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Goel SS, Aoun J, Reardon MJ. Editorial: Going from Evolut PRO+ to Evolut FX: A step in the right direction. Cardiovasc Revasc Med 2024:S1553-8389(24)00462-7. [PMID: 38714398 DOI: 10.1016/j.carrev.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/09/2024]
Affiliation(s)
- Sachin S Goel
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States of America
| | - Joe Aoun
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States of America
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States of America.
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Perrin N, Ben-Ali W, Ludwig S, Duncan A, Weimann J, Nickenig G, Tanaka T, Coisne A, Vincentelli A, Makkar R, Webb JG, Akodad M, Muller DWM, Jansz P, Praz F, Reineke D, Wild MG, Hausleiter J, Goel SS, Denti P, Chehab O, Dahle G, Baldus S, Ruge H, Kaneko T, Ternacle J, Dumonteil N, von Bardeleben RS, Flagiello M, Walther T, Taramasso M, Søndergaard L, Bleiziffer S, Fam N, Kempfert J, Granada JF, Tang GHL, Conradi L, Modine T. Outcomes After Transcatheter Mitral Valve Replacement According to Regurgitation Etiology. Ann Thorac Surg 2024; 117:958-964. [PMID: 37717882 DOI: 10.1016/j.athoracsur.2023.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Whether transcatheter mitral valve replacement (TMVR) devices perform similarly with respect to the underlying mitral regurgitation (MR) etiology remains unknown. The aim of the present analysis was to assess outcomes of TMVR according to the MR underlying etiology among the CHoice of OptImal transCatheter trEatment for Mitral Insufficiency (CHOICE-MI) registry. METHODS Of 746 patients, 229 patients (30.7%) underwent TMVR. The study population was subdivided according to primary, secondary, or mixed MR. Patients with mitral annular calcification were excluded. The primary study endpoint was a composite endpoint of all-cause mortality or hospitalization for heart failure at 1 year. Secondary study endpoints were all-cause and cardiovascular mortality at 1 year, New York Heart Association functional class, and residual MR, both at discharge and 1 year. RESULTS The predominant MR etiology was secondary MR (58.4%), followed by primary MR (28.7%) and mixed MR (12.9%). Technical success and procedural mortality were similar according to MR etiology. Discharge echocardiography revealed residual MR 2+ in 11.3%, 3.7%, and 5.3% of patients with primary, secondary, and mixed MR, respectively (P = .1). MR elimination was similar in all groups up to the 1-year follow-up. There was no difference in terms of primary combined outcome occurrence according to MR etiology. One-year all-cause mortality was reported in 28.8%, 24.2%, and 32.1% of patients with primary, secondary, and mixed MR, respectively (P = .07). CONCLUSIONS In our study we did not find differences in short-term and 1-year outcomes after TMVR according to MR etiology.
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Affiliation(s)
- Nils Perrin
- Montreal Heart Institute, Montreal, Quebec, Canada
| | | | - Sebastian Ludwig
- University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research (DZHK): Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Alison Duncan
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Jessica Weimann
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | | | - Augustin Coisne
- Department of Cardiology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Andre Vincentelli
- Department of Cardiology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Raj Makkar
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - John G Webb
- Department of Cardiology, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Mariama Akodad
- Department of Cardiology, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - David W M Muller
- Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Paul Jansz
- Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - David Reineke
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Mirjam G Wild
- Department of Cardiology, Bern University Hospital, Bern, Switzerland; Ludwig Maximilian University of Munich, Munich, Germany
| | | | - Sachin S Goel
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Paolo Denti
- Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy
| | - Omar Chehab
- Department of Cardiology, St Thomas' Hospital, London, United Kingdom
| | - Gry Dahle
- Department of Cardiac Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Stephan Baldus
- Department of Cardiology, University Hospital of Cologne, Cologne, Germany
| | | | - Tsuyoshi Kaneko
- Department of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Julien Ternacle
- Department of Cardiac Surgery, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | | | - Michele Flagiello
- Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France
| | - Thomas Walther
- Department of Cardiology, Frankfurt University Hospital, Frankfurt, Germany
| | - Maurizio Taramasso
- HerzZentrum Hirslanden, Zürich, Switzerland; CardioCentro, Lugano, Switzerland
| | | | | | - Neil Fam
- Department of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Gilbert H L Tang
- Department of Cardiac Surgery, Mount Sinai Hospital, New York, New York
| | - Lenard Conradi
- German Center for Cardiovascular Research (DZHK): Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Thomas Modine
- Department of Cardiac Surgery, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
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Bou Chaaya RG, Hatab T, Samimi S, Qamar F, Kharsa C, Aoun J, Faza N, Little SH, Atkins MD, Reardon MJ, Kleiman NS, Nagueh SF, Zoghbi WA, Guha A, Zaid S, Goel SS. Prognostic Value of Right Ventricular Afterload in Patients Undergoing Mitral Transcatheter Edge-to-Edge Repair. J Am Heart Assoc 2024; 13:e033510. [PMID: 38567665 DOI: 10.1161/jaha.123.033510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/25/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Pulmonary hypertension (PH) and secondary mitral regurgitation (MR) are associated with adverse outcomes after mitral transcatheter edge-to-edge repair. We aim to study the prognostic value of invasively measured right ventricular afterload in patients undergoing mitral transcatheter edge-to-edge repair. METHODS AND RESULTS We identified patients who underwent right heart catheterization ≤1 month before transcatheter edge-to-edge repair. The end points were all-cause mortality and a composite of mortality and heart failure hospitalization at 2 years. Using the receiver operating characteristic curve-derived threshold of 0.6 for pulmonary effective arterial elastance ([Ea], pulmonary artery systolic pressure/stroke volume), patients were stratified into 3 profiles based on PH severity (low elastance [HE]: Ea <0.6/mean pulmonary artery pressure (mPAP)) <35; High Elastance with No/Mild PH (HE-): Ea ≥0.6/mPAP <35; and HE with Moderate/Severe PH (HE+): Ea ≥0.6/mPAP ≥35) and MR pathogenesis (Primary MR [PMR])/low elastance, PMR/HE, and secondary MR). The association between this classification and clinical outcomes was examined using Cox regression. Among 114 patients included, 50.9% had PMR. Mean±SD age was 74.7±10.6 years. Patients with Ea ≥0.6 were more likely to have diabetes, atrial fibrillation, New York Heart Association III/IV status, and secondary MR (all P<0.05). Overall, 2-year cumulative survival was 71.1% and was lower in patients with secondary MR and mPAP ≥35. Compared with patients with low elastance, cumulative 2-year event-free survival was significantly lower in HE- and HE+ patients (85.5% versus 50.4% versus 41.0%, respectively, P=0.001). Also, cumulative 2-year event-free survival was significantly higher in patients with PMR/low elastance when compared with PMR/HE and patients with secondary mitral regurgitation (85.5% versus 55.5% versus 46.1%, respectively, P=0.005). CONCLUSIONS Assessment of the preprocedural cardiopulmonary profile based on mPAP, MR pathogenesis, and Ea guides patient selection by identifying hemodynamic features that indicate likely benefit from mitral-transcatheter edge-to-edge repair in PH or lack thereof.
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Affiliation(s)
| | - Taha Hatab
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Sahar Samimi
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Fatima Qamar
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Chloe Kharsa
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Joe Aoun
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Nadeen Faza
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | | | - Marvin D Atkins
- Department of Cardiovascular Surgery Houston Methodist Hospital Houston TX
| | - Michael J Reardon
- Department of Cardiovascular Surgery Houston Methodist Hospital Houston TX
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Sherif F Nagueh
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | | | - Ashrith Guha
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Syed Zaid
- Department of Cardiology Baylor School of Medicine and the Michael E DeBakey VAMC Houston TX
| | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
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Zaid S, Wessly P, Hatab T, Faza N, Little SH, Atkins MD, Reardon MJ, Kleiman NS, Zoghbi WA, Goel SS. Intraprocedural Doppler and Invasive Hemodynamic Profiling Predict Clinical Outcomes After Mitral TEER. JACC Cardiovasc Imaging 2024; 17:454-456. [PMID: 38032586 DOI: 10.1016/j.jcmg.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/02/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
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Goel SS, Reardon MJ. TAV-in-SAV or Redo SAVR: Are We Comparing Apples With Oranges? Am J Cardiol 2024; 215:70-71. [PMID: 38134980 DOI: 10.1016/j.amjcard.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023]
Affiliation(s)
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
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Kleiman NS, Goel SS. The Shape of Things to Come? Is a Trial of Combined Interventional Procedures Necessary in Today's World? Circulation 2024; 149:744-746. [PMID: 38437486 DOI: 10.1161/circulationaha.123.067744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Affiliation(s)
- Neal S Kleiman
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
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7
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Hatab T, Samimi S, Bou Chaaya RG, Qamar F, Kharsa C, Wessly P, Faza N, Little SH, Atkins MD, Reardon MJ, Kleiman NS, Zoghbi WA, Nagueh SF, Zaid S, Goel SS. Echocardiographic Profiling Predicts Clinical Outcomes After Mitral Transcatheter Edge-to-Edge Repair. J Am Heart Assoc 2024; 13:e032784. [PMID: 38390821 PMCID: PMC10944065 DOI: 10.1161/jaha.123.032784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/27/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Prior studies investigating the impact of residual mitral regurgitation (MR), tricuspid regurgitation (TR), and elevated predischarge transmitral mean pressure gradient (TMPG) on outcomes after mitral transcatheter edge-to-edge repair (TEER) have assessed each parameter in isolation. We sought to examine the prognostic value of combining predischarge MR, TR, and TMPG to study long-term outcomes after TEER. METHODS AND RESULTS We reviewed the records of 291 patients who underwent successful mitral TEER at our institution between March 2014 and June 2022. Using well-established outcomes-related cutoffs for predischarge MR (≥moderate), TR (≥moderate), and TMPG (≥5 mm Hg), 3 echo profiles were developed based on the number of risk factors present (optimal: 0 risk factors, mixed: 1 risk factor, poor: ≥2 risk factors). Discrimination of the profiles for predicting the primary composite end point of all-cause mortality and heart failure hospitalization at 2 years was examined using Cox regression. Overall, mean age was 76.7±10.6 years, 43.3% were women, and 53% had primary MR. Two-year event-free survival was 61%. Predischarge TR≥moderate, MR≥moderate, and TMPG≥5 mm Hg were risk factors associated with the primary end point. Compared with the optimal profile, there was an incremental risk in 2-year event-rate with each worsening profile (optimal as reference; mixed profile: hazard ratio (HR), 2.87 [95% CI, 1.71-5.17], P<0.001; poor profile: HR, 3.76 [95% CI, 1.84-6.53], P<0.001). Echocardiographic profile was statistically associated with the 2-year mortality end point (optimal as reference; mixed profile: HR, 3.55 [95% CI, 1.81-5.96], P<0.001; poor profile: HR, 3.39 [95% CI, 2.56-7.33], P=0.02). CONCLUSIONS The echocardiographic profile integrating predischarge TR, MR, and TMPG presents a novel prognostic stratification tool for patients undergoing mitral TEER.
