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Qin T, Mao W, Caballero A, Kamioka N, Lerakis S, Lain S, Elefteriades J, Liang L, Sun W. Patient-specific analysis of bicuspid aortic valve hemodynamics using a fully coupled fluid-structure interaction model. Comput Biol Med 2024; 172:108191. [PMID: 38457932 DOI: 10.1016/j.compbiomed.2024.108191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/10/2024] [Accepted: 02/18/2024] [Indexed: 03/10/2024]
Abstract
Bicuspid aortic valve (BAV), the most common congenital heart disease, is prone to develop significant valvular dysfunction and aortic wall abnormalities such as ascending aortic aneurysm. Growing evidence has suggested that abnormal BAV hemodynamics could contribute to disease progression. In order to investigate BAV hemodynamics, we performed 3D patient-specific fluid-structure interaction (FSI) simulations with fully coupled blood flow dynamics and valve motion throughout the cardiac cycle. Results showed that the hemodynamics during systole can be characterized by a systolic jet and two counter-rotating recirculation vortices. At peak systole, the jet was usually eccentric, with asymmetric recirculation vortices and helical flow motion in the ascending aorta. The flow structure at peak systole was quantified using the vorticity, flow rate reversal ratio and local normalized helicity (LNH) at four locations from the aortic root to the ascending aorta. The systolic jet was evaluated with the peak velocity, normalized flow displacement, and jet angle. It was found that peak velocity and normalized flow displacement (rather than jet angle) gave a strong correlation with the vorticity and LNH in the ascending aorta, which suggests that these two metrics could be used for clinical noninvasive evaluation of abnormal blood flow patterns in BAV patients.
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Affiliation(s)
- Tongran Qin
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA; Sutra Medical Inc, Lake Forest, CA, USA
| | - Wenbin Mao
- Mechanical Engineering, University of South Florida, FL, USA
| | - Andrés Caballero
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA; PAI+ Research Group, Mechanical Engineering Department, Universidad Autónoma de Occidente, Cali, Colombia
| | | | - Stamatios Lerakis
- Emory University, School of Medicine, Atlanta, GA, USA; Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Santiago Lain
- PAI+ Research Group, Mechanical Engineering Department, Universidad Autónoma de Occidente, Cali, Colombia
| | - John Elefteriades
- Aortic Institute, School of Medicine, Yale University, New Haven, CT, USA
| | - Liang Liang
- Department of Computer Science, University of Miami, Coral Gables, FL, USA
| | - Wei Sun
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA; Sutra Medical Inc, Lake Forest, CA, USA.
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Murakami T, Ohno Y, Horinouchi H, Noda S, Hashimoto K, Miyamoto J, Kamioka N, Natsumeda M, Tanaka S, Ikari Y. Vericiguat and transcatheter edge-to-edge mitral valve repair for combined post- and pre-capillary pulmonary hypertension due to left ventricular low ejection fraction and functional mitral regurgitation. J Cardiol Cases 2024; 29:78-81. [PMID: 38362582 PMCID: PMC10865131 DOI: 10.1016/j.jccase.2023.10.011] [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: 05/26/2023] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 02/17/2024] Open
Abstract
A 66-year-old female was diagnosed with combined post- and pre-capillary pulmonary hypertension due to heart failure with reduced ejection fraction (47 %) and functional mitral regurgitation [mean pulmonary arterial wedge pressure: 27 mmHg; pulmonary arterial pressure: 91/30 (56) mmHg; pulmonary vascular resistance: 12.9 Wood units; and cardiac index: 1.77 L/min/m2]. Following treatment with vericiguat (a novel oral soluble guanylate cyclase stimulator), hemodynamics improved [mean pulmonary arterial wedge pressure: 27 mmHg; pulmonary arterial pressure: 54/26 (35) mmHg; pulmonary vascular resistance: 2.2 Wood units; and cardiac index: 2.80 L/min/m2]. Therefore, transcatheter edge-to-edge repair for functional mitral regurgitation was performed. One month later, further improvement in hemodynamics was confirmed. Learning objective Vericiguat (a novel oral soluble guanylate cyclase stimulator) and transcatheter edge-to-edge mitral valve repair may improve combined post- and pre-capillary pulmonary hypertension due to low ejection fraction of the left ventricle and functional mitral regurgitation.
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Affiliation(s)
- Tsutomu Murakami
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Yohei Ohno
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Hitomi Horinouchi
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Satoshi Noda
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Kaho Hashimoto
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Junichi Miyamoto
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Norihiko Kamioka
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Makoto Natsumeda
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Shigemitsu Tanaka
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
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Nagai T, Horinouchi H, Hashimoto K, Ijichi T, Kamioka N, Murakami T, Ohno Y, Yoshioka K, Ikari Y. Incremental Value of Global Longitudinal Strain for Confirming Heart Failure-Related Symptoms in Severe Aortic Stenosis. Am J Cardiol 2023; 209:1-7. [PMID: 37839463 DOI: 10.1016/j.amjcard.2023.09.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 10/17/2023]
Abstract
The indications or timing of aortic valve replacement for symptomatic aortic stenosis (AS) are based on a patient's life expectancy and symptoms. However, clinical decision-making may be difficult because symptoms are subjective and cannot be quantitatively assessed and confirmed. This study aimed to evaluate the association between heart failure (HF)-related symptoms and cardiac hemodynamic left ventricular deformations in patients with severe AS using transthoracic echocardiographic assessments of left ventricular global longitudinal strain (LV-GLS). The medical records of patients hospitalized for AS between February 2017 and September 2019 were retrospectively screened. Independent cardiologists analyzed the transthoracic echocardiographic images of a digital echocardiography database. The cohort comprised 177 hospitalized patients with severe AS and no history of HF. The subgroup with HF-related symptoms included 87 patients, whereas that without HF-related symptoms included 90 patients. In 145 patients without atrial fibrillation, the left atrial volume index (LAVI) and LV-GLS were significantly associated with HF-related symptoms (odds ratio 1.033, 95% confidence interval 1.008 to 1.059, p = 0.011 and odds ratio 1.224, 95% confidence interval 1.118 to 1.340, p <0.0001, respectively). Moreover, the combination of brain natriuretic peptide level, LAVI, and LV-GLS showed better diagnostic accuracy than the combination of brain natriuretic peptide level and LAVI (p = 0.005). However, there were no such tendencies in 32 patients with atrial fibrillation. The HF-related symptoms in patients with severe AS were strongly linked to LV-GLS. LV-GLS showed incremental value for confirming HF-related symptoms.
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Affiliation(s)
- Tomoo Nagai
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan.
| | - Hitomi Horinouchi
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Kaho Hashimoto
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Takeshi Ijichi
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Norihiko Kamioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Tsutomu Murakami
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Yohei Ohno
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Yuji Ikari
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
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Murakami T, Horinouchi H, Noda S, Hashimoto K, Miyamoto J, Kamioka N, Nagai T, Sakai K, Torii S, Tanaka S, Okada K, Cho Y, Urimoto G, Ito K, Nakazawa G, Ikari Y, Ohno Y. Feasibility and Outcome of Transjugular Intracardiac Echocardiography-Guided Transcatheter Aortic Valve Replacement. JACC Asia 2023; 3:925-934. [PMID: 38155789 PMCID: PMC10751646 DOI: 10.1016/j.jacasi.2023.07.013] [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: 04/17/2023] [Revised: 07/18/2023] [Accepted: 07/29/2023] [Indexed: 12/30/2023]
Abstract
Background There are limited data on the impact of intracardiac echocardiography (ICE)-guided transcatheter aortic valve replacement (TAVR) on the new permanent pacemaker implantation (PPMI) rate. Objectives This study investigated the feasibility and outcome of transjugular ICE (TJ-ICE) -guided TAVR, by visualizing the relationship between the membranous septum (MS) and the transcatheter aortic valve (TAV). Methods Among patients with severe aortic stenosis who underwent TAVR between February 2017 and June 2020, this study enrolled a total of 163 patients with TJ-ICE-guided TAVR. MS length was measured by ICE. The primary endpoint of this study was the incidence of new PPMI at 30 days. Results The mean age of the patients in this study was 84.9 ± 4.6 years, and 71.2% of the patients were female. Device success was 96.3% with TJ-ICE guidance. A TJ-ICE-related complication occurred in 1 case (0.6%). The median length of the MS was 5.8 mm (IQR: 5.0-6.9 mm). Excellent intraobserver (intraclass correlation coefficient [ICC]: 0.94; 95% CI:0.79-0.98; P < 0.001) and interobserver (ICC: 0.93; 95% CI: -0.05 to 0.98; P < 0.001) agreements were shown. The new PPMI rate was 6.7% at 30 days without a significant difference between balloon-expandable valves and self-expandable valves (3.4% vs 8.7%; P = 0.226). Patients with a TAV implantation depth less than MS length had a significantly lower incidence of new PPMI compared with patients with a TAV implantation depth greater than MS length (2.1% vs 13.4%; P = 0.005), regardless of baseline right bundle branch block presence (6.7% vs 66.7%; P = 0.004) or absence (1.2% vs 8.2%; P = 0.041). Conclusions TJ-ICE-guided TAVR demonstrated remarkable feasibility and safety. The TJ-ICE-guided final TAV position had a significant impact on the new PPMI rate. (Tokai Valve Registry; UMIN000036671).
