1
|
Grubb KJ, Lisko JC, O'Hair D, Merhi W, Forrest JK, Mahoney P, Van Mieghem NM, Windecker S, Yakubov SJ, Williams MR, Chetcuti SJ, Deeb GM, Kleiman NS, Althouse AD, Reardon MJ. Reinterventions After CoreValve/Evolut Transcatheter or Surgical Aortic Valve Replacement for Treatment of Severe Aortic Stenosis. JACC Cardiovasc Interv 2024; 17:1007-1016. [PMID: 38573257 DOI: 10.1016/j.jcin.2024.01.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/26/2023] [Accepted: 01/20/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Data on valve reintervention after transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) are limited. OBJECTIVES The authors compared the 5-year incidence of valve reintervention after self-expanding CoreValve/Evolut TAVR vs SAVR. METHODS Pooled data from CoreValve and Evolut R/PRO (Medtronic) randomized trials and single-arm studies encompassed 5,925 TAVR (4,478 CoreValve and 1,447 Evolut R/PRO) and 1,832 SAVR patients. Reinterventions were categorized by indication, timing, and treatment. The cumulative incidence of reintervention was compared between TAVR vs SAVR, Evolut vs CoreValve, and Evolut vs SAVR. RESULTS There were 99 reinterventions (80 TAVR and 19 SAVR). The cumulative incidence of reintervention through 5 years was higher with TAVR vs SAVR (2.2% vs 1.5%; P = 0.017), with differences observed early (≤1 year; adjusted subdistribution HR: 3.50; 95% CI: 1.53-8.02) but not from >1 to 5 years (adjusted subdistribution HR: 1.05; 95% CI: 0.48-2.28). The most common reason for reintervention was paravalvular regurgitation after TAVR and endocarditis after SAVR. Evolut had a significantly lower incidence of reintervention than CoreValve (0.9% vs 1.6%; P = 0.006) at 5 years with differences observed early (adjusted subdistribution HR: 0.30; 95% CI: 0.12-0.73) but not from >1 to 5 years (adjusted subdistribution HR: 0.61; 95% CI: 0.21-1.74). The 5-year incidence of reintervention was similar for Evolut vs SAVR (0.9% vs 1.5%; P = 0.41). CONCLUSIONS A low incidence of reintervention was observed for CoreValve/Evolut R/PRO and SAVR through 5 years. Reintervention occurred most often at ≤1 year for TAVR and >1 year for SAVR. Most early reinterventions were with the first-generation CoreValve and managed percutaneously. Reinterventions were more common following CoreValve TAVR compared with Evolut TAVR or SAVR.
Collapse
Affiliation(s)
- Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, USA.
| | - John C Lisko
- Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Daniel O'Hair
- Cardiovascular Service Line, Boulder Community Health, Boulder, Colorado, USA
| | - William Merhi
- Department of Interventional Cardiology, Corewell Health, Grand Rapids, Michigan, USA; Department of Cardiothoracic Surgery, Corewell Health, Grand Rapids, Michigan, USA
| | - John K Forrest
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Paul Mahoney
- University of Pittsburgh Medical Center Harrisburg, Harrisburg, Pennsylvania, USA
| | | | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | | | | | - Stanley J Chetcuti
- University of Michigan Health Systems-University Hospital, Ann Arbor, Michigan, USA
| | - G Michael Deeb
- University of Michigan Health Systems-University Hospital, Ann Arbor, Michigan, USA
| | - Neal S Kleiman
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | | |
Collapse
|
2
|
Bajwa T, Attizzani GF, Gada H, Chetcuti SJ, Williams MR, Ahmed M, Petrossian GA, Saybolt MD, Allaqaband SQ, Merhi WM, Stoler RC, Bezerra H, Mahoney P, Wu W, Jumper R, Lambrecht L, Tang GHL. Use and performance of the evolut FX transcatheter aortic valve system. Cardiovasc Revasc Med 2024:S1553-8389(24)00145-3. [PMID: 38599918 DOI: 10.1016/j.carrev.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/22/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The next generation supra-annular, self-expanding Evolut FX transcatheter aortic valve (TAV) system was designed to improve catheter deliverability, provide stable and symmetric valve deployment, and assess commissural alignment during the procedure. The impact of these modifications has not been clinically evaluated. METHODS Procedural information was collected by survey in 2 Stages: Stage I comprised 23 centers with extensive experience with Evolut TAV systems, and Stage II comprised an additional 46 centers with a broad range of balloon- and self-expanding system experience. Operators were to compare the experience with the Evolut FX to the predicate Evolut PRO+ system. RESULTS There were 285 cases during Stage I from June 24 to August 12, 2022, and 254 cases during Stage II from August 15 to September 11, 2022. Overall, the cusp overlap technique was used in 88.6 %, and commissural alignment was achieved in 96.1 % of these cases. Compared to implanter's previous experience with the Evolut PRO+ system, less resistance was noted with the Evolut FX system: in 83.0 % of cases during vascular insertion, in 84.7 % of cases while tracking through the vasculature, in 84.4 % of cases while traversing over the arch, and 76.1 % of cases in advancing across the valve. Better symmetry of valve depth was observed in 423 of 525 cases (80.6 %). CONCLUSION Evolut FX system design modifications translated into improvements in catheter deliverability, deployment symmetry and stability, and commissural alignment as assessed by experienced self-expanding and balloon expandable operators.
Collapse
Affiliation(s)
- Tanvir Bajwa
- Advocate Aurora Health Care, 2801 W. Kinnickinnic River Parkway,Milwaukee, WI 53215, United States of America.
| | - Guilherme F Attizzani
- University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, United States of America.
| | - Hemal Gada
- University of Pittsburgh-Pinnacle, 1000 N Front Street, Wormleysburg, PA 17043, United States of America
| | - Stanley J Chetcuti
- University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, United States of America.
| | - Mathew R Williams
- New York University - Langone Health, 530 1st Ave. Suite 9V, New York, NY 10016, United States of America.
| | - Mustafa Ahmed
- University of Alabama Medicine, 2000 6th Avenue South, Floor 4, Birmingham, AL 35233, United States of America.
| | - George A Petrossian
- Saint Francis Hospital, Vizza Pavilion, 100 Port Washington Blvd Ste G04, Roslyn, NY 11576, United States of America
| | - Matthew D Saybolt
- Jersey Shore University Medical Center, 1945 NJ-33, Neptune Township, NJ 07753, United States of America
| | - Suhail Q Allaqaband
- Advocate Aurora Health Care, 2801 W. Kinnickinnic River Parkway,Milwaukee, WI 53215, United States of America.
| | - William M Merhi
- Spectrum Health Hospitals, 743 E Beltline Ave NE, Grand Rapids, MI 49525, United States of America.
| | - Robert C Stoler
- Baylor Scott & White Heart and Vascular Hospital at Baylor Scott & White University Medical Center, 621 N Hall St #500, Dallas, TX 75226, United States of America.
| | - Hiram Bezerra
- Tampa General Hospital, University of South Florida; 2 Tampa General Circle, Tampa, FL 33606, United States of America.
| | - Paul Mahoney
- Sentara Norfolk General Hospital, 600 Gresham Dr Ste 8630A, Norfolk, VA 23507, United States of America
| | - Willis Wu
- Rex Hospital, 2800 Blue Ridge Rd Suite 201, Raleigh, NC 27607, United States of America.
| | - Robert Jumper
- St. Vincent's Medical Center, 115 Technology Dr UNIT C300, Trumbull, CT 06611, United States of America.
| | - Larry Lambrecht
- Medtronic, 8200 Coral Sea St., Mounds View, MN 55112, United States of America.
| | - Gilbert H L Tang
- Mount Sinai Health System, 1190 5th Ave, New York, NY 10029, United States of America
| |
Collapse
|
3
|
Bajwa TK, Laham RJ, Khabbaz K, Dauerman HL, Waksman R, Weiss E, Allaqaband S, Badr S, Caskey M, Byrne T, Applegate RJ, Kon ND, Li S, Kleiman NS, Reardon MJ, Chetcuti SJ, Deeb GM. Five-Year Follow-Up from the CoreValve Expanded Use Transcatheter Aortic Valve-in-Surgical Aortic Valve Study. Am J Cardiol 2024; 214:1-7. [PMID: 38110018 DOI: 10.1016/j.amjcard.2023.11.071] [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: 10/24/2023] [Accepted: 11/24/2023] [Indexed: 12/20/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) provides an option for extreme-risk patients who underwent reoperation for a failed surgical aortic bioprosthesis. Long-term data on patients who underwent TAVR within a failed surgical aortic valve (TAV-in-SAV) are limited. The CoreValve Expanded Use Study evaluated patients at extreme surgical risk who underwent TAV-in-SAV. Outcomes at 5 years were analyzed by SAV failure mode (stenosis, regurgitation, or combined). Echocardiographic outcomes are site-reported. TAV-in-SAV was attempted in 226 patients with a mean age of 76.7 ± 10.8 years; 63.3% were male, the Society of Thoracic Surgeons predicted risk of mortality score was 9.0 ± 6.7%, and 87.5% had a New York Heart Association classification III or IV symptoms. Most of the failed surgical bioprostheses were stented (81.9%), with an average implant duration of 10.2 ± 4.3 years. The 5-year all-cause mortality or major stroke rate was 47.2% in all patients; 54.4% in the stenosis, 37.6% in the regurgitation, and 38.0% in the combined groups (p = 0.046). At 5 years, all-cause mortality was higher in patients with versus without 30-day severe prosthesis-patient mismatch (51.7% vs 38.3%, p = 0.026). The overall aortic valve reintervention rate was 5.9%; highest in the regurgitation group (12.6%). The mean aortic valve gradient was 14.1 ± 9.8 mm Hg and effective orifice area was 1.57 ± 0.70 at 5 years. Few patients had >mild paravalvular regurgitation at 5 years (5.5% moderate, 0.0% severe). TAV-in-SAV with supra-annular, self-expanding TAVR continues to represent a safe and lasting intermediate option for extreme-risk patients who have appropriate sizing of the preexisting failed surgical valve. Clinical and hemodynamic outcomes were stable through 5 years.
Collapse
Affiliation(s)
- Tanvir K Bajwa
- XXX, Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin.
| | - Roger J Laham
- Department of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kamal Khabbaz
- Department of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Harold L Dauerman
- Department of Cardiovascular Medicine, University of Vermont, Burlington, Vermont
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC
| | - Eric Weiss
- XXX, Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Suhail Allaqaband
- XXX, Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Salem Badr
- XXX, Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Michael Caskey
- Department of Cardiothoracic Surgery and Interventional Cardiology, Arizona Heart Hospital, Phoenix, Arizona
| | - Timothy Byrne
- Department of Cardiothoracic Surgery and Interventional Cardiology, Arizona Heart Hospital, Phoenix, Arizona
| | - Robert J Applegate
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Neal D Kon
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Shuzhen Li
- Department of Structural Heart and Aortic Statistics, Medtronic, Mounds View, Minnesota
| | - Neal S Kleiman
- Department of Cardiovascular Medicine and Cardiovascular Surgery, Houston Methodist Hospital, Houston, Texas
| | - Michael J Reardon
- Department of Cardiovascular Medicine and Cardiovascular Surgery, Houston Methodist Hospital, Houston, Texas
| | - Stanley J Chetcuti
- Department of Cardiology and Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - G Michael Deeb
- Department of Cardiology and Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
4
|
Duggal NM, Engoren M, Chadderdon SM, Rodriguez E, Morse MA, Vannan MA, Yadav PK, Morcos M, Li F, Reisman M, Garcia-Sayan E, Raghunathan D, Sodhi N, Sorajja P, Chen L, Rogers JH, Calfon MA, Kovach CP, Gill EA, Zahr FE, Chetcuti SJ, Yuan Y, Mentz GB, Lim DS, Ailawadi G. Mortality Associated With Proportionality of Secondary Mitral Regurgitation After Transcatheter Mitral Valve Repair: North American Mitraclip for Functional Mitral Regurgitation Registry. Am J Cardiol 2024; 213:99-105. [PMID: 38110022 DOI: 10.1016/j.amjcard.2023.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/17/2023] [Accepted: 12/09/2023] [Indexed: 12/20/2023]
Abstract
The association, if any, between the effective regurgitant orifice area (EROA) to left ventricular end-diastolic volume (LVEDV) ratio and 1-year mortality is controversial in patients who undergo mitral transcatheter edge-to-edge repair (m-TEER) with the MitraClip system (Abbott Vascular, Santa Clara, CA). This study's objective was to determine the association between EROA/LVEDV and 1-year mortality in patients who undergo m-TEER with MitraClip. In patients with severe secondary (functional) mitral regurgitation (MR), we analyzed registry data from 11 centers using generalized linear models with the generalized estimating equations approach. We studied 525 patients with secondary MR who underwent m-TEER. Most patients were male (63%) and were New York Heart Association class III (61%) or IV (21%). Mitral regurgitation was caused by ischemic cardiomyopathy in 51% of patients. EROA/LVEDV values varied widely, with median = 0.19 mm2/ml, interquartile range [0.12,0.28] mm2/ml, and 187 patients (36%) had values <0.15 mm2/ml. Postprocedural mitral regurgitation severity was substantially alleviated, being 1+ or less in 74%, 2+ in 20%, 3+ in 4%, and 4+ in 2%; 1-year mortality was 22%. After adjustment for confounders, the logarithmic transformation (Ln) of EROA/LVEDV was associated with 1-year mortality (odds ratio 0.600, 95% confidence interval 0.386 to 0.933, p = 0.023). A higher Society of Thoracic Surgeons risk score was also associated with increased mortality. In conclusion, lower values of Ln(EROA/LVEDV) were associated with increased 1-year mortality in this multicenter registry. The slope of the association is steep at low values but gradually flattens as Ln(EROA/LVEDV) increases.