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Affiliation(s)
- Taha Hatab
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Sahar Samimi
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | | | - Fatima Qamar
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Chloe Kharsa
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | | | - Nadeen Faza
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | | | - Marvin D Atkins
- Department of Cardiovascular Surgery Houston Methodist Hospital Houston TX
| | - Michael J Reardon
- Department of Cardiovascular Surgery Houston Methodist Hospital Houston TX
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | | | - Sherif F Nagueh
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Syed Zaid
- Department of Cardiology Baylor School of Medicine and the Michael E DeBakey VAMC Houston TX
| | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
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8
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Zaid S, Kleiman NS, Goel SS, Szerlip MI, Mack MJ, Marin-Cuartas M, Mohammadi S, Nazif TM, Unbehaun A, Andreas M, Brinster DR, Robinson NB, Wang L, Ramlawi B, Conradi L, Desai ND, Forrest JK, Bagur R, Nguyen TC, Waksman R, Leroux L, Van Belle E, Grubb KJ, Ahmad HA, Denti P, Modine T, Bapat VN, Kaneko T, Reardon MJ, Tang GHL, Explant-Tavr Registry Investigators OBOT. Impact of transcatheter heart valve type on outcomes of surgical explantation after failed transcatheter aortic valve replacement: the EXPLANT-TAVR international registry. EUROINTERVENTION 2024; 20:e146-e157. [PMID: 38224255 PMCID: PMC10786178 DOI: 10.4244/eij-d-23-00722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/16/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND There are limited data on the impact of transcatheter heart valve (THV) type on the outcomes of surgical explantation after THV failure. AIMS We sought to determine the outcomes of transcatheter aortic valve replacement (TAVR) explantation for failed balloon-expandable valves (BEV) versus self-expanding valves (SEV). METHODS From November 2009 to February 2022, 401 patients across 42 centres in the EXPLANT-TAVR registry underwent TAVR explantation during a separate admission from the initial TAVR. Mechanically expandable valves (N=10, 2.5%) were excluded. The outcomes of TAVR explantation were compared for 202 (51.7%) failed BEV and 189 (48.3%) failed SEV. RESULTS Among 391 patients analysed (mean age: 73.0±9.8 years; 33.8% female), the median time from index TAVR to TAVR explantation was 13.3 months (interquartile range 5.1-34.8), with no differences between groups. Indications for TAVR explantation included endocarditis (36.0% failed SEV vs 55.4% failed BEV; p<0.001), paravalvular leak (21.2% vs 11.9%; p=0.014), structural valve deterioration (30.2% vs 21.8%; p=0.065) and prosthesis-patient mismatch (8.5% vs 10.4%; p=0.61). The SEV group trended fewer urgent/emergency surgeries (52.0% vs 62.3%; p=0.057) and more root replacement (15.3% vs 7.4%; p=0.016). Concomitant cardiac procedures were performed in 57.8% of patients, including coronary artery bypass graft (24.8%), and mitral (38.9%) and tricuspid (14.6%) valve surgery, with no differences between groups. In-hospital, 30-day, and 1-year mortality and stroke rates were similar between groups (allp>0.05), with no differences in cumulative mortality at 3 years (log-rank p=0.95). On multivariable analysis, concomitant mitral surgery was an independent predictor of 1-year mortality after BEV explant (hazard ratio [HR] 2.00, 95% confidence interval [CI]: 1.07-3.72) and SEV explant (HR 2.00, 95% CI: 1.08-3.69). CONCLUSIONS In the EXPLANT-TAVR global registry, BEV and SEV groups had different indications for surgical explantation, with more root replacements in SEV failure, but no differences in midterm mortality and morbidities. Further refinement of TAVR explantation techniques are important to improving outcomes.
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Affiliation(s)
- Syed Zaid
- Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | | | | | | | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Québec City, QC, Canada
| | - Tamim M Nazif
- Columbia University Irving Medical Center, New York, NY, USA
| | | | | | | | | | - Lin Wang
- St. Francis Hospital, Roslyn, NY, USA
| | | | - Lenard Conradi
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | | | - Rodrigo Bagur
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Tom C Nguyen
- University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Ron Waksman
- MedStar Washington Hospital Center, Washington, D.C., USA
| | | | | | | | | | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | | | | | - Tsuyoshi Kaneko
- Washington University School of Medicine, St. Louis, MO, USA
| | - Michael J Reardon
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
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Hashem A, Khalouf A, Agrawal A, Mohamad MS, Nayfeh T, Kashou A, Chaaya RGB, Rai D, Verghese B, Little SH, Goldsweig A, Naidu S, Goel SS. Feasibility and Safety of Intracardiac Echocardiography Guidance in Mitral Transcatheter Edge-to-Edge Repair: Analysis of the National Inpatient Sample Data From 2015 to 2020. Curr Probl Cardiol 2024; 49:102042. [PMID: 37595856 DOI: 10.1016/j.cpcardiol.2023.102042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 08/20/2023]
Abstract
Data on the use of intracardiac echocardiography (ICE) guidance in mitral transcatheter edge-to-edge repair (mTEER) procedure is limited to case reports and small case series. Our study aims to assess the feasibility, safety, utilization patterns, and clinical outcomes of mTEER procedure with ICE guidance using a nationally representative real-world cohort of patients. This study used the National Inpatient Sample database from quarter 4 of 2015 to 2020. We used a propensity-matched analysis and adjusted odds ratios for in-hospital outcomes/complications. A P value of < 0.05 was considered significant. A total of 38,770 weighted cases of mTEER were identified. Of the included patients 665 patients underwent ICE-guided mTEER while 38,105 had TEE-guided mTEER. There were no differences in the in-hospital mortality between both groups (2.5% vs 3.0%, P = 0.58). Adjusted odds of in-hospital mortality (aOR 0.83, 95%CI [0.42-1.64]) were not significantly different. There were no differences in periprocedural complications including cardiac (aOR 0.85, 95%CI [0.54-1.35]), bleeding (aOR 1.45, 95%CI [0.93-2.33]), respiratory (aOR 0.88, 95%CI [0.61-1.25]), and renal (aOR 0.89, 95%CI [0.66-1.20]) complications between patients undergoing ICE-guided vs TEE-guided mTEER. There was no difference in GI complications between both groups (aOR 1.11, 95%CI [0.46-2.70]). The adjusted length of stay was less among ICE-guided mTEER (median: 1 vs 2, P < 0.01) with lower inflation-adjusted costs of hospitalization ($35,513 vs $47,067, P < 0.01). ICE-guided mTEER is safe when compared with TEE guided mTEER with no significant differences in in-hospital mortality, cardiac, bleeding, respiratory, and renal complications.
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Affiliation(s)
- Anas Hashem
- Department of Medicine, Rochester General Hospital, Rochester, NY
| | - Amani Khalouf
- Department of Medicine, Rochester General Hospital, Rochester, NY
| | - Ankit Agrawal
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Tarek Nayfeh
- Evidence-based Medicine, Mayo Clinic School of Medicine, Rochester, MN
| | - Anthony Kashou
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, MN
| | - Rody G Bou Chaaya
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Devesh Rai
- Department of Cardiovascular Medicine, Sands-constellation Heart Institute, Rochester, NY
| | - Basil Verghese
- Department of Medicine, Rochester General Hospital, Rochester, NY
| | - Stephen H Little
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Andrew Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, MA
| | - Srihari Naidu
- Department of Cardiovascular Medicine, Westchester Medical Center, Westchester, NY
| | - Sachin S Goel
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX.
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Goel SS, Zaid S, Reardon MJ. Editorial: Go big or go home. Cardiovasc Revasc Med 2023; 57:6-7. [PMID: 37586997 DOI: 10.1016/j.carrev.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Sachin S Goel
- Department of Cardiology, Houston Methodist Hospital, United States of America.
| | - Syed Zaid
- Interventional Cardiology, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, United States of America.