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Affiliation(s)
- Tsutomu Murakami
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Hitomi Horinouchi
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Satoshi Noda
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Kaho Hashimoto
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Junichi Miyamoto
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Norihiko Kamioka
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Tomoo Nagai
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Katsuaki Sakai
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Sho Torii
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Shigemitsu Tanaka
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Kimiaki Okada
- Department of Cardiac Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Yasunori Cho
- Department of Cardiac Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Genya Urimoto
- Department of Anesthesiology, Tokai University School of Medicine, Isehara, Japan
| | - Kenji Ito
- Department of Anesthesiology, Tokai University School of Medicine, Isehara, Japan
| | - Gaku Nakazawa
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Yohei Ohno
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
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Horinouchi H, Nagai T, Ohno Y, Miyamoto J, Kamioka N, Murakami T, Yoshioka K, Ikari Y. Mechanisms and implications of mitral regurgitation in patients with severe aortic stenosis who received transcatheter aortic valve replacement. Echocardiography 2023; 40:1187-1195. [PMID: 37715609 DOI: 10.1111/echo.15693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023] Open
Abstract
INTRODUCTION This study aimed to investigate the mechanisms and clinical implications of mitral regurgitation (MR) in patients with severe aortic stenosis (AS) who received transcatheter aortic valve replacement (TAVR). METHODS We conducted retrospective echocardiographic analyses at baseline and 6 months after TAVR in 140 patients with symptomatic AS (85 ± 5 years) who underwent TAVR. We defined significant MR as ≥ moderate based on evaluation of transthoracic echocardiography (TTE). RESULTS There were 48 patients (34%) with preexisting MR at the baseline. Among measured TTE parameters, end-systolic wall stress (ESWS), mitral annulus area, and mitral valve thickening index were independent factors associated with preexisting MR (odds ratio [OR]: 1.013, 95% confidence interval [CI]: 1.005-1.021; OR: 1.740, 95% CI: 1.314-2.376; OR: 2.306, 95% CI: 1.426-3.848; respectively). Six months after TAVR, there were 34 patients with post-existing MR, A history of atrial fibrillation and ESWS after TAVR were independent factors (OR: 3.013, 95% CI: 1.208-7.556; OR: 1.013, 95% CI: 1.000-1.023; respectively). The Kaplan-Meier plot indicated that preexisting MR was a risk factor for heart failure-related events within 1 year of discharge after TAVR (p = .012). CONCLUSIONS In patients who underwent TAVR for severe AS, preexisting MR was associated with having a thickened mitral valve and large mitral annulus size induced by high ESWS. These patients may have worse prognosis after TAVR and should be closely monitored in the long term.
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Affiliation(s)
- Hitomi Horinouchi
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Tomoo Nagai
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Yohei Ohno
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Junichi Miyamoto
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Norihiko Kamioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Tsutomu Murakami
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Yuji Ikari
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
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Horinouchi H, Nagai T, Ohno Y, Miyamoto J, Murakami T, Kamioka N, Yoshioka K, Ikari Y. Short-term Outcomes of Urgent Transcatheter Aortic Valve Replacement in Symptomatic Aortic Stenosis That Requires Emergency Hospital Admission. Intern Med 2023; 62:2457-2463. [PMID: 36725049 PMCID: PMC10518535 DOI: 10.2169/internalmedicine.0638-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/13/2022] [Indexed: 02/03/2023] Open
Abstract
Objective This study retrospectively compared the outcomes of emergently admitted patients with aortic stenosis (AS) with or without urgent transcatheter aortic valve replacement (TAVR). Methods Patients hospitalized between February 2015 and December 2019 for symptomatic AS were retrospectively analyzed by comparing the received conservative management [continued medical therapy with or without elective surgical transcatheter replacement (SAVR) or TAVR scheduled after the index hospitalization] and urgent TAVR (TAVR during the index hospitalization). Results The cohort comprised 114 patients with symptomatic AS who required emergency admission. Urgent TAVR was performed for 37 patients, while conservative management was provided for 77 patients, including 1 who received urgent SAVR. Urgent TAVR was more likely to be performed in patients with a history of hospitalization for heart failure, high New York Heart Association class scores, a lower clinical frailty scale at admission, and a high aortic valve peak velocity (p=0.01, p<0.001, p<0.01 and p=0.02, respectively). Kaplan-Meier analyses with log-rank test revealed favorable outcomes of urgent TAVR in all-cause mortality and cardiovascular events within 60 days of admission (p<0.01, p<0.01, respectively). Conclusion Urgent TAVR had better short-term outcomes in patients with symptomatic AS who required emergency hospital admission than conservative management. When considering urgent TAVR, patients with typical heart failure symptoms due to AS with a history of heart failure hospitalization and relatively little frailty can be selected.
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Affiliation(s)
- Hitomi Horinouchi
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | - Tomoo Nagai
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | - Yohei Ohno
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | - Junichi Miyamoto
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | - Tsutomu Murakami
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | - Norihiko Kamioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | - Yuji Ikari
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Japan
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Kamioka N, Greenbaum AB, Lederman RJ, Khan JM, Lisko JC, Byku I, Gleason PT, Grubb KJ, Leshnower B, Block PC, Stewart JP, Babaliaros VC. First Application of the LAMPOON Procedure to a Surgical Mitral Bioprosthesis. Cardiovasc Revasc Med 2023; 53S:S176-S179. [PMID: 35879191 PMCID: PMC9622428 DOI: 10.1016/j.carrev.2022.04.023] [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] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 11/26/2022]
Abstract
A cardiogenic shock patient with a history of a surgical mitral valve replacement presented to the hospital with critical mitral stenosis with thickening of prosthetic valve leaflets and thrombus in left atrial appendage. We considered TMVR inside of the degenerated bioprosthetic valve. However, there were two concerns during TMVR based on multimodality imaging assessment: 1) LVOT obstruction due to the surgical bioprosthetic leaflet, 2) stroke due to left atrial appendage thrombus. We performed TMVR with LAMPOON (laceration of the anterior leaflet of the surgical valve to prevent left ventricular outflow tract obstruction) for the bioprosthesis using cerebral protection. While the LAMPOON procedure has developed to prevent LVOT obstruction by the native anterior mitral leaflet during transcatheter mitral valve-in-ring or valve-in-mitral annular calcification, this is the first case that illustrates its use for mitral valve-in-valve replacement.
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Affiliation(s)
- Norihiko Kamioka
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Adam B Greenbaum
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - John C Lisko
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Isida Byku
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Patrick T Gleason
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Kendra J Grubb
- Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Bradley Leshnower
- Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Peter C Block
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - James P Stewart
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Vasilis C Babaliaros
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America.
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Khan JM, Kamioka N, Lisko JC, Perdoncin E, Zhang C, Maini A, Chen M, Li Y, Ludwig S, Westermann D, Amat Santos IJ, Kalińczuk Ł, Sinning JM, Kawaguchi T, Fuku Y, Cheema AN, Félix-Oliveira A, Yamamoto M, Kagase A, Codner P, Valle RD, Iyer VS, Kim HS, Lin MS, Maini B, Rodriguez R, Montorfano M, Ancona MB, Tada N, Miyasaka M, Ahmad H, Ruggiero NJ, Torguson R, Ben-Dor I, Shults CC, Weissman G, Lederman RJ, Greenbaum AB, Babaliaros VC, Waksman R, Rogers T. Coronary Obstruction From TAVR in Native Aortic Stenosis: Development and Validation of Multivariate Prediction Model. JACC Cardiovasc Interv 2023; 16:415-425. [PMID: 36858660 PMCID: PMC9991077 DOI: 10.1016/j.jcin.2022.11.018] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 03/03/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR)-related coronary artery obstruction prediction remains unsatisfactory despite high mortality and novel preventive therapies. OBJECTIVES This study sought to develop a predictive model for TAVR-related coronary obstruction in native aortic stenosis. METHODS Preprocedure computed tomography and fluoroscopy images of patients in whom TAVR caused coronary artery obstruction were collected. Central laboratories made measurements, which were compared with unobstructed patients from a single-center database. A multivariate model was developed and validated against a 1:1 propensity-matched subselection of the unobstructed cohort. RESULTS Sixty patients with angiographically confirmed coronary obstruction and 1,381 without obstruction were included. In-hospital death was higher in the obstruction cohort (26.7% vs 0.7%; P < 0.001). Annular area and perimeter, coronary height, sinus width, and sinotubular junction height and width were all significantly smaller in the obstructed cohort. Obstruction was most common on the left side (78.3%) and at the level of the coronary artery ostium (92.1%). Coronary artery height and sinus width, but not annulus area, were significant risk factors for obstruction by logistic regression but performed poorly in predicting obstruction. The new multivariate model (coronary obstruction IF cusp height > coronary height, AND virtual valve-to-coronary distance ≤4 mm OR culprit leaflet calcium volume >600 mm3) performed well, with an area under the curve of 0.93 (sensitivity = 0.93, specificity = 0.84) for the left coronary artery and 0.94 (sensitivity = 0.92, specificity = 0.96) for the right. CONCLUSIONS A novel computed tomography-based multivariate prediction model that can be implemented routinely in real-world practice predicted coronary artery obstruction from TAVR in native aortic stenosis.