Collapse
Affiliation(s)
- Neal M Duggal
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
| | - Milo Engoren
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Scott M Chadderdon
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Evelio Rodriguez
- Department of Cardiothoracic Surgery, Ascension Saint Thomas Heart, Nashville, Tennessee
| | - M Andrew Morse
- Division of Cardiology, Ascension Saint Thomas Heart, Nashville, Tennessee
| | - Mani A Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Pradeep K Yadav
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Michael Morcos
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Flora Li
- Department of Anesthesiology, University of Washington, Seattle, Washington
| | - Mark Reisman
- Division of Cardiology, Weill Cornell Medical Center, New York, New York
| | - Enrique Garcia-Sayan
- Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Deepa Raghunathan
- Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Nishtha Sodhi
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute, Abbott Northwestern Medical Center, Minneapolis, Minnesota
| | - Lily Chen
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California
| | - Jason H Rogers
- Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California
| | - Marcella A Calfon
- Division of Cardiology, University of California Los Angeles, Los Angeles, California
| | | | - Edward A Gill
- Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Firas E Zahr
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Stanley J Chetcuti
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Yuan Yuan
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Graciela B Mentz
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - D Scott Lim
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
5
|
Forrest JK, Deeb GM, Yakubov SJ, Gada H, Mumtaz MA, Ramlawi B, Bajwa T, Teirstein PS, DeFrain M, Muppala M, Rutkin BJ, Chawla A, Jenson B, Chetcuti SJ, Stoler RC, Poulin MF, Khabbaz K, Levack M, Goel K, Tchétché D, Lam KY, Tonino PAL, Ito S, Oh JK, Huang J, Popma JJ, Kleiman N, Reardon MJ. 3-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis. J Am Coll Cardiol 2023; 81:1663-1674. [PMID: 36882136 DOI: 10.1016/j.jacc.2023.02.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Randomized data comparing outcomes of transcatheter aortic valve replacement (TAVR) with surgery in low-surgical risk patients at time points beyond 2 years is limited. This presents an unknown for physicians striving to educate patients as part of a shared decision-making process. OBJECTIVES The authors evaluated 3-year clinical and echocardiographic outcomes from the Evolut Low Risk trial. METHODS Low-risk patients were randomized to TAVR with a self-expanding, supra-annular valve or surgery. The primary endpoint of all-cause mortality or disabling stroke and several secondary endpoints were assessed at 3 years. RESULTS There were 1,414 attempted implantations (730 TAVR; 684 surgery). Patients had a mean age of 74 years and 35% were women. At 3 years, the primary endpoint occurred in 7.4% of TAVR patients and 10.4% of surgery patients (HR: 0.70; 95% CI: 0.49-1.00; P = 0.051). The difference between treatment arms for all-cause mortality or disabling stroke remained broadly consistent over time: -1.8% at year 1; -2.0% at year 2; and -2.9% at year 3. The incidence of mild paravalvular regurgitation (20.3% TAVR vs 2.5% surgery) and pacemaker placement (23.2% TAVR vs 9.1% surgery; P < 0.001) were lower in the surgery group. Rates of moderate or greater paravalvular regurgitation for both groups were <1% and not significantly different. Patients who underwent TAVR had significantly improved valve hemodynamics (mean gradient 9.1 mm Hg TAVR vs 12.1 mm Hg surgery; P < 0.001) at 3 years. CONCLUSIONS Within the Evolut Low Risk study, TAVR at 3 years showed durable benefits compared with surgery with respect to all-cause mortality or disabling stroke. (Medtronic Evolut Transcatheter Aortic Valve Replacement in Low Risk Patients; NCT02701283).
Collapse
Affiliation(s)
- John K Forrest
- Yale University School of Medicine, New Haven, Connecticut, USA.
| | - G Michael Deeb
- University of Michigan Health Systems University Hospital, Ann Arbor, Michigan, USA
| | | | - Hemal Gada
- University of Pittsburgh Medical Center, Harrisburg, Pennsylvania, USA
| | - Mubashir A Mumtaz
- University of Pittsburgh Medical Center, Harrisburg, Pennsylvania, USA
| | - Basel Ramlawi
- Lankenau Heart Institute, Philadelphia, Pennsylvania, USA
| | - Tanvir Bajwa
- Aurora St Luke's Medical Center, Milwaukee, Wisconsin, USA
| | | | | | | | - Bruce J Rutkin
- North Shore University Hospital, Manhasset, New York, USA
| | - Atul Chawla
- Mercy Medical Center, Iowa Heart, Des Moines, Iowa, USA
| | - Bart Jenson
- Mercy Medical Center, Iowa Heart, Des Moines, Iowa, USA
| | - Stanley J Chetcuti
- University of Michigan Health Systems University Hospital, Ann Arbor, Michigan, USA
| | | | | | - Kamal Khabbaz
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Melissa Levack
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kashish Goel
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Ka Yan Lam
- Catharina Ziekenhuis, Eindhoven, the Netherlands
| | | | - Saki Ito
- Echocardiography Core Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Jae K Oh
- Echocardiography Core Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Neal Kleiman
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | |
Collapse
|
6
|
Hawkins RB, Deeb GM, Sukul D, Patel HJ, Gualano SK, Chetcuti SJ, Grossman PM, Ailawadi G, Fukuhara S. Redo Surgical Aortic Valve Replacement After Prior Transcatheter Versus Surgical Aortic Valve Replacement. JACC Cardiovasc Interv 2023; 16:942-953. [PMID: 37100557 DOI: 10.1016/j.jcin.2023.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Aortic stenosis treatment should consider risks and benefits for lifetime management. Although the feasibility of redo transcatheter aortic valve replacement (TAVR) remains unclear, concerns are emerging regarding reoperation after TAVR. OBJECTIVES The authors sought to define comparative risk of surgical aortic valve replacement (SAVR) after prior TAVR or SAVR. METHODS Data on patients undergoing bioprosthetic SAVR after TAVR and/or SAVR were extracted from the Society of Thoracic Surgeons Database (2011-2021). Overall and isolated SAVR cohorts were analyzed. The primary outcome was operative mortality. Risk adjustment using hierarchical logistic regression as well as propensity score matching for isolated SAVR cases were performed. RESULTS Of 31,106 SAVR patients, 1,126 had prior TAVR (TAVR-SAVR), 674 had prior SAVR and TAVR (SAVR-TAVR-SAVR), and 29,306 had prior SAVR (SAVR-SAVR). Yearly rates of TAVR-SAVR and SAVR-TAVR-SAVR increased over time, whereas SAVR-SAVR was stable. The TAVR-SAVR patients were older, with higher acuity, and with greater comorbidities than other cohorts. The unadjusted operative mortality was highest in the TAVR-SAVR group (17% vs 12% vs 9%, respectively; P < 0.001). Compared with SAVR-SAVR, risk-adjusted operative mortality was significantly higher for TAVR-SAVR (OR: 1.53; P = 0.004), but not SAVR-TAVR-SAVR (OR: 1.02; P = 0.927). After propensity score matching, operative mortality of isolated SAVR was 1.74 times higher for TAVR-SAVR than SAVR-SAVR patients (P = 0.020). CONCLUSIONS The number of post-TAVR reoperations is increasing and represent a high-risk population. Yet even in isolated SAVR cases, SAVR after TAVR is independently associated with increased risk of mortality. Patients with life expectancy beyond a TAVR valve and unsuitable anatomy for redo-TAVR should consider a SAVR-first approach.
Collapse
Affiliation(s)
- Robert B Hawkins
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Devraj Sukul
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah K Gualano
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Stanley J Chetcuti
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - P Michael Grossman
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
| |
Collapse
|
7
|
Grubb KJ, Gada H, Mittal S, Nazif T, Rodés-Cabau J, Fraser DGW, Lin L, Rovin JD, Khalil R, Sultan I, Gardner B, Lorenz D, Chetcuti SJ, Patel NC, Harvey JE, Mahoney P, Schwartz B, Jafar Z, Wang J, Potluri S, Vora AN, Sanchez C, Corrigan A, Li S, Yakubov SJ. Clinical Impact of Standardized TAVR Technique and Care Pathway: Insights From the Optimize PRO Study. JACC Cardiovasc Interv 2023; 16:558-570. [PMID: 36922042 DOI: 10.1016/j.jcin.2023.01.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Procedural success and clinical outcomes after transcatheter aortic valve replacement (TAVR) have improved, but residual aortic regurgitation (AR) and new permanent pacemaker implantation (PPI) rates remain variable because of a lack of uniform periprocedural management and implantation. OBJECTIVES The Optimize PRO study evaluates valve performance and procedural outcomes using an "optimized" TAVR care pathway and the cusp overlap technique (COT) in patients receiving the Evolut PRO/PRO+ (Medtronic) self-expanding valves. METHODS Optimize PRO, a nonrandomized, prospective, postmarket study conducted in the United States, Canada, Europe, Middle East, and Australia, is enrolling patients with severe symptomatic aortic stenosis and no pre-existing pacemaker. Sites follow a standardized TAVR care pathway, including early discharge and a conduction disturbance management algorithm, and transfemoral deployment using the COT. RESULTS A total of 400 attempted implants from the United States and Canada comprised the main cohort of this second interim analysis. The mean age was 78.7 ± 6.6 years, and the mean Society of Thoracic Surgeons predictive risk of mortality was 3.0 ± 2.4. The median length of stay was 1 day. There were no instances of moderate or severe AR at discharge. At 30 days, all-cause mortality or stroke was 3.8%, all-cause mortality was 0.8%, disabling stroke was 0.7%, hospital readmission was 10.1%, and cardiovascular rehospitalization was 6.1%. The new PPI rate was 9.8%, 5.8% with 4-step COT compliance. In the multivariable model, right bundle branch block and the depth of the implant increased the risk of PPI, whereas using the 4-step COT lowered 30-day PPI. CONCLUSIONS The use of the TAVR care pathway and COT resulted in favorable clinical outcomes with no moderate or severe AR and low PPI rates at 30 days while facilitating early discharge and reproducible outcomes across various sites and operators. (Optimize PRO; NCT04091048).
Collapse
Affiliation(s)
- Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, USA.
| | - Hemal Gada
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleysburg, Pennsylvania, USA; Center for Heart Valve Disease, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Suneet Mittal
- Division of Cardiology and the Snyder Center for Comprehensive Atrial Fibrillation at Valley Health System, Ridgewood, New Jersey, USA
| | - Tamim Nazif
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Hospital Clínic de Barcelona, Barcelona, Spain
| | - Douglas G W Fraser
- Cardiology Department, Manchester Heart Centre, Central Manchester University Hospitals, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Lang Lin
- Department of Interventional Cardiology, Morton Plant Hospital, Clearwater, Florida, USA; Department of Cardiovascular Surgery, Morton Plant Hospital, Clearwater, Florida, USA
| | - Joshua D Rovin
- Department of Interventional Cardiology, Morton Plant Hospital, Clearwater, Florida, USA; Department of Cardiovascular Surgery, Morton Plant Hospital, Clearwater, Florida, USA
| | - Ramzi Khalil
- Department of Cardiology, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Ibrahim Sultan
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleysburg, Pennsylvania, USA; Center for Heart Valve Disease, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Blake Gardner
- Saint George Regional Hospital, St. George, Utah, USA
| | - David Lorenz
- Saint Vincent's Medical Center, Bridgeport, Connecticut, USA
| | - Stanley J Chetcuti
- Department of Interventional Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan, USA; Department of Cardiovascular Surgery, University of Michigan Hospitals, Ann Arbor, Michigan, USA
| | - Nainesh C Patel
- Division of Cardiology, Lehigh Valley Health Network/University of South Florida College of Medicine, Allentown, Pennsylvania, USA
| | - James E Harvey
- Department of Cardiovascular Diseases, York Hospital-Wellspan Health System, York, Pennsylvania, USA
| | - Paul Mahoney
- Structural Heart Center, Sentara Heart Hospital, Norfolk, Virginia, USA
| | - Brian Schwartz
- Department of Cardiology, Kettering Medical Center, Dayton, Ohio, USA
| | - Zubair Jafar
- Department of Cardiology, Vassar Brothers Medical Center, Poughkeepsie, New York, USA
| | - John Wang
- Section of Interventional Cardiology, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Srinivasa Potluri
- Department of Interventional Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas, USA
| | - Amit N Vora
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleysburg, Pennsylvania, USA; Center for Heart Valve Disease, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carlos Sanchez
- Department of Interventional Cardiology, Riverside Methodist-OhioHealth, Columbus, Ohio, USA
| | - Amy Corrigan
- Department of Clinical Research, Medtronic, Minneapolis, Minnesota, USA
| | - Shuzhen Li
- Department of Structural Heart and Aortic Clinical Research and Medical Science, Medtronic, Minneapolis, Minnesota, USA
| | - Steven J Yakubov
- Department of Interventional Cardiology, Riverside Methodist-OhioHealth, Columbus, Ohio, USA
| |
Collapse
|
8
|
Gogia S, Vahl TP, Thourani VH, Yadav PK, George I, Kodali SK, Hamid N, Ranard L, Chen T, Matsumura M, Maehara A, Treede H, Baldus S, Daniels D, Sheridan BC, Zahr F, Russo MJ, McCabe JM, Chetcuti SJ, Leon MB, Makkar RR, Khalique OK. Cardiac Computed Tomography Angiography Anatomical Characterization of Patients Screened for a Dedicated Transfemoral Transcatheter Valve System for Primary Aortic Regurgitation. Structural Heart 2023. [DOI: 10.1016/j.shj.2023.100164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
|
9
|
Chetcuti SJ, Bajwa T, Attizzani GF, Gada H, Ahmed M, Lambrecht L, Tang GH. CRT-700.33 Performance and Use of the Evolut FX Transcatheter Aortic Valve System: Results From the Evolut FX Limited Market Release Clinical Survey. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
|
10
|
Van Mieghem NM, Deeb GM, Søndergaard L, Grube E, Windecker S, Gada H, Mumtaz M, Olsen PS, Heiser JC, Merhi W, Kleiman NS, Chetcuti SJ, Gleason TG, Lee JS, Cheng W, Makkar RR, Crestanello J, George B, George I, Kodali S, Yakubov SJ, Serruys PW, Lange R, Piazza N, Williams MR, Oh JK, Adams DH, Li S, Reardon MJ. Self-expanding Transcatheter vs Surgical Aortic Valve Replacement in Intermediate-Risk Patients: 5-Year Outcomes of the SURTAVI Randomized Clinical Trial. JAMA Cardiol 2022; 7:1000-1008. [PMID: 36001335 PMCID: PMC9403849 DOI: 10.1001/jamacardio.2022.2695] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/28/2022] [Indexed: 12/30/2022]
Abstract
Importance In patients with severe aortic valve stenosis at intermediate surgical risk, transcatheter aortic valve replacement (TAVR) with a self-expanding supra-annular valve was noninferior to surgery for all-cause mortality or disabling stroke at 2 years. Comparisons of longer-term clinical and hemodynamic outcomes in these patients are limited. Objective To report prespecified secondary 5-year outcomes from the Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement (SURTAVI) randomized clinical trial. Design, Setting, and Participants SURTAVI is a prospective randomized, unblinded clinical trial. Randomization was stratified by investigational site and need for revascularization determined by the local heart teams. Patients with severe aortic valve stenosis deemed to be at intermediate risk of 30-day surgical mortality were enrolled at 87 centers from June 19, 2012, to June 30, 2016, in Europe and North America. Analysis took place between August and October 2021. Intervention Patients were randomized to TAVR with a self-expanding, supra-annular transcatheter or a surgical bioprosthesis. Main Outcomes and Measures The prespecified secondary end points of death or disabling stroke and other adverse events and hemodynamic findings at 5 years. An independent clinical event committee adjudicated all serious adverse events and an independent echocardiographic core laboratory evaluated all echocardiograms at 5 years. Results A total of 1660 individuals underwent an attempted TAVR (n = 864) or surgical (n = 796) procedure. The mean (SD) age was 79.8 (6.2) years, 724 (43.6%) were female, and the mean (SD) Society of Thoracic Surgery Predicted Risk of Mortality score was 4.5% (1.6%). At 5 years, the rates of death or disabling stroke were similar (TAVR, 31.3% vs surgery, 30.8%; hazard ratio, 1.02 [95% CI, 0.85-1.22]; P = .85). Transprosthetic gradients remained lower (mean [SD], 8.6 [5.5] mm Hg vs 11.2 [6.0] mm Hg; P < .001) and aortic valve areas were higher (mean [SD], 2.2 [0.7] cm2 vs 1.8 [0.6] cm2; P < .001) with TAVR vs surgery. More patients had moderate/severe paravalvular leak with TAVR than surgery (11 [3.0%] vs 2 [0.7%]; risk difference, 2.37% [95% CI, 0.17%- 4.85%]; P = .05). New pacemaker implantation rates were higher for TAVR than surgery at 5 years (289 [39.1%] vs 94 [15.1%]; hazard ratio, 3.30 [95% CI, 2.61-4.17]; log-rank P < .001), as were valve reintervention rates (27 [3.5%] vs 11 [1.9%]; hazard ratio, 2.21 [95% CI, 1.10-4.45]; log-rank P = .02), although between 2 and 5 years only 6 patients who underwent TAVR and 7 who underwent surgery required a reintervention. Conclusions and Relevance Among intermediate-risk patients with symptomatic severe aortic stenosis, major clinical outcomes at 5 years were similar for TAVR and surgery. TAVR was associated with superior hemodynamic valve performance but also with more paravalvular leak and valve reinterventions.