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Khan SU, Agarwal S, Arshad HB, Akbar UA, Mamas MA, Arora S, Baber U, Goel SS, Kleiman NS, Shah AR. Intravascular imaging guided versus coronary angiography guided percutaneous coronary intervention: systematic review and meta-analysis. BMJ 2023; 383:e077848. [PMID: 37973170 PMCID: PMC10652093 DOI: 10.1136/bmj-2023-077848] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To assess the absolute treatment effects of intravascular imaging guided versus angiography guided percutaneous coronary intervention in patients with coronary artery disease, considering their baseline risk. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed/Medline, Embase, and Cochrane Library databases up to 31 August 2023. STUDY SELECTION Randomized controlled trials comparing intravascular imaging (intravascular ultrasonography or optical coherence tomography) guided versus coronary angiography guided percutaneous coronary intervention in adults with coronary artery disease. MAIN OUTCOME MEASURES Random effect meta-analysis and GRADE (grading of recommendations, assessment, development, and evaluation) were used to assess certainty of evidence. Data included rate ratios and absolute risks per 1000 people for cardiac death, myocardial infarction, stent thrombosis, target vessel revascularization, and target lesion revascularization. Absolute risk differences were estimated using SYNTAX risk categories for baseline risks at five years, assuming constant rate ratios across different cardiovascular risk thresholds. RESULTS In 20 randomized controlled trials (n=11 698), intravascular imaging guided percutaneous coronary intervention was associated with a reduced risk of cardiac death (rate ratio 0.53, 95% confidence interval 0.39 to 0.72), myocardial infarction (0.81, 0.68 to 0.97), stent thrombosis (0.44, 0.27 to 0.72), target vessel revascularization (0.74, 0.61 to 0.89), and target lesion revascularization (0.71, 0.59 to 0.86) but not all cause death (0.81, 0.64 to 1.02). Using SYNTAX risk categories, high certainty evidence showed that from low risk to high risk, intravascular imaging was likely associated with 23 to 64 fewer cardiac deaths, 15 to 19 fewer myocardial infarctions, 9 to 13 fewer stent thrombosis events, 28 to 38 fewer target vessel revascularization events, and 35 to 48 fewer target lesion revascularization events per 1000 people. CONCLUSIONS Compared with coronary angiography guided percutaneous coronary intervention, intravascular imaging guided percutaneous coronary intervention was associated with significantly reduced cardiac death and cardiovascular outcomes in patients with coronary artery disease. The estimated absolute effects of intravascular imaging guided percutaneous coronary intervention showed a proportional relation with baseline risk, driven by the severity and complexity of coronary artery disease. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023433568.
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Affiliation(s)
- Safi U Khan
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Siddharth Agarwal
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Hassaan B Arshad
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Usman Ali Akbar
- Department of Medicine, West Virginia University - Camden Clark Medical Center, Parkersburg, WV, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stroke-On-Trent, UK
- Department of Medicine, Jefferson University, Philadelphia, PA, USA
| | - Shilpkumar Arora
- University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Usman Baber
- Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sachin S Goel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Neal S Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Alpesh R Shah
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
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12
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Zaid S, Goel SS, Reardon MJ. Self-Expanding Transcatheter Aortic Valves Optimize Transvalvular Hemodynamics Independently of Intra- Versus Supra-Annular Design. Am J Cardiol 2023; 207:513-514. [PMID: 37802698 DOI: 10.1016/j.amjcard.2023.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Syed Zaid
- Division of Cardiology, Baylor College of Medicine, Michael DeBakey VA Medical Center, Houston, Texas
| | - Sachin S Goel
- Division of Cardiology, Houston Methodist DeBakey Heart and Vascular Institute, Houston, Texas
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Institute,Houston, Texas.
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13
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Elbadawi A, Abumoawad A, Elgendy IY, Ghoeweba M, Mohsen A, Zahr F, Goel SS, Kaple RK, Bavry A, Kumbhani DJ. Repeat Mitral Valve Interventions After Failed Transcatheter Edge-to-Edge Repair With MitraClip. Am J Cardiol 2023; 206:382-384. [PMID: 37690940 DOI: 10.1016/j.amjcard.2023.08.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Ayman Elbadawi
- Division of Cardiology, Christus Good Shepperd Medical Center, Longview, Texas.
| | - Abelrahman Abumoawad
- Division of Cardiology, University of Boston Medical Center, Boston, Massachusetts
| | - Islam Y Elgendy
- Gill Heart Institute, University of Kentucky, Lexington, Kentucky
| | - Mohamed Ghoeweba
- Department of Vascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Amr Mohsen
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California
| | - Firas Zahr
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Ryan K Kaple
- Division of Cardiology, Hackensack University Medical Center, Hackensack, New Jersey
| | - Anthony Bavry
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dharam J Kumbhani
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
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14
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Hatab T, Zaid S, Wessly P, Faza N, Little SH, Atkins MD, Reardon MJ, Kleiman NS, Zoghbi WA, Goel SS. Characteristics and Outcomes of Patients Ineligible for Transcatheter Mitral Valve Replacement. Struct Heart 2023; 7:100206. [PMID: 38046865 PMCID: PMC10692344 DOI: 10.1016/j.shj.2023.100206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/07/2023] [Accepted: 05/25/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Taha Hatab
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Syed Zaid
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Priscilla Wessly
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Nadeen Faza
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Stephen H. Little
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Marvin D. Atkins
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Michael J. Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Neal S. Kleiman
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - William A. Zoghbi
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Sachin S. Goel
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
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15
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Hatab T, Bou Chaaya RG, Zaid S, Wessly P, Satish P, Villanueva V, Faza N, Little SH, Atkins MD, Reardon MJ, Kleiman NS, Zoghbi WA, Goel SS. Feasibility and Outcomes of Mitral Transcatheter Edge-To-Edge Repair in Patients With Variable Degrees of Mitral Annular Calcification. J Am Heart Assoc 2023; 12:e031118. [PMID: 37753800 PMCID: PMC10727232 DOI: 10.1161/jaha.123.031118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/23/2023] [Indexed: 09/28/2023]
Abstract
Background The clinical significance of mitral annular calcification (MAC) in patients undergoing mitral transcatheter edge-to-edge repair is not well understood. There is limited evidence regarding the feasibility, durability of repair, and the prognostic value of MAC in this population. We sought to examine the prognostic value of MAC, its severity, and its impact on procedural success and durability of mitral transcatheter edge-to-edge repair. Methods and Results We reviewed the records of 280 patients with moderate-severe or severe mitral regurgitation who underwent mitral transcatheter edge-to-edge repair with MitraClip from March 2014 to March 2022. The primary end point was cumulative survival at 1 year. Independent factors associated with the primary end point were identified using multivariable Cox regression. Among 280 patients included in the final analysis, 249 had none/mild MAC, and 31 had moderate/severe MAC. Median follow-up was 23.1 months (interquartile range: 11.1-40.4). Procedural success was comparable in the MAC and non-MAC groups (92.6% versus 91.4%, P=0.79) with similar rates of residual mitral regurgitation ≤2 at 1 year (86.7% versus 93.2%, P=0.55). Moderate/severe MAC was associated with less improvement in New York Heart Association III/IV at 30 days when compared with none/mild MAC (45.8% versus 14.3%, P=0.001). The moderate/severe MAC group had lower cumulative 1-year survival (56.8% versus 80.0%, hazard ratio [HR], 1.98 [95% CI, 1.27-3.10], P=0.002). Moderate/severe MAC and Society of Thoracic Surgeons predicted risk of mortality for mitral valve repair were independently associated with the primary end point (HR, 2.20 [1.10-4.41], P=0.02; and HR, 1.014 [1.006-1.078], P=0.02, respectively). Conclusions Mitral TEER is a safe and feasible intervention in selected patients with significant MAC and associated with similar mitral regurgitation reduction at 1 year compared with patients with none/mild MAC. Patients with moderate/severe MAC had a high 1-year mortality and less improvement in their symptoms after TEER.
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Affiliation(s)
- Taha Hatab
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | | | - Syed Zaid
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | | | - Priyanka Satish
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | | | - Nadeen Faza
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | | | - Marvin D. Atkins
- Department of Cardiovascular SurgeryHouston Methodist HospitalHoustonTX
| | | | - Neal S. Kleiman
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | | | - Sachin S. Goel
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
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16
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Hatab T, Zaid S, Wessly P, Reardon MJ, Atkins MD, Faza N, Little SH, Kleiman NS, Goel SS. TAV-in-TAV in Failed Homograft: Redo TAVI in a Patient With 3 Previous Sternotomies. JACC Case Rep 2023; 22:101973. [PMID: 37790767 PMCID: PMC10544086 DOI: 10.1016/j.jaccas.2023.101973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 10/05/2023]
Abstract
A 59-year-old male patient with history of rheumatic heart disease with 3 previous surgical aortic valve replacements with the last one being homograft followed by transcatheter aortic valve implantation in failed homograft presented with severe aortic regurgitation and cardiogenic shock requiring urgent TAV-in-TAV-in homograft. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Taha Hatab
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Syed Zaid
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Priscilla Wessly
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Michael J. Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Marvin D. Atkins
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Nadeen Faza
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Stephen H. Little
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Neal S. Kleiman
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sachin S. Goel
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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17
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Agarwal S, Thakkar S, Zaid S, Bansal A, Patel H, Akhtar K, Khosla J, Goel SS, Baber U. Impact of Frailty on Outcomes in Patients Who Underwent Transcatheter Mitral Valve Replacement. Am J Cardiol 2023; 203:301-303. [PMID: 37517124 DOI: 10.1016/j.amjcard.2023.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Siddharth Agarwal
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Samarthkumar Thakkar
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Syed Zaid
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Agam Bansal
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Harsh Patel
- Department of Cardiology, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Khawaja Akhtar
- Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Jagjit Khosla
- Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Sachin S Goel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Usman Baber
- Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
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18
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Ludwig S, Perrin N, Coisne A, Ben Ali W, Weimann J, Duncan A, Akodad M, Scotti A, Kalbacher D, Bleiziffer S, Nickenig G, Hausleiter J, Ruge H, Adam M, Petronio AS, Dumonteil N, Sondergaard L, Adamo M, Regazzoli D, Garatti A, Schmidt T, Dahle G, Taramasso M, Walther T, Kempfert J, Obadia JF, Chehab O, Tang GHL, Latib A, Goel SS, Fam NP, Andreas M, Muller DW, Denti P, Praz F, von Bardeleben RS, Granada JF, Modine T, Conradi L. Clinical outcomes of transcatheter mitral valve replacement: two-year results of the CHOICE-MI Registry. EUROINTERVENTION 2023; 19:512-525. [PMID: 37235388 PMCID: PMC10436071 DOI: 10.4244/eij-d-22-01037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/31/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Transcatheter mitral valve replacement (TMVR) using dedicated devices is an alternative therapy for high-risk patients with symptomatic mitral regurgitation (MR). AIMS This study aimed to assess the 2-year outcomes and predictors of mortality in patients undergoing TMVR from the multicentre CHOICE-MI Registry. METHODS The CHOICE-MI Registry included consecutive patients with symptomatic MR treated with 11 different dedicated TMVR devices at 31 international centres. The investigated endpoints included mortality and heart failure hospitalisation rates, procedural complications, residual MR, and functional status. Multivariable Cox regression analysis was applied to identify independent predictors of 2-year mortality. RESULTS A total of 400 patients, median age 76 years (interquartile range [IQR] 71, 81), 59.5% male, EuroSCORE II 6.2% (IQR 3.8, 12.0), underwent TMVR. Technical success was achieved in 95.2% of patients. MR reduction to ≤1+ was observed in 95.2% at discharge with durable results at 1 and 2 years. New York Heart Association Functional Class had improved significantly at 1 and 2 years. All-cause mortality was 9.2% at 30 days, 27.9% at 1 year and 38.1% at 2 years after TMVR. Chronic obstructive pulmonary disease, reduced glomerular filtration rate, and low serum albumin were independent predictors of 2-year mortality. Among the 30-day complications, left ventricular outflow tract obstruction, access site and bleeding complications showed the strongest impact on 2-year mortality. CONCLUSIONS In this real-world registry of patients with symptomatic MR undergoing TMVR, treatment with TMVR was associated with a durable resolution of MR and significant functional improvement at 2 years. Two-year mortality was 38.1%. Optimised patient selection and improved access site management are mandatory to improve outcomes.
