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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.
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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
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Kleiman NS, Van Mieghem NM, Reardon MJ, Gada H, Mumtaz M, Olsen PS, Heiser J, Merhi W, Chetcuti S, Deeb GM, Chawla A, Kiaii B, Teefy P, Chu MWA, Yakubov SJ, Windecker S, Althouse AD, Baron SJ. Quality of Life 5 Years Following Transfemoral TAVR or SAVR in Intermediate Risk Patients. JACC Cardiovasc Interv 2024; 17:979-988. [PMID: 38658126 DOI: 10.1016/j.jcin.2024.02.014] [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: 04/26/2023] [Revised: 01/12/2024] [Accepted: 02/04/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Symptomatic patients with severe aortic stenosis (AS) at high risk for surgical aortic valve replacement (SAVR) sustain comparable improvements in health status over 5 years after transcatheter aortic valve replacement (TAVR) or SAVR. Whether a similar long-term benefit is observed among intermediate-risk AS patients is unknown. OBJECTIVES The purpose of this study was to assess health status outcomes through 5 years in intermediate risk patients treated with a self-expanding TAVR prosthesis or SAVR using data from the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial. METHODS Intermediate-risk patients randomized to transfemoral TAVR or SAVR in the SURTAVI trial had disease-specific health status assessed at baseline, 30 days, and annually to 5 years using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Health status was compared between groups using fixed effects repeated measures modelling. RESULTS Of the 1,584 patients (TAVR, n = 805; SAVR, n = 779) included in the analysis, health status improved more rapidly after TAVR compared with SAVR. However, by 1 year, both groups experienced large health status benefits (mean change in KCCQ-Overall Summary Score (KCCQ-OS) from baseline: TAVR: 20.5 ± 22.4; SAVR: 20.5 ± 22.2). This benefit was sustained, albeit modestly attenuated, at 5 years (mean change in KCCQ-OS from baseline: TAVR: 15.4 ± 25.1; SAVR: 14.3 ± 24.2). There were no significant differences in health status between the cohorts at 1 year or beyond. Similar findings were observed in the KCCQ subscales, although a substantial attenuation of benefit was noted in the physical limitation subscale over time in both groups. CONCLUSIONS In intermediate-risk AS patients, both transfemoral TAVR and SAVR resulted in comparable and durable health status benefits to 5 years. Further research is necessary to elucidate the mechanisms for the small decline in health status noted at 5 years compared with 1 year in both groups. (Safety and Efficacy Study of the Medtronic CoreValve® System in the Treatment of Severe, Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement [SURTAVI]; NCT01586910).
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Affiliation(s)
- Neal S Kleiman
- Department of Interventional Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
| | | | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Hemal Gada
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleysburg, Pennsylvania, USA
| | - Mubashir Mumtaz
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Pinnacle Health, Harrisburg, Pennsylvania, USA
| | - Peter Skov Olsen
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - John Heiser
- Department of Interventional Cardiology, Corewell Health, Grand Rapids, Michigan, USA
| | - William Merhi
- Department of Cardiothoracic Surgery, Corewell Health, Grand Rapids, Michigan, USA
| | - Stanley Chetcuti
- Interventional Cardiology, University of Michigan, Ann Arbor, Michigan, USA
| | - G Michael Deeb
- Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Atul Chawla
- Department of Cardiology, Iowa Heart Center, Des Moines, Iowa, USA
| | - Bob Kiaii
- Division of Cardiac Surgery, University of California-Davis Health, Sacramento, California, USA
| | - Patrick Teefy
- Divisions of Cardiology and Cardiac Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Michael W A Chu
- Divisions of Cardiology and Cardiac Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Steven J Yakubov
- Interventional Cardiology, OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Stephan Windecker
- Department of Cardiology, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Suzanne J Baron
- Massachusetts General Hospital, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA
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3
