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Bajwa T, Attizzani GF, Gada H, Chetcuti SJ, Williams MR, Ahmed M, Petrossian GA, Saybolt MD, Allaqaband SQ, Merhi WM, Stoler RC, Bezerra H, Mahoney P, Wu W, Jumper R, Lambrecht L, Tang GHL. Use and performance of the evolut FX transcatheter aortic valve system. Cardiovasc Revasc Med 2024:S1553-8389(24)00145-3. [PMID: 38599918 DOI: 10.1016/j.carrev.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/22/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The next generation supra-annular, self-expanding Evolut FX transcatheter aortic valve (TAV) system was designed to improve catheter deliverability, provide stable and symmetric valve deployment, and assess commissural alignment during the procedure. The impact of these modifications has not been clinically evaluated. METHODS Procedural information was collected by survey in 2 Stages: Stage I comprised 23 centers with extensive experience with Evolut TAV systems, and Stage II comprised an additional 46 centers with a broad range of balloon- and self-expanding system experience. Operators were to compare the experience with the Evolut FX to the predicate Evolut PRO+ system. RESULTS There were 285 cases during Stage I from June 24 to August 12, 2022, and 254 cases during Stage II from August 15 to September 11, 2022. Overall, the cusp overlap technique was used in 88.6 %, and commissural alignment was achieved in 96.1 % of these cases. Compared to implanter's previous experience with the Evolut PRO+ system, less resistance was noted with the Evolut FX system: in 83.0 % of cases during vascular insertion, in 84.7 % of cases while tracking through the vasculature, in 84.4 % of cases while traversing over the arch, and 76.1 % of cases in advancing across the valve. Better symmetry of valve depth was observed in 423 of 525 cases (80.6 %). CONCLUSION Evolut FX system design modifications translated into improvements in catheter deliverability, deployment symmetry and stability, and commissural alignment as assessed by experienced self-expanding and balloon expandable operators.
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Affiliation(s)
- Tanvir Bajwa
- Advocate Aurora Health Care, 2801 W. Kinnickinnic River Parkway,Milwaukee, WI 53215, United States of America.
| | - Guilherme F Attizzani
- University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, United States of America.
| | - Hemal Gada
- University of Pittsburgh-Pinnacle, 1000 N Front Street, Wormleysburg, PA 17043, United States of America
| | - Stanley J Chetcuti
- University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, United States of America.
| | - Mathew R Williams
- New York University - Langone Health, 530 1st Ave. Suite 9V, New York, NY 10016, United States of America.
| | - Mustafa Ahmed
- University of Alabama Medicine, 2000 6th Avenue South, Floor 4, Birmingham, AL 35233, United States of America.
| | - George A Petrossian
- Saint Francis Hospital, Vizza Pavilion, 100 Port Washington Blvd Ste G04, Roslyn, NY 11576, United States of America
| | - Matthew D Saybolt
- Jersey Shore University Medical Center, 1945 NJ-33, Neptune Township, NJ 07753, United States of America
| | - Suhail Q Allaqaband
- Advocate Aurora Health Care, 2801 W. Kinnickinnic River Parkway,Milwaukee, WI 53215, United States of America.
| | - William M Merhi
- Spectrum Health Hospitals, 743 E Beltline Ave NE, Grand Rapids, MI 49525, United States of America.
| | - Robert C Stoler
- Baylor Scott & White Heart and Vascular Hospital at Baylor Scott & White University Medical Center, 621 N Hall St #500, Dallas, TX 75226, United States of America.
| | - Hiram Bezerra
- Tampa General Hospital, University of South Florida; 2 Tampa General Circle, Tampa, FL 33606, United States of America.
| | - Paul Mahoney
- Sentara Norfolk General Hospital, 600 Gresham Dr Ste 8630A, Norfolk, VA 23507, United States of America
| | - Willis Wu
- Rex Hospital, 2800 Blue Ridge Rd Suite 201, Raleigh, NC 27607, United States of America.
| | - Robert Jumper
- St. Vincent's Medical Center, 115 Technology Dr UNIT C300, Trumbull, CT 06611, United States of America.
| | - Larry Lambrecht
- Medtronic, 8200 Coral Sea St., Mounds View, MN 55112, United States of America.
| | - Gilbert H L Tang
- Mount Sinai Health System, 1190 5th Ave, New York, NY 10029, United States of America
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Kandzari DE, Garcia-Garcia HM, Stoler RC, Wang J, Picone M, Ben-Dor I, Garcia SA. Ultrathin bioresorbable polymer sirolimus-eluting stents in US patients undergoing coronary revascularization: 1-Year outcomes from the BIOFLOW VII trial. Catheter Cardiovasc Interv 2023; 102:464-471. [PMID: 37493431 DOI: 10.1002/ccd.30783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/23/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Ultrathin strut coronary drug-eluting stents (DES) have demonstrated improved safety and efficacy in large contemporary trials. The evaluation of an ultrathin strut DES in a post-market United States (US) patient population was undertaken. OBJECTIVE The purpose of this post-approval study is to confirm that the clinical performance of an ultrathin strut bioresorbable polymer sirolimus-eluting stent (BP SES) in clinical practice is similar to that observed with BP SES in the BIOFLOW V pivotal trial. METHODS BIOFLOW VII is a prospective, multicenter, single-arm US post-market approval study to confirm the clinical performance of BP SES in a real-world setting. The primary endpoint of 1-year target lesion failure (TLF) was compared with a performance goal of 6.9% based on an adapted BIOFLOW V trial BP SES TLF rate and TLF rates from other US market-released DES utilizing the Society for Cardiovascular Angiography and Interventions definition for peri-procedural myocardial infarction (MI). Subjects undergoing percutaneous coronary intervention with BP SES were consented within 24 h post-index procedure with planned follow-up through 5 years. RESULTS Among 556 enrolled patients, clinical demographics included: 34.7% female, 35.6% with diabetes mellitus, and 56.8% with acute coronary syndromes. The average stent length (mean ± standard deviation) was 20.2 ± 11.8 mm, and the mean number of stents per patient was 1.3 ± 0.6. Procedure success was 99.1% (551/556), and device success was 99.9% (689/690). Among 531 subjects included in the primary endpoint analysis, the 1-year rate of TLF rate was 1.7% (9/531), and the primary endpoint was met compared with the performance goal (p < 0.0001, 95% confidence interval: 0.69%, 3.43%). Rates of target vessel MI and clinically driven target lesion revascularization were 1.3% (7/531) and 0.9% (5/531), with no occurrence of cardiac death. Definite stent thrombosis was observed for two cases (0.4%; 2/556) with one acute (≤24 h) and one late (>30 days and ≤1 year) event. CONCLUSION In a post-approval study, 1-year clinical outcomes with BP SES were consistent with prior trials supporting the safety and effectiveness of ultrathin BP SES.
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Affiliation(s)
| | - Hector M Garcia-Garcia
- Division of Interventional Cardiology, MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, USA
| | - Robert C Stoler
- Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas, USA
| | - John Wang
- MedStar Union Memorial Hospital, MedStar Health Research Institute, Baltimore, Maryland, USA
| | | | - Itsik Ben-Dor
- Division of Interventional Cardiology, MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, USA
| | - Santiago A Garcia
- The Christ Hospital and Lindner Center for Research and Education, Cincinnati, Ohio, USA
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Forrest JK, Deeb GM, Yakubov SJ, Gada H, Mumtaz MA, Ramlawi B, Bajwa T, Teirstein PS, DeFrain M, Muppala M, Rutkin BJ, Chawla A, Jenson B, Chetcuti SJ, Stoler RC, Poulin MF, Khabbaz K, Levack M, Goel K, Tchétché D, Lam KY, Tonino PAL, Ito S, Oh JK, Huang J, Popma JJ, Kleiman N, Reardon MJ. 3-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis. J Am Coll Cardiol 2023; 81:1663-1674. [PMID: 36882136 DOI: 10.1016/j.jacc.2023.02.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Randomized data comparing outcomes of transcatheter aortic valve replacement (TAVR) with surgery in low-surgical risk patients at time points beyond 2 years is limited. This presents an unknown for physicians striving to educate patients as part of a shared decision-making process. OBJECTIVES The authors evaluated 3-year clinical and echocardiographic outcomes from the Evolut Low Risk trial. METHODS Low-risk patients were randomized to TAVR with a self-expanding, supra-annular valve or surgery. The primary endpoint of all-cause mortality or disabling stroke and several secondary endpoints were assessed at 3 years. RESULTS There were 1,414 attempted implantations (730 TAVR; 684 surgery). Patients had a mean age of 74 years and 35% were women. At 3 years, the primary endpoint occurred in 7.4% of TAVR patients and 10.4% of surgery patients (HR: 0.70; 95% CI: 0.49-1.00; P = 0.051). The difference between treatment arms for all-cause mortality or disabling stroke remained broadly consistent over time: -1.8% at year 1; -2.0% at year 2; and -2.9% at year 3. The incidence of mild paravalvular regurgitation (20.3% TAVR vs 2.5% surgery) and pacemaker placement (23.2% TAVR vs 9.1% surgery; P < 0.001) were lower in the surgery group. Rates of moderate or greater paravalvular regurgitation for both groups were <1% and not significantly different. Patients who underwent TAVR had significantly improved valve hemodynamics (mean gradient 9.1 mm Hg TAVR vs 12.1 mm Hg surgery; P < 0.001) at 3 years. CONCLUSIONS Within the Evolut Low Risk study, TAVR at 3 years showed durable benefits compared with surgery with respect to all-cause mortality or disabling stroke. (Medtronic Evolut Transcatheter Aortic Valve Replacement in Low Risk Patients; NCT02701283).
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Affiliation(s)
- John K Forrest
- Yale University School of Medicine, New Haven, Connecticut, USA.
| | - G Michael Deeb
- University of Michigan Health Systems University Hospital, Ann Arbor, Michigan, USA
| | | | - Hemal Gada
- University of Pittsburgh Medical Center, Harrisburg, Pennsylvania, USA
| | - Mubashir A Mumtaz
- University of Pittsburgh Medical Center, Harrisburg, Pennsylvania, USA
| | - Basel Ramlawi
- Lankenau Heart Institute, Philadelphia, Pennsylvania, USA
| | - Tanvir Bajwa
- Aurora St Luke's Medical Center, Milwaukee, Wisconsin, USA
| | | | | | | | - Bruce J Rutkin
- North Shore University Hospital, Manhasset, New York, USA
| | - Atul Chawla
- Mercy Medical Center, Iowa Heart, Des Moines, Iowa, USA
| | - Bart Jenson
- Mercy Medical Center, Iowa Heart, Des Moines, Iowa, USA
| | - Stanley J Chetcuti
- University of Michigan Health Systems University Hospital, Ann Arbor, Michigan, USA
| | | | | | - Kamal Khabbaz
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Melissa Levack
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kashish Goel
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Ka Yan Lam
- Catharina Ziekenhuis, Eindhoven, the Netherlands
| | | | - Saki Ito
- Echocardiography Core Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Jae K Oh
- Echocardiography Core Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Neal Kleiman
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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Kasliwal N, Abdallah M, Stoler RC, Hebeler RF, Gunn DC, Ramamoorthy S. Efficacy of nasal continuous positive airway pressure as a preferred airway management during intravenous sedation of patients undergoing transcatheter aortic valve replacement. Proc AMIA Symp 2023; 36:351-353. [PMID: 37091776 PMCID: PMC10120441 DOI: 10.1080/08998280.2023.2187174] [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] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Background As the incidence of aortic stenosis is increasing in correlation with the aging population, symptomatic patients commonly require valve replacement procedures. If left untreated, symptomatic aortic stenosis can lead to death in 2 to 3 years. Often, transcatheter aortic valve replacement (TAVR) procedures are performed with the assistance of oxygenation via nasal cannula. However, oxygenation achieved through a nasal continuous positive airway pressure (nCPAP) device could be a more optimized strategy for patients without any sacrifice in efficacy compared to nasal cannula. Methods A retrospective chart review was conducted on 28 patients at Baylor University Medical Center who presented to the operating room for a TAVR between January and October 2021. Fourteen patients received oxygenation via nasal cannula (control group) and 14 received oxygenation with nCPAP. Information gathered included method of oxygenation, length of stay, episodes of hypoxia (defined as sustained oxygen saturation <92% for at least 1 minute), paravalvular leak, pacemaker placement, and mean atrial valve (AV) gradient before and after the procedure. Results In the nCPAP group, the average length of stay was 2.79 days vs 2.71 days in the nasal cannula group. In the nCPAP group, no patient required a permanent pacemaker, while the nasal cannula group had a 40% rate of permanent pacemaker placement. The average preprocedure AV gradient was 51.14 in the nCPAP group and 42.57 in the nasal cannula group. The average postprocedure AV gradient was 8.5 in the nCPAP group and 5.36 in the nasal cannula group. Both groups had an intensive care unit admission rate of 0%. The rate of paravalvular leak was 35.7% in the nCPAP group and 28.6% in the nasal cannula group. The nCPAP group had an average of 0 episodes of hypoxia and the nasal cannula group had an average of 0.93 episodes of hypoxia. Conclusion The findings demonstrate the viability of nCPAP as an effective method of oxygenation during intravenous sedation of TAVR patients when compared to oxygenation achieved via nasal cannula during TAVRs.