Collapse
Affiliation(s)
- Nicolas M. Van Mieghem
- Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - G. Michael Deeb
- Department of Interventional Cardiology, University of Michigan, Ann Arbor
- Department of Cardiac Surgery, University of Michigan, Ann Arbor
| | - Lars Søndergaard
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Eberhard Grube
- Department of Interventional Cardiology, University of Bonn, Bonn, Germany
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Hemal Gada
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle Health, Harrisburg, Pennsylvania
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Pinnacle Health, Harrisburg, Pennsylvania
| | - Mubashir Mumtaz
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle Health, Harrisburg, Pennsylvania
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Pinnacle Health, Harrisburg, Pennsylvania
| | - Peter S. Olsen
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - John C. Heiser
- Department of Interventional Cardiology, Spectrum Health, Grand Rapids, Michigan
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan
| | - William Merhi
- Department of Interventional Cardiology, Spectrum Health, Grand Rapids, Michigan
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan
| | - Neal S. Kleiman
- Department of Interventional Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | | | - Thomas G. Gleason
- Department of Interventional Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Now with Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joon Sup Lee
- Department of Interventional Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Wen Cheng
- Department of Interventional Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Raj R. Makkar
- Department of Interventional Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Juan Crestanello
- Department of Interventional Cardiology, Ohio State University Wexner Medical Center, Columbus
- Now with Mayo Clinic, Rochester, Minnesota
- Department of Cardiovascular Surgery, Ohio State University Wexner Medical Center, Columbus
| | - Barry George
- Department of Interventional Cardiology, Ohio State University Wexner Medical Center, Columbus
- Department of Cardiovascular Surgery, Ohio State University Wexner Medical Center, Columbus
| | - Isaac George
- Department of Interventional Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York
- Department of Cardiothoracic Surgery, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York
| | - Susheel Kodali
- Department of Interventional Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York
- Department of Cardiothoracic Surgery, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York
| | - Steven J. Yakubov
- Department of Interventional Cardiology, OhioHealth Riverside Methodist Hospital, Columbus
| | - Patrick W. Serruys
- Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Now with National University of Ireland, Galway, Ireland
| | - Rüdiger Lange
- Department of Cardiac Surgery, German Heart Center, Munich, Germany
| | - Nicolo Piazza
- Department of Interventional Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mathew R. Williams
- Department of Interventional Cardiology and Cardiac Surgery, Langone-New York University, New York
| | - Jae K. Oh
- Echocardiography Core Laboratory, Mayo Clinic, Rochester, Minnesota
| | - David H. Adams
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York
| | - Shuzhen Li
- Clinical Research, Medtronic, Minneapolis, Minnesota
| | - Michael J. Reardon
- Department of Interventional Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| |
Collapse
|
11
|
Forrest JK, Deeb GM, Yakubov SJ, Rovin JD, Mumtaz M, Gada H, O'Hair D, Bajwa T, Sorajja P, Heiser JC, Merhi W, Mangi A, Spriggs DJ, Kleiman NS, Chetcuti SJ, Teirstein PS, Zorn GL, Tadros P, Tchétché D, Resar JR, Walton A, Gleason TG, Ramlawi B, Iskander A, Caputo R, Oh JK, Huang J, Reardon MJ. 2-Year Outcomes After Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients. J Am Coll Cardiol 2022; 79:882-896. [PMID: 35241222 DOI: 10.1016/j.jacc.2021.11.062] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND The Evolut Low Risk Trial (Medtronic Evolut Transcatheter Aortic Valve Replacement in Low Risk Patients) showed that transcatheter aortic valve replacement (TAVR) with a supra-annular, self-expanding valve was noninferior to surgery for the primary endpoint of all-cause mortality or disabling stroke at 2 years. This finding was based on a Bayesian analysis performed after 850 patients had reached 1 year of follow-up. OBJECTIVES The goal of this study was to report the full 2-year clinical and echocardiographic outcomes for patients enrolled in the Evolut Low Risk Trial. METHODS A total of 1,414 low-surgical risk patients with severe aortic stenosis were randomized to receive TAVR or surgical AVR. An independent clinical events committee adjudicated adverse events, and a central echocardiographic core laboratory assessed hemodynamic endpoints. RESULTS An attempted implant was performed in 730 TAVR and 684 surgical patients from March 2016 to May 2019. The Kaplan-Meier rates for the complete 2-year primary endpoint of death or disabling stroke were 4.3% in the TAVR group and 6.3% in the surgery group (P = 0.084). These rates were comparable to the interim Bayesian rates of 5.3% with TAVR and 6.7% with surgery (difference: -1.4%; 95% Bayesian credible interval: -4.9% to 2.1%). All-cause mortality rates were 3.5% vs 4.4% (P = 0.366), and disabling stroke rates were 1.5% vs 2.7% (P = 0.119), respectively. Between years 1 and 2, there was no convergence of the primary outcome curves. CONCLUSIONS The complete 2-year follow-up from the Evolut Low Risk Trial found that TAVR is noninferior to surgery for the primary endpoint of all-cause mortality or disabling stroke, with event rates that were slightly better than those predicted by using the Bayesian analysis. (Medtronic Evolut Transcatheter Aortic Valve Replacement in Low Risk Patients [Evolut Low Risk Trial]; NCT02701283).
Collapse
Affiliation(s)
- John K Forrest
- Department of Internal Medicine (Cardiology), Yale University School of Medicine, New Haven, Connecticut, USA; Department of Surgery (Cardiac Surgery), Yale University School of Medicine, New Haven, Connecticut, USA.
| | - G Michael Deeb
- Department of Interventional Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan, USA; Department of Cardiovascular Surgery, University of Michigan Hospitals, Ann Arbor, Michigan, USA
| | - Steven J Yakubov
- Department of Interventional Cardiology, Riverside Methodist-OhioHealth, Columbus, Ohio, USA
| | - Joshua D Rovin
- Department of Cardiac Surgery, Morton Plant Hospital, Clearwater, Florida, USA
| | - Mubashir Mumtaz
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleyburg, Pennsylvania, USA; Department of Cardiovascular and Thoracic Surgery, University of Pittsburgh Medical Center Pinnacle, Wormleyburg, Pennsylvania, USA
| | - Hemal Gada
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleyburg, Pennsylvania, USA; Department of Cardiovascular and Thoracic Surgery, University of Pittsburgh Medical Center Pinnacle, Wormleyburg, Pennsylvania, USA
| | - Daniel O'Hair
- Department of Interventional Cardiology, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA; Department of Cardiovascular Surgery, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA
| | - Tanvir Bajwa
- Department of Interventional Cardiology, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA; Department of Cardiovascular Surgery, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA
| | - Paul Sorajja
- Department of Interventional Cardiology, Minneapolis Heart Institute-Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - John C Heiser
- Department of Interventional Cardiology, Spectrum Health, Grand Rapids, Michigan, USA; Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan, USA
| | - William Merhi
- Department of Interventional Cardiology, Spectrum Health, Grand Rapids, Michigan, USA; Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan, USA
| | - Abeel Mangi
- Department of Internal Medicine (Cardiology), Yale University School of Medicine, New Haven, Connecticut, USA; Department of Surgery (Cardiac Surgery), Yale University School of Medicine, New Haven, Connecticut, USA
| | - Douglas J Spriggs
- Department of Cardiac Surgery, Morton Plant Hospital, Clearwater, Florida, USA
| | - Neal S Kleiman
- Department of Interventional Cardiology, Houston Methodist-DeBakey Heart and Vascular Center, Houston, Texas, USA; Department of Cardiothoracic Surgery, Houston Methodist-DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Stanley J Chetcuti
- Department of Interventional Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan, USA; Department of Cardiovascular Surgery, University of Michigan Hospitals, Ann Arbor, Michigan, USA
| | - Paul S Teirstein
- Department of Interventional Cardiology, Scripps Clinic, La Jolla, California, USA
| | - George L Zorn
- Department of Interventional Cardiology, University of Kansas, Kansas City, Kansas, USA; Department of Cardiac Surgery, University of Kansas, Kansas City, Kansas, USA
| | - Peter Tadros
- Department of Interventional Cardiology, University of Kansas, Kansas City, Kansas, USA; Department of Cardiac Surgery, University of Kansas, Kansas City, Kansas, USA
| | - Didier Tchétché
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Jon R Resar
- Department of Interventional Cardiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Antony Walton
- Department of Interventional Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Thomas G Gleason
- Department of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Basel Ramlawi
- Department of Cardiovascular Surgery, Valley Health System, Winchester, Virginia, USA
| | - Ayman Iskander
- Department of Interventional Cardiology, Saint Joseph's Hospital Health Center, Syracuse, New York, USA; Department of Cardiovascular Surgery, Saint Joseph's Hospital Health Center, Syracuse, New York, USA
| | - Ronald Caputo
- Department of Interventional Cardiology, Saint Joseph's Hospital Health Center, Syracuse, New York, USA; Department of Cardiovascular Surgery, Saint Joseph's Hospital Health Center, Syracuse, New York, USA
| | - Jae K Oh
- Division of Cardiovascular Ultrasound, Mayo Clinic, Rochester, Minnesota, USA
| | - Jian Huang
- Department of Statistics, Medtronic, Minneapolis, Minnesota, USA
| | - Michael J Reardon
- Department of Interventional Cardiology, Houston Methodist-DeBakey Heart and Vascular Center, Houston, Texas, USA; Department of Cardiothoracic Surgery, Houston Methodist-DeBakey Heart and Vascular Center, Houston, Texas, USA
| |
Collapse
|
12
|
Goel SS, Kleiman NS, Chetcuti SJ, Deeb GM, Yakubov SJ, Boatman SV, Van Mieghem NM, Reardon MJ. IMPACT OF RENIN-ANGIOTENSIN SYSTEM INHIBITORS ON CLINICAL OUTCOMES IN PATIENTS WITH SEVERE SYMPTOMATIC AORTIC STENOSIS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT WITH A SELF-EXPANDING BIOPROSTHESIS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01767-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
13
|
Fukuhara S, Tanaka D, Brescia AA, Wai Sang SL, Grossman PM, Sukul D, Chetcuti SJ, He C, Eng MH, Patel HJ, Deeb GM. Aortic valve reintervention in patients with failing transcatheter aortic bioprostheses: A statewide experience. J Thorac Cardiovasc Surg 2021; 165:2011-2020.e5. [PMID: 34538638 DOI: 10.1016/j.jtcvs.2021.08.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/11/2021] [Revised: 08/11/2021] [Accepted: 08/23/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Despite the rapid adoption of transcatheter aortic valve replacement since its approval, the frequency and outcomes of aortic valve reintervention after transcatheter aortic valve replacement are poorly understood. METHODS Valve reinterventions, either surgical transcatheter aortic valve replacement valve explantation or repeat transcatheter aortic valve replacement, between 2012 and 2019 were queried using the Society of Thoracic Surgeons Database and the Transcatheter Valve Therapy Registry through the Michigan Statewide quality collaborative. The reintervention frequency and clinical outcomes including observed-to-expected mortality ratio using Society of Thoracic Surgeons Predicted Risk of Mortality were reviewed. RESULTS Among 9694 transcatheter aortic valve replacement recipients, a total of 87 patients (0.90%) received a reintervention, consisting of 34 transcatheter aortic valve replacement explants and 53 repeat transcatheter aortic valve replacement procedures. The transcatheter aortic valve replacement explant group demonstrated a higher Society of Thoracic Surgeons Predicted Risk of Mortality. Reintervention cases increased from 0 in 2012 and 2013 to 26 in 2019. The proportion of transcatheter aortic valve replacement explants among all reinterventions increased and was 65% in 2019. Self-expandable devices had a higher reintervention rate than balloon-expandable devices secondary to a higher transcatheter aortic valve replacement explant frequency (0.58% [23/3957] vs 0.19% [11/5737]; P = .001), whereas repeat transcatheter aortic valve replacement rates were similar (0.61% [24/3957] vs 0.51% [29/5737]; P = .51). Among patients with transcatheter aortic valve replacement explants, contraindications to repeat transcatheter aortic valve replacement included unfavorable anatomy (75%), need for other cardiac surgery (29%), other structural issues by transcatheter aortic valve replacement device (18%), and endocarditis (12%). For transcatheter aortic valve replacement explant and repeat transcatheter aortic valve replacement, the 30-day mortality was 15% and 2% (P = .032) and the observed-to-expected mortality ratio was 1.8 and 0.3 (P = .018), respectively. CONCLUSIONS Aortic valve reintervention remains rare but is increasing. The clinical impact of transcatheter aortic valve replacement explant was substantial, and the proportion of transcatheter aortic valve replacement explants was significantly higher in patients with a self-expandable device.