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Affiliation(s)
- Sebastian Ludwig
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Cardiovascular Research Foundation, New York, NY, USA
| | - Nils Perrin
- Structural Valve Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Augustin Coisne
- Cardiovascular Research Foundation, New York, NY, USA
- CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Walid Ben Ali
- Structural Valve Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Jessica Weimann
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | | | | | - Andrea Scotti
- Cardiovascular Research Foundation, New York, NY, USA
- Montefiore Einstein Center for Heart and Vascular Care, Montefiore Medical Center, New York, NY, USA
| | - Daniel Kalbacher
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Sabine Bleiziffer
- Department of Cardiothoracic Surgery, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany and Ruhr University Bochum, Bochum, Germany
| | | | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Hendrik Ruge
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
- INSURE – Institute for Translational Cardiac Surgery, Department of Cardiovascular Surgery, German Heart Centre Munich, Germany
| | - Matti Adam
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur Toulouse, Toulouse, France
| | | | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | | | - Tobias Schmidt
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Gry Dahle
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | | | | | | | | | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Azeem Latib
- Montefiore Einstein Center for Heart and Vascular Care, Montefiore Medical Center, New York, NY, USA
| | - Sachin S Goel
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Neil P Fam
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | | | | | - Thomas Modine
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
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Hatab T, Zaid S, Toro S, Wessly P, Malahfji M, Faza N, Little SH, Kleiman NS, Reardon MJ, Goel SS. Now You See Me Now You Don't: Subaortic Membrane Causing a Diagnostic Dilemma. JACC Case Rep 2023; 18:101916. [PMID: 37545690 PMCID: PMC10401130 DOI: 10.1016/j.jaccas.2023.101916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 08/08/2023]
Abstract
Subaortic stenosis secondary to subaortic membrane is the second most common form of left ventricular outflow tract obstruction. We present the case of a 70-year-old male patient who presented with a 6-week history of progressive signs of heart failure. Multimodality imaging was required to confirm the presence of a subaortic membrane. (Level of Difficulty: Beginner.).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sachin S. Goel
- Address for correspondence: Dr Sachin S. Goel, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower, Suite 18.53, Houston, Texas 77030, USA. @SachinGoelMD
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20
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Zaid S, Attizzani GF, Krishnamoorthy P, Yoon SH, Palma Dallan LA, Chetcuti S, Fukuhara S, Grossman PM, Goel SS, Atkins MD, Kleiman NS, Puri R, Bakhtadze B, Byrne T, Ibrahim AW, Grubb KJ, Tully A, Herrmann HC, Faggioni M, Ramlawi B, Khera S, Lerakis S, Dangas GD, Kini AS, Sharma SK, Reardon MJ, Tang GHL. First-in-Human Multicenter Experience of the Newest Generation Supra-Annular Self-Expanding Evolut FX TAVR System. JACC Cardiovasc Interv 2023; 16:1626-1635. [PMID: 37438029 DOI: 10.1016/j.jcin.2023.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND The latest-generation Evolut FX TAVR system (Medtronic) offers several potential design improvements over its predecessors, but early reported experience has been limited. OBJECTIVES This study sought to report our multicenter, limited market release, first-in-human experience of transcatheter aortic valve replacement (TAVR) with the Evolut FX system and compare it with a single-center PRO+ (Medtronic) experience. METHODS From June 27 to September 16, 2022, 226 consecutive patients from 9 US centers underwent transfemoral TAVR with the Evolut FX system for native aortic stenosis (89.4%) or prosthetic valve degeneration (10.6%). Commissural alignment was defined as 0° to 30° between native and FX commissures. Patient, anatomical, and procedural characteristics were retrospectively reviewed, and 30-day clinical and echocardiographic outcomes per Valve Academic Research Consortium-3 definitions were reported. RESULTS Of 226 patients, 34.1% were low risk, 4% had a bicuspid valve, and 11.5% had a horizontal root (≥60°). Direct Inline sheath (Medtronic) was used in 67.6% and Lunderquist stiff wire (Cook Medical) in 35.4% of cases. Optimal hat marker orientation during deployment was achieved in 98.4%, with commissural alignment in 96.5%. At 30 days, 14.3% mild, 0.9% moderate, and no severe paravalvular leak were observed. Compared with the Evolut PRO+ experience from 1 center, FX had a more symmetrical implantation with shallower depth at the left coronary cusp (P < 0.001), fewer device recaptures (26.1% vs 39.5%; P = 0.004), and improved commissural alignment (96.5% vs 80.2%; P < 0.001). CONCLUSIONS The Evolut FX system demonstrated favorable 30-day outcomes with a significant improvement over PRO+ in achieving commissural alignment, fewer device recaptures, and more symmetrical implantation. These features may benefit younger patients undergoing TAVR with the supra-annular, self-expanding valve, where lifetime management would be important.
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Affiliation(s)
- Syed Zaid
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | | | - Sung-Han Yoon
- University Hospitals of Cleveland, Cleveland, Ohio, USA
| | | | | | | | | | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Marvin D Atkins
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | | | - Timothy Byrne
- Abrazo Arizona Heart Hospital, Phoenix, Arizona, USA
| | | | | | | | - Howard C Herrmann
- University of Pennsylvania Perlman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michela Faggioni
- University of Pennsylvania Perlman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Basel Ramlawi
- Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Sahil Khera
- Mount Sinai Hospital, New York, New York, USA
| | | | | | | | | | - Michael J Reardon
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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21
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Khan SU, Zahid S, Alkhouli MA, Akbar UA, Zaid S, Arshad HB, Little SH, Reardon MJ, Kleiman NS, Goel SS. An Updated Meta-Analysis on Cerebral Embolic Protection in Patients Undergoing Transcatheter Aortic Valve Intervention Stratified by Baseline Surgical Risk and Device Type. Struct Heart 2023; 7:100178. [PMID: 37520141 PMCID: PMC10382981 DOI: 10.1016/j.shj.2023.100178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 08/01/2023]
Abstract
Background Transcatheter aortic valve intervention (TAVI) can lead to the embolization of debris. Capturing the debris by cerebral embolic protection (CEP) devices may reduce the risk of stroke. New evidence has allowed us to examine the effects of CEP in patients undergoing TAVI. We aimed to assess the effects of CEP overall and stratified by the device used (SENTINEL or TriGuard) and the surgical risk of the patients. Methods We selected randomized controlled trials using electronic databases through September 17, 2022. We estimated random-effects risk ratios (RR) with (95% confidence interval) and calculated absolute risk differences at 30 days across baseline surgical risks derived from the TAVI trials for any stroke (disabling and nondisabling) and all-cause mortality. Results Among 6 trials (n = 3921), CEP vs. control did not reduce any stroke [RR: 0.95 (0.50-1.81)], disabling [RR: 0.75 (0.18-3.16)] or nondisabling [RR: 0.99 (0.65-1.49)] strokes, or all-cause mortality [RR: 1.23 (0.55-2.77)]. However, when analyzed by device, SENTINEL reduced disabling stroke [RR: 0.46 (0.22-0.95)], translating into 6 fewer per 1000 in high-risk, 3 fewer per 1000 in intermediate-risk, and 1 fewer per 1000 in low surgical-risk patients. CEP vs. control did not reduce the risk of any bleeding [RR: 1.03 (0.44-2.40)], major vascular complications [RR: 1.41 (0.57-3.48)], or acute kidney injury [RR: 1.36 (0.57-3.28)]. Conclusions This updated meta-analysis showed that SENTINEL CEP might reduce disabling stroke in patients undergoing TAVI. Patients with high and intermediate surgical risks were most likely to derive benefits.