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Affiliation(s)
- Nimit Kasliwal
- Department of Anesthesiology, Baylor University Medical Center, Dallas, Texas
- Texas A&M Health Science Center School of Medicine, Dallas, Texas
| | - Mahdi Abdallah
- Department of Anesthesiology, Baylor University Medical Center, Dallas, Texas
- Texas A&M Health Science Center School of Medicine, Dallas, Texas
| | | | - Robert F. Hebeler
- Department of Anesthesiology, Baylor University Medical Center, Dallas, Texas
| | - Daniel C. Gunn
- Department of Anesthesiology, Baylor University Medical Center, Dallas, Texas
- United States Anesthesia Partners, Dallas, Texas
| | - Saravanan Ramamoorthy
- Department of Anesthesiology, Baylor University Medical Center, Dallas, Texas
- United States Anesthesia Partners, Dallas, Texas
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Moubarak G, Huff EA, Stoler RC, Harrington K, Dalton HA, Safa MM, Tecson KM, Sudhakaran S, Banwait JK, Kluis A, DiMaio JM, Mack MJ, Szerlip M. A HEALTH SYSTEM-WIDE COLLABORATIVE MODEL TO IMPROVE OUTCOMES OF TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01313-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: 03/06/2023]
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Kapadia SR, Makkar R, Leon M, Abdel-Wahab M, Waggoner T, Massberg S, Rottbauer W, Horr S, Sondergaard L, Karha J, Gooley R, Satler L, Stoler RC, Messé SR, Baron SJ, Seeger J, Kodali S, Krishnaswamy A, Thourani VH, Harrington K, Pocock S, Modolo R, Allocco DJ, Meredith IT, Linke A. Cerebral Embolic Protection during Transcatheter Aortic-Valve Replacement. N Engl J Med 2022; 387:1253-1263. [PMID: 36121045 DOI: 10.1056/nejmoa2204961] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transcatheter aortic-valve replacement (TAVR) for the treatment of aortic stenosis can lead to embolization of debris. Capture of debris by devices that provide cerebral embolic protection (CEP) may reduce the risk of stroke. METHODS We randomly assigned patients with aortic stenosis in a 1:1 ratio to undergo transfemoral TAVR with CEP (CEP group) or without CEP (control group). The primary end point was stroke within 72 hours after TAVR or before discharge (whichever came first) in the intention-to-treat population. Disabling stroke, death, transient ischemic attack, delirium, major or minor vascular complications at the CEP access site, and acute kidney injury were also assessed. A neurology professional examined all the patients at baseline and after TAVR. RESULTS A total of 3000 patients across North America, Europe, and Australia underwent randomization; 1501 were assigned to the CEP group and 1499 to the control group. A CEP device was successfully deployed in 1406 of the 1489 patients (94.4%) in whom an attempt was made. The incidence of stroke within 72 hours after TAVR or before discharge did not differ significantly between the CEP group and the control group (2.3% vs. 2.9%; difference, -0.6 percentage points; 95% confidence interval, -1.7 to 0.5; P = 0.30). Disabling stroke occurred in 0.5% of the patients in the CEP group and in 1.3% of those in the control group. There were no substantial differences between the CEP group and the control group in the percentage of patients who died (0.5% vs. 0.3%); had a stroke, a transient ischemic attack, or delirium (3.1% vs. 3.7%); or had acute kidney injury (0.5% vs. 0.5%). One patient (0.1%) had a vascular complication at the CEP access site. CONCLUSIONS Among patients with aortic stenosis undergoing transfemoral TAVR, the use of CEP did not have a significant effect on the incidence of periprocedural stroke, but on the basis of the 95% confidence interval around this outcome, the results may not rule out a benefit of CEP during TAVR. (Funded by Boston Scientific; PROTECTED TAVR ClinicalTrials.gov number, NCT04149535.).
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Affiliation(s)
- Samir R Kapadia
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Raj Makkar
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Martin Leon
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Mohamed Abdel-Wahab
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Thomas Waggoner
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Steffen Massberg
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Wolfgang Rottbauer
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Samuel Horr
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Lars Sondergaard
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Juhana Karha
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Robert Gooley
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Lowell Satler
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Robert C Stoler
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Steven R Messé
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Suzanne J Baron
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Julia Seeger
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Susheel Kodali
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Amar Krishnaswamy
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Vinod H Thourani
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Katherine Harrington
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Stuart Pocock
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Rodrigo Modolo
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Dominic J Allocco
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Ian T Meredith
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
| | - Axel Linke
- From the Department of Cardiovascular Medicine (S.R.K.), Cleveland Clinic Foundation (A.K.), Cleveland; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles (R. Makkar); Columbia Interventional Cardiovascular Care (M.L.), Columbia University Medical Center (S.K.), New York; Leipzig Heart Center, University of Leipzig, Leipzig (M.A.-W.), Medizinische Klinik und Poliklinik I, Klinikum der Universität München and German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich (S.M.), Universitaetsklinikum Ulm, Ulm (W.R.), Medical Campus Lake Constance, Friedrichshafen (J.S.), and the Clinic for Internal Medicine and Cardiology, Technische Universität Dresden, Herzzentrum, Dresden (A.L.) - all in Germany; Pima Heart and Vascular, Tucson Medical Center Healthcare, Tucson, AZ (T.W.); Centennial Medical Center, Nashville (S.H.); Rigshospitalet, Copenhagen University Hospital, Copenhagen (L. Sondergaard); Heart Hospital of Austin, Austin (J.K.), Baylor Heart and Vascular Hospital, Dallas (R.C.S.), and Baylor Scott and White the Heart Hospital-Plano, Plano (K.H.) - all in Texas; Monash Medical Centre, Clayton, VIC, Australia (R.G.); Washington Hospital Center, Washington, DC (L. Satler); the Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.); Lahey Hospital and Medical Center, Burlington (S.J.B.), and Boston Scientific, Marlborough (R. Modolo, D.J.A., I.T.M.) - both in Massachusetts; Piedmont Heart Institute, Atlanta (V.H.T.); and the London School of Hygiene and Tropical Medicine, London (S.P.)
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7
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Rizik DG, Rajagopal V, Makkar RR, Bajwa T, Kleiman NS, Linke A, Kereiakes DJ, Waksman R, Thourani VH, Stoler RC, Mishkel GJ, Iyer VS, Buchbinder M, Götberg M, Bjursten H, Allocco DJ, Reardon MJ. Long-term Outcomes of Transcatheter Aortic Valve Replacement With the Lotus Valve vs CoreValve/EvolutR: A Secondary Analysis of the REPRISE III Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2238792. [PMID: 36301543 PMCID: PMC9614584 DOI: 10.1001/jamanetworkopen.2022.38792] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Long-term follow-up after transcatheter aortic valve replacement (TAVR) is of interest given that longitudinal data on mortality and durability of transcatheter heart valves are limited. The REPRISE III (Repositionable Percutaneous Replacement of Stenotic Aortic Valve Through Implantation of Lotus Valve System-Randomized Clinical Evaluation) randomized clinical trial compared the mechanically expanded Lotus valve with the self-expanding CoreValve/EvolutR TAVR platforms. OBJECTIVE To describe the final 5-year outcomes of the REPRISE III trial. DESIGN, SETTING, AND PARTICIPANTS This prespecified secondary analysis assessed the final 5-year clinical, functional, and echocardiographic outcomes of 912 patients from the REPRISE III trial, which was conducted at 55 centers in North America, Europe, and Australia between September 22, 2014, and December 24, 2015. Patients had high risk for aortic stenosis or severe or symptomatic aortic stenosis. Data were analyzed from September 22, 2014, to May 21, 2021. INTERVENTION Lotus valve or CoreValve/EvolutR TAVR platforms. MAIN OUTCOMES AND MEASURES Valve Academic Research Consortium-2 end points, hemodynamic measures, functional status, and health status were examined through the 5-year follow-up. RESULTS A total of 912 patients (mean [SD] age, 82.8 [7.3] years; 463 women [50.8%]) were randomized to either the Lotus valve group (n = 607) or CoreValve/EvolutR group (n = 305), with a baseline Society of Thoracic Surgeons risk score of 6.8%. Clinical follow-up data from the REPRISE III trial were available for 581 patients (95.7%) in the Lotus valve group and 285 patients (93.4%) in the CoreValve/EvolutR group. At 5 years, the cumulative event rate for all-cause mortality was 50.9% in the Lotus valve group vs 52.8% in the CoreValve/EvolutR group (P = .59). Disabling stroke was less frequent with the Lotus valve vs CoreValve/EvolutR (cumulative event rates, 8.3% vs 12.2%; P = .04), whereas the cumulative event rates for overall stroke were similar in both groups (14.1% vs 15.3%; P = .38). Insertion of a new permanent pacemaker (38.9% vs 27.3%; P < .001) and detection of prosthetic aortic valve thrombosis (5.8% vs 1.8%; P = .007) were more common in the Lotus valve group than in the CoreValve/EvolutR group. A smaller proportion of patients who received the Lotus valve experienced valve malpositioning (0% vs 2.6%; P < .001) and required the use of a second valve (1.0% vs 3.8%; P < .001) during the procedure compared with those who received the CoreValve/EvolutR. Compared with the Lotus valve group, the CoreValve/EvolutR group had a significantly lower mean (SD) aortic gradient (7.8 [4.2] mm Hg vs 12.6 [6.7] mm Hg; P < .001) and larger valve areas (1.57 [0.56] cm2 vs 1.42 [0.42] cm2; P = .10). After 5 years, the proportion of patients with moderate or greater paravalvular leak was not significantly higher with the CoreValve/EvolutR than with the Lotus valve (1.9% vs 0%; P = .31); however, the proportion of patients with mild paravalvular leak was higher in the CoreValve/EvolutR group compared with the Lotus valve group (23.1% vs 7.8%; P = .006). Long-term, similar improvements in New York Heart Association class and Kansas City Cardiomyopathy Questionnaire score were observed in both groups. CONCLUSIONS AND RELEVANCE The REPRISE III trial found that, at 5 years, the clinical outcomes of the Lotus valve were comparable to those of the CoreValve/EvolutR and that the Lotus valve was safe and effective. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02202434.
