1
|
Kapadia SR, Krishnaswamy A, Whisenant B, Potluri S, Iyer V, Aragon J, Gideon P, Strote J, Leonardi R, Agarwal H, Larrain G, Sanchez C, Panaich SS, Harvey J, Vahl T, Menon V, Wolski K, Wang Q, Leon MB. Concomitant Left Atrial Appendage Occlusion and Transcatheter Aortic Valve Replacement Among Patients With Atrial Fibrillation. Circulation 2024; 149:734-743. [PMID: 37874908 DOI: 10.1161/circulationaha.123.067312] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 09/25/2023] [Accepted: 10/19/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is common in patients undergoing transcatheter aortic valve replacement (TAVR) and is associated with increased risk of bleeding and stroke. While left atrial appendage occlusion (LAAO) is approved as an alternative to anticoagulants for stroke prevention in patients with AF, placement of these devices in patients with severe aortic stenosis, or when performed at the same time as TAVR, has not been extensively studied. METHODS WATCH-TAVR (WATCHMAN for Patients with AF Undergoing TAVR) was a multicenter, randomized trial evaluating the safety and effectiveness of concomitant TAVR and LAAO with WATCHMAN in AF patients. Patients were randomized 1:1 to TAVR + LAAO or TAVR + medical therapy. WATCHMAN patients received anticoagulation for 45 days followed by dual antiplatelet therapy until 6 months. Anticoagulation was per treating physician preference for patients randomized to TAVR + medical therapy. The primary noninferiority end point was all-cause mortality, stroke, and major bleeding at 2 years between the 2 strategies. RESULTS The study enrolled 349 patients (177 TAVR + LAAO and 172 TAVR + medical therapy) between December 2017 and November 2020 at 34 US centers. The mean age of patients was 81 years, and the mean scores for CHA2DS2-VASc and HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/alcohol concomitantly) were 4.9 and 3.0, respectively. At baseline, 85.4% of patients were taking anticoagulants and 71.3% patients were on antiplatelet therapy. The cohorts were well-balanced for baseline characteristics. The incremental LAAO procedure time was 38 minutes, and the median contrast volume used for combined procedures was 119 mL versus 70 mL with TAVR alone. At the 24-month follow-up, 82.5% compared with 50.8% of patients were on any antiplatelet therapy, and 13.9% compared with 66.7% of patients were on any anticoagulation therapy in TAVR + LAAO compared with TAVR + medical therapy group, respectively. For the composite primary end point, TAVR + LAAO was noninferior to TAVR + medical therapy (22.7 versus 27.3 events per 100 patient-years for TAVR + LAAO and TAVR + medical therapy, respectively; hazard ratio, 0.86 [95% CI, 0.60-1.22]; Pnoninferiority<0.001). CONCLUSIONS Concomitant WATCHMAN LAAO and TAVR is noninferior to TAVR with medical therapy in severe aortic stenosis patients with AF. The increased complexity and risks of the combined procedure should be considered when concomitant LAAO is viewed as an alternative to medical therapy for patients with AF undergoing TAVR. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03173534.
Collapse
Affiliation(s)
- Samir R Kapadia
- Cleveland Clinic, Cleveland, OH (S.R.K., A.K., V.M., K.W., Q.W.)
| | | | | | | | | | | | - Philip Gideon
- Banner University Medical Center, Phoenix, AZ (P.G.)
| | | | - Robert Leonardi
- Lexington Medical Heart and Vascular Center, West Columbia, SC (R.L.)
| | | | | | | | | | | | - Torsten Vahl
- Columbia University Medical Center, New York, NY (T.V., M.B.L.)
| | - Venu Menon
- Cleveland Clinic, Cleveland, OH (S.R.K., A.K., V.M., K.W., Q.W.)
| | - Kathy Wolski
- Cleveland Clinic, Cleveland, OH (S.R.K., A.K., V.M., K.W., Q.W.)
| | - Qiuqing Wang
- Cleveland Clinic, Cleveland, OH (S.R.K., A.K., V.M., K.W., Q.W.)
| | - Martin B Leon
- Columbia University Medical Center, New York, NY (T.V., M.B.L.)
| |
Collapse
|
2
|
Gafoor S, Panaich SS. Two Are Better Than One: Are Concomitant Procedures the Future of Transcatheter Interventions? JACC Cardiovasc Interv 2024; 17:274-276. [PMID: 38267142 DOI: 10.1016/j.jcin.2023.11.013] [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] [Received: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 01/26/2024]
Affiliation(s)
- Sameer Gafoor
- Swedish Heart and Vascular, Seattle, Washington, USA
| | | |
Collapse
|
3
|
Mesnier J, Simard T, Jung RG, Lehenbauer KR, Piayda K, Pracon R, Jackson GG, Flores-Umanzor E, Faroux L, Korsholm K, Chun JKR, Chen S, Maarse M, Montrella K, Chaker Z, Spoon JN, Pastormerlo LE, Meincke F, Sawant AC, Moldovan CM, Qintar M, Aktas MK, Branca L, Radinovic A, Ram P, El-Zein RS, Flautt T, Ding WY, Sayegh B, Benito-González T, Lee OH, Badejoko SO, Paitazoglou C, Karim N, Zaghloul AM, Agarwal H, Kaplan RM, Alli O, Ahmed A, Suradi HS, Knight BP, Alla VM, Panaich SS, Wong T, Bergmann MW, Chothia R, Kim JS, Pérez de Prado A, Bazaz R, Gupta D, Valderrábano M, Sanchez CE, El Chami MF, Mazzone P, Adamo M, Ling F, Wang DD, O'Neill W, Wojakowski W, Pershad A, Berti S, Spoon DB, Kawsara A, Jabbour G, Boersma LVA, Schmidt B, Nielsen-Kudsk JE, Freixa X, Ellis CR, Fauchier L, Demkow M, Sievert H, Main ML, Hibbert B, Holmes DR, Alkhouli M, Rodés-Cabau J. Persistent and Recurrent Device-Related Thrombus After Left Atrial Appendage Closure: Incidence, Predictors, and Outcomes. JACC Cardiovasc Interv 2023; 16:2722-2732. [PMID: 38030358 DOI: 10.1016/j.jcin.2023.09.017] [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: 06/14/2023] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Scarce data exist on the evolution of device-related thrombus (DRT) after left atrial appendage closure (LAAC). OBJECTIVES This study sought to assess the incidence, predictors, and clinical impact of persistent and recurrent DRT in LAAC recipients. METHODS Data were obtained from an international multicenter registry including 237 patients diagnosed with DRT after LAAC. Of these, 214 patients with a subsequent imaging examination after the initial diagnosis of DRT were included. Unfavorable evolution of DRT was defined as either persisting or recurrent DRT. RESULTS DRT resolved in 153 (71.5%) cases and persisted in 61 (28.5%) cases. Larger DRT size (OR per 1-mm increase: 1.08; 95% CI: 1.02-1.15; P = 0.009) and female (OR: 2.44; 95% CI: 1.12-5.26; P = 0.02) were independently associated with persistent DRT. After DRT resolution, 82 (53.6%) of 153 patients had repeated device imaging, with 14 (17.1%) cases diagnosed with recurrent DRT. Overall, 75 (35.0%) patients had unfavorable evolution of DRT, and the sole predictor was average thrombus size at initial diagnosis (OR per 1-mm increase: 1.09; 95% CI: 1.03-1.16; P = 0.003), with an optimal cutoff size of 7 mm (OR: 2.51; 95% CI: 1.39-4.52; P = 0.002). Unfavorable evolution of DRT was associated with a higher rate of thromboembolic events compared with resolved DRT (26.7% vs 15.1%; HR: 2.13; 95% CI: 1.15-3.94; P = 0.02). CONCLUSIONS About one-third of DRT events had an unfavorable evolution (either persisting or recurring), with a larger initial thrombus size (particularly >7 mm) portending an increased risk. Unfavorable evolution of DRT was associated with a 2-fold higher risk of thromboembolic events compared with resolved DRT.
Collapse
Affiliation(s)
- Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Trevor Simard
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Richard G Jung
- Capital Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kyle R Lehenbauer
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Kerstin Piayda
- CardioVascular Center Frankfurt, Frankfurt, Germany; Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, Gießen, Germany
| | - Radoslaw Pracon
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | | | - Eduardo Flores-Umanzor
- Department of Cardiology, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Kasper Korsholm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | - Moniek Maarse
- Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands; LB Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Kristi Montrella
- Heart and Vascular Institute, University of Pittsburgh Medical Center, University of Pittsburgh, Altoona, Pennsylvania, USA
| | - Zakeih Chaker
- Division of Cardiology, West Virginia School of Medicine, Morgantown, West Virginia, USA
| | - Jocelyn N Spoon
- International Heart Institute of Montana, Missoula, Montana, USA
| | - Luigi E Pastormerlo
- Fondazione Toscana Gabriele Monasterio Massa, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | | | - Carmen M Moldovan
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Mohammed Qintar
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA; Department of Cardiology, Sparrow Hospital, Michigan State University, Lansing, Michigan
| | - Mehmet K Aktas
- Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Luca Branca
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Radinovic
- Arrhythmology Department, San Raffaele University Hospital, Milan, Italy
| | - Pradhum Ram
- Emory University Hospital, Atlanta, Georgia, USA
| | - Rayan S El-Zein
- Division of Cardiology, OhioHealth Doctors Hospital/OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | | | - Wern Yew Ding
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Bassel Sayegh
- Heart, Lung and Vascular Institute, Excela Health, Independence Health System, Pittsburgh, Pennsylvania, USA
| | | | - Oh-Hyun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Solomon O Badejoko
- Division of Internal Medicine, St Joseph's Medical Center (Dignity Health), Stockton, California, USA
| | | | - Nabeela Karim
- Royal Brompton and Harefield Hospitals, Part of Guys' and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Ahmed M Zaghloul
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | - Rachel M Kaplan
- Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| | - Oluseun Alli
- Division of Cardiology, Novant Health Heart and Vascular Institute, Charlotte, North Carolina, USA
| | - Aamir Ahmed
- Rush University Medical Center, Chicago, Illinois, USA
| | | | - Bradley P Knight
- Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| | - Venkata M Alla
- Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Sidakpal S Panaich
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Tom Wong
- Royal Brompton and Harefield Hospitals, Part of Guys' and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | | | - Rashaad Chothia
- Division of Internal Medicine, St Joseph's Medical Center (Dignity Health), Stockton, California, USA
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | - Raveen Bazaz
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dhiraj Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Carlos E Sanchez
- Division of Cardiology, OhioHealth Doctors Hospital/OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | | | - Patrizio Mazzone
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Fred Ling
- Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Dee Dee Wang
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - William O'Neill
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Wojtek Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Ashish Pershad
- Chandler Regional Medical Center, Chandler, Arizona, USA
| | - Sergio Berti
- Fondazione Toscana Gabriele Monasterio Massa, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Daniel B Spoon
- International Heart Institute of Montana, Missoula, Montana, USA
| | - Akram Kawsara
- Division of Cardiology, West Virginia School of Medicine, Morgantown, West Virginia, USA
| | - George Jabbour
- Heart and Vascular Institute, University of Pittsburgh Medical Center, University of Pittsburgh, Altoona, Pennsylvania, USA
| | - Lucas V A Boersma
- Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands; LB Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | | | - Xavier Freixa
- Department of Cardiology, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | | | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Faculté de Médecine, Université François Rabelais, Tours, France
| | - Marcin Demkow
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Horst Sievert
- Heart, Lung and Vascular Institute, Excela Health, Independence Health System, Pittsburgh, Pennsylvania, USA
| | - Michael L Main
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Benjamin Hibbert
- Capital Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Department of Cardiology, Hospital Clínic of Barcelona, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain.
| |
Collapse
|
4
|
Guddeti RR, Gill GS, Parekh JD, Jhand AS, Walters RW, Panaich SS, Goldsweig AM, Alla VM. Transcatheter Aortic Valve Implantation in Mixed Aortic Valve Disease: A Multicenter Study. Am J Cardiol 2023; 203:394-402. [PMID: 37517135 DOI: 10.1016/j.amjcard.2023.07.064] [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: 03/04/2023] [Revised: 07/06/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023]
Abstract
Mixed aortic valve disease (MAVD), defined by the concurrent presence of aortic stenosis (AS) and insufficiency is frequently seen in patients who have undergone transcatheter aortic valve implantation (TAVI). However, studies comparing the outcomes of TAVI in MAVD versus isolated AS have demonstrated conflicting results. Therefore, we aim to assess the outcomes of TAVI in patients with MAVD in comparison with those with isolated severe AS. Patients who underwent native valve TAVI for severe AS at 3 tertiary care academic centers between January 2012 and December 2020 were included and categorized into 3 groups based on concomitant aortic insufficiency (AI) as follows: group 1, no AI; group 2, mild AI; and group 3, moderate to severe AI. Outcomes of interest included all-cause mortality and all-cause readmission rates at 30 days and 1 year. Other outcomes include bleeding, stroke, vascular complications, and the incidence of paravalvular leak at 30 days after the procedure. Of the 1,588 patients who underwent TAVI during the study period, 775 patients (49%) had isolated AS, 606 (38%) had mild AI, and 207 (13%) had moderate to severe AI. Society of Thoracic Surgeons risk scores were significantly different among the 3 groups (5% in group 1, 5.5% in group 2, and 6% in group 3, p = 0.003). Balloon-expandable valves were used in about 2/3 of the population. No statistically significant differences in 30-day or 1-year all-cause mortality and all-cause readmission rates were noted among the 3 groups. Post-TAVI paravalvular leak at follow-up was significantly lower in group 1 (2.3%) and group 2 (2%) compared with group 3 (5.6%) (p = 0.01). In summary, TAVI in MAVD is associated with comparable outcomes at 1 year compared with patients with isolated severe AS.
