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Abushouk A, Kansara T, Abdelfattah O, Badwan O, Hariri E, Chaudhury P, Kapadia SR. The Dicrotic Notch: Mechanisms, Characteristics, and Clinical Correlations. Curr Cardiol Rep 2023; 25:807-816. [PMID: 37493873 DOI: 10.1007/s11886-023-01901-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE OF REVIEW The dicrotic notch (DN) has long been considered a marker of arterial stiffness and compliance. Herein, we explored the recent developments in vascular medicine research in an attempt to assess the DN utility in clinical cardiovascular medicine. RECENT FINDINGS Since its discovery, several studies have attempted to measure the changes in different parameters of the DN in physiological and pathological states. Despite the significance of their findings, the clinical role of the DN remained limited. This may have been related to the difficulty of measuring the DN via indwelling arterial catheters in the past. However, over the past two decades, several non-invasive methods have been developed, which may re-ignite interest in DN research. The DN may have broader applications in clinical cardiovascular medicine. Further research is needed to establish the accuracy of DN non-invasive measurement methods and compare its prognostic value to other circulatory parameters.
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Affiliation(s)
- Abdelrahman Abushouk
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Tikal Kansara
- Department of Hospital Medicine, Union Hospital, Cleveland Clinic Foundation, Dover, OH, USA
| | - Omar Abdelfattah
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Osamah Badwan
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Essa Hariri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
- Division of Cardiovascular Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Pulkit Chaudhury
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, USA.
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Abushouk AI, Spilias N, Isogai T, Kansara T, Agrawal A, Hariri E, Abdelfattah O, Krishnaswamy A, Reed GW, Puri R, Yun J, Kapadia S. Three-Year Outcomes of Balloon-Expandable Transcatheter Aortic Valve Implantation According to Annular Size. Am J Cardiol 2023; 194:9-16. [PMID: 36921423 DOI: 10.1016/j.amjcard.2023.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/23/2023] [Accepted: 01/31/2023] [Indexed: 03/18/2023]
Abstract
Data on the association between annular size and transcatheter aortic valve implantation (TAVI) outcomes beyond 1 year are limited. The present study assessed the association between the aortic annulus size and TAVI clinical and hemodynamic outcomes at 3 years of follow-up. Patients were classified according to the aortic annulus size as having small, intermediate, and large annuli (size <400, 400 to 574, and ≥575 mm2, respectively). The co-primary endpoints were all-cause mortality and heart failure hospitalization. Further, the changes in hemodynamic outcomes over the follow-up period (median 37, interquartile range: 26 to 45 months) were assessed. The present analysis included 850 patients, with 182 patients (21.4%), 538 patients (63.3%), and 130 patients (15.3%) in the small, intermediate, and large-sized aortic annulus groups, respectively. The groups had comparable age and pre-TAVI pressure gradients; however, patients with small annuli had higher Society of Thoracic Surgeons risk scores. Adjusted Cox regression analysis showed that compared to patients with intermediate-sized annuli, patients with small and large annuli had similar all-cause mortality (hazard ratio [HR] = 1.11, 95% confidence interval [CI] 0.72 to 1.69 and HR = 0.74, 95% CI 0.48 to 1.16, respectively) and heart failure hospitalization rates (HR = 0.96, 95% CI 0.55 to 1.69 and HR = 1.26, 95% CI 0.73 to 2.17, respectively). However, patients with small annuli had consistently higher mean and peak pressure gradients and a higher risk of patient-prosthesis mismatch. The risks of moderate-to-severe regurgitation and structural valve deterioration were similar between the three groups. In conclusion, although patients with small annuli had higher transvalvular gradients, there was no significant association between the aortic annulus size and TAVI clinical outcomes at 3 years of follow-up. Future studies should compare the performance of transcatheter valve types in patients with different aortic annulus sizes.