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Modine T, Forrest JK, Van Mieghem NM, Deeb GM, Yakubov SJ, Ali WB, Tchétché D, Lam KY, Oh JK, Huang J, Mehran R, Reardon MJ. Transcatheter or Surgical Aortic Valve Replacement in Women With Small Annuli at Low or Intermediate Surgical Risk. Am J Cardiol 2024:S0002-9149(24)00273-X. [PMID: 38641189 DOI: 10.1016/j.amjcard.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/20/2024] [Accepted: 04/06/2024] [Indexed: 04/21/2024]
Abstract
There are limited data from randomized controlled trials assessing the impact of transcatheter aortic valve replacement (TAVR) or surgery in women with aortic stenosis and small aortic annuli. We evaluated 2-year clinical and hemodynamic outcomes after aortic valve replacement to understand acute valve performance and early and midterm clinical outcomes. This post hoc analysis pooled women enrolled in the randomized, prospective, multicenter Evolut Low Risk and SURTAVI intermediate risk trials. Women with severe aortic stenosis at low or intermediate surgical risk who had a computed tomography-measured annular perimeter of ≤72.3 mm were included and underwent self-expanding, supra-annular TAVR or surgery. The primary end point was 2-year all-cause mortality or disabling stroke rate. The study included 620 women (323 TAVR, 297 surgery) with a mean age of 78 years. At 2 years, the all-cause mortality or disabling stroke was 6.5% for TAVR and 8.0% for surgery, p = 0.47. Pacemaker rates were 20.0% for TAVR and 8.3% for surgery, p <0.001. The mean effective orifice area at 2 years was 1.9 ± 0.5 cm2 for TAVR and 1.6 ± 0.5 cm2 for surgery and the mean gradient was 8.0 ± 4.1 versus 12.7 ± 6.0 mm Hg, respectively (both p <0.001). Moderate or severe patient-prothesis mismatch at discharge occurred in 10.9% of patients who underwent TAVR and 33.2% of patients who underwent surgery, p <0.001. In conclusion, in women with small annuli, the clinical outcomes to 2 years were similar between self-expanding, supra-annular TAVR and surgery, with better hemodynamics in the TAVR group and fewer pacemakers in the surgical group.
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Affiliation(s)
- Thomas Modine
- Department of Cardiac Surgery, Cardiologique de Haut Lévèque - (CHU) de Bordeaux, France.
| | - John K Forrest
- Department of Internal Medicine (Cardiology), Yale University School of Medicine, New Haven, Connecticut
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - G Michael Deeb
- Department of Cardiothoracic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Steven J Yakubov
- Department of Interventional Cardiology, Riverside Methodist - OhioHealth, Columbus, Ohio
| | - Walid Ben Ali
- Department of Surgery, Montreal Heart Institute, Montreal, Canada
| | - Didier Tchétché
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Ka Yan Lam
- Department of Cardiothoracic Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Jae K Oh
- Department of Medicine (Echocardiography), Mayo Clinic, Rochester, Minnesota
| | | | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
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Lakkireddy DR, Wilber DJ, Mittal S, Tschopp D, Ellis CR, Rasekh A, Hounshell T, Evonich R, Chandhok S, Berger RD, Horton R, Hoskins MH, Calkins H, Yakubov SJ, Simons P, Saville BR, Lee RJ. Pulmonary Vein Isolation With or Without Left Atrial Appendage Ligation in Atrial Fibrillation: The aMAZE Randomized Clinical Trial. JAMA 2024; 331:1099-1108. [PMID: 38563835 PMCID: PMC10988350 DOI: 10.1001/jama.2024.3026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 02/21/2024] [Indexed: 04/04/2024]
Abstract
Importance Left atrial appendage elimination may improve catheter ablation outcomes for atrial fibrillation. Objective To assess the safety and effectiveness of percutaneous left atrial appendage ligation adjunctive to catheter pulmonary vein isolation for nonparoxysmal atrial fibrillation. Design, Setting, and Participants This multicenter, prospective, open-label, randomized clinical trial evaluated the safety and effectiveness of percutaneous left atrial appendage ligation adjunctive to planned pulmonary vein isolation for nonparoxysmal atrial fibrillation present for less than 3 years. Eligible patients were randomized in a 2:1 ratio to undergo left atrial appendage ligation and pulmonary vein isolation or pulmonary vein isolation alone. Use of a 2:1 randomization ratio was intended to provide more device experience and safety data. Patients were enrolled from October 2015 to December 2019 at 53 US sites, with the final follow-up visit on April 21, 2021. Interventions Left atrial appendage ligation plus pulmonary vein isolation compared with pulmonary vein isolation alone. Main Outcomes and Measures A bayesian adaptive analysis was used for primary end points. Primary effectiveness was freedom from documented atrial arrythmias of