Collapse
Affiliation(s)
- Raviteja R Guddeti
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, Nebraska
| | - Gauravpal S Gill
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, Nebraska
| | - Jai D Parekh
- Division of Cardiovascular Diseases, University of Iowa, Iowa City, Iowa
| | - Aravdeep S Jhand
- Division of Cardiovascular Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Ryan W Walters
- Department of Clinical Research, Creighton University School of Medicine, Omaha, Nebraska
| | - Sidakpal S Panaich
- Division of Cardiovascular Diseases, University of Iowa, Iowa City, Iowa
| | - Andrew M Goldsweig
- Division of Cardiovascular Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - Venkata Mahesh Alla
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, Nebraska.
| |
Collapse
|
5
|
Thakkar S, Patel HP, Kumar A, Tan BEX, Arora S, Patel S, Doshi R, Depta JP, Kalra A, Dani SS, Deshmukh A, Badheka A, Widmer RJ, Mamas MA, Rihal CS, Girotra S, Panaich SS. Outcomes of Impella compared with intra-aortic balloon pump in ST-elevation myocardial infarction complicated by cardiogenic shock. Am Heart J Plus 2021; 12:100067. [PMID: 38559603 PMCID: PMC10978134 DOI: 10.1016/j.ahjo.2021.100067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 04/04/2024]
Abstract
Background Despite limited randomized trial data demonstrating clinical efficacy, the utilization of Impella in ST-elevation myocardial infarction (STEMI) patients complicated with cardiogenic shock (CS) has increased over time. Methods We identified 75,769 hospitalizations with STEMI complicated by CS between October 2015 and December 2018 using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. From this cohort, hospitalizations were stratified according to IABP or Impella placement. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were divided into efficacy, safety, and device-related complications. Propensity-score matching was used to account for differences in the baseline characteristics between the groups. Logistic regression was performed to get the odds ratio and confidence intervals. Results Among 75,769 admissions with STEMI and CS, hospitalizations with <18 years old, both IABP and Impella placement, and who underwent ECMO and/or LVAD implantation were excluded. After the exclusion, out of 72,791 admissions, 25,260 (34.70%) hospitalizations received IABP, and 7825 (10.75%) received Impella support. After propensity score-matched analysis, 7345 hospitalizations were included in each group. All-cause in-hospital mortality was higher in the hospitalizations requiring Impella support as compared to IABP (42.10% vs. 31.54%, adjusted OR 1.71; 95% confidence interval (CI) 1.60-1.84, P < 0.0001). Impella was associated with a higher risk of in-hospital complications and hospitalization cost compared with IABP. Conclusion Impella compared with IABP in STEMI patients with CS was associated with higher in-hospital mortality and other adverse clinical and procedural outcomes.
Collapse
Affiliation(s)
| | - Harsh P. Patel
- Department of Internal Medicine, Louis A Weiss Memorial Hospital, Chicago, IL, USA
| | - Ashish Kumar
- Section of Cardiovascular Research, Heart, Vascular and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Bryan E-Xin Tan
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Shilpkumar Arora
- Department of Cardiology, Case Western University, Cleveland, OH, USA
| | - Smit Patel
- Department of Internal Medicine, Vassar Brothers Medical Center, Poughkeepsie, NY, USA
| | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, USA
| | - Jeremiah P. Depta
- Sands Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | - Ankur Kalra
- Section of Cardiovascular Research, Heart, Vascular and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sourbha S. Dani
- Department of Cardiology, Lahey Hospital & Medical Center, MA, USA
| | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Apurva Badheka
- Heart and Vascular Center, The Everett Clinic, Everett, WA, USA
| | - Robert J. Widmer
- Department of Cardiovascular Medicine, Baylor Scott & White Health, Temple, TX, USA
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Institute of Applied Clinical Science, Keele University, Stoke-on-Trent, UK
- Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | | | - Saket Girotra
- Department of Cardiology, University of Iowa Carver College of Medicine, IA, USA
| | - Sidakpal S. Panaich
- Department of Cardiology, University of Iowa Carver College of Medicine, IA, USA
| |
Collapse
|
6
|
Arora S, Jaswaney R, Jani C, Zuzek Z, Thakkar S, Patel M, Panaich SS, Tripathi B, Arora N, Josephson R, Osman MN, Hoit BD, Zidar D, Shishehbor MH. Invasive Approaches in the Management of Cocaine-Associated Non-ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Interv 2021; 14:623-636. [PMID: 33736770 DOI: 10.1016/j.jcin.2021.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to determine the impact of invasive approaches and revascularization in patients with cocaine-associated non-ST-segment elevation myocardial infarction (NSTEMI). BACKGROUND The role of invasive approaches in cocaine-associated NSTEMI is uncertain. METHODS This retrospective cohort study identified 3,735 patients with NSTEMI and history of cocaine use from the Nationwide Readmissions Database from 2016 to 2017. Invasive approaches were defined as coronary angiography, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). Revascularization was defined as PCI and CABG. The primary efficacy outcome was major adverse cardiac events (MACE), and the primary safety outcome was emergent revascularization. Nonadherence was identified using appropriate International Classification of Diseases-Tenth Revision codes. Two propensity-matched cohorts were generated (noninvasive vs. invasive and noninvasive vs. revascularization) through multivariate logistic regression. RESULTS In the propensity score-matched cohorts, an invasive approach (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.56 to 0.92; p = 0.008) and revascularization (HR: 0.54; 95% CI: 0.40 to 0.73; p < 0.001) (compared with a noninvasive approach) were associated with a lower rate of MACE, without an increase in emergent revascularization. On stratification, PCI and CABG individually were associated with a lower rate of MACE. Emergent revascularization was increased with PCI (HR: 1.78; 95% CI: 1.12 to 2.81; p = 0.014) but not with CABG. Nonadherent patients after PCI and CABG did not have significant difference in rate of MACE. PCI in nonadherent patients was associated with an increase in emergent revascularization (HR: 4.45; 95% CI: 2.07 to 9.57; p < 0.001). CONCLUSIONS Invasive approaches and revascularization for cocaine-associated NSTEMI are associated with lower morbidity. A history of medical nonadherence was not associated with a difference in morbidity but was associated with an increased risk for emergent revascularization with PCI.
Collapse
Affiliation(s)
- Shilpkumar Arora
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Rahul Jaswaney
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Chinmay Jani
- Mount Auburn Hospital-Harvard Medical School, Cambridge, Massachusetts, USA
| | - Zachary Zuzek
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Mohini Patel
- Boston University School of Public Health, Boston, Massachusetts, USA
| | | | | | | | - Richard Josephson
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Mohammed Najeeb Osman
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Brian D Hoit
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - David Zidar
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Mehdi H Shishehbor
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA.
| |
Collapse
|
7
|
Simard T, Jung RG, Lehenbauer K, Piayda K, Pracoń R, Jackson GG, Flores-Umanzor E, Faroux L, Korsholm K, Chun JKR, Chen S, Maarse M, Montrella K, Chaker Z, Spoon JN, Pastormerlo LE, Meincke F, Sawant AC, Moldovan CM, Qintar M, Aktas MK, Branca L, Radinovic A, Ram P, El-Zein RS, Flautt T, Ding WY, Sayegh B, Benito-González T, Lee OH, Badejoko SO, Paitazoglou C, Karim N, Zaghloul AM, Agrawal H, Kaplan RM, Alli O, Ahmed A, Suradi HS, Knight BP, Alla VM, Panaich SS, Wong T, Bergmann MW, Chothia R, Kim JS, Pérez de Prado A, Bazaz R, Gupta D, Valderrabano M, Sanchez CE, El Chami MF, Mazzone P, Adamo M, Ling F, Wang DD, O'Neill W, Wojakowski W, Pershad A, Berti S, Spoon D, Kawsara A, Jabbour G, Boersma LVA, Schmidt B, Nielsen-Kudsk JE, Rodés-Cabau J, Freixa X, Ellis CR, Fauchier L, Demkow M, Sievert H, Main ML, Hibbert B, Holmes DR, Alkhouli M. Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion. J Am Coll Cardiol 2021; 78:297-313. [PMID: 34294267 DOI: 10.1016/j.jacc.2021.04.098] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [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: 02/01/2021] [Revised: 04/05/2021] [Accepted: 04/29/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Device-related thrombus (DRT) has been considered an Achilles' heel of left atrial appendage occlusion (LAAO). However, data on DRT prediction remain limited. OBJECTIVES This study constructed a DRT registry via a multicenter collaboration aimed to assess outcomes and predictors of DRT. METHODS Thirty-seven international centers contributed LAAO cases with and without DRT (device-matched and temporally related to the DRT cases). This study described the management patterns and mid-term outcomes of DRT and assessed patient and procedural predictors of DRT. RESULTS A total of 711 patients (237 with and 474 without DRT) were included. Follow-up duration was similar in the DRT and no-DRT groups, median 1.8 years (interquartile range: 0.9-3.0 years) versus 1.6 years (interquartile range: 1.0-2.9 years), respectively (P = 0.76). DRTs were detected between days 0 to 45, 45 to 180, 180 to 365, and >365 in 24.9%, 38.8%, 16.0%, and 20.3% of patients. DRT presence was associated with a higher risk of the composite endpoint of death, ischemic stroke, or systemic embolization (HR: 2.37; 95% CI, 1.58-3.56; P < 0.001) driven by ischemic stroke (HR: 3.49; 95% CI: 1.35-9.00; P = 0.01). At last known follow-up, 25.3% of patients had DRT. Discharge medications after LAAO did not have an impact on DRT. Multivariable analysis identified 5 DRT risk factors: hypercoagulability disorder (odds ratio [OR]: 17.50; 95% CI: 3.39-90.45), pericardial effusion (OR: 13.45; 95% CI: 1.46-123.52), renal insufficiency (OR: 4.02; 95% CI: 1.22-13.25), implantation depth >10 mm from the pulmonary vein limbus (OR: 2.41; 95% CI: 1.57-3.69), and non-paroxysmal atrial fibrillation (OR: 1.90; 95% CI: 1.22-2.97). Following conversion to risk factor points, patients with ≥2 risk points for DRT had a 2.1-fold increased risk of DRT compared with those without any risk factors. CONCLUSIONS DRT after LAAO is associated with ischemic events. Patient- and procedure-specific factors are associated with the risk of DRT and may aid in risk stratification of patients referred for LAAO.