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Affiliation(s)
- Jaffar M Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Norihiko Kamioka
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA; Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - John C Lisko
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Emily Perdoncin
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Cheng Zhang
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Aneel Maini
- Georgetown University School of Medicine, Washington, DC, USA
| | - Mao Chen
- Department of Cardiology, West China School of Medicine, West China Hospital, Sichuan University, China
| | - Yijian Li
- Department of Cardiology, West China School of Medicine, West China Hospital, Sichuan University, China
| | - Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; Cardiovascular Research Foundation, New York, New York, USA
| | - Dirk Westermann
- Department of Cardiology and Angiology I, University Heart Center Freiburg - Bad Krozingen, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Ignacio J Amat Santos
- Department of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | | | - Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Asim N Cheema
- Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Afonso Félix-Oliveira
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Institute of Pharmacology and Neurosciences, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center/Nagoya Heart Center, Nagoya, Japan
| | - Ai Kagase
- Department of Cardiology, Toyohashi Heart Center/Nagoya Heart Center, Nagoya, Japan
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
| | - Raquel Del Valle
- Interventional Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Vijay S Iyer
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Mao-Shin Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Brijeshwar Maini
- Department of Cardiology, Florida Atlantic University, Boca Raton, Florida, USA
| | - Roberto Rodriguez
- Structural Heart Program, Main Line Health, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Masaki Miyasaka
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Hasan Ahmad
- Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Nicholas J Ruggiero
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Rebecca Torguson
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Christian C Shults
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Gaby Weissman
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Vasilis C Babaliaros
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
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Sekigawa Y, Tanaka S, Suzuki D, Miyamoto J, Nakamura N, Torii S, Murakami T, Kamioka N, Ijichi T, Natsumeda M, Ohno Y, Ikari Y. Pathology of Sapien 3 After Impella-CP Insertion for Acute Coronary Syndrome With Cardiogenic Shock. Circ J 2023; 87:672. [PMID: 36823099 DOI: 10.1253/circj.cj-22-0818] [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] [Indexed: 02/24/2023]
Affiliation(s)
- Yotaro Sekigawa
- Department of Cardiology, Tokai University School of Medicine
| | | | - Daiki Suzuki
- Department of Cardiology, Tokai University School of Medicine
| | | | | | - Sho Torii
- Department of Cardiology, Tokai University School of Medicine
| | | | | | - Takeshi Ijichi
- Department of Cardiology, Tokai University School of Medicine
| | | | - Yohei Ohno
- Department of Cardiology, Tokai University School of Medicine
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine
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Miyamoto J, Ohno Y, Kamioka N, Ikari Y, Otsuka T, Tada N, Naganuma T, Yamawaki M, Yamanaka F, Shirai S, Mizutani K, Tabata M, Ueno H, Takagi K, Watanabe Y, Yamamoto M, Hayashida K. Impact of Periprocedural Pulmonary Hypertension on Outcomes After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2022; 80:1601-1613. [DOI: 10.1016/j.jacc.2022.08.757] [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: 07/12/2022] [Revised: 08/02/2022] [Accepted: 08/10/2022] [Indexed: 11/05/2022]
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Condado JF, Greenbaum A, Kamioka N, Rogers T, Khan JM, Lederman RJ, Babaliaros V. Leaflet Modification Technologies. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch58] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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12
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Lee KH, Yagishita A, Ohno Y, Sakai T, Sakai K, Miyamoto J, Horinouchi H, Sakama S, Kamioka N, Murakami T, Ayabe K, Amino M, Yoshioka K, Ikari Y. Late-onset atrioventricular block after transcatheter aortic valve replacement. Heart Rhythm O2 2022; 2:607-613. [PMID: 34988505 PMCID: PMC8703188 DOI: 10.1016/j.hroo.2021.11.001] [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] [Indexed: 11/24/2022] Open
Abstract
Background Conduction disturbances leading to permanent pacemaker implantation (PPI) rarely occur late after transcatheter aortic valve replacement (TAVR). The clinical features of this phenomenon and its association with periprocedural conduction disturbances remain uncertain. Objectives We aimed to determine the incidence and characteristics of late-onset atrioventricular block (AVB) after TAVR. Methods This single-center study included 246 patients undergoing TAVR. Late-onset AVB was defined as AVB ≥1 month after the TAVR. Results Periprocedural AVB (periAVB) occurred in 43 patients (17%). Patients with periAVB had a higher rate of right bundle branch block (47% vs 7%, P < .0001). Of the 43 patients with periAVB, 15 underwent PPI (35%) at a median duration of 6 days, whereas 1 of the remaining 203 patients without periAVB underwent PPI within 1 month (0.5%). During a median follow-up duration of 365 days, late-onset AVB occurred in 10 of 230 patients without PPI within 1 month (4%) at a median duration of 76 days. All 10 patients presented transient periprocedural atrioventricular conduction disturbances, including 8 patients with periAVB (80%), all of whom recovered within 1 month, and 9 patients underwent self-expanding valve implantation (90%). The mortality rate in patients with PPI within 1 month was higher than in those without, although the difference was not statistically significant (hazard ratio 2.68, 95% confidence interval 0.97–9.05, log-rank P = .09). Conclusion Late-onset AVB occurred in a minority of patients undergoing TAVR. Greater vigilance is warranted, particularly in patients with transient conduction disturbances during the periprocedural period following self-expanding valve implantation.
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Affiliation(s)
| | - Atsuhiko Yagishita
- Address reprint requests and correspondence: Dr Atsuhiko Yagishita, Department of Cardiology, Tokai University, Shimokasuya 143, Isehara, Kanagawa, Japan.
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13
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Perdoncin E, Bruce CG, Babaliaros VC, Yildirim DK, Depta JP, McCabe JM, Gleason PT, Xie J, Grubb KJ, Paone G, Kohli K, Kamioka N, Khan JM, Rogers T, Lederman RJ, Greenbaum AB. Balloon-Augmented Leaflet Modification With Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction and Laceration of the Anterior Mitral Leaflet to Prevent Outflow Obstruction: Benchtop Validation and First In-Man Experience. Circ Cardiovasc Interv 2021; 14:e011028. [PMID: 34674556 DOI: 10.1161/circinterventions.121.011028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) and laceration of the anterior mitral leaflet to prevent outflow obstruction (LAMPOON) reduce the risk of coronary and left ventricular outflow obstruction obstruction during transcatheter aortic valve replacement and transcatheter mitral valve replacement. Despite successful laceration, BASILICA or LAMPOON may fail to prevent obstruction caused by inadequate leaflet splay in patients having challenging anatomy such as very small valve-to-coronary distance, diffusely calcified, rigid leaflets, or undergoing transcatheter aortic valve replacement inside existing transcatheter aortic valve replacement. We describe a novel technique of balloon-augmented (BA) leaflet laceration to enhance leaflet splay. METHODS We measured the incremental leaflet splay from BA-BASILICA in vitro. From November 2019 to March 2021, 16 patients underwent BA-BASILICA and 4 BA-LAMPOON at 3 centers. RESULTS BA-BASILICA increased benchtop leaflet tip splay 17%, maximum splay angle 30%, and splay area 23%, resulting in a more rounded apex and larger effective area. Sixteen patients at risk for inadequate BASILICA leaflet splay, including 4 transcatheter aortic valve replacement inside existing transcatheter aortic valve replacement, underwent BA-BASILICA. All had successful leaflet laceration. One had coronary obstruction requiring immediate orthotopic stenting. Two underwent elective orthotopic coronary stenting through the transcatheter valve cells for leaflet prolapse without coronary ischemia. There were no deaths during the procedure or at 30 days. Four patients at risk for inadequate anterior mitral leaflet splay underwent BA-LAMPOON. All had successful target leaflet laceration without left ventricular outflow obstruction obstruction or procedural death. One died within 30 days. CONCLUSIONS BA leaflet laceration enhances leaflet splay in vitro and may allow transcatheter aortic valve replacement and transcatheter mitral valve replacement in patients otherwise ineligible for traditional BASILICA or LAMPOON due to challenging anatomy. Graphic Abstract: A graphic abstract is available for this article.
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Affiliation(s)
- Emily Perdoncin
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (E.P., V.C.B., P.T.G., J.X., K.J.G., G.P., N.K., A.B.G.)
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.G.B., D.K.Y., J.M.K., T.R., R.J.L.)
| | - Vasilis C Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (E.P., V.C.B., P.T.G., J.X., K.J.G., G.P., N.K., A.B.G.)
| | - Dursun Korel Yildirim
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.G.B., D.K.Y., J.M.K., T.R., R.J.L.)
| | - Jeremiah P Depta
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, NY (J.P.D.)
| | - James M McCabe
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.G.B., D.K.Y., J.M.K., T.R., R.J.L.).,Division of Cardiology, University of Washington, Seattle (J.M.M.)
| | - Patrick T Gleason
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (E.P., V.C.B., P.T.G., J.X., K.J.G., G.P., N.K., A.B.G.)
| | - Joe Xie
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (E.P., V.C.B., P.T.G., J.X., K.J.G., G.P., N.K., A.B.G.)
| | - Kendra J Grubb
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (E.P., V.C.B., P.T.G., J.X., K.J.G., G.P., N.K., A.B.G.)
| | - Gaetano Paone
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (E.P., V.C.B., P.T.G., J.X., K.J.G., G.P., N.K., A.B.G.)
| | - Keshav Kohli
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Institute of Technology and Emory University, Atlanta (K.K.)
| | - Norihiko Kamioka
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (E.P., V.C.B., P.T.G., J.X., K.J.G., G.P., N.K., A.B.G.)
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.G.B., D.K.Y., J.M.K., T.R., R.J.L.)
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.G.B., D.K.Y., J.M.K., T.R., R.J.L.)
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.G.B., D.K.Y., J.M.K., T.R., R.J.L.)
| | - Adam B Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (E.P., V.C.B., P.T.G., J.X., K.J.G., G.P., N.K., A.B.G.)