greater than 30 seconds duration 12 months after undergoing pulmonary vein isolation. Rhythm was assessed by Holter monitoring at 6 and 12 months after pulmonary vein isolation, symptomatic event monitoring, or any electrocardiographic tracing obtained through 12 months after pulmonary vein isolation. Primary safety was a composite of predefined serious adverse events compared with a prespecified 10% performance goal 30 days after the procedure. Left atrial appendage closure was evaluated through 12 months after pulmonary vein isolation. Results Overall, 404 patients were randomized to undergo left atrial appendage ligation plus pulmonary vein isolation and 206 were randomized to undergo pulmonary vein isolation alone. Primary effectiveness was 64.3% with left atrial appendage ligation and pulmonary vein isolation and 59.9% with pulmonary vein isolation only (difference, 4.3% [bayesian 95% credible interval, -4.2% to 13.2%]; posterior superiority probability, 0.835), which did not meet the statistical criterion to establish superiority (0.977). Primary safety was met, with a 30-day serious adverse event rate of 3.4% (bayesian 95% credible interval, 2.0% to 5.0%; posterior probability, 1.0) which was less than the prespecified threshold of 10%. At 12 months after pulmonary vein isolation, complete left atrial appendage closure (0 mm residual communication) was observed in 84% of patients and less than or equal to 5 mm residual communication was observed in 99% of patients. Conclusions and Relevance Percutaneous left atrial appendage ligation adjunctive to pulmonary vein isolation did not meet prespecified efficacy criteria for freedom from atrial arrhythmias at 12 months compared with pulmonary vein isolation alone for patients with nonparoxysmal atrial fibrillation, but met prespecified safety criteria and demonstrated high rates of closure at 12 months. Trial Registration ClinicalTrials.gov Identifier: NCT02513797.
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Affiliation(s)
| | - David J Wilber
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | | | | | | | | | | | | | - Sheetal Chandhok
- Bryn Mawr Medical Specialists Association, Bryn Mawr, Pennsylvania
| | | | | | | | | | | | | | | | - Randall J Lee
- AtriCure, Inc, Mason, Ohio
- University of California, San Francisco
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5
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Bapat V, Weiss E, Bajwa T, Thourani VH, Yadav P, Thaden JJ, Lim DS, Reardon M, Pinney S, Adams DH, Yakubov SJ, Modine T, Redwood SR, Walton A, Spargias K, Zhang A, Mack M, Leon MB. 2-Year Clinical and Echocardiography Follow-Up of Transcatheter Mitral Valve Replacement With the Transapical Intrepid System. JACC Cardiovasc Interv 2024:S1936-8798(24)00527-2. [PMID: 38639690 DOI: 10.1016/j.jcin.2024.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Thirty-day outcomes with the investigational Intrepid transapical (TA) transcatheter mitral valve replacement (TMVR) system have previously demonstrated good technical success, but longer-term outcomes in larger cohorts need to be evaluated. OBJECTIVES The authors sought to evaluate the 2-year safety and performance of the Intrepid TA-TMVR system in patients with symptomatic, ≥moderate-severe mitral regurgitation (MR) and high surgical risk. METHODS Patient eligibility was determined by local heart teams and approved by a central screening committee. Clinical events were adjudicated by an independent clinical events committee. Echocardiography was evaluated by an independent core laboratory. RESULTS The cohort included 252 patients that were enrolled at 58 international sites before February 2021 as part of the global Pilot Study (n = 95) or APOLLO trial (primary cohort noneligible + TA roll-ins, n = 157). Mean age was 74.2 years, mean STS-PROM was 6.3%, 60.3% were male, and 80.6% were in NYHA functional class III/IV. Most presented with secondary MR (70.1%), and nearly all had ≥moderate-severe MR (98.4%). All-cause mortality was 13.1% (30-day), 27.3% (1-year), and 36.2% (2-year). The 30-day ≥major bleeding event rate was 22.3%. Heart failure rehospitalization was 9.6% (30-day) and 36.2% (2-year). At 2 years, >50% of patients were alive with improvement in NYHA functional class (82.1%, class I/II), and all patients with available echocardiograms had ≤mild MR. CONCLUSIONS This analysis represents the largest reported TA-TMVR experience with the longest follow-up in high-risk ≥moderate-severe MR patients. Early mortality and heart failure rehospitalizations were significant, exacerbated by early TA-related bleeding events; however, meaningful improvements in clinical outcomes and marked reductions in MR severity were observed through 2 years.