Collapse
Affiliation(s)
- Trevor Simard
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA. https://twitter.com/tjsimard
| | - Richard G Jung
- Capital Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kyle Lehenbauer
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Kerstin Piayda
- CardioVascular Center Frankfurt, Frankfurt, Germany; Heinrich-Heine-University, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| | - Radoslaw Pracoń
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | | | - Eduardo Flores-Umanzor
- Department of Cardiology, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Kasper Korsholm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | - Moniek Maarse
- Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands; LB Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Kristi Montrella
- University of Pittsburgh Medical Center Heart and Vascular Institute, University of Pittsburgh, Altoona, Pennsylvania, USA
| | - Zakeih Chaker
- Division of Cardiology, West Virginia School of Medicine, Morgantown, West Virginia, USA
| | - Jocelyn N Spoon
- International Heart Institute of Montana, Missoula, Montana, USA
| | - Luigi E Pastormerlo
- Fondazione Toscana Gabriele Monasterio Massa, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | | | - Carmen M Moldovan
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Mohammed Qintar
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Mehmet K Aktas
- Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Luca Branca
- Catheterization Laboratory, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy
| | - Andrea Radinovic
- Arrhythmology Department, San Raffaele University Hospital, Milan, Italy
| | - Pradhum Ram
- Emory University Hospital, Atlanta, Georgia, USA
| | - Rayan S El-Zein
- Division of Cardiology, OhioHealth Doctors Hospital/OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | | | - Wern Yew Ding
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Bassel Sayegh
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; The Heart, Lung and Vascular Institute, Excela Health, Pittsburgh, Pennsylvania, USA
| | | | - Oh-Hyun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Solomon O Badejoko
- Division of Internal Medicine, St Joseph's Medical Center (Dignity Health), Stockton, California, USA
| | | | - Nabeela Karim
- Royal Brompton and Harefield Hospitals, Part of Guys' and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Ahmed M Zaghloul
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | - Rachel M Kaplan
- Northwestern University, Bluhm Cardiovascular Institute, Chicago, Illinois, USA
| | - Oluseun Alli
- Division of Cardiology, Novant Health Heart and Vascular Institute, Charlotte, North Carolina, USA
| | - Aamir Ahmed
- Rush University Medical Center, Chicago, Illinois, USA
| | | | - Bradley P Knight
- Northwestern University, Bluhm Cardiovascular Institute, Chicago, Illinois, USA
| | - Venkata M Alla
- Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Sidakpal S Panaich
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Tom Wong
- Royal Brompton and Harefield Hospitals, Part of Guys' and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | | | - Rashaad Chothia
- Division of Internal Medicine, St Joseph's Medical Center (Dignity Health), Stockton, California, USA
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | - Raveen Bazaz
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dhiraj Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Carlos E Sanchez
- Division of Cardiology, OhioHealth Doctors Hospital/OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | | | - Patrizio Mazzone
- Arrhythmology Department, San Raffaele University Hospital, Milan, Italy
| | - Marianna Adamo
- Catheterization Laboratory, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy
| | - Fred Ling
- Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Dee Dee Wang
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - William O'Neill
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Wojtek Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Sergio Berti
- Fondazione Toscana Gabriele Monasterio Massa, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Daniel Spoon
- International Heart Institute of Montana, Missoula, Montana, USA
| | - Akram Kawsara
- Division of Cardiology, West Virginia School of Medicine, Morgantown, West Virginia, USA
| | - George Jabbour
- University of Pittsburgh Medical Center Heart and Vascular Institute, University of Pittsburgh, Altoona, Pennsylvania, USA
| | - Lucas V A Boersma
- Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands; LB Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Xavier Freixa
- Department of Cardiology, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | | | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Faculté de Médecine, Université François Rabelais, Tours, France
| | - Marcin Demkow
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | | | - Michael L Main
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Benjamin Hibbert
- Capital Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
| |
Collapse
|
8
|
Affiliation(s)
- Sidakpal S Panaich
- Department of Cardiovascular Medicine University of Iowa Hospitals & Clinics Iowa City IA
| | - Saket Girotra
- Department of Cardiovascular Medicine University of Iowa Hospitals & Clinics Iowa City IA
| |
Collapse
|
9
|
Majmundar M, Kumar A, Doshi R, Shah P, Arora S, Shariff M, Adalja D, Visco F, Amin H, Vallabhajosyula S, Gullapalli N, Kapadia SR, Kalra A, Panaich SS. Meta-Analysis of Transcatheter Aortic Valve Implantation in Patients With Stenotic Bicuspid Versus Tricuspid Aortic Valve. Am J Cardiol 2021; 145:102-110. [PMID: 33460604 DOI: 10.1016/j.amjcard.2020.12.085] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/28/2020] [Accepted: 12/31/2020] [Indexed: 01/10/2023]
Abstract
Most of the trials investigating the role of transcatheter aortic valve implantation (TAVI) across various strata of risk categories have excluded patients with bicuspid aortic stenosis (BAS) due to its anatomical complexities. The aim of this study was to perform a meta-analysis with meta-regression of studies comparing clinical, procedural, and after-procedural echocardiographic outcomes in BAS versus tricuspid aortic stenosis (TAS) patients who underwent TAVI. We searched the PubMed and Cochrane databases for relevant articles from the inception of the database to October 2019. Continuous and categorical variables were pooled using inverse variance and Mantel-Haenszel method, respectively, using the random-effect model. To rate the certainty of evidence for each outcome, we used the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach. Nineteen articles were included in the final analysis. There was no difference in the risk of 30-day mortality, 1-year mortality, 30-day cardiovascular mortality, major and/or life-threatening bleeding, major vascular complications, acute kidney injury, permanent pacemaker implantation, device success, annular rupture, after-procedural aortic valve area, and mean pressure gradient between the 2 groups. BAS patients who underwent TAVI had a higher risk of 30-day stroke, conversion to surgery, need for second valve implantation, and moderate to severe paravalvular leak. In conclusion, the present meta-analysis supports the feasibility of TAVI in surgically ineligible patients with BAS. However, the incidence of certain procedural complications such as stroke, conversion to surgery, second valve implantation, and paravalvular leak is higher among BAS patients compared with TAS patients, which must be discussed with the patient during the decision-making process.
Collapse
|
10
|
Sistla PA, Porayette P, Aldoss OT, Panaich SS. Transcatheter Valve Implantation in a Severely Regurgitant Apicoaortic Conduit. JACC Cardiovasc Interv 2021; 14:e53-e56. [PMID: 33582081 DOI: 10.1016/j.jcin.2020.12.012] [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: 11/16/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Phanicharan A Sistla
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
| | - Prashob Porayette
- Department of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Osamah T Aldoss
- Department of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Sidakpal S Panaich
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| |
Collapse
|
11
|
Arora S, Lahewala S, Zuzek Z, Thakkar S, Jani C, Jaswaney R, Singh A, Bhyan P, Arora N, Main A, Osman MN, Hoit BD, Attizzani GF, Panaich SS. Transcatheter aortic valve replacement in aortic regurgitation: The U.S. experience. Catheter Cardiovasc Interv 2020; 98:E153-E162. [DOI: 10.1002/ccd.29379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 07/13/2020] [Revised: 09/17/2020] [Accepted: 10/23/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Shilpkumar Arora
- Harrington Heart and Vascular Institute, University Hospital Cleveland Medical Center Case Western Reserve University Cleveland Ohio
| | - Sopan Lahewala
- Department of Medicine Saint Francis Hospital and Medical Center Hartford Connecticut
| | - Zachary Zuzek
- Harrington Heart and Vascular Institute, University Hospital Cleveland Medical Center Case Western Reserve University Cleveland Ohio
| | | | - Chinmay Jani
- Department of Medicine Mount Auburn Hospital‐Harvard Medical School Cambridge Massachusetts
| | - Rahul Jaswaney
- Harrington Heart and Vascular Institute, University Hospital Cleveland Medical Center Case Western Reserve University Cleveland Ohio
| | - Aanandita Singh
- Department of Medicine Sri Guru Ram Das Institute of Medical Sciences & Research Amritsar Punjab India
| | - Poonam Bhyan
- Department of Medicine Cape Fear Valley Medical Center North Carolina
| | - Nirav Arora
- Department of Computer Science Lamar University Beaumont Texas
| | - Anthony Main
- Harrington Heart and Vascular Institute, University Hospital Cleveland Medical Center Case Western Reserve University Cleveland Ohio
| | - Mohammed Najeeb Osman
- Harrington Heart and Vascular Institute, University Hospital Cleveland Medical Center Case Western Reserve University Cleveland Ohio
| | - Brian D. Hoit
- Harrington Heart and Vascular Institute, University Hospital Cleveland Medical Center Case Western Reserve University Cleveland Ohio
| | - Guilherme F. Attizzani
- Harrington Heart and Vascular Institute, University Hospital Cleveland Medical Center Case Western Reserve University Cleveland Ohio
| | - Sidakpal S. Panaich
- Department of Cardiology University of Iowa Hospitals & Clinics Iowa city Iowa
| |
Collapse
|
12
|
Panaich SS, Qazi AH, Horwitz PA, Staffey K, Rossen JD. Transcatheter Repair of Anterior Mitral Leaflet Perforation: Deploy, Retrieve, Redeploy. JACC Case Rep 2019; 1:689-693. [PMID: 34316910 PMCID: PMC8288573 DOI: 10.1016/j.jaccas.2019.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/30/2019] [Accepted: 10/08/2019] [Indexed: 12/04/2022]
Abstract
We describe a case of anterior mitral leaflet perforation successfully treated with the Amplatzer Cribriform device, with resultant hemolytic anemia. The device was retrieved, and perforation occluded with the GORE CARDIOFORM device with resolution of hemolysis. (Level of Difficulty: Advanced.)
Collapse
Affiliation(s)
- Sidakpal S Panaich
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Abdul H Qazi
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Phillip A Horwitz
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Kimberly Staffey
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - James D Rossen
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| |
Collapse
|
13
|
Raphael CE, Malouf JF, Maor E, Panaich SS, Pollak PM, Reeder GS, Rihal CS, Eleid MF. A hybrid technique for treatment of commissural primary mitral regurgitation. Catheter Cardiovasc Interv 2019; 93:692-698. [PMID: 30244543 DOI: 10.1002/ccd.27904] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/09/2018] [Accepted: 08/29/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND MitraClip is an effective transcatheter therapy for mitral regurgitation (MR). However, MitraClip is challenging in commissural MR and the optimal therapeutic approach is unclear. METHODS We describe a case series of six consecutive patients with severe commissural primary mitral regurgitation who underwent MitraClip insertion followed by an Amplatzer Vascular Plug (AVP) II occluder between the commissure and the MitraClip. RESULTS The procedure was successful in all patients. MR was reduced from severe to mild/trivial in 50% and moderate in 50% of cases. On 30-day follow-up, NYHA class had improved from III (6 patients) to I (2 patients), II (2 patients), and III (2 patients). The mean transmitral gradient was 2.5 ± 1.8 mmHg at baseline and 4.8 ± 2.6 mmHg following the procedure. One patient developed hemolysis immediately post procedure. The other five patients remained well during a median follow-up of 20 months (range 5-50 months) with no reported device dislodgement. CONCLUSIONS Elective treatment of severe commissural MR with a laterally or medially placed MitraClip coupled with an AVP II occluder between the clip and the commissure is feasible and safe. This approach may provide a useful management alternative in selected patients.
Collapse
Affiliation(s)
- Claire E Raphael
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Joseph F Malouf
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Elad Maor
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sidakpal S Panaich
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Peter M Pollak
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Guy S Reeder
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
14
|
Panaich SS, Maor E, Reddy G, Raphael CE, Cabalka A, Hagler DJ, Reeder GS, Rihal CS, Eleid MF. Effect of percutaneous paravalvular leak closure on hemolysis. Catheter Cardiovasc Interv 2018; 93:713-719. [DOI: 10.1002/ccd.27917] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 04/19/2018] [Revised: 08/13/2018] [Accepted: 09/09/2018] [Indexed: 11/10/2022]
Affiliation(s)
| | - Elad Maor
- Department of Cardiovascular Diseases. Mayo Clinic, Rochester Minnesota
| | - Gautam Reddy
- Department of Cardiovascular Diseases. Mayo Clinic, Rochester Minnesota
| | - Claire E. Raphael
- Department of Cardiovascular Diseases. Mayo Clinic, Rochester Minnesota
| | - Allison Cabalka
- Department of Cardiovascular Diseases. Mayo Clinic, Rochester Minnesota
| | - Donald J. Hagler
- Department of Cardiovascular Diseases. Mayo Clinic, Rochester Minnesota
| | - Guy S. Reeder
- Department of Cardiovascular Diseases. Mayo Clinic, Rochester Minnesota
| | | | - Mackram F. Eleid
- Department of Cardiovascular Diseases. Mayo Clinic, Rochester Minnesota
| |
Collapse
|
15
|
Panaich SS, Munger T, Friedman P, Rihal CS, Holmes DR. Case-Based Discussion Regarding Challenges in Patient Selection and Procedural Planning in Left Atrial Appendage Occlusion. Mayo Clin Proc 2018; 93:630-638. [PMID: 29728202 DOI: 10.1016/j.mayocp.2018.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 03/16/2018] [Accepted: 03/16/2018] [Indexed: 11/15/2022]
Abstract
Atrial fibrillation (AF) accounts for most embolic strokes, especially in elderly individuals. Although anticoagulation is known to reduce the risk of embolic stroke, a significant proportion of patients have relative or absolute contraindications to anticoagulation. The left atrial appendage has been implicated as the major source of emboli in more than 90% of ischemic strokes in nonvalvular AF. Left atrial appendage occlusion offers an alternative for stroke prevention in patients with an elevated stroke risk (CHADS2 score ≥2 or CHA2DS2-VASc score ≥3) who have a rationale for avoiding long-term oral anticoagulation after a shared decision-making process. However, there remain significant challenges in left atrial appendage occlusion therapy related to patient selection, the procedure itself, and postprocedural patient management decisions. In this review article, we discuss some of these challenges in a case discussion-based approach.