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Affiliation(s)
- Abdelrahman I Abushouk
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nikolaos Spilias
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Tikal Kansara
- Department of Internal Medicine, Cleveland Clinic Union Hospital, Dover, Ohio
| | - Ankit Agrawal
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Essa Hariri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Omar Abdelfattah
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - James Yun
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
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Abushouk A, Spilias N, Isogai T, Kansara T, Agrawal A, Hariri E, Abdelfattah O, Krishnaswamy A, Puri R, Yun J, Kapadia SR. MID-TERM OUTCOMES OF TRANSCATHETER AORTIC VALVE IMPLANTATION IN PATIENTS WITH SMALL AORTIC ANNULI. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01303-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Bazarbashi N, Hsiung I, Spilias N, Ahuja K, Patel J, Kaur S, Hill A, Rossi J, Gad M, Abdelfattah O, Popovic Z, Miyasaka R, Yun J, Unai S, Rishi puri, Reed G, Krishnaswamy A, Kapadia S. CRT-700.15 Left Main Protection During Transcatheter Aortic Valve Replacement With a Balloon Expandable Valve. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.277] [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: 02/22/2023]
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Abushouk A, Agrawal A, Hariri E, Dykun I, Kansara T, Saad A, Abdelfattah O, Badwan O, Jaggi C, Farwati M, Harb SC, Puri R, Reed GW, Krishnaswamy A, Yun J, Kapadia S. Association between haematological parameters and outcomes following transcatheter aortic valve implantation at mid-term follow-up. Open Heart 2022; 9:openhrt-2022-002108. [PMID: 36600647 PMCID: PMC9748985 DOI: 10.1136/openhrt-2022-002108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/14/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Patients undergoing transcatheter aortic valve implantation (TAVI) often have multiple comorbidities, such as anaemia and chronic inflammatory disorders. We sought to investigate the association between preoperative and postoperative haematological parameters and clinical outcomes in TAVI patients at mid-term follow-up. METHODS In the present study, consecutive patients (N=908) who underwent TAVI at the Cleveland Clinic between 2017 and 2019 with available complete blood counts were studied. Data were collected on preoperative and postoperative anaemia and elevations in neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Survival analysis was used to study the association of haematologic parameters with all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE). RESULTS We found that preoperative anaemia and elevated NLR were significantly associated with a higher risk of all-cause mortality (aHR=1.6 (95% CI: 1.1 to 2.0) and 1.4 (95% CI: 1.1 to 1.6), respectively) and MACCE (aHR=1.9 (95% CI: 1.3 to 2.8) and 1.6 (95% CI: 1.1 to 2.4), respectively). While an elevated preoperative PLR was not associated with increased mortality risk, it had a significant association with MACCE risk (aHR: 1.6 (95% CI: 1.1 to 2.4)). Further, postoperative anaemia, elevated NLR and PLR were associated with increased risks of all-cause mortality and MACCE. CONCLUSION Pathological alterations in haematological parameters were associated with higher risks of post-TAVI mortality and MACCE at mid-term follow-up. Our findings advocate for further incorporating haematological parameters in the preoperative evaluation of TAVI candidates.
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Affiliation(s)
- Abdelrahman Abushouk
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ankit Agrawal
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Essa Hariri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Iryna Dykun
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Tikal Kansara
- Department of Internal Medicine, Cleveland Clinic Union Hospital, Dover, Ohio, USA
| | - Anas Saad
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Omar Abdelfattah
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Osamah Badwan
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Connor Jaggi
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Medhat Farwati
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - James Yun
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Abushouk AI, Abdelfattah O, Gad MM, Saad A, Hariri E, Isogai T, Shekhar S, Reed GW, Puri R, Yun J, Vargo PR, Weiss AJ, Burns D, Unai S, Popovic Z, Harb SC, Krishnaswamy A, Svensson LG, Johnston DR, Kapadia SR. Two-year outcomes after transcatheter aortic valve-in-valve implantation in degenerated surgical valves. Catheter Cardiovasc Interv 2022; 100:860-867. [PMID: 36116028 DOI: 10.1002/ccd.30388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Transcatheter aortic valve-in-valve implantation (ViV-TAVI) has emerged in recent years as a safe alternative to redo surgery in high-risk patients. Although early results are encouraging, data beyond short-term outcomes are lacking. Herein, we aimed to assess the 2-year outcomes after ViV-TAVI. METHODS Patients undergoing ViV-TAVI for degenerated surgical valves between 2013 and 2019 at the Cleveland Clinic were reviewed. The coprimary endpoints were all-cause mortality and congestive heart failure (CHF) hospitalizations. We used time-to-event analyses to assess the primary outcomes. Further, we measured the changes in transvalvular gradients and the incidence of structural valve deterioration (SVD). RESULTS One hundred and eighty-eight patients were studied (mean age = 76 years; 65% males). At 2 years of follow-up, all-cause mortality and CHF hospitalizations occurred in 15 (8%) and 28 (14.9%) patients, respectively. On multivariable analysis, the postprocedural length of stay was a significant predictor for both all-cause mortality (hazard ratio [HR] = 1.1; 95% confidence interval [CI]: 1.01, 1.19) and CHF hospitalization (HR = 1.16; 95% CI: 1.07, 1.27). However, the internal diameter of the surgical valve was not associated with significant differences in both primary endpoints. For hemodynamic outcomes, nine patients (4.8%) developed SVD. The mean and peak transvalvular pressure gradients remained stable over the follow-up period. CONCLUSION ViV-TAVI for degenerated surgical valves was associated with favorable 2-year clinical and hemodynamic outcomes. Further studies are needed to better understand the role of ViV-TAVI as a treatment option in the life management of aortic valve disease.