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Affiliation(s)
- Vinayak Bapat
- St. Thomas' Hospital, London, United Kingdom; New York Presbyterian/Columbia University Medical Center, New York, New York, USA.
| | - Eric Weiss
- Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA
| | - Tanvir Bajwa
- Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA
| | | | | | | | - D Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | - Michael Reardon
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sean Pinney
- Mount Sinai Medical Center, New York, New York, USA
| | | | | | - Thomas Modine
- Department of Heart Valve Therapy, CHU Bordeaux, Bordeaux, France
| | | | - Antony Walton
- Cardiology Department, The Alfred, Melbourne, Australia
| | | | | | - Michael Mack
- Baylor Scott and White Heart Hospital, Plano, Texas, USA
| | - Martin B Leon
- New York Presbyterian/Columbia University Medical Center, New York, New York, USA
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6
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Meier D, Grant D, Frawley C, Akodad M, Landes U, Khokhar AA, Dudek D, George I, Rinaldi MJ, Kim WK, Yakubov SJ, Sorajja P, Tarantini G, Wood DA, Webb JG, Sellers SL, Sathananthan J. Redo-TAVI with the ACURATE neo2 and Prime XL for balloon-expandable transcatheter heart valve failure. EUROINTERVENTION 2024; 20:e376-e388. [PMID: 38506739 PMCID: PMC10941669 DOI: 10.4244/eij-d-23-00783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/06/2023] [Indexed: 03/21/2024]
Abstract
BACKGROUND There are limited data regarding treatment for failed balloon-expandable transcatheter heart valves (THVs) in redo-transcatheter aortic valve implantation (TAVI). AIMS We aimed to assess THV performance, neoskirt height and expansion when performing redo-TAVI with the ACURATE platform inside a SAPIEN 3 (S3) compared to redo-TAVI with an S3 in an S3. METHODS Redo-TAVI was performed on the bench using each available size of the S3, the ACURATE neo2 (ACn2) and the next-generation ACURATE Prime XL (AC XL) implanted at 2 different depths within 20 mm/23 mm/26 mm/29 mm S3s serving as the "failed" index THV. Hydrodynamic testing was performed to assess THV function. Multimodality assessment was performed using photography, X-ray, microcomputed tomography (micro-CT), and high-speed videos. RESULTS The ACURATE in S3 combinations had favourable hydrodynamic performance compared to the S3 in S3 for all size combinations. In the 20 mm S3, redo-TAVI with the ACn2 had lower gradients compared to the S3 (mean gradient 16.3 mmHg for the ACn2 vs 24.7 mmHg for the 20 mm S3 in 20 mm S3). Pinwheeling was less marked for the ACURATE THVs than for the S3s. On micro-CT, the S3s used for redo-TAVI were underexpanded across all sizes. This was also observed for the ACURATE platform, but to a lesser extent. CONCLUSIONS Redo-TAVI with an ACn2/AC XL within an S3 has favourable hydrodynamic performance and less pinwheeling compared to an S3 in S3. This comes at the price of a taller neoskirt.
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Affiliation(s)
- David Meier
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Daire Grant
- Boston Scientific Corporation, Marlborough, MA, USA
| | | | - Mariama Akodad
- Ramsay Santé, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Uri Landes
- Edith Wolfson Medical Center, Holon, Israel and Tel-Aviv University, Tel-Aviv, Israel
| | - Arif A Khokhar
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Isaac George
- Division of Cardiothoracic Surgery, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | | | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Klinik Heart Center, Bad Nauheim, Germany
| | - Steven J Yakubov
- Department of Interventional Cardiology, Riverside Methodist-OhioHealth Hospital, Columbus, OH, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA and Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Giuseppe Tarantini
- Humanitas Research Hospital IRCCS, Rozzano, Italy
- University of Padua Medical School, Padua, Italy
| | - David A Wood
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - John G Webb
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Stephanie L Sellers
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Janarthanan Sathananthan
- Boston Scientific Corporation, Marlborough, MA, USA
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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7
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Badin A, Yakubov SJ. Editorial: Leadless pacemaker implantation by interventional cardiologists following TAVR: "Democratizing pacing". Cardiovasc Revasc Med 2024:S1553-8389(24)00022-8. [PMID: 38355339 DOI: 10.1016/j.carrev.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/16/2024]
Affiliation(s)
- Auroa Badin
- OhioHealth, Riverside Methodist Hospital, United States of America
| | - Steven J Yakubov
- OhioHealth, Riverside Methodist Hospital, United States of America.
