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Alabdaljabar MS, Elhadi M, Geske JB, Klarich KW, Guerrero M, Eleid MF. Sex-Related Differences in Patients With Hypertrophic Cardiomyopathy Undergoing Alcohol Septal Ablation. J Am Heart Assoc 2024; 13:e032553. [PMID: 38700034 DOI: 10.1161/jaha.123.032553] [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: 12/23/2023] [Accepted: 04/02/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Previous studies have shown that women with hypertrophic obstructive cardiomyopathy (HCM) have worse long-term outcomes irrespective of intervention. However, the outcomes of patients undergoing alcohol septal ablation (ASA) based on sex have not been described. Hence, this study aimed to evaluate pressure changes and long-term mortality in patients with HCM undergoing ASA based on sex. METHODS AND RESULTS This is a single-center retrospective study evaluating hemodynamic changes and long-term mortality in patients with HCM treated with ASA according to sex. A total of 259 patients were included (aged 68.4±11.9 years, 62.2% women). Women had higher age and baseline pressures at the time of ASA, with a greater percent reduction in mean left atrial pressure (men versus women: 2.2% versus 15.9%, respectively; P=0.02). Women had better survival (median survival rate of men versus women: 8.6 versus 12.5 years, respectively; P=0.011). On Cox multivariable regression, predictors of mortality were age (per group change <60 years, 61-70 years, 71-80 years, and >80 years; hazard ratio [HR], 1.45 [95% CI, 1.10-1.91], P=0.008), female sex (HR, 0.59 [95% CI, 0.35-0.99], P=0.048), chronic kidney disease (HR, 1.88 [95% CI, 1.06-3.33], P=0.031), and left ventricular outflow tract gradient reduction ≤86% (HR, 1.91 [95% CI, 1.14-3.19], P=0.014). CONCLUSIONS Women with HCM undergoing ASA are older and have higher left-sided baseline pressures compared with men yet have better survival. Further studies exploring the mechanisms of differential outcomes according to sex in patients with HCM undergoing ASA are needed.
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Affiliation(s)
| | - Mohamed Elhadi
- Department of Internal Medicine Mayo Clinic Rochester MN
| | - Jeffrey B Geske
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Kyle W Klarich
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Mayra Guerrero
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Mackram F Eleid
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
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El Shaer A, Chavez Ponce AA, Ali MT, Oguz D, Pislaru SV, Nkomo VT, Padang R, Eleid MF, Guerrero M, Reeder GS, Rihal CS, Alkhouli M, Thaden JJ. Pulmonary Vein Flow Morphology After Transcatheter Mitral Valve Edge-to-Edge Repair as Predictor of Survival. J Am Soc Echocardiogr 2024; 37:530-537. [PMID: 38341053 DOI: 10.1016/j.echo.2024.01.016] [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: 11/07/2023] [Revised: 01/10/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Data on the prognostic factors after mitral valve (MV) transcatheter edge-to-edge repair (TEER; MV-TEER) are limited. Pulsed-wave Doppler interrogation of pulmonary vein flow (PVF) is a convenient method to assess the hemodynamic burden of residual mitral regurgitation (MR), which could be of utility as a predictor of outcomes. METHODS Patients that underwent MV-TEER between May 2014 and December 2021 at our institution were evaluated. Pulmonary vein flow patterns post-MV-TEER were reviewed on the procedural transesophageal echocardiogram and classified as normal (systolic dominant or codominant) or abnormal (systolic blunting or reversal). The PVF pattern was correlated with all-cause mortality at follow-up. RESULTS Two-hundred sixty-five patients had diagnostic PVF post-MV-TEER, with 73 (27.5%) categorized as normal and 192 (72.5%) categorized as abnormal. Patients with abnormal PVF morphology were more likely to have atrial fibrillation (70% vs 42%, P < .001) and greater than moderate residual MR (16% vs 3%, P = .01) and had higher mean left atrial pressure (18.1 ± 5.0 vs 15.9 ± 4.2 mm Hg, P = .002) and left atrial V wave (26.6 ± 8.5 vs 21.4 ± 7.3 mm Hg, P < .001) postprocedure. In multivariable analysis, abnormal PVF morphology post-MV-TEER was independently associated with mortality at follow-up (hazard ratio = 1.70; 95% CI, 1.06-2.74; P = .03) after correction for end-stage renal disease, atrial fibrillation, and residual MR. Results were similar in subgroups of patients with moderate or less and those with mild or less residual MR. CONCLUSIONS Pulmonary vein flow morphology is a simple and objective tool to assess MR severity immediately post-MV-TEER and offers important prognostic information to optimize procedural results. Additional studies are needed to determine whether patients with abnormal PVF pattern post-MV-TEER would benefit from more intensive goal-directed medical therapy postprocedure.
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Affiliation(s)
- Ahmed El Shaer
- Department of Internal Medicine, University of Wisconsin Hospital, Madison, Wisconsin
| | | | - Mays T Ali
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Didem Oguz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Guy S Reeder
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jeremy J Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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Naser JA, Alexandrino FB, Harada T, Michelena HI, Borlaug BA, Eleid MF, Lin G, Scott C, Kennedy AM, Pellikka PA, Nkomo VT, Pislaru SV. The Natural History of Atrial Functional Mitral Regurgitation. J Am Coll Cardiol 2024; 83:1495-1507. [PMID: 38530687 DOI: 10.1016/j.jacc.2024.02.026] [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: 01/25/2024] [Accepted: 02/20/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND The natural history of moderate/severe atrial functional mitral regurgitation (AFMR) is unknown. OBJECTIVES The authors sought to study the incidence of left ventricular (LV) systolic dysfunction (LVSD), progression or regression of ≥mild-moderate AFMR, and impact on mortality. METHODS Adults with left atrial (LA) volume index ≥40 mL/m2, ≥mild-moderate AFMR, and follow-up echocardiogram were followed for incident LVSD (ejection fraction <50% and ≥10% lower than baseline), progression of mild-moderate/moderate AFMR to severe, and persistent regression of AFMR to no/trivial. Relation of AFMR progression or regression as time-dependent covariates with all-cause mortality was studied. Incidence of LVSD was compared with patients with no/mild AFMR matched on age, sex, comorbidities and ejection fraction. Patients were followed until mitral intervention, myocardial infarction, or last follow-up. RESULTS A total of 635 patients (median age 75 years, 51% female, 96% mild-moderate/moderate AFMR, 4% severe AFMR) were included. Over a median 2.2 years (Q1-Q3: 1.0-4.3 years), incidence rates per 100 person-years were 3.2 for LVSD (P = 0.52 vs patients with no/mild AFMR), 1.9 for progression of AFMR, and 3.9 for regression. Female sex and larger LA volume index were independently associated with progression, whereas younger age, male sex, absent atrial fibrillation, and higher LA emptying fraction were independently associated with regression. Neither AFMR progression nor regression was independently associated with mortality. Instead, independent risk factors for mortality included older age, concentric LV geometry, and higher estimated LV filling and pulmonary pressures. CONCLUSIONS In patients with predominantly mild-moderate/moderate AFMR, regression of MR was more common than progression, but neither was associated with mortality. Instead, diastolic function abnormalities were more important. Over a median 2-year follow-up, LVSD risk was not increased.
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Affiliation(s)
- Jwan A Naser
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | | | - Tomonari Harada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher Scott
- Department of Biostatistics and Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Austin M Kennedy
- Department of Biostatistics and Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Welle GA, Hahn RT, Lindenfeld J, Lin G, Nkomo VT, Hausleiter J, Lurz PC, Pislaru SV, Davidson CJ, Eleid MF. New Approaches to Assessment and Management of Tricuspid Regurgitation Before Intervention. JACC Cardiovasc Interv 2024; 17:837-858. [PMID: 38599687 DOI: 10.1016/j.jcin.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/22/2024] [Accepted: 02/13/2024] [Indexed: 04/12/2024]
Abstract
Severe tricuspid regurgitation (TR) is a progressive condition associated with substantial morbidity, poor quality of life, and increased mortality. Patients with TR commonly have coexisting conditions including congestive heart failure, pulmonary hypertension, chronic lung disease, atrial fibrillation, and cardiovascular implantable electronic devices, which can increase the complexity of medical and surgical TR management. As such, the optimal timing of referral for isolated tricuspid valve (TV) intervention is undefined, and TV surgery has been associated with elevated risk of morbidity and mortality. More recently, an unprecedented growth in TR treatment options, namely the development of a wide range of transcatheter TV interventions (TTVI) is stimulating increased interest and referral for TV intervention across the entire medical community. However, there are no stepwise algorithms for the optimal management of symptomatic severe TR before TTVI. This article reviews the contemporary assessment and management of TR with addition of a medical framework to optimize TR before referral for TTVI.
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Affiliation(s)
- Garrett A Welle
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. https://twitter.com/GarrettWelleMD
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA. https://twitter.com/hahn_rt
| | - Joann Lindenfeld
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Charles J Davidson
- Division of Cardiology, Northwestern University Medical Center, Chicago, Illinois, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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5
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Guerrero ME, Bapat VN, Mahoney P, Krishnaswamy A, Eleid MF, Eng MH, Yadav P, Coylewright M, Makkar R, Szerlip M, Nazif T, Kodali S, George I, Greenbaum A, Babaliaros V, Kapadia S, Rihal CS, Whisenant B, Thourani VH, McCabe JM. Contemporary 1-Year Outcomes of Mitral Valve-in-Ring With Balloon-Expandable Aortic Transcatheter Valves in the U.S. JACC Cardiovasc Interv 2024; 17:874-886. [PMID: 38599690 DOI: 10.1016/j.jcin.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Adequate valve performance after surgical mitral valve repair with an annuloplasty ring is not always sustained over time. The risk of repeat mitral valve surgery may be high in these patients. Transcatheter mitral valve-in-ring (MViR) is emerging as an alternative for high-risk patients. OBJECTIVES The authors sought to assess contemporary outcomes of MViR using third-generation balloon-expandable aortic transcatheter heart valves. METHODS Patients who underwent MViR and were enrolled in the STDS/ACC TVT (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy) Registry between August 2015 and December 2022 were analyzed. RESULTS A total of 820 patients underwent MViR at 236 sites, mean age was 72.2 ± 10.4 years, 50.9% were female, mean STS score was 8.2% ± 6.9%, and most (78%) were in NYHA functional class III to IV. Mean left ventricular ejection fraction was 47.8% ± 14.2%, mean mitral gradient was 8.9 ± 7.0 mm Hg, and 75.5% had ≥ moderate mitral regurgitation. Access was transseptal in 93.9% with 88% technical success. All-cause mortality at 30 days was 8.3%, and at 1 year, 22.4%, with a reintervention rate of 9.1%. At 1-year follow-up, 75.6% were NYHA functional class I to II, Kansas City Cardiomyopathy Questionnaire score increased by 25.9 ± 29.1 points, mean mitral valve gradient was 8.4 ± 3.4 mm Hg, and 91.7% had ≤ mild mitral regurgitation. CONCLUSIONS MViR with third-generation balloon-expandable aortic transcatheter heart valves is associated with a significant reduction in mitral regurgitation and improvement in symptoms at 1 year, but with elevated valvular gradients and a high reintervention rate. MViR is a reasonable alternative for high-risk patients unable undergo surgery who have appropriate anatomy for the procedure. (STS/ACC TVT Registry Mitral Module [TMVR]; NCT02245763).