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Affiliation(s)
- Abdelrahman I Abushouk
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Omar Abdelfattah
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mohamed M Gad
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Anas Saad
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Essa Hariri
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - James Yun
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Patrick R Vargo
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Aaron J Weiss
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Daniel Burns
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Zoran Popovic
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Douglas R Johnston
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Shekhar S, Ajay A, Agrawal A, Kumar A, Kaur M, Isogai T, Saad A, Abushouk AI, Abdelfattah O, Lak H, Farwati M, Ahuja K, Verma BR, Wunderle K, Ellis S, Khatri J, Ziada K, Krishnaswamy A, Kapadia S. Radiation reduction in a modern catheterization laboratory: A single-center experience. Catheter Cardiovasc Interv 2022; 100:575-584. [PMID: 36073017 DOI: 10.1002/ccd.30396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/31/2022] [Accepted: 08/18/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Measures were undertaken at the Cleveland Clinic to reduce radiation exposure to patients and personnel working in the catheterization laboratories. We report our experience with these improved systems over a 7-year period in patients undergoing diagnostic catheterization (DC) and percutaneous coronary interventions (PCIs). METHODS Patients were categorized into preinitiative (2009-2012) and postinitiative (2013-2019) groups in the DC and PCI cohorts. Propensity score matching was done between the pre- and postinitiative groups for both cohorts based on age, sex, body surface area, total fluoroscopy time, and total acquisition time. The effectiveness of radiation reduction measures was assessed by comparing the total air kerma (Ka,r ), and fluoroscopy- and acquisition-mode air kerma in patients in the two groups. RESULTS In the DC cohort, there was a significant reduction in Ka,r in the postinitiative group in comparison to the preinitiative group (median, 396 vs. 857 mGy; p < 0.001). In the PCI cohort, Ka,r in the postinitiative group was 1265 mGy, which was significantly lower than the corresponding values in the preinitiative group (1994 mGy; p < 0.001). We also observed a significant reduction in fluoroscopy- and acquisition-based air kerma rates, and air kerma area product in the postinitiative group in comparison to the preinitiative group in both matched and unmatched DC and PCI cohorts after the institution of radiation reduction measures. CONCLUSION There was a significant and sustained reduction in radiation exposure to patients in the catheterization laboratory with the implementation of advanced protocols. Similar algorithms can be applied in other laboratories to achieve a similar reduction in radiation exposure.
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Affiliation(s)
- Shashank Shekhar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Abhishek Ajay
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anirudh Kumar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Manpreet Kaur
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anas Saad
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Abdelrahman I Abushouk
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Omar Abdelfattah
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hassan Lak
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Medhat Farwati
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Keerat Ahuja
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Beni R Verma
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kevin Wunderle
- Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stephen Ellis
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jaikirshan Khatri
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Khaled Ziada
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Abdelfattah O, Elsayed M, sayed A, Prasad R, Barakat AF, Elgendy I, Andrade JG, Bunch TJ, Thosani AJ, Saliba WI, Nakagawa H, Wazni OM, Hussein AA. PO-711-07 NETWORK META-ANALYSIS OF OPTIMAL INITIAL ATRIAL FIBRILLATION THERAPIES: CRYOABLATION, RADIOFREQUENCY ABLATION, AND ANTI-ARRHYTHMIC DRUGS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1132] [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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Abdelfattah O, Abushouk A, Saad AM, Isogai T, Shekhar S, Gad MM, Kapadia SR. SHORT TERM OUTCOMES OF SAVR VERSUS TAVR WITH BARIATRIC SURGERY: POPULATION BASED STUDY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01896-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abushouk AI, Abdelfattah O, Saad A, Isogai T, Shekhar S, Yun J, Puri R, Reed GW, Krishnaswamy A, Kapadia S. Durability of Bioprosthetic Surgical Aortic Valves in Patients Who Underwent Transcatheter Valve-in-Valve Implantation. Am J Cardiol 2022; 165:132-133. [PMID: 34879924 DOI: 10.1016/j.amjcard.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | - Omar Abdelfattah
- Department of Cardiovascular Medicine; Department of Internal Medicine, Morristown Medical Center, Atlantic Health System, Morristown, New Jersey
| | - Anas Saad
- Department of Cardiovascular Medicine
| | | | | | - James Yun
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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Hariri E, Kassis N, Iskandar JP, Schurgers LJ, Saad A, Abdelfattah O, Bansal A, Isogai T, Harb SC, Kapadia S. Vitamin K 2-a neglected player in cardiovascular health: a narrative review. Open Heart 2021; 8:openhrt-2021-001715. [PMID: 34785587 PMCID: PMC8596038 DOI: 10.1136/openhrt-2021-001715] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/04/2021] [Indexed: 12/15/2022] Open
Abstract
Vitamin K2 serves an important role in cardiovascular health through regulation of calcium homeostasis. Its effects on the cardiovascular system are mediated through activation of the anti-calcific protein known as matrix Gla protein. In its inactive form, this protein is associated with various markers of cardiovascular disease including increased arterial stiffness, vascular and valvular calcification, insulin resistance and heart failure indices which ultimately increase cardiovascular mortality. Supplementation of vitamin K2 has been strongly associated with improved cardiovascular outcomes through its modification of systemic calcification and arterial stiffness. Although its direct effects on delaying the progression of vascular and valvular calcification is currently the subject of multiple randomised clinical trials, prior reports suggest potential improved survival among cardiac patients with vitamin K2 supplementation. Strengthened by its affordability and Food and Drug Adminstration (FDA)-proven safety, vitamin K2 supplementation is a viable and promising option to improve cardiovascular outcomes.
