmitral gradient achieved in patients undergoing MitraClip therapy. Additionally, there are many modalities used for the intraprocedural assessment of MS with no one modality considered to be the benchmark. We herein describe a case which illustrates the dynamic nature of clip-leaflet interaction, and review intraprocedural techniques for invasively and noninvasively assessing MS.
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Affiliation(s)
- Gagan D Singh
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, CA.
| | - Thomas W Smith
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, CA
| | - Jason H Rogers
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, CA.
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Zhou J, Rogers JH, Lee SH, Sun D, Yao H, Mao JJ, Kong KY. Oral Mucosa Harbors a High Frequency of Endothelial Cells: A Novel Postnatal Cell Source for Angiogenic Regeneration. Stem Cells Dev 2016; 26:91-101. [PMID: 27832737 DOI: 10.1089/scd.2016.0175] [Citation(s) in RCA: 2] [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] [Indexed: 01/24/2023] Open
Abstract
Endothelial progenitor cells/endothelial cells (EPCs/ECs) have great potential to treat pathological conditions such as cardiac infarction, muscle ischemia, and bone fractures, but isolation of EPC/ECs from existing cell sources is challenging due to their low EC frequency. We have isolated endothelial progenitor (EP)-like cells from rat oral mucosa and characterized their yield, immunophenotype, growth, and in vivo angiogenic potential. The frequency of EP-like cells derived from oral mucosa is thousands of folds higher than EPCs derived from donor-match bone marrow samples. EP-like cells from oral mucosa were positive for EC markers CD31, VE-Cadherin, and VEGFR2. Oral mucosa-derived EP-like cells displayed robust uptake of acetylated low-density lipoprotein and formed stable capillary networks in Matrigel. Subcutaneously implanted oral mucosa-derived EP-like cells anastomosed with host blood vessels, implicating their ability to elicit angiogenesis. Similar to endothelial colony-forming cells, EP-like cells from oral mucosa have a significantly higher proliferative rate than human umbilical vein endothelial cells. These findings identify a putative EPC source that is easily accessible in the oral cavity, potentially from discarded tissue specimens, and yet with robust yield and potency for angiogenesis in tissue and organ regeneration.
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Affiliation(s)
- Jian Zhou
- 1 Center for Craniofacial Regeneration, Columbia University Medical Center , New York, New York.,2 Department of General Dentistry, Capital Medical University School of Stomatology , Beijing, China
| | - Jason H Rogers
- 3 Department of Internal Medicine and the Cancer Research and Treatment Center, University of New Mexico Health Science Center , Albuquerque, New Mexico
| | - Scott H Lee
- 4 Pratt School of Engineering, Duke University , Durham, North Carolina
| | - DongMing Sun
- 5 W. M. Keck Center for Collaborative Neuroscience, Rutgers University , New Brunswick, New Jersey
| | - Hai Yao
- 6 Clemson-MUSC Bioengineering Program , Department of Craniofacial Biology, Charleston, South Carolina
| | - Jeremy J Mao
- 1 Center for Craniofacial Regeneration, Columbia University Medical Center , New York, New York
| | - Kimi Y Kong
- 1 Center for Craniofacial Regeneration, Columbia University Medical Center , New York, New York.,7 Hematology/Oncology Division, Department of Medicine, University of Florida , Gainesville, Florida
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