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Kim DW, Kamioka N, Babaliaros VC. Reply: Transcatheter Pulmonary Valve Replacement With 32-mm Balloon-Expandable Prosthesis: Another Strategy in Mildly Dilated RVOT. JACC Cardiovasc Interv 2021; 14:712-713. [PMID: 33736782 DOI: 10.1016/j.jcin.2021.01.047] [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: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 10/21/2022]
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15
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Greenbaum AB, Lisko JC, Gleason PT, Kamioka N, Metcalf DP, Greenbaum MA, Paone G, Grubb KJ, Lederman RJ, Babaliaros VC. Annular-to-Apical "Emory Angle" to Ensure Coaxial Mitral Implantation of the SAPIEN 3 Valve. JACC Cardiovasc Interv 2021; 13:2447-2450. [PMID: 33092718 DOI: 10.1016/j.jcin.2020.07.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/01/2020] [Accepted: 07/21/2020] [Indexed: 11/27/2022]
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16
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Kamioka N, Babaliaros VC, Lisko JC, Sahu A, Shashidharan S, Carazo MR, Jokhadar M, Rodriguez FH, Book WM, Gleason PT, Keeling WB, Jaber W, Block PC, Lederman RJ, Greenbaum AB, Kim DW. Single-Barrel, Double-Barrel, and Fenestrated Endografts to Facilitate Transcatheter Pulmonary Valve Replacement in Large RVOT. JACC Cardiovasc Interv 2021; 13:2755-2765. [PMID: 33303113 DOI: 10.1016/j.jcin.2020.08.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/10/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to test the hypothesis that narrowing the landing zone using commercially available endografts would enable transcatheter pulmonary valve replacement (TPVR) using commercially available transcatheter heart valves. BACKGROUND TPVR is challenging in an outsized native or patch-repaired right ventricular outflow tract (RVOT). Downsizing the RVOT for TPVR is currently possible only using investigational devices. In patients ineligible because of excessive RVOT size, TPVR landing zones were created using commercially available endografts. METHODS Consecutive patients with native or patch-repaired RVOTs and high or prohibitive surgical risk were reviewed, and this report describes the authors' experience with endograft-facilitated TPVR (EF-TPVR) offered to patients ineligible for investigational or commercial devices. All EF-TPVR patients were surgery ineligible, with symptomatic, severe pulmonary insufficiency, enlarged RVOTs, and severe right ventricular (RV) enlargement (>150 ml/m2). TPVR and surgical pulmonary valve replacement (SPVR) were compared in patients with less severe RV enlargement. RESULTS Fourteen patients had large RVOTs unsuitable for conventional TPVR; 6 patients (1 surgery ineligible) received investigational devices, and 8 otherwise ineligible patients underwent compassionate EF-TPVR (n = 5 with tetralogy of Fallot). Three strategies were applied on the basis of progressively larger RVOT size: single-barrel, in situ fenestrated, and double-barrel endografts as required to anchor 1 (single-barrel and fenestrated) or 2 (double-barrel) transcatheter heart valves. All were technically successful, without procedure-related, 30-day, or in-hospital deaths. Two late complications (stent obstruction and embolization) were treated percutaneously. One patient died of ventricular tachycardia 36 days after EF-TPVR. Compared with 48 SPVRs, RV enlargement was greater, but 30-day and 1-year mortality and readmission were no different. The mean transvalvular pressure gradient was lower after EF-TPVR (3.8 ± 0.8 mm Hg vs. 10.7 ± 4.1 mm Hg; p < 0.001; 30 days). More than mild pulmonary insufficiency was equivalent in both (EF-TPVR 0.0% [n = 0 of 8] vs. SPVR 4.3% [n = 1 of 43]; p = 1.00; 30 days). CONCLUSIONS EF-TPVR may be an alternative for patients with pulmonic insufficiency and enlarged RVOTs ineligible for other therapies.
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Affiliation(s)
- Norihiko Kamioka
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vasilis C Babaliaros
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John C Lisko
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anurag Sahu
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Matthew R Carazo
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Maan Jokhadar
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Fred H Rodriguez
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Wendy M Book
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Patrick T Gleason
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - William B Keeling
- Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Wissam Jaber
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Peter C Block
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Adam B Greenbaum
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dennis W Kim
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA; Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
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Agrawal A, Alexy T, Kamioka N, Shafi T, Stowe J, Morris AA, Vega JD, Babaliaros V, Burke MA. Outflow graft obstruction after left ventricular assist device implantation: a retrospective, single-centre case series. ESC Heart Fail 2021; 8:2349-2353. [PMID: 33787080 PMCID: PMC8120379 DOI: 10.1002/ehf2.13333] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/21/2020] [Revised: 02/24/2021] [Accepted: 03/12/2021] [Indexed: 11/22/2022] Open
Abstract
Aims Outflow graft obstruction is a poorly described complication following left ventricular assist device (LVAD) surgery. We sought to define the incidence of LVAD outflow graft obstruction and assess clinical outcomes with a percutaneous treatment strategy. Methods and results From January 2012 to October 2020, 322 patients with LVAD were managed at our institution. Patients with LVAD outflow graft obstruction were identified by cardiac computed tomography with angiography and invasive haemodynamic assessment and were subsequently treated with percutaneous intervention. Poisson regression was used to analyse time‐dependent differences in the incidence of LVAD outflow graft obstruction. Kaplan–Meier analysis was used to estimate survival. Twenty patients (6.2%) developed haemodynamically significant LVAD outflow graft obstruction at a rate of 0.03 events per patient‐year. Outflow graft obstruction presented a median of 33 (26–49) months after surgery. Patients presented with low estimated LVAD pump flow (95%), heart failure (90%), or both (85%), and 59% developed cardiogenic shock prior to intervention. The most common aetiology identified by cardiac computed tomography with angiography was external compression of the outflow graft (78%). On presentation, the median peak gradient in the outflow graft was 78 (64–100) mmHg. Outflow graft stenting was 100% successful with no in‐hospital mortality, and it reduced the peak outflow graft gradient to 10 (2–17) mmHg (P < 0.001). Outflow graft stenting was durable with two patients (10%) requiring a repeat procedure over a median follow‐up of 13 (7–20) months and did not impact survival. Conclusions Left ventricular assist device outflow graft obstruction is a relatively common and underappreciated cause of recurrent heart failure and LVAD dysfunction. Outflow graft stenting can be achieved with low morbidity and provides a long‐term solution to this complication.
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Affiliation(s)
- Akanksha Agrawal
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, Suite 322, Atlanta, GA, 30322, USA
| | - Tamas Alexy
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, Suite 322, Atlanta, GA, 30322, USA
| | - Norihiko Kamioka
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, Suite 322, Atlanta, GA, 30322, USA
| | - Taimur Shafi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, Suite 322, Atlanta, GA, 30322, USA
| | - Judson Stowe
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, Suite 322, Atlanta, GA, 30322, USA
| | - Alanna A Morris
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, Suite 322, Atlanta, GA, 30322, USA
| | - J David Vega
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Vasilis Babaliaros
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, Suite 322, Atlanta, GA, 30322, USA
| | - Michael A Burke
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, Suite 322, Atlanta, GA, 30322, USA
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Lisko JC, Babaliaros VC, Khan JM, Kamioka N, Gleason PT, Paone G, Byku I, Tiwana J, McCabe JM, Cherukuri K, Khalil R, Lasorda D, Goel SS, Kleiman NS, Reardon MJ, Daniels DV, Spies C, Mahoney P, Case BC, Whisenant BK, Yadav PK, Condado JF, Koch R, Grubb KJ, Bruce CG, Rogers T, Lederman RJ, Greenbaum AB. Tip-to-Base LAMPOON for Transcatheter Mitral Valve Replacement With a Protected Mitral Annulus. JACC Cardiovasc Interv 2021; 14:541-550. [PMID: 33663781 DOI: 10.1016/j.jcin.2020.11.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate tip-to-base intentional laceration of the anterior mitral leaflet to prevent left ventricular outflow tract obstruction (LAMPOON) in patients undergoing transcatheter mitral valve replacement (TMVR) in annuloplasty rings or surgical mitral valves. BACKGROUND LAMPOON is an effective adjunct to TMVR that prevents left ventricular outflow tract obstruction (LVOTO). Laceration is typically performed from the base to the tip of the anterior mitral leaflet. A modified laceration technique from leaflet tip to base may be effective in patients with a prosthesis that protects the aortomitral curtain. METHODS This is a multicenter, 21-patient, consecutive retrospective observational cohort. Patients underwent tip-to-base LAMPOON to prevent LVOTO and leaflet overhang, or therapeutically to lacerate a long anterior mitral leaflet risking or causing LVOTO. Outcomes were compared with findings from patients in the LAMPOON investigational device exemption trial with a prior mitral annuloplasty. RESULTS Twenty-one patients with a annuloplasty or valve prosthesis-protected mitral annulus underwent tip-to-base LAMPOON (19 preventive, 2 rescue). Leaflet laceration was successful in all and successfully prevented or treated LVOTO in all patients. No patients had significant LVOTO upon discharge. There were 2 cases of unintentional aortic valve injury (1 patient underwent emergency transcatheter aortic valve replacement and 1 patient underwent urgent surgical aortic valve replacement). In both cases, the patients had a supra-annular ring annuloplasty, and the retrograde aortic guiding catheter failed to insulate the guidewire lacerating surface from the aortic root. All patients survived to 30 days. Compared with classic retrograde LAMPOON, there was a trend toward shorter procedure time. CONCLUSIONS Tip-to-base laceration is a simple, effective, and safe LAMPOON variant applicable to patients with an appropriately positioned mitral annular ring or bioprosthetic valve. Operators should take care to insulate the lacerating surface from adjacent structures.
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Affiliation(s)
- John C Lisko
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vasilis C Babaliaros
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA.
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Norihiko Kamioka
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Patrick T Gleason
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gaetano Paone
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Isida Byku
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jasleen Tiwana
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - James M McCabe
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Krishna Cherukuri
- Division of Cardiology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Ramzi Khalil
- Division of Cardiology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - David Lasorda
- Division of Cardiology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Sachin S Goel
- Division of Cardiology, Houston Methodist, Houston, Texas, USA
| | - Neal S Kleiman
- Division of Cardiology, Houston Methodist, Houston, Texas, USA
| | | | - David V Daniels
- Division of Cardiology, Palo Alto Medical Foundation, San Francisco, California, USA
| | - Christian Spies
- Division of Cardiology, Palo Alto Medical Foundation, San Francisco, California, USA
| | - Paul Mahoney
- Division of Cardiology, Sentara Heart Center, Norfolk, Virginia, USA
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Pradeep K Yadav
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Jose F Condado
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rachel Koch
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kendra J Grubb
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Adam B Greenbaum
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
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Case BC, Lisko JC, Babaliaros VC, Greenbaum AB, Satler L, Ben-Dor I, Forrestal BJ, Yerasi C, Kamioka N, Rogers T, Waksman R, Lederman RJ, Khan JM. LAMPOON techniques to prevent or manage left ventricular outflow tract obstruction in transcatheter mitral valve replacement. Ann Cardiothorac Surg 2021; 10:172-179. [PMID: 33575191 DOI: 10.21037/acs-2020-mv-25] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Transcatheter mitral valve replacement (TMVR) is a therapeutic option for patients with severe mitral disease who are deemed inoperable due to their overall surgical risk. The close relationships between the left ventricular outflow tract (LVOT) and the anterior mitral valve leaflet can lead to LVOT obstruction, a common complication with high mortality. Predicting and preventing LVOT obstruction is therefore essential, prior to TMVR. Laceration of the Anterior Mitral leaflet to Prevent Outflow ObtructioN (LAMPOON) is a transcatheter electrosurgical technique to split the anterior mitral valve leaflet immediately prior to TMVR. The technique has been studied in a prospective clinical trial and has evolved with many iterations for specific anatomies. In this review, we discuss the different LAMPOON techniques to prevent and treat LVOT obstruction.
