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Messas E, Ijsselmuiden A, Trifunović-Zamaklar D, Cholley B, Puymirat E, Halim J, Karan R, van Gameren M, Terzić D, Milićević V, Tanter M, Pernot M, Goudot G. Treatment of severe symptomatic aortic valve stenosis using non-invasive ultrasound therapy: a cohort study. Lancet 2023; 402:2317-2325. [PMID: 37972628 DOI: 10.1016/s0140-6736(23)01518-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Calcific aortic stenosis is commonly treated using surgical or transcatheter aortic valve replacement; however, many patients are not considered suitable candidates for these interventions due to severe comorbidities and limited life expectancy. As such, non-invasive therapies might offer alternative therapeutic possibilities in these patients. This study aimed to assess the safety of non-invasive ultrasound therapy and its ability to improve valvular function by softening calcified valve tissue. METHODS This prospective, multicentre, single-arm series enrolled 40 adult patients with severe symptomatic aortic valve stenosis at three hospitals in France, the Netherlands, and Serbia between March 13, 2019, and May 8, 2022. Patients were treated with transthoracically delivered non-invasive ultrasound therapy. Follow-ups were scheduled at 1, 3, 6, 12, and 24 months. The primary endpoints were procedure-related deaths within 30 days and improved valve function. We report the 6-month data. This study is registered at ClinicalTrials.gov, NCT03779620 and NCT04665596. FINDINGS 40 high-risk patients with a mean Society of Thoracic Surgeons score of 5·6% (SD 4·4) and multiple severe comorbidities were included. The primary endpoint, procedure-related mortality, did not occur; furthermore, no life-threatening or cerebrovascular events were reported. Improved valve function was confirmed up to 6 months, reflected by a 10% increase in mean aortic valve area from 0·58 cm2 (SD 0·19) at baseline to 0·64 cm2 (0·21) at follow-up (p=0·0088), and a 7% decrease in mean pressure gradient from 41·9 mm Hg (20·1) to 38·8 mm Hg (17·8; p=0·024). At 6 months, the New York Heart Association score had improved or stabilised in 24 (96%) of 25 patients, and the mean Kansas City Cardiomyopathy Questionnaire score had improved by 33%, from 48·5 (SD 22·6) to 64·5 (21·0). One serious procedure-related adverse event occurred in a patient who presented with a transient decrease in peripheral oxygen saturation. Non-serious adverse events included pain, discomfort during treatment, and transient arrhythmias. INTERPRETATION This novel, non-invasive ultrasound therapy for calcified aortic stenosis proved to be safe and feasible. FUNDING Cardiawave.
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Affiliation(s)
- Emmanuel Messas
- Cardiovascular Department, Hôpital Européen Georges-Pompidou, Université Paris-Cité, Paris, France; Paris Cardiovascular Research Center, Inserm UMR_U970, Université Paris-Cité, Paris, France; STOP-AS Research Consortium, Recherche Hospitalo-Universitaire, Rouen, France.
| | | | - Danijela Trifunović-Zamaklar
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Bernard Cholley
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges-Pompidou, Université Paris-Cité, Paris, France; Innovative Therapies in Haemostasis, Inserm UMR_S1140, Université Paris-Cité, Paris, France
| | - Etienne Puymirat
- Cardiovascular Department, Hôpital Européen Georges-Pompidou, Université Paris-Cité, Paris, France; Paris Cardiovascular Research Center, Inserm UMR_U970, Université Paris-Cité, Paris, France
| | - Jonathan Halim
- Cardiology Department, Amphia Hospital, Breda, Netherlands
| | - Radmila Karan
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Department of Anaesthesiology and Intensive Care at Clinic for Cardiac Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Duško Terzić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Cardiac Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Vladimir Milićević
- Clinic for Cardiac Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Mickael Tanter
- Physics for Medicine Paris, Inserm/ESPCI Paris-PSL/CRNS, Paris, France
| | - Mathieu Pernot
- Physics for Medicine Paris, Inserm/ESPCI Paris-PSL/CRNS, Paris, France
| | - Guillaume Goudot
- Cardiovascular Department, Hôpital Européen Georges-Pompidou, Université Paris-Cité, Paris, France
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2
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Dillen DMM, Vlaar PJ, Vermeer AJE, Paradies V, van Kuijk JP, Vink MA, Oemrawsingh RM, Hofma SH, Magro M, Remkes WS, de Smet BJGL, van Rees JB, Somi S, Halim J, Zimmermann FM, Wijnbergen IF, Tijssen JGP, Tonino PAL, Teeuwen K. Bifurcation PCI with a hybrid strategy with drug- eluting balloons versus a stepwise provisional two- stent strategy: Rationale and design of the hybrid DEB study. Am Heart J 2023; 266:168-175. [PMID: 37806333 DOI: 10.1016/j.ahj.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
The optimal treatment strategy for coronary bifurcation lesions by percutaneous coronary intervention (PCI) is complex and remains a subject of debate. Current guidelines advise a stepwise provisional approach with optional two-stent strategy. However, a two-stent strategy, both upfront and stepwise provisional, is technically demanding. Therefore, there is increasing interest in the use of drug-eluting balloons (DEB) in bifurcation lesions, mainly after a provisional approach with unsatisfactory result of the side branch. Some small pilot studies already showed that the use of DEB in bifurcation lesions is safe and feasible. However, a randomized comparison of this hybrid DEB strategy with a two-stent strategy is currently lacking. TRIAL DESIGN The Hybrid DEB study is a prospective, multicenter, randomized controlled trial investigating noninferiority of a hybrid DEB approach, using a combination of a drug-eluting stent (DES) in the main vessel and DEB in the side branch, compared to stepwise provisional two-stent strategy in patients with true bifurcation lesions. A total of 500 patients with de novo true coronary bifurcation lesions, treated with a stepwise provisional approach and an unsatisfactory result of the side branch after main vessel stenting (≥ 70% stenosis and/or < thrombolysis in myocardial infarction III flow), will be randomized in a 1:1 ratio to receive either treatment with a DEB or with a DES in the side branch. The primary endpoint is a composite endpoint of the occurrence of all-cause death, periprocedural or spontaneous myocardial infarction and/or target vessel revascularization at the anticipated median 2-year follow-up. CONCLUSION The Hybrid DEB study will compare in a multicenter, randomized fashion a hybrid DEB approach with a stepwise provisional two-stent strategy in patients with true bifurcation lesions. TRIAL REGISTRATION ClinicalTrials.gov no. NCT05731687.