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Affiliation(s)
- David G. Rizik
- Department of Cardiology, HonorHealth and the Scottsdale-Lincoln Health Network, Scottsdale, Arizona
| | | | - Raj R. Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Tanvir Bajwa
- Department of Medicine, Aurora St Luke's Medical Center, Milwaukee, Wisconsin
| | - Neal S. Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Technische Universität Dresden, Dresden, Germany
| | - Dean J. Kereiakes
- The Christ Hospital Heart and Vascular Center/The Lindner Research Center Cincinnati, Cincinnati, Ohio
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Vinod H. Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | | | - Gregory J. Mishkel
- Division of Cardiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Vijay S. Iyer
- Gates Vascular Institute, Interventional Cardiology, University at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Maurice Buchbinder
- Department of Cardiology, Foundation for Cardiovascular Medicine, Stanford University, Stanford, California
| | - Matthias Götberg
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Henrik Bjursten
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden
| | | | - Michael J. Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
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8
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Al-Azizi K, Shih E, Squiers J, Potluri SP, Szerlip M, Brinkman W, Schaffer JM, Harrington K, Mixon TA, Stoler RC, Ryan WH, Krueger AR, Hamandi M, Banwait JK, DiMaio JM, Mack MJ. VALIDATION OF THE STS/ACC TVT RISK SCORE IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT STRATIFIED BY RISK. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01649-7] [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: 10/18/2022]
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9
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Van Mieghem NM, Reardon MJ, Yakubov SJ, Heiser J, Merhi W, Windecker S, Makkar RR, Cheng W, Robbins M, Fail P, Feinberg E, Stoler RC, Hebeler R, Serruys PW, Popma JJ. Clinical outcomes of TAVI or SAVR in men and women with aortic stenosis at intermediate operative risk: a post hoc analysis of the randomised SURTAVI trial. EUROINTERVENTION 2020; 16:833-841. [DOI: 10.4244/eij-d-20-00303] [Citation(s) in RCA: 4] [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] [Indexed: 11/23/2022]
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10
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Briedis K, Aldujeli A, Aldujeili M, Briede K, Zaliunas R, Hamadeh A, Stoler RC, McCullough PA. Considerations for Management of Acute Coronary Syndromes During the SARS-CoV-2 (COVID-19) Pandemic. Am J Cardiol 2020; 131:115-119. [PMID: 32723554 PMCID: PMC7324338 DOI: 10.1016/j.amjcard.2020.06.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 01/22/2023]
Abstract
Accumulating evidence suggests that influenza and influenza-like illnesses can act as a trigger for acute myocardial infarction. Despite these unprecedented times providers should not overlook acute coronary syndrome (ACS) guidelines, but may choose to modify the recommended approach in situations with confirmed or suspected COVID-19 disease. In this document, we suggest recommendations as to how to triage patients diagnosed with ACSs and provide with algorithms of how to manage the patients and decide the appropriate treatment options in the era of COVID-19 pandemic. We also address the inpatient logistics and discharge to follow-up considerations for the function of already established ACS network during the pandemic.
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Affiliation(s)
- Kasparas Briedis
- Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania; Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Ali Aldujeli
- Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania; Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Kamilija Briede
- Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania; Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Remigijus Zaliunas
- Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania; Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Anas Hamadeh
- Baylor University Medical Center, Dallas, Texas; Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas
| | - Robert C Stoler
- Baylor University Medical Center, Dallas, Texas; Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas
| | - Peter A McCullough
- Baylor University Medical Center, Dallas, Texas; Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas
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11
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Hamadeh A, Aldujeli A, Briedis K, Tecson KM, Sanz-Sánchez J, Al Dujeili M, Al-Obeidi A, Diez JL, Žaliūnas R, Stoler RC, McCullough PA. Characteristics and Outcomes in Patients Presenting With COVID-19 and ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2020; 131:1-6. [PMID: 32732010 PMCID: PMC7333635 DOI: 10.1016/j.amjcard.2020.06.063] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/22/2020] [Accepted: 06/26/2020] [Indexed: 12/15/2022]
Abstract
There is limited information regarding clinical characteristics and outcomes of patients with SARS-CoV-2 (COVID-19) disease presenting with ST-segment elevation myocardial infarction (STEMI). In this multicenter retrospective study, we reviewed charts of patients admitted with symptomatic COVID-19 infection and STEMI to a total of 4 hospitals spanning Italy, Lithuania, Spain and Iraq from February 1, 2020 to April 15, 2020. A total of 78 patients were included in this study, 49 (63%) of whom were men, with a median age of 65 [58, 71] years, and high comorbidity burden. During hospitalization, 8 (10%) developed acute respiratory distress syndrome, and 14 (18%) required mechanical ventilation. 19 (24%) patients were treated with primary Percutaneous Coronary Intervention (PCI) and 59 (76%) were treated with fibrinolytic therapy. 13 (17%) patients required cardiac resuscitation, and 9 (11%) died. For the 19 patients treated with primary PCI, 8 (42%) required intubation and 8 (42%) required cardiac resuscitation; stent thrombosis occurred in 4 patients (21%). A total of 5 patients (26%) died during hospitalization. 50 (85%) of the 59 patients initially treated with fibrinolytic therapy had successful fibrinolysis. The median time to reperfusion was 27 minutes [20, 34]. Hemorrhagic stroke occurred in 5 patients (9%). Six patients (10%) required invasive mechanical ventilation; 5 (9%) required cardiac resuscitation, and 4 (7%) died. In conclusion, this is the largest case series to-date of COVID-19 positive patients presenting with STEMI and spans 4 countries. We found a high rate of stent thrombosis, indicating a possible need to adapt STEMI management for COVID-19 patients.
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Affiliation(s)
- Anas Hamadeh
- Baylor University Medical Center, Dallas, Texas; Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas.
| | - Ali Aldujeli
- Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | | | | | | | - Ammar Al-Obeidi
- Al-Kafeel Super specialty hospital, Karbala, Iraq; Karbala cardiac and cardiosurgical center, Karbala, Iraq
| | - Jose Luís Diez
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Robert C Stoler
- Baylor University Medical Center, Dallas, Texas; Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas
| | - Peter A McCullough
- Baylor University Medical Center, Dallas, Texas; Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas; Baylor Heart and Vascular Institute, Dallas, Texas
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12
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Rosol Z, Vasudevan A, Sawhney R, Hebeler RF, Tecson KM, Stoler RC. Hybrid intervention approach to coronary artery and valvular heart disease. Proc (Bayl Univ Med Cent) 2020; 33:520-523. [PMID: 33100519 DOI: 10.1080/08998280.2020.1784638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Coronary angiography is used to assess the burden of coronary artery disease prior to surgical valve repair/replacement and often leads to concomitant bypass and valve surgery. We sought to evaluate outcomes of an alternative, hybrid approach involving percutaneous coronary intervention (PCI) and valve surgery, assessing the rate of stent thrombosis as a primary outcome. We reviewed charts of consecutive patients who underwent planned PCI prior to surgical valve repair/replacement by a single surgeon from January 2008 to December 2016. We calculated rates of surgical complication, duration of dual antiplatelet therapy (DAPT) prior to surgery, and rates of stent thrombosis and in-stent restenosis. Twenty-four patients were included in this study. Surgery was performed a median of 52.5 days following PCI. DAPT was withheld an average of 8 days before and resumed an average of 4 days after surgery. Ninety-two percent of surgeries were minimally invasive. There were no bleeding complications, stent thromboses, or restenosis events. All patients survived the 1-year follow-up. For patients with mixed coronary and valvular heart disease, a heart team approach involving preoperative PCI followed by staged minimally invasive valvular surgery appears to be safe and warrants further exploration.
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Affiliation(s)
- Zachary Rosol
- Baylor University Medical Center, Dallas, Texas.,Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Anupama Vasudevan
- Baylor Heart and Vascular Institute, Dallas, Texas.,College of Medicine, Texas A&M Health Science Center, Dallas, Texas
| | - Rahul Sawhney
- Baylor University Medical Center, Dallas, Texas.,Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Robert F Hebeler
- Baylor University Medical Center, Dallas, Texas.,Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Kristen M Tecson
- Baylor Heart and Vascular Institute, Dallas, Texas.,College of Medicine, Texas A&M Health Science Center, Dallas, Texas
| | - Robert C Stoler
- Baylor University Medical Center, Dallas, Texas.,Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas.,College of Medicine, Texas A&M Health Science Center, Dallas, Texas
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13
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Roberts CS, Stoler RC, Roberts WC. The Case for Primary Prevention of Atherosclerotic Events from Study of a Single Patient. Am J Cardiol 2020; 125:1443-1445. [PMID: 32005440 DOI: 10.1016/j.amjcard.2019.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
This report describes a 64-year-old woman who presented with unstable angina pectoris, her first atherosclerotic event, and who underwent coronary bypass including endarterectomy of the entire right coronary artery which was diffusely and severely narrowed by atherosclerotic plaque. Preoperatively, she fulfilled none of the present-day criteria for lipid-lowering drug therapy. The report demonstrates the deficiency of present-day lipid-lowering drug guidelines and emphasizes the need to switch emphasis from decreasing risk of an atherosclerotic event to the prevention of arterial plaques, a goal which will require a much lower threshold of low-density lipoprotein cholesterol to initiate drug therapy.
