1
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Tang GH, Spencer J, Rogers T, Grubb KJ, Gleason P, Gada H, Mahoney P, Dauerman HL, Forrest JK, Reardon MJ, Blanke P, Leipsic JA, Abdel-Wahab M, Attizzani GF, Puri R, Caskey M, Chung CJ, Chen YH, Dudek D, Allen KB, Chhatriwalla AK, Htun WW, Blackman DJ, Tarantini G, Zhingre Sanchez J, Schwartz G, Popma JJ, Sathananthan J. Feasibility of Coronary Access Following Redo-TAVR for Evolut Failure: A Computed Tomography Simulation Study. Circ Cardiovasc Interv 2023; 16:e013238. [PMID: 37988439 PMCID: PMC10653288 DOI: 10.1161/circinterventions.123.013238] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/11/2023] [Accepted: 09/06/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Coronary accessibility following redo-transcatheter aortic valve replacement (redo-TAVR) is increasingly important, particularly in younger low-risk patients. This study aimed to predict coronary accessibility after simulated Sapien-3 balloon-expandable valve implantation within an Evolut supra-annular, self-expanding valve using pre-TAVR computed tomography (CT) imaging. METHODS A total of 219 pre-TAVR CT scans from the Evolut Low-Risk CT substudy were analyzed. Virtual Evolut and Sapien-3 valves were sized using CT-based diameters. Two initial Evolut implant depths were analyzed, 3 and 5 mm. Coronary accessibility was evaluated for 2 Sapien-3 in Evolut implant positions: Sapien-3 outflow at Evolut node 4 and Evolut node 5. RESULTS With a 3-mm initial Evolut implant depth, suitable coronary access was predicted in 84% of patients with the Sapien-3 outflow at Evolut node 4, and in 31% of cases with the Sapien-3 outflow at Evolut node 5 (P<0.001). Coronary accessibility improved with a 5-mm Evolut implant depth: 97% at node 4 and 65% at node 5 (P<0.001). When comparing 3- to 5-mm Evolut implant depth, sinus sequestration was the lowest with Sapien-3 outflow at Evolut node 4 (13% versus 2%; P<0.001), and the highest at Evolut node 5 (61% versus 32%; P<0.001). CONCLUSIONS Coronary accessibility after Sapien-3 in Evolut redo-TAVR relates to the initial Evolut implant depth, the Sapien-3 outflow position within the Evolut, and the native annular anatomy. This CT-based quantitative analysis may provide useful information to inform and refine individualized preprocedural CT planning of the initial TAVR and guide lifetime management for future coronary access after redo-TAVR. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02701283.
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Affiliation(s)
- Gilbert H.L. Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York (G.H.L.T.)
| | - Julianne Spencer
- Structural Heart & Aortic, Medtronic, Mounds View, MN (J. Spencer, J.Z.S., G.S., J.J.P.)
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC (T.R.)
| | - Kendra J. Grubb
- Division of Cardiothoracic Surgery (K.J.G.), Emory University, Atlanta, GA
- Structural Heart and Valve Center (K.J.G., P.G.), Emory University, Atlanta, GA
| | - Patrick Gleason
- Structural Heart and Valve Center (K.J.G., P.G.), Emory University, Atlanta, GA
- Division of Cardiology (P.G.), Emory University, Atlanta, GA
| | - Hemal Gada
- University of Pittsburgh Medical Center Pinnacle Health, PA (H.G.)
| | | | | | - John K. Forrest
- Division of Cardiology, Yale School of Medicine, New Haven, CT (J.K.F.)
| | | | - Philipp Blanke
- Center for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.A.L.)
| | - Jonathon A. Leipsic
- Center for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.A.L.)
| | | | - Guilherme F. Attizzani
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH (G.F.A.)
| | | | | | - Christine J. Chung
- Division of Cardiology, University of Washington Medical Center, Seattle (C.J.C.)
| | - Ying-Hwa Chen
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan (Y.-H.C.)
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Keith B. Allen
- St. Luke’s Mid America Heart Institute, Kansas City, MO (K.B.A., A.K.C.)
| | | | | | - Daniel J. Blackman
- Department of Cardiology, Leeds Teaching Hospitals, Leeds, United Kingdom (D.J.B.)
| | - Giuseppe Tarantini
- Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Italy (G.T.)
| | - Jorge Zhingre Sanchez
- Structural Heart & Aortic, Medtronic, Mounds View, MN (J. Spencer, J.Z.S., G.S., J.J.P.)
| | - Greta Schwartz
- Structural Heart & Aortic, Medtronic, Mounds View, MN (J. Spencer, J.Z.S., G.S., J.J.P.)
| | - Jeffrey J. Popma
- Structural Heart & Aortic, Medtronic, Mounds View, MN (J. Spencer, J.Z.S., G.S., J.J.P.)