Collapse
Affiliation(s)
- Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich.
| | - Daizo Tanaka
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich; Division of Cardiac Surgery, Henry Ford Hospital, Detroit, Mich
| | - Alex A Brescia
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich
| | - Stephane Leung Wai Sang
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich; Meijer Heart and Vascular Institute, Cardiothoracic Surgery, Grand Rapids, Mich
| | - P Michael Grossman
- Department of Internal Medicine, University of Michigan, Ann Arbor, Mich; Blue Cross Blue Shield Cardiovascular Consortium, Ann Arbor, Mich
| | - Devraj Sukul
- Department of Internal Medicine, University of Michigan, Ann Arbor, Mich; Blue Cross Blue Shield Cardiovascular Consortium, Ann Arbor, Mich
| | - Stanley J Chetcuti
- Department of Internal Medicine, University of Michigan, Ann Arbor, Mich; Blue Cross Blue Shield Cardiovascular Consortium, Ann Arbor, Mich
| | - Chang He
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich
| | - Marvin H Eng
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Mich
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich
| |
Collapse
|
14
|
Brescia AA, Deeb GM, Sang SLW, Tanaka D, Grossman PM, Sukul D, He C, Theurer PF, Clark M, Shannon FL, Chetcuti SJ, Fukuhara S. Surgical Explantation of Transcatheter Aortic Valve Bioprostheses: A Statewide Experience. Circ Cardiovasc Interv 2021; 14:e009927. [PMID: 33719506 DOI: 10.1161/circinterventions.120.009927] [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] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Alexander A Brescia
- Department of Cardiac Surgery (A.A.B., G.M.D., S.F.), University of Michigan, Ann Arbor
| | - G Michael Deeb
- Department of Cardiac Surgery (A.A.B., G.M.D., S.F.), University of Michigan, Ann Arbor.,Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.)
| | - Stephane Leung Wai Sang
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.).,Spectrum Health Medical Group, Cardiothoracic Surgery, Grand Rapids, MI (S.L.W.S.)
| | - Daizo Tanaka
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.).,Henry Ford Hospital Division of Cardiac Surgery, Detroit, MI (D.T.)
| | - P Michael Grossman
- Department of Internal Medicine (P.M.G., D.S., S.J.C.), University of Michigan, Ann Arbor.,Blue Cross Blue Shield Cardiovascular Consortium, Ann Arbor, MI (P.M.G., D.S., S.J.C.)
| | - Devraj Sukul
- Department of Internal Medicine (P.M.G., D.S., S.J.C.), University of Michigan, Ann Arbor.,Blue Cross Blue Shield Cardiovascular Consortium, Ann Arbor, MI (P.M.G., D.S., S.J.C.)
| | - Chang He
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.)
| | - Patricia F Theurer
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.)
| | - Melissa Clark
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.)
| | - Francis L Shannon
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.).,Division of Cardiovascular Surgery, Beaumont Health, Royal Oak, MI (F.L.S.)
| | - Stanley J Chetcuti
- Department of Internal Medicine (P.M.G., D.S., S.J.C.), University of Michigan, Ann Arbor.,Blue Cross Blue Shield Cardiovascular Consortium, Ann Arbor, MI (P.M.G., D.S., S.J.C.)
| | - Shinichi Fukuhara
- Department of Cardiac Surgery (A.A.B., G.M.D., S.F.), University of Michigan, Ann Arbor.,Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor (G.M.D., S.L.W.S., D.T., C.H., P.F.T., M.C., F.L.S., S.F.)
| | | |
Collapse
|
15
|
Duggal N, Romano M, Menees D, Chetcuti SJ, Bolling SF, Ailawadi G. Transcatheter Mitral Valve Repair With Leaflet-to-Ring Technique in the Presence of a Radiolucent Prosthetic Ring. JACC Cardiovasc Interv 2020; 14:e1-e4. [PMID: 33309311 DOI: 10.1016/j.jcin.2020.10.051] [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: 10/19/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Neal Duggal
- Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan, USA.
| | - Matthew Romano
- Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Daniel Menees
- Department of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Stanley J Chetcuti
- Department of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Steven F Bolling
- Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| |
Collapse
|
16
|
Forrest JK, Ramlawi B, Deeb GM, Zahr F, Song HK, Kleiman NS, Chetcuti SJ, Michelena HI, Mangi AA, Skiles JA, Huang J, Popma JJ, Reardon MJ. Transcatheter Aortic Valve Replacement in Low-risk Patients With Bicuspid Aortic Valve Stenosis. JAMA Cardiol 2020; 6:50-57. [PMID: 33031491 DOI: 10.1001/jamacardio.2020.4738] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The outcomes of transcatheter aortic valve replacement (TAVR) in low-risk patients with bicuspid aortic valve stenosis have not been studied in a large scale, multicentered, prospective fashion. Objective To evaluate the procedural safety, efficacy, and 30-day outcomes of TAVR in patients with bicuspid aortic stenosis at low surgical risk. Design, Setting, and Participants The Low Risk Bicuspid Study is a prospective, single-arm trial study with inclusion/exclusion criteria developed from the Evolut Low Risk Randomized Trial. Follow-up is planned for 10 years. Patients underwent TAVR at 25 centers in the United States who were also participating in the Evolut Low Risk Randomized Trial from December 2018 to October 2019. Eligible patients had severe bicuspid aortic valve stenosis and met American Heart Association/American College of Cardiology guideline indications for aortic valve replacement. Interventions Patients underwent attempted implant of an Evolut or Evolut PRO transcatheter aortic valve, with valve size based on annular measurements. Main Outcomes and Measures The prespecified primary end point was the incidence of all-cause mortality or disabling stroke at 30 days. The prespecified primary efficacy end point was device success defined as the absence of procedural mortality, the correct position of 1 bioprosthetic heart valve in the proper anatomical location, and the absence of more than mild aortic regurgitation postprocedure. Results A total of 150 patients underwent an attempted implant. Baseline characteristics include mean age of 70.3 (5.5) years, 48.0% female (n = 72), and a mean Society of Thoracic Surgeons score of 1.4 (0.6%). Most patients (136; 90.7%) had Sievers type I valve morphology. The incidence of all-cause mortality or disabling stroke was 1.3% (95% CI, 0.3%-5.3%) at 30 days. The device success rate was 95.3% (95% CI, 90.5%-98.1%). At 30 days, the mean (SD) AV gradient was 7.6 (3.7) mm Hg and effective orifice area was 2.3 (0.7) cm2. A new permanent pacemaker was implanted in 22 patients (15.1%). No patients had greater than mild paravalvular leak. Conclusions and Relevance Transcatheter aortic valve replacement in low-surgical risk patients with bicuspid aortic valve stenosis achieved favorable 30-day results, with low rates of death and stroke and high device success rate. Trial Registration ClinicalTrials.gov Identifier: NCT03635424.
Collapse
Affiliation(s)
- John K Forrest
- Departments of Internal Medicine (Cardiology) and Surgery (Cardiac Surgery), Yale University School of Medicine, New Haven, Connecticut
| | - Basel Ramlawi
- Department of Cardiothoracic Surgery and Cardiology, Valley Health System, Winchester, Virginia
| | - G Michael Deeb
- Departments of Cardiac Surgery and Interventional Cardiology, University of Michigan Hospitals, Ann Arbor
| | - Firas Zahr
- Departments of Interventional Cardiology and Cardiothoracic Surgery, Oregon Health and Science University, Portland
| | - Howard K Song
- Departments of Interventional Cardiology and Cardiothoracic Surgery, Oregon Health and Science University, Portland
| | - Neal S Kleiman
- Departments of Interventional Cardiology and Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Institute, Houston, Texas
| | - Stanley J Chetcuti
- Departments of Cardiac Surgery and Interventional Cardiology, University of Michigan Hospitals, Ann Arbor
| | - Hector I Michelena
- Division of Cardiovascular Ultrasound, Mayo Clinic, Rochester, Minnesota
| | - Abeel A Mangi
- Departments of Internal Medicine (Cardiology) and Surgery (Cardiac Surgery), Yale University School of Medicine, New Haven, Connecticut
| | - Jeffrey A Skiles
- Department of Cardiothoracic Surgery and Cardiology, Valley Health System, Winchester, Virginia
| | - Jian Huang
- Department of Statistics, Medtronic, Minneapolis, Minnesota
| | - Jeffrey J Popma
- Department of Interventional Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Michael J Reardon
- Departments of Interventional Cardiology and Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Institute, Houston, Texas
| |
Collapse
|
17
|
Deeb GM, Popma JJ, Chetcuti SJ, Yakubov SJ, Mumtaz M, Gleason TG, Williams MR, Gada H, Oh JK, Li S, Boulware MJ, Kappetein AP, Reardon MJ. Computed Tomography Annular Dimensions: A Novel Method to Compare Prosthetic Valve Hemodynamics. Ann Thorac Surg 2020; 110:1502-1510. [PMID: 32289296 DOI: 10.1016/j.athoracsur.2020.03.012] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/19/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The Cardiac Surgical Societies Valve Labeling Task Force consensus document acknowledged inconsistent sizing and labeling of prosthetic heart valves. This study compared the labeled size, internal diameter, and hemodynamics of different surgical and transcatheter valve types implanted into the same size annulus, measured by preprocedural computed tomography (CT). METHODS Patients were retrospectively sorted into 3 CT annular diameter size groups: small (less than 23 mm), medium (23 to less than 26 mm), and large (26 mm or greater). Surgical valves were sorted into 4 categories based on tissue and design: (stentless porcine, standard stented bovine, wraparound stented bovine, and stented porcine). Comparisons were made within the surgical types and with a transcatheter valve. Echocardiograms were independently assessed and CTs were centrally measured. RESULTS We analyzed 726 surgical and 923 transcatheter valve paired data sets. Among the various valve types implanted into the same size CT annulus, there were significant differences regarding size, internal diameter, and hemodynamics within all 3 size groups. Root enlargement procedures occurred in 1.2% with no differences across valve types or size groups. Transcatheter valve hemodynamics were similar to stentless valves and were significantly better than all stented valves. There was no difference in hemodynamics between the 2 bovine stented valve types, and stented porcine valves were inferior to all valve types. CONCLUSIONS This study documents that prosthetic heart valve sizing and labeling inconsistencies exist. Use of preoperative CT annular dimensions is the most accurate method to compare size, internal diameter, and hemodynamics of bioprosthetic aortic valves because it compares values among various valve types implanted into the same size annulus.
Collapse
Affiliation(s)
- G Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
| | - Jeffrey J Popma
- Department of Interventional Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Stanley J Chetcuti
- Department of Interventional Cardiology, University of Michigan, Ann Arbor, Michigan; Department of Interventional Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Steven J Yakubov
- Department of Interventional Cardiology, Riverside Methodist-Ohio Health, Columbus, Ohio
| | - Mubashir Mumtaz
- Department of Cardiac Surgery, University of Pittsburgh Medical Center-Pinnacle, Wormsleysburg, Pennsylvania; Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Thomas G Gleason
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mathew R Williams
- Department of Cardiac Surgery, New York University-Langone Medical Center, New York, New York
| | - Hemal Gada
- Department of Interventional Cardiology, University of Pittsburgh Medical Center-Pinnacle, Wormsleysburg, Pennsylvania
| | - Jae K Oh
- Echocardiography Department, Mayo Clinic, Rochester, Minnesota
| | - Shuzhen Li
- Department of Statistical Services, Medtronic, Minneapolis, Minnesota
| | | | - Arie Pieter Kappetein
- Department of Cardiac Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Institute, Houston, Texas
| |
Collapse
|
18
|
Nazif TM, Chen S, Codner P, Grossman PM, Menees DS, Sanchez CE, Yakubov SJ, White J, Kapadia S, Whisenant BK, Forrest JK, Krishnaswamy A, Arshi A, Orford JL, Leon MB, Dizon JM, Kodali SK, Chetcuti SJ. The initial U.S. experience with the Tempo active fixation temporary pacing lead in structural heart interventions. Catheter Cardiovasc Interv 2020; 95:1051-1056. [PMID: 31478304 DOI: 10.1002/ccd.28476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/30/2019] [Accepted: 08/12/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This multicenter retrospective study of the initial U.S. experience evaluated the safety and efficacy of temporary cardiac pacing with the Tempo® Temporary Pacing Lead. BACKGROUND Despite increasing use of temporary cardiac pacing with the rapid growth of structural heart procedures, temporary pacing leads have not significantly improved. The Tempo lead is a new temporary pacing lead with a soft tip intended to minimize the risk of perforation and a novel active fixation mechanism designed to enhance lead stability. METHODS Data from 269 consecutive structural heart procedures were collected. Outcomes included device safety (absence of clinically significant cardiac perforation, new pericardial effusion, or sustained ventricular arrhythmia) and efficacy (clinically acceptable pacing thresholds with successful pace capture throughout the index procedure). Postprocedure practices and sustained lead performance were also analyzed. RESULTS The Tempo lead was successfully positioned in the right ventricle and achieved pacing in 264 of 269 patients (98.1%). Two patients (0.8%) experienced loss of pace capture. Procedural mean pace capture threshold (PCT) was 0.7 ± 0.8 mA. There were no clinically significant perforations, pericardial effusions, or sustained device-related arrhythmias. The Tempo lead was left in place postprocedure in 189 patients (71.6%) for mean duration of 43.3 ± 0.7 hr (range 2.5-221.3 hr) with final PCT of 0.84 ± 1.04 mA (n = 80). Of these patients, 84.1% mobilized out of bed with no lead dislodgment. CONCLUSION The Tempo lead is safe and effective for temporary cardiac pacing for structural heart procedures, provides stable peri and postprocedural pacing and allows mobilization of patients who require temporary pacing leads.
Collapse
Affiliation(s)
- Tamim M Nazif
- Columbia University Irving Medical Center, New York, New York.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Shmuel Chen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Pablo Codner
- Columbia University Irving Medical Center, New York, New York
| | - Paul M Grossman
- University of Michigan Cardiovascular Center, Ann Arbor, Michigan
| | - Daniel S Menees
- University of Michigan Cardiovascular Center, Ann Arbor, Michigan
| | | | | | - Jonathan White
- Cleveland Clinic Heart & Vascular Institute, Cleveland, Ohio
| | - Samir Kapadia
- Cleveland Clinic Heart & Vascular Institute, Cleveland, Ohio
| | | | - John K Forrest
- Yale University School of Medicine, New Haven, Connecticut
| | | | - Arash Arshi
- OhioHealth/Riverside Methodist Hospital, Columbus, Ohio
| | - James L Orford
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah
| | - Martin B Leon
- Columbia University Irving Medical Center, New York, New York.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - José M Dizon
- Columbia University Irving Medical Center, New York, New York
| | - Susheel K Kodali
- Columbia University Irving Medical Center, New York, New York.,Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | | |
Collapse
|
19
|
Fukuhara S, Hobbs R, Chetcuti SJ, Patel HJ. Modified Transcatheter Hufnagel Procedure as a Bridge to Surgical Aortic Valve Replacement. Ann Thorac Surg 2019; 109:e435-e437. [PMID: 31760052 DOI: 10.1016/j.athoracsur.2019.09.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/27/2019] [Accepted: 09/22/2019] [Indexed: 11/30/2022]
Abstract
The history of aortic valve surgery began with the Hufnagel procedure. In 1953, Hufnagel reported the first successful treatment of aortic insufficiency by the implantation of a ball-valve prosthesis into the descending aorta. We present a 33-year-old male patient with a complicated surgical history needing a sixth-time redo aortic valve replacement for severe prosthetic paravalvular leak in the presence of fresh intracranial hemorrhage. His deteriorating clinical picture was successfully temporized by a transcatheter valve placement in the descending aorta (modified Hufnagel procedure). This report illustrates a potential role of a modified Hufnagel procedure as a bridge to definitive surgery.