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Affiliation(s)
- Safi U. Khan
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Salman Zahid
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, USA
| | - Mohamad A. Alkhouli
- Division of Interventional Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Usman Ali Akbar
- Department of Medicine, North Shore University Hospital, New York, New York, USA
| | - Syed Zaid
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Hassaan B. Arshad
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Stephen H. Little
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Michael J. Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Neal S. Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Sachin S. Goel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
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22
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Hatab T, Wessly P, Zaid S, Faza N, Chang SM, Kleiman NS, Little SH, Goel SS. When Echocardiography Is Challenging in Localizing Bioprosthetic Aortic Regurgitation: Dye Don't Lie. JACC Case Rep 2023; 15:101853. [PMID: 37283832 PMCID: PMC10240279 DOI: 10.1016/j.jaccas.2023.101853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 06/08/2023]
Abstract
Transesophageal echocardiography is the main imaging modality for localizing and quantifying prosthetic aortic regurgitation. We describe a case of bioprosthetic aortic paravalvular leak (PVL) where transesophageal echocardiography was inadequate; aortic root angiography and computed tomography fusion were critical in diagnosing and guiding closure. Multimodality imaging can be pivotal in localizing PVL and guiding transcatheter PVL closure. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Taha Hatab
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Priscilla Wessly
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Syed Zaid
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Nadeen Faza
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Su Min Chang
- Department of Cardiology, Houston Methodist Debakey Heart and Vascular Center, Houston, Texas, USA
| | - Neal S. Kleiman
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Stephen H. Little
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sachin S. Goel
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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23
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Zaid S, Avvedimento M, Vitanova K, Akansel S, Bhadra OD, Ascione G, Saha S, Noack T, Tagliari AP, Pizano A, Donatelle M, Squiers JJ, Goel K, Leurent G, Asgar AW, Ruaengsri C, Wang L, Leroux L, Flagiello M, Algadheeb M, Werner P, Ghattas A, Bartorelli AL, Dumonteil N, Geirsson A, Van Belle E, Massi F, Wyler von Ballmoos M, Goel SS, Reardon MJ, Bapat VN, Nazif TM, Kaneko T, Modine T, Denti P, Tang GHL. Impact of Mitral Regurgitation Etiology on Mitral Surgery After Transcatheter Edge-to-Edge Repair: From the CUTTING-EDGE Registry. JACC Cardiovasc Interv 2023; 16:1176-1188. [PMID: 37225288 DOI: 10.1016/j.jcin.2023.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/30/2023] [Accepted: 02/21/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Although >150,000 mitral TEER procedures have been performed worldwide, the impact of MR etiology on MV surgery after TEER remains unknown. OBJECTIVES The authors sought to compare outcomes of mitral valve (MV) surgery after failed transcatheter edge-to-edge repair (TEER) stratified by mitral regurgitation (MR) etiology. METHODS Data from the CUTTING-EDGE registry were retrospectively analyzed. Surgeries were stratified by MR etiology: primary (PMR) and secondary (SMR). MVARC (Mitral Valve Academic Research Consortium) outcomes at 30 days and 1 year were evaluated. Median follow-up was 9.1 months (IQR: 1.1-25.8 months) after surgery. RESULTS From July 2009 to July 2020, 330 patients underwent MV surgery after TEER, of which 47% had PMR and 53.0% had SMR. Mean age was 73.8 ± 10.1 years, median STS risk at initial TEER was 4.0% (IQR: 2.2%-7.3%). Compared with PMR, SMR had a higher EuroSCORE, more comorbidities, lower LVEF pre-TEER and presurgery (all P < 0.05). SMR patients had more aborted TEER (25.7% vs 16.3%; P = 0.043), more surgery for mitral stenosis after TEER (19.4% vs 9.0%; P = 0.008), and fewer MV repairs (4.0% vs 11.0%; P = 0.019). Thirty-day mortality was numerically higher in SMR (20.4% vs 12.7%; P = 0.072), with an observed-to-expected ratio of 3.6 (95% CI: 1.9-5.3) overall, 2.6 (95% CI: 1.2-4.0) in PMR, and 4.6 (95% CI: 2.6-6.6) in SMR. SMR had significantly higher 1-year mortality (38.3% vs 23.2%; P = 0.019). On Kaplan-Meier analysis, the actuarial estimates of cumulative survival were significantly lower in SMR at 1 and 3 years. CONCLUSIONS The risk of MV surgery after TEER is nontrivial, with higher mortality after surgery, especially in SMR patients. These findings provide valuable data for further research to improve these outcomes.
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Affiliation(s)
- Syed Zaid
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | | | | | - Oliver D Bhadra
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | | | | | | | - Alejandro Pizano
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | - Kashish Goel
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Chawannuch Ruaengsri
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California, USA
| | - Lin Wang
- St. Francis Hospital, Roslyn, New York, USA
| | | | | | - Muhanad Algadheeb
- London Health Sciences Center, Western University, London, Ontario, Canada
| | - Paul Werner
- Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | | | | | | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Michael J Reardon
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | - Tamim M Nazif
- Columbia University Medical Center, New York, New York, USA
| | - Tsuyoshi Kaneko
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
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24
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Tang GHL, Zaid S, Kleiman NS, Goel SS, Fukuhara S, Marin-Cuartas M, Kiefer P, Abdel-Wahab M, De Backer O, Søndergaard L, Saha S, Hagl C, Wyler von Ballmoos M, Bhadra O, Conradi L, Grubb KJ, Shih E, DiMaio JM, Szerlip M, Vitanova K, Ruge H, Unbehaun A, Kempfert J, Pirelli L, Kliger CA, Van Mieghem N, Hokken TW, Adrichem R, Modine T, Corona S, Wang L, Petrossian G, Robinson N, Meier D, Webb JG, Cheung A, Ramlawi B, Herrmann HC, Desai ND, Andreas M, Mach M, Waksman R, Schults CC, Ahmad H, Goldberg JB, Geirsson A, Forrest JK, Denti P, Belluschi I, Ben-Ali W, Asgar AW, Taramasso M, Rovin JD, Di Eusanio M, Colli A, Kaneko T, Nazif TN, Leon MB, Bapat VN, Mack MJ, Reardon MJ, Sathananthan J. Explant vs Redo-TAVR After Transcatheter Valve Failure: Mid-Term Outcomes From the EXPLANTORREDO-TAVR International Registry. JACC Cardiovasc Interv 2023; 16:927-941. [PMID: 37100556 DOI: 10.1016/j.jcin.2023.01.376] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/02/2023] [Accepted: 01/31/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Valve reintervention after transcatheter aortic valve replacement (TAVR) failure has not been studied in detail. OBJECTIVES The authors sought to determine outcomes of TAVR surgical explantation (TAVR-explant) vs redo-TAVR because they are largely unknown. METHODS From May 2009 to February 2022, 396 patients in the international EXPLANTORREDO-TAVR registry underwent TAVR-explant (181, 46.4%) or redo-TAVR (215, 54.3%) for transcatheter heart valve (THV) failure during a separate admission from the initial TAVR. Outcomes were reported at 30 days and 1 year. RESULTS The incidence of reintervention after THV failure was 0.59% with increasing volume during the study period. Median time from index-TAVR to reintervention was shorter in TAVR-explant vs redo-TAVR (17.6 months [IQR: 5.0-40.7 months] vs 45.7 months [IQR: 10.6-75.6 months]; P < 0.001], respectively. TAVR-explant had more prosthesis-patient mismatch (17.1% vs 0.5%; P < 0.001) as the indication for reintervention, whereas redo-TAVR had more structural valve degeneration (63.7% vs 51.9%; P = 0.023), with a similar incidence of ≥moderate paravalvular leak between groups (28.7% vs 32.8% in redo-TAVR; P = 0.44). There was a similar proportion of balloon-expandable THV failures (39.8% TAVR-explant vs 40.5% redo-TAVR; P = 0.92). Median follow-up was 11.3 (IQR: 1.6-27.1 months) after reintervention. Compared with redo-TAVR, TAVR-explant had higher mortality at 30 days (13.6% vs 3.4%; P < 0.001) and 1 year (32.4% vs 15.4%; P = 0.001), with similar stroke rates between groups. On landmark analysis, mortality was similar between groups after 30 days (P = 0.91). CONCLUSIONS In this first report of the EXPLANTORREDO-TAVR global registry, TAVR-explant had a shorter median time to reintervention, with less structural valve degeneration, more prosthesis-patient mismatch, and similar paravalvular leak rates compared with redo-TAVR. TAVR-explant had higher mortality at 30 days and 1 year, but similar rates on landmark analysis after 30 days.