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Affiliation(s)
- Essa Hariri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Nicholas Kassis
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jean-Pierre Iskandar
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Leon J Schurgers
- Biochemistry, Maastricht University CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Anas Saad
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Omar Abdelfattah
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.,Department of Cardiovascular Medicine, Morristown Medical Center, Morristown, New Jersey, USA
| | - Agam Bansal
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Serge C Harb
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Isogai T, Shekhar S, Abdelfattah O, Tarakji K, Wazni O, Kalra A, Yun J, Krishnaswamy A, Reed G, Puri R, Kapadia S. TCT-488 Conduction Disturbance, Pacemaker Rates, and Hospital Length of Stay Following Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1341] [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: 10/20/2022]
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Sayed A, Awad A, El-Shahat N, Said K, Moustafa K, Mahdi A, Okasha O, Souka A, Saleh Y, Abdelfattah O. TCT-236 Short- and Mid-Term Clinical Outcomes of Transcatheter Tricuspid Valve Repair for Tricuspid Regurgitation: Systematic Review and Meta-Analysis. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1089] [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: 11/28/2022]
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Saleh Y, Al-abcha A, Abdelkarim O, Abdelfattah O, Abela G, Hashim H, Goel S, Kleiman N. TCT-87 Clinical Outcomes of Optical Coherence Tomography-Guided Compared With Intravascular Ultrasound-Guided Percutaneous Coronary Intervention: A Meta-Analysis. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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15
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Abushouk AI, Abdelfattah O, Saad A, Isogai T, Farwati M, Yun J, Popovic Z, Shekhar S, Puri R, Reed GW, Krishnaswamy A, Kapadia SR. Predictors of Procedural Success in Patients With Degenerated Surgical Valves Undergoing Transcatheter Aortic Valve-in-Valve Implantation. Front Cardiovasc Med 2021; 8:718835. [PMID: 34631823 PMCID: PMC8497979 DOI: 10.3389/fcvm.2021.718835] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Valve-in-Valve transcatheter aortic valve implantation (ViV-TAVI) is a growing alternative for redo-surgery in patients with degenerated surgical valves. To our knowledge, data are lacking on the determinants on ViV-TAVI procedural success in patients with degenerated surgical valves. Methods: All consecutive patients undergoing ViV-TAVI for degenerated surgical valves at the Cleveland Clinic were analyzed. Data were extracted from our patient registry on baseline patient characteristics, echocardiographic parameters, and procedural details. To identify possible predictors of ViV-TAVI procedural success, we employed a multivariate logistic regression model. Results: A total of 186 patients who underwent ViV-TAVI were analyzed, with procedural success (VARC-2 device success and absence of periprocedural MACCE) reported in 165 (88.7%) patients. Patients with successful ViV-TAVI were significantly younger and had more frequent utilization of the transfemoral access than those with failed procedure. Other baseline and procedural characteristics were comparable between both groups. In terms of echocardiographic parameters, the procedural success group had a significantly lower AV peak pressure gradient (62.1 ± 24.7 vs. 74.1 ± 34.6 mmHg; p = 0.04) and lower incidence of moderate-to-severe aortic regurgitation [AR] (30.4 vs. 55%; p = 0.04). However, no significant differences between both groups were noted in terms of AV mean pressure gradient and left ventricular measurements. In multivariate analysis, lower AV peak pressure gradient (OR = 0.97, 95% CI: 0.95–0.99) and absence of moderate-to-severe AR (OR = 0.65, 95% CI: 0.44–0.95) at baseline emerged as independent predictors of ViV-TAVI procedural success. Conclusion: Valve-in-Valve TAVI for degenerated surgical valves is a feasible approach with high success rates, especially in those with lower AV peak pressure gradient and absence of moderate-to-severe AR. Studies with larger sample size and longer follow-up are required to further characterize the predictors of ViV-TAVI success and other clinical outcomes.
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Affiliation(s)
- Abdelrahman I Abushouk
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Omar Abdelfattah
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States.,Department of Internal Medicine, Morristown Medical Center, Atlantic Health System, Morristown, NJ, United States
| | - Anas Saad
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Medhat Farwati
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - James Yun
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Zoran Popovic
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
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Abushouk AI, Abdelfattah O, Saad A, Gad MM, Reed GW, Puri R, Yun J, Vargo PR, Weiss A, Burns D, Popovic Z, Harb SC, Krishnaswamy A, Svensson LG, Kapadia SR. Late Clinical and Hemodynamic Outcomes in patients with degenerated bioprosthetic aortic valves undergoing transcatheter valve-in-valve implantation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Clinical studies have shown promising early outcomes for valve-in-valve transcatheter aortic valve implantation (ViV-TAVI); however, the late outcomes of this procedure remain under-investigated.