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Affiliation(s)
- Mayra E Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Vinayak N Bapat
- Department of Cardiothoracic Surgery, Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Paul Mahoney
- Division of Cardiology, Department of Cardiovascular Services, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | | | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Marvin H Eng
- Division of Cardiology, Banner University Medical Center, Phoenix, Arizona, USA
| | - Pradeep Yadav
- Division of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Megan Coylewright
- Division of Cardiology Erlanger Health System, Chattanooga, Tennessee, USA
| | - Raj Makkar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Molly Szerlip
- Baylor Scott and White, The Heart Hospital, Plano, Texas, USA
| | - Tamim Nazif
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Susheel Kodali
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Isaac George
- Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Adam Greenbaum
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vasilis Babaliaros
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian Whisenant
- Division of Cardiology, Intermountain Heart Institute, Salt Lake City, Utah, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - James M McCabe
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
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6
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Danielson AP, Collins JD, Pislaru SV, Padang R, Kane GC, Foley TA, Williamson EE, Eleid MF, Thaden JJ. Comparison of Tricuspid Annular Dimension Measurements Using Automated Three-Dimensional Transthoracic Echocardiography and Computed Tomography in Patients Evaluated for Transcatheter Tricuspid Valve Intervention. J Am Soc Echocardiogr 2024:S0894-7317(24)00105-6. [PMID: 38452828 DOI: 10.1016/j.echo.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Alex P Danielson
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Thomas A Foley
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jeremy J Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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7
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Eleid MF. Generalizing Tricuspid Clinical Trial Results to the "Real World". JACC Cardiovasc Interv 2024; 17:549-551. [PMID: 38418057 DOI: 10.1016/j.jcin.2023.11.031] [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: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 03/01/2024]
Affiliation(s)
- Mackram F Eleid
- Divisions of Interventional Cardiology and Structural Heart Disease, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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8
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Kucuk HO, Nan JZ, Larson KF, Sinak LJ, Eleid MF. Percutaneous Vacuum-Assisted Aspiration of Mobile Caseous Mitral Annulus Calcification. JACC Case Rep 2024; 29:102182. [PMID: 38361568 PMCID: PMC10865118 DOI: 10.1016/j.jaccas.2023.102182] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 02/17/2024]
Abstract
A 68-year-old woman presented with an incidentally found intracardiac mass. Transesophageal echocardiography (TEE) showed a 26 × 8 mm mobile mass attached to a calcified posterolateral mitral annulus. The mass was removed with a commercially available percutaneous catheter system using cerebral embolic protection and TEE guidance. The pathologic examination showed caseous mitral annular calcification.
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Affiliation(s)
- Hilal Olgun Kucuk
- Cardiovascular Medicine Department, Mayo Clinic, Rochester, Minnesota, USA
| | - John Z. Nan
- Cardiovascular Medicine Department, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn F. Larson
- Cardiovascular Medicine Department, Mayo Clinic, Rochester, Minnesota, USA
| | - Lawrence J. Sinak
- Cardiovascular Medicine Department, Mayo Clinic, Rochester, Minnesota, USA
| | - Mackram F. Eleid
- Cardiovascular Medicine Department, Mayo Clinic, Rochester, Minnesota, USA
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9
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Tan NY, Adedinsewo D, El Sabbagh A, Sayed Ahmed AF, Carolina Morales-Lara A, Wieczorek M, Madhavan M, Mulpuru SK, Deshmukh AJ, Asirvatham SJ, Eleid MF, Friedman PA, Cha YM, Killu AM. Incidence and Outcomes of New-Onset Right Bundle Branch Block Following Transcatheter Aortic Valve Replacement. Circ Arrhythm Electrophysiol 2024; 17:e012377. [PMID: 38288627 DOI: 10.1161/circep.123.012377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/02/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND The incidence and prognosis of right bundle branch block (RBBB) following transcatheter aortic valve replacement (TAVR) are unknown. Hence, we sought to characterize the incidence of post-TAVR RBBB and determine associated risks of permanent pacemaker (PPM) implantation and mortality. METHODS All patients 18 years and above without preexisting RBBB or PPM who underwent TAVR at US Mayo Clinic sites and Mayo Clinic Health Systems from June 2010 to May 2021 were evaluated. Post-TAVR RBBB was defined as new-onset RBBB in the postimplantation period. The risks of PPM implantation (within 90 days) and mortality following TAVR were compared for patients with and without post-TAVR RBBB using Kaplan-Meier analysis and Cox proportional hazards modeling. The risks of PPM implantation (within 90 days) and mortality following TAVR were compared for patients with and without post-TAVR RBBB using Kaplan-Meier analysis and Cox proportional hazards modeling. RESULTS Of 1992 patients, 15 (0.75%) experienced new RBBB post-TAVR. There was a higher degree of valve oversizing among patients with new RBBB post-TAVR versus those without (17.9% versus 10.0%; P=0.034). Ten patients (66.7%) with post-TAVR RBBB experienced high-grade atrioventricular block and underwent PPM implantation (median 1 day; Q1, 0.2 and Q3, 4), compared with 268/1977 (13.6%) without RBBB. Following propensity score adjustment for covariates (age, sex, balloon-expandable valve, annulus diameter, and valve oversizing), post-TAVR RBBB was significantly associated with PPM implantation (hazard ratio, 8.36 [95% CI, 4.19-16.7]; P<0.001). No statistically significant increase in mortality was seen with post-TAVR RBBB (hazard ratio, 0.83 [95% CI, 0.33-2.11]; P=0.69), adjusting for age and sex. CONCLUSIONS Although infrequent, post-TAVR RBBB was associated with elevated PPM implantation risk. The mechanisms for its development and its clinical prognosis require further study.
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Affiliation(s)
- Nicholas Y Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (N.Y.T., M.M., S.K.M., A.J.D., S.J.A., M.F.E., P.A.F., Y.-M.C., A.M.K.)
| | | | | | | | | | - Mikolaj Wieczorek
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL (M.W.)
| | - Malini Madhavan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (N.Y.T., M.M., S.K.M., A.J.D., S.J.A., M.F.E., P.A.F., Y.-M.C., A.M.K.)
| | - Siva K Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (N.Y.T., M.M., S.K.M., A.J.D., S.J.A., M.F.E., P.A.F., Y.-M.C., A.M.K.)
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (N.Y.T., M.M., S.K.M., A.J.D., S.J.A., M.F.E., P.A.F., Y.-M.C., A.M.K.)
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (N.Y.T., M.M., S.K.M., A.J.D., S.J.A., M.F.E., P.A.F., Y.-M.C., A.M.K.)
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (N.Y.T., M.M., S.K.M., A.J.D., S.J.A., M.F.E., P.A.F., Y.-M.C., A.M.K.)
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (N.Y.T., M.M., S.K.M., A.J.D., S.J.A., M.F.E., P.A.F., Y.-M.C., A.M.K.)
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (N.Y.T., M.M., S.K.M., A.J.D., S.J.A., M.F.E., P.A.F., Y.-M.C., A.M.K.)
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (N.Y.T., M.M., S.K.M., A.J.D., S.J.A., M.F.E., P.A.F., Y.-M.C., A.M.K.)
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10
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Naser JA, Luis SA, Pislaru SV, Michelena HI, Kennedy AM, Eleid MF, Crestanello JA, Chebib FT, Pellikka PA, Nkomo VT. Impact on Kidney Function and Medium-Term Outcomes of Transcatheter Aortic Valve Replacement in Patients With Chronic Kidney Disease. Am J Cardiol 2024; 210:163-171. [PMID: 37863302 DOI: 10.1016/j.amjcard.2023.10.014] [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: 09/17/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 10/22/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is now widely approved for the treatment of aortic stenosis, regardless of the patients' surgical risk. However, the outcomes of TAVR and their determinants in patients with chronic kidney disease (CKD) beyond 1 year of follow-up are unknown. We aimed to assess the medium-term outcomes of TAVR in CKD, develop a risk score to estimate the 2-year mortality in patients with CKD, and evaluate the changes in kidney function at discharge after TAVR. Adults who underwent TAVR were retrospectively identified. The CKD stage was determined using the Chronic Kidney Disease Epidemiology 2021 creatinine formula. Improved kidney function was defined as post-TAVR creatinine ≤50% of pre-TAVR creatinine or decrease in creatinine of ≥0.3 mg/100 ml compared with pre-TAVR creatinine. Overall, 1,523 patients (median age 82 years; 59% men; 735 with CKD stage II or less, 661 with CKD III, 83 with CKD IV, and 44 with CKD V [of whom 40 were on dialysis]) were included. The all-cause mortality was higher in CKD stages IV and V on the multivariable analysis (p <0.001) at median follow-up of 2.9 (interquartile range 2.0 to 4.2) years. Moderate or severe tricuspid regurgitation, anemia, right ventricular systolic pressure >40 mm Hg and CKD stages IV and V were independent predictors of 2-year mortality and were used to develop a risk score. At hospital discharge, persisting acute kidney injury after TAVR occurred in 88 of 1,466 patients (6%), whereas improved kidney function occurred in 170 of 1,466 patients (12%). In conclusion, CKD stage was an independent determinant of mortality beyond 2 years after TAVR. Kidney function was more likely to improve than worsen at the time of hospital discharge after TAVR.
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Affiliation(s)
- Jwan A Naser
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sushil Allen Luis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Austin M Kennedy
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Fouad T Chebib
- Department of Nephrology and Hypertension Division, Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida
| | | | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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11
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Garcia S, Elmariah S, Cubeddu RJ, Zahr F, Eleid MF, Kodali SK, Seshiah P, Sharma R, Lim DS. Mitral Transcatheter Edge-to-Edge Repair With the PASCAL Precision System: Device Knobology and Review of Advanced Steering Maneuvers. Struct Heart 2024; 8:100234. [PMID: 38283574 PMCID: PMC10818146 DOI: 10.1016/j.shj.2023.100234] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/08/2023] [Accepted: 10/08/2023] [Indexed: 01/30/2024]
Abstract
In 2022, the Food and Drug Administration approved a second mitral transcatheter edge-to-edge repair device for the treatment of primary mitral regurgitation (PASCAL Precision Transcatheter Valve Repair System, Edwards Lifesciences, Irvine, CA). The PASCAL Precision system consists of a guide sheath, implant system, and accessories. The implant system consists of a steerable catheter, an implant catheter, and the implant (PASCAL or PASCAL Ace). The guide sheath and steerable catheter move and flex independently from each other and are not keyed, allowing for freedom of rotation in three dimensions. This manuscript provides an overview of the PASCAL Precision system and describes the basic and advanced steering maneuvers to facilitate effective and safe mitral transcatheter edge-to-edge repair.
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Affiliation(s)
| | - Sammy Elmariah
- University of California, San Francisco, California, USA
| | | | - Firas Zahr
- Oregon Health Sciences University, Portland, Oregon, USA
| | | | | | - Puvi Seshiah
- The Christ Hospital Health Network, Cincinnati, Ohio, USA
| | | | - D. Scott Lim
- University of Virginia, Charlottesville, Virginia, USA
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12
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Alexandrino FB, Sandhu S, Oguz D, Nkomo VT, Eleid MF, Rihal CS, Guerrero M, Alkhouli M, Pislaru SV, Thaden JJ. Estimating Mitral Valve Area Post-Transcatheter Edge-to-Edge Repair: As Simple as 50-40. JACC Cardiovasc Interv 2023; 16:2948-2950. [PMID: 38092507 DOI: 10.1016/j.jcin.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/14/2023] [Accepted: 10/03/2023] [Indexed: 12/18/2023]
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13
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Rezkalla JA, Eleid MF. Extending the success of transcatheter valvular interventions to transplanted hearts. Trends Cardiovasc Med 2023:S1050-1738(23)00098-1. [PMID: 37992884 DOI: 10.1016/j.tcm.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Joshua A Rezkalla
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, United States
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, United States.