| | - Janarthanan Sathananthan
- Center for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada (J. Sathananthan)
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2
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Grubb KJ, Shekiladze N, Spencer J, Perdoncin E, Tang GHL, Xie J, Lisko J, Sanchez JZ, Lucas LM, Sathananthan J, Rogers T, Deeb GM, Fukuhara S, Blanke P, Leipsic JA, Forrest JK, Reardon MJ, Gleason P. Feasibility of redo-TAVI in self-expanding Evolut valves: a CT analysis from the Evolut Low Risk Trial substudy. EUROINTERVENTION 2023; 19:e330-e339. [PMID: 37067193 PMCID: PMC10333920 DOI: 10.4244/eij-d-22-01125] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/08/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation in an existing transcatheter valve (redo-TAVI) pins the index valve leaflets in the open position (neoskirt), which can cause coronary flow compromise and limit access. Whether anatomy may preclude redo-TAVI in self-expanding Evolut valves is unknown. AIMS We aimed to evaluate the anatomical feasibility of redo-TAVI by simulating implantation of a balloon-expandable SAPIEN 3 (S3) within an Evolut or an Evolut within an Evolut. METHODS A total of 204 post-TAVI computed tomography (CT) scans from the Evolut Low Risk CT substudy were analysed. Five redo-TAVI positions were evaluated: S3-in-Evolut inflow-to-inflow, S3 outflow at Evolut nodes 4, 5, and 6, and Evolut-in-Evolut inflow-to-inflow. Univariable modelling identified pre-TAVI clinical characteristics, CT anatomical parameters, and procedural variables associated with coronary flow compromise using the neoskirt height and post-TAVI aortic root dimensions. RESULTS The risk of coronary flow compromise was lowest when the S3 outflow was at Evolut node 4 (20%) and highest when at Evolut node 6 (75%). The highest likelihood of preserving coronary accessibility occurred with the S3 outflow at Evolut node 4. Female sex and higher body mass index were associated with a higher risk of coronary flow compromise, as were a smaller annulus diameter, lower sinus of Valsalva height and width, shorter coronary height, smaller sinotubular junction diameter, and shallower Evolut implant depth. CONCLUSIONS The feasibility of redo-TAVI after Evolut failure is multifactorial and relates to the native annular anatomy, as well as the implantation depth of the index and second bioprostheses. Placement of an S3 at a lower Evolut position may reduce the risk of coronary flow compromise while preserving coronary access. CLINICALTRIALS gov: NCT02701283.
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Affiliation(s)
- Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA
- Structural Heart and Valve Center, Emory University, Atlanta, GA, USA
| | - Nikoloz Shekiladze
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA
- Structural Heart and Valve Center, Emory University, Atlanta, GA, USA
| | - Julianne Spencer
- Research and Development, Structural Heart & Aortic, Medtronic, Mounds View, MN, USA
| | - Emily Perdoncin
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA
- Structural Heart and Valve Center, Emory University, Atlanta, GA, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Joe Xie
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA
- Structural Heart and Valve Center, Emory University, Atlanta, GA, USA
| | - John Lisko
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA
- Structural Heart and Valve Center, Emory University, Atlanta, GA, USA
| | - Jorge Zhingre Sanchez
- Research and Development, Structural Heart & Aortic, Medtronic, Mounds View, MN, USA
| | | | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, D.C., USA
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Philipp Blanke
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jonathon A Leipsic
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - John K Forrest
- Section of Cardiology, Yale School of Medicine, New Haven, CT, USA
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist, Houston, TX, USA
| | - Patrick Gleason
- Structural Heart and Valve Center, Emory University, Atlanta, GA, USA
- Division of Cardiology, Emory University, Atlanta, GA, USA
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3
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Kodali SK, Hahn RT, Davidson CJ, Narang A, Greenbaum A, Gleason P, Kapadia S, Miyasaka R, Zahr F, Chadderdon S, Smith RL, Grayburn P, Kipperman RM, Marcoff L, Whisenant B, Gonzales M, Makkar R, Makar M, O'Neill W, Wang DD, Gray WA, Abramson S, Hermiller J, Mitchel L, Lim DS, Fowler D, Williams M, Pislaru SV, Dahou A, Mack MJ, Leon MB, Eleid MF. 1-Year Outcomes of Transcatheter Tricuspid Valve Repair. J Am Coll Cardiol 2023; 81:1766-1776. [PMID: 37137586 DOI: 10.1016/j.jacc.2023.02.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/14/2023] [Accepted: 02/21/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Surgical management of isolated tricuspid regurgitation (TR) is associated with high morbidity and mortality, thereby creating a significant need for a lower-risk transcatheter solution. OBJECTIVES The single-arm, multicenter, prospective CLASP TR (Edwards PASCAL TrAnScatheter Valve RePair System in Tricuspid Regurgitation [CLASP TR] Early Feasibility Study) evaluated 1-year outcomes of the PASCAL transcatheter valve repair system (Edwards Lifesciences) to treat TR. METHODS Study inclusion required a previous diagnosis of severe or greater TR and persistent symptoms despite medical treatment. An independent core laboratory evaluated echocardiographic results, and a clinical events committee adjudicated major adverse events. The study evaluated primary safety and performance outcomes, with echocardiographic, clinical, and functional endpoints. Study investigators report 1-year all-cause mortality and heart failure hospitalization rates. RESULTS Sixty-five patients were enrolled: mean age of 77.4 years; 55.4% female; and 97.0% with severe to torrential TR. At 30 days, cardiovascular mortality was 3.1%, the stroke rate was 1.5%, and no device-related reinterventions were reported. Between 30 days and 1 year, there were an additional 3 cardiovascular deaths (4.8%), 2 strokes (3.2%), and 1 unplanned or emergency reintervention (1.6%). One-year postprocedure, TR severity significantly reduced (P < 0.001), with 31 of 36 (86.0%) patients achieving moderate or less TR; 100% had at least 1 TR grade reduction. Freedom from all-cause mortality and heart failure hospitalization by Kaplan-Meier analyses were 87.9% and 78.5%, respectively. Their New York Heart Association functional class significantly improved (P < 0.001) with 92% in class I or II, 6-minute walk distance increased by 94 m (P = 0.014), and overall Kansas City Cardiomyopathy Questionnaire scores improved by 18 points (P < 0.001). CONCLUSIONS The PASCAL system demonstrated low complication and high survival rates, with significant and sustained improvements in TR, functional status, and quality of life at 1 year. (Edwards PASCAL TrAnScatheter Valve RePair System in Tricuspid Regurgitation [CLASP TR] Early Feasibility Study [CLASP TR EFS]; NCT03745313).