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Affiliation(s)
- Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - John C Lisko
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA, USA
| | | | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA, USA
| | - Lowell Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Brian J Forrestal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Charan Yerasi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Norihiko Kamioka
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.,Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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20
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Trusty PM, Bhat SS, Sadri V, Salim MT, Funnell E, Kamioka N, Sharma R, Makkar R, Babaliaros V, Yoganathan AP. The role of flow stasis in transcatheter aortic valve leaflet thrombosis. J Thorac Cardiovasc Surg 2020; 164:e105-e117. [PMID: 33342573 DOI: 10.1016/j.jtcvs.2020.10.139] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE With the recent expanded indication for transcatheter aortic valve replacement to low-risk surgical patients, thrombus formation in the neosinus is of particular interest due to concerns of reduced leaflet motion and long-term transcatheter heart valve durability. Although flow stasis likely plays a role, a direct connection between neosinus flow stasis and thrombus severity is yet to be established. METHODS Patients (n = 23) were selected to minimize potential confounding factors related to thrombus formation. Patient-specific 3-dimensional reconstructed in vitro models were created to replicate in vivo anatomy and valve deployment using the patient-specific cardiac output and idealized coronary flows. Dye was injected into each neosinus to quantify washout time as a measure of flow stasis. RESULTS Flow stasis (washout time) showed a significant, positive correlation with thrombus volume in the neosinus (rho = 0.621, P < .0001). Neither thrombus volume nor washout time was significantly different in the left, right, and noncoronary neosinuses (P ≥ .54). CONCLUSIONS This is the first patient-specific study correlating flow stasis with thrombus volume in the neosinus post-transcatheter aortic valve replacement across multiple valve types and sizes. Neosinus-specific factors create hemodynamic and thrombotic variability within individual patients. Measurement of neosinus flow stasis may guide strategies to improve outcomes in transcatheter aortic valve replacement.
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Affiliation(s)
- Phillip M Trusty
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga
| | - Sanchita S Bhat
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga
| | - Vahid Sadri
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga
| | - Md Tausif Salim
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, Ga
| | - Emelia Funnell
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga
| | | | | | - Raj Makkar
- Cedars Sinai Heart Institute, Los Angeles, Calif
| | | | - Ajit P Yoganathan
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga.
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21
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Byku I, Kamioka N, Greenbaum AB, Gleason P, Babaliaros VC, Grubb KJ. Master of cardiothoracic surgery: transcaval transcatheter aortic valve replacement. Ann Cardiothorac Surg 2020; 9:531-533. [PMID: 33312918 DOI: 10.21037/acs-2020-av-17] [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] [Indexed: 11/06/2022]
Affiliation(s)
- Isida Byku
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Norihiko Kamioka
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Adam B Greenbaum
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Patrick Gleason
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Vasilis C Babaliaros
- Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Kendra J Grubb
- Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
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22
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Lisko JC, Greenbaum AB, Guyton RA, Kamioka N, Grubb KJ, Gleason PT, Byku I, Condado JF, Jadue A, Paone G, Block PC, Alvarez L, Xie J, Khan JM, Rogers T, Lederman RJ, Babaliaros VC. Electrosurgical Detachment of MitraClips From the Anterior Mitral Leaflet Prior to Transcatheter Mitral Valve Implantation. JACC Cardiovasc Interv 2020; 13:2361-2370. [PMID: 33011144 PMCID: PMC7584767 DOI: 10.1016/j.jcin.2020.06.047] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/20/2020] [Accepted: 06/18/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this study was to test the hypothesis that transcatheter electrosurgery might allow intentional detachment of previously placed MitraClip(s) from the anterior leaflet to recreate a single mitral orifice for transcatheter mitral valve implantation (TMVI), leaving the retained MitraClip(s) securely fastened to the posterior leaflet and without interfering with the mitral bioprosthesis. BACKGROUND Patients with severe mitral regurgitation or stenosis despite edge-to-edge mitral repair with the MitraClip typically have few therapeutic options because the resultant double orifice precludes TMVI. Transcatheter electrosurgery may allow detachment of failed MitraClip(s) from the anterior leaflet to recreate a single orifice for TMVI. METHODS This was a single-center, 5-patient, consecutive, retrospective observational cohort. Patients underwent transcatheter electrosurgical laceration and stabilization of failed MitraClip(s) to recreate a single orifice, leaving the MitraClip(s) securely fastened to the posterior leaflet. Subsequently, patients underwent TMVI with an investigational device, the Tendyne mitral bioprosthesis, on a compassionate basis. Patients were followed up to 30 days. RESULTS MitraClip detachment from the anterior leaflet and Tendyne implantation were successful in all patients. All patients survived to discharge. All patients were discharged with grade 0 central mitral regurgitation. Two patients had moderate perivalvular mitral regurgitation that did not require reintervention. During the follow-up period of 30 days, there were no deaths, cases of valve dysfunction, or reintervention. There was no evidence of erosion or bioprosthetic valve dysfunction attributable to the retained MitraClip(s) still attached to the posterior leaflet. CONCLUSIONS Transcatheter electrosurgical detachment of failed MitraClips from the anterior leaflet followed by TMVI is technically feasible and safe at 30 days. Longer term study is needed to determine the clinical benefit of this approach and new algorithms for TMVI sizing following electrosurgical laceration and stabilization of a failed MitraClip to avoid perivalvular leak.
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Affiliation(s)
- John C Lisko
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Adam B Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Robert A Guyton
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Norihiko Kamioka
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Kendra J Grubb
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Patrick T Gleason
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Isida Byku
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Jose F Condado
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Andres Jadue
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Gaetano Paone
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Peter C Block
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Lucia Alvarez
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Joe Xie
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Vasilis C Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia.
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23
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Yoon SH, Kim WK, Dhoble A, Milhorini Pio S, Babaliaros V, Jilaihawi H, Pilgrim T, De Backer O, Bleiziffer S, Vincent F, Shmidt T, Butter C, Kamioka N, Eschenbach L, Renker M, Asami M, Lazkani M, Fujita B, Birs A, Barbanti M, Pershad A, Landes U, Oldemeyer B, Kitamura M, Oakley L, Ochiai T, Chakravarty T, Nakamura M, Ruile P, Deuschl F, Berman D, Modine T, Ensminger S, Kornowski R, Lange R, McCabe JM, Williams MR, Whisenant B, Delgado V, Windecker S, Van Belle E, Sondergaard L, Chevalier B, Mack M, Bax JJ, Leon MB, Makkar RR. Bicuspid Aortic Valve Morphology and Outcomes After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2020; 76:1018-1030. [DOI: 10.1016/j.jacc.2020.07.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/09/2020] [Accepted: 07/02/2020] [Indexed: 11/24/2022]
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24
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Kumar A, Sammour Y, Reginauld S, Sato K, Agrawal N, Lee JM, Meenakshisundaram C, Ramanan T, Kamioka N, Sawant AC, Mohananey D, Gleason PT, Devireddy C, Krishnaswamy A, Mavromatis K, Grubb K, Svensson LG, Tuzcu EM, Block PC, Iyer V, Babaliaros V, Kapadia S, Samady H. Adverse clinical outcomes in patients undergoing both PCI and TAVR: Analysis from a pooled multi-center registry. Catheter Cardiovasc Interv 2020; 97:529-539. [PMID: 32845036 DOI: 10.1002/ccd.29233] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/02/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is a paucity of data regarding the optimum timing of PCI in relation to TAVR. OBJECTIVE We compared the major adverse cardiovascular and cerebrovascular events (MACCE) rates among patients who underwent percutaneous coronary intervention (PCI) before transcatheter aortic valve replacement (TAVR) with those who received PCI with/after TAVR. METHODS In this multicenter study, we pooled all consecutive patients who underwent TAVR at three high volume centers. RESULTS Among 3,982 patients who underwent TAVR, 327 (8%) patients underwent PCI within 1 year before TAVR, 38 (1%) had PCI the same day as TAVR and 15 (0.5%) had PCI within 2 months after TAVR. Overall, among patients who received both PCI and TAVR (n = 380), history of previous CABG (HR:0.501; p = .001), higher BMI at TAVR (HR:0.970; p = .038), and statin therapy after TAVR (HR:0.660, p = .037) were independently associated with lower MACCE while warfarin therapy after TAVR was associated with a higher risk of MACCE (HR:1.779, p = .017). Patients who received PCI within 1 year before TAVR had similar baseline demographics, STS scores, clinical risk factors when compared to patients receiving PCI with/after TAVR. Both groups were similar in PCI (Syntax Score, ACC/AHA lesion class) and TAVR (valve types, access) related variables. There were no significant differences in terms of MACCE (log rank p = .550), all-cause mortality (log rank p = .433), strokes (log rank p = .153), and repeat PCI (log rank p = .054) in patients who underwent PCI with/after TAVR when compared to patients who received PCI before TAVR. CONCLUSION Among patients who underwent both PCI and TAVR, history of CABG, higher BMI, and statin therapy had lower, while those discharged on warfarin, had higher adverse event rates. Adverse events rates were similar regardless of timing of PCI.