Collapse
Affiliation(s)
- Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
| | - Reilly Hobbs
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Stanley J Chetcuti
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
20
|
Dauerman HL, Deeb GM, O’Hair DP, Waksman R, Yakubov SJ, Kleiman NS, Chetcuti SJ, Hermiller JB, Bajwa T, Khabbaz K, de Marchena E, Salerno T, Dries-Devlin JL, Li S, Popma JJ, Reardon MJ. Durability and Clinical Outcomes of Transcatheter Aortic Valve Replacement for Failed Surgical Bioprostheses. Circ Cardiovasc Interv 2019; 12:e008155. [DOI: 10.1161/circinterventions.119.008155] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Valve-in-valve transcatheter aortic valve replacement (TAVR) is an option when a surgical valve demonstrates deterioration and dysfunction. This study reports 3-year results following valve-in-valve with self-expanding TAVR.
Methods:
The CoreValve US Expanded Use Study is a prospective, nonrandomized, single-arm study that evaluates safety and effectiveness of TAVR in extreme risk patients with symptomatic failed surgical biologic aortic valves. Study end points include all-cause mortality, need for valve reintervention, hemodynamic changes over time, and quality of life through 3 years. Patients were stratified by presence of preexisting surgical valve prosthesis-patient mismatch.
Results:
From March 2013 to May 2015, 226 patients deemed extreme risk (STS-PROM [Society of Thoracic Surgeons Predicted Risk of Mortality] 9.0±7%) had attempted valve-in-valve TAVR. Preexisting surgical valve prosthesis-patient mismatch was present in 47.2% of the cohort. At 3 years, all-cause mortality or major stroke was 28.6%, and 93% of patients were in New York Heart Association I or II heart failure. Valve performance was maintained over 3 years with low valve reintervention rates (4.4%), an improvement in effective orifice area over time and a 2.7% rate of severe structural valve deterioration. Preexisting severe prosthesis-patient mismatch was not associated with 3-year mortality but was associated with significantly less improvement in quality of life at 3-year follow-up (
P
=0.01).
Conclusions:
Self-expanding TAVR in patients with failed surgical bioprostheses at extreme risk for surgery was associated with durable hemodynamics and excellent clinical outcomes. Preexisting surgical valve prosthesis-patient mismatch was not associated with mortality but did limit patient improvement in quality of life over 3-year follow-up.
Clinical Trial Registration:
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01675440.
Collapse
Affiliation(s)
| | - G. Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor (G.M.D.)
| | - Daniel P. O’Hair
- Departments of Cardiac Surgery and Cardiology, Aurora Healthcare, Milwaukee, WI (D.P.O., T.B.)
- Current address: Boulder Heart, CO (D.P.O.)
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (R.W.)
| | - Steven J. Yakubov
- Department of Cardiology, Riverside Methodist Hospital, Columbus, OH (S.J.Y.)
| | - Neal S. Kleiman
- Departments of Cardiology and Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K., M.J.R.)
| | | | - James B. Hermiller
- Division of Cardiovascular Medicine, St Vincent’s Medical Center, IN (J.B.H.)
| | - Tanvir Bajwa
- Departments of Cardiac Surgery and Cardiology, Aurora Healthcare, Milwaukee, WI (D.P.O., T.B.)
| | - Kamal Khabbaz
- Departments of Cardiovascular Surgery and Internal Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA (K.K., J.J.P.)
| | - Eduardo de Marchena
- Divisions of Cardiology and Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, FL (E.d.M., T.S.)
| | - Tomas Salerno
- Divisions of Cardiology and Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, FL (E.d.M., T.S.)
| | - Jessica L. Dries-Devlin
- Coronary and Structural Heart Clinical Operations, Medtronic, Mounds View, MN (J.L.D.-D., S.L.)
| | - Shuzhen Li
- Coronary and Structural Heart Clinical Operations, Medtronic, Mounds View, MN (J.L.D.-D., S.L.)
| | - Jeffrey J. Popma
- Departments of Cardiovascular Surgery and Internal Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA (K.K., J.J.P.)
| | - Michael J. Reardon
- Departments of Cardiology and Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K., M.J.R.)
| |
Collapse
|
21
|
Sanchez CE, Hermiller JB, Pinto DS, Chetcuti SJ, Arshi A, Forrest JK, Huang J, Yakubov SJ. Predictors and Risk Calculator of Early Unplanned Hospital Readmission Following Contemporary Self-Expanding Transcatheter Aortic Valve Replacement from the STS/ACC TVT Registry. Cardiovasc Revasc Med 2019; 21:263-270. [PMID: 31255552 DOI: 10.1016/j.carrev.2019.05.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 02/07/2019] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Predictors of hospital readmissions and tools to predict readmissions after TAVR are scarce. Our objective was to identify predictors of early hospital readmission following TAVR in contemporary clinical practice and develop a risk calculator. METHODS Patients with a contemporary self-expanding TAVR between 2015 and 2017 in the STS/ACC/TVT Registry™ database were included. Patients were divided into a derivation and validation cohort (2:1). A risk score was calculated using the derivation cohort based on multivariable predictors of 30-day unplanned readmissions and applied to the validation cohort. RESULTS A total of 10,345 TAVR patients at 350 centers were included. Unplanned 30-day hospital readmission was 9.2%. Patients with an early readmission had higher 30-day rates for mortality (2.3% vs. 0.8%, p ≪ 0.001), stroke (4.1% vs. 2.7% p = 0.009), major vascular complications (2.0% vs. 1.0%, p = 0.003) and new pacemaker implantation (25.7% vs. 18.6%, p ≪ 0.001). Multivariable predictors of 30-day readmission included diabetes, atrial fibrillation, advanced heart failure symptoms, home oxygen, decreased 5-m gait speed or the inability to walk, serum creatinine ≫1.6 mg/dL, index hospitalization length of stay ≫5 days, major vascular complication and ≥ moderate post-procedure aortic or mitral valve regurgitation. Based on these predictors, we stratified 30-day readmission risk into low-, moderate- and high-risk subsets. There was a 2.5× difference in readmission rates between the low- (5.8%) and high-risk subsets (14.6%). CONCLUSION We stratified the risk of early hospital readmission after TAVR based on a simple scoring system. This score may improve discharge planning centered on the individual's readmission risk. SUMMARY Unplanned readmissions in the United States are prevalent and costly accounting for $41.3 billion in annual hospital payments and are associated with adverse clinical outcomes. We found that diabetes, atrial fibrillation, advanced heart failure symptoms, home oxygen, frailty, acute kidney injury, prolonged hospitalization, major vascular complications, and moderate or worse post-procedure aortic or mitral valve regurgitation predicted of 30-day readmission following self-expanding TAVR. This information may improve discharge planning centered on each patient's readmission risk.
Collapse
Affiliation(s)
- Carlos E Sanchez
- Department of Interventional Cardiology, Riverside Methodist Hospital-OhioHealth, 3705 Olentangy River Road, Columbus, OH 43214, United States of America.
| | - James B Hermiller
- Department of Interventional Cardiology, St. Vincent's Medical Center, I10590 N Meridian St Fl 2, Indianapolis, IN 46290, United States of America
| | - Duane S Pinto
- Department of Interventional Cardiology, Beth Israel Deaconess Medical Center, 185 Pilgrim Road Palmer 4, Boston, MA 02215, United States of America.
| | - Stanley J Chetcuti
- Department of Interventional Cardiology, University of Michigan Hospitals, 1500 East Medical Center, SPC 5869, Ann Arbor, MI 48109, United States of America.
| | - Arash Arshi
- Department of Interventional Cardiology, Riverside Methodist Hospital-OhioHealth, 3705 Olentangy River Road, Columbus, OH 43214, United States of America.
| | - John K Forrest
- Department of Cardiology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, United States of America.
| | - Jian Huang
- Statistical Services, Medtronic, 8200 Coral Sea Street, Mounds View, MN 55112, United States of America.
| | - Steven J Yakubov
- Department of Interventional Cardiology, Riverside Methodist Hospital-OhioHealth, 3705 Olentangy River Road, Columbus, OH 43214, United States of America.
| |
Collapse
|
22
|
Popma JJ, Deeb GM, Yakubov SJ, Mumtaz M, Gada H, O'Hair D, Bajwa T, Heiser JC, Merhi W, Kleiman NS, Askew J, Sorajja P, Rovin J, Chetcuti SJ, Adams DH, Teirstein PS, Zorn GL, Forrest JK, Tchétché D, Resar J, Walton A, Piazza N, Ramlawi B, Robinson N, Petrossian G, Gleason TG, Oh JK, Boulware MJ, Qiao H, Mugglin AS, Reardon MJ. Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients. N Engl J Med 2019; 380:1706-1715. [PMID: 30883053 DOI: 10.1056/nejmoa1816885] [Citation(s) in RCA: 2220] [Impact Index Per Article: 444.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Transcatheter aortic-valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis who are at increased risk for death from surgery; less is known about TAVR in low-risk patients. METHODS We performed a randomized noninferiority trial in which TAVR with a self-expanding supraannular bioprosthesis was compared with surgical aortic-valve replacement in patients who had severe aortic stenosis and were at low surgical risk. When 850 patients had reached 12-month follow-up, we analyzed data regarding the primary end point, a composite of death or disabling stroke at 24 months, using Bayesian methods. RESULTS Of the 1468 patients who underwent randomization, an attempted TAVR or surgical procedure was performed in 1403. The patients' mean age was 74 years. The 24-month estimated incidence of the primary end point was 5.3% in the TAVR group and 6.7% in the surgery group (difference, -1.4 percentage points; 95% Bayesian credible interval for difference, -4.9 to 2.1; posterior probability of noninferiority >0.999). At 30 days, patients who had undergone TAVR, as compared with surgery, had a lower incidence of disabling stroke (0.5% vs. 1.7%), bleeding complications (2.4% vs. 7.5%), acute kidney injury (0.9% vs. 2.8%), and atrial fibrillation (7.7% vs. 35.4%) and a higher incidence of moderate or severe aortic regurgitation (3.5% vs. 0.5%) and pacemaker implantation (17.4% vs. 6.1%). At 12 months, patients in the TAVR group had lower aortic-valve gradients than those in the surgery group (8.6 mm Hg vs. 11.2 mm Hg) and larger effective orifice areas (2.3 cm2 vs. 2.0 cm2). CONCLUSIONS In patients with severe aortic stenosis who were at low surgical risk, TAVR with a self-expanding supraannular bioprosthesis was noninferior to surgery with respect to the composite end point of death or disabling stroke at 24 months. (Funded by Medtronic; ClinicalTrials.gov number, NCT02701283.).
Collapse
Affiliation(s)
- Jeffrey J Popma
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - G Michael Deeb
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Steven J Yakubov
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Mubashir Mumtaz
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Hemal Gada
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Daniel O'Hair
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Tanvir Bajwa
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - John C Heiser
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - William Merhi
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Neal S Kleiman
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Judah Askew
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Paul Sorajja
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Joshua Rovin
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Stanley J Chetcuti
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - David H Adams
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Paul S Teirstein
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - George L Zorn
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - John K Forrest
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Didier Tchétché
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Jon Resar
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Antony Walton
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Nicolo Piazza
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Basel Ramlawi
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Newell Robinson
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - George Petrossian
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Thomas G Gleason
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Jae K Oh
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Michael J Boulware
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Hongyan Qiao
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Andrew S Mugglin
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Michael J Reardon
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| |
Collapse
|
23
|
Kleiman NS, Popma JJ, Chetcuti SJ, Serruys PW, Van Mieghem NM, Stoler RC, Harrison JK, Brecker SJ. 600.04 Coronary Intervention After Self-Expanding Transcatheter or Surgical Aortic Valve Replacement in the SURTAVI Trial. JACC Cardiovasc Interv 2019. [DOI: 10.1016/j.jcin.2019.01.156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
24
|
Chetcuti SJ, Deeb GM, Popma JJ, Yakubov SJ, Grossman PM, Patel HJ, Casale A, Dauerman HL, Resar JR, Boulware MJ, Dries-Devlin JL, Li S, Oh JK, Reardon MJ. Self-Expanding Transcatheter Aortic Valve Replacement in Patients With Low-Gradient Aortic Stenosis. JACC Cardiovasc Imaging 2018; 12:67-80. [PMID: 30448116 DOI: 10.1016/j.jcmg.2018.07.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 07/03/2018] [Accepted: 07/20/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The authors sought to compare clinical and hemodynamic outcomes in patients receiving transcatheter aortic valve replacement (TAVR) for low-gradient (LG) aortic stenosis in the CoreValve EUS (Expanded Use Study) versus those with high-gradient (HG) aortic stenosis from the CoreValve U.S. Pivotal Extreme Risk Trial and CAS (Continued Access Study). BACKGROUND The EUS examined the impact of TAVR in patients unsuitable for surgical aortic valve replacement who were excluded from the U.S. Pivotal Extreme Risk Trial due to LG aortic stenosis. METHODS EUS patients were stratified by left ventricular ejection fraction: normal (≥50%, LG-normal ejection fraction), and low (<50%, did not respond to dobutamine by generating a mean gradient >40 mm Hg and/or velocity >4.0 m/s, "nonresponders"), and compared with extreme-risk patients from U.S. Pivotal and CAS that had either low resting gradient and responded to dobutamine ("responders"), or a high resting gradient (HG) or velocity. The primary endpoint was all-cause mortality or major stroke at 1 year. Hemodynamics and quality of life are reported at 30 days and 1 year. RESULTS At 30 days, patients with LG/low left ventricular ejection fraction (nonresponders and responders) had significantly higher rates of all-cause mortality or major stroke, all-cause mortality, and cardiovascular mortality than both HG and LG-normal ejection fraction patients. At 1 year, only the responders had higher rates of these outcomes in comparison to the other 3 groups. Mean gradient and effective orifice area improved significantly in all patients and were maintained through 1 year. New York Heart Association functional classification and Kansas City Cardiomyopathy Questionnaire overall summary scores improved (p < 0.05) in all cohorts through 1 year. When all 4 subgroups were pooled, both decreasing mean gradient and stroke volume index were associated with increased mortality. Pre-procedural mean gradient was the only hemodynamic independent predictor of 1-year mortality by multivariate analysis. CONCLUSIONS In this study, TAVR provided EUS patients significant hemodynamic relief with both 1-year survival and quality of life outcomes comparable to Pivotal and CAS patients (Safety & Efficacy Study of the Medtronic CoreValve System-Treatment of Symptomatic Severe Aortic Stenosis With Significant Comorbidities in Extreme Risk Subjects Who Need Aortic Valve Replacement, NCT01675440; Safety and Efficacy Study of the Medtronic CoreValve System in the Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very High Risk Subjects Who Need Aortic Valve Replacement, NCT01240902; Safety and Efficacy Continued Access Study of the Medtronic CoreValve System in the Treatment of Symptomatic Severe Aortic Stenosis in Very High Risk Subjects and High Risk Subjects Who Need Aortic Valve Replacement, NCT01531374).