Purpose
We performed the present analysis to assess the late clinical and hemodynamic outcomes of ViV-TAVI in patients with degenerated bioprosthetic aortic valves.
Methods
A comprehensive chart review was performed for eligible patients to retrieve data on procedural characteristics, admission details following the procedure, and echocardiographic parameters. Clinical outcomes included all-cause mortality, heart failure hospitalization and structural valve deterioration (SVD), as defined by VARC-II criteria, up to 5 years of follow-up. To assess the trends in mean and peak transvalvular gradients, data from the follow-up echocardiographic reports were analyzed using Syngo Dynamics imaging software.
Results
A total of 188 patients were included with a mean age of 75.8±10.4 years. Balloon- and self-expandable valves were used in 155 (82.4%) and 33 (17.6%) patients, respectively. At 30 days, 3 (1.6%) patients died and 8 (4.2%) required hospitalization for heart failure, while at 5 years, both events were recorded in 29 (15.4%) and 37 (19.7) patients, respectively. Kaplan-Meier survival analysis showed that patients with smaller surgical valves (internal diameter ≤21 mm) had a significantly higher mortality rate (log-rank p=0.021) than those with larger valves; however, no significant difference (log-rank p=0.59) was detected between different transcatheter valves (self vs. balloon-expandable). Three patients underwent re-intervention, performed via a transcatheter approach. Further, assessment of follow-up echocardiographic reports revealed 9 (4.8%) cases of SVD, as well as stable mean (16.3±6.9 at discharge and 16.9±11.3) and peak (30.3±12.1 at discharge and 30.7±18.4 at 5 years) transvalvular gradients. No difference (p>0.05) was observed based on transcatheter valve type or surgical valve internal diameter in terms of mean and peak transvalvular gradients throughout the follow-up period.
Conclusion
The present study showed good clinical outcomes among patients undergoing VIV-TAVI, with stable VIV performance over a five-year period. Future long-term studies are warranted to analyze the predictors of outcomes following ViV-TAVI and explore the role of this treatment option in the life-long management of aortic stenosis.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Jennifer and Robert McNeil Donation to the Heart, Thoracic, and Vascular Institute at Cleveland Clinic. Figure 1
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Affiliation(s)
- A I Abushouk
- Cleveland Clinic Foundation, Cardiovascular Medicine, Cleveland, United States of America
| | - O Abdelfattah
- Cleveland Clinic Foundation, Cardiovascular Medicine, Cleveland, United States of America
| | - A Saad
- Cleveland Clinic Foundation, Cardiovascular Medicine, Cleveland, United States of America
| | - M M Gad
- Cleveland Clinic Foundation, Cardiovascular Medicine, Cleveland, United States of America
| | - G W Reed
- Cleveland Clinic Foundation, Cardiovascular Medicine, Cleveland, United States of America
| | - R Puri
- Cleveland Clinic Foundation, Cardiovascular Medicine, Cleveland, United States of America
| | - J Yun
- Cleveland Clinic Foundation, Thoracic and Cardiovascular Surgery, Cleveland, United States of America
| | - P R Vargo
- Cleveland Clinic Foundation, Thoracic and Cardiovascular Surgery, Cleveland, United States of America
| | - A Weiss
- Cleveland Clinic Foundation, Thoracic and Cardiovascular Surgery, Cleveland, United States of America
| | - D Burns
- Cleveland Clinic Foundation, Thoracic and Cardiovascular Surgery, Cleveland, United States of America
| | - Z Popovic
- Cleveland Clinic Foundation, Cardiovascular Medicine, Cleveland, United States of America
| | - S C Harb
- Cleveland Clinic Foundation, Cardiovascular Medicine, Cleveland, United States of America
| | - A Krishnaswamy
- Cleveland Clinic Foundation, Cardiovascular Medicine, Cleveland, United States of America
| | - L G Svensson
- Cleveland Clinic Foundation, Thoracic and Cardiovascular Surgery, Cleveland, United States of America
| | - S R Kapadia
- Cleveland Clinic Foundation, Cardiovascular Medicine, Cleveland, United States of America
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Abushouk A, Yunusa I, Elmehrath AO, Elmatboly AM, Saad A, Fayek SH, Abdelfattah O, Ghanem E, Isogai T, Shekhar S, Reed GW, Puri R, Kalra A, Kapadia SR. Evidence in crisis: a closer look into the quality of published systematic reviews in the cardiology literature. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3151] [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
Systematic reviews are usually considered as the highest level of evidence and are increasingly used in shaping cardiology policies and guidelines. However, as the rate of publishing systematic reviews increases annually, there are rising concerns regarding their quality and reporting standards.