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8
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Forrest JK, Deeb GM, Yakubov SJ, Gada H, Mumtaz MA, Ramlawi B, Bajwa T, Teirstein PS, Tchétché D, Huang J, Reardon MJ. 4-Year Outcomes of Patients With Aortic Stenosis in the Evolut Low Risk Trial. J Am Coll Cardiol 2023; 82:2163-2165. [PMID: 37877907 DOI: 10.1016/j.jacc.2023.09.813] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/26/2023]
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
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Gupta R, Mahmoudi E, Behnoush AH, Malik AH, Mahajan P, Lin M, Bandyopadhyay D, Goel A, Chakraborty S, Aedma SK, Gupta HB, Vyas AV, Combs WG, Mathur M, Yakubov SJ, Patel NC. Clinical outcomes and the impact of valve morphology for transcatheter aortic valve replacement in bicuspid aortic valves: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2023; 102:721-730. [PMID: 37605512 DOI: 10.1002/ccd.30808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 05/16/2023] [Accepted: 08/13/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Bicuspid aortic valve (BAV) is present in approximately 0.5%-2% of the general population, causing significant aortic stenosis (AS) in 12%-37% of affected individuals. Transcatheter aortic valve replacement (TAVR) is being considered the treatment of choice in patients with symptomatic AS across all risk spectra. AIM Aim Our study aims to compare TAVR outcomes in patients with BAV versus tricuspid aortic valves (TAV). METHODS A comprehensive literature search was performed in PubMed, Web of Science, and Cochrane trials. Studies were included if they included BAV and TAV patients undergoing TAVR with quantitative data available for at least one of our predefined outcomes. Meta-analysis was performed by the random-effects model using Stata software. RESULTS Fifty studies of 203,288 patients were included. BAV patients had increased 30-day all-cause mortality (odds ratio [OR] = 1.23 [1.00-1.50], p = 0.05), in-hospital stroke (OR = 1.39 [1.01-1.93], p = 0.05), in-hospital and 30-day PPI (OR = 1.13 [1.00-1.27], p = 0.04; OR = 1.16 [1.04-1.13], p = 0.01) and in-hospital, 30-day and 1-year aortic regurgitation (AR) (OR = 1.48 [1.19-1.83], p < 0.01; OR = 1.79 [1.26-2.52], p < 0.01; OR = 1.64 [1.03-2.60], p = 0.04). Subgroup analysis on new-generation valves showed a reduced 1-year all-cause mortality (OR = 0.86 [CI = 0.75-0.98], p = 0.03), despite higher in-hospital and 30-day PPI (OR = 0.1.21 [1.04-1.41], p = 0.01; OR = 1.17 [1.05-1.31], p = 0.01) and in-hospital AR (OR = 1.62 [1.14-2.31], p = 0.01) in the BAV group. The quality of included studies was moderate-to-high, and only three analyses presented high heterogeneity. CONCLUSION TAVR is associated with comparable outcomes in patients with BAV and TAV. Careful selection of BAV cases by preprocedural assessment of valve anatomy and burden of calcification, pre- and post-procedural dilation, and implementing newer generations of valves may improve the safety and efficacy of TAVR in BAV patients.
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Affiliation(s)
- Rahul Gupta
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Elham Mahmoudi
- Universal Scientific Education and Research Network, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Aaqib H Malik
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Pranav Mahajan
- Department of Medicine, Carle Foundation Hospital, Urbana, Illinois, USA
| | - Muling Lin
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Dhrubajyoti Bandyopadhyay
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Akshay Goel
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Sandipan Chakraborty
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Surya K Aedma
- Department of Medicine, Carle Foundation Hospital, Urbana, Illinois, USA
| | - Harsh Bala Gupta
- Guru Nanak Dev Hospital, Department of medicine, Government Medical College, Amritsar, Punjab, India
| | - Apurva V Vyas
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - William G Combs
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Moses Mathur
- Heart & Vascular Institute, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Steven J Yakubov
- Department of Interventional Cardiology, Riverside Methodist-Ohio Health, Columbus, Ohio, USA
| | - Nainesh C Patel
- Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
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10
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Yakubov SJ, Amin A. Pacing After TAVR: Just Give Me the Beat, But Improve the Instruments. JACC Cardiovasc Interv 2023; 16:1092-1094. [PMID: 37164608 DOI: 10.1016/j.jcin.2023.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 05/12/2023]
Affiliation(s)
- Steven J Yakubov
- Department of Cardiology, Riverside Methodist Hospital OhioHealth, Columbus, Ohio, USA.