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Affiliation(s)
- Daimy M M Dillen
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
| | - Pieter Jan Vlaar
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Amy J E Vermeer
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Valeria Paradies
- Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Jan-Peter van Kuijk
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Maarten A Vink
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Rohit M Oemrawsingh
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Sjoerd H Hofma
- Department of Cardiology, Medical Center Leeuwarden, The Netherlands
| | - Michael Magro
- Department of Cardiology, Elisabeth- TweeSteden Hospital, Tilburg, The Netherlands
| | | | - Bart J G L de Smet
- Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands
| | | | - Samer Somi
- Department of Cardiology, Haga Hospital, The Hague, The Netherlands
| | - Jonathan Halim
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Inge F Wijnbergen
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Jan G P Tijssen
- Department of Clinical Epidemiology and Biostatistics, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Koen Teeuwen
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
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3
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Halim J, den Heijer P, van den Branden B, Meuwissen M, Vos J, Schölzel B, IJsselmuiden A. Short-term outcome after transcatheter aortic valve replacement with a novel balloon-expandable valve. Neth Heart J 2023; 31:500-505. [PMID: 36480146 PMCID: PMC10667167 DOI: 10.1007/s12471-022-01738-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Transcatheter aortic valve replacement (TAVR) has been expanding rapidly with numerous transcatheter heart valve (THV) systems currently available. The Myval balloon-expandable (BE) valve (Meril Life Sciences Pvt. Ltd., India) is a novel THV system indicated for the treatment of patients with severe aortic stenosis. The primary objective of this study is to assess the safety and performance of the Myval BE valve. METHODS In this prospective single-centre study, 120 consecutive patients who underwent TAVR with the Myval BE valve were included. Clinical outcomes were evaluated at 30 days and 6 months using Valve Academic Research Consortium‑2 criteria. All-cause mortality, stroke, acute kidney injury, major vascular complications, moderate or severe paravalvular leakage (PVL) and need for a permanent pacemaker implantation (PPI) were investigated. RESULTS At 6‑month follow-up, all-cause death and cardiac death were seen in 5.8% and 0.8% of the patients respectively. Periprocedural stroke and need for PPI were both seen in 3.3% of the patients. Access-site-related vascular and bleeding complications were absent. Improved valve haemodynamics and no moderate to severe PVL could be seen at 30 days. An intermediate valve size was selected in 51% of the patients. CONCLUSIONS The Myval BE valve demonstrates improved valve haemodynamics, absence of moderate to severe PVL and good safety outcomes at 6‑month follow-up with low cardiac death rate and acceptable rates of permanent pacemaker implantation and periprocedural stroke. Future randomised controlled trials will further establish the clinical utility of the Myval BE valve.
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Affiliation(s)
- J Halim
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands.
| | - P den Heijer
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - B van den Branden
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - M Meuwissen
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - J Vos
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - B Schölzel
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - A IJsselmuiden
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
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4
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van Ginkel DJ, Bor WL, Dubois CLF, Aarts HM, Rooijakkers MJP, van Bergeijk KH, Rosseel L, Veenstra L, De Backer O, Van Mieghem NM, van der Kley F, Wilgenhof A, Leonora R, Halim J, Schotborgh CE, Barbato E, Van Der Heyden JAS, Frambach P, Ferdinande B, Mylotte D, Fabris E, Rensing BJWM, Timmers L, Swaans MJ, Brouwer J, Nijenhuis VJ, Peper J, Vriesendorp PA, de Laat B, Ninivaggi M, Stragier H, Voskuil M, IJsselmuiden AJJ, Hermanides RS, Agostoni P, van 't Hof AWJ, Wykrzykowska JJ, van Royen N, Delewi R, Ten Berg JM. Periprocedural continuation versus interruption of oral anticoagulant drugs during transcatheter aortic valve implantation: rationale and design of the POPular PAUSE TAVI trial. EUROINTERVENTION 2023; 19:766-771. [PMID: 37605804 PMCID: PMC10654764 DOI: 10.4244/eij-d-23-00206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/11/2023] [Indexed: 08/23/2023]
Abstract
About one-third of patients undergoing transcatheter aortic valve implantation (TAVI) use oral anticoagulants (OAC), mainly due to atrial fibrillation. General guidelines advise interrupting OAC in patients with a high risk of bleeding undergoing interventions. However, preliminary observational data suggest that the continuation of OAC during TAVI is safe and may reduce the risk of periprocedural thromboembolic events. The Periprocedural Continuation Versus Interruption of Oral Anticoagulant Drugs During Transcatheter Aortic Valve Implantation (POPular PAUSE TAVI) is a multicentre, randomised clinical trial with open-label treatment and blinded endpoint assessment. Patients are randomised 1:1 to periprocedural continuation versus interruption of OAC and are stratified for vitamin K antagonist or direct oral anticoagulant use. The primary endpoint is a composite of cardiovascular mortality, all stroke, myocardial infarction, major vascular complications and type 2-4 bleeding within 30 days after TAVI, according to the Valve Academic Research Consortium-3 criteria. Secondary endpoints include separate individual and composite outcomes, quality of life and cost-effectiveness. Since continuation of OAC is associated with the ancillary benefit that it simplifies periprocedural management, the primary outcome is first analysed for non-inferiority; if non-inferiority is proven, superiority will be tested. Recruitment started in November 2020, and the trial will continue until a total of 858 patients have been included and followed for 90 days. In summary, POPular PAUSE TAVI is the first randomised clinical trial to assess the safety and efficacy of periprocedural continuation versus interruption of OAC in patients undergoing TAVI.