Purpose
The current analysis provides an insight into the quality of published systematic reviews in cardiology and provides recommendations for researchers, clinicians, and stakeholders in this regard.
Methods
Using a comprehensive Medline/PubMed search, we retrieved all systematic reviews, published between 2009 and 2019 in five general cardiology journals with the highest impact factor as per the Clarivate Analytics 2019 Journal Impact Factor List (Circulation, European Heart Journal, Journal of the American College of Cardiology, Circulation Research, and JAMA Cardiology). We assessed the methodological characteristics, eligibility criteria, reporting standards, as well as review quality scores according to the AMSTAR tool.
Results
Among 352 retrieved reviews, 275 (75.3%) performed direct head-to-head analysis and 164 (46.6%) included only clinical trials. The median numbers of searched databases and included studies were 3 (IQR: 2, 3) and 13 (IQR: 7, 30). The primary outcomes were often hard clinical endpoints as mortality (39.2%) and stroke (11.9%). 64 (18.2%) registered their protocol, 208 (58.4%) used validated tools for risk of bias assessment, 177 (52.3%) assessed for publication bias, and 221 (62.8%) adhered to the PRISMA checklist. Thirty-five reviews detected significant publication bias, which was significantly associated with heterogeneity of the primary outcome. The AMSTAR quality scores were low or critically low in 71% of evaluated reviews. Further, 87 (24.7%) did not report on whether they received funding or not, 33 (9.4%) reported receiving no funding, and 232 adequately reported on their funding sources [70 (19.9%) from governmental/academic sources, 120 (34.1%) from pharmaceutical companies, and 42 (11.9%) from both sources]. analysis showed that reviews with advanced statistical analysis, those that included RCTs, adhered to the PRISMA checklist, or had higher AMSTAR quality scores had significantly higher citation metrics (p<0.05).
Conclusion
Due to the widespread low quality and poor reporting in cardiovascular systematic reviews, clinicians should be educated on the value of methodological quality in interpreting systematic review findings. In addition, academic societies and guideline writing groups should implement rigorous critical appraisal and peer review policies to improve the synthesis and utilization of systematic reviews in evidence-based cardiovascular medicine.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Abushouk
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - I Yunusa
- Harvard T. H. Chan School of Public Health, Boston, United States of America
| | | | | | - A Saad
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - S H Fayek
- Kasr Alainy school of medicine, Cairo, Egypt
| | - O Abdelfattah
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - E Ghanem
- Al-Azhar University, Cairo, Egypt
| | - T Isogai
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - S Shekhar
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - G W Reed
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - R Puri
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - A Kalra
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - S R Kapadia
- Cleveland Clinic Foundation, Cleveland, United States of America
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Abdelfattah O, Saad A, Abushouk A, Gad M, Isogai T, Hariri E, Shekhar S, Genereux P, Kapadia S. RACIAL DISPARITIES IN SHORT-TERM OUTCOMES OF PATIENTS UNDERGOING LEFT ATRIAL APPENDAGE CLOSURE USING WATCHMAN DEVICE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02464-5] [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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19
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Abdelfattah O, Saad A, Gad M, Abushouk A, Ahmed T, Hariri E, Kapadia S. SHORT TERM OUTCOMES IN TAVR WITH VERSUS WITHOUT BARIATRIC SURGERY: POPULATION BASED STUDY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02474-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Farwati M, Saad AM, Jain V, Ahuja KR, Bansal A, Gad MM, Isogai T, Abdelfattah O, Shekhar S, Kassis N, Hariri E, Svensson L, Krishnaswamy A, Kapadia S. Impact of Economic Status on Utilization and Outcomes of Transcatheter Aortic Valve Implantation and Mitraclip. Am J Cardiol 2021; 142:116-123. [PMID: 33285094 DOI: 10.1016/j.amjcard.2020.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
Data on the impact of economic status on Transcatheter aortic valve implantation (TAVI) and MitraClip (MC) is lacking. Patients who underwent TAVI and/or MC during 2012 to 2017 were identified in the Nationwide Readmission Database and divided by zip code estimated income quartile into 4 groups (Q1 to Q4). The utilization of TAVI and/or MC was defined as the number of TAVIs and/or MCs over all admissions with an aortic and/or mitral valve disease (AVD and/or MVD) and represented per 1,000 admissions. A total of 168,853 patients underwent TAVI; 20.6% in Q1, 26.3% in Q2, 27.3% in Q3, and 25.8% in Q4, while 15,387 patients underwent MC; 22% in Q1, 26.2% in Q2, 26.3% in Q3, and 25.5% in Q4. The annual utilization of TAVIs and/or MCs increased over the study period and was generally lower with lower income. In 2012, TAVI was performed for 8.2, 8.8, 10.8, and 11.3 per 1,000 AVD admissions in Q1, Q2, Q3, and Q4, respectively. In 2017, TAVI was performed for 54.1, 65.1, 68.6, and 71 per 1,000 AVD admissions in Q1, Q2, Q3, and Q4, respectively. In 2014, MC was performed for 1.6, 2.1, 1.8, and 1.9 per 1,000 MVD admissions in Q1, Q2, Q3, and Q4, respectively. In 2017, MC was performed for 5.6, 6.5, 8, and 8 per 1,000 MVD admissions in Q1, Q2, Q3, and Q4, respectively. In-hospital mortality, stroke, and 30-day readmissions were generally comparable across groups. Lower-income patients may be underrepresented among patients undergoing TAVI and MC despite comparable outcomes. Further studies are needed to examine the etiologies behind these disparities and identify targeted strategies for its mitigation.