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Affiliation(s)
- Susheel K Kodali
- Columbia University Irving Medical Center, New York, New York, USA.
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Akhil Narang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | | | | | - Firas Zahr
- Oregon Health and Science University Hospital, Portland, Oregon, USA
| | - Scott Chadderdon
- Oregon Health and Science University Hospital, Portland, Oregon, USA
| | - Robert L Smith
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Paul Grayburn
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | | | - Leo Marcoff
- Morristown Medical Center, Morristown, New Jersey, USA
| | | | | | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Moody Makar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | | | | | - James Hermiller
- St Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | - Lucas Mitchel
- St Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | - D Scott Lim
- University of Virginia Health System, Charlottesville, Virginia, USA
| | - Dale Fowler
- University of Virginia Health System, Charlottesville, Virginia, USA
| | | | | | | | - Michael J Mack
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Martin B Leon
- Columbia University Irving Medical Center, New York, New York, USA
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4
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Koch R, Inci E, Grubb K, Leshnower B, Paone G, Ueyama H, Devireddy C, Gleason P, Xie J, Wei J, Rainer K, Ceretto-Clark B, Byku I, Greenbaum A, Babaliaros V, Perdoncin E. A Comparison of Thirty-Day Clinical and Echocardiographic Outcomes of Patients Undergoing Transcatheter vs. Surgical Aortic Valve Replacement for Native Aortic Insufficiency. Cardiovasc Revasc Med 2023; 46:85-89. [PMID: 35965211 DOI: 10.1016/j.carrev.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES We aim to compare in-hospital and 30-day outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) for native aortic insufficiency (AI). BACKGROUND TAVR is increasingly used off-label in patients with AI deemed high risk for SAVR. There is a paucity of data comparing TAVR and SAVR with current commercially available TAVR devices. METHODS A single-center, retrospective cohort study of patients undergoing TAVR or SAVR for native AI between 2014 and 2020 was performed. Data were obtained from the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database, Transcatheter Valve Therapy (TVT) registry, and chart review. In-hospital and 30-day outcomes are reported. RESULTS Of 125 total patients, 91 underwent SAVR and 34 underwent TAVR. The TAVR group had a higher STS predictive risk of mortality (PROM) (TAVR = 3.96 %, SAVR = 1.25 %, p < 0.0001). In the postoperative period, the SAVR group had higher rates of new-onset atrial fibrillation (20.9 % vs. 0 %, p < 0.001), while the TAVR group had higher rates of complete heart block requiring permanent pacemaker implantation (20.6 % vs. 2.2 %, p < 0.001). There was no difference in in-hospital or 30-day mortality, stroke, myocardial infarction, residual AI, or repeat valve intervention. CONCLUSIONS Despite higher STS PROM and more comorbidities, patients who underwent TAVR for AI had similar in-hospital and 30-day outcomes as patients who underwent SAVR for AI. These results support TAVR in selected high-risk patients with AI, with the knowledge that pacemaker needs may be higher than patients undergoing SAVR.
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Affiliation(s)
- Rachel Koch
- Department of Internal Medicine, Emory University Hospital, Atlanta, GA, USA
| | - Errol Inci
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Kendra Grubb
- Division of Cardiothoracic Surgery, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Bradley Leshnower
- Division of Cardiothoracic Surgery, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Gaetano Paone
- Division of Cardiothoracic Surgery, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Hiroki Ueyama
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Chandan Devireddy
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Patrick Gleason
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Joe Xie
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Jane Wei
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Isida Byku
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Adam Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Vasilis Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA.
| | - Emily Perdoncin
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA, USA.
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5
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Tully A, Tom S, Xie J, O'Brian C, Gleason P, Grubb KJ. Evolving computed tomography angiography for aortic valve replacement: Optimizing transcatheter and surgical therapies. J Card Surg 2022; 37:4124-4132. [PMID: 36168827 DOI: 10.1111/jocs.16977] [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: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 01/06/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) has transformed the treatment of aortic stenosis and pre-procedure planning relies heavily on advanced imaging. Multidetector computed tomography angiography, the "TAVR CT," facilitates essential planning steps of measuring the aortic root for valve sizing and feasibility and assessment of potential access vessels, making it the guideline gold standard in preprocedural TAVR work up. This Impact of Advanced Imaging Techniques on Cardiac Surgery article will examine the development of TAVR CT, illustrate the current impact and utility, and highlight potential areas of future growth. Clinicians who keep informed of these changes and can become proficient with TAVR CT analyses will offer patients the most optimal results and fuel future therapeutic growth.