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14
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Alabdaljabar MS, Naser JA, Kane CJ, Lara-Breitinger KM, Anand V, Pislaru C, Eleid MF, Alkhouli MA, Kane GC, Pellikka PA, Lin G, Nkomo VT, Pislaru SV. Tricuspid Regurgitation Impact on Outcomes Score for Risk Stratification in Patients With Pulmonary Hypertension. J Am Soc Echocardiogr 2023; 36:1213-1215. [PMID: 37490988 DOI: 10.1016/j.echo.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/27/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023]
Affiliation(s)
| | - Jwan A Naser
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Conor J Kane
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Cristina Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mohamad A Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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15
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Welle GA, Eleid MF. Editorial commentary: Is it time to change focus to understand severe bicuspid aortic stenosis TAVI outcomes? Trends Cardiovasc Med 2023; 33:468-469. [PMID: 35661727 DOI: 10.1016/j.tcm.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Garrett A Welle
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
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16
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Guerrero ME, Grayburn P, Smith RL, Sorajja P, Wang DD, Ahmad Y, Blusztein D, Cavalcante J, Tang GHL, Ailawadi G, Lim DS, Blanke P, Eleid MF, Kaneko T, Thourani VH, Bapat V, Mack MJ, Leon MB, George I. Diagnosis, Classification, and Management Strategies for Mitral Annular Calcification: A Heart Valve Collaboratory Position Statement. JACC Cardiovasc Interv 2023; 16:2195-2210. [PMID: 37758378 DOI: 10.1016/j.jcin.2023.06.044] [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: 01/27/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 10/02/2023]
Abstract
Mitral annular calcium (MAC) with severe mitral valvular dysfunction presents a complex problem, as valve replacement, either surgical or transcatheter, is challenging because of anatomy, technical considerations, concomitant comorbidities, and advanced age. The authors review the clinical and anatomical features of MAC that are favorable (green light), challenging (yellow light), or prohibitive (red light) for surgical or transcatheter mitral valve interventions. Under the auspices of the Heart Valve Collaboratory, an expert working group of cardiac surgeons, interventional cardiologists, and interventional imaging cardiologists was formed to develop recommendations regarding treatment options for patients with MAC as well as a proposed grading and staging system using both anatomical and clinical features.
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Affiliation(s)
| | | | | | - Paul Sorajja
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | - Yousif Ahmad
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - David Blusztein
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - João Cavalcante
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | | | - D Scott Lim
- University of Virginia, Charlottesville, Virginia, USA
| | - Philipp Blanke
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Tsuyoshi Kaneko
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Vinayak Bapat
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | - Martin B Leon
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Isaac George
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
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17
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Guerrero ME, Eleid MF, Wang DD, Pursnani A, Kodali SK, George I, Palacios I, Russell H, Makkar RR, Kar S, Satler LF, Rajagopal V, Dangas G, Tang GHL, McCabe JM, Whisenant BK, Fang K, Balan P, Smalling R, Kaptzan T, Lewis B, Douglas PS, Hahn RT, Thaden J, Oh JK, Leon M, O'Neill W, Rihal C. 5-Year Prospective Evaluation of Mitral Valve-in-Valve, Valve-in-Ring, and Valve-in-MAC Outcomes: MITRAL Trial Final Results. JACC Cardiovasc Interv 2023; 16:2211-2227. [PMID: 37758379 DOI: 10.1016/j.jcin.2023.06.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 05/15/2023] [Revised: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The MITRAL (Mitral Implantation of Transcatheter Valves) trial is the first prospective trial to evaluate the safety and feasibility of balloon-expandable aortic transcatheter heart valves in patients with failed surgical bioprostheses or annuloplasty rings and severe mitral annular calcification treated with mitral valve-in-valve (MViV), valve-in-ring (MViR), or valve-in-mitral annular calcification (ViMAC). OBJECTIVES The aim of this study was to evaluate 5-year outcomes among these patients. METHODS A multicenter prospective study was conducted among patients at high surgical risk at 13 U.S. sites. Patients underwent MViV (n = 30), MViR (n = 30), or ViMAC (n = 31) and were followed annually for 5 years. Kansas City Cardiomyopathy Questionnaire scores were obtained at baseline and follow-up visits. Echocardiograms were analyzed at independent core laboratories. RESULTS A total of 91 patients underwent transcatheter mitral valve replacement (February 2015 to December 2017). The mean age was 74.3 ± 8.9 years. At 5-year follow-up, the lowest all-cause mortality was observed in the MViV group (21.4%), 94.7% of patients were in NYHA functional class I or II, and the mean mitral gradient was 6.6 ± 2.5 mm Hg. The MViR and ViMAC groups had higher all-cause mortality (65.5% and 67.9%), most survivors were in NYHA functional classes I and II (50% and 55.6%), and mean mitral gradients remained stable (5.8 ± 0.1 and 6.7 ± 2.5 mm Hg). Significant improvements in Kansas City Cardiomyopathy Questionnaire scores were observed when all 3 arms were pooled. CONCLUSIONS MViV, MViR, and ViMAC procedures were associated with sustained improvement of heart failure symptoms and quality of life among survivors at 5 years. Transcatheter heart valve function remained stable in all 3 groups. Patients treated with MViV had excellent survival at 5 years, whereas survival was lower in the MViR and ViMAC groups, consistent with underlying disease severity. Patients with more residual mitral regurgitation had higher mortality.
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Affiliation(s)
- Mayra E Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA
| | - Amit Pursnani
- Division of Cardiology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Susheel K Kodali
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Isaac George
- Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Igor Palacios
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hyde Russell
- Division of Cardiovascular Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Raj R Makkar
- Department of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Saibal Kar
- Division of Cardiology, Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | - Lowell F Satler
- Division of Cardiology, Medstar Washington Hospital Center, Washington, District of Columbia, USA
| | - Vivek Rajagopal
- Division of Cardiology, Piedmont Hospital, Atlanta, Georgia, USA
| | - George Dangas
- Division of Cardiology, Mount Sinai Health System, New York, New York, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | - James M McCabe
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Brian K Whisenant
- Division of Cardiology, Intermountain Heart Institute, Salt Lake City, Utah, USA
| | - Kenith Fang
- Division of Cardiology, Banner University Medical Center, Phoenix, Arizona, USA
| | - Prakash Balan
- Division of Cardiology, Banner University Medical Center, Phoenix, Arizona, USA
| | - Richard Smalling
- Division of Cardiology, Memorial Hermann Heart and Vascular Center, Texas Medical Center, Houston, Texas, USA
| | - Tatiana Kaptzan
- Cardiovascular Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Bradley Lewis
- Division of Biostatistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Jeremy Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Martin Leon
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - William O'Neill
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan, USA
| | - Charanjit Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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18
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Welle GA, Cifci G, Pislaru SV, Eleid MF. Transcatheter closure of a native mitral valve following mitral valve bypass surgery using a novel left atrial-to-left ventricle conduit-associated arteriovenous rail. Eur Heart J Case Rep 2023; 7:ytad396. [PMID: 37701922 PMCID: PMC10493635 DOI: 10.1093/ehjcr/ytad396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/14/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023]
Affiliation(s)
- Garrett A Welle
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, 200 First St. SW, Rochester, MN 55905, USA
| | - Gizem Cifci
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, 200 First St. SW, Rochester, MN 55905, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, 200 First St. SW, Rochester, MN 55905, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, 200 First St. SW, Rochester, MN 55905, USA
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19
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Rezkalla J, Eleid MF. Transcatheter Treatment of Residual Systolic-Anterior Motion and Severe Mitral Regurgitation in Hypertrophic Cardiomyopathy. JACC Cardiovasc Interv 2023; 16:2053-2055. [PMID: 37354166 DOI: 10.1016/j.jcin.2023.05.016] [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: 04/11/2023] [Revised: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 06/26/2023]
Affiliation(s)
- Joshua Rezkalla
- Department of Cardiovascular Diseases, Mayo College of Medicine, Rochester, Minnesota, USA.
| | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo College of Medicine, Rochester, Minnesota, USA
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20
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Ingraham BS, AbouEzzeddine OF, Eleid MF, Reddy YN. Dynamic Mitral Regurgitation-An Easy to Miss Reversible Cause of Severe Pulmonary Vascular Remodeling. Circ Heart Fail 2023; 16:e010735. [PMID: 37492944 PMCID: PMC10527762 DOI: 10.1161/circheartfailure.123.010735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Respirophasic MR in HFrEF with severe pulmonary vascular disease and low output heart failure– Is there a role for treating the MR? @yreddyhf @BrendenIngraham @mayoclinicCV
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Affiliation(s)
| | | | - Mackram F. Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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21
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Alabdaljabar MS, Cendrowski EE, Nishimura RA, Miranda WR, Geske JB, Rihal CS, Eleid MF. Hemodynamic Predictors of Outcome Following Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy. Circ Cardiovasc Interv 2023; 16:e013068. [PMID: 37582173 PMCID: PMC10424819 DOI: 10.1161/circinterventions.123.013068] [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: 03/17/2023] [Accepted: 07/11/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Alcohol septal ablation (ASA) is a minimally invasive treatment for drug-refractory obstructive hypertrophic cardiomyopathy. Detailed assessment of pressure changes and predictors of mortality and procedure success are not well defined. METHODS This is a single-center study evaluating pressure changes and predictors of mortality and procedure success in transseptal ASA. Survival analysis and predictors of mortality were assessed using the Kaplan-Meier analysis and Cox regression, respectively. RESULTS A total of 156 patients were included (mean age, 67.3 years; 46.8% women). Left atrial (LA) pressure and left ventricular outflow tract (LVOT) gradient decreased, whereas aortic pulse pressure (PP) increased post-ASA. Patients with lower baseline mean LA pressure ( 82% (gradient change median), and PP increase >19% (PP change median) had superior survival. On Cox univariable regression, baseline mean LA pressure >median (19 mm Hg; hazard ratio [HR], 2.09 [95% CI, 1.05-4.18]; P=0.036), residual LVOT gradient (HR, 1.02 [95% CI, 1.01-1.03]; P=0.003), and LVOT gradient percent reduction median (28 mm Hg; HR, 2.36 [95% CI, 1.17-4.76]; P=0.016), baseline mean LA pressure >median (19 mm Hg; HR, 2.70 [95% CI, 1.33-5.50]; P=0.006), percentage reduction in gradient CONCLUSIONS ASA is associated with an acute decrease in the LVOT gradient and LA pressures and increase in aortic PP. Mean LA pressure, percentage decrease in LVOT gradient, and increase in PP are strong predictors of survival free of all-cause mortality following ASA and are important variables for procedural guidance.