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14
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Reardon MJ, Feldman TE, Meduri CU, Makkar RR, O'Hair D, Linke A, Kereiakes DJ, Waksman R, Babliaros V, Stoler RC, Mishkel GJ, Rizik DG, Iyer VS, Gleason TG, Tchétché D, Rovin JD, Lhermusier T, Carrié D, Hodson RW, Allocco DJ, Meredith IT. Two-Year Outcomes After Transcatheter Aortic Valve Replacement With Mechanical vs Self-expanding Valves: The REPRISE III Randomized Clinical Trial. JAMA Cardiol 2020; 4:223-229. [PMID: 30810703 DOI: 10.1001/jamacardio.2019.0091] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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]
Abstract
Importance To our knowledge, REPRISE III is the first large randomized comparison of 2 different transcatheter aortic valve replacement platforms: the mechanically expanded Lotus valve (Boston Scientific) and self-expanding CoreValve (Medtronic). Objective To evaluate outcomes of Lotus vs CoreValve after 2 years. Design, Setting, and Participants A total of 912 patients with high/extreme risk and severe, symptomatic aortic stenosis enrolled between September 22, 2014, and December 24, 2015, were randomized 2:1 to receive Lotus (607 [66.6%]) or CoreValve (305 [33.4%] at 55 centers in North America, Europe, and Australia. The first 2-year visit occurred on October 17, 2016, and the last was conducted on April 12, 2018. Clinical and echocardiographic assessments are complete through 2 years and will continue annually through 5 years. Main Outcomes and Measures All-cause mortality and all-cause mortality or disabling stroke at 2 years. Other clinical factors included overall stroke, disabling stroke, repeated procedures, rehospitalization, valve thrombosis, and pacemaker implantation. Echocardiographic analyses included effective orifice area, mean gradient, and paravalvular leaks (PVLs). Results Of 912 participants, the mean (SD) age was 82.8 (7.3) years, 465 (51%) were women, and the mean (SD) Society of Thoracic Surgeons predicted risk of mortality was 6.8% (4.0%). At 2 years, all-cause death was 21.3% with Lotus vs 22.5% with CoreValve (hazard ratio [HR], 0.94; 95% CI, 0.69-1.26; P = .67) and all-cause mortality or disabling stroke was 22.8% with Lotus and 27.0% with CoreValve (HR, 0.81; 95% CI, 0.61-1.07; P = .14). Overall stroke was 8.4% vs 11.4% (HR, 0.75; 95% CI, 0.48-1.17; P = .21); disabling stroke was more frequent with CoreValve vs Lotus (4.7% Lotus vs 8.6% CoreValve; HR, 0.53; 95% CI, 0.31-0.93; P = .02). More Lotus patients received a new permanent pacemaker (41.7% vs 26.1%; HR, 1.87; 95% CI, 1.41-2.49; P < .01) or had a valve thrombosis (3.0% vs 0.0%; P < .01) compared with CoreValve. More patients who received CoreValve experienced a repeated procedure (0.6% Lotus vs 2.9% CoreValve; HR, 0.19; 95% CI, 0.05-0.70; P < .01), valve migration (0.0% vs 0.7%; P = .05), or embolization (0.0% vs 2.0%; P < .01) than Lotus. Valve areas remained significantly larger and the mean gradient was lower with CoreValve than Lotus (valve area, mean [SD]: Lotus, 1.53 [0.49] cm2 vs CoreValve, 1.76 [0.51] cm2; P < .01; valve gradient, mean [SD]: Lotus, 13.0 [6.7] mm Hg vs 8.1 [3.7] mm Hg; P < .01). Moderate or greater PVL was more frequent with CoreValve (0.3% Lotus vs 3.8% CoreValve; P < .01) at 2 years. Larger improvements in New York Heart Association (NYHA) functional class were observed with Lotus compared with CoreValve (improved by ≥1 NYHA class: Lotus, 338 of 402 [84.1%] vs CoreValve, 143 of 189 [75.7%]; P = .01; improved by ≥2 NYHA classes: 122 of 402 [37.3%] vs 65 of 305 [21.3%]). Conclusions and Relevance After 2 years, all-cause mortality rates, mortality or disabling stroke were similar between Lotus and CoreValve. Disabling stroke, functional class, valve migration, and PVL favored the Lotus arm whereas valve hemodynamics, thrombosis, and new pacemaker implantation favored the CoreValve arm. Trial Registration clinicaltrials.gov Identifier: NCT02202434.
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Affiliation(s)
- Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Ted E Feldman
- Evanston Hospital Cardiology Division, Northshore University Health System, Evanston, Illinois
| | | | - Raj R Makkar
- Cedars-Sinai Heart Institute, Los Angeles, California
| | - Daniel O'Hair
- Aurora St Luke's Medical Center, Milwaukee, Wisconsin
| | - Axel Linke
- Heart Center Dresde, Dresden University Hospital, Dresden, Germany
| | - Dean J Kereiakes
- The Lindner Research Center, The Christ Hospital Heart and Vascular Center, Cincinnati, Ohio
| | | | | | | | | | - David G Rizik
- HonorHealth, Scottsdale-Lincoln Health Network, Scottsdale, Arizona
| | - Vijay S Iyer
- Gates Vascular Institute, University at Buffalo, Buffalo, New York
| | - Thomas G Gleason
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Didier Tchétché
- Department of Internal Medicine/Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Joshua D Rovin
- Morton Plant Mease Healthcare System, Clearwater, Florida
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15
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Meduri CU, Kereiakes DJ, Rajagopal V, Makkar RR, O'Hair D, Linke A, Waksman R, Babliaros V, Stoler RC, Mishkel GJ, Rizik DG, Iyer VS, Schindler J, Allocco DJ, Meredith IT, Feldman TE, Reardon MJ. Pacemaker Implantation and Dependency After Transcatheter Aortic Valve Replacement in the REPRISE III Trial. J Am Heart Assoc 2019; 8:e012594. [PMID: 31640455 PMCID: PMC6898843 DOI: 10.1161/jaha.119.012594] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background As transcatheter aortic valve replacement expands to younger and/or lower risk patients, the long‐term consequences of permanent pacemaker implantation are a concern. Pacemaker dependency and impact have not been methodically assessed in transcatheter aortic valve replacement trials. We report the incidence and predictors of pacemaker implantation and pacemaker dependency after transcatheter aortic valve replacement with the Lotus valve. Methods and Results A total of 912 patients with high/extreme surgical risk and symptomatic aortic stenosis were randomized 2:1 (Lotus:CoreValve) in REPRISE III (The Repositionable Percutaneous Replacement of Stenotic Aortic Valve through Implantation of Lotus Valve System—Randomized Clinical Evaluation) trial. Systematic assessment of pacemaker dependency was pre‐specified in the trial design. Pacemaker implantation within 30 days was more frequent with Lotus than CoreValve. By multivariable analysis, predictors of pacemaker implantation included baseline right bundle branch block and depth of implantation; diabetes mellitus was also a predictor with Lotus. No association between new pacemaker implantation and clinical outcomes was found. Pacemaker dependency was dynamic (30 days: 43%; 1 year: 50%) and not consistent for individual patients over time. Predictors of pacemaker dependency at 30 days included baseline right bundle branch block, female sex, and depth of implantation. No differences in mortality or stroke were found between patients who were pacemaker dependent or not at 30 days. Rehospitalization was higher in patients who were not pacemaker dependent versus patients without a pacemaker or those who were dependent. Conclusions Pacemaker implantation was not associated with adverse clinical outcomes. Most patients with a new pacemaker at 30 days were not dependent at 1 year. Mortality and stroke were similar between patients with or without pacemaker dependency and patients without a pacemaker. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier NCT02202434.
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Affiliation(s)
| | - Dean J Kereiakes
- The Christ Hospital Heart and Vascular Center The Lindner Research Center Cincinnati OH
| | | | | | | | - Axel Linke
- Dresden University Hospital, Heart Center Dresden Germany
| | | | | | | | | | - David G Rizik
- HonorHealth and the Scottsdale-Lincoln Health Network Scottsdale AZ
| | - Vijay S Iyer
- University at Buffalo/Gates Vascular Institute Buffalo NY
| | | | | | | | - Ted E Feldman
- Edwards Lifesciences Irvine California.,Northshore University Health System Evanston Hospital Evanston Illinois
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16
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Roberts CS, Milligan GP, Stoler RC, Grayburn PA, Roberts WC. Mitral stenosis produced by infective endocarditis involving a previously anatomically normal valve. Proc (Bayl Univ Med Cent) 2019; 32:387-389. [PMID: 31384194 DOI: 10.1080/08998280.2019.1617011] [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: 05/01/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022] Open
Abstract
Described herein is a 63-year-old man who developed methicillin-sensitive Staphylococcus aureus endocarditis on a previously anatomically normal mitral valve. The resulting vegetations were so large that severe mitral stenosis resulted. The development of valve stenosis due exclusively to infective endocarditis is extremely rare.
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Affiliation(s)
- Charles S Roberts
- Department of Cardiac Surgery, Baylor University Medical Center and the Baylor Scott & White Heart and Vascular HospitalDallasTexas
| | - Gregory P Milligan
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center and the Baylor Scott & White Heart and Vascular HospitalDallasTexas
| | - Robert C Stoler
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center and the Baylor Scott & White Heart and Vascular HospitalDallasTexas
| | - Paul A Grayburn
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center and the Baylor Scott & White Heart and Vascular HospitalDallasTexas
| | - William C Roberts
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center and the Baylor Scott & White Heart and Vascular HospitalDallasTexas
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17
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Vasudevan A, Choi JW, Feghali GA, Kluger AY, Lander SR, Tecson KM, Sathyamoorthy M, Schussler JM, Stoler RC, Vallabhan RC, Velasco CE, Yoon A, McCullough PA. First and recurrent events after percutaneous coronary intervention: implications for survival analyses. SCAND CARDIOVASC J 2019; 53:299-304. [PMID: 31315473 DOI: 10.1080/14017431.2019.1645349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives. Using composite endpoints and/or only first events in clinical research result in information loss and alternative statistical methods which incorporate recurrent event data exist. We compared information-loss under traditional analyses to alternative models. Design. We conducted a retrospective analysis of patients who underwent percutaneous coronary intervention (Jan2010-Dec2014) and constructed Cox models for a composite endpoint (readmission/death), a shared frailty model for recurrent events, and a joint frailty (JF) model to simultaneously account for recurrent and terminal events and evaluated the impact of heart failure (HF) on the outcome. Results. Among 4901 patients, 2047(41.8%) experienced a readmission or death within 1 year. Of those with recurrent events, 60% had ≥1 readmission and 6% had >4; a total of 121(2.5%) patients died during follow-up. The presence of HF conferred an adjusted Hazard ratio (HR) of 1.32 (95% CI: 1.18-1.47, p < .001) for the risk of composite endpoint (Cox model), 1.44 (95% CI: 1.36-1.52, p < .001) in the frailty model, and 1.34 (95% CI:1.22-1.46, p < .001) in the JF model. However, HF was not associated with death (HR 0.87, 95% CI: 0.52-1.48, p = .61) in the JF model. Conclusions. Using a composite endpoint and/or only the first event yields substantial loss of information, as many individuals endure >1 event. JF models reduce bias by simultaneously providing event-specific HRs for recurrent and terminal events.