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Affiliation(s)
- Andrew Tully
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, USA.,Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA
| | - Stephanie Tom
- Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA.,Department of Surgery, Emory University, Atlanta, Georgia, USA
| | - Joe Xie
- Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA.,Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Colin O'Brian
- Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA.,Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Patrick Gleason
- Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA.,Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, USA.,Structural Heart and Valve Center, Emory University, Atlanta, Georgia, USA
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6
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Gaignard S, Babaliaros V, Perdoncin E, Gleason P, Xie J, Jokhadar M. Transcatheter Mitral Valve Repair in a Tricuspid Atresia Patient With Potts and Glenn Shunts. JACC Case Rep 2022; 4:1379-1383. [PMID: 36299650 PMCID: PMC9588587 DOI: 10.1016/j.jaccas.2022.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/26/2022] [Accepted: 08/12/2022] [Indexed: 11/06/2022]
Abstract
Our patient was a 50-year-old woman with tricuspid atresia who had undergone palliation with a Potts shunt to the left pulmonary artery as an infant and a classic Glenn shunt to the right pulmonary artery as a young child. Under general anesthesia, she underwent transcatheter edge-to-edge repair of the mitral valve for severe symptomatic mitral regurgitation. (Level of Difficulty: Advanced.)
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Key Words
- ASD, atrial septal defect
- EROA, effective regurgitant orifice area
- LPA, left pulmonary artery
- LV, left ventricular
- MC, MitraClip
- MR, mitral regurgitation
- PEEP, positive end-expiratory pressure
- RPA, right pulmonary artery
- TEE, transesophageal echocardiography
- TEER, transcatheter edge-to-edge repair
- congenital heart disease
- cyanotic heart disease
- echocardiography
- mitral valve
- pulmonary circulation
- systolic heart failure
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Affiliation(s)
- Scott Gaignard
- Address for correspondence: Dr Scott Gaignard, Emory University School of Medicine, Emory Faculty Office Building, 49 Jesse Hill Jr Drive Southeast, Atlanta, Georgia 30303, USA.
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7
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Patel K, Ceballos A, Babaliaros V, Greenbaum A, Grubb K, Gleason P, Xie J. TCT-364 Aortic Valve Calcium Score Predicts Improvement in Stroke Volume After Transcatheter Aortic Valve Replacement in Low Flow, Low Gradient Aortic Stenosis. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.427] [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: 11/30/2022]
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8
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Chadderdon SM, Eleid MF, Thaden JJ, Makkar R, Nakamura M, Babaliaros V, Greenbaum A, Gleason P, Kodali S, Hahn RT, Koulogiannis KP, Marcoff L, Grayburn P, Smith RL, Song HK, Lim DS, Gray WA, Hawthorne K, Deuschl F, Narang A, Davidson C, Zahr FE. Three-Dimensional Intracardiac Echocardiography for Tricuspid Transcatheter Edge-to-Edge Repair. Struct Heart 2022; 6:100071. [PMID: 37288338 PMCID: PMC10242583 DOI: 10.1016/j.shj.2022.100071] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/08/2022] [Accepted: 06/17/2022] [Indexed: 06/09/2023]
Abstract
Patients with severe symptomatic tricuspid regurgitation face a significant dilemma in treatment options, as the yearly mortality with medical therapy and the surgical mortality for tricuspid repair or replacement are high. Transcatheter edge-to-edge repair (TEER) for the tricuspid valve is becoming a viable option in patients, although procedural success is dependent on high-quality imaging. While transesophageal echocardiography remains the standard for tricuspid TEER procedures, intracardiac echocardiography (ICE) with three-dimensional (3D) multiplanar reconstruction (MPR) has many theoretical and practical advantages. The aim of this article was to describe the in vitro wet lab-based imaging work done to facilitate the best approach to 3D MPR ICE imaging and the procedural experience gained with 3D MPR ICE in tricuspid TEER procedures with the PASCAL device.
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Affiliation(s)
- Scott M. Chadderdon
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Mackram F. Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeremy J. Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Raj Makkar
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Mamoo Nakamura
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Vasilis Babaliaros
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Adam Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Patrick Gleason
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Susheel Kodali
- Structural Heart & Vascular Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Rebecca T. Hahn
- Structural Heart & Vascular Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Konstantinos P. Koulogiannis
- Department of Cardiovascular Medicine, Morristown Medical Center/Atlantic Health System, Morristown, New Jersey, USA
| | - Leo Marcoff
- Department of Cardiovascular Medicine, Morristown Medical Center/Atlantic Health System, Morristown, New Jersey, USA
| | - Paul Grayburn
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | | | - Howard K. Song
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - D. Scott Lim
- Division of Cardiology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - William A. Gray
- Department of Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Katie Hawthorne
- Department of Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | | | - Akhil Narang
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Charles Davidson
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Firas E. Zahr
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
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Schwartz AM, Kim E, Gleason P, Li X, Ko YA, Wells BJ. Aortic Dimensions Are Larger in Patients With Fibromuscular Dysplasia. J Am Heart Assoc 2022; 11:e023858. [PMID: 35699179 PMCID: PMC9238647 DOI: 10.1161/jaha.121.023858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Fibromuscular dysplasia (FMD) is a disease of unknown etiology that causes stenosis, aneurysmal dilatation, and dissection of vascular beds. Known to affect medium-sized arteries, FMD is not typically considered to affect the aorta. We tested the hypothesis that aortic size in FMD is abnormal compared with age- and sex-matched controls. Methods and Results Medical records and computed tomography angiography images were reviewed in female patients with a diagnosis of FMD who were seen in the vascular medicine clinic at Emory Healthcare. Aortic dimensions were measured at 6 different landmarks. Using 2 sample t tests, the aortic measurements and height-indexed measurements were compared with published normal values in healthy women of a similar age. A total of 94 female patients were included in the study. The median age was 57 (interquartile range, 50-65). FMD involvement was present most commonly in the extracranial carotid (77.7%) and renal (43.6%) arteries. All 6 aortic segments were found to be larger in both absolute measures and height-indexed measures in the FMD population (P<0.001). The largest differences were observed within the absolute measures of the sinotubular junction with mean±SD (mm) (29.9±4.1) versus (27±2.5), ascending aorta (32.7±4.4) versus (30.0±3.5), and descending aorta (24.7±3.0) versus (22.0±2.0) (P<0.001). Conclusions Aortic diameters in female patients with FMD are larger when compared with published age- and sex-matched normal values. These findings suggest that FMD may also affect the large-sized arteries.