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Affiliation(s)
| | - Emily E. Cendrowski
- Cardiovascular Medicine (E.E.C., R.A.N., W.R.M., J.B.G., C.S.R., M.F.E.), Mayo Clinic, Rochester, MN
| | - Rick A. Nishimura
- Cardiovascular Medicine (E.E.C., R.A.N., W.R.M., J.B.G., C.S.R., M.F.E.), Mayo Clinic, Rochester, MN
| | - William R. Miranda
- Cardiovascular Medicine (E.E.C., R.A.N., W.R.M., J.B.G., C.S.R., M.F.E.), Mayo Clinic, Rochester, MN
| | - Jeffrey B. Geske
- Cardiovascular Medicine (E.E.C., R.A.N., W.R.M., J.B.G., C.S.R., M.F.E.), Mayo Clinic, Rochester, MN
| | - Charanjit S. Rihal
- Cardiovascular Medicine (E.E.C., R.A.N., W.R.M., J.B.G., C.S.R., M.F.E.), Mayo Clinic, Rochester, MN
| | - Mackram F. Eleid
- Cardiovascular Medicine (E.E.C., R.A.N., W.R.M., J.B.G., C.S.R., M.F.E.), Mayo Clinic, Rochester, MN
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22
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Rajiah PS, Reddy P, Baliyan V, Hedgire SS, Foley TA, Williamson EE, Eleid MF. Utility of CT and MRI in Tricuspid Valve Interventions. Radiographics 2023; 43:e220153. [PMID: 37384544 DOI: 10.1148/rg.220153] [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] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Transcatheter tricuspid valve interventions (TTVIs) comprise a variety of catheter-based interventional techniques for treatment of tricuspid regurgitation (TR) in patients at high surgical risk and those with failed previous surgeries. Several TTVI devices with different mechanisms of action are either currently used or in preclinical evaluation. Echocardiography is the first-line modality for evaluation of tricuspid valve disease that provides information on tricuspid valve morphology, mechanism of TR, and hemodynamics. Cardiac CT and MRI have several advantages for a comprehensive preprocedure evaluation. CT and MRI provide complementary information to that of echocardiography on the mechanism and cause of TR. MRI can quantify the severity of TR using indirect or direct techniques that involve two-dimensional or four-dimensional flow sequences. MRI and CT can also accurately quantify right ventricular volumes and function, which is crucial for timing of intervention. CT provides comprehensive three-dimensional information on the morphology of the valve, annulus, subvalvular apparatus, and adjacent structures. CT is the procedure of choice for evaluation of several device-specific measurements, including tricuspid annulus dimensions, annulus-to-right coronary artery distance, leaflet morphology, coaptation gaps, caval dimensions, and cavoatrial-to-hepatic vein distance. CT allows evaluation of the vascular access as well as optimal procedure fluoroscopic angles and catheter trajectory. Postprocedure CT and MRI are useful in detection of complications such as paravalvular leak, pseudoaneurysm, thrombus, pannus, infective endocarditis, and device migration. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Prabhakar Shantha Rajiah
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Prajwal Reddy
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Vinit Baliyan
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Sandeep S Hedgire
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Thomas A Foley
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Eric E Williamson
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
| | - Mackram F Eleid
- From the Departments of Radiology (P.S.R., T.A.F., E.E.W.) and Cardiology (P.R., M.F.E.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Radiology, Massachusetts General Hospital, Boston, Mass (V.B., S.S.H.)
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23
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Alabdaljabar MS, Eleid MF. Risk Factors, Management, and Avoidance of Conduction System Disease after Transcatheter Aortic Valve Replacement. J Clin Med 2023; 12:4405. [PMID: 37445439 DOI: 10.3390/jcm12134405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/14/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Transcatheter valve replacement (TAVR) is a rapidly developing modality to treat patients with aortic stenosis (AS). Conduction disease post TAVR is one of the most frequent and serious complications experienced by patients. Multiple factors contribute to the risk of conduction disease, including AS and the severity of valve calcification, patients' pre-existing conditions (i.e., conduction disease, anatomical variations, and short septum) in addition to procedure-related factors (e.g., self-expanding valves, implantation depth, valve-to-annulus ratio, and procedure technique). Detailed evaluation of risk profiles could allow us to better prevent, recognize, and treat this entity. Available evidence on management of conduction disease post TAVR is based on expert opinion and varies widely. Currently, conduction disease in TAVR patients is managed depending on patient risk, with minimal-to-no inpatient/outpatient observation, inpatient monitoring (24-48 h) followed by ambulatory monitoring, or either prolonged inpatient and outpatient monitoring or permanent pacemaker implantation. Herein, we review the incidence and risk factors of TAVR-associated conduction disease and discuss its management.
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Affiliation(s)
| | - Mackram F Eleid
- Division of Interventional Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
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Rezkalla J, Reddy Y, Nishimura RA, Padang R, Pislaru SV, Rihal CS, Eleid MF. Right heart catheterization predictors of symptomatic improvement in patients undergoing transcatheter tricuspid valve edge-to-edge repair. Catheter Cardiovasc Interv 2023. [PMID: 37350295 DOI: 10.1002/ccd.30754] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/11/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Transcatheter tricuspid valve edge-to-edge repair (TTEER) is associated with improvement in outcomes for symptomatic patients with severe tricuspid regurgitation (TR). However, reliable predictors for clinical success are not yet fully defined. This study aims to describe right heart catheterization (RHC) findings in patients referred for TTEER and identify hemodynamic characteristics of patients who experience immediate symptomatic improvement following successful TR intervention. METHODS Patients who underwent TTEER and had a separate RHC within the preceding 6 months were included. Hemodynamic tracings from the RHC and TTEER procedures were reviewed and recorded. Clinical success was defined as a successful device implant with at least 1-grade of TR reduction and improvement in NYHA class by 1 or more grades on 30-day echocardiogram and clinical follow-up. RESULTS Thirteen patients underwent an RHC within 6 months of TTEER procedure (median age 76 years [IQR: 73-80]). All patients were on a stable dose of loop diuretics. Baseline right atrial pressure was severely elevated (mean 19 mmHg [IQR: 9-24 mmHg]) with prominent CV waves. Median pulmonary capillary wedge pressure (PCWP) was 20 mmHg (IQR: 14-22) and 70% of patients had a mean PCWP > 15 mmHg at rest. Median PCWP CV-wave was 34 mmHg (IQR: 23-42). Higher PCWP CV-wave height (40 mmHg [IQR 33-43] versus 18 mmHg [IQR 17-31]) was associated with lower likelihood of clinical success (OR 0.83, 95% CI: 0.35-0.97, p = 0.04). CONCLUSIONS Inclusion of invasive hemodynamics as part of pre-TTEER evaluation may allow for improved TR phenotyping and patient selection. Patients with a large left atrial CV wave on resting RHC were less likely to experience immediate symptomatic improvement despite procedural success with TTEER.
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Affiliation(s)
- Joshua Rezkalla
- Department of Cardiovascular Diseases, Mayo College of Medicine, Rochester, Minnesota, USA
| | - Yogesh Reddy
- Department of Cardiovascular Diseases, Mayo College of Medicine, Rochester, Minnesota, USA
| | - Rick A Nishimura
- Department of Cardiovascular Diseases, Mayo College of Medicine, Rochester, Minnesota, USA
| | - Ratnasari Padang
- Department of Cardiovascular Diseases, Mayo College of Medicine, Rochester, Minnesota, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Diseases, Mayo College of Medicine, Rochester, Minnesota, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo College of Medicine, Rochester, Minnesota, USA
| | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo College of Medicine, Rochester, Minnesota, USA
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Hosseini M, Lahr BD, Greason KL, Arghami A, Gulati R, Eleid MF, Crestanello JA. Obesity and vascular complication in percutaneous transfemoral transcatheter aortic valve insertion. Catheter Cardiovasc Interv 2023; 101:1221-1228. [PMID: 37036273 DOI: 10.1002/ccd.30658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/01/2023] [Accepted: 03/19/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Obesity has been associated with an increased risk of vascular complication during percutaneous coronary intervention, but there are no data on the risk of vascular complication during percutaneous transfemoral transcatheter aortic valve insertion (TAVI). OBJECTIVES We hypothesized there would be a similar increased risk associated with TAVI. METHODS We reviewed the records of 1176 patients who received percutaneous transfemoral transcatheter aortic valve insertion from September 2015 to September 2020. All patients received 1) preoperative computed tomoraphy angiography assessment of the abdomen and pelvis to delineate iliofemoral artery anatomy, 2) ultrasound-guided percutaneous femoral arterial access, and 3) pre-closure of the delivery sheath femoral access site. Vascular complication was recorded based on definitions set forth by Valve Academic Research Consortium 3. RESULTS The median age of patients was 81 years, and 60% were men. The median body mass index (BMI) was 29 kg/m2 (range, 11-67), and 91 (8%) patients had a value ≥40 kg/m2 (i.e., morbid obesity). Delivery sheath size was 14-French in 859 (73%) patients, 16-French in 311 (26%), and 18-French in 6 (1%). Vascular complication occurred in 53 (5%) patients, including 39 (7%) among the first half of procedures and 14 (2%) among the second half (p < 0.001). When stratified by obesity status (BMI < or ≥30 kg/m2 , p < 0.001), the complication rate was 4% in nonobese patients and 5% in obese patients. Multivariable analysis showed no overall association between risk of vascular complication and BMI categories (p = 0.583)BMI continuous values (p = 0.529), or sheath size (p = 0.217). CONCLUSIONS Obesity is not associated with a vascular complication during percutaneous transfemoral transcatheter aortic valve insertion. The operation should not be denied in obese patients.
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Affiliation(s)
- Motahar Hosseini
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian D Lahr
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajiv Gulati
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan A Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Rezkalla J, Eleid MF. The clinical role of invasive hemodynamics in the evaluation and treatment of structural heart disease. Expert Rev Cardiovasc Ther 2023. [PMID: 37232429 DOI: 10.1080/14779072.2023.2219058] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Recognition and evaluation of structural heart disease has become more common in clinical practice and will continue to grow as the population ages. With the growing availability of surgical and transcatheter interventional options, appropriate evaluation and patient selection for therapy is required. While echocardiography can frequently provide the required anatomic and hemodynamic information required to guide therapeutic decisions, there remains subsets of patients in which noninvasive testing yields inconclusive results prompting the need for invasive hemodynamics. AREAS COVERED This article reviews the indications and strengths of invasive hemodynamics in a variety of structural heart diseases. We describe the utilization and benefits of continuous hemodynamics during transcatheter interventions and review the prognostic information that can be gleaned from changes in hemodynamics after intervention. EXPERT OPINION The advancement of transcatheter therapies for structural heart disease has sparked a renewed interest in the utilization of invasive hemodynamics. Continued growth and accessibility of comprehensive hemodynamics for clinical practice will rely on clinicians to continually review, refine, and develop procedural techniques beyond the current training standards in order to further advance the field.
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Affiliation(s)
- Joshua Rezkalla
- Department of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, USA
| | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, USA
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Naser JA, Kucuk HO, Gochanour BR, Scott CG, Kennedy AM, Luis SA, Pislaru C, Greason KL, Crestanello JA, Gulati R, Eleid MF, Nkomo VT, Pislaru SV. Medium-Term Outcomes of the Different Antithrombotic Regimens After Transcatheter Aortic Valve Implantation. Am J Cardiol 2023:S0002-9149(23)00214-X. [PMID: 37202327 DOI: 10.1016/j.amjcard.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 05/20/2023]
Abstract
Bioprosthetic valve thrombosis is associated with accelerated bioprosthesis degeneration and valve re-replacement. Whether 3-month warfarin use after transcatheter aortic valve implantation (TAVI) protects against such consequences is unknown. We aimed to investigate if 3-month warfarin treatment after TAVI is associated with better outcomes than dual antiplatelet therapy (DAPT) and single antiplatelet therapy (SAPT) at medium-term follow-up. Adults who underwent TAVI were identified retrospectively (n = 1,501) and classified into warfarin, DAPT, and SAPT groups based on antithrombotic regimen received. Patients with atrial fibrillation were excluded. Outcomes and valve hemodynamics were compared between the groups. Annualized change from baseline in mean gradients and effective orifice area at last follow-up echocardiography was calculated. Overall, 844 patients were included (mean age: 80 ± 9 years, 43% women; 633 receiving warfarin, 164 DAPT, and 47 SAPT). Median time to follow-up was 2.5 (interquartile range 1.2 to 3.9) years. There were no differences in the adjusted outcome end points of ischemic stroke, death, valve re-replacement/intervention, structural valve degeneration, or their composite end point at follow-up. Annualized change in aortic valve area was significantly higher in DAPT (-0.11 [0.19] cm2/year) than warfarin (-0.06 [0.25] cm2/y, p = 0.03), but annualized change in mean gradients was not different (p >0.05). In conclusion, antithrombotic regimen, including warfarin, after TAVI was associated with marginally lower decrease in aortic valve area but no difference in medium-term clinical outcomes compared with DAPT and SAPT.