Collapse
Affiliation(s)
| | - Thomas Munger
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Paul Friedman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
| |
Collapse
|
16
|
Raphael CE, Maor E, Panaich SS, Reeder G, Rihal CS, Eleid MF. The Use of Intraprocedural Reinfusion During MitraClip Implantation to Reduce Blood Loss and Transfusion Requirements. J Invasive Cardiol 2018; 30:E1-E3. [PMID: 29289949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND MitraClip implantation has been shown to reduce mitral regurgitation and is an effective treatment option for patients at high risk for conventional surgery. Blood loss is common during the procedure. We assessed the utility of intraprocedural reinfusion of blood aspirated during MitraClip implantation. METHODS We compared hemoglobin before and after MitraClip implantation and transfusion requirements in patients who did (n = 83) and did not receive reinfusion (n = 31) during their procedure. For patients who received reinfusion, blood removed during device manipulation was carefully injected back into the patient through the 24 Fr delivery sheath, followed by a saline flush. RESULTS As expected, patients who received reinfusion had a smaller reduction in hemoglobin post procedure compared to those who did not (0.96 ± 1.0 g/dL vs 1.55 ± 0.94 g/dL; P<.01). There was a trend to lower requirements for blood transfusion in the reinfusion groups (0.39 ± 0.96 units/patient vs 0.15 ± 0.53 units/patient; P<.10). At 30-day follow-up, there was no difference in mortality, stroke, endocarditis, or thromboembolic events between groups. CONCLUSION Reinfusion of aspirated blood during MitraClip was associated with reduced blood loss and a trend to reduced requirement for blood transfusion post procedure. Reinfusion during the procedure appeared safe, with no complications.
Collapse
Affiliation(s)
| | | | | | | | | | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA.
| |
Collapse
|
17
|
Panaich SS, Arora S, Badheka A, Kumar V, Maor E, Raphael C, Deshmukh A, Reeder G, Eleid M, Rihal CS. Procedural trends, outcomes, and readmission rates pre-and post-FDA approval for MitraClip from the National Readmission Database (2013-14). Catheter Cardiovasc Interv 2017; 91:1171-1181. [DOI: 10.1002/ccd.27366] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 07/21/2017] [Revised: 09/01/2017] [Accepted: 09/12/2017] [Indexed: 11/12/2022]
Affiliation(s)
| | - Shilpkumar Arora
- Department of Cardiology, Mount Sinai St Luke's Roosevelt Hospital Center; New York
| | - Apurva Badheka
- Department of Cardiology, The Everett Clinic; Everett Washington
| | - Varun Kumar
- Department of Cardiology, Mount Sinai St Luke's Roosevelt Hospital Center; New York
| | - Elad Maor
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Claire Raphael
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Abhishek Deshmukh
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Guy Reeder
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Mackram Eleid
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | | |
Collapse
|
18
|
Arora S, Panaich SS, Ainani N, Kumar V, Patel NJ, Tripathi B, Shah P, Patel N, Lahewala S, Deshmukh A, Badheka A, Grines C. Comparison of In-Hospital Outcomes and Readmission Rates in Acute Pulmonary Embolism Between Systemic and Catheter-Directed Thrombolysis (from the National Readmission Database). Am J Cardiol 2017; 120:1653-1661. [PMID: 28882336 DOI: 10.1016/j.amjcard.2017.07.066] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 05/06/2017] [Revised: 07/07/2017] [Accepted: 07/21/2017] [Indexed: 12/14/2022]
Abstract
There are sparse comparative data on in-hospital outcomes and readmission rates in patients with acute pulmonary embolism (PE) who receive systemic thrombolytics versus catheter-directed thrombolysis (CDT). The study cohort was derived from the National Readmission Database 2013 to 2014, subset of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality. Systemic and CDT were identified using appropriate International Classification of Diseases, 9th Revision, Clinical Modification codes. The co-primary outcomes were in-hospital mortality and 30-day readmissions and secondary outcome was combined in-hospital mortality + gastrointestinal bleed + intracranial hemorrhage. We used propensity score match analysis without replacement using Greedy's algorithm to adjust for possible confounders. We identified a total of 4,426 patients (3,107: systemic thrombolysis and 1,319: CDT) with acute PE who were treated with thrombolysis. In our 2:1 propensity score algorithm, in-hospital mortality was lower in the CDT group (6.12%) versus systemic thrombolytics (14.94%) (odds ratio 0.37, 95% confidence interval 0.28 to 0.49, p <0.001). There was also a lower composite secondary outcome (in-hospital mortality + gastrointestinal bleed + intracranial hemorrhage) in patients who received CDT (8.42%) versus those who received systemic thrombolytics (18.13%) (odds ratio 0.41, 95% confidence interval 0.33 to 0.53, p <0.001). Thirty-day readmission was lower in patients with CDT group (7.65%) compared with systemic thrombolytics (10.58%, p = 0.009). In conclusion, in-hospital mortality, as well as bleeding during primary admission was significantly lower with CDT compared with systemic thrombolytics for patients with acute PE. There was also significant decrease in rate of readmissions among patients receiving CDT compared with systemic thrombolytics.
Collapse
Affiliation(s)
- Shilpkumar Arora
- Department of Cardiology, Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, New York.
| | | | - Nitesh Ainani
- Department of Cardiology, Baystate Medical Center, Springfield, Massachusetts
| | - Varun Kumar
- Department of Cardiology, Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, New York
| | - Nileshkumar J Patel
- Department of Cardiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Byomesh Tripathi
- Department of Cardiology, Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, New York
| | - Purav Shah
- Department of Cardiology, Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, New York
| | - Nirali Patel
- Department of Cardiology, University of Southern California, Los Angeles, California
| | - Sopan Lahewala
- Department of Internal Medicine, RWJ Barnabas health/Jersey City Medical Center, Jersey City, New Jersey
| | | | - Apurva Badheka
- Department of Cardiology, The Everett Clinic, Everett, Washington
| | - Cindy Grines
- Department of Cardiology, Detroit Medical Center, Detroit, Michigan
| |
Collapse
|
19
|
Raphael CE, Alkhouli M, Maor E, Panaich SS, Alli O, Coylewright M, Reeder GS, Sandhu G, Holmes DR, Nishimura R, Malouf J, Cabalka A, Eleid MF, Rihal CS. Building Blocks of Structural Intervention. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005686. [DOI: 10.1161/circinterventions.117.005686] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Claire E. Raphael
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Mohamad Alkhouli
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Elad Maor
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Sidakpal S. Panaich
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Oluseun Alli
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Megan Coylewright
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Guy S. Reeder
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Gurpreet Sandhu
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - David R. Holmes
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Rick Nishimura
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Joseph Malouf
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Allison Cabalka
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Mackram F. Eleid
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Charanjit S. Rihal
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| |
Collapse
|
20
|
Panaich SS, Eleid MF. Current status of MitraClip for patients with mitral and tricuspid regurgitation. Trends Cardiovasc Med 2017; 28:200-209. [PMID: 28863973 DOI: 10.1016/j.tcm.2017.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 06/30/2017] [Revised: 08/01/2017] [Accepted: 08/12/2017] [Indexed: 11/17/2022]
Abstract
Mitral valve regurgitation (MR) affects approximately 4 million people in the United States alone, increasing in prevalence with age. Approved by the Food and Drug Administration (FDA) in October 2013, percutaneous edge-to-edge transcatheter mitral valve repair (also known as the MitraClip system) has been used in over 40,000 patients globally. Additionally, there is keen interest and early exploration into the use of MitraClip for treatment of severe symptomatic tricuspid regurgitation, another undertreated disease with significant morbidity and mortality. In this manuscript, we aim to review the current indications, procedural details as well as emerging indications for this novel technology.
Collapse
Affiliation(s)
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
21
|
Maor E, Raphael CE, Panaich SS, Alkhouli M, Cabalka A, Hagler DJ, Pollak PM, Reeder GS, Eleid MF, Rihal CS. Left atrial pressure and predictors of survival after percutaneous mitral paravalvular leak closure. Catheter Cardiovasc Interv 2017; 90:861-869. [DOI: 10.1002/ccd.27179] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 05/19/2017] [Accepted: 06/08/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Elad Maor
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester Minnesota
| | - Claire E. Raphael
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester Minnesota
| | | | - Mohamad Alkhouli
- Division of Cardiology; West Virginia University Heart & Vascular Institute; Morgantown West Virginia
| | - Allison Cabalka
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester Minnesota
| | - Donald J. Hagler
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester Minnesota
| | - Peter M. Pollak
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester Minnesota
| | - Guy S. Reeder
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester Minnesota
| | - Mackram F. Eleid
- Department of Cardiovascular Medicine; Mayo Clinic; Rochester Minnesota
| | | |
Collapse
|
22
|
Panaich SS, Holmes DR. Who Should Be Referred for Left Atrial Appendage Occlusion Therapy? Curr Treat Options Cardiovasc Med 2017; 19:42. [PMID: 28466118 DOI: 10.1007/s11936-017-0540-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OPINION STATEMENT Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting approximately 7 million individuals in USA. It is one of the most significant arrhythmias, which accounts for a majority of embolic strokes, especially in elderly individuals. Although oral anti-coagulation is beneficial in lowering the risk of stroke, 1 in 10 patients have a contra-indication to warfarin therapy. Among patients who do tolerate either warfarin or novel oral anticoagulant (NOAC), major or recurrent bleeding, intracranial bleeds, etc. often lead to interruption of anti-coagulation. Previous studies have reported that >90% of cardioemboli in non-valvular atrial fibrillation (NVAF) originate in the left atrial appendage. Left atrial appendage occlusion (LAAO) is currently covered by the Centers for Medicare & Medicaid Services (CMS) as an alternative for stroke prevention in patients with an elevated stroke risk (CHADS2 ≥2 or CHA2DS2-VASc score ≥3) who have appropriate rational for avoiding long-term oral anticoagulation following a shared-decision making process. In this review, we discuss the currently available LAAO devices and more importantly, appropriate patient selection for this strategy.
Collapse
Affiliation(s)
- Sidakpal S Panaich
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street, Rochester, MN, 55905, USA
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street, Rochester, MN, 55905, USA.
| |
Collapse
|
23
|
Maor E, Raphael CE, Panaich SS, Reeder GS, Nishimura RA, Nkomo VT, Rihal CS, Eleid MF. Acute Changes in Left Atrial Pressure After MitraClip Are Associated With Improvement in 6-Minute Walk Distance. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004856. [DOI: 10.1161/circinterventions.116.004856] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [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: 12/08/2016] [Accepted: 03/06/2017] [Indexed: 11/16/2022]
Abstract
Background—
Data on the clinical use of left atrial (LA) hemodynamic monitoring during MitraClip procedure are limited. This study evaluated the association between intraprocedural changes in LA pressure after MitraClip and improvement in exercise capacity as documented by 6-minute walk test (6MWT).
Methods and Results—
Study population included 50 patients who underwent MitraClip at the Mayo Clinic (Rochester, MN), between June 2014 and July 2016 and completed both baseline and 30-day follow-up 6MWT. Primary outcome for the current analysis was defined as 6MWT improvement above the median. Mean age of the study population was 79±10 years, and 34 (68%) were men. Baseline preprocedural 6MWT distance was 308 m (interquartile range [IQR], 234–394 m). Acute, intraprocedural change in LA pressure after MitraClip was 3 mm Hg (IQR, 1–6 mm Hg), and change in V wave was 11 mm Hg (IQR, 6–19 mm Hg). Median 6MWT improvement was 25 m (IQR, 19–47 m). Univariate analysis showed that patients with ≤ mild postprocedural mitral regurgitation were 4-fold more likely to experience an improvement in 6MWT (
P
=0.02). Multivariate model demonstrated that each 5 mm Hg decrease in V wave was associated with 49% increased likelihood for improvement in 6-minute walk (
P
=0.04). Similar model with V-wave change as a dichotomous variable showed that patients with a V-wave decrease of ≥11 mm Hg were 3.8× more likely to improve their 6MWT (
P
=0.05).
Conclusions—
Acute changes in LA pressure after MitraClip procedure are associated with clinical improvement as measured by 6MWT. Continuous LA pressure monitoring may be a useful tool for procedural guidance during transcatheter mitral repair.
Collapse
Affiliation(s)
- Elad Maor
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Claire E. Raphael
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Guy S. Reeder
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Rick A. Nishimura
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Vuyisile T. Nkomo
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Charanjit S. Rihal
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Mackram F. Eleid
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| |
Collapse
|
24
|
Agnihotri K, Singh V, Panaich SS, Patel NJ, Patel N, Arora S, Pau D, Deshmukh A, Badheka AO. Management of Hypertension in Patients with Aortic Valvular Stenosis. Curr Hypertens Rev 2017; 13:41-45. [PMID: 28245786 DOI: 10.2174/1573402113666170228150229] [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: 12/05/2016] [Revised: 02/18/2017] [Accepted: 02/20/2017] [Indexed: 11/22/2022]
Abstract
Aortic stenosis (AS) has an increasing prevalence with age and is commonly associated with hypertension. While it has been established that hypertension is associated with increased mortality in patients with AS, further randomized control trials addressing the use of antihypertensives specifically in patients with AS are needed. The management of hypertension in patients with AS needs a cautious approach due to complex hemodynamic and structural changes involved. Comorbidities like coronary artery disease, heart failure and arrhythmias further dictate management of hypertension in patients with AS. The aim of this article is to review the various agents used in the management of hypertension in patients with AS.