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Affiliation(s)
- Arielle M Schwartz
- Willis Hurst Internal Medicine Residency Program Emory University Atlanta GA
| | - Esther Kim
- Division of Cardiovascular Medicine, Department of Medicine Vanderbilt University Medical Center Nashville NC
| | - Patrick Gleason
- Division of Cardiology, Department of Medicine Emory University School of Medicine Atlanta GA
| | - Xiaona Li
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health Emory University Atlanta GA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health Emory University Atlanta GA
| | - Bryan J Wells
- Division of Cardiology, Department of Medicine Emory University School of Medicine Atlanta GA
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10
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Kim J, Black G, perdoncin E, Shekiladze N, Gleason P, Grubb K, Devireddy C, Bhatia NK, Merchant FM, El-Chami MF, Westerman SB, Shah AD, Leon AR, Lloyd MS, Kiani S. PO-620-06 VALIDATION OF RISK SCORE PREDICTING NEED FOR PACEMAKER IMPLANT AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.833] [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: 11/25/2022]
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11
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Akodad M, Sellers S, Landes U, Meier D, Tang GHL, Gada H, Rogers T, Caskey M, Rutkin B, Puri R, Rovin J, Leipsic J, Sondergaard L, Grubb KJ, Gleason P, Garde K, Tadros H, Teodoru S, Wood DA, Webb JG, Sathananthan J. Balloon-Expandable Valve for Treatment of Evolut Valve Failure: Implications on Neoskirt Height and Leaflet Overhang. JACC Cardiovasc Interv 2022; 15:368-377. [PMID: 35210043 DOI: 10.1016/j.jcin.2021.12.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/26/2021] [Accepted: 12/14/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study sought to determine the degree of Evolut (Medtronic) leaflet pinning, diameter expansion, leaflet overhang, and performance at different implant depths of the balloon-expandable Sapien 3 (S3, Edwards Lifesciences LLC) transcatheter heart valve (THV) within the Evolut THV. BACKGROUND Preservation of coronary access and flow is a major factor when considering the treatment of failed Evolut THVs. METHODS An in vitro study was performed with 20-, 23-, 26-, and 29-mm S3 THVs deployed within 23-, 26-, 29-, and 34-mm Evolut R THVs, respectively. The S3 outflow was positioned at various depths at node 4, 5, and 6 of the Evolut R. Neoskirt height, leaflet overhang, performance, and Evolut R valve housing diameter expansion were assessed under physiological conditions as per ISO 5840-3 standard. RESULTS The neoskirt height for the Evolut R was shorter when the S3 outflow was positioned at node 4 compared with node 6 (node 4 height for 23 mm = 16.3 mm, 26 mm = 17.1 mm, 29 mm = 18.3 mm, and 34 mm = 19.9 mm vs node 6 height for 23 mm = 23.9 mm, 26 mm = 23.4 mm, 29 mm = 24.7 mm, and 34 mm = 27 mm Evolut R). All configurations exhibited acceptable hydrodynamic performance irrespective of the degree of leaflet overhang, except the 29-mm S3 implanted in 34-mm Evolut R at node 4 (regurgitant fraction >20%). The valve housing radius of the index Evolut R increased when the S3 was implanted, with the increase ranging from 0 to 2.5 mm. CONCLUSIONS Placement of the S3 at a lower implant position within an index Evolut R reduces the neoskirt height with no significant compromise to S3 valve function despite a higher degree of leaflet overhang. Low S3 implantation may facilitate future coronary access after redo transcatheter aortic valve replacement.
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Affiliation(s)
- Mariama Akodad
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada; Cardiovascular Translational Laboratory, Vancouver, Canada
| | - Stephanie Sellers
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada; Cardiovascular Translational Laboratory, Vancouver, Canada
| | - Uri Landes
- Edith Wolfson Medical Center, Holon, Israel; Tel-Aviv University, Tel-Aviv, Israel
| | - David Meier
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada; Cardiovascular Translational Laboratory, Vancouver, Canada
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | - Hemal Gada
- Department of Cardiothoracic Surgery, Pinnacle Health, Harrisburg, Pennsylvania, USA
| | - Toby Rogers
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Michael Caskey
- Department of Cardiovascular Surgery, Abrazo Arizona Heart Hospital, Phoenix, Arizona, USA
| | - Bruce Rutkin
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joshua Rovin
- Department of Cardiovascular and Thoracic Surgery, Morton Plant Hospital, BayCare Health System, Clearwater, Florida, USA
| | - Jonathon Leipsic
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada; Cardiovascular Translational Laboratory, Vancouver, Canada
| | - Lars Sondergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Patrick Gleason
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Kshitija Garde
- Research and Development, Structural Heart & Aortic, Medtronic, Santa Ana, California, USA
| | - Hatem Tadros
- Research and Development, Structural Heart & Aortic, Medtronic, Santa Ana, California, USA
| | - Sebastian Teodoru
- Research and Development, Structural Heart & Aortic, Medtronic, Santa Ana, California, USA
| | - David A Wood
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada; Cardiovascular Translational Laboratory, Vancouver, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada; Cardiovascular Translational Laboratory, Vancouver, Canada
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada; Cardiovascular Translational Laboratory, Vancouver, Canada.