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Affiliation(s)
- Arnav Kumar
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Yasser Sammour
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Shawn Reginauld
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Kimi Sato
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nikhil Agrawal
- Department of Medicine Division of Cardiology, State University of New York at Buffalo, Buffalo, New York
| | - Joo Myung Lee
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | | | - Thammi Ramanan
- Department of Medicine Division of Cardiology, State University of New York at Buffalo, Buffalo, New York
| | - Norihiko Kamioka
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Abhishek C Sawant
- Department of Medicine Division of Cardiology, State University of New York at Buffalo, Buffalo, New York
| | | | - Patrick T Gleason
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Chandan Devireddy
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Amar Krishnaswamy
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Kreton Mavromatis
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Kendra Grubb
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Lars G Svensson
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - E Murat Tuzcu
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Peter C Block
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Vijay Iyer
- Department of Medicine Division of Cardiology, State University of New York at Buffalo, Buffalo, New York
| | - Vasilis Babaliaros
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Samir Kapadia
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Habib Samady
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
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25
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Keegan P, Lisko JC, Kamioka N, Maidman S, Binongo JN, Wei J, Vadlamudi R, Edwards JK, Vatsa N, Maini A, Reginauld S, Gleason P, Stewart J, Devireddy C, Block PC, Greenbaum A, Guyton RA, Babaliaros VC. Nurse Led Sedation: The Clinical and Echocardiographic Outcomes of the 5-Year Emory Experience. Structural Heart 2020. [DOI: 10.1080/24748706.2020.1773591] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Patricia Keegan
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John C. Lisko
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Norihiko Kamioka
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Samuel Maidman
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jose N. Binongo
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jane Wei
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ratna Vadlamudi
- Division of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - J. Kirk Edwards
- Division of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Aneesha Maini
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shawn Reginauld
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Patrick Gleason
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - James Stewart
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chandan Devireddy
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Peter C. Block
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Adam Greenbaum
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert A. Guyton
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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26
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Qin T, Caballero A, Mao W, Barrett B, Kamioka N, Lerakis S, Sun W. The role of stress concentration in calcified bicuspid aortic valve. J R Soc Interface 2020; 17:20190893. [PMID: 32517630 DOI: 10.1098/rsif.2019.0893] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Calcific aortic valve disease (CAVD) is the most common valvular heart disease in the aging population, and is now believed to be a slow, progressive, yet actively regulated process. The disease progression can be divided into two phases: initiation phase associated with lipid deposition and inflammation response, and the later propagation phase with active calcification growth. It has been hypothesized that elevated mechanical stress plays a major role in both phases of disease progression. In order to identify a direct link between leaflet stress and calcification development, we performed patient-specific finite-element (FE) analyses of six bicuspid aortic valves (BAV), where the leaflets, raphe and calcifications were all considered. The results showed that during the initiation phase, calcium buildup is likely to occur along the leaflet-root attachment curve (ATC), and the commissures, which are subject to the most drastic changes in stress during the cardiac cycle. During the propagation phase, the presence of calcification would lead to local stress concentration along its boundary, hence further calcification growth. Three patterns of calcification formation were identified on BAV leaflets: 'radial', which extended radially from ATC into the leaflet belly region; 'commissure to commissure', which extended circumferentially along the coaptation; and 'raphe', which located in the vicinity of the raphe. Furthermore, we found a strong correlation between regions with a high risk of calcium buildup and regions with elevated mechanical stress. The high-risk regions predicted at diastole on the non-calcified leaflet from FE models agreed reasonably well with the in vivo calcification locations, which indicates that patient-specific FE modelling could help us to evaluate the potential risk of calcification formation in the early stage of CAVD.
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Affiliation(s)
- Tongran Qin
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Andrés Caballero
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Wenbin Mao
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Brian Barrett
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | | | - Stamatios Lerakis
- School of Medicine, Emory University, Atlanta, GA, USA.,Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Wei Sun
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
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27
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Lisko JC, Greenbaum AB, Khan JM, Kamioka N, Gleason PT, Byku I, Condado JF, Jadue A, Paone G, Grubb KJ, Tiwana J, McCabe JM, Rogers T, Lederman RJ, Babaliaros VC. Antegrade Intentional Laceration of the Anterior Mitral Leaflet to Prevent Left Ventricular Outflow Tract Obstruction: A Simplified Technique From Bench to Bedside. Circ Cardiovasc Interv 2020; 13:e008903. [PMID: 32513014 DOI: 10.1161/circinterventions.119.008903] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intentional laceration of the anterior mitral leaflet (LAMPOON) is an effective adjunct to transcatheter mitral valve replacement that prevents left ventricular outflow tract (LVOT) obstruction. To date, LAMPOON has been performed in over 150 patients using a retrograde approach that can be technically challenging. A modified antegrade transseptal technique may simplify the procedure. METHODS Antegrade LAMPOON was developed and tested in nonsurvival pig experiments. Thereafter, antegrade LAMPOON was performed in patients at prohibitive risk of LVOT obstruction. Clinical, procedural, and angiographic details were abstracted from medical records of their index procedure, and were compared with findings in comparable patients at risk of fixed-LVOT obstruction in the LAMPOON investigational device exemption trial. RESULTS Eight patients at risk of fixed LVOT obstruction underwent antegrade LAMPOON. Leaflet traversal and laceration were technically successful in all. There were no cases of clinically significant LVOT obstruction (mean LVOT gradient at discharge: 5.4±1.4 mm Hg). One patient suffered a ventricular wire perforation, unrelated to the antegrade LAMPOON technique, and did not survive to discharge. At the time of discharge, no patients had an increase of >10 mm Hg in LVOT gradient compared with baseline. Procedure times (from traversal to transcatheter mitral valve replacement) were shorter, compared with the retrograde technique in the LAMPOON investigational device exemption trial (39±09 versus 65±35 minutes). All patients survived (8/8, 100%) the procedure, and 7/8 (88%) survived to 30 days, similar to subjects in the LAMPOON investigational device exemption trial. CONCLUSIONS Antegrade LAMPOON is an effective, reproducible, and simplified strategy to lacerate the anterior leaflet before transcatheter mitral valve replacement. The authors recommend the technique as the new standard for LAMPOON.
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Affiliation(s)
- John C Lisko
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, GA (J.C.L., A.B.G., N.K., P.T.G., I.B., J.F.C., A.J., G.P., K.J.G., V.C.B.)
| | - Adam B Greenbaum
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, GA (J.C.L., A.B.G., N.K., P.T.G., I.B., J.F.C., A.J., G.P., K.J.G., V.C.B.)
| | - Jaffar M Khan
- Cadiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland (J.M.K., T.R., R.J.L.)
| | - Norihiko Kamioka
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, GA (J.C.L., A.B.G., N.K., P.T.G., I.B., J.F.C., A.J., G.P., K.J.G., V.C.B.)
| | - Patrick T Gleason
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, GA (J.C.L., A.B.G., N.K., P.T.G., I.B., J.F.C., A.J., G.P., K.J.G., V.C.B.)
| | - Isida Byku
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, GA (J.C.L., A.B.G., N.K., P.T.G., I.B., J.F.C., A.J., G.P., K.J.G., V.C.B.)
| | - Jose F Condado
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, GA (J.C.L., A.B.G., N.K., P.T.G., I.B., J.F.C., A.J., G.P., K.J.G., V.C.B.)
| | - Andres Jadue
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, GA (J.C.L., A.B.G., N.K., P.T.G., I.B., J.F.C., A.J., G.P., K.J.G., V.C.B.)
| | - Gaetano Paone
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, GA (J.C.L., A.B.G., N.K., P.T.G., I.B., J.F.C., A.J., G.P., K.J.G., V.C.B.)
| | - Kendra J Grubb
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, GA (J.C.L., A.B.G., N.K., P.T.G., I.B., J.F.C., A.J., G.P., K.J.G., V.C.B.)
| | - Jasleen Tiwana
- Division of Cardiology, University of Washington Medical Center, Seattle (J.T., J.M.M.)
| | - James M McCabe
- Division of Cardiology, University of Washington Medical Center, Seattle (J.T., J.M.M.)
| | - Toby Rogers
- Cadiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland (J.M.K., T.R., R.J.L.)
| | - Robert J Lederman
- Cadiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland (J.M.K., T.R., R.J.L.)
| | - Vasilis C Babaliaros
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, GA (J.C.L., A.B.G., N.K., P.T.G., I.B., J.F.C., A.J., G.P., K.J.G., V.C.B.)
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Maidman SD, Lisko JC, Kamioka N, Chen EP, Mavromatis K, Halkos M, Stewart JP, Lattouf OM, Keeling WB, Gleason P, Sommerfeld AJ, Maini A, Ibrahim AW, Grubb KJ, Leshnower BG, Guyton R, Greenbaum AB, Block PC, Babaliaros VC, Devireddy C. Outcomes Following Shock Aortic Valve Replacement: Transcatheter Versus Surgical Approaches. Cardiovasc Revasc Med 2020; 21:1313-1318. [PMID: 32305316 DOI: 10.1016/j.carrev.2020.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/12/2020] [Accepted: 03/12/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To compare transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) for patients in shock. BACKGROUND There are minimal data on the clinical and echocardiographic outcomes for patients in shock that undergo TAVR and no data comparing these outcomes to similar patients undergoing SAVR. METHODS This is a single center, retrospective cohort study of patients having Society of Thoracic Surgeons (STS)-defined urgent or emergent AVR for aortic stenosis with clinical signs and symptoms of shock. Inclusion criteria were based on the Society of Cardiovascular Angiography & Interventions (SCAI) shock consensus statement and included: the need for inotropic or vasopressor agents, mechanical ventilation, continuous renal replacement therapy or newly initiated hemodialysis, and/or utilization of mechanical hemodynamic support. Clinical and echocardiographic outcomes for TAVR and SAVR were compared. RESULTS Thirty-seven patients met the inclusion criteria for this study (17 TAVR, 20 SAVR). TAVR patients had a higher STS Predicted Risk of Mortality (PROM) score of 22.3% compared to 11.8% for SAVR patients (p = 0.001). No significant differences were found in baseline echocardiographic results. TAVR procedures required less procedure room time (185.9 min TAVR, 348.5 min SAVR, p < 0.001) and fewer intraoperative packed red blood cell (pRBC) transfusions (0.2 units TAVR, 3.4 units SAVR, p < 0.001). TAVR patients also had lower rates of prolonged postoperative ventilation compared to SAVR patients (38.5% TAVR, 75.0% SAVR, p = 0.047). TAVR and SAVR had similar rates of mortality at discharge (2 TAVR, 1 SAVR, p = 0.584), 30-days (2 TAVR, 1 SAVR, p = 0.584), and 1-year (8 TAVR, 5 SAVR, p = 0.149). CONCLUSIONS Despite a higher risk TAVR group, patients in shock undergoing either TAVR or SAVR have similar 30-day mortality. At one year, SAVR patients have a numerically better, though not statistically significant, survival. These findings support the use of TAVR for patients in shock with aortic stenosis.