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Affiliation(s)
- Dirk Jan van Ginkel
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Willem L Bor
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | | | - Hugo M Aarts
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maxim J P Rooijakkers
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kees H van Bergeijk
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Liesbeth Rosseel
- Department of Cardiology, Algemeen Stedelijk Hospital Aalst, Aalst, Belgium
| | - Leo Veenstra
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Frank van der Kley
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Adriaan Wilgenhof
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Cardiology, Hospital Network Antwerp (ZNA) Middelheim, Antwerp, Belgium
| | - Remigio Leonora
- Department of Cardiology, Isala Hospital, Zwolle, the Netherlands
| | - Jonathan Halim
- Department of Cardiology, Amphia Hospital, Breda, the Netherlands
| | | | - Emanuele Barbato
- Cardiovascular Center Aalst, Onze Lieve Vrouwe Hospital, Aalst, the Netherlands
| | | | - Peter Frambach
- Department of Cardiology, Institut National de Chirurgie Cardiaque et de Cardiologie Interventionnelle, Luxembourg City, Luxembourg
| | - Bert Ferdinande
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
| | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Enrico Fabris
- Cardiothoracovascular Department, University of Trieste, Trieste, Italy
| | - Benno J W M Rensing
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Leo Timmers
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Jorn Brouwer
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Vincent J Nijenhuis
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Joyce Peper
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Pieter A Vriesendorp
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bas de Laat
- Department of Functional Coagulation, Synapse Research Institute, Maastricht, the Netherlands
| | - Marisa Ninivaggi
- Department of Functional Coagulation, Synapse Research Institute, Maastricht, the Netherlands
| | - Hendrik Stragier
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Hospital Oost-Limburg, Genk, Belgium
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Renicus S Hermanides
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Arnoud W J van 't Hof
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Joanna J Wykrzykowska
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ronak Delewi
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jurrien M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
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Amat-Santos IJ, García-Gómez M, de Marco F, Won-Keun K, Brito J, Halim J, Jose J, Sengotuvelu G, Seth A, Terkelsen C, Protasiewicz M, Bonilla N, García B, Sánchez-Luna JP, Blasco-Turrión S, González JC, González-Bartol E, Ijsselmuiden AJJ, Gómez-Salvador I, Carrasco Moraleja M, San Román A. Latest-iteration balloon- and self-expandable transcatheter valves for severe bicuspid aortic stenosis: the TRITON study. Rev Esp Cardiol (Engl Ed) 2023; 76:872-880. [PMID: 36898524 DOI: 10.1016/j.rec.2023.03.002] [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] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/09/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES No comparisons have been published yet regarding the newest iteration of balloon- and self-expandable transcatheter heart valves for the treatment of bicuspid aortic valve (BAV) stenosis. METHODS Multicenter registry of consecutive patients with severe BAV stenosis treated with balloon-expandable transcatheter heart valves (Myval and SAPIEN 3 Ultra, S3U) or self-expanding Evolut PRO+(EP+). TriMatch analysis was carried out to minimize the impact of baseline differences. The primary endpoint of the study was 30-day device success, and the secondary endpoints were the composite and individual components of early safety at 30 days. RESULTS A total of 360 patients (age 76.6±7.6 years, 71.9% males) were included: 122 Myval (33.9%), 129 S3U (35.8%), and 109 EP+(30.3%). The mean STS score was 3.6±1.9%. There were no cases of coronary artery occlusion, annulus rupture, aortic dissection, or procedural death. The primary endpoint of device success at 30 days was significantly higher in the Myval group (Myval: 100%; S3U: 87.5%; and EP+: 81.3%), mainly due to higher residual aortic gradients with S3U and greater≥moderate aortic regurgitation (AR) with EP+. No significant differences were found in the unadjusted rate of pacemaker implantation. CONCLUSIONS In patients with BAV stenosis deemed unsuitable for surgery, Myval, S3U and EP+showed similar safety but balloon-expandable Myval had better gradients than S3U, and both balloon-expandable devices had lower residual AR than EP+, suggesting that, taking into consideration the patient-specific risks, any of these devices can be selected with optimal outcomes.