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Kodali SK, Hahn RT, Davidson CJ, Narang A, Greenbaum A, Gleason P, Kapadia S, Miyasaka R, Zahr F, Chadderdon S, Smith RL, Grayburn P, Kipperman RM, Marcoff L, Whisenant B, Gonzales M, Makkar R, Makar M, O'Neill W, Wang DD, Gray WA, Abramson S, Hermiller J, Mitchel L, Lim DS, Fowler D, Williams M, Pislaru SV, Dahou A, Mack MJ, Leon MB, Eleid MF. 1-Year Outcomes of Transcatheter Tricuspid Valve Repair. J Am Coll Cardiol 2023; 81:1766-1776. [PMID: 37137586 DOI: 10.1016/j.jacc.2023.02.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/14/2023] [Accepted: 02/21/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Surgical management of isolated tricuspid regurgitation (TR) is associated with high morbidity and mortality, thereby creating a significant need for a lower-risk transcatheter solution. OBJECTIVES The single-arm, multicenter, prospective CLASP TR (Edwards PASCAL TrAnScatheter Valve RePair System in Tricuspid Regurgitation [CLASP TR] Early Feasibility Study) evaluated 1-year outcomes of the PASCAL transcatheter valve repair system (Edwards Lifesciences) to treat TR. METHODS Study inclusion required a previous diagnosis of severe or greater TR and persistent symptoms despite medical treatment. An independent core laboratory evaluated echocardiographic results, and a clinical events committee adjudicated major adverse events. The study evaluated primary safety and performance outcomes, with echocardiographic, clinical, and functional endpoints. Study investigators report 1-year all-cause mortality and heart failure hospitalization rates. RESULTS Sixty-five patients were enrolled: mean age of 77.4 years; 55.4% female; and 97.0% with severe to torrential TR. At 30 days, cardiovascular mortality was 3.1%, the stroke rate was 1.5%, and no device-related reinterventions were reported. Between 30 days and 1 year, there were an additional 3 cardiovascular deaths (4.8%), 2 strokes (3.2%), and 1 unplanned or emergency reintervention (1.6%). One-year postprocedure, TR severity significantly reduced (P < 0.001), with 31 of 36 (86.0%) patients achieving moderate or less TR; 100% had at least 1 TR grade reduction. Freedom from all-cause mortality and heart failure hospitalization by Kaplan-Meier analyses were 87.9% and 78.5%, respectively. Their New York Heart Association functional class significantly improved (P < 0.001) with 92% in class I or II, 6-minute walk distance increased by 94 m (P = 0.014), and overall Kansas City Cardiomyopathy Questionnaire scores improved by 18 points (P < 0.001). CONCLUSIONS The PASCAL system demonstrated low complication and high survival rates, with significant and sustained improvements in TR, functional status, and quality of life at 1 year. (Edwards PASCAL TrAnScatheter Valve RePair System in Tricuspid Regurgitation [CLASP TR] Early Feasibility Study [CLASP TR EFS]; NCT03745313).
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Affiliation(s)
- Susheel K Kodali
- Columbia University Irving Medical Center, New York, New York, USA.
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Akhil Narang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | | | | | - Firas Zahr
- Oregon Health and Science University Hospital, Portland, Oregon, USA
| | - Scott Chadderdon
- Oregon Health and Science University Hospital, Portland, Oregon, USA
| | - Robert L Smith
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Paul Grayburn
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | | | - Leo Marcoff
- Morristown Medical Center, Morristown, New Jersey, USA
| | | | | | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Moody Makar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | | | | | - James Hermiller
- St Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | - Lucas Mitchel
- St Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | - D Scott Lim
- University of Virginia Health System, Charlottesville, Virginia, USA
| | - Dale Fowler
- University of Virginia Health System, Charlottesville, Virginia, USA
| | | | | | | | - Michael J Mack
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Martin B Leon
- Columbia University Irving Medical Center, New York, New York, USA
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Chao CJ, Agasthi P, Seri AR, Barry T, Shanbhag A, Wang Y, Eleid MF, Fortuin D, Sweeney JP, Pollak P, El Sabbagh A, Lester SJ, Freeman WK, Naqvi TZ, Holmes DR, Appleton CP, Arsanjani R. Transcatheter Aortic Valve Replacement Prognostication with Augmented Mean Arterial Pressure. J Cardiovasc Dev Dis 2023; 10:jcdd10050192. [PMID: 37233159 DOI: 10.3390/jcdd10050192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Post-transcatheter aortic valve replacement (TAVR) patient outcome is an important research topic. To accurately assess post-TAVR mortality, we examined a family of new echo parameters (augmented systolic blood pressure (AugSBP) and arterial mean pressure (AugMAP)) derived from blood pressure and aortic valve gradients. METHODS Patients in the Mayo Clinic National Cardiovascular Diseases Registry-TAVR database who underwent TAVR between 1 January 2012 and 30 June 2017 were identified to retrieve baseline clinical, echocardiographic and mortality data. AugSBP, AugMAP and valvulo-arterial impedance (Zva) (Zva) were evaluated using Cox regression. Receiver operating characteristic curve analysis and the c-index were used to assess the model performance against the Society of Thoracic Surgeons (STS) risk score. RESULTS The final cohort contained 974 patients with a mean age of 81.4 ± 8.3 years old, and 56.6% were male. The mean STS risk score was 8.2 ± 5.2. The median follow-up duration was 354 days, and the one-year all-cause mortality rate was 14.2%. Both univariate and multivariate Cox regression showed that AugSBP and AugMAP parameters were independent predictors for intermediate-term post-TAVR mortality (all p < 0.0001). AugMAP1 < 102.5 mmHg was associated with a 3-fold-increased risk of all-cause mortality 1-year post-TAVR (hazard ratio 3.0, 95%confidence interval 2.0-4.5, p < 0.0001). A univariate model of AugMAP1 surpassed the STS score model in predicting intermediate-term post-TAVR mortality (area under the curve: 0.700 vs. 0.587, p = 0.005; c-index: 0.681 vs. 0.585, p = 0.001). CONCLUSIONS Augmented mean arterial pressure provides clinicians with a simple but effective approach to quickly identify patients at risk and potentially improve post-TAVR prognosis.
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Affiliation(s)
- Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN 55905, USA
| | - Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN 55905, USA
| | - Amith R Seri
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Timothy Barry
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Anusha Shanbhag
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Yuxiang Wang
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN 55905, USA
| | - David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - John P Sweeney
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Peter Pollak
- Department of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Abdallah El Sabbagh
- Department of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Steven J Lester
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - William K Freeman
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - Tasneem Z Naqvi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN 55905, USA
| | | | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA
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Eleid MF, Collins JD, Mahoney P, Williamson EE, Killu AM, Whisenant BK, Rihal CS, Guerrero ME. Emerging Approaches to Management of Left Ventricular Outflow Obstruction Risk in Transcatheter Mitral Valve Replacement. JACC Cardiovasc Interv 2023; 16:885-895. [PMID: 37100552 DOI: 10.1016/j.jcin.2023.01.357] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 11/22/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 04/28/2023]
Abstract
An increasing number of patients with mitral valve disease are high risk for surgery and in need of less invasive treatments including transcatheter mitral valve replacement (TMVR). Left ventricular outflow tract (LVOT) obstruction is a predictor of poor outcome after TMVR, and its risk can be accurately predicted using cardiac computed tomography analysis. Novel treatment strategies that have shown efficacy in reducing risk of LVOT obstruction after TMVR include pre-emptive alcohol septal ablation, radiofrequency ablation, and anterior leaflet electrosurgical laceration. This review describes recent advances in the management of LVOT obstruction risk after TMVR, provides a new management algorithm, and explores forthcoming studies that will further advance the field.
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Affiliation(s)
- Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. https://twitter.com/EleidMack
| | | | | | | | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian K Whisenant
- Division of Cardiology, Intermountain Heart Institute, Salt Lake City, Utah, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mayra E Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. https://twitter.com/MayraGuerreroMD
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Samimi S, Chavez Ponce A, Alarouri HS, Shaer AE, Eleid MF, Guerrero ME, Rihal CS, Alkhouli M. Predictors of hemodynamic response to mitral transcatheter edge-to-edge repair. Catheter Cardiovasc Interv 2023; 101:1120-1127. [PMID: 37017419 DOI: 10.1002/ccd.30646] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/20/2023] [Accepted: 03/10/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Improvement in left atrial pressure (LAP) during transcatheter edge-to-edge repair (TEER) is associated with improved outcomes. We sought to investigate the predictors of optimal hemodynamic response to TEER. METHODS We identified patients who underwent TEER at Mayo Clinic between May 2014 and February 2022. Patients with missing LAP data, an aborted procedure, and those undergoing a concomitant tricuspid TEER were excluded. We performed a logistic regression analysis to identify predictors of optimal hemodynamic response to TEER (defined as LAP ≤ 15 mmHg). RESULTS A total of 473 patients were included (Mean age 78.5 ± 9.4 years, 67.2% males). Overall, 195 (41.2%) achieved an optimal hemodynamic response after TEER. Patients who did not achieve an optimal response had higher baseline LAP (20.0 [17-25] vs. 15.0 [12-18] mmHg, p < 0.001), higher prevalence of AF (68.3% vs. 55.9%, p = 0.006), functional MR (47.5% vs. 35.9%, p = 0.009), annular calcification (41% vs. 29.2%, p = 0.02), lower left ventricular EF (55% vs. 58%, p = 0.02), and more frequent postprocedural severe MR (11.9% vs. 5.1%, p = 0.02) and elevated mitral gradient >5 mmHg (30.6% vs. 14.4%, p < 0.001). In the multivariate logistic regression analysis, AF (OR = 0.58; 95% CI = 0.35-0.96; p = 0.03), baseline LAP (OR = 0.80; 95% CI = 0.75-0.84; p < 0.001) and postprocedural mitral gradient <5 mmHg (OR = 0.35; 95% CI = 0.19-0.65; p < 0.001), were independent predictors of achieving an optimal hemodynamic response. In the multivariate model, residual MR was not independently associated with optimal hemodynamic response. CONCLUSIONS Optimal hemodynamic response is achieved in 4 in 10 patients undergoing TEER. AF, higher baseline LAP, and higher postprocedural mitral gradient were negative predictors of optimal hemodynamic response after TEER.
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Affiliation(s)
- Sahar Samimi
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Hasan S Alarouri
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmed El Shaer
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Mackram F Eleid
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Mayra E Guerrero
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
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Agasthi P, Ashraf H, Pujari SH, Girardo M, Tseng A, Mookadam F, Venepally N, Buras MR, Abraham B, Khetarpal BK, Allam M, MD SKM, Eleid MF, Greason KL, Beohar N, Sweeney J, Fortuin D, Holmes DRJ, Arsanjani R. Prediction of permanent pacemaker implantation after transcatheter aortic valve replacement: The role of machine learning. World J Cardiol 2023; 15:95-105. [PMID: 37033682 PMCID: PMC10074998 DOI: 10.4330/wjc.v15.i3.95] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/04/2023] [Accepted: 03/01/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Atrioventricular block requiring permanent pacemaker (PPM) implantation is an important complication of transcatheter aortic valve replacement (TAVR). Application of machine learning could potentially be used to predict pre-procedural risk for PPM.
AIM To apply machine learning to be used to predict pre-procedural risk for PPM.
METHODS A retrospective study of 1200 patients who underwent TAVR (January 2014-December 2017) was performed. 964 patients without prior PPM were included for a 30-d analysis and 657 patients without PPM requirement through 30 d were included for a 1-year analysis. After the exclusion of variables with near-zero variance or ≥ 50% missing data, 167 variables were included in the random forest gradient boosting algorithm (GBM) optimized using 5-fold cross-validations repeated 10 times. The receiver operator curve (ROC) for the GBM model and PPM risk score models were calculated to predict the risk of PPM at 30 d and 1 year.
RESULTS Of 964 patients included in the 30-d analysis without prior PPM, 19.6% required PPM post-TAVR. The mean age of patients was 80.9 ± 8.7 years. 42.1 % were female. Of 657 patients included in the 1-year analysis, the mean age of the patients was 80.7 ± 8.2. Of those, 42.6% of patients were female and 26.7% required PPM at 1-year post-TAVR. The area under ROC to predict 30-d and 1-year risk of PPM for the GBM model (0.66 and 0.72) was superior to that of the PPM risk score (0.55 and 0.54) with a P value < 0.001.