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Affiliation(s)
- Anupama Vasudevan
- Baylor Scott & White Research Institute, Dallas, TX, USA.,Texas A&M Health Science Center College of Medicine, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA
| | - James W Choi
- Texas A&M Health Science Center College of Medicine, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA.,Baylor University Medical Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
| | - Georges A Feghali
- Texas A&M Health Science Center College of Medicine, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA.,Baylor University Medical Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
| | - Aaron Y Kluger
- Baylor Scott & White Research Institute, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA
| | - Stuart R Lander
- Texas A&M Health Science Center College of Medicine, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA.,Baylor University Medical Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
| | - Kristen M Tecson
- Baylor Scott & White Research Institute, Dallas, TX, USA.,Texas A&M Health Science Center College of Medicine, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA
| | - Mohanakrishnan Sathyamoorthy
- Baylor Heart and Vascular Institute, Dallas, TX, USA.,Baylor University Medical Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
| | - Jeffrey M Schussler
- Texas A&M Health Science Center College of Medicine, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA.,Baylor University Medical Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
| | - Robert C Stoler
- Texas A&M Health Science Center College of Medicine, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA.,Baylor University Medical Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
| | - Ravi C Vallabhan
- Texas A&M Health Science Center College of Medicine, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA.,Baylor University Medical Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
| | - Carlos E Velasco
- Texas A&M Health Science Center College of Medicine, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA.,Baylor University Medical Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
| | - Anthony Yoon
- Texas A&M Health Science Center College of Medicine, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA.,Baylor University Medical Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
| | - Peter A McCullough
- Texas A&M Health Science Center College of Medicine, Dallas, TX, USA.,Baylor Heart and Vascular Institute, Dallas, TX, USA.,Baylor University Medical Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
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18
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Kleiman NS, Popma JJ, Chetcuti SJ, Serruys PW, Van Mieghem NM, Stoler RC, Harrison JK, Brecker SJ. 600.04 Coronary Intervention After Self-Expanding Transcatheter or Surgical Aortic Valve Replacement in the SURTAVI Trial. JACC Cardiovasc Interv 2019. [DOI: 10.1016/j.jcin.2019.01.156] [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: 11/16/2022]
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19
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Vasudevan A, Choi JW, Feghali GA, Lander SR, Jialiang L, Schussler JM, Stoler RC, Vallabhan RC, Velasco CE, McCullough PA. Event dependence in the analysis of cardiovascular readmissions postpercutaneous coronary intervention. J Investig Med 2019; 67:943-949. [PMID: 30659091 DOI: 10.1136/jim-2018-000873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2018] [Indexed: 11/04/2022]
Abstract
Recurrent hospitalizations are common in longitudinal studies; however, many forms of cumulative event analyses assume recurrent events are independent. We explore the presence of event dependence when readmissions are spaced apart by at least 30 and 60 days. We set up a comparative framework with the assumption that patients with emergency percutaneous coronary intervention (PCI) will be at higher risk for recurrent cardiovascular readmissions than those with elective procedures. A retrospective study of patients who underwent PCI (January 2008-December 2012) with their follow-up information obtained from a regional database for hospitalization was conducted. Conditional gap time (CG), frailty gamma (FG) and conditional frailty models (CFM) were constructed to evaluate the dependence of events. Relative bias (%RB) in point estimates using CFM as the reference was calculated for comparison of the models. Among 4380 patients, emergent cases were at higher risk as compared with elective cases for recurrent events in different statistical models and time-spaced data sets, but the magnitude of HRs varied across the models (adjusted HR [95% CI]: all readmissions [unstructured data]-CG 1.16 [1.09 to 1.22], FG 1.45 [1.33 to 1.57], CFM 1.24 [1.16 to 1.32]; 30-day spaced-CG1.14 [1.08 to 1.21], FG 1.28 [1.17 to 1.39], CFM 1.17 [1.10 to 1.26]; and 60-day spaced-CG 1.14 [1.07 to 1.22], FG 1.23 [1.13 to 1.34] CFM 1.18 [1.09 to 1.26]). For all of the time-spaced readmissions, we found that the values of %RB were closer to the conditional models, suggesting that event dependence dominated the data despite attempts to create independence by increasing the space in time between admissions. Our analysis showed that independent of the intercurrent event duration, prior events have an influence on future events. Hence, event dependence should be accounted for when analyzing recurrent events and challenges contemporary methods for such analysis.
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Affiliation(s)
- Anupama Vasudevan
- Department of Cardiology, Baylor Scott & White Research Institute, Plano, Texas, USA
| | - James W Choi
- Baylor Heart and Vascular Institute, Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - Georges A Feghali
- Baylor Heart and Vascular Institute, Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - Stuart R Lander
- Baylor Heart and Vascular Institute, Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - Li Jialiang
- National University of Singapore Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Jeffrey M Schussler
- Baylor Heart and Vascular Institute, Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - Robert C Stoler
- Baylor Heart and Vascular Institute, Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - Ravi C Vallabhan
- Baylor Heart and Vascular Institute, Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - Carlos E Velasco
- Baylor Heart and Vascular Institute, Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - Peter A McCullough
- Baylor Heart and Vascular Institute, Baylor University Medical Center at Dallas, Dallas, Texas, USA
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20
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Grayburn PA, Oh JK, Reardon MJ, Popma JJ, Deeb GM, Boulware M, Huang J, Stoler RC. Effect of Baseline Aortic Regurgitation on Mortality in Patients Treated With Transcatheter or Surgical Aortic Valve Replacement (from the CoreValve US Pivotal Trial). Am J Cardiol 2018; 122:1527-1535. [PMID: 30172363 DOI: 10.1016/j.amjcard.2018.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/09/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
This study was performed to determine if baseline aortic regurgitation (AR) affects the deleterious effects of postprocedure paravalvular leak following transcatheter aortic valve implantation (TAVI). We evaluated the effect of baseline AR on mortality in a large cohort of patients randomized to transcatheter or surgical aortic valve replacement (SAVR). The analysis cohort comprised 739 patients who underwent attempted TAVI (n = 386) or SAVR (n = 353) in the CoreValve US Pivotal High Risk Trial and had baseline AR measurements. Patients were stratified by the severity of baseline AR into those with none and/or trace and those with ≥mild AR. Echocardiographic measurements were assessed by an independent core laboratory. Of the 386 TAVI patients, 204 (52.9%) had none and/or trace at baseline AR; 182 (47.2%) had ≥mild AR. Of the 353 SAVR patients, 169 (47.9%) had none and/or trace and 184 (52.1%) ≥mild AR. The presence of ≥mild baseline AR was associated with lower all-cause mortality at 1 year following TAVI (9.4% vs 18.6%, p = 0.008) or SAVR (13.3% vs 24.4%, p = 0.009). Mortality remained lower in the ≥mild baseline AR patients at 3 years after SAVR (p = 0.011), but not TAVI. In conclusion, baseline AR appears to provide a protective effect on survival and quality of life in both TAVI and SAVR patients at 1 year; this effect persists out to 3 years in SAVR patients.
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21
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Ball TN, Vasudevan A, Mi Ko J, Assar MD, McCullough PA, Stoler RC. Analysis of electrocardiographic intervals before and after transcatheter aortic valve implantation to predict the need for permanent pacing. Proc (Bayl Univ Med Cent) 2018; 31:407-413. [PMID: 30948968 DOI: 10.1080/08998280.2018.1471884] [Citation(s) in RCA: 2] [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: 02/07/2018] [Revised: 04/23/2018] [Accepted: 04/30/2018] [Indexed: 10/28/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is growing in utilization in the USA, and atrioventricular heart block is a common complication of the procedure. In patients with conduction system changes following TAVI, there are no clear guidelines for permanent pacing, leading to difficult clinical decisions on how long to leave temporary transvenous pacemakers in place. The aim of our study was to determine whether changes in electrocardiogram characteristics could predict the need for permanent pacing. A retrospective analysis was conducted of 209 consecutive TAVI patients seen from January 2012 to December 2015 at Baylor Heart and Vascular Hospital, Dallas. The baseline characteristics were similar between those who received a permanent pacemaker (PPM) within 7 days of the procedure (21.1%) and those who did not (78.9%); of those who did receive a PPM, 79.5% were implanted for complete heart block. The median (range) percentage change in the sum of QRS and PR was significantly higher in those who received a PPM (20.2%) than those who did not (7.1%) (P = 0.004). Using the percentage change in the sum of QRS and PR to predict PPM, the area under the curve was found to be 0.69. The optimal cutpoint was found to be 18.9% (sensitivity = 0.63, specificity = 0.73). Our study suggests that delay in the conduction system immediately following TAVI predicts the need for permanent pacing.
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Affiliation(s)
- Timothy N Ball
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Baylor Heart and Vascular Institute, and Baylor Jack and Jane Hamilton Heart and Vascular HospitalDallas Texas
| | - Anupama Vasudevan
- Baylor Scott & White Research InstituteDallas Texas.,Division of Cardiology, Texas A&M Health Science Center College of Medicine, Dallas CampusDallas Texas
| | - Jong Mi Ko
- Baylor Scott & White Research InstituteDallas Texas
| | - Manish D Assar
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Baylor Heart and Vascular Institute, and Baylor Jack and Jane Hamilton Heart and Vascular HospitalDallas Texas
| | - Peter A McCullough
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Baylor Heart and Vascular Institute, and Baylor Jack and Jane Hamilton Heart and Vascular HospitalDallas Texas.,Division of Cardiology, Texas A&M Health Science Center College of Medicine, Dallas CampusDallas Texas
| | - Robert C Stoler
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Baylor Heart and Vascular Institute, and Baylor Jack and Jane Hamilton Heart and Vascular HospitalDallas Texas.,Division of Cardiology, Texas A&M Health Science Center College of Medicine, Dallas CampusDallas Texas
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22
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Tecson KM, Brown D, Choi JW, Feghali G, Gonzalez-Stawinski GV, Hamman BL, Hebeler R, Lander SR, Lima B, Potluri S, Schussler JM, Stoler RC, Velasco C, McCullough PA. Major Adverse Renal and Cardiac Events After Coronary Angiography and Cardiac Surgery. Ann Thorac Surg 2018; 105:1724-1730. [DOI: 10.1016/j.athoracsur.2018.01.010] [Citation(s) in RCA: 6] [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: 10/26/2017] [Revised: 12/13/2017] [Accepted: 01/03/2018] [Indexed: 02/04/2023]
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23
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Barbin CM, Vasudevan A, Choi JW, McCullough PA, Schussler JM, Vallabhan RC, Stoler RC. Frequency of abnormal fractional flow reserve measurements among major coronary arteries. Cardiovasc Revasc Med 2018; 20:143-146. [PMID: 29807815 DOI: 10.1016/j.carrev.2018.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/18/2018] [Revised: 03/28/2018] [Accepted: 04/12/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Fractional flow reserve(FFR) is a validated tool for evaluating functional severity and guiding the revascularization of angiographically moderate coronary artery lesions. OBJECTIVE To study if there is a higher frequency of positive FFR measurements in the left anterior descending(LAD) versus other major coronary arteries and also evaluate the differences in the total length of the stent placed. METHODS A retrospective cohort study including all subjects (January 2011 to December 2015) who had fractional flow reserve (FFR) measured during coronary catheterization was conducted. Coronary catheterizations with FFR at a single tertiary care center were reviewed and FFR ≤ 0.80 post adenosine was deemed positive. The differences in the baseline characteristics and the degree of stenosis were compared between the different vessel groups. RESULTS Of the 758 vessels included in the analysis, the majority were LAD(51.3%) followed by right coronary artery(RCA)(22.8%), Circumflex(22.2%), Left main(2.2%), and Ramus intermedius(1.5%). 25.1% of 758 vessels were FFR positive. The proportion of positive FFR were higher among LAD versus other vessels(33.2%vs.16.5%,p < 0.001), while no differences were noted between RCA and circumflex(p = 0.87) or other vessels excluding LAD(p = 0.69). Of 175 patients who received stents, no statistical difference was noted in the median[range] total length of the stent between LAD(22[9-64]) and the other coronary arteries (18[8-42])(p = 0.19). In patients with an FFR <0.75, we found that the stent length(median [range]) was significantly longer in LAD(28[9-42]) than the other coronary arteries(18[8-42])(p = 0.03). CONCLUSION In our study, FFR was almost twice as likely to be positive in the LAD when compared to other major coronary arteries. Furthermore, there was a trend towards FFR positive LAD lesions needing longer stents than other coronary arteries. This data should encourage operators to evaluate moderate, long lesions in the LAD with FFR, as they have a higher probability of functional significance.
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Affiliation(s)
- Clay M Barbin
- Department of Internal Medicine, Cardiology Division, Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, United States.
| | - Anupama Vasudevan
- Baylor Scott & White Research Institute, Dallas, TX, United States; Texas A&M Health Science Center College of Medicine, Dallas Campus, Dallas, TX, United States.
| | - James W Choi
- Department of Internal Medicine, Cardiology Division, Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, United States; Texas A&M Health Science Center College of Medicine, Dallas Campus, Dallas, TX, United States.
| | - Peter A McCullough
- Department of Internal Medicine, Cardiology Division, Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, United States; Texas A&M Health Science Center College of Medicine, Dallas Campus, Dallas, TX, United States
| | - Jeffrey M Schussler
- Department of Internal Medicine, Cardiology Division, Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, United States; Texas A&M Health Science Center College of Medicine, Dallas Campus, Dallas, TX, United States.
| | - Ravi C Vallabhan
- Department of Internal Medicine, Cardiology Division, Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, United States; Texas A&M Health Science Center College of Medicine, Dallas Campus, Dallas, TX, United States.
| | - Robert C Stoler
- Department of Internal Medicine, Cardiology Division, Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, United States; Texas A&M Health Science Center College of Medicine, Dallas Campus, Dallas, TX, United States.