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Affiliation(s)
- Ignacio J Amat-Santos
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Spain.
| | - Mario García-Gómez
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Spain
| | | | - Kim Won-Keun
- Cardiology Department, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Joao Brito
- Cardiology Department, Hospital Santa Cruz, Lisbon, Portugal
| | - Jonathan Halim
- Cardiology Department, Amphia Hospital, Breda, The Netherlands
| | - John Jose
- Cardiology Department, Christian Medical College Vellore, Tamil Nadu, India
| | | | - Ashok Seth
- Cardiology Department, Fortis Escorts Heart Institute, New Delhi Hospital, Delhi, India
| | | | - Marcin Protasiewicz
- Cardiology Department, Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Nelson Bonilla
- Departamento de Cardiología, Hospital Médico Quirúrgico, Instituto Salvadoreño del Seguro Social, San Salvador, El Salvador
| | - Bruno García
- Departamento de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Juan Pablo Sánchez-Luna
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Sara Blasco-Turrión
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - José Carlos González
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Esther González-Bartol
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Itziar Gómez-Salvador
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Spain
| | - Manuel Carrasco Moraleja
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Spain
| | - Alberto San Román
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Spain
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6
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Halim J, Rooijakkers M, den Heijer P, El Haddad M, van den Branden B, Vos J, Schölzel B, Meuwissen M, van Gameren M, El Messaoudi S, van Royen N, IJsselmuiden S. Assessing the Novel Myval Balloon-Expandable Valve with the Evolut Valve: A Propensity-Matched Study. J Clin Med 2023; 12:4213. [PMID: 37445248 DOI: 10.3390/jcm12134213] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/08/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The Myval balloon-expandable (BE) valve has shown encouraging early clinical data in terms of safety and efficacy. Comparative data with other well-established contemporary valves are nonetheless still scarce. This study aims to compare the performance of the Myval BE valve with the Evolut self-expanding (SE) valve. METHODS In this retrospective single-center study, 223 patients with symptomatic severe aortic stenosis (AS) were included and treated with the Myval BE valve (n = 120) or with the Evolut SE valve (n = 103). Then, 91 pairs were compared after matching. Clinical outcomes were evaluated at 30 days and 1 year. Echocardiographic follow-up was performed at 30 days. RESULTS Procedural complications were rare in both groups. At the 30-day follow-up, no significant difference in cardiac death (Myval: 1% vs. Evolut: 2%, p = 0.56), stroke (2% vs. 4%, p = 0.41) and myocardial infarction (1% vs. 3%, p = 0.31) was observed. A permanent pacemaker implantation (PPI) was significantly less needed in the Myval group (4% vs. 15%, p = 0.01). At 1 year, cardiac death (2% vs. 4%, p = 0.41) and the stroke rate (7% vs. 5%, p = 0.76) were similar. Moderate-severe paravalvular leakage (PVL) was also comparable in both groups (1% vs. 4%, p = 0.17). CONCLUSION Safety and efficacy outcomes were comparable between the two valves, except for a higher PPI rate for the Evolut SE valve. Up to 1-year follow-up, clinical outcomes showed acceptable rates of stroke and cardiac death with both valves. Valve hemodynamics were excellent with a low rate of moderate-severe PVL in both groups.
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Affiliation(s)
- Jonathan Halim
- Department of Cardiology, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands
| | - Maxim Rooijakkers
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Peter den Heijer
- Department of Cardiology, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands
| | - Milad El Haddad
- Department of Cardiology, AZ Sint-Jan Brugge, Ruddershove 10, 8000 Bruges, Belgium
| | - Ben van den Branden
- Department of Cardiology, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands
| | - Jeroen Vos
- Department of Cardiology, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands
| | - Bas Schölzel
- Department of Cardiology, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands
| | - Martijn Meuwissen
- Department of Cardiology, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands
| | - Menno van Gameren
- Department of Cardiology, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands
| | - Saloua El Messaoudi
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Sander IJsselmuiden
- Department of Cardiology, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands
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Halim J, Silva A, Budden C, Dunaway DJ, Jeelani NUO, Ong J, James G. Initial UK series of endoscopic suturectomy with postoperative helmeting for craniosynostosis: early report of perioperative experience. Br J Neurosurg 2023; 37:20-25. [PMID: 33241967 DOI: 10.1080/02688697.2020.1846681] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Endoscopic suturectomy with postoperative helmeting (ESCH) has emerged as a successful treatment for craniosynostosis, initially in North America. We report early outcomes from the first cohort of ESCH patients treated in the United Kingdom (UK). METHODS Retrospective cohort study with electronic chart review. RESULTS 18 consecutive patients from the first ESCH procedure in UK (May 2017) until January 2020 identified. 12 male and 6 female infantsd, with a mean age of 4.6 months (range 2.5-7.8 months) and weight of 6.8 kg (range 4.8-9.8 kg). Diagnoses were metopic (n = 8), unicoronal (n = 7), sagittal (n = 2) and multi-sutural (n = 1) synostoses. Median incision length was 3 cm (range 2-10 cm). 16/18 received no blood products, with 2 (both metopics) requiring transfusion (1 donor exposure). Mean operative time (including anaesthesia) was 96 min (range 40-127 min). Median length of hospital stay was 1 night. 1 surgical complication (superficial infection). All patients are currently undergoing helmet orthosis therapy. So far, no patients have required revisional or squint surgery. CONCLUSION Early experience from the first UK cohort of ESCH suggests that this is a safe and well tolerated technique with low morbidity, transfusion and short hospital stay. Long-term results in terms of shape, cosmetic and developmental outcome are awaited.