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Affiliation(s)
| | - Syed Zaid
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Sachin S Goel
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | | | | | | | | | - Ole De Backer
- The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Søndergaard
- The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Shekhar Saha
- German Centre for Cardiovascular Research (DZHK), Munich Heart Alliance, Munich, Germany
| | - Christian Hagl
- Ludwig Maximillian University of Munich, Munich, Germany
| | | | - Oliver Bhadra
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lenard Conradi
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Emily Shih
- Baylor Scott and White Health, Heart Hospital Plano, Plano, Texas, USA
| | - J Michael DiMaio
- Baylor Scott and White Health, Heart Hospital Plano, Plano, Texas, USA
| | - Molly Szerlip
- Baylor Scott and White Health, Heart Hospital Plano, Plano, Texas, USA
| | | | | | | | | | | | | | | | | | - Rik Adrichem
- Eramus University Medical Center, Rotterdam, the Netherlands
| | - Thomas Modine
- UMCV Hôpital Haut-Lévêque, CHU Bordeaux, Bordeaux, France
| | - Silvia Corona
- UMCV Hôpital Haut-Lévêque, CHU Bordeaux, Bordeaux, France
| | - Lin Wang
- St. Francis Hospital, Roslyn, New York, USA
| | | | | | - David Meier
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Anson Cheung
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Basel Ramlawi
- Lankanau Heart Institute at Main Line Health, Philadelphia, Pennsylvania, USA
| | | | - Nimesh D Desai
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Markus Mach
- Medical University of Vienna, Vienna, Austria
| | - Ron Waksman
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Hasan Ahmad
- Westchester Medical Center, Valhalla, New York, USA
| | | | | | | | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | | | | | | | | | | | | | | | - Tsuyoshi Kaneko
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Tamim N Nazif
- Columbia University Irving Medical Center, New York, New York, USA
| | - Martin B Leon
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Michael J Mack
- Baylor Scott and White Health, Heart Hospital Plano, Plano, Texas, USA
| | - Michael J Reardon
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
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25
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Reardon MJ, Goel SS. SAPIEN 3 Ultra: better sealing, reduced paravalvular leak and a move in the right direction? EUROINTERVENTION 2023; 18:1391-1392. [PMID: 37092270 PMCID: PMC10111123 DOI: 10.4244/eij-e-23-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Affiliation(s)
- Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Sachin S Goel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
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26
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Goel SS, Reardon MJ. Indication Creep in Transcatheter Aortic Valve Implantation-Data or Desire? JAMA Cardiol 2023:2804195. [PMID: 37074692 DOI: 10.1001/jamacardio.2023.0674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Affiliation(s)
- Sachin S Goel
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Texas
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27
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Khan SU, Lone AN, Akbar UA, Arshad HB, Arshad A, Arora S, Kaluski E, Aoun J, Goel SS, Shah AR, Kleiman NS. Assessment of Repeat Revascularization in Percutaneous Coronary Intervention Randomized Controlled Trials as a Surrogate for Mortality: A Meta-Regression Analysis. Curr Probl Cardiol 2023; 48:101555. [PMID: 36529233 DOI: 10.1016/j.cpcardiol.2022.101555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/16/2022]
Abstract
The association of repeat revascularization after percutaneous coronary intervention (PCI) with mortality is uncertain. To assess the association of repeat revascularization after PCI with mortality in patients with coronary artery disease (CAD). We identified randomized controlled trials comparing PCI with coronary artery bypass graft (CABG) or optimal medical therapy (OMT) using electronic databases through January 1, 2022. We performed a random-effects meta-regression between repeat revascularization rates after PCI (absolute risk difference [%] between PCI and CABG or OMT) with the relative risks (RR) of mortality. We assessed surrogacy of repeat revascularization for mortality using the coefficient of determination (R2), with threshold of 0.80. In 33 trials (21,735 patients), at median follow-up of 4 (2-7) years, repeat revascularization was higher after PCI than CABG [RR: 2.45 (95% confidence interval, 1.99-3.03)], but lower vs OMT [RR: 0.64 (0.46-0.88)]. Overall, meta-regression showed that repeat revascularization rates after PCI had no significant association with all-cause mortality [RR: 1.01 (0.99-1.02); R2=0.10) or cardiovascular mortality [RR: 1.01 (CI: 0.99-1.03); R2=0.09]. In PCI vs CABG (R2=0.0) or PCI vs OMT trials (R2=0.28), repeat revascularization did not meet the threshold for surrogacy for all-cause or cardiovascular mortality (R2=0.0). We observed concordant results for subgroup analyses (enrollment time, follow-up, sample size, risk of bias, stent types, and coronary artery disease), and multivariable analysis adjusted for demographics, comorbidities, risk of bias, MI, and follow-up duration. In summary, this meta-regression did not establish repeat revascularization after PCI as a surrogate for all-cause or cardiovascular mortality.
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Affiliation(s)
- Safi U Khan
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Ahmad N Lone
- Guthrie Health System/Robert Packer Hospital, Sayre, PA
| | - Usman Ali Akbar
- Division of Infectious Disease, the University of Louisville, Louisville, KY
| | - Hassaan B Arshad
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Adeel Arshad
- Department of Medical Oncology, Ohio State University Comprehensive Cancer Care Center, Columbus, OH
| | - Shilpkumar Arora
- Department of Cardiology, Case Western Reserve University, Cleveland, OH
| | - Edo Kaluski
- Guthrie Health System/Robert Packer Hospital, Sayre, PA
| | - Joe Aoun
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Sachin S Goel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Alpesh R Shah
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Neal S Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX.
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Abraham B, Sous M, Sedhom R, Megaly M, Roman S, Sweeney J, Alkhouli M, Pollak P, El Sabbagh A, Garcia S, Goel SS, Saad M, Fortuin D. Meta-Analysis on Transcarotid Versus Transfemoral and Other Alternate Accesses for Transcatheter Aortic Valve Implantation. Am J Cardiol 2023; 192:196-205. [PMID: 36821875 DOI: 10.1016/j.amjcard.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/02/2023] [Accepted: 01/13/2023] [Indexed: 02/23/2023]
Abstract
Transcarotid access has emerged as the preferred access site for transcatheter aortic valve implantation (TAVI) in patients with prohibitive iliofemoral anatomy. This study aimed to compare outcomes with transcarotid with those of other accesses in patients who underwent TAVI. Cochrane, EMBASE, and MEDLINE databases were searched for all published studies that compared outcomes with transcarotid with those of other accesses (transfemoral, transaxillary/subclavian, transaortic, and transapical) in patients who underwent TAVI. The primary outcome was all-cause mortality. Secondary outcomes included major bleeding, major vascular complications, stroke, myocardial infarction, permanent pacemaker implantation, and peri-aortic valve insufficiency. We included 22 observational studies with a total of 11,896 patients. Outcomes were reported during hospitalization and at 1-month follow-up. The transcarotid approach had higher mortality at 1 month (3.7% vs 2.6%, p = 0.02) but lower major vascular complications during hospitalization (1.5% vs 3.4%, p = 0.04) than did transfemoral access. The transcarotid approach had lower major vascular complications (2% vs 2.3%, p = 0.04) than did the transaxillary/subclavian but higher major bleeding (5.3% vs 2.6%, p = 0.03). The transaortic approach was associated with higher in-hospital (11.7% vs 1.9%, p = 0.02) and 1-month mortality (14.4% vs 3.9%, p = 0.007) rates than was transcarotid access. The transcarotid approach numerically reduced mortality and the risk of major vascular complications and major bleeding compared with the transapical approach; however, this did not reach statistical significance. The transcarotid approach did not increase the risk of stroke compared with transfemoral or the other alternative accesses. In conclusion, the transcarotid or transaxillary/subclavian approach had associated comparable outcomes that were better than those of the transapical and transaortic approaches. There was no difference in stroke risk between transcarotid access and other accesses.
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Affiliation(s)
- Bishoy Abraham
- Department of Cardiovascular Disease, Mayo Clinic Hospital, Phoenix, Arizona.
| | - Mina Sous
- Department of Medicine, Amita Health Saint Francis Hospital, Evanston, Illinois
| | - Ramy Sedhom
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Michael Megaly
- Department of Cardiovascular Disease, Willis-Knighton Health System, Shreveport, Louisiana
| | - Sherif Roman
- Department of Medicine, St Joseph's University, Clifton, New Jersey
| | - John Sweeney
- Department of Cardiovascular Disease, Mayo Clinic Hospital, Phoenix, Arizona
| | - Mohamad Alkhouli
- Department of Cardiovascular Disease, Mayo Clinic Hospital, Rochester, Minnesota
| | - Peter Pollak
- Department of Cardiovascular Disease, Mayo Clinic Hospital, Rochester, Minnesota
| | - Abdallah El Sabbagh
- Department of Cardiovascular Disease, Mayo Clinic Hospital, Jacksonville, Florida
| | - Santigao Garcia
- Department of Cardiovascular Disease, the Christ Hospital, Cincinnati, Ohio
| | - Sachin S Goel
- Department of Cardiovascular Disease, Houston Methodist Hospital, Houston, Texas
| | - Marwan Saad
- Department of Medicine, Division of Cardiovascular Disease, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - David Fortuin
- Department of Cardiovascular Disease, Mayo Clinic Hospital, Phoenix, Arizona
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29
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Agrawal A, Reardon MJ, Goel SS. Transcatheter Mitral Valve Replacement in Patients with Mitral Annular Calcification: A Review. Heart Int 2023; 17:19-26. [PMID: 37456353 PMCID: PMC10339466 DOI: 10.17925/hi.2023.17.1.19] [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: 11/14/2022] [Accepted: 01/31/2023] [Indexed: 07/18/2023] Open
Abstract
Mitral annular calcification (MAC) is a progressive degenerative calcification of the mitral valve (MV) that is associated with mitral stenosis, regurgitation or both. Patients with MAC are poor candidates for MV surgery because of technical challenges and high peri-operative mortality. Transcatheter MV replacement (TMVR) has emerged as an option for such high surgical risk patients. This has been described with the use of the SAPIEN transcatheter heart valve (valve-in-MAC) and dedicated TMVR devices. Careful anatomic assessment is important to avoid complications of TMVR, such as left ventricular outflow tract obstruction, valve migration, embolization and paravalvular mitral regurgitation. In this review, we discuss the pathology, importance of preprocedural multimodality imaging for optimal patient selection, clinical outcomes and complications associated with TMVR in patients with MAC.
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Affiliation(s)
- Ankit Agrawal
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michael J Reardon
- Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, USA
| | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, USA
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30
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Hatab T, Zaid S, Toro S, Little SH, Kleiman NS, Reardon MJ, Goel SS. NOW YOU SEE ME NOW YOU DON’T: SUBAORTIC MEMBRANE CAUSING A DIAGNOSTIC DILEMMA. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04290-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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Wessly P, Hatab T, Zaid S, Telmesani A, Ali SA, Khan S, Hinohara T, Faza NN, Reardon MJ, Kleiman NS, Zoghbi WA, Little SH, Goel SS. INTRAPROCEDURAL HEMODYNAMIC RISK PROFILING USING PULMONARY VEIN FLOW CHANGE TO PREDICT CLINICAL OUTCOMES AFTER MITRAL TRANSCATHETER EDGE TO EDGE REPAIR (TEER). J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01255-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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Sammour YM, Spertus JA, Kennedy K, Morrow DA, Daniels LB, Jones P, Alger H, Stevens L, Shah A, Goel SS, de Lemos JA, Hayek SS, Sutton NR, Kleiman NS. Site-level variability in the processes of care and outcomes over time among patients with COVID-19 and myocardial injury: Insights from the American Heart Association's COVID-19 Cardiovascular Disease Registry. Am Heart J Plus 2023; 27:100265. [PMID: 36779177 PMCID: PMC9894823 DOI: 10.1016/j.ahjo.2023.100265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
Background Elevated cardiac troponin (cTn) levels in patients with COVID-19 has been associated with worse outcomes. Guidelines on best practices of those patients remain uncertain. Methods We included patients with COVID-19 and cTn above the assay-specific upper limit of normal (ULN) enrolled in the American Heart Association's COVID-19 registry between March 2020-January 2021. Site-level variability in invasive coronary angiography, LVEF assessment, ICU utilization, and inpatient mortality were determined by calculating adjusted median odds ratio (MOR) using hierarchical logistic regression models. Temporal trends were assessed with Cochran-Armitage trend test. Results Among 32,636 patients, we included 6234 (19.4 %) with cTn above ULN (age 68.7 ± 16.0 years, 56.5 % male, 51.5 % Caucasian), of whom 1365 (21.6 %) had ≥5-fold elevations. Across 55 sites, the median rate of invasive coronary angiography was 0.1 % with adjusted MOR 1.5(1.0,2.3), median LVEF assessment was 25.5 %, MOR 3.0(2.2,3.9), ICU utilization was 41.7 %, MOR 2.2(1.8,2.6), and mortality was 20.9 %, MOR 1.7(1.5,2.0). Over time, we noted a significant increase in invasive coronary angiography (p-trend = 0.001), and LVEF assessment (p-trend<0.001), and reduction in mortality (p-trend<0.001), without significant change in ICU admissions (p-trend = 0.08). Similar variability and temporal trends were seen among patients with ≥5-fold cTn elevation. Conclusions The use of invasive coronary angiography among patients with COVID-19 and myocardial injury was very low during the early pandemic. We found moderate institutional variability in processes of care with an uptrend in invasive catheterization and LVEF assessment, and downtrend in mortality. Comparative effectiveness studies are needed to examine whether variability in care is associated with differences in outcomes.