| | - Anish Amin
- OhioHealth Research Institute, Columbus, Ohio, USA
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11
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Forrest JK, Deeb GM, Yakubov SJ, Gada H, Mumtaz MA, Ramlawi B, Bajwa T, Teirstein PS, DeFrain M, Muppala M, Rutkin BJ, Chawla A, Jenson B, Chetcuti SJ, Stoler RC, Poulin MF, Khabbaz K, Levack M, Goel K, Tchétché D, Lam KY, Tonino PAL, Ito S, Oh JK, Huang J, Popma JJ, Kleiman N, Reardon MJ. 3-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis. J Am Coll Cardiol 2023; 81:1663-1674. [PMID: 36882136 DOI: 10.1016/j.jacc.2023.02.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Randomized data comparing outcomes of transcatheter aortic valve replacement (TAVR) with surgery in low-surgical risk patients at time points beyond 2 years is limited. This presents an unknown for physicians striving to educate patients as part of a shared decision-making process. OBJECTIVES The authors evaluated 3-year clinical and echocardiographic outcomes from the Evolut Low Risk trial. METHODS Low-risk patients were randomized to TAVR with a self-expanding, supra-annular valve or surgery. The primary endpoint of all-cause mortality or disabling stroke and several secondary endpoints were assessed at 3 years. RESULTS There were 1,414 attempted implantations (730 TAVR; 684 surgery). Patients had a mean age of 74 years and 35% were women. At 3 years, the primary endpoint occurred in 7.4% of TAVR patients and 10.4% of surgery patients (HR: 0.70; 95% CI: 0.49-1.00; P = 0.051). The difference between treatment arms for all-cause mortality or disabling stroke remained broadly consistent over time: -1.8% at year 1; -2.0% at year 2; and -2.9% at year 3. The incidence of mild paravalvular regurgitation (20.3% TAVR vs 2.5% surgery) and pacemaker placement (23.2% TAVR vs 9.1% surgery; P < 0.001) were lower in the surgery group. Rates of moderate or greater paravalvular regurgitation for both groups were <1% and not significantly different. Patients who underwent TAVR had significantly improved valve hemodynamics (mean gradient 9.1 mm Hg TAVR vs 12.1 mm Hg surgery; P < 0.001) at 3 years. CONCLUSIONS Within the Evolut Low Risk study, TAVR at 3 years showed durable benefits compared with surgery with respect to all-cause mortality or disabling stroke. (Medtronic Evolut Transcatheter Aortic Valve Replacement in Low Risk Patients; NCT02701283).
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Affiliation(s)
- John K Forrest
- Yale University School of Medicine, New Haven, Connecticut, USA.
| | - G Michael Deeb
- University of Michigan Health Systems University Hospital, Ann Arbor, Michigan, USA
| | | | - Hemal Gada
- University of Pittsburgh Medical Center, Harrisburg, Pennsylvania, USA
| | - Mubashir A Mumtaz
- University of Pittsburgh Medical Center, Harrisburg, Pennsylvania, USA
| | - Basel Ramlawi
- Lankenau Heart Institute, Philadelphia, Pennsylvania, USA
| | - Tanvir Bajwa
- Aurora St Luke's Medical Center, Milwaukee, Wisconsin, USA
| | | | | | | | - Bruce J Rutkin
- North Shore University Hospital, Manhasset, New York, USA
| | - Atul Chawla
- Mercy Medical Center, Iowa Heart, Des Moines, Iowa, USA
| | - Bart Jenson
- Mercy Medical Center, Iowa Heart, Des Moines, Iowa, USA
| | - Stanley J Chetcuti
- University of Michigan Health Systems University Hospital, Ann Arbor, Michigan, USA
| | | | | | - Kamal Khabbaz
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Melissa Levack
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kashish Goel
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Ka Yan Lam
- Catharina Ziekenhuis, Eindhoven, the Netherlands
| | | | - Saki Ito
- Echocardiography Core Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Jae K Oh
- Echocardiography Core Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Neal Kleiman
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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12
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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).