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Affiliation(s)
- Jonathan Halim
- Barts and The London School of Medicine, QMUL, London, UK
| | - Adikarige Silva
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
| | - Curtis Budden
- Craniofacial Unit, Great Ormond Street Hospital, London, UK
| | - David J Dunaway
- Craniofacial Unit, Great Ormond Street Hospital, London, UK.,Great Ormond Street Institute of Child Health, UCL, London, UK
| | - N U Owase Jeelani
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK.,Craniofacial Unit, Great Ormond Street Hospital, London, UK.,Great Ormond Street Institute of Child Health, UCL, London, UK
| | - Juling Ong
- Craniofacial Unit, Great Ormond Street Hospital, London, UK.,Great Ormond Street Institute of Child Health, UCL, London, UK
| | - Greg James
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK.,Craniofacial Unit, Great Ormond Street Hospital, London, UK.,Great Ormond Street Institute of Child Health, UCL, London, UK
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8
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Halim J, Westcott F, Cascone N, Coombes A. Risk factors associated with post-operative uveitis after cataract surgery: a retrospective case-control study. Eye (Lond) 2022; 36:198-205. [PMID: 33674727 PMCID: PMC8727621 DOI: 10.1038/s41433-021-01486-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/18/2021] [Accepted: 02/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/AIM Post-operative uveitis is the most common complication after cataract surgery in the UK. The study aims to evaluate the risk of post-operative uveitis in cataract surgery patients of different ethnicity in the presence and absence of co-morbidities as well as operative complications using multivariate analysis. METHODS A retrospective case-control study of patients undergoing phacoemulsification cataract surgery between January 2018 to December 2019 at two hospital sites. Differences in demographic and clinical characteristics were compared between two groups defined by the development of post-operative uveitis. Statistically significant factors in univariate analysis were further analysed using multivariate analysis to account for confounders. RESULTS One thousand and five hundred eighty seven eyes had undergone phacoemulsification cataract operations with 104 (6.6%) developing post-operative uveitis. Compared to eyes of White/Mixed/Other ethnicity, Asian and Afro-Caribbean eyes were associated with a twofold (OR 2.02, 95% CI 1.16-3.52, P = 0.013) and fivefold (OR 5.15, 95% CI 2.85-9.29, P < 0.001) risk of post-operative uveitis, respectively. Complicated surgery involving eyes with small pupil/iris hooks/Malyugin ring (OR 2.70, 95% CI 1.16-6.30, P = 0.022) and posterior capsular rupture (OR 6.00, 95% CI 2.55-14.12, P < 0.001) were associated with an increased risk of post-operative uveitis. CONCLUSIONS The factors significantly associated with a post-operative uveitis outcome were patients of Asian and Afro-Caribbean ethnicity, small intra-operative pupil size, use of iris hooks or Malyugin ring and PCR. The post-operative management plan should be tailored in these group of patients with a view of early assessment and prompt management of symptoms.
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Affiliation(s)
- Jonathan Halim
- grid.4868.20000 0001 2171 1133Barts and The London School of Medicine and Dentistry, QMUL, London, UK
| | - Felix Westcott
- grid.4991.50000 0004 1936 8948Oxford University Medical School, University of Oxford, Oxford, UK
| | - Nikhil Cascone
- grid.139534.90000 0001 0372 5777Ophthalmology Department, Barts Health NHS Trust, London, UK
| | - Andrew Coombes
- grid.139534.90000 0001 0372 5777Ophthalmology Department, Barts Health NHS Trust, London, UK
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9
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Santos-Martinez S, Halim J, Castro-Mejía A, De Marco F, Trani C, Martin P, Infusino F, Ancona M, Moreno R, den Heijer P, Nombela-Franco L, Bedogni F, Sardella G, Montorfano M, Revilla-Orodea A, Delgado-Arana JR, Barrero A, Gómez-Salvador I, IJsselmuiden AJJ, Redondo A, Gutiérrez H, Serrador A, Serruys PW, Román JAS, Amat-Santos IJ. Myval versus alternative balloon- and self-expandable transcatheter heart valves: A central core lab analysis of conduction disturbances. Int J Cardiol 2022; 351:25-31. [PMID: 34979152 DOI: 10.1016/j.ijcard.2021.12.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Several studies have compared surface electrocardiographic changes following different self-expandable (SE) (Evolut (Medtronic, USA); Acurate (Boston Scientific, USA); Portico (Abbott, USA); and Allegra (NVT, Germany)) and balloon-expandable (BE) Sapien-3 (Edwards Lifesciences, USA) transcatheter heart valves. We aimed to compare these prosthesis with the novel Myval BE prosthesis (Meril Life, India). METHODS Academic European registry of consecutive patients with severe aortic stenosis who received any of the 6 aforementioned valves. Baseline, post-procedural, and discharge 12‑leads electrocardiograms (ECG) were centrally analyzed and compared. RESULTS A total of 1131 patients were included: 135 Myval (11.9%), 290 Sapien-3 (25.6%), 298 Evolut (26.3%), 180 Acurate (15.9%), 125 Portico (11.1%), and 103 Allegra (9.1%). There were no baseline differences in intraventricular conduction disturbances rate. Compared to the novel BE Myval, there were similar procedural and in-hospital outcomes. Similar rates of early new permanent pacemaker implant (PPI) were observed amongst Myval (7.4%), Sapien-3 (13.4%), and Acurate (9.1%), but Evolut, Portico, and Allegra presented significantly higher rates (18.5%, p = 0.003; 29.5% p < 0.001 and 22%, p = 0.001, respectively). Central analysis of ECGs, unraveled significant prolongation of the PR segment with Evolut, Portico and Allegra whereas Evolut, Acurate, and Portico showed significant QRS widening compared to Myval. However, at discharge no differences in PR segment duration were observed while, Evolut, and Portico- but not Acurate, Allegra or Sapien-3 - still presented significant widening of QRS segment compared to Myval. CONCLUSIONS After blinded central ECG analysis, the novel Myval balloon-expandable prosthesis was associated with a low rate of early conduction disturbances.