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Affiliation(s)
- Yasser M. Sammour
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - John A. Spertus
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, MO, USA
| | - Kevin Kennedy
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, MO, USA
| | - David A. Morrow
- Cardovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Phil Jones
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, MO, USA
| | - Heather Alger
- National Director Data Solutions & Research Quality and Health IT, American Heart Association, USA
| | - Laura Stevens
- National Director Data Solutions & Research Quality and Health IT, American Heart Association, USA
| | - Alpesh Shah
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Sachin S. Goel
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | | | - Salim S. Hayek
- Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Neal S. Kleiman
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
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Thakkar S, Zahid S, Hashem AM, Ali OTA, Gowda SN, Ullah W, Khan S, Patel H, Mohamed MS, Faza NN, Goel SS. TRENDS, PREDICTORS, AND OUTCOMES OF MITRAL TRANSCATHETER EDGE-TO-EDGE REPAIR AS SALVAGE THERAPY IN PATIENTS WITH CARDIOGENIC SHOCK-INSIGHTS FROM THE UNITED STATES NATIONWIDE READMISSION DATABASE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01299-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Zahid S, Khan M, Ullah W, Arshad A, Zaid S, Little SH, Kleiman NS, Goel SS, Khan S. MACHINE LEARNING DERIVED RISK-PREDICTION MODEL FOR 30-DAY READMISSION FOLLOWING MITRAL TRANSCATHETER EDGE TO EDGE REPAIR. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01272-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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Hatab T, Wessly P, Okunrintemi V, Zaid S, Chinnadurai P, Kleiman NS, Little SH, Goel SS. WHEN ECHOCARDIOGRAPHY IS CHALLENGING IN LOCALIZING BIOPROSTHETIC AORTIC REGURGITATION - DYE DON’T LIE …!! J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04292-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Rivera FB, De Luna D, Ansay MF, Nguyen RT, Flores G, Ong K, Goel SS, Inohara T, Volgman AS. TRANSCATHETER AORTIC VALVE REPLACEMENT OUTCOMES IN ASIA: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01545-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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37
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Bashir H, Reardon M, Goel SS, Fam N, Jelisejevas J, Webb JG, Ye J, Frisoli TM, Siddiqui M, Garcia S, Answini GA, Kereiakes DJ. CRT-700.1 Multi-Center Compassionate use Early Feasibility Evaluation of J-Valve Transcatheter Treatment for Severe Aortic Valve Regurgitation: Preliminary Results. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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38
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Gupta M, Minhas AMK, Goel SS, Dani SS, Alam M, Nazir S, Khan SU, Aronow W, Jain V. Contemporary trends in utilization and outcomes of percutaneous left atrial appendage occlusion in the United States from 2016 to 2019. Heart Rhythm 2023; 20:313-314. [PMID: 36257480 DOI: 10.1016/j.hrthm.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/21/2022] [Accepted: 10/12/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Mohak Gupta
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Abdul M K Minhas
- Department of Medicine, Forrest General Hospital, Hattiesburg, Mississippi
| | - Sachin S Goel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Sourbha S Dani
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts
| | - Mahboob Alam
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Salik Nazir
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Safi U Khan
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Wilbert Aronow
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Vardhmaan Jain
- Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
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Hatab T, Wessly P, Syed Z, Telmesani A, Villanueva V, Faza N, Atkins MD, Reardon MJ, Kleiman NS, Little SH, Zoghbi WA, Goel SS. CRT-700.09 Impact of Mitral Annular Calcification on Outcomes After Mitral Transcatheter Edge-to-Edge Repair. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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40
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Islam M, Hennawi HA, Bakir M, Khedr A, Goel SS. MINOCA mimic: Type 2 myocardial infarction due to severe aortic stenosis complicated by cardiogenic shock. Glob Cardiol Sci Pract 2023; 2023:e202301. [PMID: 36890844 PMCID: PMC9988295 DOI: 10.21542/gcsp.2023.1] [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] [Received: 12/02/2022] [Accepted: 01/10/2023] [Indexed: 02/08/2023] Open
Abstract
Acute myocardial infarction without significant obstructive coronary disease presents a challenging clinical entity that requires timely intervention. The term myocardial infarction with nonobstructive coronary arteries (MINOCA) describes a working diagnosis attributed to varying etiologies in patients with a presumed ischemic cardiac condition. Several overlapping etiologies can be classified as type 2 myocardial infarction (MI). The 2019 AHA statement established diagnostic criteria and clarified the associated confusion, aiding in appropriate diagnosis. In this report, we present a case of demand-ischemia MINOCA and cardiogenic shock in a patient with severe aortic stenosis (AS).
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Affiliation(s)
- Momin Islam
- Houston Methodist Hospital, Department of Cardiology, USA
| | - Hussam Al Hennawi
- Department of Internal Medicine, Jefferson Abington Hospital, Abington, PA, USA
| | - Mohamad Bakir
- Alfaisal University, College of Medicine, Riyadh, Saudi Arabia
| | - Anwar Khedr
- Mayo Clinic Health System, Mankato, Minnesota, USA
| | - Sachin S Goel
- Houston Methodist Hospital, Department of Cardiology, USA
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41
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Aoun J, Reardon MJ, Goel SS. Transcatheter Mitral Valve Replacement with Dedicated Devices. Methodist Debakey Cardiovasc J 2023; 19:50-56. [PMID: 37213879 PMCID: PMC10198241 DOI: 10.14797/mdcvj.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 04/26/2023] [Indexed: 05/23/2023] Open
Abstract
Mitral regurgitation is the most common form of valvular heart disease. The anatomy and pathophysiology of mitral valve regurgitation are very complex, and dedicated devices are required for transcatheter mitral valve replacement in patients with a high or prohibitive surgical risk. In the United States, all transcatheter mitral valve replacement devices are still being studied and are not yet approved for commercial use. Early feasibility studies have demonstrated good technical success and short-term outcomes, but larger samples and longer-term outcomes still need to be assessed. Furthermore, significant advances in device technology, delivery systems, and implantation techniques are essential to avoid left ventricular outflow tract obstruction, and valvular and paravalvular regurgitation as well as ensuring good anchoring of the prosthesis.
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Affiliation(s)
- Joe Aoun
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Michael J. Reardon
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Sachin S Goel
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
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42
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Desai PV, Goel SS, Kleiman NS, Reardon MJ. Transcatheter Aortic Valve Implantation: Long-Term Outcomes and Durability. Methodist Debakey Cardiovasc J 2023; 19:15-25. [PMID: 37213878 PMCID: PMC10198228 DOI: 10.14797/mdcvj.1201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/27/2023] [Indexed: 05/23/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has become the standard of care in symptomatic older patients with severe aortic stenosis regardless of surgical risk. With the development of newer generation transcatheter bioprostheses, improved delivery systems, better preprocedure planning with imaging guidance, increased operator experience, shorter hospital length of stay, and low short- and mid-term complication rates, TAVI is gaining popularity among younger patients at low or intermediate surgical risk. Long-term outcomes and durability of transcatheter heart valves have become substantially important for this younger population due to their longer life expectancy. The lack of standardized definitions of bioprosthetic valve dysfunction and disagreement about how to account for the competing risks made comparison of transcatheter heart valves with surgical bioprostheses challenging until recently. In this review, the authors discuss the mid- to long-term (≥ 5 years) clinical outcomes observed in the landmark TAVI trials and analyze the available long-term durability data emphasizing the importance of using standardized definitions of bioprosthetic valve dysfunction.
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Affiliation(s)
| | - Sachin S. Goel
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Neal S. Kleiman
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Michael J. Reardon
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
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Gupta T, von Ballmoos MWC, Reardon MJ, Kleiman NS, Goel SS. Ventricular Embolization of Mitral Valve in Valve Rescued With a Second Valve. J Invasive Cardiol 2023; 35:E55-E56. [PMID: 36588095] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Valve embolization is a catastrophic complication of mitral valve-in-valve and valve-in-ring procedures and occurs due to inadequate ventricular positioning, undersizing, or insufficient anchoring. Emergent cardiac surgery to retrieve the embolized valve is usually required for overt embolization. In the situation described herein, a decision was made to attempt to deploy a second valve at a proper depth to anchor the embolized valve and prevent further migration. This case highlights the technique of deploying a second valve to anchor the embolized valve if valve migration has occurred with minimal movement.
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Affiliation(s)
| | | | | | | | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin Street, Suite 1853, Houston, TX 77030 USA.