Collapse
Affiliation(s)
- Stanley J Chetcuti
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
| | - Jeffrey J Popma
- Department of Internal Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Steven J Yakubov
- Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio
| | - P Michael Grossman
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Alfred Casale
- Department of Cardiothoracic Surgery, Geisinger Health System, Danville, Pennsylvania
| | - Harold L Dauerman
- Department of Cardiology, University of Vermont Medical Center, Burlington, Vermont
| | - Jon R Resar
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael J Boulware
- Coronary and Structural Heart Clinical Department, Medtronic, Mounds View, Minnesota
| | | | - Shuzhen Li
- Coronary and Structural Heart Clinical Department, Medtronic, Mounds View, Minnesota
| | - Jae K Oh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| |
Collapse
|
25
|
Pineda AM, Kevin Harrison J, Kleiman NS, Reardon MJ, Conte JV, O'Hair DP, Chetcuti SJ, Huang J, Yakubov SJ, Popma JJ, Beohar N. Clinical impact of baseline chronic kidney disease in patients undergoing transcatheter or surgical aortic valve replacement. Catheter Cardiovasc Interv 2018; 93:740-748. [DOI: 10.1002/ccd.27928] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 09/17/2018] [Accepted: 09/24/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Andres M. Pineda
- Division of CardiologyUniversity of Florida College of Medicine‐Jacksonville Jacksonville Florida
| | - J. Kevin Harrison
- Department of MedicineDuke University Medical Center Durham North Carolina
| | - Neal S. Kleiman
- Department of CardiologyHouston Methodist DeBakey Heart and Vascular Center Houston Texas
| | - Michael J. Reardon
- Department of Cardiothoracic SurgeryHouston Methodist DeBakey Heart and Vascular Center Houston Texas
| | - John V. Conte
- Division of Cardiac SurgeryJohns Hopkins University Baltimore Maryland
| | - Daniel P. O'Hair
- Department of Cardiothoracic SurgeryAurora Healthcare Milwaukee Wisconsin
| | - Stanley J. Chetcuti
- Department of Internal Medicine, Division of CardiologyUniversity of Michigan Ann Arbor Michigan
| | - Jian Huang
- Coronary and Structural Heart Clinical Department Mounds View Minnesota
| | | | - Jeffrey J. Popma
- Department of Internal Medicine, Cardiovascular DivisionBeth Israel Deaconess Medical Center Boston Massachusetts
| | - Nirat Beohar
- Division of Cardiology at Mount Sinai Medical Center, Columbia University Miami Beach Florida
| |
Collapse
|
26
|
Kleiman NS, Maini BJ, Reardon MJ, Conte J, Katz S, Rajagopal V, Kauten J, Hartman A, McKay R, Hagberg R, Huang J, Popma J, Ad N, Aharonian V, Anderson WD, Applegate R, Bafi A, Bajwa T, Bakhos M, Ball S, Batra S, Beohar N, Brachinsky W, Brinster D, Brown J, Byrne J, Byrne T, Casale A, Caskey M, Chawla A, Cohen H, Coselli J, Costa M, Cheatham J, Chetcuti SJ, Crestanello J, Davis T, Michael Deeb G, Diez J, Dauerman H, Elefteriades J, Fail P, Feinberg E, Fontana G, Forrest JL, Galloway A, Giacomini J, Gleason TG, Guadiani V, Harrison JK, Hebeler R, Heimansohn D, Heiser J, Heller L, Henry S, Hermiller J, Hockmuth D, Hughes GC, Joye J, Kafi A, Kar B, Khabbaz K, Kipperman R, Kliger C, Kon N, Lamelas J, Lee JS, Leya F, Londono JC, Macheers S, Mangi A, de Marchena E, Markowitz A, Matthews R, Merhi W, Mumtaz M, O’Hair D, Petrossian G, Pfeffer T, Raybuck B, Resar J, Robbins M, Robbins R, Robinson N, Ring M, Salerno T, Schreiber T, Schmoker J, Sharma S, Siwek L, Skelding K, Slater J, Starnes V, Stoler R, Subramanian V, Tadros P, Thompson C, Waksman R, Watson D, Yakubov S, Zhao D, Zorn GL. Neurological Events Following Transcatheter Aortic Valve Replacement and Their Predictors: A Report From the CoreValve Trials. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003551. [PMID: 27601429 DOI: 10.1161/circinterventions.115.003551] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [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: 09/09/2015] [Accepted: 07/15/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The risk for stroke after transcatheter aortic valve replacement (TAVR) is an important concern. Identification of predictors for stroke is likely to be a critical factor aiding patient selection and management as TAVR use becomes widespread. METHODS AND RESULTS Patients enrolled in the CoreValve US Extreme Risk and High Risk Pivotal Trials or Continued Access Study treated with the self-expanding CoreValve bioprosthesis were included in this analysis. The 1-year stroke rate after TAVR was 8.4%. Analysis of the stroke hazard rate identified an early phase (0-10 days; 4.1% of strokes) and a late phase (11-365 days; 4.3% of strokes). Baseline predictors of early stroke included National Institutes of Health stroke scale score >0, prior stroke, prior transient ischemic attack, peripheral vascular disease, absence of prior coronary artery bypass surgery, angina, low body mass index (<21 kg/m(2)), and falls within the past 6 months. Significant procedural predictors were total time in the catheterization laboratory or operating room, delivery catheter in the body time, rapid pacing used during valvuloplasty, and repositioning of the prosthesis. Predictors of stroke between 11 and 365 days were small body surface area, severe aortic calcification, and falls within the past 6 months. There were no significant imaging predictors of early or late stroke. CONCLUSIONS Predictors of early stroke after TAVR included clinical and procedural factors; predictors of later stroke were limited to patient but not anatomic characteristics. These findings indicate that further refinement of imaging to identify anatomic factors predisposing to embolization may help improve stroke prediction in patients undergoing TAVR. CLINICAL TRIAL REGISTRATIONS URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01240902, NCT01531374.
Collapse
Affiliation(s)
- Neal S Kleiman
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.).
| | - Brijeshwar J Maini
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Michael J Reardon
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - John Conte
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Stanley Katz
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Vivek Rajagopal
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - James Kauten
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Alan Hartman
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Raymond McKay
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Robert Hagberg
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Jian Huang
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Jeffrey Popma
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | | | | | | | | | | | - Amar Bafi
- Washington Hospital Center/Georgetown Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Joseph Coselli
- Texas Heart Institute at St Lukes Episcopal Hospital/Baylor College of Medicine
| | | | | | | | | | | | | | - Jose Diez
- Texas Heart Institute at St Lukes Episcopal Hospital/Baylor College of Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Scott Henry
- Detroit Medical Center Cardiovascular Institute
| | | | | | | | | | - Ali Kafi
- Detroit Medical Center Cardiovascular Institute
| | - Biswajit Kar
- Texas Heart Institute at St Lukes Episcopal Hospital/Baylor College of Medicine
| | | | | | | | - Neal Kon
- Wake Forest University Baptist Medical Center
| | | | | | | | | | | | | | | | | | - Ray Matthews
- University of Southern California University Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lee Siwek
- Providence Sacred Heart Medical Center
| | | | | | | | | | | | | | | | - Ron Waksman
- Washington Hospital Center/Georgetown Hospital
| | - Daniel Watson
- Riverside Methodist Hospital/Ohio Health Research Institute
| | - Steven Yakubov
- Riverside Methodist Hospital/Ohio Health Research Institute
| | | | | | | |
Collapse
|
27
|
Sorajja P, Kodali S, Reardon MJ, Szeto WY, Chetcuti SJ, Hermiller J, Chenoweth S, Adams DH, Popma JJ. Outcomes for the Commercial Use of Self-Expanding Prostheses in Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2017; 10:2090-2098. [DOI: 10.1016/j.jcin.2017.07.027] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/20/2017] [Accepted: 07/19/2017] [Indexed: 11/28/2022]
|
28
|
O’Hair DP, Bajwa TK, Chetcuti SJ, Deeb GM, Stoler RC, Hebeler RF, Maini B, Mumtaz M, Kleiman NS, Reardon MJ, Li S, Adams DH, Watson DR, Yakubov SJ, Popma JJ, Petrossian G. One-Year Outcomes of Transcatheter Aortic Valve Replacement in Patients With End-Stage Renal Disease. Ann Thorac Surg 2017; 103:1392-1398. [DOI: 10.1016/j.athoracsur.2016.11.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/29/2016] [Accepted: 11/21/2016] [Indexed: 11/28/2022]
|
29
|
Gurm HS, Sanz-Guerrero J, Johnson DD, Jensen A, Seth M, Chetcuti SJ, Lalonde T, Greenbaum A, Dixon SR, Shih A. Using simulation for teaching femoral arterial access: A multicentric collaboration. Catheter Cardiovasc Interv 2015; 87:376-80. [PMID: 26489781 DOI: 10.1002/ccd.26256] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 09/08/2015] [Accepted: 09/16/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the impact of simulation training on complications associated with femoral arterial access obtained by first year cardiology fellows. BACKGROUND Prior studies demonstrate a higher incidence of arterial access related complications among patients undergoing invasive cardiac procedures. METHODS First year cardiology fellows at four teaching hospitals in Michigan tracked their femoral access experience and any associated complications between July 2011 and June 2013. Fellows starting their academic training in July 2012 were first trained on a specially developed simulator before starting their rotation in the catheterization laboratory. The primary outcome was access proficiency, defined as five successful femoral access attempts without any complication or need to seek help from a more experienced team member. RESULTS A total of 1,278 femoral access attempts were made by 21 fellows in 2011-2012 compared with 869 femoral access attempts made by 21 fellows in 2012-2013. There was a lower rate of access related complications in patients undergoing access attempts by first year fellows in year 2 compared with year 1 (2.1% versus 4.5%, P = 0.003). The number of procedures to achieve procedural proficiency was significantly higher in year 1 compared with year 2 (median 20 versus 10, P = 0.007). CONCLUSIONS Incorporation of simulation in the training of first year fellows was associated with an improvement in proficiency and a clinically meaningful reduction in vascular complications.
Collapse
Affiliation(s)
- Hitinder S Gurm
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jorge Sanz-Guerrero
- Facultades De Ingenieria Medicina Y Ciencias Biologicas, Instituto De Ingenieria Biologica Y Medica, Pontificia Universidad Catolica De Chile, Santiago, Chile.,Department of Mechanical Engineering, Wu Manufacturing Research Center University of Michigan, Ann Arbor, Michigan
| | - Daniel D Johnson
- Department of Mechanical Engineering, Wu Manufacturing Research Center University of Michigan, Ann Arbor, Michigan
| | - Andrea Jensen
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Milan Seth
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Stanley J Chetcuti
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Thomas Lalonde
- Department of Cardiovascular Medicine, St. John Hospital, Detroit, Michigan
| | - Adam Greenbaum
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Simon R Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, Michigan
| | - Albert Shih
- Department of Mechanical Engineering, Wu Manufacturing Research Center University of Michigan, Ann Arbor, Michigan.,Biomedical Engineering, University of Michigan, Ann Arbor
| |
Collapse
|
30
|
Deeb GM, Chetcuti SJ, Bajwa T, O'Hair D, Dauerman HL, Schmoker JD, Popma J, Khabbaz KR, Yakubov S, Oh JK, Reardon MJ. TCT-96 Self-Expanding TAVR in Patients with Failed Surgical Bioprosthesis: Results from the CoreValve US Expanded Use Study. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.141] [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]
|
31
|
O'Hair D, Petrossian G, Bajwa T, Chetcuti SJ, Deeb GM, Kleiman N, Reardon MJ. TCT-100 Transcatheter Aortic Valve Replacement in Patients With End-Stage Renal Disease: One Year Outcomes from the CoreValve US Expanded Use Study. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.146] [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]
|
32
|
Popma J, Reardon MJ, Sorajja P, Szeto WY, Hermiller J, Chetcuti SJ, Kodali S, Adams D. TCT-97 Transcatheter Aortic Valve Replacement Using the Self-Expanding Bioprosthesis: First Report from the Transcatheter Valve Therapies Registry. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
33
|
Chetcuti SJ, Deeb GM, Skelding KA, Casale A, Waksman R, Bafi A, Oh JK, Yakubov S, Reardon MJ, Adams D, Popma J. TCT-636 Self-Expanding TAVR in Patients with Low-Gradient, Low Output Aortic Stenosis: 12 Month Results from the CoreValve US Expanded Use Study. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
34
|
Chetcuti SJ, Deeb GM, Skelding K, Casale A, Waksman R, Bafi A, Yakubov S, Reardon M, Adams D, Popma J. SELF-EXPANDING TAVR IN PATIENTS WITH LOW-GRADIENT AORTIC STENOSIS: 30-DAY RESULTS FROM THE COREVALVE US EXPANDED USE STUDY. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61693-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
35
|
Tait AR, Voepel-Lewis T, Chetcuti SJ, Brennan-Martinez C, Levine R. Enhancing patient understanding of medical procedures: evaluation of an interactive multimedia program with in-line exercises. Int J Med Inform 2014; 83:376-84. [PMID: 24552970 DOI: 10.1016/j.ijmedinf.2014.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/10/2013] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Standard print and verbal information provided to patients undergoing treatments are often difficult to understand and may impair their ability to be truly informed. This study examined the effect of an interactive multimedia informational program with in-line exercises and corrected feedback on patients' real-time understanding of their cardiac catheterization procedure. METHODS 151 adult patients scheduled for diagnostic cardiac catheterization were randomized to receive information about their procedure using either the standard institutional verbal and written information (SI) or an interactive iPad-based informational program (IPI). Subject understanding was evaluated using semi-structured interviews at baseline, immediately following catheterization, and 2 weeks after the procedure. In addition, for those randomized to the IPI, the ability to respond correctly to several in-line exercises was recorded. Subjects' perceptions of, and preferences for the information delivery were also elicited. RESULTS Subjects randomized to the IPI program had significantly better understanding following the intervention compared with those randomized to the SI group (8.3±2.4 vs 7.4±2.5, respectively, 0-12 scale where 12=complete understanding, P<0.05). First-time correct responses to the in-line exercises ranged from 24.3% to 100%. Subjects reported that the in-line exercises were very helpful (9.1±1.7, 0-10 scale, where 10=extremely helpful) and the iPad program very easy to use (9.0±1.6, 0-10 scale, where 10=extremely easy) suggesting good clinical utility. DISCUSSION Results demonstrated the ability of an interactive multimedia program to enhance patients' understanding of their medical procedure. Importantly, the incorporation of in-line exercises permitted identification of knowledge deficits, provided corrected feedback, and confirmed the patients' understanding of treatment information in real-time when consent was sought.