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21
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Saad AM, Kassis N, Isogai T, Gad MM, Ahuja KR, Abdelfattah O, Shekhar S, Farwati M, Yun JJ, Krishnaswamy A, Svensson LG, Kapadia S. Trends in Outcomes of Transcatheter and Surgical Aortic Valve Replacement in the United States (2012-2017). Am J Cardiol 2021; 141:79-85. [PMID: 33275895 DOI: 10.1016/j.amjcard.2020.10.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 12/20/2022]
Abstract
As the use of transcatheter aortic valve implantation (TAVI) expands to varying patient populations, impacting the landscape of surgical aortic valve replacement (SAVR), this study sought to assess volume and performance trends of aortic valve replacement (AVR) in the United States during 2012-2017. The Nationwide Readmissions Database was queried for patients who underwent endovascular/transapical TAVI, isolated SAVR, or complex aortic valve surgery between 2012 and 2017. Temporal trends in annual case volume, admission costs, in-hospital outcomes, and 30-day readmission were evaluated. Of 624,303 patients (median age 72 years) who received AVR, 387,011 (62%) were men. Among these patients, 170,521 (27%) underwent TAVI and 453,782 (73%) underwent SAVR with 299,398 isolated and 154,384 complex aortic valve surgery. TAVI patients were significantly older and higher risk compared with SAVR patients. From 2012 to 2017, the annual number of TAVI increased from 8,295 to 55,168 whereas SAVR volume remained remarkably stable. Patients who underwent AVR demonstrated significant improvements in mortality, stroke, duration of hospitalization, and 30-day readmission. In conclusion, this large contemporary analysis reports the considerable growth of AVR in the United States. It remains unequivocal that the treatment of aortic stenosis is improving overall with reduced mortality following AVR, highlighting the effectiveness of various process improvements such as newer valves, enhanced patient selection, and the interdisciplinary Heart Team approach.
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Sammour Y, Banerjee K, Kumar A, Lak H, Chawla S, Incognito C, Patel J, Kaur M, Abdelfattah O, Svensson LG, Tuzcu EM, Reed GW, Puri R, Yun J, Krishnaswamy A, Kapadia S. Systematic Approach to High Implantation of SAPIEN-3 Valve Achieves a Lower Rate of Conduction Abnormalities Including Pacemaker Implantation. Circ Cardiovasc Interv 2021; 14:e009407. [PMID: 33430603 DOI: 10.1161/circinterventions.120.009407] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [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: 12/29/2022]
Abstract
BACKGROUND The conventional method of implanting balloon-expandable SAPIEN-3 (S3) valve results in a final 70:30 or 80:20 ratio of the valve in the aorta:left ventricular outflow tract with published rates of permanent pacemaker around 10%. We sought to evaluate whether higher implantation of S3 reduces conduction abnormalities including the need for permanent pacemaker. METHODS We included consecutive patients who underwent transfemoral transcatheter aortic valve replacement using S3 between April 2015 and December 2018 and compared outcomes with typical valve deployment strategy to our more contemporary high deployment technique (HDT). We excluded patients with nontransfemoral access or valve-in-valve. RESULTS Among 1028 patients, HDT was performed in 406 patients (39.5%). Mean implantation depth under the noncoronary cusp was significantly smaller with HDT compared with conventional technique (1.5±1.6 versus 3.2±1.9 mm; P<0.001). Successful implantation was achieved in 100% of the patients in both groups with no cases of conversion to open heart surgery, second valve implantation within the first transcatheter aortic valve replacement, or coronary occlusion during transcatheter aortic valve replacement. One patient (0.2%) had valve embolization with HDT (P=0.216). Thirty-day permanent pacemaker rates were lower with HDT (5.5% versus 13.1%; P<0.001), as were rates of complete heart block (3.5% versus 11.2%; P<0.001) and new-onset left bundle branch block (5.3% versus 12.2%; P<0.001). There were no differences in mild (16.5% versus 15.9%; P=0.804), or moderate-to-severe aortic regurgitation (1% versus 2.7%; P=0.081) at 1 year. HDT was associated with slightly higher 1-year mean gradients (13.1±6.2 versus 11.8±4.9 mm Hg; P=0.042) and peak gradients (25±11.9 versus 22.5±9 mm Hg; P=0.026). However, Doppler velocity index was similar (0.47±0.15 versus 0.48±0.13; P=0.772). CONCLUSIONS Our novel technique for balloon-expandable S3 valve positioning consistently achieves higher implantation resulting in substantial reduction in conduction abnormalities and permanent pacemaker requirement after transcatheter aortic valve replacement without compromising procedural safety or valve hemodynamics. Operators should consider this as an important technique to improve patient outcomes.