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24
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Abstract
Out-of-hospital cardiac arrest (OHCA) is a major cause of mortality that is responsible for over 300,000 deaths in the United States each year. Underlying cardiac etiologies remain the most common culprit. Despite medical advances in the treatment of coronary artery disease, the mortality following OHCA remains dismal. Additionally, of those who survive the initial event, many are left with debilitating and irreversible anoxic brain injuries. Therefore, improving survival as well as neurologic outcome is of primary importance in this group. Our goal was to evaluate the underlying etiologies, neurologic outcomes, and cardiac interventions being performed in patients with OHCA presenting to our large tertiary care center. We retrospectively reviewed 181 charts of patients presenting to our emergency department over a 1-year time period with a diagnosis of OHCA. Following exclusion criteria, 130 patients remained, with 17 of those surviving to hospital admission. Of the 17 initial survivors, only 9 survived to hospital discharge and only 6 of those obtained good neurologic outcomes. Additionally, there was no mortality benefit in the 4 patients who had coronary angiography or percutaneous intervention.
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Affiliation(s)
- Charles E Howard
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - John S Garrett
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
| | - Robert C Stoler
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas.,Department of Cardiology, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Jeffrey M Schussler
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas.,Department of Cardiology, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas.,Texas A&M College of Medicine, Dallas, Texas
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25
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Feldman TE, Reardon MJ, Rajagopal V, Makkar RR, Bajwa TK, Kleiman NS, Linke A, Kereiakes DJ, Waksman R, Thourani VH, Stoler RC, Mishkel GJ, Rizik DG, Iyer VS, Gleason TG, Tchétché D, Rovin JD, Buchbinder M, Meredith IT, Götberg M, Bjursten H, Meduri C, Salinger MH, Allocco DJ, Dawkins KD. Effect of Mechanically Expanded vs Self-Expanding Transcatheter Aortic Valve Replacement on Mortality and Major Adverse Clinical Events in High-Risk Patients With Aortic Stenosis: The REPRISE III Randomized Clinical Trial. JAMA 2018; 319:27-37. [PMID: 29297076 PMCID: PMC5833545 DOI: 10.1001/jama.2017.19132] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Transcatheter aortic valve replacement (TAVR) is established for selected patients with severe aortic stenosis. However, limitations such as suboptimal deployment, conduction disturbances, and paravalvular leak occur. OBJECTIVE To evaluate if a mechanically expanded valve (MEV) is noninferior to an approved self-expanding valve (SEV) in high-risk patients with aortic stenosis undergoing TAVR. DESIGN, SETTING, AND PARTICIPANTS The REPRISE III trial was conducted in 912 patients with high or extreme risk and severe, symptomatic aortic stenosis at 55 centers in North America, Europe, and Australia between September 22, 2014, and December 24, 2015, with final follow-up on March 8, 2017. INTERVENTIONS Participants were randomized in a 2:1 ratio to receive either an MEV (n = 607) or an SEV (n = 305). MAIN OUTCOMES AND MEASURES The primary safety end point was the 30-day composite of all-cause mortality, stroke, life-threatening or major bleeding, stage 2/3 acute kidney injury, and major vascular complications tested for noninferiority (margin, 10.5%). The primary effectiveness end point was the 1-year composite of all-cause mortality, disabling stroke, and moderate or greater paravalvular leak tested for noninferiority (margin, 9.5%). If noninferiority criteria were met, the secondary end point of 1-year moderate or greater paravalvular leak was tested for superiority in the full analysis data set. RESULTS Among 912 randomized patients (mean age, 82.8 [SD, 7.3] years; 463 [51%] women; predicted risk of mortality, 6.8%), 874 (96%) were evaluable at 1 year. The primary safety composite end point at 30 days occurred in 20.3% of MEV patients and 17.2% of SEV patients (difference, 3.1%; Farrington-Manning 97.5% CI, -∞ to 8.3%; P = .003 for noninferiority). At 1 year, the primary effectiveness composite end point occurred in 15.4% with the MEV and 25.5% with the SEV (difference, -10.1%; Farrington-Manning 97.5% CI, -∞ to -4.4%; P<.001 for noninferiority). The 1-year rates of moderate or severe paravalvular leak were 0.9% for the MEV and 6.8% for the SEV (difference, -6.1%; 95% CI, -9.6% to -2.6%; P < .001). The superiority analysis for primary effectiveness was statistically significant (difference, -10.2%; 95% CI, -16.3% to -4.0%; P < .001). The MEV had higher rates of new pacemaker implants (35.5% vs 19.6%; P < .001) and valve thrombosis (1.5% vs 0%) but lower rates of repeat procedures (0.2% vs 2.0%), valve-in-valve deployments (0% vs 3.7%), and valve malpositioning (0% vs 2.7%). CONCLUSIONS AND RELEVANCE Among high-risk patients with aortic stenosis, use of the MEV compared with the SEV did not result in inferior outcomes for the primary safety end point or the primary effectiveness end point. These findings suggest that the MEV may be a useful addition for TAVR in high-risk patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02202434.
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Affiliation(s)
- Ted E Feldman
- Evanston Hospital Cardiology Division, Northshore University Health System, Evanston, Illinois
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | | | - Raj R Makkar
- Cedars-Sinai Heart Institute, Los Angeles, California
| | | | - Neal S Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Axel Linke
- University of Leipzig, Heart Center and Leipzig Heart Institute, Leipzig, Germany
| | - Dean J Kereiakes
- Christ Hospital Heart and Vascular Center/Lindner Research Center, Cincinnati, Ohio
| | | | | | | | | | - David G Rizik
- HonorHealth and the Scottsdale-Lincoln Health Network, Scottsdale, Arizona
| | - Vijay S Iyer
- University at Buffalo/Gates Vascular Institute, Buffalo, New York
| | - Thomas G Gleason
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Joshua D Rovin
- Morton Plant Mease Healthcare System, Clearwater, Florida
| | - Maurice Buchbinder
- Foundation for Cardiovascular Medicine, Stanford University, Stanford, California
| | | | - Matthias Götberg
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Henrik Bjursten
- Department of Cardiothoracic Surgery, Clinical Sciences, Lund University, Skåne University University Hospital, Lund, Sweden
| | | | - Michael H Salinger
- Evanston Hospital Cardiology Division, Northshore University Health System, Evanston, Illinois
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Sannino A, Cedars A, Stoler RC, Szerlip M, Mack MJ, Grayburn PA. Comparison of Efficacy and Safety of Transcatheter Aortic Valve Implantation in Patients With Bicuspid Versus Tricuspid Aortic Valves. Am J Cardiol 2017; 120:1601-1606. [PMID: 28886853 DOI: 10.1016/j.amjcard.2017.07.053] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/03/2017] [Accepted: 07/10/2017] [Indexed: 01/10/2023]
Abstract
Bicuspid aortic valve (BAV) stenosis has been considered a contraindication to transcatheter aortic valve implantation (TAVI). The aim of this study is to compare the efficacy and safety of TAVI in patients with BAV with those with tricuspid aortic valve (TAV) using balloon-expandable and self-expanding transcatheter heart valves. This retrospective study included 823 consecutive patients with severe, symptomatic aortic valve stenosis undergoing TAVI in 2 institutions, Baylor Heart and Vascular Hospital (Dallas, TX) and The Heart Hospital Baylor Plano (Plano, TX), from January 2012 to February 2016. Efficacy was evaluated by postprocedural valve function as mean gradient, peak velocity, effective orifice area, and ≥moderate paravalvular leak. Safety end points included all-cause 30-day and 1-year mortality, immediate postprocedural mortality and 30-day cardiovascular mortality, procedural success, pacemaker implantation, and procedural complications. Of the 823 included patients, 735 had TAV and 77 had BAV. Baseline characteristics were similar between the 2 groups. Procedural success was high in both BAV and TAV (98.7% vs 99.1%, p = ns). There were no significant differences between groups in valve hemodynamics after TAVI, pacemaker implantation rate, or procedural complications. There were no differences regarding immediate postprocedural mortality (BAV vs TAV, 1.1% vs 0.8%, p = ns), nor 30-day cardiovascular mortality (3.4% vs 2.3%, p = ns). All-cause mortality at 30 days (3.4% vs 3.1%, p = ns) and 1-year (8.5% vs 10.5%) were similar. Patients with BAV showed similar procedural and clinical outcomes to patients with TAV. Therefore, TAVI appears to be a safe and effective procedure for patients with BAVs as well as those with TAVs.
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Sannino A, Stoler RC, Hebeler RF, Szerlip M, Mack MJ, Grayburn PA. Clinical Relevance of Baseline TCP in Transcatheter Aortic Valve Replacement. J Invasive Cardiol 2017; 29:353-358. [PMID: 28974661] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIMS To investigate the influence of baseline thrombocytopenia (TCP) on short-term and long-term outcomes after transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS A total of 732 consecutive patients with severe, symptomatic aortic stenosis undergoing TAVR from January 2012 to December 2015 were included. Primary outcomes of interest were the relationship of baseline TCP with 30-day and 1-year all-cause mortality. Secondary outcomes of interest were procedural complications and in-hospital mortality in the same subgroups. The prevalence of TCP (defined as platelet count <150 × 109/L) at baseline was 21.9%, of whom 4.0% had moderate/severe TCP (defined as platelet count <100 × 109/L). Compared to no or mild TCP, moderate/severe TCP at baseline was associated with a significantly higher 30-day mortality (23.3% vs 2.3% and 3.1%, respectively; P<.001) and 1-year mortality (40.0% vs 8.3% and 13.4%, respectively; P<.001). In Cox regression analysis, moderate/severe baseline TCP was an independent predictor of 30-day and 1-year mortality (hazard ratio [HR], 13.18; 95% confidence interval [CI], 4.49-38.64; P<.001 and HR, 5.90; 95% CI, 2.68-13.02; P<.001, respectively). CONCLUSIONS In conclusion, baseline TCP is a strong predictor of mortality in TAVR patients, possibly identifying a specific subgroup of frail patients; therefore, it should be taken into account when addressing TAVR risk.
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Affiliation(s)
| | | | | | | | | | - Paul A Grayburn
- Baylor University Medical Center, Baylor Heart and Vascular Hospital and the Heart Hospital Baylor Plano, 621 N. Hall Street, Suite H030, Dallas, TX 75226 USA.