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12
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Koch R, Perdoncin E, Wei JW, Binongo J, Ceretto-Clark B, Rainer K, Greenbaum A, Byku I, Devireddy C, Grubb K, Guyton R, Paone G, Gleason P, Xie J, Babaliaros V. A COMPARISON OF CLINICAL AND ECHOCARDIOGRAPHIC OUTCOMES OF PATIENTS UNDERGOING TRANSCATHETER VS. SURGICAL AORTIC VALVE REPLACEMENT FOR PURE, NATIVE AORTIC INSUFFICIENCY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02489-x] [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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13
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Schwartz AM, Kim SH, Gleason P, Li X, Ko YA, Wells B. AORTIC DIMENSIONS IN FIBROMUSCULAR DYSPLASIA. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03193-4] [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: 10/21/2022]
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14
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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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15
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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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16
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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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17
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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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18
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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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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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Maslow A, Abisse S, Parikh L, Apruzzese P, Cilia L, Gleason P, Singh A, Poppas A. Echocardiographic Predictors of Tricuspid Ring Annuloplasty Repair Failure for Functional Tricuspid Regurgitation. J Cardiothorac Vasc Anesth 2019; 33:2624-2633. [DOI: 10.1053/j.jvca.2019.05.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/25/2019] [Accepted: 05/27/2019] [Indexed: 01/20/2023]
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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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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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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 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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Kiani S, Kamioka N, Lisko J, Mengistu A, Stewart J, Gleason P, Grubb K, Greenbaum AB, Devireddy C, Guyton R, Leshnower B, Babaliaros V, Hoskins M. PREDICTORS FOR THE NEED FOR NEW PERMANENT PACEMAKER IMPLANTATION, AND HIGH PACING BURDEN ON FOLLOW-UP AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT WITH THE EDWARDS-SAPIEN 3 VALVE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31094-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kamioka N, Caughron H, Lisko J, Binongo J, Almuwaqqat Z, Keegan P, Gleason P, Byku I, Alvarez L, Reginauld S, Maini A, Grubb K, Devireddy C, Mavromatis K, Leshnower B, Stewart J, Guyton R, Block P, Greenbaum AB, Babaliaros V. IMPACT OF HEMODIALYSIS ON EARLY DEGENERATION OF BIOPROSTHESIS AND CLINICAL OUTCOME AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31703-6] [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: 10/27/2022]
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Kamioka N, Keegan P, Lerakis S, Binongo J, Caughron H, Reginauld S, Patel H, Maini A, Yousef A, Gleason P, Leshnower B, Devireddy C, Mavromatis K, Stewart J, Block P, Thourani V, Guyton R, Babaliaros V. TCT-259 1000 Minimalist TAVR: Sapien through Sapien-3. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1390] [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: 10/28/2022]
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Khan J, Lederman R, Guyton R, Devireddy C, Kamioka N, Yousef A, Gleason P, Babaliaros V. TCT-860 LAMPOON to Facilitate Tendyne Transcatheter Mitral Valve Replacement: From Animal Model to First-in-Human. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.2110] [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: 10/28/2022]
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Khan J, Lederman R, Sanon S, Leshnower B, Yousef A, Gleason P, Lerakis S, Rogers T, Greenbaum A, Babaliaros V. TCT-484 Electrosurgical Laceration of Alfieri Stitch (ELASTIC) to Facilitate Transcatheter Mitral Valve Replacement: First-in-Human Report. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1659] [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: 11/24/2022]
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Kamioka N, Babaliaros V, Morse MA, Frisoli T, Lerakis S, Iturbe JM, Binongo J, Corrigan F, Yousef A, Gleason P, Wells JA, Caughron H, Dong A, Rodriguez E, Leshnower B, O’Neill W, Paone G, Eng M, Guyton R, Block PC, Greenbaum A. Comparison of Clinical and Echocardiographic Outcomes After Surgical Redo Mitral Valve Replacement and Transcatheter Mitral Valve-in-Valve Therapy. JACC Cardiovasc Interv 2018; 11:1131-1138. [DOI: 10.1016/j.jcin.2018.03.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/05/2018] [Accepted: 03/05/2018] [Indexed: 12/15/2022]
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Champaloux S, Gleason P. Can lowering generics member cost share impact CMS star adherence metrics? Res Social Adm Pharm 2018. [DOI: 10.1016/j.sapharm.2018.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Khan JM, Lederman RJ, Sanon S, Leshnower BG, Yousef A, Gleason P, Lerakis S, Rogers T, Greenbaum AB, Babaliaros VC. Transcatheter Mitral Valve Replacement After Transcatheter Electrosurgical Laceration of Alfieri STItCh (ELASTIC): First-in-Human Report. JACC Cardiovasc Interv 2018; 11:808-811. [PMID: 29605244 DOI: 10.1016/j.jcin.2017.11.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/28/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jaffar M Khan
- 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
| | - Saurabh Sanon
- Structural Heart Transcatheter Therapies, Tenet Health Palm Beach Gardens Medical Center, Palm Beach Gardens, Florida
| | - Bradley G Leshnower
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia
| | - Altayyeb Yousef
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia
| | - Patrick Gleason
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia
| | - Stamatios Lerakis
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Adam B Greenbaum
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan
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Kamioka N, Caughron H, Lerakis S, Yousef A, Gleason P, Stewart J, Devireddy C, Leshnower B, Guyton RA, Block P, Babaliaros V. OUTCOMES AFTER TRANSCATHETER TRICUSPID VALVE-IN-VALVE THERAPY VERSUS RE-DO ISOLATED SURGICAL TVR IN PATIENTS WITH PREVIOUS TRICUSPID BIOPROSTHETIC VALVES. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31920-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kim JH, Hollowed C, Irwin-Weyant M, Patel K, Hosny K, Gleason P, Aida H, Gowani Z, Sher S, Shoop J, Galante A, Clark C, Quyyumi A, Collop N, Baggish A. SLEEP DISORDERED BREATHING AND CARDIOVASCULAR CORRELATES IN COLLEGIATE AMERICAN STYLE FOOTBALL PARTICIPANTS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34841-6] [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: 11/26/2022]
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Parikh L, Poppas A, Abisse S, Gleason P, Maslow A, Singh A, Cilia L. ECHOCARDIOGRAPHIC PREDICTORS OF TRICUSPID RING FAILURE. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35342-1] [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: 12/01/2022]
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38
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Agboola F, Herring R, Ghamsary M, Handysides D, Gleason P, Rivera M, Gutierrez S. Towards improving healthy food access through
community-supported-agriculture-farmshare programs in food desert areas and
among low income populations. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.117] [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: 10/21/2022] Open
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Roberts J, Sealy D, Marshak HH, Manda-Taylor L, Gleason P, Mataya R. The patient-provider relationship and antenatal care uptake at two referral hospitals in Malawi: A qualitative study. Malawi Med J 2015; 27:145-150. [PMID: 26955436 PMCID: PMC4761706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Approximately 90% of Malawian women attend antenatal care at least once during their pregnancies; however, most mothers first present during months five and six and do not adhere to the World Health Organization's recommended four visits. The objective of this study was to explore the role the patient-provider relationship has on antenatal care uptake. METHODS A qualitative study, consisting of interviews with 20 urban pregnant mothers and eight health workers, was conducted from September to December 2014. Two large tertiary care hospitals in the Central and Southern regions of Malawi were selected as study sites. RESULTS Several factors influenced antenatal care attendance. Significant barriers reported included the patient-provider relationship, clinic wait times, family and friend support, distance from home to the clinic, transportation, cost, and number of visits. The patient-provider relationship appears to have a large impact on antenatal clinic participation. Mothers indicated that health workers often mistreat or demean them during visits. Additionally, health workers revealed that, due to staff shortages, patients often do not receive the care they deserve. CONCLUSIONS The results of this study suggest that, in addition to other factors, healthcare provider attitudes influence antenatal clinic attendance. Improving the patient-provider relationship may increase antenatal clinic attendance and decrease pregnancy complications during pregnancy. Professional development opportunities and quality improvement programmes are would help improve patient care and health outcomes while the continued staff shortages in the country are addressed.
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Affiliation(s)
- J Roberts
- School of Public Health, Loma Linda University, Loma Linda, California, USA
| | - D Sealy
- School of Public Health, Loma Linda University, Loma Linda, California, USA
| | - H Hopp Marshak
- School of Public Health, Loma Linda University, Loma Linda, California, USA
| | - L Manda-Taylor
- University of Malawi, College of Medicine, Chichiri Blantyre 3, Malawi
| | - P Gleason
- School of Public Health, Loma Linda University, Loma Linda, California, USA
| | - R Mataya
- School of Public Health, Loma Linda University, Loma Linda, California, USA; University of Malawi, College of Medicine, Chichiri Blantyre 3, Malawi
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Johnson KA, Partsch DJ, Gleason P, Makay K. Comparison of two home blood pressure monitors with a mercury sphygmomanometer in an ambulatory population. Pharmacotherapy 1999; 19:333-9. [PMID: 10221371 DOI: 10.1592/phco.19.4.333.30936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We performed a randomized, single-visit, crossover study to compare the precision of a digital monitor and an aneroid monitor relative to a desktop mercury sphygmomanometer (DMS). Three blood pressure measurements per patient, one per device, were taken over 25 minutes. Of 99 patients, 95 had complete blood pressure data. Systolic blood pressures measured with the digital monitor were significantly different from those with the DMS (p<0.01). Thirty-four percent of systolic and 48% of diastolic pressures measured with the digital monitor were within +/- 5 mm Hg of the DMS. The aneroid monitor performed significantly better than the digital monitor, with 54% of systolic (p<0.01) and 58% of diastolic blood pressures within +/- 5 mm Hg of the DMS standard. Health care providers are encouraged to supervise patients' initial use of a home blood pressure monitor and calibrate readings against a standard mercury sphygmomanometer.
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Affiliation(s)
- K A Johnson
- HealthAmerica of Pennsylvania, Inc., Pittsburgh 15222, USA
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Rangarajan A, Gleason P. Young unwed fathers of AFDC children: do they provide support? Demography 1998; 35:175-86. [PMID: 9622780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We examine the support provided by fathers of children born to disadvantaged teenage mothers. Our sample includes the fathers of 6,009 children born over a two-year period to 3,855 teenage mothers receiving AFDC in three economically depressed inner cities. These fathers provide little social and economic support to their children. Support declines as their children age from infants to toddlers and as fathers' relationships with the mothers grow more distant. Fathers' employment status and educational attainment positively affect the amount of economic support that they provide but do not strongly influence the amount of social support they provide.
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Affiliation(s)
- A Rangarajan
- Mathematica Policy Research, Princeton, NJ 08543, USA.