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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
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13
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Bhogal S, Rogers T, Aladin A, Ben-Dor I, Cohen JE, Shults CC, Wermers JP, Weissman G, Satler LF, Reardon MJ, Yakubov SJ, Waksman R. TAVR in 2023: Who Should Not Get It? Am J Cardiol 2023; 193:1-18. [PMID: 36857839 DOI: 10.1016/j.amjcard.2023.01.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/10/2023] [Accepted: 01/21/2023] [Indexed: 03/03/2023]
Abstract
Since the first transcatheter delivery of an aortic valve prosthesis was performed by Cribier et al in 2002, the picture of aortic stenosis (AS) therapeutics has changed dramatically. Initiated from an indication of inoperable to high surgical risk, extending to intermediate and low risk, transcatheter aortic valve replacement (TAVR) is now an approved treatment for patients with severe, symptomatic AS across all the risk categories. The current evidence supports TAVR as a frontline therapy for treating severe AS. The crucial question remains concerning the subset of patients who still are not ideal candidates for TAVR because of certain inherent anatomic, nonmodifiable, and procedure-specific factors. Therefore, in this study, we focus on these scenarios and reasons for referring selected patients for surgical aortic valve replacement in 2023.
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Affiliation(s)
- Sukhdeep Bhogal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amer Aladin
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Jeffrey E Cohen
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Christian C Shults
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Jason P Wermers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Gaby Weissman
- Department of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Michael J Reardon
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, Texas
| | - Steven J Yakubov
- Department of Cardiology, McConnell Heart Hospital at Riverside Methodist Hospital, Columbus, Ohio
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
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14
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Yakubov SJ, Johnson G, Wittel J. CRT-700.13 A Novel Polymer TAVR Valve: Validation of Design Considerations From Bench to Chronic Ovine Model. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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15
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Gada H, Vora AN, Tang GHL, Mumtaz M, Forrest JK, Laham RJ, Yakubov SJ, Deeb GM, Rammohan C, Huang J, Reardon MJ. Site-Level Variation and Predictors of Permanent Pacemaker Implantation Following TAVR in the Evolut Low-Risk Trial. Cardiovasc Revasc Med 2023; 47:48-54. [PMID: 36266154 DOI: 10.1016/j.carrev.2022.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 03/21/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 01/28/2023]
Abstract
We evaluated predictors of permanent pacemaker implantation (PPI) following self-expanding transcatheter aortic valve replacement (TAVR), examined site-to-site variability of PPI rates, and explored the relationship of implantation methods on the need for PPI. Despite the benefits of TAVR compared to surgical aortic valve replacement, increased PPI remains a limitation. A total of 699 patients without baseline PPI were included in the study. Clinical, echocardiographic, and procedural characteristics were compared in patient with and without new PPI. Clinical outcomes were assessed at 30 days and 1 year. Funnel plots were constructed to display site-to- site variability and identify outliers in PPI. Clinical outcomes were similar in patients with and without PPI. Predictors of a new PPI within 7 days included a baseline right bundle branch block (p < 0.001) and not using general anesthesia (p = 0.003). There was substantial site to site variability in the rate of PPI. Patients at sites with a lower PPI rate had shallower implantation depth at the non-coronary (p < 0.001) and the left coronary sinus (p < 0.001), and fewer patients with an implantation depth > 5 mm below the annulus (p = 0.004). In low-risk patients undergoing TAVR with Evolut valves, baseline conduction disorders and implant depth were important predictors of PPI. Implantation method may have contributed to this variability in PPI rates across clinical sites.