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Affiliation(s)
| | | | | | | | - Carlo Trani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Pedro Martin
- Hospital Universitario de Gran Canaria Dr Negrin, Gran Canaria, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alfredo Redondo
- CIBERCV, Hospital Clinico Universitario de Valladolid, Spain
| | | | - Ana Serrador
- CIBERCV, Hospital Clinico Universitario de Valladolid, Spain
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland
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10
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Halim J, Brouwer J, Lycke M, Swaans MJ, Van der Heyden J. Transcatheter aortic valve replacement: impact of pre-procedural FEops HEARTguide assessment on device size selection in borderline annulus size cases. Neth Heart J 2021; 29:654-661. [PMID: 34495448 PMCID: PMC8630271 DOI: 10.1007/s12471-021-01620-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The aim of this study is to evaluate device size selection in patients within the borderline annulus size range undergoing transcatheter aortic valve replacement (TAVR) and to assess if pre-procedural patient-specific computer simulation will lead to the selection of a different device size than standard of care. BACKGROUND In TAVR, appropriate device sizing is imperative. In borderline annulus size cases no standardised technique for tailored device size selection is currently available. Pre-procedural patient-specific computer simulation can be used, predicting the risk for paravalvular leakage (PVL) and need for permanent pacemaker implantation (PPI). METHODS In this multicentre retrospective study, 140 patients in the borderline annulus size range were included. Hereafter, device size selection was left to the discretion of the operator. After TAVR, in 24 of the 140 patients, patient-specific computer simulation calculated the most appropriate device size expected to give the lowest risk for PVL and need for PPI. In these 24 patients, device size selection based on patient-specific computer simulation was compared with standard-of-care device size selection relying on a standardised matrix (Medtronic). RESULTS In a significant proportion of the 140 patients (26.4%) a different device size than recommended by the matrix was implanted. In 10 of the 24 patients (41.7%) in whom a computer simulation was performed, a different device size was recommended than by means of the matrix. CONCLUSIONS Device size selection in patients within the borderline annulus size range is still ambiguous. In these patients, patient-specific computer simulation is feasible and can contribute to a more tailored device size selection.
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Affiliation(s)
- J Halim
- Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium.
| | - J Brouwer
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - M Lycke
- Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium
| | - M J Swaans
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - J Van der Heyden
- Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium
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11
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García-Gómez M, Delgado-Arana JR, Halim J, De Marco F, Trani C, Martin P, Won-Keun K, Montorfano M, den Heijer P, Bedogni F, Sardella G, IJsselmuiden AJJ, Campante Teles R, Aristizabal-Duque CH, Gordillo X, Santos-Martinez S, Barrero A, Gómez-Salvador I, Ancona M, Redondo A, Román JAS, Amat-Santos IJ. Next-generation balloon-expandable Myval transcatheter heart valve in low-risk aortic stenosis patients. Catheter Cardiovasc Interv 2021; 99:889-895. [PMID: 34390296 DOI: 10.1002/ccd.29923] [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: 05/05/2021] [Revised: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We aimed to describe hemodynamic performance and clinical outcomes at 30-day follow-up of the balloon-expandable (BE) Myval transcatheter heart valve (THV) in low-risk patients. BACKGROUND The results of the next-generation BE Myval THV in low-risk aortic stenosis (AS) patients are still unknown. METHODS Retrospective registry performed in nine European centers including patients with low predicted operative mortality risk according to Society of thoracic surgeons (STS) and European system for cardiac operative risk evaluation (EuroSCORE-II) scores. RESULTS Between September 2019 and February 2021, a total of 100 patients (51% males, mean age 80 ± 6.5 years) were included. Mean STS score and EuroSCORE-II were 2.4 ± 0.8% and 2.2 ± 0.7%, respectively. Intermediate sizes were used in 39% (21.5 mm: 8%, 24.5 mm: 15%, 27.5 mm: 15%). There were no cases of valve embolization, coronary artery occlusion, annulus rupture, or procedural death. A definitive pacemaker implantation was needed in eight patients (8%). At 30-day follow-up aortic valve area (0.7 ± 0.2 vs. 2.1 ± 0.6 cm2 ) and mean aortic valve gradient (43.4 ± 11.1 vs. 9.0 ± 3.7 mmHg) improved significantly (p < 0.001). Moderate aortic regurgitation occurred in 4%. Endpoints of early safety and clinical efficacy were 3 and 1%, respectively. CONCLUSIONS Hemodynamic performance and 30-day clinical outcomes of the BE Myval THV in low-risk AS patients were favorable. Longer-term follow-up is warranted.