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Affiliation(s)
- Samuel D Maidman
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - John C Lisko
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Norihiko Kamioka
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Edward P Chen
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Kreton Mavromatis
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Michael Halkos
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States of America
| | - James P Stewart
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Omar M Lattouf
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States of America
| | - W Brent Keeling
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Patrick Gleason
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Alex J Sommerfeld
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Aneesha Maini
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Akram W Ibrahim
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Bradley G Leshnower
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Robert Guyton
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Adam B Greenbaum
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Peter C Block
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Vasilis C Babaliaros
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America.
| | - Chandan Devireddy
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
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Burke M, Alexy T, Kamioka N, Shafi T, Turbyfield C, Stowe J, Porter J, Iturbe J, Kim D, Wittersheim K, Nguyen D, Laskar S, Gupta D, Bhatt K, Smith A, Cole R, Morris A, Vega J, Babaliaros V. Outflow Graft Obstruction Causing Recurrent Heart Failure after Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.947] [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] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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30
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Corrigan Iii FE, Iturbe JM, Lerakis S, Kamioka N, Babaliaros VC, Clements SD. Percutaneous Closure of Paravalvular Leak from a Rocking Mitral Valve in a 74-Year-Old Man at High Surgical Risk. Tex Heart Inst J 2020; 47:160-162. [PMID: 32603469 DOI: 10.14503/thij-18-6626] [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: 11/23/2022]
Abstract
Dehiscence of a prosthetic heart valve or excessive rocking during the cardiac cycle is thought to preclude percutaneous paravalvular leak closure. However, surgical repair of paravalvular leak is associated with recurrent dehiscence and poor outcomes. We present the case of a symptomatic 74-year-old man in whom we performed percutaneous anchoring, involving multiple plugs and multimodal imaging, to stabilize a rocking mitral valve and close a substantial paravalvular leak caused by dehiscence. To our knowledge, using this technique to correct both conditions is novel.
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Affiliation(s)
- Frank E Corrigan Iii
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia 30322
| | - Jose Miguel Iturbe
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia 30322
| | - Stamatios Lerakis
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia 30322
| | - Norihiko Kamioka
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia 30322
| | - Vasilis C Babaliaros
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia 30322
| | - Stephen D Clements
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia 30322
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Jadue A, Lisko JC, Contreras JFC, Kamioka N, Babaliaros V, Greenbaum A, Paone G, Byku I, Guyton R, Maini A, Devireddy C, Grubb K. TRANSCATHETER AORTIC VALVE REPLACEMENT OUTCOMES IN PATIENTS WITH NATIVE AORTIC VALVE INSUFFICENCY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32748-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Kumar A, Sammour Y, Reginauld S, Sato K, Agrawal N, Meenakshisundaram C, Kamioka N, Sawant AC, Devireddy C, Krishnaswamy A, Greenbaum AB, Mavromatis K, Grubb K, Byku I, Svensson L, Tuzcu M, Block PC, Iyer V, Kapadia S, Babaliaros V. CRT-600.08 A Comparison of Clinical Outcomes According to the Timing of PCI and TAVR: A Pooled Analysis From a Multicenter Registry. JACC Cardiovasc Interv 2020. [DOI: 10.1016/j.jcin.2020.01.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sengupta A, Zaid S, Kamioka N, Terre J, Miyasaka M, Hirji SA, Hensey M, Geloo N, Petrossian G, Robinson N, Sarin E, Ryan L, Yoon SH, Tan CW, Khalique OK, Kodali SK, Kaneko T, Shah PB, Wong SC, Salemi A, Sharma K, Kozina JA, Szerlip MA, Don CW, Gafoor S, Zhang M, Newhart Z, Kapadia SR, Mick SL, Krishnaswamy A, Kini A, Ahmad H, Lansman SL, Mack MJ, Webb JG, Babaliaros V, Thourani VH, Makkar RR, Leon MB, George I, Tang GH. Mid-Term Outcomes of Transcatheter Aortic Valve Replacement in Extremely Large Annuli With Edwards SAPIEN 3 Valve. JACC Cardiovasc Interv 2020; 13:210-216. [DOI: 10.1016/j.jcin.2019.08.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/22/2019] [Accepted: 08/29/2019] [Indexed: 12/21/2022]
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Babaliaros V, Greenbaum AB, Kamioka N, Khan JM, Rogers T, Corrigan F, Lerakis S, Gleason P, Yousef A, Kim DW, Holtz N, Leshnower B, Guyton RA, Lederman RJ. Bedside Modification of Delivery System for Transcatheter Transseptal Mitral Replacement With POULEZ System and SAPIEN-3 Valve. JACC Cardiovasc Interv 2019; 11:1207-1209. [PMID: 29929643 DOI: 10.1016/j.jcin.2018.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/05/2018] [Accepted: 03/12/2018] [Indexed: 10/28/2022]
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Kiani S, Kamioka N, Black GB, Lu MLR, Lisko JC, Rao B, Mengistu A, Gleason PT, Stewart JP, Caughron H, Dong A, Patel H, Grubb KJ, Greenbaum AB, Devireddy CM, Guyton RA, Leshnower B, Merchant FM, El-Chami M, Westerman SB, Lloyd MS, Babaliaros VC, Hoskins MH. Development of a Risk Score to Predict New Pacemaker Implantation After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 12:2133-2142. [DOI: 10.1016/j.jcin.2019.07.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/05/2019] [Accepted: 07/11/2019] [Indexed: 11/29/2022]
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Kiani S, Kamioka N, Caughron H, Dong A, Patel H, Lisko J, Gleason P, Stewart J, Grubb K, Greenbaum A, Devireddy C, Guyton R, Leshnower B, Babaliaros V, Hoskins M. P1019Validation of a risk score to predict the need for pacemaker implantation after transcatheter aortic valve replacement. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
New conduction abnormalities necessitating pacemaker implantation (PMI) is a common occurrence after TAVR. There is an increased rate of PMI in the those receiving the most contemporary implanted valve, the Edwards Sapien-3 (S3), compared to prior generation balloon expandable valves. We previously described predictors of PMI in a large cohort. Herein we sought to validate these predictors of PMI in a subsequent validation cohort.
Methods
We evaluated all patients undergoing first time elective TAVR with S3 at our institution (n=326). We developed a risk score based on a predictive model we have previously described. Patients received one point for each of the following: history of syncope, oversizing of the valve >16%, baseline right bundle branch block morphology, and two points for a QRS duration >115 ms. We performed regression analysis of the risk score and need for PMI. We also evaluated the performance of the risk score using ROC analysis.
Results
Thirty patients (8%) of the total cohort had need for PMI after S3 implantation. Those with PMI had a higher rate of pre-existing infra-nodal conduction system disease – including QRS duration >115ms (57% vs. 20%, p<0.001) and right bundle branch block (RBBB) morphology (47% vs. 10%, p<0.001) - as well as more frequent valve oversizing >15.7% (47% vs. 23%, p<0.01). There was no significant difference in a history of syncope (10% vs. 8%, p=0.72) between groups. The PMI risk score had an area under the curve of 0.753 on ROC analysis. The PMI risk score was significantly associated with PMI (OR 2.37; 95% CI [1.64–3.34], p<0.001).
Rate of PMI Stratified by Risk Score
Conclusions
The PMI risk score was strongly predictive of the need for PMI after implantation of the S3 valve in a large validation cohort. The PMI risk score performed well in sensitivity analysis. This PMI risk score represents a simple tool to help further risk stratify patients being considered for TAVR.