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Ijaz SH, Minhas AMK, Jain V, Rifai MA, Sharma G, Mehta A, Dani SS, Fudim M, Al-Kindi SG, Sperling L, Shapiro MD, Alam M, Virani SS, Goel SS, Nasir K, Khan SU. Characteristics and outcomes in acute myocardial infarction hospitalizations among the older population (age ≥80 years) in the United States, 2004-2018. Arch Gerontol Geriatr 2023; 111:104930. [DOI: 10.1016/j.archger.2023.104930] [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] [Received: 12/20/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/23/2023]
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45
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Goel SS. The Current and Future Landscape of Structural Heart Interventions. Methodist Debakey Cardiovasc J 2023; 19:1-3. [PMID: 37213872 PMCID: PMC10198246 DOI: 10.14797/mdcvj.1251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/23/2023] Open
Affiliation(s)
- Sachin S. Goel
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas, US
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46
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Minhas AMK, Gul S, Sheikh AB, Nazir S, Ahuja KR, Anwar MN, Dani SS, Goel SS, Virani SS, Alam M. Association of Body Mass Index With Outcomes in Patients Undergoing Percutaneous Left Atrial Appendage Closure With the Watchman Device. Curr Probl Cardiol 2022; 47:101009. [PMID: 34599987 DOI: 10.1016/j.cpcardiol.2021.101009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/19/2022]
Affiliation(s)
| | - Sajjad Gul
- Department of Internal Medicine, Reading Hospital-Tower Health System, West Reading, PA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM.
| | - Salik Nazir
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH
| | - Keerat Rai Ahuja
- Department of Cardiology, Reading Hospital-Tower Health System, West Reading, PA
| | - Muhammad Nadeem Anwar
- Department of Internal Medicine, Oklahoma City Veterans Affair Medical Center, Oklahoma City, OK
| | - Sourbha S Dani
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA
| | - Sachin S Goel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Salim S Virani
- Michael E. DeBakey Veterans Affair Medical Center & Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Mahboob Alam
- Michael E. DeBakey Veterans Affair Medical Center & Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX
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47
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Al Abri Q, El Nihum LI, Hinohara T, Chang SM, Faza NN, Goel SS, Kleiman NS, Wyler von Ballmoos MC, Atkins MD, Reardon MJ. Late Transcatheter Aortic Valve Thrombosis Leading to Cardiogenic Shock. JACC Case Rep 2022; 4:1459-1463. [PMID: 36444179 PMCID: PMC9700056 DOI: 10.1016/j.jaccas.2022.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/18/2022] [Accepted: 07/27/2022] [Indexed: 06/16/2023]
Abstract
A 67-year-old woman with prior transcatheter aortic valve replacement presented with worsening dyspnea. Imaging revealed transcatheter aortic valve thrombosis and aortic stenosis. Despite oral anticoagulation, she progressively deteriorated and developed cardiogenic shock. We highlight the Heart Team's role in treating this unusual late thrombosis. (Level of Difficulty: Intermediate.).
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Key Words
- CT, computed tomography
- DAPT, dual antiplatelet therapy
- HALT, hypoattenuated leaflet thrombosis
- IABP, intra-aortic balloon pump
- LVEF, left ventricular ejection fraction
- OAC, oral anticoagulation
- SAPT, single antiplatelet therapy
- SAVR, surgical aortic valve replacement
- TAV, transcatheter aortic valve
- TAVR, transcatheter aortic valve replacement
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
- hypoattenuated leaflet thrombosis
- transcatheter heart valve
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Affiliation(s)
- Qasim Al Abri
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Lamees I. El Nihum
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
- Texas A&M College of Medicine, Bryan, Texas, USA
| | - Tomoya Hinohara
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Su Min Chang
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Nadeen N. Faza
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Sachin S. Goel
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Neal S. Kleiman
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | | | - Marvin D. Atkins
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Michael J. Reardon
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
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Elbadawi A, Dang AT, Sedhom R, Hamed M, Eid M, Golwala H, Goel SS, Mamas MA, Elgendy IY. Direct Oral Anticoagulants Versus Antiplatelet Therapy After Transcatheter Aortic Valve Replacement: A Meta-Analysis of Randomized Trials. Circ Cardiovasc Interv 2022; 15:e012194. [PMID: 36065799 DOI: 10.1161/circinterventions.122.012194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ayman Elbadawi
- Division of Cardiology' University of Texas Southwestern Medical Center' Dallas (A.E.)
| | - Alexander T Dang
- Department of Internal Medicine, University of Texas Medical Branch, Galveston (A.T.D.)
| | - Ramy Sedhom
- Division of Cardiology' Loma Linda University Health' CA (R.S.)
| | - Mohamed Hamed
- Division of Internal Medicine, Florida Atlantic University, Boca Raton (M.H.)
| | - Mennaallah Eid
- Department of Internal Medicine, Lincoln Medical Center, New York, NY (M.E.)
| | - Harsh Golwala
- Division of Cardiology, Oregon Health and Science University, Portland (H.G.)
| | - Sachin S Goel
- Houston Methodist DeBakey Heart & Vascular Center, TX (S.S.G.)
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, United Kingdom (M.A.M.)
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington (I.Y.E.)
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49
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Jain V, Minhas AMK, Kleiman NS, Arshad HB, Saleh Y, Pandat SS, Dani SS, Goel SS, Faza N, Butt SA, Blankstein R, Cainzos-Achirica M, Nasir K, Khan SU. Cardiac Arrest in Young Adults with Ischemic Heart Disease in the United States, 2004-2018. Curr Probl Cardiol 2022; 47:101312. [PMID: 35839933 DOI: 10.1016/j.cpcardiol.2022.101312] [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: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cardiac arrest (CA) among young adults (<45 y) with ischemic heart disease (IHD) remained understudied. OBJECTIVE To evaluate the trends in clinical profile, in-hospital mortality, and health care resource utilization in CA-related hospitalizations among young adults with IHD. METHODS National Inpatient Sample (2004-2018) was used to identify adults aged 18- 45 years. RESULTS Of 77,359 weighted CA-related hospitalizations (mean age: 39 [0.05] y; 34.3% women), 65% had a myocardial infarction (MI), and 58% had a shockable rhythm. Between 2004 and 2018, CA-related hospitalizations among young adults with IHD increased from 1.8% to 2.4%. Overall, in-hospital mortality was 36.4%, which was higher for women vs. men (40.4% vs. 34.2%; p<0.001) and Black vs. White adults (43.9% vs. 33.3%; p<0.001). In-hospital mortality increased from 33.5% to 38.1%, with a consistent upward trend in men, White adults, and both MI and non-MI cases. However, in STEMI (40%), in-hospital mortality decreased from 34.6% to 20.2% (p-trend <0.001), while it increased in NSTEMI (14.8%) from 34.3% to 47.5% (p-trend <0.001). Overall mean length of stay (LOS) (7 to 9 days) and mean inflation-adjusted care cost ($34,431 to $44,646) increased over the study duration. CONCLUSION CA-related hospitalizations and associated LOS and inflation-adjusted care costs have increased in the last 15 years. In-hospital mortality increased by ∼5% during the study period with a higher mortality in women and among black adults. While increased CA-related hospitalizations may reflect improved pre-hospital care, greater efforts are needed to address improve in-hospital survival in CA among young adults with IHD.
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Affiliation(s)
| | | | - Neal S Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Hassaan B Arshad
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Yehia Saleh
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Summit S Pandat
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Sourbha S Dani
- Division of Cardiology, Lahey Hospital, and Medical Center, Beth Israel Lahey Health, Burlington, MA
| | - Sachin S Goel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Nadeen Faza
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Sara Ayaz Butt
- Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Ron Blankstein
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
| | - Miguel Cainzos-Achirica
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX; Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX; Center for Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, TX; Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Khurram Nasir
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX; Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX; Center for Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, TX; Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Safi U Khan
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX.
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Zaidi SH, Minhas AMK, Sagheer S, ManeshGangwani K, Dani SS, Goel SS, Alam M, Sheikh AB, Hirji S, Wasty N. Clinical Outcomes of Transcatheter Aortic Valve Replacement (TAVR) vs. Surgical Aortic Valve Replacement (SAVR) in Patients With Durable Left Ventricular Assist Device (LVAD). Curr Probl Cardiol 2022; 47:101313. [PMID: 35817155 DOI: 10.1016/j.cpcardiol.2022.101313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patients with left ventricular assist device often develop aortic insufficiency requiring an intervention on the aortic valve. We sought to analyze the outcomes of patients with a history of LVAD who underwent either transcatheter aortic valve replacement or surgical aortic valve replacement. METHODS The Nationwide Readmission Database was used to extract relevant patient information from January 1, 2016, to December 31, 2018. The NRD is a nationally representative sample of all-payer discharges from U.S. non-federal hospitals. The primary outcome of interest was in-hospital mortality. Secondary outcomes included length of stay, clinical outcomes, costs, and 30-day all-cause readmissions. Complex samples multivariable logistic and linear regression models were used to determine the association of procedure type with outcomes. RESULTS Among 148 hospitalizations with a history of LVAD, 87 underwent TAVR, and 61 underwent SAVR. The inpatient mortality in SAVR group was numerically higher compared to the TAVR cohort, however, it did not reach statistical significance. The use of invasive mechanical ventilation, and rates of cardiogenic shock, bleeding, and vascular complications were higher in the SAVR cohort compared to the TAVR cohort. The mean length of stay and costs were higher in the SAVR cohort compared to the TAVR cohort. The 30-day all-cause readmission rate was numerically higher in the SAVR group but not statistically significant. CONCLUSIONS TAVR in patients with LVAD may be a viable treatment option for patients with AI with potential for better inpatient mortality and inpatient outcomes compared to patients who undergo SAVR in appropriately selected patients.
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Affiliation(s)
- Syeda Humna Zaidi
- Division of Internal Medicine, Karachi Medical and Dental College, Pakistan
| | | | - Shazib Sagheer
- Division of Cardiology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
| | | | - Sourbha S Dani
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA, USA
| | - Sachin S Goel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston TX, USA
| | - Mahboob Alam
- Michael E. DeBakey Veterans Affair Medical Center & Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Abu Baker Sheikh
- Division of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Sameer Hirji
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Najam Wasty
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
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