CONCLUSION The GBM model has good discrimination and calibration in identifying patients at high risk of PPM post-TAVR.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Hasan Ashraf
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Sai Harika Pujari
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY 11201, United States
| | - Marlene Girardo
- Department of Biostatistics, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Andrew Tseng
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Farouk Mookadam
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Nithin Venepally
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Matthew R Buras
- Department of Statistics, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Bishoy Abraham
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | | | - Mohamed Allam
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Siva K Mulpuru MD
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905, United States
| | - Nirat Beohar
- Mount Sinai Medical Center, Columbia University, Miami Beach, FL 33138, United States
| | - John Sweeney
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - David Fortuin
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - David R Jr Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Reza Arsanjani
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
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Ponce AC, Samimi S, El Shaer A, Sulaiman S, Eleid MF, Guererro M, Thaden J, Rihal CS, Alkhouli M. Hemodynamic Profiling of Patients Undergoing Transcatheter Mitral Edge-to-Edge Repair. JACC Cardiovasc Interv 2023; 16:1008-1009. [PMID: 36964099 DOI: 10.1016/j.jcin.2023.01.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/21/2023] [Accepted: 01/31/2023] [Indexed: 03/26/2023]
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Ghorbanzadeh A, Lewis BR, Kaptzan T, Williamson E, Thaden J, Oh JK, Eleid MF, Guerrero ME. OUTCOMES OF IATROGENIC ATRIAL SEPTAL DEFECT CLOSURE AFTER TRANSSEPTAL TRANSCATHETER MV REPLACEMENT (TMVR) IN THE MITRAL (MITRAL IMPLANTATION OF TRANSCATHETER VALVES) TRIAL. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01293-7] [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: 03/06/2023]
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Santos-Patarroyo S, Vallejo BA, Toro-Manotas R, Daryanani A, Nkomo VT, Michelena HI, Eleid MF, Greason K, Villarraga HR. ECHOCARDIOGRAPHIC PREDICTORS OF 18-MONTH ALL-CAUSE MORTALITY IN CANCER PATIENTS (CHEST RADIOTHERAPY AND CHEMOTHERAPY VS CHEMOTHERAPY ONLY VS CONTROLS) THAT UNDERWENT TAVR FOR SEVERE AORTIC STENOSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02446-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Lugo-Fagundo N, Pierre K, Adedinsewo D, Simard T, Alkhouli M, Eleid MF, Rihal CS, Guerrero M, El Sabbagh A. The impact of baseline transmitral diastolic mean gradient on left atrial pressure reduction in patients undergoing transcatheter mitral valve edge-to-edge repair. Catheter Cardiovasc Interv 2023; 101:605-609. [PMID: 36718052 DOI: 10.1002/ccd.30577] [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: 08/24/2022] [Revised: 12/23/2022] [Accepted: 01/15/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Elevated transmitral gradient post transcatheter mitral valve edge-to-edge repair (TEER) has been associated with worse outcomes. Whether an elevated baseline transmitral diastolic mean gradient (MG) ≥5 mmHg is associated with hemodynamic outcomes after TEER is unknown. METHODS A total of 164 consecutive patients undergoing TEER at Mayo Clinic between June 2014 and May 2018 were analyzed in this retrospective study. Baseline demographics, as well as clinical, echocardiographic, and procedural data were obtained. Data on direct left atrial pressure (LAP) before and after TEER were recorded. Logistic regression models were constructed to evaluate the association between preprocedure transmitral diastolic mean gradient (pre-MG) and (1) improvement in LAP following TEER, (2) postprocedure transmitral diastolic mean gradient (post-MG). A decrease in LAP post TEER was considered an improvement in hemodynamic response. Pre-MG was categorized as: ≥5 and <5 mmHg. RESULTS Median age of the cohort was 81.5 years (Q1: 76.3, Q3: 87) and 34% were female. At baseline, median transmitral diastolic MG was 4 mmHg (Q1: 3, Q3: 5) and median LAP was 19 mmHg (Q1:16, Q3: 23.5). In a multivariable model, adjusted for age and sex, patients with pre-MG ≥ 5 mmHg were less likely to see an improvement in LAP post TEER (adjusted odds ratio [aOR]: 0.22, 95% confidence interval [CI]: 0.09, 0.55; p = 0.001) and more likely to have elevated post-MG (aOR; 7.08, 95% CI: 2.93, 17.13; p < 0.001). CONCLUSION Higher pre-MG (≥5 mmHg) was associated with a lower reduction in LAP and higher residual transmitral gradient following TEER suggesting other potential contributors to increased LAP besides mitral regurgitation as a cause of elevated baseline MG.
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Affiliation(s)
- Nahyr Lugo-Fagundo
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Keniel Pierre
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Demilade Adedinsewo
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Abdallah El Sabbagh
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Eleid MF, Nkomo VT, Pislaru SV, Gersh BJ. Valvular Heart Disease: New Concepts in Pathophysiology and Therapeutic Approaches. Annu Rev Med 2023; 74:155-170. [PMID: 36400067 DOI: 10.1146/annurev-med-042921-122533] [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] [Indexed: 11/21/2022]
Abstract
This review discusses recent advancements in the field of valvular heart disease. Topics covered include recognition of the impact of atrial fibrillation on development and assessment of valvular disease, strategies for global prevention of rheumatic heart disease, understanding and management of secondary mitral regurgitation, the updated classification of bicuspid aortic valve disease, recognition of heightened cardiovascular risk associated with moderate aortic stenosis, and a growing armamentarium of transcatheter therapies.
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Affiliation(s)
- Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA;
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA;
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA;
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA;
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Crestanello JA, Greason KL, Mathew J, Eleid MF, Nkomo VT, Rihal CS, Bagameri G, Holmes DR, Pislaru SV, Sandhu GS, Lee AT, King KS, Alkhouli M. The Interaction of FEV1 and NT-Pro-BNP with Outcomes after Transcatheter Aortic Valve Replacement. Eur J Cardiothorac Surg 2023; 63:6988033. [PMID: 36645236 DOI: 10.1093/ejcts/ezad017] [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: 07/27/2022] [Revised: 12/29/2022] [Accepted: 01/14/2023] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Low forced expiratory volume in 1 second (FEV1) and elevated N-terminal Pro form B-type natriuretic peptide (NT-Pro-BNP) have been individually associated with poor outcomes after transcatheter aortic valve replacement (TAVR). We hypothesized a combination of the two would provide prognostic indication after TAVR. METHODS We categorized 871 patients who received TAVR from 2008 to 2018 into 4 groups according to baseline FEV1 (< or ≥ 60% predicted) and NT-Pro-BNP (< or ≥ 1601 pg/ml): group A (n = 312, high FEV1, low NT-Pro-BNP), group B (n = 275, high FEV1, high NT-Pro-BNP), group C (n = 123 low FEV1, low NT-Pro-BNP), and group D (n = 161, low FEV1, high NT-Pro-BNP). The primary endpoint was survival at 1 and 5 years. RESULTS Patients in group A had more severe aortic stenosis and achieved the best long-term survival at 1- (93% (95% CI: 90-96) and 5- years (45.3% (95% CI: 35.4-58). Low FEV1 and high NT-Pro-BNP (group D) patients had more severe symptoms, higher Society of Thoracic Surgeons predicted risk of operative mortality, lower ejection fraction and aortic valve gradient at baseline. They had the worst survival at 1- (76% (95% CI: 69-83) and at 5-years (13.1% (95% CI: 7-25), Hazard Ratio compared to group A: 2.29 (95% CI: 1.6-3.2, p < 0.001) with 25.7% of patients in NYHA class III-IV. Patients in groups B and C had intermediate outcomes. CONCLUSIONS The combination of FEV1 and NT-Pro-BNP stratify patients into 4 groups with distinct risk profiles and clinical outcomes. Patients with low FEV1 and high NT-Pro-BNP have increased comorbidities, poor functional outcomes, and decreased long term survival after TAVR.
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Affiliation(s)
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Jessey Mathew
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Alexander T Lee
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Katherine S King
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Patlolla SH, Schaff HV, Nishimura RA, Eleid MF, Geske JB, Ommen SR. Impact of Race and Ethnicity on Use and Outcomes of Septal Reduction Therapies for Obstructive Hypertrophic Cardiomyopathy. J Am Heart Assoc 2022; 12:e026661. [PMID: 36565202 PMCID: PMC9973566 DOI: 10.1161/jaha.122.026661] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Information on impact of race and ethnicity on use and early outcomes of septal reduction therapies (SRTs) for obstructive hypertrophic obstructive cardiomyopathy are limited. Methods and Results Using the National Inpatient Sample from January 2012 through December 2019, we identified all adult admissions with a primary diagnosis of obstructive hypertrophic cardiomyopathy and those undergoing SRT. Predictors of receiving SRT and outcomes including in-hospital mortality, complications, and resource use were evaluated in racial and ethnic groups. Among a total of 18 895 adult admissions with obstructive hypertrophic cardiomyopathy, SRT was performed in 7255 (38.4%) admissions. Septal myectomy was performed in 4930 (26.1%), while alcohol septal ablation was performed in 2325 (12.3%). In adjusted analysis, Black patient (versus White patient adjusted odds ratio, 0.65 [95% CI, 0.57-0.73]; P<0.001) and Hispanic patient admissions (versus White adjusted odds ratio, 0.78 [95% CI, 0.66-0.92]; P=0.003) were less likely to receive SRT. Among admissions undergoing SRT, in-hospital mortality was significantly higher for Hispanic (adjusted odds ratio, 3.38 [95% CI, 1.81-6.30], P<0.001) and other racial and ethnic groups (adjusted odds ratio 2.02 [95% CI, 1.00-4.11]; P=0.05) compared with White patient admissions, whereas Black patient admissions had comparable mortality. Black, Hispanic, and other ethnic group patients had higher rates of SRT complications and more frequent dismissals to acute care facilities. Conclusions Among obstructive hypertrophic cardiomyopathy hospitalizations, minoritized racial groups were less likely to receive SRT. Importantly, hospitalizations of Hispanic and other ethnic patients undergoing SRT had significantly higher in-hospital mortality and complication rates. Further studies with granular echocardiographic information to assess indications for SRT are needed to better understand these differences.
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Affiliation(s)
| | | | | | | | | | - Steve R. Ommen
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
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Chao CJ, Seri A, Abraham B, Farina JM, Fennelly E, Campany M, Pereyra M, Said EF, Kenyon C, Fath AR, Smith S, Buckner-Petty S, Rayfield CA, Fortuin D, Sweeney JP, Yang EH, Ayoub C, Eleid MF, Alkhouli M, Rihal CS, Holmes DR, Pollak PM, El Sabbagh A, Oh JK, Arsanjani R. Impact of Persistent Iatrogenic Atrial Septal Defect following MitraClip. J Cardiovasc Dev Dis 2022; 10:jcdd10010001. [PMID: 36661896 PMCID: PMC9864604 DOI: 10.3390/jcdd10010001] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Prior studies have reported conflicting results of persistent iatrogenic atrial septal defect (iASD) and its impact following a transcatheter edge-to-edge repair (TEER) procedure. This study aims to evaluate the incidence of iASD and its clinical and hemodynamic impact after a TEER. METHODS Consecutive patients who underwent a TEER procedure from June 2014 to September 2020 at the Mayo Clinic were identified. The presence of iASD was retrospectively identified on post-procedure transthoracic echocardiography (TTE) to group patients into an iASD+ group and an iASD- group for comparison of prognosis and cardiac function. RESULTS A total of 316 patients were included; the mean age was 79.1 ± 9.1 years, and 67.7% were male. Persistent iASD was diagnosed in 108 (34.2%) patients. There was no difference concerning all-cause mortality, heart failure hospitalization, and stroke/TIA between groups at follow-up (median follow-up of 9 months). Post-procedure TTE demonstrated no differences regarding right ventricle (RV) and left ventricle (LV) dimensions and function, including TAPSE (15.2 ± 4.6 vs. 15.4 ± 5.5 mm, p = 0.875), and LV ejection fraction (51.1 ± 14.0% vs. 51.3 ± 13.9%, p = 0.933). However, patients with iASD had higher RV systolic pressure (48.7 ± 14.4 vs. 45.5 ± 14.5 mmHg, p = 0.042) compared with patients without iASD. CONCLUSION Notwithstanding higher RV pressures, patients with persistent iASD had no hemodynamic compromise and an equal prognosis compared with those without a residual atrial defect after a TEER procedure. These findings support the mid-term safety of procedures in which an interatrial defect needs to be created and would argue against the need for interventional closure.