Collapse
Affiliation(s)
| | - Vikas Singh
- University of Miami, Miami, FL, United States
| | - Sidakpal S Panaich
- Borgess Medical Centre, Kalamazoo, Cardiology Kalamazoo, MI, United States
| | | | - Nilay Patel
- Saint Peter`s University Hospital New Brunswick, NJ, United States
| | - Shilpkumar Arora
- Mount Sinai St. Luke`s Roosevelt Hospital New York, NY, United States
| | - Dhaval Pau
- Staten Island University Hospital Staten Island, NY, United States
| | | | | |
Collapse
|
25
|
Panaich SS, Chothani A, Badheka AO. Procedural Volume and Outcomes of Septal Reduction Therapies in Patients With Hypertrophic Obstructive Cardiomyopathy. JAMA Cardiol 2017; 2:110-111. [PMID: 27732694 DOI: 10.1001/jamacardio.2016.3767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
26
|
Panaich SS, Patel N, Agnihotri K, Arora S, Savani C, Patel NJ, Patel SV, Sonani R, Patel A, Lahewala S, Singh V, Thakkar B, Bhatt P, Deshmukh A, Badheka AO. A Review of Hypertension Management in Atrial Fibrillation. Curr Hypertens Rev 2016; 12:196-202. [PMID: 27964699 DOI: 10.2174/1573402112666161213111527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 11/27/2016] [Accepted: 11/28/2016] [Indexed: 11/22/2022]
Abstract
Atrial fibrillation (AF) is one of the commonest arrhythmias in clinical practice and has major healthcare and economic implications. It is a growing epidemic with prevalence all set to double to 12 million by 2050. After adjusting for other associated conditions, hypertension confers a 1.5- and 1.4-fold risk of developing AF, for men and women respectively. Furthermore, in patients with AF, the presence of hypertension has a cumulative effect on the risk of stroke. Growing evidence suggests reversal or attenuation of various structural and functional changes predisposing to AF with the use of antihypertensive medications. Randomized trials have shown major reduction in the risk of stroke and heart failure with blood pressure reduction. However, such trials are lacking in AF patients specifically. The Joint National Committee-8 guidelines have not addressed the threshold or goal BP for patients with known AF. Furthermore, "J-shaped" or "U-shaped" curves have been noted during hypertension management in patients with AF with published data demonstrating worse outcomes in patients with strict BP control to <110/60 mmhg similar to coronary artery disease. In this review, we outline the available literature on management of hypertension in patients with AF as well as the role of individual anti-hypertensive medications in reducing the incidence of AF Fig. 1.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Apurva O Badheka
- The Everett Clinic, 3901 Hoyt Ave, Everett, WA 98201, United States
| |
Collapse
|
27
|
Arora S, Panaich SS, Patel N, Patel NJ, Lahewala S, Thakkar B, Savani C, Jhamnani S, Singh V, Patel N, Patel S, Sonani R, Patel A, Tripathi B, Deshmukh A, Chothani A, Patel J, Bhatt P, Mohamad T, Remetz MS, Curtis JP, Attaran RR, Mena CI, Schreiber T, Grines C, Cleman M, Forrest JK, Badheka AO. Impact of Glycoprotein IIb/IIIa Inhibitors Use on Outcomes After Lower Extremity Endovascular Interventions From Nationwide Inpatient Sample (2006-2011). Catheter Cardiovasc Interv 2016; 88:605-616. [PMID: 26914274 DOI: 10.1002/ccd.26452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/08/2015] [Revised: 10/18/2015] [Accepted: 01/18/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of our study was to study the impact of glycoprotein IIb/IIIa inhibitors (GPI) on in-hospital outcomes. BACKGROUND There is paucity of data regarding the impact of GPI on the outcomes following peripheral endovascular interventions. METHODS The study cohort was derived from Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database between the years 2006 and 2011. Peripheral endovascular interventions and GPI utilization were identified using appropriate ICD-9 Diagnostic and procedural codes. Two-level hierarchical multivariate mixed models were created. The study outcomes were: primary (in-hospital mortality and amputation studied separately) and secondary (composite of in-hospital mortality and postprocedural complications). Hospitalization costs were also assessed. RESULTS GPI utilization (OR, 95% CI, P-value) was independently predictive of lower amputation rates (0.36, 0.27-0.49, <0.001). There was no significant difference in terms of in-hospital mortality (0.59, 0.31-1.14, P 0.117), although GPI use predicted worse secondary outcomes (1.23, 1.03-1.47, 0.023). Following propensity matching, the amputation rate was lower (3.2% vs. 8%, P < 0.001), while hospitalization costs were higher in the cohort that received GPI ($21,091 ± 404 vs. 19,407 ± 133, P < 0.001). CONCLUSIONS Multivariate analysis revealed GPI use in peripheral endovascular interventions to be suggestive of an increase in composite end-point of in-hospital mortality and postprocedural complications, no impact on in-hospital mortality alone, significantly lower rate of amputation, and increase in hospitalization costs. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
| | | | - Nilay Patel
- Saint Peter's University Hospital, New Brunswick, New Jersey
| | | | | | - Badal Thakkar
- Tulane School of Public Health & Tropical Medicine, New Orleans, Louisiana
| | | | | | - Vikas Singh
- University of Miami Miller School of Medicine, Miami, Florida
| | - Nish Patel
- University of Miami Miller School of Medicine, Miami, Florida
| | - Samir Patel
- Western Reserve Health System, Youngstown, Ohio
| | - Rajesh Sonani
- Public Health Department, Emory University School of Medicine, Atlanta, Georgia
| | - Achint Patel
- Icahn School of Medicine at Mount Sinai, New York
| | | | - Abhishek Deshmukh
- Mayo Clinic, Rochester, Minnesota.,MedStar Washington Hospital Center, Washington, DC
| | | | - Jay Patel
- Detroit Medical Center, Detroit, Michigan
| | - Parth Bhatt
- Tulane School of Public Health & Tropical Medicine, New Orleans, Louisiana
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
Redo surgery for bioprosthetic tricuspid valve failure is associated with high morbidity and mortality. In recent years, transcatheter tricuspid valve-in-valve (VIV) therapy utilizing ballon-expandable transcatheter valves has become available. The tricuspid Valve-in-Valve International Data (VIVID) registry initial results represent the largest experience with tricuspid VIV therapy, demonstrating high procedural success rates with low 30 days mortality and excellent survival free of repeat tricuspid intervention in 1 year. Although longer clinic and hemodynamic follow-up will be needed to fully understand the role of this therapy, these data support the safety, feasibility and beneficial effects of tricuspid VIV therapy. For patients with bioprosthetic tricuspid valve failure, tricuspid VIV is likely to become a first-line treatment option.
Collapse
Affiliation(s)
| | - Mackram F Eleid
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
29
|
Patel SV, Jhamnani S, Patel P, Sonani R, Savani C, Patel N, Patel NJ, Panaich SS, Patel M, Theodore S, Grines C, Badheka AO. Influence of same-day admission on outcomes following transcatheter aortic valve replacement. J Card Surg 2016; 31:608-616. [DOI: 10.1111/jocs.12819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Samir V. Patel
- Department of Internal Medicine; Western Reserve Health Education; Youngstown Ohio
| | - Sunny Jhamnani
- Department of Cardiology; The Everett Clinic; Everett Washington
| | - Palak Patel
- Department of Internal Medicine; Western Reserve Health Education; Youngstown Ohio
| | - Rajesh Sonani
- Department of Internal Medicine; Brandon Regional Hospital; Brandon Florida
| | - Chirag Savani
- Department of Internal Medicine; New York Medical College; Valhalla New York
| | - Nilay Patel
- Department of Internal Medicine; Saint Peter's University Hospital; New Brunswick New Jersey
| | | | - Sidakpal S. Panaich
- Department of Cardiology; University of Miami Miller School of Medicine; Miami Florida
| | - Mihir Patel
- Department of Internal Medicine; Christus Highland Medical Center; Shreveport Louisiana
| | | | - Cindy Grines
- Department of Cardiology; Detroit Medical Center; Detroit Michigan
| | | |
Collapse
|
30
|
Chothani A, Panaich SS, Patel N, Patel NJ, Arora S, Deshmukh A, Grines C, Badheka AO. Septal Ablation and Hypertrophic Obstructive Cardiomyopathy: 7 Years US Experience. J Interv Cardiol 2016; 29:505-512. [DOI: 10.1111/joic.12319] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ankit Chothani
- Mount Sinai St. Luke's Roosevelt Hospital; New York New York
| | | | - Nilay Patel
- Saint Peter's University Hospital; New Brunswick New Jersey
| | | | | | | | | | | |
Collapse
|
31
|
Panaich SS, Patel N, Arora S, Patel NJ, Patel SV, Savani C, Singh V, Sonani R, Deshmukh A, Cleman M, Mangi A, Forrest JK, Badheka AO. Influence of hospital volume and outcomes of adult structural heart procedures. World J Cardiol 2016; 8:302-309. [PMID: 27152142 PMCID: PMC4840163 DOI: 10.4330/wjc.v8.i4.302] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/23/2015] [Accepted: 01/22/2016] [Indexed: 02/06/2023] Open
Abstract
Hospital volume is regarded amongst many in the medical community as an important quality metric. This is especially true in more complicated and less commonly performed procedures such as structural heart disease interventions. Seminal work on hospital volume relationships was done by Luft et al more than 4 decades ago, when they demonstrated that hospitals performing > 200 surgical procedures a year had 25%-41% lower mortality than those performing fewer procedures. Numerous volume-outcome studies have since been done for varied surgical procedures. An old adage “practice makes perfect” indicating superior operator and institutional experience at higher volume hospitals is believed to primarily contribute to the volume outcome relationship. Compelling evidence from a slew of recent publications has also highlighted the role of hospital volume in predicting superior post-procedural outcomes following structural heart disease interventions. These included transcatheter aortic valve repair, transcatheter mitral valve repair, septal ablation and septal myectomy for hypertrophic obstructive cardiomyopathy, left atrial appendage closure and atrial septal defect/patent foramen ovale closure. This is especially important since these structural heart interventions are relatively complex with evolving technology and a steep learning curve. The benefit was demonstrated both in lower mortality and complications as well as better economics in terms of lower length of stay and hospitalization costs seen at high volume centers. We present an overview of the available literature that underscores the importance of hospital volume in complex structural heart disease interventions.
Collapse
|
32
|
Patel NJ, Badheka AO, Jhamnani S, Panaich SS, Singh V, Patel N, Arora S, Grines CL, Cleman M, Forrest JK. Effect of Hospital Volume on Outcomes of Transcatheter Mitral Valve Repair: An Early US Experience. J Interv Cardiol 2016; 28:464-71. [PMID: 26489974 DOI: 10.1111/joic.12228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Transcatheter mitral valve repair (TMVR) is a complex procedure for patients with mitral regurgitation who cannot get surgery. However, there is a lack of data on how hospital volumes affect these outcomes. METHODS We performed a cross sectional study based on Healthcare Cost and Utilization Project's Nationwide Inpatient Sample database of 2012 and identified subjects using the ICD-9-CM procedure code of 35.97, which was introduced in October 2010 for percutaneous mitral valve repair if present in the primary or secondary procedure field. Hospital volumes were divided into tertiles. The primary outcome was a composite of in-hospital mortality and peri-procedural complications. Length of stay and hospitalization cost were also assessed. RESULTS A total of 95 (weighted n = 475) TMVR procedures were identified. The mean age of the overall cohort was 70 years; 43.2% were female and 63.2% had a significant baseline burden of co-morbidities. The composite of in-hospital mortality and peri-procedural complications decreased with increasing TMVR hospital volume: 48.7% in the first tertile, 17.4% in the second tertile, and 9.1% in the third tertile. Additionally, we saw a decrease in the length of stay and a trend in decrease in the hospitalization cost. CONCLUSION In hospitals performing TMVR, higher hospital volumes are associated with a reduction in a composite of in-hospital mortality and post-procedural complications, in addition to the shorter length of stay.