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Affiliation(s)
- Mario García-Gómez
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Jose Raúl Delgado-Arana
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Jonathan Halim
- Cardiology Department, Amphia Hospital Breda, Breda, Netherlands
| | | | - Carlo Trani
- Cardiology Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Pedro Martin
- Cardiology Department, Hospital Universitario de Gran Canaria Dr Negrin, Gran Canaria, Spain
| | - Kim Won-Keun
- Cardiology Department, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Matteo Montorfano
- Cardiology Department, San Raffaele Scientific Institute, Milan, Italy
| | - Peter den Heijer
- Cardiology Department, Amphia Hospital Breda, Breda, Netherlands
| | | | | | | | | | | | - Ximena Gordillo
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Sandra Santos-Martinez
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Alejandro Barrero
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Itziar Gómez-Salvador
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Marco Ancona
- Cardiology Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alfredo Redondo
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - J Alberto San Román
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Ignacio J Amat-Santos
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
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12
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Delgado-Arana JR, Gordillo-Monge MX, Halim J, De Marco F, Trani C, Martin P, Infusino F, Ancona M, den Heijer P, Bedogni F, Nombela Franco L, Moreno R, Sargella G, Montorfano M, Aristizabal-Duque C, Romero-Delgado T, Santos S, Barrero A, Gomez Salvador I, IJsselmuiden S, Redondo Diéguez A, San Román Calvar JA, Amat-Santos IJ. Early clinical and haemodynamic matched comparison of balloon-expandable valves. Heart 2021; 108:725-732. [PMID: 34285104 DOI: 10.1136/heartjnl-2021-319349] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 03/17/2021] [Accepted: 06/18/2021] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES The balloon-expandable Sapien-3 valve demonstrated superior results in terms of residual aortic regurgitation when compared with self-expandable devices. We aimed to compare for the first-time early outcomes of Sapien-3 transcatheter heart valve (THV) with the balloon-expandable Myval device. METHODS Consecutive real-world patients from nine European institutions with symptomatic severe aortic stenosis treated either with Sapien-3 or Myval THV devices after June 2018 were compared. Early clinical outcomes were prospectively gathered and blinded analysis of 30-day echocardiography was conducted. Matching for the following variables was performed: age, body surface area, Society of Thoracic Surgeons risk score, left ventricular function, mean gradient, transfemoral approach, aortic valvular calcium, aortic annulus mean diameter, area and eccentricity index. RESULTS A total of 416 patients treated either with the Sapien-3 (n=286, 68.7%) or with Myval THV (n=130, 31.3%) were included and 103 pairs compared after matching. Baseline characteristics were similar. Procedural success rate (Sapien-3: 94.2%; Myval: 93.2%, p=0.219), 30-day mortality (Sapien-3: 2.9%; Myval: 0.97%, p=0.625), clinical efficacy (12.6 vs 4.9%, p=0.057) and early safety (12.6 vs 4.9%, p=0.096) were comparable. There was a lower need for new permanent pacemaker (15.5 vs 5.8% p=0.020) with Myval. No significant differences were found in terms of ≥moderate aortic regurgitation (1% for Sapien-3, 0% for Myval, p=0.314), but mean gradients were higher following Sapien-3 than after Myval (p<0.001). CONCLUSIONS The new Myval balloon-expandable THV was favourable in terms of safety, with low rate of permanent pacemaker and with favourable residual gradients and paravalvular leak rate according to blinded echocardiographic analysis.
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Affiliation(s)
- Jose R Delgado-Arana
- Cardiology Depatment, Valladolid University Hospital, Valladolid, Castilla y León, Spain
| | | | - Jonathan Halim
- Cardiology Department, Amphia Hospital, Breda, North Brabant, Netherlands
| | | | - Carlo Trani
- Department of Cardiovascular Medecine, Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Pedro Martin
- Cardiology Department, Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Fabio Infusino
- Cardiology Department, Umberto I Policlinico di Roma, Roma, Lazio, Italy
| | - Marco Ancona
- Cardiology Department, Istituto Scientifico Universitario San Raffaele, Milano, Lombardia, Italy
| | - Peter den Heijer
- Cardiology Department, Amphia Hospital, Breda, North Brabant, Netherlands
| | - Francesco Bedogni
- Istituto Clinico S. Ambrogio, Department of Cardiology IRCCS San Donato, Milan, Italy
| | - Luis Nombela Franco
- Interventional Cardiology, Hospital Clinico Universitario San Carlos, Madrid, Spain.,Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Quebec, Canada
| | - Raul Moreno
- Interventional Cardiology, University Hospital La Paz, Madrid, Spain
| | - Gennaro Sargella
- Cardiology Department, Umberto I Policlinico di Roma, Roma, Lazio, Italy
| | - Matteo Montorfano
- Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Sandra Santos
- Cardiology, Hospital Clinico Universitario de Valladolid, Valladolid, Valladolid, Spain
| | - Alejandro Barrero
- Interventional Cardiology, Valladolid University Hospital, Valladolid, Castilla y León, Spain
| | - Itziar Gomez Salvador
- Biostatistics Department, Institute of Heart Sciences-ICICOR- University Hospital, Valladolid, Spain, Valladolid, Spain
| | | | - Alfredo Redondo Diéguez
- Cardiovascular, Royal Brompton Hospital, London, UK.,Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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13
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Halim J, Jelley J, Zhang N, Ornstein M, Patel B. The effect of verbal feedback, video feedback, and self-assessment on laparoscopic intracorporeal suturing skills in novices: a randomized trial. Surg Endosc 2020; 35:3787-3795. [PMID: 32804266 DOI: 10.1007/s00464-020-07871-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/05/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Laparoscopic skill acquisition involves a steep learning curve and laparoscopic suturing is an exceptionally challenging task. By improving the way feedback is given, trainees can learn these skills more effectively. This study aims to establish the most effective form of structured feedback on laparoscopic suturing skill acquisition in novices, by comparing the effects of expert verbal feedback, video review with expert feedback (video feedback), and video review with self-assessment. METHODS A prospective randomized blinded trial comparing verbal feedback, video feedback, and self-assessment. Novices in laparoscopic surgery were tasked with performing laparoscopic suturing with intracorporeal knot tying. Time was given for practice, and pre- and post-feedback assessments were undertaken. Suturing performance was measured using a task-specific checklist and global ratings. A post-study questionnaire was used to measure participant-perceived confidence, knowledge, and experience levels. RESULTS Fifty-one participants were randomized and allocated equally into the three groups. Performance in all three groups improved significantly from baseline. Video feedback had the largest improvement margin with checklist and global score improvements of 17.1% (± 9.9%) and 14.7% (± 9.3%), respectively. Performance improvements between groups were statistically significant in the global components (p = 0.004) but not the checklist components (p = 0.186). Global score improvement was significantly better in the video feedback group but was statistically insignificant between the self-assessment and verbal feedback groups. Questionnaire responses demonstrated positive results in confidence, knowledge, and experience levels, across all three study groups, with no differences between the groups (p > 0.05). CONCLUSION Structured video feedback facilitates reflection and self-directed learning, which improves the ability to develop proficiency in surgical skills. Combining both self-assessment and video feedback may be beneficial over verbal feedback alone due to the advantages of video review. These techniques should therefore be considered for implementation into surgical education curricula.