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Affiliation(s)
- Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN 55902, USA
| | - Amith Seri
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Bishoy Abraham
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Juan M Farina
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Evelyn Fennelly
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Megan Campany
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Milagros Pereyra
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Ebram F Said
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Courtney Kenyon
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Ayman R Fath
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN 55902, USA
| | - Sean Smith
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Skye Buckner-Petty
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Corbin A Rayfield
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - John P Sweeney
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Eric H Yang
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Chadi Ayoub
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN 55902, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN 55902, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN 55902, USA
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN 55902, USA
| | - Peter M Pollak
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Abdallah El Sabbagh
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Jae K Oh
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN 55902, USA
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ 85054, USA
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Alabdaljabar MS, Eleid MF. Dynamic Left Ventricular Outflow Tract Obstruction Exacerbated by Thoracic Kyphosis. JACC Case Rep 2022; 7:101710. [PMID: 36776797 PMCID: PMC9911919 DOI: 10.1016/j.jaccas.2022.101710] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022]
Abstract
We present a 74-year-old woman with kyphosis and symptoms of pre/syncope. Heart catheterization revealed dynamic left ventricular outflow tract obstruction (DLVOTO) with Brockenbrough Braunwald response only when kyphotic posture was assumed. She had a positive response to metoprolol. DLVOTO is a challenging diagnosis in the absence of resting LVOTO. (Level of Difficulty: Beginner.).
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Affiliation(s)
| | - Mackram F. Eleid
- Division of Interventional Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA,Address for correspondence: Dr. Mackram F. Eleid, Division of Interventional Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
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Eleid MF, Wang DD, Pursnani A, Kodali SK, George I, Palacios I, Russell H, Makkar RR, Kar S, Satler LF, Rajagopal V, Dangas G, Tang GH, McCabe JM, Whisenant BK, Fang K, Kaptzan T, Lewis B, Douglas P, Hahn R, Thaden J, Oh JK, Leon M, O'Neill W, Rihal CS, Guerrero ME. 2-Year Outcomes of Transcatheter Mitral Valve Replacement in Patients With Annular Calcification, Rings, and Bioprostheses. J Am Coll Cardiol 2022; 80:2171-2183. [DOI: 10.1016/j.jacc.2022.09.037] [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] [Received: 07/14/2022] [Revised: 08/25/2022] [Accepted: 09/14/2022] [Indexed: 11/30/2022]
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Kronzer EK, Eleid MF, Alkhouli MA, Thaden JJ, Padang R, Nkomo VT, Rihal CS, Pislaru SV, Kane GC. Rates of Oropharyngeal and Esophageal Complications During Structural Heart Disease Procedures Under Transesophageal Echocardiography Guidance. J Am Soc Echocardiogr 2022; 36:431-433. [PMID: 36368437 DOI: 10.1016/j.echo.2022.11.003] [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: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Ellen K Kronzer
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mohamad A Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jeremy J Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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El Shaer A, Chavez Ponce A, Mazur P, Greason K, Arghami A, Eleid MF, Guerrero M, Rihal CS, Crestanello JA, Alkhouli M. Mitral Valve Surgery for Persistent or Recurrent Mitral Regurgitation After Transcatheter Edge-to-Edge Repair Is Associated With Improved Survival. J Am Heart Assoc 2022; 11:e026236. [PMID: 36250668 PMCID: PMC9673655 DOI: 10.1161/jaha.122.026236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background The management of severe mitral regurgitation (MR) after transcatheter edge‐to‐edge repair (TEER) remains a clinical conundrum. Considering the growing volume of TEER, more outcomes data for mitral surgery in this cohort are needed. Methods and Results Symptomatic patients with persistent or recurrent severe MR after TEER evaluated between May 2014 and June 2021 were included. The primary outcome was all‐cause mortality in patients who were treated with surgery versus medical therapy. The Kaplan–Meier and Cox regression methods were used to report risk‐adjusted survival analyses. Among the 142 included patients, 44 (31.0%) underwent mitral surgery. Patients who underwent surgery were younger than those treated medically (74.1±8.9 versus 78.6±10.5 years, P=0.01). Major comorbidities were similar except obesity, sleep apnea, left ventricular dimensions, and ejection fraction. Society of Thoracic Surgeons Predicted Risk of Operative Mortality was 9.0±4.7 versus 7.9±4.9 in the surgical versus medical therapy groups, respectively, P=0.22. Time from TEER to detection of severe MR was similar in both groups (median [interquartile range] 97.5 [39.5–384] versus 93.5 [40–389] days in the surgical versus medical groups, respectively [P>0.05]). In the surgical group, valve replacement was performed in all patients. Operative mortality was 4.5% (observed/expected ratio 0.55), and major complications were uncommon. After risk‐adjustment, surgery was associated with significantly lower all‐cause mortality (adjusted hazard ratio, 0.33 [95% CI, 0.12–0.92], P=0.001) compared with medial therapy. Conclusions Compared with medical therapy, mitral surgery in patients with severe persistent or recurrent MR after TEER is associated with lower mortality despite the high‐risk profile of these patients. Patients with severe MR after TEER should be considered for surgery at a referral mitral surgical center.
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Affiliation(s)
- Ahmed El Shaer
- Department of Cardiovascular Disease Mayo Clinic Rochester MN
| | | | - Piotr Mazur
- Department of Cardiovascular Surgery Mayo Clinic Rochester MN
| | - Kevin Greason
- Department of Cardiovascular Surgery Mayo Clinic Rochester MN
| | - Arman Arghami
- Department of Cardiovascular Surgery Mayo Clinic Rochester MN
| | - Mackram F Eleid
- Department of Cardiovascular Surgery Mayo Clinic Rochester MN
| | - Mayra Guerrero
- Department of Cardiovascular Disease Mayo Clinic Rochester MN
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Guerrero M, Eleid MF, Wang DD, Pursnani A, Kodali S, George I, Palacios I, Makkar R, Satler L, Kaptzan T, Lewis B, Thaden J, Oh J, O'Neill W, Rihal C. 4 year outcomes in a prospective evaluation of transcatheter mitral valve-in-valve, valve-in-ring and valve-in-mitral annular calcification: results from the MITRAL trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The MITRAL Trial (Mitral Implantation of TRAnscatheter vaLves) evaluates the safety and feasibility of balloon-expandable aortic transcatheter heart valves in patients with severe mitral valve disease with mitral annular calcification (MAC), failed surgical rings or failed bioprostheses.
Purpose
We sought to evaluate 4-year outcomes of patients enrolled in the MITRAL trial.
Methods
This is a prospective study that enrolled 91 high surgical risk patients at 13 sites in the U.S. 30 patients underwent Mitral Valve-in-Valve (MViV), 30 Valve-in-Ring (MViR) and 31 Valve-in-MAC (ViMAC). 4-year outcomes of these patients were evaluated in this analysis. Primary endpoints and key serious adverse events including deaths were adjudicated by an independent Clinical Events Committee. Cardiac computed tomography (CT) and echocardiographic images were evaluated by independent CT and Echocardiographic Core Laboratories.
Results
Mean age was 74.3±8.9 years. Most patients undergoing MViV and ViMAC were female (MVIV=63.3%, MViR=36.7% and ViMAC=71%). Mean STS score was 9.2±6.6% (MViV 10.2±6.5%, MViR 8.7±4.7%, ViMAC=8.6±8.2%). All-cause mortality at 4 years was higher for ViMAC and MViR: MViV=6.9% (cardiovascular 3.4%), MViR=48.1% (cardiovascular 18.5%), ViMAC=51.9% (cardiovascular 29.6%), p=0.002 (Figure 1). At 4 years, all survivors had ≤1+ mitral regurgitation and most had none or trace mitral regurgitation (MViV=87.5, MViR=33.3% and ViMAC=100%). Mean mitral valve gradients remained stable (MViV=5.9±2.2 mmHg, MViR= 6.6±5.1 mmHg, ViMAC=5.1±1.0 mmHg), Figure 2. Most survivors experienced significant improvement of symptoms and were in NYHA class I-II at 4-year follow-up (MViV=78.9%, MViR=66.7% and ViMAC=66.7%).
Conclusions
MViV is associated with excellent outcomes at 4 years. MViR and ViMAC were associated with higher mortality at 4 years. However, most survivors in all groups experienced sustained improvement of symptoms and stable THV performance at 4 years. Whether survival bias had an impact on THV performance and improved symptoms at follow-up is not known and deserves further evaluation.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Unrestricted Research Grant from Edwards Lifesciences.
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Affiliation(s)
- M Guerrero
- Mayo Clinic , Rochester , United States of America
| | - M F Eleid
- Mayo Clinic , Rochester , United States of America
| | - D D Wang
- Henry Ford Hospital , Detroit , United States of America
| | - A Pursnani
- Evanston Hospital Northshore , Evanston , United States of America
| | - S Kodali
- Columbia University Medical Center , New York , United States of America
| | - I George
- Columbia University Medical Center , New York , United States of America
| | - I Palacios
- Massachusetts General Hospital , Boston , United States of America
| | - R Makkar
- Cedars-Sinai Medical Center , Los Angeles , United States of America
| | - L Satler
- Medstar Washington Hospital Centre, Washington , DC , United States of America
| | - T Kaptzan
- Mayo Clinic , Rochester , United States of America
| | - B Lewis
- Mayo Clinic , Rochester , United States of America
| | - J Thaden
- Mayo Clinic , Rochester , United States of America
| | - J Oh
- Mayo Clinic , Rochester , United States of America
| | - W O'Neill
- Henry Ford Hospital , Detroit , United States of America
| | - C Rihal
- Mayo Clinic , Rochester , United States of America
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Naser J, Gochanour BR, Scott CG, Luis SA, Greason KL, Crestanello JA, Gulati R, Eleid MF, Nkomo VT, Pislaru SV. The use of warfarin as part of antithrombotic strategy after transcutaneous aortic valve replacement is not associated with better medium-term outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Bioprosthetic valve thrombosis is currently a well-recognized cause of bioprosthetic valve dysfunction. It was found to be associated with accelerated degeneration of the bioprosthesis with higher rates of valve re-replacement, even after treatment with anticoagulation. We hypothesized that the use of warfarin for three months after transcatheter aortic valve replacement (TAVR) protects against accelerated valve degeneration and is therefore associated with better outcomes compared to dual antiplatelet therapy (DAPT).