Collapse
Affiliation(s)
| | | | | | | | - Vikas Singh
- University of Miami Miller School of Medicine, Miami, Florida
| | - Nilay Patel
- Saint Peter's University Hospital, New Brunswick, New Jersey
| | | | | | | | | |
Collapse
|
33
|
Panaich SS, Arora S, Patel N, Patel NJ, Patel SV, Savani C, Singh V, Jhamnani S, Sonani R, Lahewala S, Thakkar B, Patel A, Dave A, Shah H, Bhatt P, Jaiswal R, Ghatak A, Gupta V, Deshmukh A, Kondur A, Schreiber T, Grines C, Badheka AO. In-Hospital Outcomes of Atherectomy During Endovascular Lower Extremity Revascularization. Am J Cardiol 2016; 117:676-684. [PMID: 26732418 DOI: 10.1016/j.amjcard.2015.11.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 11/18/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022]
Abstract
Contemporary data on clinical outcomes after utilization of atherectomy in lower extremity endovascular revascularization are sparse. The study cohort was derived from Healthcare Cost and Utilization Project nationwide inpatient sample database from the year 2012. Peripheral endovascular interventions including atherectomy were identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes. The subjects were divided and compared in 2 groups: atherectomy versus no atherectomy. Two-level hierarchical multivariate mixed models were created. The coprimary outcomes were in-hospital mortality and amputation; secondary outcome was a composite of in-hospital mortality and periprocedural complications. Hospitalization costs were also assessed. Atherectomy utilization (odds ratio, 95% CI, p value) was independently predictive of lower in-hospital mortality (0.46, 0.28 to 0.75, 0.002) and lower amputation rates (0.83, 0.71 to 0.97, 0.020). Atherectomy use was also predictive of significantly lower secondary composite outcome of in-hospital mortality and complications (0.79, 0.69 to 0.90, 0.001). In the propensity-matched cohort, atherectomy utilization was again associated with a lower rate of amputation (11.18% vs 12.92%, p = 0.029), in-hospital mortality (0.71% vs 1.53%, p 0.001), and any complication (13.24% vs 16.09%, p 0.001). However, atherectomy use was also associated with higher costs ($24,790 ± 397 vs $22635 ± 251, p <0.001). Atherectomy use in conjunction with angioplasty (with or without stenting) was associated with improved in-hospital outcomes in terms of lower amputation rates, mortality, and postprocedural complications.
Collapse
|
34
|
Panaich SS, Patel N, Agnihotri K, Arora S, Savani C, Sonani R, Patel NJ, Patel SV, Solanki S, Schreiber T, Grines C, Badheka AO. Volume-outcome relationship for peripheral endovascular interventions: a review of existing literature. Expert Rev Pharmacoecon Outcomes Res 2016; 16:103-9. [PMID: 26732517 DOI: 10.1586/14737167.2016.1138859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The incidence and prevalence of peripheral vascular disease has been increasing. When coexistent with coronary artery disease (CAD), it has shown to predict higher mortality along with poorer quality-of-life consequently leading to a marked increase in healthcare costs. Broadly, there has been an increase in utilization of endovascular techniques in the management of peripheral vascular diseases. An inverse relation between volume and outcomes has been noted in these procedures. Additionally, improved resource utilization has also been noted with higher hospital and operator volumes. This has led to proposals to regionalize these procedures to high volume hospitals. There have also been calls to introduce the idea of having a set threshold of procedures for providers. This review presents an overview of published literature on the volume-outcome relationship affecting the outcomes of peripheral endovascular procedures.
Collapse
Affiliation(s)
| | - Nilay Patel
- b Internal Medicine Department , Saint Peter's University Hospital , New Brunswick , NJ , USA
| | - Kanishk Agnihotri
- b Internal Medicine Department , Saint Peter's University Hospital , New Brunswick , NJ , USA
| | - Shilpkumar Arora
- c Internal Medicine Department , Mount Sinai St. Luke's Roosevelt Hospital , New York , NY , USA
| | - Chirag Savani
- d Epidemiology Department , New York Medical College , Valhalla , NY , USA
| | - Raj Sonani
- e Public Health Department , Emory University School of Medicine , Atlanta , GA , USA
| | - Nileshkumar J Patel
- f Cardiology Department , University of Miami Miller school of Medicine , Miami , FL , USA
| | - Samir V Patel
- g Internal Medicine Department , Western Reserve Health System , Youngstown , OH , USA
| | - Shantanu Solanki
- h Internal Medicine Department , Westchester Medical center at New York Medical College , Valhalla , NY , USA
| | | | - Cindy Grines
- i Cardiology Department , Detroit Medical Centre , Detroit , MI , USA
| | - Apurva O Badheka
- j Cardiology Department , The Everett Clinic , Everett , WA , USA
| |
Collapse
|
35
|
Panaich SS, Arora S, Patel N, Patel NJ, Savani C, Patel A, Thakkar B, Singh V, Patel S, Patel N, Agnihotri K, Bhatt P, Deshmukh A, Gupta V, Attaran RR, Mena CI, Grines CL, Cleman M, Forrest JK, Badheka AO. Intravascular Ultrasound in Lower Extremity Peripheral Vascular Interventions. J Endovasc Ther 2015; 23:65-75. [DOI: 10.1177/1526602815620780] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To examine the impact of intravascular ultrasound (IVUS) utilization during lower limb endovascular interventions as regards postprocedural complications and amputation. Methods: The study cohort was derived from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database between the years 2006 and 2011. Peripheral endovascular interventions were identified using appropriate ICD-9 procedure codes. Two-level hierarchical multivariate mixed models were created. The co-primary outcomes were in-hospital mortality and amputation; the secondary outcome was postprocedural complications. Model results are given as the odds ratio (OR) and 95% confidence interval (CI). Hospitalization costs were also assessed. Results: Overall, among the 92,714 patients extracted from the database during the observation period, IVUS was used in 1299 (1.4%) patients. IVUS utilization during lower extremity peripheral vascular procedures was independently predictive of a lower rate of postprocedural complications (OR 0.80, 95% CI 0.66 to 0.99, p=0.037) as well as lower amputation rates (OR 0.59, 95% CI 0.45 to 0.77, p<0.001) without any significant impact on in-hospital mortality. Multivariate analysis also revealed IVUS utilization to be predictive of a nonsignificant increase in hospitalization costs ($1333, 95% CI −$167 to +$2833, p=0.082). Conclusion: IVUS use during lower limb endovascular interventions is predictive of lower postprocedural complication and amputation rates with a nonsignificant increase in hospitalization costs.
Collapse
Affiliation(s)
| | | | - Nilay Patel
- Saint Peter’s University Hospital, New Brunswick, NJ, USA
| | | | | | - Achint Patel
- Icahn School of Public Health at Mount Sinai, New York, NY, USA
| | - Badal Thakkar
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Vikas Singh
- University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Samir Patel
- Western Reserve Health System, Youngstown, OH, USA
| | - Nish Patel
- University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | | | - Parth Bhatt
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Kaur BP, Lahewala S, Arora S, Agnihotri K, Panaich SS, Secord E, Levine D. Asthma: Hospitalization Trends and Predictors of In-Hospital Mortality and Hospitalization Costs in the USA (2001-2010). Int Arch Allergy Immunol 2015; 168:71-8. [PMID: 26595589 DOI: 10.1159/000441687] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 10/12/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In the last decade, the proportion of people with asthma in the USA grew by nearly 15%, with 479,300 hospitalizations and 1.9 million emergency department visits in 2009 alone. The primary objective of our study was to evaluate in-hospital outcomes in patients admitted with asthma exacerbation in terms of mortality, length of stay (LOS) and hospitalization costs. METHODS We queried the HCUP's Nationwide Inpatient Sample (NIS) between 2001 and 2010 using the ICD9-CM diagnosis code 493 for asthma (n = 760,418 patients). The NIS represents 20% of all hospitals in the USA. Multivariate logistic regression analysis was used to evaluate predictors of in-hospital mortality. LOS and hospitalization costs were also analyzed. RESULTS The overall LOS was 3.9 days and as high as 8.3 days in patients requiring mechanical ventilation. LOS has decreased in recent years, though it continues to be higher than in 2001. The hospitalization cost increased steadily over the study period. The overall in-hospital mortality was 1% and as high as 9.8% in patients requiring mechanical ventilation. Multivariate predictors of longer LOS, higher hospitalization costs and in-hospital mortality included increasing age and hospitalizations during the winter months. Private insurance was predictive of lower hospitalization costs and LOS as well as lower in-hospital mortality. CONCLUSION Asthma continues to account for significant in-hospital mortality and resource utilization, especially in mechanically ventilated patients. Age, admissions during winter months and the type of insurance are independent predictors of in-hospital outcomes.
Collapse
Affiliation(s)
- Bani Preet Kaur
- Detroit Medical Center, Wayne State University, Detroit, Mich., USA
| | | | | | | | | | | | | |
Collapse
|
37
|
Panaich SS, Arora S, Patel N, Patel N, Savani C, Patel A, Thakkar B, Jhamnani S, Singh V, Patel S, Bhatt P, Bhimani R, Patel P, Dave A, Sonani R, Patel A, Desai M, Mohamed B, Deshmukh A, Badheka AO. Impact of hospital volume on outcomes of lower extremity endovascular interventions: the better half? Am J Cardiol 2015; 116:1645. [PMID: 26428027 DOI: 10.1016/j.amjcard.2015.07.022] [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: 07/08/2015] [Accepted: 07/12/2015] [Indexed: 11/19/2022]
|
38
|
Singh V, Patel SV, Savani C, Patel NJ, Patel N, Arora S, Panaich SS, Deshmukh A, Cleman M, Mangi A, Forrest JK, Badheka AO. Mechanical circulatory support devices and transcatheter aortic valve implantation (from the National Inpatient Sample). Am J Cardiol 2015; 116:1574-80. [PMID: 26434512 DOI: 10.1016/j.amjcard.2015.08.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 07/17/2015] [Revised: 08/20/2015] [Accepted: 08/20/2015] [Indexed: 11/16/2022]
Abstract
High-risk surgical patients undergoing transcatheter aortic valve implantation (TAVI) represent an emerging population, which may benefit from short-term use of mechanical circulatory support (MCS) devices. The aim of this study was to determine the practice and inhospital outcomes of MCS utilization in patients undergoing TAVI. We analyzed data from Nationwide Inpatient Sample (2011 and 2012) using the International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. A total of 1,794 TAVI procedures (375 hospitals in the United States) were identified of which 190 (10.6%) used an MCS device (MCS group) and 1,604 (89.4%) did not (non-MCS group). The use of MCS devices with TAVI was associated with significant increase in the inhospital mortality (14.9% vs 3.5%, p <0.01). The mean length (11.8 ± 0.8 vs 8.1 ± 0.2 days, p <0.01) and cost ($68,997 ± 3,656 vs $55,878 ± 653, p = 0.03) of hospitalization were also significantly greater in the MCS group. Ventricular fibrillation arrest, transapical access for TAVI, and cardiogenic shock were the most significant predictors of MCS use during TAVI. In the multivariate model, use of any MCS device was found to be an independent predictor of increased mortality (odds ratio 3.5, 95% confidence interval 2.6 to 4.6, p <0.0001) and complications (odds ratio 3.3, 95% confidence interval 2.8 to 3.9, p <0.0001). The propensity score-matched analysis also showed a similar result. In conclusion, the unacceptably high rates of mortality and complications coupled with a significant increase in the length and cost of hospitalization should raise concerns about utility of MCS devices during TAVI in this prohibitive surgical risk population.
Collapse
Affiliation(s)
- Vikas Singh
- Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida
| | - Samir V Patel
- Internal Medicine Department, Western Reserve Health Education, Youngstown, Ohio
| | - Chirag Savani
- Public Health Department, New York Medical College, Valhalla, New York
| | - Nileshkumar J Patel
- Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida
| | - Nilay Patel
- Internal Medicine Department, Saint Peter's University Hospital, New Brunswick, New Jersey
| | - Shilpkumar Arora
- Internal Medicine Department, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York
| | | | | | - Michael Cleman
- Cardiology Department, Yale School of Medicine, New Haven, Connecticut
| | - Abeel Mangi
- Interventional Cardiology Department, The Everett Clinic, Everett, Washington
| | - John K Forrest
- Interventional Cardiology Department, The Everett Clinic, Everett, Washington
| | - Apurva O Badheka
- Interventional Cardiology Department, The Everett Clinic, Everett, Washington.
| |
Collapse
|
39
|
Bhatt P, Patel NJ, Patel A, Sonani R, Patel A, Panaich SS, Thakkar B, Savani C, Jhamnani S, Patel N, Patel N, Pant S, Patel S, Arora S, Dave A, Singh V, Chothani A, Patel J, Ansari M, Deshmukh A, Bhimani R, Grines C, Cleman M, Mangi A, Forrest JK, Badheka AO. Impact of Hospital Volume on Outcomes of Endovascular Stenting for Adult Aortic Coarctation. Am J Cardiol 2015; 116:1418-24. [PMID: 26471501 DOI: 10.1016/j.amjcard.2015.07.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 07/29/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022]
Abstract
Use of transcatheter endovascular stenting has been increasing in the treatment of coarctation of aorta (CoA). The present study was undertaken on adults with CoA who underwent stent placement from 2000 to 2011 to analyze the relation of hospital volumes to the outcomes of stenting in adults with CoA. It was a retrospective study based on Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (NIS) database from 2000 to 2011 and identified subjects using the International Classification of Diseases, Ninth Revision, Clinical Modification procedure code of 747.10 (CoA). Annual hospital volume was calculated using unique hospital identifiers. Weights provided by the Nationwide Inpatient Sample were used to generate national estimates. A total of 105 (weighted 521) subjects were identified with International Classification of Diseases, Ninth Revision, code of 39.90 (Endovascular stent). Hospital volumes were divided into tertiles. We compared the highest tertile (≥3 procedures annually) with other tertiles (<3 procedure annually). The composite outcomes of the analysis were procedure-related complications, length of stay (LOS), and cost in relation to the hospital volume. No inhospital death was reported in either group. Hospitals with ≥3 procedures annually had significantly lower incidence of complications (9.5% vs 23.0%) compared to the hospitals with <3 procedures annually (p-value 0.002). Similar results were obtained after multivariate regression analysis in relation to hospital volume. Shorter LOS and lower cost were observed with annual hospital volume of ≥3 procedures. In conclusion, stenting adults for CoA is remarkably safe, and the outcomes of the procedure have improved in centers with annual hospital volume of ≥3 procedures. There is also decreasing trend of procedure-related complications, shorter LOS, and lower costs compared to centers with annual volume <3 procedures.