Collapse
Affiliation(s)
- Alan R Tait
- Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, United States; Center for Bioethics and Social Sciences in Medicine, University of Michigan, United States.
| | - Terri Voepel-Lewis
- Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, United States
| | - Stanley J Chetcuti
- Department of Cardiology, University of Michigan Health System, Ann Arbor, MI, United States
| | | | - Robert Levine
- Emergency Care Center, Jackson Memorial Hospital, Miami, FL, United States; ArchieMD, Inc., Boca Raton, FL, United States
| |
Collapse
|
36
|
Kolias TJ, Hagan PG, Chetcuti SJ, Eberhart DL, Kline NM, Lucas SD, Hamilton JD. New universal strain software accurately assesses cardiac systolic and diastolic function using speckle tracking echocardiography. Echocardiography 2014; 31:947-55. [PMID: 24446589 DOI: 10.1111/echo.12512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND We have developed new universal strain software (USS) that can be used to perform speckle tracking of any Digital Imaging and Communications in Medicine (DICOM) image, regardless of the ultrasound system used to obtain it. METHODS Fifty patients prospectively underwent echocardiography immediately prior to cardiac catheterization. Biplane peak global longitudinal strain (GLS), peak systolic longitudinal strain rate (SSR), peak early diastolic longitudinal strain rate (DSR), and peak early diastolic circumferential strain rate (DCSR) were determined using conventional strain software (CSS) that uses raw data, and using the new USS applied to DICOM images. RESULTS Universal strain software correlated with CSS for GLS (r = 0.78, P < 0.001), SSR (r = 0.78, P < 0.001), DSR (r = 0.54, P < 0.001), and DCSR (r = 0.43, P = 0.019). GLS and SSR using USS correlated with left ventricular ejection fraction (LVEF) (r = -0.67 and -0.71, respectively) as well as using CSS (r = -0.66 and -0.71). Patients with diastolic dysfunction had significantly lower DSR (0.61 vs. 0.87/sec, P = 0.02) and DCSR (0.89 vs. 1.23/sec, P = 0.03), and less negative GLS (-10.8 vs. -16.1%, P = 0.002) using USS in all patients, as well as among those with LVEF ≥ 50%. Receiver-operating characteristic (ROC) analysis for detection of diastolic dysfunction revealed a sensitivity and specificity of 82% and 83% for DCSR < 1.09/sec (area under the curve [AUC = 0.80]) and 85% and 83% for GLS > -13.7% (AUC = 0.84) using USS. CONCLUSION Universal strain software can be used to accurately assess LV systolic and diastolic function using speckle tracking echocardiography.
Collapse
Affiliation(s)
- Theodore J Kolias
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Cardiovascular Center, Ann Arbor, Michigan
| | | | | | | | | | | | | |
Collapse
|
37
|
Barnes GD, Katz A, Desmond JS, Kronick SL, Beach J, Chetcuti SJ, Bates ER, Gurm HS. False activation of the cardiac catheterization laboratory for primary PCI. Am J Manag Care 2013; 19:671-675. [PMID: 24304215] [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: 06/02/2023]
Abstract
OBJECTIVES We sought to evaluate trends in door-to-balloon (D2B) times and false activation rates for the cardiac catheterization laboratory (CCL) in patients presenting to the emergency department (ED) with acute ST-elevation myocardial infarction (STEMI). In patients with STEMI, national efforts have focused on reducing D2B times for primary percutaneous coronary intervention (P-PCI). This emphasis on time-to-treatment may increase the rate of false CCL activations and unnecessary healthcare utilization. STUDY DESIGN Retrospective quality improvement chart review. METHODS We examined all emergent CCL activations for P-PCI between 2007 and 2011 at the University of Michigan Hospital. False activation was defined as emergent CCL activation when the patient did not require CCL care or emergent cardiology evaluation in the ED. Pre-hospital or ED false activation rates and mean D2B time were retrospectively determined by chart review. RESULTS The CCL was activated 717 times for suspected STEMI. The number of CCL activations increased from 96 in 2007 to 190 in 2011. False CCL activations accounted for 28% of all prehospital and 29% of all ED activations. The false activation rate increased from 15% of all cases in 2007 to 40% of all cases in 2011. The median D2B time decreased from 67 minutes in 2007 to 55 minutes in 2011. CONCLUSIONS Over a 5-year period with a strong emphasis on reducing D2B times, there has been an increased CCL false activation rate for P-PCI.
Collapse
Affiliation(s)
- Geoffery D Barnes
- CVC Cardiovascular Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5853. E-mail:
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Booher AM, Chetcuti SJ, Bach DS. The impact of percutaneous coronary intervention on ischemic mitral regurgitation. J Heart Valve Dis 2012; 21:564-569. [PMID: 23167219] [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: 06/01/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The study aim was to determine if significant ischemic mitral regurgitation (IMR) is adequately addressed in patients undergoing multi-vessel percutaneous coronary intervention (PCI). METHODS The cardiac catheterization laboratory database at the authors' institution was accessed over a five-year interval to identify those patients who had undergone multi-vessel PCI. Both, pre- and post-revascularization echocardiographic data were retrieved, and clinical data, MR presence and severity, and outcomes were each assessed. RESULTS In total, 150 patients (100 males, 50 females; mean age 63 +/- 12 years) underwent PCI. Of these 150 patients, pre-procedural echocardiograms were not performed in 54 cases (35%); hence, the study group comprised 96 patients with both pre- and postprocedural echocardiograms. Of these patients, 21 (22%) had moderate or greater (2+) IMR. The severity of the IMR did not change significantly after multivessel PCI (2 +/- 0.8+ preoperatively versus 1.9 +/- 1.0+ postoperatively). CONCLUSION Clinically significant IMR occurred not infrequently among patients treated with multivessel PCI, but the severity did not change with percutaneous revascularization, despite this being predominantly complete. In more than one-third of the patients, adequate pre-PCI echocardiography was unavailable, which suggested the possibility that not all IMR had been identified.
Collapse
Affiliation(s)
- Anna M Booher
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.
| | | | | |
Collapse
|
39
|
Plaisance BR, Munir K, Share DA, Mansour MA, Fox JM, Bove PG, Riba AL, Chetcuti SJ, Gurm HS, Grossman PM. Safety of Contemporary Percutaneous Peripheral Arterial Interventions in the Elderly. JACC Cardiovasc Interv 2011; 4:694-701. [DOI: 10.1016/j.jcin.2011.03.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 02/23/2011] [Accepted: 03/05/2011] [Indexed: 10/18/2022]
|
40
|
Kasapis C, Gurm HS, Chetcuti SJ, Munir K, Luciano A, Smith D, Aronow HD, Kassab EH, Knox MF, Moscucci M, Share D, Grossman PM. Defining the Optimal Degree of Heparin Anticoagulation for Peripheral Vascular Interventions. Circ Cardiovasc Interv 2010; 3:593-601. [DOI: 10.1161/circinterventions.110.957381] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The optimal degree of heparin anticoagulation for peripheral vascular interventions (PVIs) has not been defined. We sought to correlate total heparin dose and peak procedural activated clotting time (ACT) with postprocedural outcomes in patients undergoing PVI.
Methods and Results—
We studied 4743 patients who received heparin during PVIs in a regional, multicenter registry. From those, 1246 had recorded peak procedural ACT with the same point-of-care device. Periprocedural and in-hospital outcomes were compared between patients who received a total heparin dose <60 U/kg (n=2161) and ≥60 U/kg (n=2582). Similarly, outcomes were evaluated between groups with a peak procedural ACT <250 seconds (n=855) and ≥250 seconds (n=391). Technical and procedural success as well as intraprocedural thrombotic events did not differ between groups. Patients with heparin dose ≥60 U/kg had a higher rate of postprocedural hemoglobin drop ≥3 g/dL (7.09% versus 5.09%, respectively,
P
=0.004) and a higher transfusion rate compared with those with heparin dose <60 U/kg (4.92% versus 3.15%, respectively,
P
=0.002). In multivariate analysis, independent predictors of bleeding requiring transfusion were total heparin dose ≥60 U/kg, ACT ≥250 seconds, female sex, age ≥70 years, prior anemia, prior heart failure, low creatinine clearance, hybrid vascular surgery, rest pain, and below-knee intervention. In propensity-matched, risk-adjusted models and after hierarchical modeling, total heparin dose ≥60 U/kg and ACT ≥250 seconds remained strong predictors of post-PVI drop in hemoglobin ≥3 g/dL or transfusion.
Conclusions—
During PVI, higher total heparin dose (≥60 U/kg) and peak ACT ≥250 seconds were predictors of postprocedural transfusion. The high technical and procedural success in all groups suggests that use of weight-based heparin dosing with a target ACT <250 seconds in PVI may minimize the bleeding risk without compromising procedural success or increasing thromboembolic complications.
Collapse
Affiliation(s)
- Christos Kasapis
- From the Division of Cardiovascular Medicine (C.K., H.S.G., S.J.C., K.M., A.L., D.S., P.M.G.), University of Michigan Health System, Ann Arbor, Mich; the Department of Cardiology (H.S.G., S.J.C., P.M.G.), Veterans Administration Health System Ann Arbor, Ann Arbor, Mich; Michigan Heart and Vascular Institute (H.D.A.), St Joseph Mercy Hospital, Ann Arbor, Mich; Dearborn Cardiology Associates (E.H.K.), Oakwood Hospital and Medical Center, Dearborn, Mich; the Department of Radiology (M.F.K.), Spectrum
| | - Hitinder S. Gurm
- From the Division of Cardiovascular Medicine (C.K., H.S.G., S.J.C., K.M., A.L., D.S., P.M.G.), University of Michigan Health System, Ann Arbor, Mich; the Department of Cardiology (H.S.G., S.J.C., P.M.G.), Veterans Administration Health System Ann Arbor, Ann Arbor, Mich; Michigan Heart and Vascular Institute (H.D.A.), St Joseph Mercy Hospital, Ann Arbor, Mich; Dearborn Cardiology Associates (E.H.K.), Oakwood Hospital and Medical Center, Dearborn, Mich; the Department of Radiology (M.F.K.), Spectrum
| | - Stanley J. Chetcuti
- From the Division of Cardiovascular Medicine (C.K., H.S.G., S.J.C., K.M., A.L., D.S., P.M.G.), University of Michigan Health System, Ann Arbor, Mich; the Department of Cardiology (H.S.G., S.J.C., P.M.G.), Veterans Administration Health System Ann Arbor, Ann Arbor, Mich; Michigan Heart and Vascular Institute (H.D.A.), St Joseph Mercy Hospital, Ann Arbor, Mich; Dearborn Cardiology Associates (E.H.K.), Oakwood Hospital and Medical Center, Dearborn, Mich; the Department of Radiology (M.F.K.), Spectrum
| | - Khan Munir
- From the Division of Cardiovascular Medicine (C.K., H.S.G., S.J.C., K.M., A.L., D.S., P.M.G.), University of Michigan Health System, Ann Arbor, Mich; the Department of Cardiology (H.S.G., S.J.C., P.M.G.), Veterans Administration Health System Ann Arbor, Ann Arbor, Mich; Michigan Heart and Vascular Institute (H.D.A.), St Joseph Mercy Hospital, Ann Arbor, Mich; Dearborn Cardiology Associates (E.H.K.), Oakwood Hospital and Medical Center, Dearborn, Mich; the Department of Radiology (M.F.K.), Spectrum
| | - Ann Luciano
- From the Division of Cardiovascular Medicine (C.K., H.S.G., S.J.C., K.M., A.L., D.S., P.M.G.), University of Michigan Health System, Ann Arbor, Mich; the Department of Cardiology (H.S.G., S.J.C., P.M.G.), Veterans Administration Health System Ann Arbor, Ann Arbor, Mich; Michigan Heart and Vascular Institute (H.D.A.), St Joseph Mercy Hospital, Ann Arbor, Mich; Dearborn Cardiology Associates (E.H.K.), Oakwood Hospital and Medical Center, Dearborn, Mich; the Department of Radiology (M.F.K.), Spectrum
| | - Dean Smith
- From the Division of Cardiovascular Medicine (C.K., H.S.G., S.J.C., K.M., A.L., D.S., P.M.G.), University of Michigan Health System, Ann Arbor, Mich; the Department of Cardiology (H.S.G., S.J.C., P.M.G.), Veterans Administration Health System Ann Arbor, Ann Arbor, Mich; Michigan Heart and Vascular Institute (H.D.A.), St Joseph Mercy Hospital, Ann Arbor, Mich; Dearborn Cardiology Associates (E.H.K.), Oakwood Hospital and Medical Center, Dearborn, Mich; the Department of Radiology (M.F.K.), Spectrum
| | - Herbert D. Aronow
- From the Division of Cardiovascular Medicine (C.K., H.S.G., S.J.C., K.M., A.L., D.S., P.M.G.), University of Michigan Health System, Ann Arbor, Mich; the Department of Cardiology (H.S.G., S.J.C., P.M.G.), Veterans Administration Health System Ann Arbor, Ann Arbor, Mich; Michigan Heart and Vascular Institute (H.D.A.), St Joseph Mercy Hospital, Ann Arbor, Mich; Dearborn Cardiology Associates (E.H.K.), Oakwood Hospital and Medical Center, Dearborn, Mich; the Department of Radiology (M.F.K.), Spectrum
| | - Elias H. Kassab
- From the Division of Cardiovascular Medicine (C.K., H.S.G., S.J.C., K.M., A.L., D.S., P.M.G.), University of Michigan Health System, Ann Arbor, Mich; the Department of Cardiology (H.S.G., S.J.C., P.M.G.), Veterans Administration Health System Ann Arbor, Ann Arbor, Mich; Michigan Heart and Vascular Institute (H.D.A.), St Joseph Mercy Hospital, Ann Arbor, Mich; Dearborn Cardiology Associates (E.H.K.), Oakwood Hospital and Medical Center, Dearborn, Mich; the Department of Radiology (M.F.K.), Spectrum
| | - Michael F. Knox
- From the Division of Cardiovascular Medicine (C.K., H.S.G., S.J.C., K.M., A.L., D.S., P.M.G.), University of Michigan Health System, Ann Arbor, Mich; the Department of Cardiology (H.S.G., S.J.C., P.M.G.), Veterans Administration Health System Ann Arbor, Ann Arbor, Mich; Michigan Heart and Vascular Institute (H.D.A.), St Joseph Mercy Hospital, Ann Arbor, Mich; Dearborn Cardiology Associates (E.H.K.), Oakwood Hospital and Medical Center, Dearborn, Mich; the Department of Radiology (M.F.K.), Spectrum
| | - Mauro Moscucci
- From the Division of Cardiovascular Medicine (C.K., H.S.G., S.J.C., K.M., A.L., D.S., P.M.G.), University of Michigan Health System, Ann Arbor, Mich; the Department of Cardiology (H.S.G., S.J.C., P.M.G.), Veterans Administration Health System Ann Arbor, Ann Arbor, Mich; Michigan Heart and Vascular Institute (H.D.A.), St Joseph Mercy Hospital, Ann Arbor, Mich; Dearborn Cardiology Associates (E.H.K.), Oakwood Hospital and Medical Center, Dearborn, Mich; the Department of Radiology (M.F.K.), Spectrum
| | - David Share
- From the Division of Cardiovascular Medicine (C.K., H.S.G., S.J.C., K.M., A.L., D.S., P.M.G.), University of Michigan Health System, Ann Arbor, Mich; the Department of Cardiology (H.S.G., S.J.C., P.M.G.), Veterans Administration Health System Ann Arbor, Ann Arbor, Mich; Michigan Heart and Vascular Institute (H.D.A.), St Joseph Mercy Hospital, Ann Arbor, Mich; Dearborn Cardiology Associates (E.H.K.), Oakwood Hospital and Medical Center, Dearborn, Mich; the Department of Radiology (M.F.K.), Spectrum
| | - P. Michael Grossman
- From the Division of Cardiovascular Medicine (C.K., H.S.G., S.J.C., K.M., A.L., D.S., P.M.G.), University of Michigan Health System, Ann Arbor, Mich; the Department of Cardiology (H.S.G., S.J.C., P.M.G.), Veterans Administration Health System Ann Arbor, Ann Arbor, Mich; Michigan Heart and Vascular Institute (H.D.A.), St Joseph Mercy Hospital, Ann Arbor, Mich; Dearborn Cardiology Associates (E.H.K.), Oakwood Hospital and Medical Center, Dearborn, Mich; the Department of Radiology (M.F.K.), Spectrum
| |
Collapse
|
41
|
Kasapis C, Grossman PM, Chetcuti SJ. Cardiovascular flashlight. Percutaneous treatment of a giant right coronary artery pseudoaneurysm in Adamantiades-Behcet's syndrome. Eur Heart J 2009; 30:2630. [PMID: 19674981 DOI: 10.1093/eurheartj/ehp340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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] Open
Affiliation(s)
- Christos Kasapis
- Division of Cardiovascular Medicine, University of Michigan Health System Cardiovascular Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5869, USA.