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Grayburn PA, Stoler RC, Mack MJ. The 2017 ACC/AHA Updated Valve Guidelines Regarding Mitral Regurgitation: The Guidelines Get it Right. Structural Heart 2017. [DOI: 10.1080/24748706.2017.1326648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Paul A. Grayburn
- Baylor Scott and White Healthcare System, Baylor University Medical Center, Baylor Heart and Vascular Hospital, Dallas, TX, USA
- The Heart Hospital Baylor Plano, Plano, TX, USA
| | - Robert C. Stoler
- Baylor Scott and White Healthcare System, Baylor University Medical Center, Baylor Heart and Vascular Hospital, Dallas, TX, USA
- The Heart Hospital Baylor Plano, Plano, TX, USA
| | - Michael J. Mack
- Baylor Scott and White Healthcare System, Baylor University Medical Center, Baylor Heart and Vascular Hospital, Dallas, TX, USA
- The Heart Hospital Baylor Plano, Plano, TX, USA
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O’Hair DP, Bajwa TK, Chetcuti SJ, Deeb GM, Stoler RC, Hebeler RF, Maini B, Mumtaz M, Kleiman NS, Reardon MJ, Li S, Adams DH, Watson DR, Yakubov SJ, Popma JJ, Petrossian G. One-Year Outcomes of Transcatheter Aortic Valve Replacement in Patients With End-Stage Renal Disease. Ann Thorac Surg 2017; 103:1392-1398. [DOI: 10.1016/j.athoracsur.2016.11.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/29/2016] [Accepted: 11/21/2016] [Indexed: 11/28/2022]
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Roberts WC, Grayburn PA, Guileyardo JM, Stoler RC. Full Development of Consequences of Congenital Pulmonic Stenosis in Eighty-Four Years. Am J Cardiol 2017; 119:1284-1287. [PMID: 28256252 DOI: 10.1016/j.amjcard.2016.11.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 11/29/2016] [Accepted: 11/29/2016] [Indexed: 11/29/2022]
Abstract
Described herein is an 84-year-old woman, the oldest reported, with severe pulmonic stenosis who underwent a highly successful pulmonic valvotomy at age 77 and highly unsuccessfully attempted percutaneous pulmonic valve implantation at age 84. During the 84 years she developed nearly all clinical and morphologic consequences of pulmonic stenosis, including heavy calcification of the pulmonic valve, heavy calcification of the tricuspid valve annulus, severe right ventricular wall thickening without ventricular cavity dilation, aneurysm of the pulmonary truck, multiple focal ventricular wall scars without narrowing of the epicardial coronary arteries, wall thickening and luminal narrowing of the intramural coronary arteries, and extremely low 12-lead QRS electrocardiographic voltage.
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Affiliation(s)
- William C Roberts
- Baylor Heart and Vascular Institute, the Departments of Internal Medicine (Division of Cardiology) and Pathology, Baylor University Medical Center, Dallas, Texas.
| | - Paul A Grayburn
- Baylor Heart and Vascular Institute, the Departments of Internal Medicine (Division of Cardiology) and Pathology, Baylor University Medical Center, Dallas, Texas
| | - Joseph M Guileyardo
- Baylor Heart and Vascular Institute, the Departments of Internal Medicine (Division of Cardiology) and Pathology, Baylor University Medical Center, Dallas, Texas
| | - Robert C Stoler
- Baylor Heart and Vascular Institute, the Departments of Internal Medicine (Division of Cardiology) and Pathology, Baylor University Medical Center, Dallas, Texas
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Stoler RC, Oh JK, Reardon M, Adams D, Popma J, Kliger C, Brinster D, Grayburn P. EFFECT OF BASELINE AORTIC REGURGITATION ON MORTALITY IN THE CORE VALVE US PIVOTAL HIGH RISK TRIAL. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35315-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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32
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Muller DW, Farivar RS, Jansz P, Bae R, Walters D, Clarke A, Grayburn PA, Stoler RC, Dahle G, Rein KA, Shaw M, Scalia GM, Guerrero M, Pearson P, Kapadia S, Gillinov M, Pichard A, Corso P, Popma J, Chuang M, Blanke P, Leipsic J, Sorajja P, Muller D, Jansz P, Shaw M, Conellan M, Spina R, Pedersen W, Sorajja P, Farivar RS, Bae R, Sun B, Walters D, Clarke A, Scalia G, Grayburn P, Stoler R, Hebeler R, Dahle G, Rein KA, Fiane A, Guerrero M, Pearson P, Feldman T, Salinger M, Smart S, Kapadia S, Gillinov M, Mick S, Krishnaswamy A, Pichard A, Corso P, Chuang M, Popma J, Leipsic J, Blanke P, Carroll J, George I, Missov E, Kiser A. Transcatheter Mitral Valve Replacement for Patients With Symptomatic Mitral Regurgitation. J Am Coll Cardiol 2017; 69:381-391. [DOI: 10.1016/j.jacc.2016.10.068] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 10/14/2016] [Accepted: 10/18/2016] [Indexed: 11/15/2022]
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Patankar GR, Grayburn PA, Hebeler RF, Henry AC, Stoler RC. Avulsion of Aortic Leaflet During Transcatheter Aortic Valve Replacement. J Interv Cardiol 2016; 29:549-551. [PMID: 27534597 DOI: 10.1111/joic.12313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Gautam R Patankar
- Department of Cardiology, Baylor University Medical Center, Dallas, Texas
| | - Paul A Grayburn
- Department of Cardiology, Baylor University Medical Center, Dallas, Texas
| | - Robert F Hebeler
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas.
| | - Albert C Henry
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas
| | - Robert C Stoler
- Department of Cardiology, Baylor University Medical Center, Dallas, Texas
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Velasco CE, Patel M, Mogollon J, Grodin JM, Stoler RC. Myocardial Infarction Related to Trauma. Rev Cardiovasc Med 2015; 16:261-4. [DOI: 10.3909/ricm0795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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35
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Falcone AM, Varghese JJ, Stoler RC, Choi JW. Effectiveness of Balloon Valvuloplasty for Stenosis of a Bioprosthesis in the Tricuspid Valve Position. Proc (Bayl Univ Med Cent) 2015; 28:502-3. [DOI: 10.1080/08998280.2015.11929323] [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: 10/18/2022] Open
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36
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Reinhold SM, Lima B, Khalid A, Gonzalez-Stawinski GV, Stoler RC, Hall SA, Chamogeorgakis T. Heart transplantation in the Ehlers-Danlos syndrome. Proc AMIA Symp 2015; 28:492-3. [PMID: 26424951 DOI: 10.1080/08998280.2015.11929319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We describe a woman with Ehlers-Danlos syndrome and aortic aneurysm who experienced a myocardial infarction due to spontaneous left circumflex coronary artery dissection 3 weeks postpartum. She developed end-stage heart failure and subsequently underwent a successful orthotopic heart transplantation. To our knowledge, this is the first report of a heart transplant performed in an individual with Ehlers-Danlos syndrome.
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Affiliation(s)
- Stephanie M Reinhold
- Texas A&M Health Science Center College of Medicine (Reinhold); the Division of Cardiology (Khalid, Stoler, Hall) and the Department of Cardiovascular and Thoracic Surgery (Lima, Gonzalez-Stawinski, Chamogeorgakis), Baylor University Medical Center at Dallas and the Baylor Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Brian Lima
- Texas A&M Health Science Center College of Medicine (Reinhold); the Division of Cardiology (Khalid, Stoler, Hall) and the Department of Cardiovascular and Thoracic Surgery (Lima, Gonzalez-Stawinski, Chamogeorgakis), Baylor University Medical Center at Dallas and the Baylor Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Adnan Khalid
- Texas A&M Health Science Center College of Medicine (Reinhold); the Division of Cardiology (Khalid, Stoler, Hall) and the Department of Cardiovascular and Thoracic Surgery (Lima, Gonzalez-Stawinski, Chamogeorgakis), Baylor University Medical Center at Dallas and the Baylor Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Gonzalo V Gonzalez-Stawinski
- Texas A&M Health Science Center College of Medicine (Reinhold); the Division of Cardiology (Khalid, Stoler, Hall) and the Department of Cardiovascular and Thoracic Surgery (Lima, Gonzalez-Stawinski, Chamogeorgakis), Baylor University Medical Center at Dallas and the Baylor Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Robert C Stoler
- Texas A&M Health Science Center College of Medicine (Reinhold); the Division of Cardiology (Khalid, Stoler, Hall) and the Department of Cardiovascular and Thoracic Surgery (Lima, Gonzalez-Stawinski, Chamogeorgakis), Baylor University Medical Center at Dallas and the Baylor Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Shelley A Hall
- Texas A&M Health Science Center College of Medicine (Reinhold); the Division of Cardiology (Khalid, Stoler, Hall) and the Department of Cardiovascular and Thoracic Surgery (Lima, Gonzalez-Stawinski, Chamogeorgakis), Baylor University Medical Center at Dallas and the Baylor Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Themistokles Chamogeorgakis
- Texas A&M Health Science Center College of Medicine (Reinhold); the Division of Cardiology (Khalid, Stoler, Hall) and the Department of Cardiovascular and Thoracic Surgery (Lima, Gonzalez-Stawinski, Chamogeorgakis), Baylor University Medical Center at Dallas and the Baylor Hamilton Heart and Vascular Hospital, Dallas, Texas
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Affiliation(s)
- Peter A McCullough
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas; The Heart Hospital, Plano, Texas.
| | - Gautam Patanker
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Robert C Stoler
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
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Benjamin MM, Fazel P, Filardo G, Choi JW, Stoler RC. Prevalence of and risk factors of renal artery stenosis in patients with resistant hypertension. Am J Cardiol 2014; 113:687-90. [PMID: 24342757 DOI: 10.1016/j.amjcard.2013.10.046] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 10/20/2013] [Accepted: 10/20/2013] [Indexed: 11/26/2022]
Abstract
Renal artery stenosis (RAS) is a common cause of secondary hypertension. Renal artery angiography is the gold standard for diagnosing RAS. The aim of this study is to report (1) the prevalence of RAS in patients with resistant hypertension and (2) the association of RAS with peripheral vascular disease (PVD) and diabetes mellitus (DM). We studied 285 consecutive patients (mean age: 72.5 years) with resistant hypertension (systolic blood pressure >140 mm Hg despite administration of at least 3 antihypertensive drugs) who underwent renal artery angiography at Baylor Heart and Vascular Hospital from January 2006 to December 2010. Sixty-nine cases of RAS were identified (incidence: 24.2%). The propensity-adjusted analysis (controlling for clinical and nonclinical risk factors) showed a strong and significant association between RAS and PVD (odds ratio 5.15, 95% confidence interval 2.68 to 9.89, p <0.0001). However, the association between RAS and DM, a previously defined risk factor for RAS, was not significant in this cohort (odds ratio 0.63, 95% confidence interval 0.34 to 1.19, p = 0.16). In conclusion, results from this study define the prevalence of RAS in patients with resistant hypertension. Patients with PVD were found to be 5 times more likely to experience RAS than patients without PVD, whereas DM did not confer any increased risk.
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Cianci C, Kowal RC, Feghali G, Hohmann S, Stoler RC, Choi JW. Critical lower limb ischemia from an embolized Angio-Seal closure device. Proc (Bayl Univ Med Cent) 2013; 26:398-400. [PMID: 24082419 DOI: 10.1080/08998280.2013.11929017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Vascular closure devices were introduced in the early 1990s in an effort to reduce time to hemostasis, enable early ambulation, and improve the comfort of patients undergoing femoral artery access for endovascular procedures. Many of these devices leave a foreign component in or around the artery, which can lead to complications such as hematoma, pseudoaneurysm, infection, or limb ischemia. Here we present a case where device embolization led to arterial occlusion and critical limb ischemia.