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Abstract
Acute lobar nephronia (acute focal bacterial nephritis) has recently been recognized as an infectious process of the kidney. It is a radiologic diagnosis characterized as a nonliquifiable inflammatory renal mass associated with signs and symptoms of bacterial pyelonephritis. We present the successful management of a renal allograft recipient who had radiologic evidence of acute lobar nephronia within the graft six weeks after placement of an internalized ureteral stent.
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Affiliation(s)
- J V Thomalla
- Department of Surgery, Indiana University Medical Center, Indianapolis
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Abstract
As a test of the significance of previously described biochemical abnormalities in thiamine-dependent enzymes in brains and other tissues in patients with Alzheimer's disease, a double-blind, placebo-controlled, crossover, outpatient pilot study compared the effects of 3 g/d of oral thiamine hydrochloride for three months with those of a niacinamide placebo. Eleven moderately impaired patients with "probable Alzheimer's disease" by the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria completed the study. All patients were well nourished and had no stigmata of dietary thiamine deficiency. Their initial mean +/- SEM Mini-Mental State Examination score was 14.2 +/- 1.4, and the mean age was 72 years. Global cognitive rating by the Mini-Mental State Examination was higher during three months with 3 g/d of oral thiamine hydrochloride than with niacinamide placebo. Behavioral ratings, however, did not differ significantly, nor did clinical state when it was judged subjectively.
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Affiliation(s)
- J P Blass
- Will Rogers Institute, White Plains, NY
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Bronzert DA, Triche TJ, Gleason P, Lippman ME. Isolation and characterization of an estrogen-inhibited variant derived from the MCF-7 breast cancer cell line. Cancer Res 1984; 44:3942-51. [PMID: 6744309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The mechanism by which pharmacological concentrations of estrogen can paradoxically inhibit the growth of human breast cancer is unknown. We have selected for a variant line of MCF-7 which may help to understand this process. The variant was selected by exposing MCF-7 cells to high-specific-activity 16 alpha-[125I]iodoestradiol. These cells were viably frozen for two isotopic half-lives, defrosted once, then reexposed to 16 alpha-[125I]iodoestradiol to allow maximal radiation damage mediated by isotope associated with binding sites. This cell line (113) is one of 55 lines cloned from MCF-7 cells that survived this treatment. The growth response to estradiol of the 113 breast cancer cells grown in monolayer is normal for 4 to 6 days, and then the cell number plateaus as the cells appear to round up and detach. Concomitantly, a decrease in [3H]thymidine incorporation occurs. The cells cannot be rescued by removing estradiol from the medium. The inhibition is dose dependent and can be seen in concentrations of estradiol as low as 10(-10) M. The 113 cells are also inhibited by antiestrogens. They have normal levels of estrogen receptors which bind to DNA cellulose with activation. Progesterone receptors are estrogen inducible, although the levels are one-third that of wild-type MCF-7 cells. The morphological changes determined by electron microscopy of estrogen-treated cells are typical of degenerative cells. To investigate the possibility that inhibitory factors are secreted into the medium by 113 cells, conditioned medium from estrogen-exposed 113 cells is added to normal MCF-7 and 113 cells. No decrease in [3H]thymidine incorporation compared to controls is observed. When the secreted proteins are labeled with [35S]methionine and analyzed by sodium dodecyl sulfate-acrylamide gels, no major differences are apparent in the 113 and MCF-7 cells. Thus, the source of the defect is still unknown. It remains to be seen if the growth-inhibitory effects of 17 beta-estradiol on this cell line are receptor mediated or related to specific gene products which can be identified.
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Gleason P, Hepburn B. Residents' perspective on the partnership between university and state. Md State Med J 1984; 33:292-295. [PMID: 6727437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Gleason P, Fenty D, Wright B, Bonnatyne J. City-wide cooperation: the Unit Clerk Program. Dimens Health Serv 1981; 58:11. [PMID: 6786944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Roberts J, Sealy D, Hopp Marshak H, Manda-Taylor L, Gleason P, Mataya R. The patient-provider relationship and antenatal care uptake at two referral hospitals in Malawi: A qualitative study. Malawi Med J 1970. [DOI: 10.4314/mmj.v27i4.6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background In post-stroke patients, impairment of quality of life (QOL) has been associated with functional impairment, age, anxiety, depression, and fatigue. Good social support, higher education, and better socioeconomic status are associated with better QOL among stroke survivors. In Africa, studies from Nigeria and Tanzania have reported on post-stroke QOL.Background Approximately 90% of Malawian women attend antenatal care at least once during their pregnancies; however, most mothers first present during months five and six and do not adhere to the World Health Organization’s recommended four visits. The objective of this study was to explore the role the patient-provider relationship has on antenatal care uptake.Methods A qualitative study, consisting of interviews with 20 urban pregnant mothers and eight health workers, was conducted from September to December 2014. Two large tertiary care hospitals in the Central and Southern regions of Malawi were selected as study sites.Results Several factors influenced antenatal care attendance. Significant barriers reported included the patient-provider relationship, clinic wait times, family and friend support, distance from home to the clinic, transportation, cost, and number of visits. The patient-provider relationship appears to have a large impact on antenatal clinic participation. Mothers indicated that health workers often mistreat or demean them during visits. Additionally, health workers revealed that, due to staff shortages, patients often do notreceive the care they deserve.Conclusions The results of this study suggest that, in addition to other factors, healthcare provider attitudes influence antenatal clinic attendance. Improving the patient-provider relationship may increase antenatal clinic attendance and decrease pregnancy complications during pregnancy. Professional development opportunities and quality improvement programmes are would help improve patient care and health outcomes while the continued staff shortages in the country are addressed.
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