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Affiliation(s)
- S Kiani
- Emory University School of Medicine, Atlanta, United States of America
| | - N Kamioka
- Emory University School of Medicine, Cardiology, Atlanta, United States of America
| | - H Caughron
- Emory University School of Medicine, Atlanta, United States of America
| | - A Dong
- Emory University School of Medicine, Atlanta, United States of America
| | - H Patel
- Emory University School of Medicine, Atlanta, United States of America
| | - J Lisko
- Emory University School of Medicine, Cardiology, Atlanta, United States of America
| | - P Gleason
- Emory University School of Medicine, Cardiology, Atlanta, United States of America
| | - J Stewart
- Emory University School of Medicine, Cardiology, Atlanta, United States of America
| | - K Grubb
- Emory University School of Medicine, Atlanta, United States of America
| | - A Greenbaum
- Emory University School of Medicine, Cardiology, Atlanta, United States of America
| | - C Devireddy
- Emory University School of Medicine, Cardiology, Atlanta, United States of America
| | - R Guyton
- Emory University School of Medicine, Atlanta, United States of America
| | - B Leshnower
- Emory University School of Medicine, Atlanta, United States of America
| | - V Babaliaros
- Emory University School of Medicine, Cardiology, Atlanta, United States of America
| | - M Hoskins
- Emory University School of Medicine, Cardiology, Atlanta, United States of America
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Lisko J, Kamioka N, Babaliaros V, Shirai S, Kawaguchi T, Yamamoto M, Miyasaka M, Khan J, Maidman S, Gleason P, Alvarez L, Byku I, Grubb K, Guyton R, Rogers T, Lederman R, Greenbaum A. TCT-17 Coronary Obstruction Risk Assessment: A Comparison of Snorkel Stenting and BASILICA. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kamioka N, Lisko J, Maidman S, Kim D, Sahu A, Dong A, Shashidharan S, Jokhadar M, Rodriguez F, Book W, Gleason P, Block P, Babaliaros V. TCT-770 Outcomes After Endograft Facilitated Transcatheter Pulmonary Valve Replacement for Failed Repair: Surgical vs. Transcatheter Procedures. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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39
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Lisko J, Maidman S, Kamioka N, Guyton R, Gleason P, Alvarez L, Byku I, Grubb K, Shekiladze N, Bakhtadze B, Brown M, Ho A, Parihar S, Khan J, Devireddy C, Rogers T, Babaliaros V. TCT-426 TAVR Versus SAVR for Bicuspid Aortic Valve. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lisko J, Keegan P, Kamioka N, Maidman S, Binongo J, Block P, Greenbaum A, Guyton R, Babaliaros V. TCT-748 Nurse Led Sedation: The Clinical and Echocardiographic Outcomes of the 7-Year Emory Experience. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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41
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Byku I, Lisko J, Khan J, Guyton R, Gleason P, Maidman S, Alvarez L, Grubb K, Kamioka N, Devireddy C, Rogers T, Lederman R, Babaliaros V. TCT-92 Antegrade LAMPOON (Intentional Percutaneous Laceration of the Anterior Mitral Leaflet to Prevent Outflow Obstruction): A Novel Modification of the Previously Described Retrograde LAMPOON, is a Technically Feasible, Reproducible, Effective, and Safe Modification of This Procedure. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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42
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Maidman S, Lisko J, Kamioka N, Byku I, Gleason P, Alvarez L, Grubb K, Rogers T, Khan J, Guyton R, Babaliaros V, Devireddy C. TCT-703 Outcomes Following Aortic Valve Replacement for Cardiogenic Shock: Transcatheter Versus Surgical Approaches. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Madukauwa‐David ID, Sadri V, Kamioka N, Midha PA, Raghav V, Oshinski JN, Sharma R, Babaliaros V, Yoganathan AP. Transcatheter aortic valve deployment influences neo‐sinus thrombosis risk: An in vitro flow study. Catheter Cardiovasc Interv 2019; 95:1009-1016. [DOI: 10.1002/ccd.28388] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/22/2019] [Indexed: 11/08/2022]
Affiliation(s)
| | - Vahid Sadri
- Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology Atlanta Georgia
| | | | | | - Vrishank Raghav
- Department of Aerospace Engineering, Auburn University Auburn Alabama
| | - John N. Oshinski
- Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology Atlanta Georgia
- Emory University School of Medicine Atlanta Georgia
| | - Rahul Sharma
- Cedars‐Sinai Heart Institute Los Angeles California
| | | | - Ajit P. Yoganathan
- Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology Atlanta Georgia
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Lisko J, Kamioka N, Gleason P, Byku I, Alvarez L, Khan JM, Rogers T, Lederman R, Greenbaum A, Babaliaros V. Prevention and Treatment of Left Ventricular Outflow Tract Obstruction After Transcatheter Mitral Valve Replacement. Interv Cardiol Clin 2019; 8:279-285. [PMID: 31078183 PMCID: PMC10652043 DOI: 10.1016/j.iccl.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Transcatheter mitral valve replacement (TMVR) is a promising strategy for patients with mitral valve disease and no surgical options. Left ventricular outflow tract (LVOT) obstruction is a life-threatening complication of TMVR. Although there are no commercially available devices to prevent LVOT obstruction, the risk of it can be reduced by careful preprocedure planning and the use of novel modifications to commercially available devices. This article summarizes current techniques to prevent LVOT obstruction with an emphasis on electrosurgical strategies.
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Affiliation(s)
- John Lisko
- Division of Cardiology, Emory University, 1639 Pierce Drive, Atlanta, GA 30322, USA
| | - Norihiko Kamioka
- Division of Cardiology, Emory University, 1639 Pierce Drive, Atlanta, GA 30322, USA
| | - Patrick Gleason
- Division of Cardiology, Emory University, 1639 Pierce Drive, Atlanta, GA 30322, USA
| | - Isida Byku
- Division of Cardiology, Emory University, 1639 Pierce Drive, Atlanta, GA 30322, USA
| | - Lucia Alvarez
- Division of Cardiology, Emory University, 1639 Pierce Drive, Atlanta, GA 30322, USA
| | - Jaffar M Khan
- Division of Cardiology, Washington Hospital Center, 110 Irving Street, Northwest, Washington, DC 20010, USA
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, MD 20892-1538, USA
| | - Robert Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, MD 20892-1538, USA
| | - Adam Greenbaum
- Division of Cardiology, Emory University, 1639 Pierce Drive, Atlanta, GA 30322, USA
| | - Vasilis Babaliaros
- Division of Cardiology, Emory University, 1639 Pierce Drive, Atlanta, GA 30322, USA.
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Lisko J, Kamioka N, Grubb KJ. The Eternal Debate: CABG Vs PCI. Current Status of the Literature. Semin Thorac Cardiovasc Surg 2019; 31:734-739. [PMID: 31102722 DOI: 10.1053/j.semtcvs.2019.05.009] [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: 04/19/2019] [Accepted: 05/13/2019] [Indexed: 11/11/2022]
Abstract
While advances in revascularization strategies have dramatically altered the morbidity and mortality associated with coronary artery disease, significant equipoise remains regarding the optimal revascularization strategy for specific groups of patients. Herein, we review the 5 most impactful studies of the last 3 years and correlate this with a historical perspective.
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Affiliation(s)
- John Lisko
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Norihiko Kamioka
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Structural Heart and Valve Center, Atlanta, Georgia
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Kamioka N, Lederman RJ, Greenbaum AB, Khan JM, Yousef A, Gleason PT, Grubb KJ, Block PC, Leshnower B, Babaliaros VC. Postinfarction Ventricular Septal Defect Closure. Circ Cardiovasc Interv 2019; 12:e007788. [PMID: 31088121 DOI: 10.1161/circinterventions.119.007788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Norihiko Kamioka
- Division of Cardiology (N.K., A.B.G., A.Y., P.T.G., P.C.B., V.C.B.), Emory University School of Medicine, Atlanta, GA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (R.J.L., J.M.K.)
| | - Adam B Greenbaum
- Division of Cardiology (N.K., A.B.G., A.Y., P.T.G., P.C.B., V.C.B.), Emory University School of Medicine, Atlanta, GA
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (R.J.L., J.M.K.)
| | - Altayyeb Yousef
- Division of Cardiology (N.K., A.B.G., A.Y., P.T.G., P.C.B., V.C.B.), Emory University School of Medicine, Atlanta, GA
| | - Patrick T Gleason
- Division of Cardiology (N.K., A.B.G., A.Y., P.T.G., P.C.B., V.C.B.), Emory University School of Medicine, Atlanta, GA
| | - Kendra J Grubb
- Cardiothoracic Surgery (K.J.G., B.L.), Emory University School of Medicine, Atlanta, GA
| | - Peter C Block
- Division of Cardiology (N.K., A.B.G., A.Y., P.T.G., P.C.B., V.C.B.), Emory University School of Medicine, Atlanta, GA
| | - Bradley Leshnower
- Cardiothoracic Surgery (K.J.G., B.L.), Emory University School of Medicine, Atlanta, GA
| | - Vasilis C Babaliaros
- Division of Cardiology (N.K., A.B.G., A.Y., P.T.G., P.C.B., V.C.B.), Emory University School of Medicine, Atlanta, GA
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Corrigan FE, Gleason PT, Condado JF, Lisko JC, Chen JH, Kamioka N, Keegan P, Howell S, Clements SD, Babaliaros VC, Lerakis S. Imaging for Predicting, Detecting, and Managing Complications After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Imaging 2019; 12:904-920. [DOI: 10.1016/j.jcmg.2018.07.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 06/04/2018] [Accepted: 07/12/2018] [Indexed: 12/26/2022]
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Kamioka N, Corrigan F, Iturbe JM, Caughron H, Lerakis S, Thourani V, Block P, Guyton R, Babaliaros V. Mitral Bioprosthetic Valve Fracture: Bailout Procedure for Undersized Bioprosthesis During Mitral Valve-in-Valve Procedure With Paravalvular Leak Closure. JACC Cardiovasc Interv 2019; 11:e21-e22. [PMID: 29413254 DOI: 10.1016/j.jcin.2017.10.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Norihiko Kamioka
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Frank Corrigan
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Jose Miguel Iturbe
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Hope Caughron
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Stamatios Lerakis
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Vinod Thourani
- Division Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Peter Block
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Robert Guyton
- Division Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Vasilis Babaliaros
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
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Zaid S, Kamioka N, Terre J, Miyasaka M, Hirji S, Hensey M, Geloo N, Petrossian G, Robinson N, Sarin E, Yoon SH, George I, Kaneko T, Shah P, Sharma K, Szerlip M, Don C, Ahmad H, Kini A, Mack M, Webb J, Babaliaros V, Kodali S, Makkar R, Tang G. 1-YEAR RESULTS OF TRANSCATHETER AORTIC VALVE REPLACEMENT IN EXTREMELY LARGE ANNULI >683 MM2 WITH EDWARDS SAPIEN 3 VALVE: A MULTICENTER EXPERIENCE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31984-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lisko JC, Kamioka N, Sabbak N, Byku I, Alvarez L, Gleason P, Stewart J, Greenbaum AB, Babaliaros V. DOUBLE VALVE REPLACEMENT UTILIZING THE LAMPOON TECHNIQUE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)33592-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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