Methods
Consecutive adult patients who underwent TAVR in our clinic between 2012 and 2019 were identified retrospectively. Patients with atrial fibrillation were excluded. Subsequently, patients who received DAPT were propensity matched to up to 2 patients who received three months of warfarin as part of their anti-thrombotic regimen. Matching was performed for variables that were significantly different at baseline between the two groups and included diabetes mellitus, prior myocardial infarctions, chronic lung disease, peripheral arterial disease, hemoglobin at time of TAVR, kidney function [creatinine>2], use of angiotensin-converting enzyme inhibitors / angiotensin II receptor blockers, beta blockers, the Society of Thoracic Surgeons (STS) score [STS ≥8, STS 4–8, STS<4], and valve size. The two groups were then compared for outcomes of ischemic stroke, death, valve re-replacement/intervention, the composite endpoint of the aforementioned three outcomes, as well as the three-month outcome of hemorrhagic strokes. Kaplan Meier was used for outcome analysis, and discharge date was considered time zero. Patients who had their anti-thrombotic therapy interrupted were censored at that time point.
Results
A total of 1,373 patients who underwent TAVR were identified. Of these, 576 patients with atrial fibrillation were excluded. Baseline characteristics were compared between 633 patients who received three months of warfarin and 164 patients who received DAPT after TAVR. After matching the two groups, 435 patients were included in the final analysis [warfarin in 281, DAPT in 154; median time to last follow up 2.61 years], Table 1. There was no difference in matched (Figure 1) or unmatched analysis (not shown) in outcomes of ischemic stroke, death, valve re-replacement/intervention, their composite endpoint, or hemorrhagic strokes (p>0.05 for all).
Conclusion
Antithrombotic regimen including three months of warfarin after TAVR was not associated with better outcomes of ischemic strokes, deaths, and valve re-replacement/intervention or with increased risk of hemorrhagic strokes compared to DAPT.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Naser
- Mayo Clinic , Rochester , United States of America
| | | | - C G Scott
- Mayo Clinic , Rochester , United States of America
| | - S A Luis
- Mayo Clinic , Rochester , United States of America
| | - K L Greason
- Mayo Clinic , Rochester , United States of America
| | | | - R Gulati
- Mayo Clinic , Rochester , United States of America
| | - M F Eleid
- Mayo Clinic , Rochester , United States of America
| | - V T Nkomo
- Mayo Clinic , Rochester , United States of America
| | - S V Pislaru
- Mayo Clinic , Rochester , United States of America
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Killu AM, Collins JD, Eleid MF, Alkhouli M, Simard T, Rihal C, Asirvatham SJ, Guerrero M. Preemptive Septal Radiofrequency Ablation to Prevent Left Ventricular Outflow Tract Obstruction With Transcatheter Mitral Valve Replacement: A Case Series. Circ Cardiovasc Interv 2022; 15:e012228. [PMID: 36256696 DOI: 10.1161/circinterventions.122.012228] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Left ventricular outflow tract obstruction may occur following transcatheter mitral valve replacement in the setting of mitral annular calcification. METHODS We present a case series whereby preemptive septal radiofrequency ablation (RADIO-TMVR) was used to augment the left ventricular outflow tract for transcatheter mitral valve replacement in 4 patients at risk for left ventricular outflow tract obstruction despite alcohol septal ablation. RESULTS All patients were female, average age of 74.9 (68.8-80.4) years. Baseline ejection fraction was 71% (63%-75%). Mean mitral valve area was 1.28 (range, 1.0-1.59) cm2. Mean mitral valve gradient at rest was 9.5 (range, 7-11) mm Hg. New York Heart Association symptoms were III to IV at baseline. Patients underwent preemptive septal radiofrequency ablation to prevent left ventricular outflow tract obstruction with transcatheter mitral valve replacement a range between 69 and 154 days after alcohol septal ablation. Procedural time was 384 (337-424) minutes with a fluoroscopic time of 31 (14-71) minutes. Radiofrequency ablation time was 132 (100-175) minutes. As anticipated, 3 patients developed complete heart block and underwent pacemaker implantation, whereas 1 had a preexisting pacemaker. One patient developed groin hematoma and heart failure exacerbation. There were no peri-procedural deaths. Preemptive septal radiofrequency ablation to prevent left ventricular outflow tract obstruction with transcatheter mitral valve replacement resulted in septal end-diastolic wall thickness reduction compared with baseline (28.6%, 30.4%, 30.3%, and 11.1%) and following alcohol septal ablation (23.1%, 12%, 8.5%). Valve replacement in the setting of mitral annular calcification was performed in all patients 89 (range, 38-45) days after preemptive septal radiofrequency ablation to prevent left ventricular outflow tract obstruction with transcatheter mitral valve replacement. Two patients had concomitant laceration of the anterior mitral leaflet to further augment the neo-left ventricular outflow tract. Postprocedure, New York Heart Association symptoms improved to class I (3 patients) and class II (1 patient). CONCLUSIONS In at-risk individuals, preemptive septal radiofrequency ablation may be an effective strategy at preventing left ventricular outflow tract obstruction with transcatheter mitral valve replacement.
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Affiliation(s)
- Ammar M Killu
- Division of Heart Rhythm Services, Department of Cardiovascular Medicine (A.M.K., S.J.A.), Mayo Clinic Hospital, Rochester, MN
| | - Jeremy D Collins
- Department of Diagnostic Radiology (J.D.C.), Mayo Clinic Hospital, Rochester, MN
| | - Mackram F Eleid
- Division of Interventional Cardiology, Department of Cardiovascular Medicine (M.F.E., M.A., T.S., C.R., M.G.), Mayo Clinic Hospital, Rochester, MN
| | - Mohamad Alkhouli
- Division of Interventional Cardiology, Department of Cardiovascular Medicine (M.F.E., M.A., T.S., C.R., M.G.), Mayo Clinic Hospital, Rochester, MN
| | - Trevor Simard
- Division of Interventional Cardiology, Department of Cardiovascular Medicine (M.F.E., M.A., T.S., C.R., M.G.), Mayo Clinic Hospital, Rochester, MN
| | - Charanjit Rihal
- Division of Interventional Cardiology, Department of Cardiovascular Medicine (M.F.E., M.A., T.S., C.R., M.G.), Mayo Clinic Hospital, Rochester, MN
| | - Samuel J Asirvatham
- Division of Heart Rhythm Services, Department of Cardiovascular Medicine (A.M.K., S.J.A.), Mayo Clinic Hospital, Rochester, MN
- Pediatric and Adolescent Medicine and Department of Biomedical Engineering (S.J.A.), Mayo Clinic Hospital, Rochester, MN
| | - Mayra Guerrero
- Division of Interventional Cardiology, Department of Cardiovascular Medicine (M.F.E., M.A., T.S., C.R., M.G.), Mayo Clinic Hospital, Rochester, MN
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Gray WA, Abramson SV, Lim S, Fowler D, Smith RL, Grayburn PA, Kodali SK, Hahn RT, Kipperman RM, Koulogiannis KP, Eleid MF, Pislaru SV, Whisenant BK, McCabe JM, Liu J, Dahou A, Puthumana JJ, Davidson CJ. 1-Year Outcomes of Cardioband Tricuspid Valve Reconstruction System Early Feasibility Study. JACC Cardiovasc Interv 2022; 15:1921-1932. [DOI: 10.1016/j.jcin.2022.07.006] [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] [Received: 04/18/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 10/14/2022]
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Patel PP, El Sabbagh A, Johnson PW, Suliman R, Salwa N, Morales-Lara AC, Pollak P, Yamani M, Parikh P, Sonavane SK, Landolfo C, Alkhouli MA, Eleid MF, Guerrero M, Fortuin FD, Sweeney J, Noseworthy PA, Carter RE, Adedinsewo D. Sex Differences in the Impact of Aortic Valve Calcium Score on Mortality After Transcatheter Aortic Valve Replacement. Circ Cardiovasc Imaging 2022; 15:e014034. [PMID: 35920157 PMCID: PMC9397521 DOI: 10.1161/circimaging.122.014034] [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] [Indexed: 12/27/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is now an approved alternative to surgical aortic valve replacement for the treatment of severe aortic stenosis. As the clinical adoption of TAVR expands, it remains important to identify predictors of mortality after TAVR. We aimed to evaluate the impact of sex differences in aortic valve calcium score (AVCS) on long-term mortality following TAVR in a large patient sample. METHODS We included consecutive patients who successfully underwent TAVR for treatment of severe native aortic valve stenosis from June 2010 to May 2021 across all US Mayo Clinic sites with follow-up through July 2021. AVCS values were obtained from preoperative computed tomography of the chest. Additional clinical data were abstracted from medical records. Kaplan-Meier curves and Cox-proportional hazard regression models were employed to evaluate the effect of AVCS on long-term mortality. RESULTS A total of 2543 patients were evaluated in the final analysis. Forty-one percent were women, median age was 82 years (Q1: 76, Q3: 86), 18.4% received a permanent pacemaker following TAVR, and 88.5% received a balloon expandable valve. We demonstrate an increase in mortality risk with higher AVCS after multivariable adjustment (P<0.001). When stratified by sex, every 500-unit increase in AVCS was associated with a 7% increase in mortality risk among women (adjusted hazard ratio, 1.07 [95% CI, 1.02-1.12]) but not in men. CONCLUSIONS We demonstrate a notable sex difference in the association between AVCS and long-term mortality in a large TAVR patient sample. This study highlights the potential value of AVCS in preprocedural risk stratification, specifically among women undergoing TAVR. Additional studies are needed to validate this finding.
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Affiliation(s)
| | | | - Patrick W. Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - Rayan Suliman
- Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Najiyah Salwa
- Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | | | - Peter Pollak
- Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Mohamad Yamani
- Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Pragnesh Parikh
- Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | | | - Carolyn Landolfo
- Division of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | | | | | - Mayra Guerrero
- Division of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - John Sweeney
- Division of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ
| | | | - Rickey E. Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
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50
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Chadderdon SM, Eleid MF, Thaden JJ, Makkar R, Nakamura M, Babaliaros V, Greenbaum A, Gleason P, Kodali S, Hahn RT, Koulogiannis KP, Marcoff L, Grayburn P, Smith RL, Song HK, Lim DS, Gray WA, Hawthorne K, Deuschl F, Narang A, Davidson C, Zahr FE. Three-Dimensional Intracardiac Echocardiography for Tricuspid Transcatheter Edge-to-Edge Repair. Struct Heart 2022; 6:100071. [PMID: 37288338 PMCID: PMC10242583 DOI: 10.1016/j.shj.2022.100071] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/08/2022] [Accepted: 06/17/2022] [Indexed: 06/09/2023]
Abstract
Patients with severe symptomatic tricuspid regurgitation face a significant dilemma in treatment options, as the yearly mortality with medical therapy and the surgical mortality for tricuspid repair or replacement are high. Transcatheter edge-to-edge repair (TEER) for the tricuspid valve is becoming a viable option in patients, although procedural success is dependent on high-quality imaging. While transesophageal echocardiography remains the standard for tricuspid TEER procedures, intracardiac echocardiography (ICE) with three-dimensional (3D) multiplanar reconstruction (MPR) has many theoretical and practical advantages. The aim of this article was to describe the in vitro wet lab-based imaging work done to facilitate the best approach to 3D MPR ICE imaging and the procedural experience gained with 3D MPR ICE in tricuspid TEER procedures with the PASCAL device.
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Affiliation(s)
- Scott M. Chadderdon
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Mackram F. Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeremy J. Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Raj Makkar
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Mamoo Nakamura
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Vasilis Babaliaros
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Adam Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Patrick Gleason
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Susheel Kodali
- Structural Heart & Vascular Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Rebecca T. Hahn
- Structural Heart & Vascular Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Konstantinos P. Koulogiannis
- Department of Cardiovascular Medicine, Morristown Medical Center/Atlantic Health System, Morristown, New Jersey, USA
| | - Leo Marcoff
- Department of Cardiovascular Medicine, Morristown Medical Center/Atlantic Health System, Morristown, New Jersey, USA
| | - Paul Grayburn
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | | | - Howard K. Song
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - D. Scott Lim
- Division of Cardiology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - William A. Gray
- Department of Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Katie Hawthorne
- Department of Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | | | - Akhil Narang
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Charles Davidson
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Firas E. Zahr
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
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