| | | | | |
Collapse
|
42
|
Grossman PM, Gurm HS, McNamara R, LaLonde T, Changezi H, Share D, Smith DE, Chetcuti SJ, Moscucci M. Percutaneous Coronary Intervention Complications and Guide Catheter Size. JACC Cardiovasc Interv 2009; 2:636-44. [DOI: 10.1016/j.jcin.2009.05.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 05/21/2009] [Accepted: 05/21/2009] [Indexed: 11/16/2022]
|
43
|
Kasapis C, Henke PK, Chetcuti SJ, Koenig GC, Rectenwald JE, Krishnamurthy VN, Grossman PM, Gurm HS. Routine stent implantation vs. percutaneous transluminal angioplasty in femoropopliteal artery disease: a meta-analysis of randomized controlled trials. Eur Heart J 2008; 30:44-55. [PMID: 19028778 DOI: 10.1093/eurheartj/ehn514] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS We performed a meta-analysis of randomized controlled trials comparing routine stenting (ST) with percutaneous transluminal angioplasty (PTA) for symptomatic superficial femoral-popliteal artery (SFPA) disease. METHODS AND RESULTS Ten trials were pooled randomizing patients to ST (n = 724 limbs) or PTA with provisional stenting (n = 718 limbs) with a follow-up period of 9-24 months. The mean lesion length was similar in the two groups (45.8 mm in the ST group and 43.3 mm in the PTA group). We calculated the summary risk ratios (RRs) for immediate technical failure, restenosis, and target vessel revascularization (TVR) using random-effects models. The immediate technical failure was higher in the PTA group than in the ST group [17.1 vs. 5.9%, respectively, RR = 0.28, 95% confidence interval (CI) = 0.15-0.54, P < 0.001], with 10.3% of the PTA patients undergoing stenting because of suboptimal result. There was a trend for lower restenosis in the ST group (37.6% in ST vs. 45.3% in PTA, RR = 0.85, 95% CI = 0.69-1.06, P = 0.146), but no difference in the need for TVR (20% in ST vs. 20.2% in PTA, RR = 0.98, 95% CI = 0.78-1.23, P = 0.89). In an analysis restricted to nitinol stents, there was a trend towards reduction in TVR (RR = 0.79, 95% CI = 0.59-1.06, P = 0.12). CONCLUSION Despite the higher immediate success, routine stenting was not associated with a significant reduction in the rate of restenosis or TVR. Our data do not support use of routine stenting as the primary endovascular treatment for short SFPA lesions.
Collapse
Affiliation(s)
- Christos Kasapis
- Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, MI 48109-5853, USA
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Chetcuti SJ, Grossman PM, Kline-Rogers EM, Montoye C, Smith D, Moscucci M. Improving outcomes of percutaneous coronary intervention through the application of guidelines and benchmarking: reduction of major bleeding and blood transfusion as a model. Clin Cardiol 2008; 30:II44-8. [PMID: 18228651 DOI: 10.1002/clc.20230] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Blood transfusions are a relatively common occurrence after performing any percutaneous coronary intervention (PCI). Although guidelines for blood transfusion have been previously specified, retrospective analysis of transfusion practices have suggested that these guidelines are rarely applied. We describe a model for the application of a continuous quality improvement program including benchmarking and available guidelines for blood transfusion, aimed toward reducing transfusion rates among patients undergoing PCI.
Collapse
Affiliation(s)
- Stanley J Chetcuti
- University of Michigan Cardiovascular Center, Ann Arbor, Michigan 48109-5869, USA
| | | | | | | | | | | |
Collapse
|
45
|
Brown DL, Lisabeth LD, Chetcuti SJ, Grossman PM, Alexander T, Pappas JD, Moscucci M, Eagle KA, Garcia NM, Smith MA, Morgenstern LB. Screening for myocardial infarction and ischemic stroke: a population-based study. Neuroepidemiology 2007; 29:96-100. [PMID: 17925601 DOI: 10.1159/000109503] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Studies that accurately identify myocardial infarction (MI) and stroke within populations would provide valuable epidemiological information as well as data on vascular disease prevention. We performed a pilot study to assess the feasibility of adding MI surveillance to an ongoing population-based stroke surveillance study, the Brain Attack Surveillance in Corpus Christi (BASIC) Project. We also tested two screening methods for MI ascertainment: discharge International Classification of Diseases, Ninth Revision (ICD-9) codes and cardiac biomarker screening. This pilot study suggests that the addition of MI surveillance to community-based stroke surveillance studies is feasible. Screening for abnormal cardiac biomarkers to identify potential MI cases may be more accurate and efficient than using ICD-9 codes.
Collapse
Affiliation(s)
- Devin L Brown
- Stroke Program, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Boyden TF, Nallamothu BK, Moscucci M, Chan PS, Grossman PM, Tsai TT, Chetcuti SJ, Bates ER, Gurm HS. Meta-analysis of randomized trials of drug-eluting stents versus bare metal stents in patients with diabetes mellitus. Am J Cardiol 2007; 99:1399-402. [PMID: 17493468 DOI: 10.1016/j.amjcard.2006.12.069] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Revised: 12/28/2006] [Accepted: 12/28/2006] [Indexed: 11/21/2022]
Abstract
Diabetes mellitus is a major risk factor for restenosis in patients undergoing percutaneous coronary intervention. Randomized controlled trials comparing drug-eluting stents (DESs) with bare metal stents (BMSs) showed a marked decrease in in-stent restenosis and target lesion revascularization with DESs in the total patient population enrolled in the studies, including patients with diabetes. However, it remains unclear whether the antirestenotic benefit of DESs is preserved in the high-risk diabetic subgroup. MEDLINE, EMBASE, ISI Web of Knowledge, Current Contents, International Pharmaceutical Abstracts, and recent Scientific Sessions databases were searched to identify relevant clinical trials comparing DESs with BMSs. A randomized controlled trial was included if it provided outcome data for patients with diabetes for > or =1 of the following: late lumen loss, in-stent restenosis, or target lesion revascularization. Data were combined using fixed-effects models, and standard tests for heterogeneity were performed. Eight studies with 1,520 patients with diabetes were identified that reported > or =1 outcome of interest. Mean late lumen losses (7 studies) were 0.93 mm (95% confidence interval [CI] 0.510 to 1.348) with BMSs and 0.18 mm (95% CI -0.088 to +0.446) with DESs. For patients receiving a DES, this translated into a marked decrease in in-stent restenosis (7 studies, RR 0.14, 95% CI 0.10 to 0.22, p <0.001) and target lesion revascularization (8 studies, RR 0.34, 95% CI 0.26 to 0.45, p <0.001). DES use is associated with a marked decrease in in-stent restenosis and target lesion revascularization in patients with diabetes. In conclusion, the analysis supports the current widespread use of DESs in these high-risk patients.
Collapse
Affiliation(s)
- Thomas F Boyden
- University Michigan Medical School, Ann Arbor VA Medical Center, Ann Arbor, Michigan, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Jones NJ, Bates ER, Chetcuti SJ, Lederman RJ, Grossman PM. Usefulness of translesional pressure gradient and pharmacological provocation for the assessment of intermediate renal artery disease. Catheter Cardiovasc Interv 2006; 68:429-34. [PMID: 16892443 DOI: 10.1002/ccd.20697] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [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] [Indexed: 11/10/2022]
Abstract
OBJECTIVE We sought to determine the hemodynamic significance of intermediate RAS by measuring translesional systolic pressure gradients (TSPG), using a pressure-sensing guidewire at baseline and after acetylcholine (ACh) induced hyperemia, following selective renal artery angiography. BACKGROUND Renal artery stenosis (RAS) is a cause of reversible hypertension and nephropathy. Stenting effectively relieves RAS, however improvement in blood pressure control or renal function is variable and unpredictable. Hemodynamic significance is usually present with RAS when diameter stenosis is >75%, but is less predictable in intermediate (30%-75%) RAS. METHODS Twenty-two patients (26 renal arteries) with uncontrolled hypertension underwent invasive hemodynamic assessment because of intermediate RAS, defined as radiocontrast angiographic diameter stenosis (DS) between 30% and 75% (quantitative DS was measured prospectively). Translesional pressure gradients were measured using a 0.014" pressure-sensing wire. Hyperemia was induced by administration of intrarenal ACh. RESULTS Visual and measured angiographic lesion severity did not correlate with TSPG either at baseline (visual DS, R(2) = 0.091, P = 0.13; measured DS, R(2) = 0.124, P = 0.07) or with hyperemia (visual DS, R(2) = 0.057, P = 0.24; measured DS, R(2) = 0.101, P = 0.12). Baseline and maximal hyperemic gradient did correlate (R(2) = 0.567; P < 0.05). Pharmacological provocation produced a significant increase in TSPG (mean; baseline, 18 +/- 21 vs. hyperemia, 34 +/- 41 mm Hg; P < 0.05). A hemodynamically significant lesion (TSPG > 20 mm Hg) was found in 14/26 (54%) arteries (13 patients); 13 (60%) patients subsequently underwent renal artery stenting for hemodynamically significant RAS. At follow-up (at least 30 days), there was a significant decrease in systolic blood pressure (mean; 167 +/- 24 vs. 134 +/- 19 mm Hg; P < 0.001). CONCLUSIONS Intrarenal administration of ACh induces hyperemia and can be used to unmask resistive renal artery lesions. Gradient measurement and induced hyperemia may be warranted in the invasive assessment of intermediate renal artery stenoses, rather than relying on stenosis severity alone. Further study is needed to determine whether translesional pressure gradients and pharmacological provocation predict clinical benefit after renal artery stenting.
Collapse
Affiliation(s)
- Noah J Jones
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan 48109, USA
| | | | | | | | | |
Collapse
|
48
|
Shi Y, de Ana FJ, Chetcuti SJ, O'Donnell M. Motion artifact reduction for IVUS-based thermal strain imaging. IEEE Trans Ultrason Ferroelectr Freq Control 2005; 52:1312-9. [PMID: 16245600 DOI: 10.1109/tuffc.2005.1509789] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Thermal strain imaging (TSI) using intravascular ultrasound (IVUS) has the potential to identify lipid pools within rupture-prone arterial plaques and serve as a valuable supplement to current IVUS systems in diagnosing acute coronary syndromes. The major challenge for in vivo application of TSI will be cardiac motion, including bulk motion and tissue deformation. Simulations based on an artery model, including a lipid-filled plaque, demonstrate that effective bulk motion compensation can be achieved within a certain motion range using spatial interpolation. We also propose a practical imaging scheme to minimize mechanical strains caused by tissue deformation based on a linear least squares fitting strategy. This scheme was tested on clinical data by artificially superimposing thermal displacements corresponding to different temperature rises. Results suggest a 1-2 degrees C temperature rise is required to detect lipids in an atherosclerotic plaque in vivo.
Collapse
Affiliation(s)
- Yan Shi
- University of Michigan, Biomedical Engineering Department, Ann Arbor, MI 48109, USA.
| | | | | | | |
Collapse
|
49
|
Abstract
We report a case of restenosis following ostial stenting of the right coronary artery with protrusion of the stent into the aorta. Treatment was only possible after a guidewire advanced through a lower strut was used to lever the guide, and a second guidewire was advanced through the true lumen.
Collapse
Affiliation(s)
- Stanley J Chetcuti
- Division of Cardiology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan 48103, USA
| | | |
Collapse
|
50
|
Chetcuti SJ, Grossman PM, Mukherjee D, Kline-Rogers EM, Montoye C, Share D, O'Donnell MJ, Maxwell-Eward A, Meengs WL, McGinnity JG, Patel K, Moscucci MM. Improving outcome of percutaneous coronary intervention through application of guidelines and benchmarking: Reduction of blood transfusion as a model. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)82831-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|