Collapse
|
40
|
Singh V, Badheka AO, Patel SV, Patel NJ, Thakkar B, Patel N, Arora S, Patel N, Patel A, Savani C, Ghatak A, Panaich SS, Jhamnani S, Deshmukh A, Chothani A, Sonani R, Patel A, Bhatt P, Dave A, Bhimani R, Mohamad T, Grines C, Cleman M, Forrest JK, Mangi A. Comparison of Inhospital Outcomes of Surgical Aortic Valve Replacement in Hospitals With and Without Availability of a Transcatheter Aortic Valve Implantation Program (from a Nationally Representative Database). Am J Cardiol 2015; 116:1229-36. [PMID: 26297512 DOI: 10.1016/j.amjcard.2015.07.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/12/2015] [Accepted: 07/12/2015] [Indexed: 11/28/2022]
Abstract
We hypothesized that the availability of a transcatheter aortic valve implantation (TAVI) program in hospitals impacts the overall management of patients with aortic valve disease and hence may also improve postprocedural outcomes of conventional surgical aortic valve replacement (SAVR). The aim of the present study was to compare the inhospital outcomes of SAVR in centers with versus without availability of a TAVI program in an unrestricted large nationwide patient population >50 years of age. SAVRs performed on patients aged >50 years were identified from the Nationwide Inpatient Sample (NIS) for the years 2011 and 2012 using the International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. SAVR cases were divided into 2 categories: those performed at hospitals with a TAVI program (SAVR-TAVI) and those without (SAVR-non-TAVI). A total of 9,674 SAVR procedures were identified: 4,526 (46.79%) in the SAVR-TAVI group and 5,148 (53.21%) in SAVR-non-TAVI group. The mean age of the study population was 70.2 ± 0.1 years with majority (53%) of the patients aged >70 years. The mean Charlson's co-morbidity score for patients in SAVR-TAVI group was greater (greater percentage of patients were aged >80 years, had hypertension, congestive heart failure, renal failure, and peripheral arterial disease) than that of patients in SAVR-non-TAVI group (1.6 vs 1.4, p <0.001). The propensity score matching analysis showed a statistically significant lower inhospital mortality (1.25% vs 1.72%, p = 0.001) and complications rate (35.6% vs 37.3%, p = 0.004) in SAVR-TAVI group compared to SAVR-non-TAVI group. The mean length of hospital stay was similar in the 2 groups the cost of hospitalization was higher in the SAVR-TAVI group ($43,894 ± 483 vs $41,032 ± 473, p <0.0001). Having a TAVI program was a significant predictor of reduced mortality and complications rate after SAVR in multivariate analysis. In conclusion, this largest direct comparative analysis demonstrates that SAVRs performed in centers with a TAVI program are associated with significantly lower mortality and complications rates compared to those performed in centers without a TAVI program.
Collapse
Affiliation(s)
- Vikas Singh
- Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida
| | - Apurva O Badheka
- Interventional Cardiology Department, The Everett Clinic, Everett, Washington.
| | - Samir V Patel
- Internal Medicine Department, Western Reserve Health System, Youngstown, Ohio
| | - Nileshkumar J Patel
- Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida
| | - Badal Thakkar
- Epidemiology Department, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Nilay Patel
- Internal Medicine Department, Saint Peter's University Hospital, New Brunswick, New Jersey
| | - Shilpkumar Arora
- Internal Medicine Department, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York
| | - Nish Patel
- Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida
| | - Achint Patel
- Public Health Department, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Chirag Savani
- Epidemiology Department, New York Medical College, Valhalla, New York
| | - Abhijit Ghatak
- Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Sunny Jhamnani
- Interventional Cardiology Department, The Everett Clinic, Everett, Washington
| | | | - Ankit Chothani
- Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC
| | - Rajesh Sonani
- Internal Medicine Department, Emory University School of Medicine, Atlanta, Georgia
| | - Aashay Patel
- Internal Medicine Department, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | - Parth Bhatt
- Internal Medicine Department, Saint Peter's University Hospital, New Brunswick, New Jersey
| | - Abhishek Dave
- Public Health Department, Texas A&M Medical Centre, College Station, Texas
| | - Ronak Bhimani
- Internal Medicine Department, St. Vincent Charity Medical Centre, Cleveland, Ohio
| | - Tamam Mohamad
- Cardiology Department, Detroit Medical Center, Detroit, Michigan
| | - Cindy Grines
- Cardiology Department, Detroit Medical Center, Detroit, Michigan
| | - Michael Cleman
- Cardiology Department, Yale School of Medicine, New Haven, Connecticut
| | - John K Forrest
- Cardiology Department, Yale School of Medicine, New Haven, Connecticut
| | - Abeel Mangi
- Cardiology Department, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
41
|
Singh V, Patel S, Patel NJ, Savani C, Patel N, Arora S, Panaich SS, Cleman M, Mangi AA, Forrest JK, Badheka A. TCT-191 Mechanical Circulatory Support Devices and Transcatheter Aortic Valve Replacement: A Multicenter experience. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
42
|
Arora S, Patel N, Patel NJ, Panaich SS, Patel A, Lahewala S, Savani C, Thakkar B, Bhatt P, Patel S, Patel S, Singh V, Chothani A, Badheka A, Deshmukh AJ. TCT-805 Intravascular Ultrasound Utilization And In-hospital Outcomes In Peripheral Vascular Interventions: Insights From Nationwide Inpatient Sample. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.1115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
43
|
Arora S, Panaich SS, Patel N, Patel N, Lahewala S, Solanki S, Patel P, Patel A, Manvar S, Savani C, Tripathi B, Thakkar B, Jhamnani S, Singh V, Patel S, Patel J, Bhimani R, Mohamad T, Remetz MS, Curtis JP, Attaran RR, Grines C, Mena CI, Cleman M, Forrest J, Badheka AO. Impact of Hospital Volume on Outcomes of Lower Extremity Endovascular Interventions (Insights from the Nationwide Inpatient Sample [2006 to 2011]). Am J Cardiol 2015; 116:791-800. [PMID: 26100585 DOI: 10.1016/j.amjcard.2015.05.050] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 05/23/2015] [Accepted: 05/23/2015] [Indexed: 10/23/2022]
Abstract
Our primary objective was to study postprocedural outcomes and hospitalization costs after peripheral endovascular interventions and the multivariate predictors affecting the outcomes with emphasis on hospital volume. The study cohort was derived from Healthcare Cost and Utilization Project Nationwide Inpatient Sample database (2006 to 2011). Peripheral endovascular interventions were identified using appropriate International Classification of Diseases, Ninth Revision diagnostic and procedural codes. Annual institutional volumes were calculated using unique identification numbers and then divided into quartiles. Two-level hierarchical multivariate mixed models were created. The primary outcome was inhospital mortality; secondary outcome was a composite of inhospital mortality and postprocedural complications. Amputation rates and hospitalization costs were also assessed. Multivariate analysis (odds ratio, 95% confidence interval, p value) revealed age (1.46, 1.37 to 1.55, p <0.001), female gender (1.28, 1.12 to 1.46, p <0.001), baseline co-morbidity status as depicted by a greater Charlson co-morbidity index score (≥2: 4.32, 3.45 to 5.40, p <0.001), emergent or urgent admissions(2.48, 2.14 to 2.88, p <0.001), and weekend admissions (1.53, 1.26 to 1.86, p <0.001) to be significant predictors of primary outcome. An increasing hospital volume quartile was independently predictive of improved primary (0.65, 0.52 to 0.82, p <0.001 for the fourth quartile) and secondary (0.85, 0.73 to 0.97, 0.02 for the fourth quartile) outcomes and lower amputation rates (0.52, 0.45 to 0.61, p <0.001). A significant reduction hospitalization costs ($-3,889, -5,318 to -2,459, p <0.001) was also seen in high volume centers. In conclusion, a greater hospital procedural volume is associated with superior outcomes after peripheral endovascular interventions in terms of inhospital mortality, complications, and hospitalization costs.
Collapse
|
44
|
Patel N, Patel NJ, Agnihotri K, Panaich SS, Thakkar B, Patel A, Savani C, Patel N, Arora S, Deshmukh A, Bhatt P, Alfonso C, Cohen M, Tafur A, Elder M, Mohamed T, Attaran R, Schreiber T, Grines C, Badheka AO. Utilization of catheter-directed thrombolysis in pulmonary embolism and outcome difference between systemic thrombolysis and catheter-directed thrombolysis. Catheter Cardiovasc Interv 2015; 86:1219-27. [DOI: 10.1002/ccd.26108] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 06/20/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Nish Patel
- Cardiology Department; University of Miami Miller School of Medicine; Miami Florida
| | - Nileshkumar J. Patel
- Internal Medicine Department; Staten Island University Hospital; Staten Island New York
| | - Kanishk Agnihotri
- Internal Medicine Department; Saint Peters University Hospital; New Brunswick New Jersey
| | | | - Badal Thakkar
- Internal Medicine Department; Tulane School of Public Health and Tropical Medicine; New Orleans Louisiana
| | - Achint Patel
- Internal Medicine Department; Icahn School of Medicine at Mount Sinai; New York New York
| | - Chirag Savani
- Internal Medicine Department; New York Medical College; Valhalla New York
| | - Nilay Patel
- Internal Medicine Department; Saint Peters University Hospital; New Brunswick New Jersey
| | - Shilpkumar Arora
- Internal Medicine Department; Mount Sinai St Luke's Roosevelt Hospital; New York New York
| | | | - Parth Bhatt
- Internal Medicine Department; Tulane School of Public Health and Tropical Medicine; New Orleans Louisiana
| | - Carlos Alfonso
- Cardiology Department; University of Miami Miller School of Medicine; Miami Florida
| | - Mauricio Cohen
- Cardiology Department; University of Miami Miller School of Medicine; Miami Florida
| | - Alfonso Tafur
- Cardiology Department; North Shore University Health System; Chicago Illinois
| | - Mahir Elder
- Cardiology Department; Detroit Medical Center; Detroit Michigan
| | - Tamam Mohamed
- Cardiology Department; Detroit Medical Center; Detroit Michigan
| | - Ramak Attaran
- Cardiology Department; Yale School of Medicine; New Haven Connecticut
| | | | - Cindy Grines
- Cardiology Department; Detroit Medical Center; Detroit Michigan
| | - Apurva O. Badheka
- Cardiology Department; Yale School of Medicine; New Haven Connecticut
| |
Collapse
|
45
|
Badheka AO, Patel NJ, Panaich SS, Patel SV, Jhamnani S, Singh V, Pant S, Patel N, Patel N, Arora S, Thakkar B, Manvar S, Dhoble A, Patel A, Savani C, Patel J, Chothani A, Savani GT, Deshmukh A, Grines CL, Curtis J, Mangi AA, Cleman M, Forrest JK. Effect of Hospital Volume on Outcomes of Transcatheter Aortic Valve Implantation. Am J Cardiol 2015; 116:587-94. [PMID: 26092276 DOI: 10.1016/j.amjcard.2015.05.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/07/2015] [Accepted: 05/07/2015] [Indexed: 01/10/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is associated with a significant learning curve. There is paucity of data regarding the effect of hospital volume on outcomes after TAVI. This is a cross-sectional study based on Healthcare Cost and Utilization Project's Nationwide Inpatient Sample database of 2012. Subjects were identified by International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes, 35.05 (Trans-femoral/Trans-aortic Replacement of Aortic Valve) and 35.06 (Trans-apical Replacement of Aortic Valve). Annual hospital TAVI volumes were calculated using unique identification numbers and then divided into quartiles. Multivariate logistic regression models were created. The primary outcome was inhospital mortality; secondary outcome was a composite of inhospital mortality and periprocedural complications. Length of stay (LOS) and cost of hospitalization were assessed. The study included 1,481 TAVIs (weighted n = 7,405). Overall inhospital mortality rate was 5.1%, postprocedural complication rate was 43.4%, median LOS was 6 days, and median cost of hospitalization was $51,975. Inhospital mortality rates decreased with increasing hospital TAVI volume with a rate of 6.4% for lowest volume hospitals (first quartile), 5.9% (second quartile), 5.2% (third quartile), and 2.8% for the highest volume TAVI hospitals (fourth quartile). Complication rates were significantly higher in hospitals with the lowest volume quartile (48.5%) compared to hospitals in the second (44.2%), third (39.7%), and fourth (41.5%) quartiles (p <0.001). Increasing hospital volume was independently predictive of shorter LOS and lower hospitalization costs. In conclusion, higher annual hospital volumes are significantly predictive of reduced postprocedural mortality, complications, shorter LOS, and lower hospitalization costs after TAVI.