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Affiliation(s)
- Jonathan Halim
- Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London, UK.
| | - Joshua Jelley
- Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London, UK
| | - Ningning Zhang
- Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London, UK
| | - Marcus Ornstein
- Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London, UK
| | - Bijendra Patel
- Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London, UK
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14
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Halim J, Tavernier R, Missault L, Debonnaire P. A pilot with a helicopter in the left atrium: a case report of an embolized Watchman device. Eur Heart J Case Rep 2020; 4:1-4. [PMID: 33426430 PMCID: PMC7780468 DOI: 10.1093/ehjcr/ytaa161] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/23/2020] [Accepted: 05/19/2020] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Embolization of a Watchman device in patients undergoing percutaneous left atrial appendage (LAA) closure is a rare complication. Retrieval of the device can be achieved percutaneously with a snaring technique or a bioptome.
Case summary
We present an illustrative case of Watchman closure device embolization during an LAA closure attempt in a 77-year-old man. The complication was caused by anatomical restraints of the LAA, in particular limited depth resulting in poor stability of the closure device after implantation. By the use of a double snaring technique, however, we managed to retrieve the device percutaneously. By applying such strategy, a more invasive surgical approach can be prevented.
Discussion
Prompt response is needed when embolization of a Watchman device occurs. A snaring technique can be used in most cases to attempt device retrieval. A double snaring technique is in this case associated with higher retrieval success than a single snaring technique.
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Affiliation(s)
- Jonathan Halim
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, 8000 Bruges, Belgium
| | - Rene Tavernier
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, 8000 Bruges, Belgium
| | - Luc Missault
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, 8000 Bruges, Belgium
| | - Philippe Debonnaire
- Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, 8000 Bruges, Belgium
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15
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Abstract
Endovascular baroreflex amplification is an alternative treatment strategy for patients with resistant hypertension. In endovascular baroreflex, the carotid baroreflex is activated by a MobiusHD® device (MD) which has been implanted in the internal carotid artery. This review will discuss the MD technology and mechanism of action and promising results in the first-in-human prospective study involving the use of the MD in patients with resistant hypertension.
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Affiliation(s)
- Jonathan Halim
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000 Bruges, Belgium
| | - Michelle Lycke
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000 Bruges, Belgium
| | - Jan Van der Heyden
- Department of Cardiology, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000 Bruges, Belgium
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16
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Halim J, van Schaagen FRN, Riezebos RK, Lalezari S. Giant intracardiac blood cyst: assessing the relationship between its formation and previous cardiac surgery. Neth Heart J 2015; 23:392-4. [PMID: 26043925 PMCID: PMC4497992 DOI: 10.1007/s12471-015-0707-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This case report discusses a 23-year-old male patient who presented with shortness of breath during exercise. Echocardiography revealed an intracardiac mass located on the mitral valve. His medical history included surgical closure of an atrial septal defect type 2 at the age of 2 years. After being discussed within a multidisciplinary heart team, the intracardiac mass was surgically removed. Histopathological examination revealed a blood cyst. This case report emphasises that the presence of an acquired intracardiac cyst is a rare entity and that a pathophysiological association between the formation of a blood cyst and previous cardiac surgery has not been proven yet.
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Affiliation(s)
- J Halim
- Onze Lieve Vrouwe Gasthuis, PO Box 95500, 1090 HM, Amsterdam, The Netherlands,
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Hu C, Lai CC, Tao Q, Lu J, Halim J, Sun L, Zhang J, Yang J, Anasori B, Wang J, Sakka Y, Hultman L, Eklund P, Rosen J, Barsoum MW. Mo2Ga2C: a new ternary nanolaminated carbide. Chem Commun (Camb) 2015; 51:6560-3. [DOI: 10.1039/c5cc00980d] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We report the discovery of a new hexagonal Mo2Ga2C phase, wherein two Ga layers – instead of one – are stacked in a simple hexagonal arrangement in between Mo2C layers.
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Halim J, Büchi F, Haas O, Stamm M, Scherer G. Characterization of perfluorosulfonic acid membranes by conductivity measurements and small-angle x-ray scattering. Electrochim Acta 1994. [DOI: 10.1016/0013-4686(94)e0051-z] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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