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Affiliation(s)
- Yasser Sammour
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Kinjal Banerjee
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Arnav Kumar
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Hassan Lak
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Sanchit Chawla
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | | | - Jay Patel
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Manpreet Kaur
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | | | - Lars G Svensson
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - E Murat Tuzcu
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Grant W Reed
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - Rishi Puri
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | - James Yun
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
| | | | - Samir Kapadia
- Heart and Vascular Institute, Cleveland Clinic Foundation, OH
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Saad AM, Kassis N, Gad MM, Abdelfattah O, Ahuja KR, Farwati M, Isogai T, Bazarbashi N, Shekhar S, Kapadia SR. Impact of atrial fibrillation on outcomes following MitraClip: A contemporary population‐based analysis. Catheter Cardiovasc Interv 2020; 97:1252-1256. [DOI: 10.1002/ccd.29310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/19/2020] [Revised: 07/14/2020] [Accepted: 09/22/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Anas M. Saad
- Heart and Vascular Institute, Department of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland Ohio USA
| | - Nicholas Kassis
- Department of Internal Medicine Cleveland Clinic Foundation Cleveland Ohio USA
| | - Mohamed M. Gad
- Department of Internal Medicine Cleveland Clinic Foundation Cleveland Ohio USA
| | - Omar Abdelfattah
- Heart and Vascular Institute, Department of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland Ohio USA
| | - Keerat R. Ahuja
- Heart and Vascular Institute, Department of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland Ohio USA
| | - Medhat Farwati
- Department of Internal Medicine Cleveland Clinic Foundation Cleveland Ohio USA
| | - Toshiaki Isogai
- Heart and Vascular Institute, Department of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland Ohio USA
| | - Najdat Bazarbashi
- Department of Internal Medicine University of Maryland Medical Center Baltimore Maryland USA
| | - Shashank Shekhar
- Heart and Vascular Institute, Department of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland Ohio USA
| | - Samir R. Kapadia
- Heart and Vascular Institute, Department of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland Ohio USA
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Abdelfattah O, Saad A, Gad M, Farwati M, Isogai T, Ahuja KR, Hariri E, Shekhar S, Miyasaka R, Harb S, Krishnaswamy A, Kapadia S. TCT CONNECT-361 Impact of Pulmonary Hypertension on MitraClip Short-Term Outcomes: Nationwide Representative Study. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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25
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Ahuja KR, Nazir S, Isogai T, Saad A, Alamir MA, Shekhar S, Abdelfattah O, Yun J, Reed G, Puri R, Krishnaswamy A, Kapadia S. TCT CONNECT-71 Outcomes of Urgent/Emergent Endovascular Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Stenosis. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.085] [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: 11/29/2022]
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26
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Jain V, Saad AM, Gad MM, Bansal A, Abdelfattah O, Farwati M, Ahuja KR, Yun J, Krishnaswamy A, Kapadia SR. Outcomes of Cancer Patients Undergoing Transcatheter Aortic Valve Replacement. JACC CardioOncol 2020; 2:506-508. [PMID: 34396258 PMCID: PMC8352026 DOI: 10.1016/j.jaccao.2020.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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27
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Ahuja KR, Nazir S, Saad AM, Isogai T, Gad MM, Kaur M, Shekhar S, Abdelfattah O, Gupta R, Kapadia SR. Temporal Trends and Outcomes Following Urgent/Emergent Transcatheter Mitral Valve Repair in the United States. JACC Cardiovasc Interv 2020; 13:1611-1613. [DOI: 10.1016/j.jcin.2020.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/09/2020] [Accepted: 04/14/2020] [Indexed: 11/30/2022]
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28
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Kaur M, Khubber S, Verma BR, Meenakshisundaram C, Zhou L, Gad MM, Ahuja KR, Dhaliwal K, Jain V, Bazarbashi N, Saad A, Abdelfattah O, Shekhar S, Isogai T, Bansal A, Kapadia SR. THE INCIDENCE OF STROKE WITHIN 30 DAYS AFTER MITRAL CLIP A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31834-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Isogai T, Saad A, Ahuja KR, Gad MM, Shekhar S, Abdelfattah O, Kaur M, Kapadia SR. PREDICTORS OF REVASCULARIZATION IN WOMEN WITH ACUTE MYOCARDIAL INFARCTION AND SPONTANEOUS CORONARY ARTERY DISSECTION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30661-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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