Collapse
|
46
|
Badheka AO, Patel NJ, Grover P, Singh V, Patel N, Arora S, Chothani A, Mehta K, Deshmukh A, Savani GT, Patel A, Panaich SS, Shah N, Rathod A, Brown M, Mohamad T, Makkar RR, Schreiber T, Grines CL, Rihal CS, Cohen MG. Response to Letter Regarding Article "Impact of Annual Operator and Institutional Volume on Percutaneous Coronary Intervention Outcomes: A 5-Year United States Experience (2005-2009)". Circulation 2015; 132:e36-7. [PMID: 26240270 DOI: 10.1161/circulationaha.115.015221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Vikas Singh
- Miller School of Medicine, University of Miami, Miami, FL
| | - Nilay Patel
- Saint Peter's University Hospital, New Brunswick, NJ
| | | | | | - Kathan Mehta
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | - Achint Patel
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Chothani A, Shah N, Patel NJ, Deshmukh A, Singh V, Patel N, Panaich SS, Arora S, Patel A, Savani C, Thakkar B, Bhatt P, Cohen MG, Grines C, Forrest JK, Badheka AO. Vaccination Serology Status and Cardiovascular Mortality: Insight from NHANES III and Continuous NHANES. Postgrad Med 2015; 127:561-4. [DOI: 10.1080/00325481.2015.1064300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
48
|
Arora S, Panaich SS, Patel NJ, Patel N, Solanki S, Deshmukh A, Singh V, Lahewala S, Savani C, Thakkar B, Dave A, Patel A, Bhatt P, Sonani R, Patel A, Cleman M, Forrest JK, Schreiber T, Badheka AO, Grines C. Multivessel Percutaneous Coronary Interventions in the United States. Angiology 2015; 67:326-35. [DOI: 10.1177/0003319715593853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: Multivessel coronary artery disease carries significant mortality risk. Comprehensive data on inhospital outcomes following multivessel percutaneous coronary intervention (MVPCI) are sparse. Methods: We queried the Healthcare Cost and Utilization Project’s nationwide inpatient sample (NIS) between 2006 and 2011 using different International Classification of Diseases, 9th Revision, Clinical Modification procedure codes. The primary outcome was inhospital all-cause mortality, and the secondary outcome was a composite of inhospital mortality and periprocedural complications. Results: The overall mortality was low at 0.73% following MVPCI. Multivariate analysis revealed that (odds ratio, 95% confidence interval, P value) age (1.63, 1.48-1.79; <.001), female sex (1.19, 1.00-1.42; P = .05), acute myocardial infarction (AMI; 2.97, 2.35-3.74; <.001), shock (17.24, 13.61-21.85; <.001), a higher burden of comorbidities (2.09, 1.32-3.29; .002), and emergent/urgent procedure status (1.67, 1.30-2.16; <.001) are important predictors of primary and secondary outcomes. MVPCI was associated with higher mortality, length of stay (LOS), and cost of care as compared to single vessel single stent PCI. Conclusion: MVPCI is associated with higher inhospital mortality, LOS, and hospitalization costs compared to single vessel, single stent PCI. Higher volume hospitals had lower overall postprocedural mortality rate along with shorter LOS and lower hospitalization costs following MVPCI.
Collapse
Affiliation(s)
- Shilpkumar Arora
- Internal Medicine Department, Mount Sinai St Luke’s Roosevelt Hospital, New York, NY, USA
| | | | - Nileshkumar J. Patel
- Internal Medicine Department, Staten Island University Hospital, Staten Island, NY, USA
| | - Nilay Patel
- Internal Medicine Department, Saint Peter’s University Hospital, New Brunswick, NJ, USA
| | - Shantanu Solanki
- Internal Medicine Department, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Vikas Singh
- Cardiology Department, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sopan Lahewala
- Internal Medicine Department, Mount Sinai Hospital Center, New York, NY, USA
| | - Chirag Savani
- Internal Medicine Department, New York Medical College, Valhalla, NY, USA
| | - Badal Thakkar
- Internal Medicine Department, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Abhishek Dave
- Internal Medicine Department, Texas A&M University, College Station, TX, USA
| | - Achint Patel
- Internal Medicine Department, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Parth Bhatt
- Internal Medicine Department, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Rajesh Sonani
- Internal Medicine Department, Emory University School of Medicine, Atlanta, GA, USA
| | - Aashay Patel
- Internal Medicine Department, Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Michael Cleman
- Cardiology Department, Yale School of Medicine, New Haven, CT, USA
| | - John K. Forrest
- Cardiology Department, Yale School of Medicine, New Haven, CT, USA
| | | | | | - Cindy Grines
- Cardiovascular Department, Detroit Medical Center, Detroit, MI, USA
| |
Collapse
|
49
|
Badheka AO, Singh V, Patel NJ, Arora S, Patel N, Thakkar B, Jhamnani S, Pant S, Chothani A, Macon C, Panaich SS, Patel J, Manvar S, Savani C, Bhatt P, Panchal V, Patel N, Patel A, Patel D, Lahewala S, Deshmukh A, Mohamad T, Mangi AA, Cleman M, Forrest JK. Trends of Hospitalizations in the United States from 2000 to 2012 of Patients >60 Years With Aortic Valve Disease. Am J Cardiol 2015; 116:132-41. [PMID: 25983278 DOI: 10.1016/j.amjcard.2015.03.053] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 03/03/2015] [Revised: 03/26/2015] [Accepted: 03/26/2015] [Indexed: 11/27/2022]
Abstract
In recent years, there has been an increased emphasis on the diagnosis and treatment of valvular heart disease and, in particular, aortic stenosis. This has been driven in part by the development of innovative therapeutic options and by an aging patient population. We hypothesized an increase in the number of hospitalizations and the economic burden associated with aortic valve disease (AVD). Using Nationwide Inpatient Sample from 2000 to 2012, AVD-related hospitalizations were identified using International Classification of Diseases, Ninth Revision, Clinical Modification, code 424.1, as the principal discharge diagnosis. Overall AVD hospitalizations increased by 59% from 2000 to 2012. This increase was most significant in patients >80 years and those with higher burden of co-morbidities. The most frequent coexisting conditions were hypertension, heart failure, renal failure, anemia, and diabetes. Overall inhospital mortality of patients hospitalized for AVD was 3.8%, which significantly decreased from 4.5% in 2000 to 3.5% in 2012 (p <0.001). The largest decrease in mortality was seen in the subgroup of patients who had heart failure (62% reduction), higher burden of co-morbidities (58% reduction), and who were >80 years (53% reduction). There was a substantial increase in the cost of hospitalization in the last decade from $31,909 to $38,172 (p <0.001). The total annual cost for AVD hospitalization in the United States increased from $1.3 billion in 2001 to $2.1 billion in 2011 and is expected to increase to nearly 3 billion by 2020. The last decade has witnessed a significant increase in hospitalizations for AVD in the United States. The associated decrease in inhospital mortality and increase in the cost of hospitalization have considerably increased the economic burden on the public health system.
Collapse
Affiliation(s)
- Apurva O Badheka
- Cardiovascular Division, Yale School of Medicine, New Haven, Connecticut
| | - Vikas Singh
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida
| | - Nileshkumar J Patel
- Cardiovascular Division, Staten Island University Hospital, Staten Island, New York
| | - Shilpkumar Arora
- Cardiovascular Division, Mount Sinai St Luke's Roosevelt Hospital, New York, New York
| | - Nilay Patel
- Cardiovascular Division, Saint Peter's University Hospital, New Brunswick, New Jersey
| | - Badal Thakkar
- Cardiovascular Division, Tulane School of Public Health and Tropical Medicine, New Orleans, Los Angeles
| | - Sunny Jhamnani
- Cardiovascular Division, Yale School of Medicine, New Haven, Connecticut
| | - Sadip Pant
- Cardiovascular Division, Icahn School of Public Health at Mount Sinai, New York, New York
| | - Ankit Chothani
- Cardiovascular Division, University of Louisville, Louisville, Kentucky
| | - Conrad Macon
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida
| | - Sidakpal S Panaich
- Cardiovascular Division, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Jay Patel
- Cardiovascular Division, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Sohilkumar Manvar
- Cardiovascular Division, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Chirag Savani
- Cardiovascular Division, Detroit Medical Center, Detroit, Michigan
| | - Parth Bhatt
- Cardiovascular Division, Tulane School of Public Health and Tropical Medicine, New Orleans, Los Angeles
| | - Vinaykumar Panchal
- Cardiovascular Division, Tulane School of Public Health and Tropical Medicine, New Orleans, Los Angeles
| | - Neil Patel
- Cardiovascular Division, Jersey City Medical Center, Jersey City, New Jersey
| | - Achint Patel
- Cardiovascular Division, Jersey City Medical Center, Jersey City, New Jersey
| | - Darshan Patel
- Cardiovascular Division, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Sopan Lahewala
- Cardiovascular Division, Mayo Clinic, Rochester, Minnesota
| | | | - Tamam Mohamad
- Cardiovascular Division, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Abeel A Mangi
- Cardiovascular Division, Yale School of Medicine, New Haven, Connecticut
| | - Michael Cleman
- Cardiovascular Division, Yale School of Medicine, New Haven, Connecticut
| | - John K Forrest
- Cardiovascular Division, Yale School of Medicine, New Haven, Connecticut.
| |
Collapse
|
50
|
Panaich SS, Badheka AO, Arora S, Patel NJ, Thakkar B, Patel N, Singh V, Chothani A, Deshmukh A, Agnihotri K, Jhamnani S, Lahewala S, Manvar S, Panchal V, Patel A, Patel N, Bhatt P, Savani C, Patel J, Savani GT, Solanki S, Patel S, Kaki A, Mohamad T, Elder M, Kondur A, Cleman M, Forrest JK, Schreiber T, Grines C. Variability in utilization of drug eluting stents in United States: Insights from nationwide inpatient sample. Catheter Cardiovasc Interv 2015; 87:23-33. [DOI: 10.1002/ccd.25977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 01/14/2015] [Revised: 03/25/2015] [Accepted: 04/04/2015] [Indexed: 11/10/2022]
Affiliation(s)
| | - Apurva O. Badheka
- Department of Cardiology, Yale School of Medicine; New Haven Connecticut
| | - Shilpkumar Arora
- Department of Internal Medicine, Mount Sinai St. Luke's Roosevelt Hospital; New York New York
| | - Nileshkumar J. Patel
- Department of Internal Medicine; Staten Island University Hospital; Staten Island New York
| | - Badal Thakkar
- Department of Internal Medicine; Tulane School of Public Health & Tropical Medicine; New Orleans Louisiana
| | - Nilay Patel
- Department of Internal Medicine; Saint Peter's University Hospital; New Brunswick New Jersey
| | - Vikas Singh
- Department of Cardiology; University of Miami Miller School of Medicine; Miami Florida
| | - Ankit Chothani
- Department of Internal Medicine; MedStar Washington Hospital Center; Washington District of Columbia
| | | | - Kanishk Agnihotri
- Department of Internal Medicine; Saint Peter's University Hospital; New Brunswick New Jersey
| | - Sunny Jhamnani
- Department of Cardiology, Yale School of Medicine; New Haven Connecticut
| | - Sopan Lahewala
- Department of Internal Medicine; Icahn School of Medicine at Mount Sinai; New York New York
| | | | - Vinaykumar Panchal
- Department of Internal Medicine; Tulane School of Public Health & Tropical Medicine; New Orleans Louisiana
| | - Achint Patel
- Department of Internal Medicine; Icahn School of Medicine at Mount Sinai; New York New York
| | - Neil Patel
- Department of Internal Medicine; Icahn School of Medicine at Mount Sinai; New York New York
| | - Parth Bhatt
- Department of Internal Medicine; Tulane School of Public Health & Tropical Medicine; New Orleans Louisiana
| | - Chirag Savani
- Department of Internal Medicine; New York Medical College; Valhalla New York
| | - Jay Patel
- Detroit Medical Center; Detroit Michigan
| | | | - Shantanu Solanki
- Department of Internal Medicine; Icahn School of Medicine at Mount Sinai; New York New York
| | - Samir Patel
- Department of Internal Medicine, Western Reserve Health System; Youngstown Ohio
| | - Amir Kaki
- Detroit Medical Center; Detroit Michigan
| | | | | | | | - Michael Cleman
- Department of Cardiology, Yale School of Medicine; New Haven Connecticut
| | - John K. Forrest
- Department of Cardiology, Yale School of Medicine; New Haven Connecticut
| | | | | |
Collapse
|