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Affiliation(s)
- Chris Cianci
- Division of Cardiology, Department of Internal Medicine (Cianci, Kowal, Feghali, Stoler, Choi), and the Department of Vascular Surgery (Hohmann), Baylor Heart and Vascular Hospital and Baylor University Medical Center at Dallas
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Falcone AM, Choi JW, East C, Stoler RC, Fenves A, Laible E, Moshayedi P, Dunkerley J, Waters K. Renal Denervation for Resistant Hypertension. Proc (Bayl Univ Med Cent) 2013; 26:320-1. [DOI: 10.1080/08998280.2013.11928997] [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: 10/18/2022] Open
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Kim M, Muntner P, Sharma S, Choi JW, Stoler RC, Woodward M, Mann DM, Farkouh ME. Assessing patient-reported outcomes and preferences for same-day discharge after percutaneous coronary intervention: results from a pilot randomized, controlled trial. Circ Cardiovasc Qual Outcomes 2013; 6:186-92. [PMID: 23481528 DOI: 10.1161/circoutcomes.111.000069] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [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: 12/14/2022]
Abstract
BACKGROUND Same-day discharge after percutaneous coronary intervention (PCI) may be safe for some patients. Few data are available on patient-reported outcomes and preferences for same-day discharge after PCI. METHODS AND RESULTS Between March 2008 and March 2010, a total of 298 patients undergoing elective PCI via femoral access at 2 medical centers (Mount Sinai Hospital, New York, NY, and Baylor Medical Center, Dallas, TX) were randomized to same-day (n=150) or next-day (n=148) discharge. The primary outcome was high patient coping during the 7 days after discharge defined as scores <20 on the validated postdischarge coping difficulty scale. Safety outcomes, clopidogrel adherence, and patient preferences were secondary outcomes. Before discharge, patients randomized to same-day and next-day discharge were similar with respect to sociodemographic and clinical characteristics. High-coping ability, assessed 7 days after PCI, was present for 79% of patients randomized to same-day discharge and for 77% of patients randomized to next-day discharge. The difference in high coping ability, 2 (95% confidence interval, -7 to 11), did not cross the noninferiority threshold of -12% (P<0.001 that same-day discharge is not noninferior to next-day discharge). At 30 days after PCI, clopidogrel adherence, physician and emergency room visits, and hospitalization were similar in the 2 randomization groups. In addition, 80% and 68% of those randomized to same-day and next-day discharge, respectively, stated they would prefer same-day discharge if they were to have another PCI procedure. CONCLUSIONS Same-day discharge after PCI was associated with patient-reported and clinical outcomes similar to those of next-day discharge and was preferred by most patients.
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Affiliation(s)
- Michael Kim
- Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA
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Roberts WC, Stoler RC, Grayburn PA, Hebeler RF, Ko JM, Brown DL, Brinkman WT, Mack MJ, Guileyardo JM. Necropsy findings early after transcatheter aortic valve implantation for aortic stenosis. Am J Cardiol 2013. [PMID: 23186601 DOI: 10.1016/j.amjcard.2012.09.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Although transcatheter aortic valve implantation has been available for 10 years, reports of cardiovascular morphologic studies after the procedure are virtually nonexistent. The investigators describe such findings in 2 patients, both 86 years of age, who died early (hours or several days) after transcatheter aortic valve implantation. Although the prosthesis in each was seated well, and each of the 3 calcified cusps of the native aortic valves was well compressed to the wall of the aorta, thus providing a good bioprosthetic orifice, the ostium of the dominant right coronary artery in each was obliterated by the native right aortic valve cusp. Atherosclerotic plaques in the common iliac artery led to a major complication in 1 patient, who later died of hemorrhagic stroke. The other patient developed fatal cardiac tamponade secondary to perforation of the right ventricular wall by a pacemaker catheter.
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Schroder C, Stoler RC, Branning GB, Choi JW. Postpartum multivessel spontaneous coronary artery dissection confirmed by coronary CT angiography. Proc (Bayl Univ Med Cent) 2011; 19:338-41. [PMID: 17106495 PMCID: PMC1618752 DOI: 10.1080/08998280.2006.11928196] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Spontaneous coronary artery dissection is a rare but potentially life-threatening event associated with the peripartum period. We present a case of postpartum multivessel spontaneous coronary artery dissection diagnosed by conventional angiography and monitored with computed tomographic coronary angiography. The patient was initially managed medically and later received a coronary stent.
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Affiliation(s)
- Catherine Schroder
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA
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Muntner P, Mann DM, Woodward M, Choi JW, Stoler RC, Shimbo D, Farkouh ME, Kim MC. Predictors of low clopidogrel adherence following percutaneous coronary intervention. Am J Cardiol 2011; 108:822-7. [PMID: 21741610 DOI: 10.1016/j.amjcard.2011.04.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 04/27/2011] [Accepted: 04/27/2011] [Indexed: 01/13/2023]
Abstract
Few data are available on factors associated with low adherence or early clopidogrel discontinuation after percutaneous coronary intervention (PCI). Patients (n = 284) were evaluated before hospital discharge after PCI to identify factors associated with low adherence to clopidogrel 30 days later. Adherence to daily medications before PCI was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8) and categorized as low (score <6), medium (score 6 to <8), or high (score 8). Low adherence to clopidogrel was defined as MMAS-8 score <6 (n = 21) or having discontinued clopidogrel (n = 11), which was ascertained during a 30-day interview after PCI. At 30 days after PCI, 11% of patients had low adherence to clopidogrel. Odds ratios (95% confidence intervals [CIs]) for low adherence to clopidogrel were 3.78 (1.09 to 13.1), 3.06 (1.36 to 6.87), 2.46 (0.97 to 6.27), and 3.36 (0.99 to 11.4) for patients who before PCI reported taking smaller doses of medication because of cost, had difficulty filling prescriptions, had difficulty reaching their primary physician, and were not comfortable asking their doctor for instructions, respectively. Odds ratios (95% CIs) for low clopidogrel adherence after PCI in patients with medium and low versus high adherence to daily medications before PCI were 6.13 (1.34 to 28.2) and 10.9 (2.46 to 48.7), respectively. The c-statistic associated with MMAS-8 scores before PCI for discriminating low clopidogrel adherence at 30 days after PCI was 0.733 (95% CI 0.650 to 0.852). In conclusion, adherence to daily medications before PCI may be a useful indicator for identifying patients who will have low clopidogrel adherence after PCI.
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Lilly SM, Schussler JM, Stoler RC. Anomalous origin of the right coronary artery from the left sinus of Valsalva associated with syncope in a young athlete. Proc (Bayl Univ Med Cent) 2011; 24:13-4. [PMID: 21307970 DOI: 10.1080/08998280.2011.11928675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Steven M Lilly
- Division of Cardiology, Department of Internal Medicine, Baylor Jack and Jane Hamilton Heart and Vascular Hospital and Baylor University Medical Center at Dallas
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Falcone AM, Bose R, Stoler RC, Kim M, Laible E, Kang L, Waters K, Dunkerley J, Choi JW. The AmBulatory Closure Device Percutaneous Intervention (ABCD-PCI) study: a single-center experience. Proc (Bayl Univ Med Cent) 2011; 24:192-4. [PMID: 21738289 DOI: 10.1080/08998280.2011.11928713] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The AmBulatory Closure Device Percutaneous Intervention (ABCD-PCI) study is a multicenter randomized prospective controlled trial evaluating the safety of and patient satisfaction with same-day discharge following ambulatory percutaneous intervention with a closure device. This article reviews the findings from a single center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, from October 2008 through April 2010, with 23 patients in the same-day discharge group and 21 patients in the next-day discharge group. There were no differences between the groups in demographic or procedure characteristics. Outcomes were measured by a questionnaire and 7-day and 30-day follow-up phone calls. Results showed that same-day discharge after percutaneous intervention with a closure device is as safe as next-day discharge. However, there was a trend for a higher comfort level among patients in the next-day discharge group.
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Affiliation(s)
- Adam M Falcone
- Department of Internal Medicine (Falcone) and Division of Cardiology (Bose, Choi, Stoler, Laible, Kang, Waters, Dunkerley), Baylor University Medical Center at Dallas; and Mount Sinai Medical Center, New York, New York (Kim)
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Garner WL, Stoler RC, Laible EA, Kang MJ, Choi JW. Percutaneous coronary artery stenting of unprotected left main coronary artery disease using drug-eluting stents: the initial Baylor University Medical Center experience. Proc AMIA Symp 2007; 20:339-43. [PMID: 17948103 DOI: 10.1080/08998280.2007.11928317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Significant narrowing of the left main coronary artery is a high-risk condition with significant mortality risk. Bypass surgery is the current gold-standard treatment for unprotected left main (ULM) disease. Stenting utilizing drug-eluting stents (DES) is another therapeutic option for patients with ULM disease considered too high risk for bypass surgery or for patients who simply refuse bypass surgery. We have had great initial success with ULM stenting using DES in 10 selected patients at Baylor University Medical Center. Ongoing multicenter, international randomized studies comparing percutaneous coronary intervention with DES and bypass surgery will shed more light on the best treatment strategy for ULM coronary disease.
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Affiliation(s)
- William Lance Garner
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
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48
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Berbarie RF, Dockery WD, Johnson KB, Rosenthal RL, Stoler RC, Schussler JM. Use of multislice computed tomographic coronary angiography for the diagnosis of anomalous coronary arteries. Am J Cardiol 2006; 98:402-6. [PMID: 16860032 DOI: 10.1016/j.amjcard.2006.02.046] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Revised: 02/01/2006] [Accepted: 02/01/2006] [Indexed: 11/22/2022]
Abstract
The accurate diagnosis of anomalous coronary arteries by invasive angiography is limited by the inability to define the anatomic course in relation to surrounding structures. Computed tomographic coronary angiography has recently emerged as a noninvasive method to visualize the coronary arteries. Multislice computed tomography with up to 64 detector arrays, along with 3-dimensional rendering, has further improved the temporal and spatial resolution of noninvasive coronary imaging. In this series of cases, the investigators describe their institution's experience with computed tomographic coronary angiography as a complement to invasive coronary angiography in determining the origin and course of different anomalous coronary arteries in 16 patients. With the aid of 3-dimensional volume rendering, 6 anomalous right coronary arteries, 4 anomalous left circumflex coronary arteries, 4 single coronary arteries, and 2 anomalous left main coronary arteries were all clearly defined with regard to their origin and course. It is proposed that computed tomographic coronary angiography is the diagnostic test of choice in the evaluation of such anomalies.
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Affiliation(s)
- Rafic F Berbarie
- Department of Internal Medicine, Division of Cardiovascular Diseases, Baylor University Medical Center/Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas, USA
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Schussler JM, Dockery WD, Johnson KB, Rosenthal RL, Stoler RC. Critical left main coronary artery stenosis diagnosed by computed tomographic coronary angiography. Proc (Bayl Univ Med Cent) 2005; 18:407. [PMID: 16252034 PMCID: PMC1255953 DOI: 10.1080/08998280.2005.11928103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Jeffrey M Schussler
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center/Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas, USA.
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50
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Schussler JM, Dockery WD, Moore TR, Johnson KB, Rosenthal RL, Stoler RC. Computed tomographic coronary angiography: experience at Baylor University Medical Center/Baylor Jack and Jane Hamilton Heart and Vascular Hospital. Proc (Bayl Univ Med Cent) 2005; 18:228-33. [PMID: 16200178 PMCID: PMC1200730 DOI: 10.1080/08998280.2005.11928073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Noninvasive cardiac computed tomographic imaging using multislice or electron beam technology has been shown to be highly specific and sensitive in diagnosing coronary heart disease. It is about a fifth of the cost of coronary angiography and is particularly well suited for evaluating patients with a low or low to moderate probability of having obstructive coronary atherosclerosis. In addition, it offers more information than calcium scoring: because of the intravenous contrast used, it temporarily increases the density of the lumen and allows differentiation of soft plaque from calcified plaque. The Baylor Hamilton Heart and Vascular Hospital now uses this modality to define coronary atherosclerosis in patients who would otherwise have needed invasive coronary angiography; several research protocols with the technique are also under way. Baylor has recently upgraded to the 64-slice scanner. It is expected that computed tomographic coronary angiography will replace a significant percentage of invasive cardiac catheterizations.
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Affiliation(s)
- Jeffrey M Schussler
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center and Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas, USA.
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