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Affiliation(s)
- Hemal Gada
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleysburg, PA, United States of America.
| | - Amit N Vora
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleysburg, PA, United States of America
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, NY, New York, United States of America
| | - Mubashir Mumtaz
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleysburg, PA, United States of America
| | - John K Forrest
- Department of Internal Medicine (Cardiology), Yale University School of Medicine, New Haven, CT, United States of America
| | - Roger J Laham
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Steven J Yakubov
- Department of Interventional Cardiology, Riverside Methodist-Ohio Health, Columbus, OH, United States of America
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan Hospitals, Ann Arbor, MI, United States of America
| | - Chad Rammohan
- El Camino Hospital, Department of Interventional Cardiology, Mountain View, CA, United States of America
| | - Jian Huang
- Department of Statistics, Medtronic, Minneapolis, MN, United States of America
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, United States of America
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16
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O'Hair D, Yakubov SJ, Grubb KJ, Oh JK, Ito S, Deeb GM, Van Mieghem NM, Adams DH, Bajwa T, Kleiman NS, Chetcuti S, Søndergaard L, Gada H, Mumtaz M, Heiser J, Merhi WM, Petrossian G, Robinson N, Tang GHL, Rovin JD, Little SH, Jain R, Verdoliva S, Hanson T, Li S, Popma JJ, Reardon MJ. Structural Valve Deterioration After Self-Expanding Transcatheter or Surgical Aortic Valve Implantation in Patients at Intermediate or High Risk. JAMA Cardiol 2023; 8:111-119. [PMID: 36515976 PMCID: PMC9857153 DOI: 10.1001/jamacardio.2022.4627] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance The frequency and clinical importance of structural valve deterioration (SVD) in patients undergoing self-expanding transcatheter aortic valve implantation (TAVI) or surgery is poorly understood. Objective To evaluate the 5-year incidence, clinical outcomes, and predictors of hemodynamic SVD in patients undergoing self-expanding TAVI or surgery. Design, Setting, and Participants This post hoc analysis pooled data from the CoreValve US High Risk Pivotal (n = 615) and SURTAVI (n = 1484) randomized clinical trials (RCTs); it was supplemented by the CoreValve Extreme Risk Pivotal trial (n = 485) and CoreValve Continued Access Study (n = 2178). Patients with severe aortic valve stenosis deemed to be at intermediate or increased risk of 30-day surgical mortality were included. Data were collected from December 2010 to June 2016, and data were analyzed from December 2021 to October 2022. Interventions Patients were randomized to self-expanding TAVI or surgery in the RCTs or underwent self-expanding TAVI for clinical indications in the nonrandomized studies. Main Outcomes and Measures The primary end point was the incidence of SVD through 5 years (from the RCTs). Factors associated with SVD and its association with clinical outcomes were evaluated for the pooled RCT and non-RCT population. SVD was defined as (1) an increase in mean gradient of 10 mm Hg or greater from discharge or at 30 days to last echocardiography with a final mean gradient of 20 mm Hg or greater or (2) new-onset moderate or severe intraprosthetic aortic regurgitation or an increase of 1 grade or more. Results Of 4762 included patients, 2605 (54.7%) were male, and the mean (SD) age was 82.1 (7.4) years. A total of 2099 RCT patients, including 1128 who received TAVI and 971 who received surgery, and 2663 non-RCT patients who received TAVI were included. The cumulative incidence of SVD treating death as a competing risk was lower in patients undergoing TAVI than surgery (TAVI, 2.20%; surgery, 4.38%; hazard ratio [HR], 0.46; 95% CI, 0.27-0.78; P = .004). This lower risk was most pronounced in patients with smaller annuli (23 mm diameter or smaller; TAVI, 1.32%; surgery, 5.84%; HR, 0.21; 95% CI, 0.06-0.73; P = .02). SVD was associated with increased 5-year all-cause mortality (HR, 2.03; 95% CI, 1.46-2.82; P < .001), cardiovascular mortality (HR, 1.86; 95% CI, 1.20-2.90; P = .006), and valve disease or worsening heart failure hospitalizations (HR, 2.17; 95% CI, 1.23-3.84; P = .008). Predictors of SVD were developed from multivariate analysis. Conclusions and Relevance This study found a lower rate of SVD in patients undergoing self-expanding TAVI vs surgery at 5 years. Doppler echocardiography was a valuable tool to detect SVD, which was associated with worse clinical outcomes. Trial Registration ClinicalTrials.gov Identifiers: NCT01240902, NCT01586910, and NCT01531374.
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Affiliation(s)
- Daniel O'Hair
- Cardiovascular Service Line, Boulder Community Health, Boulder, Colorado
| | - Steven J Yakubov
- Department of Interventional Cardiology, Ohio Health Riverside Methodist Hospital, Columbus
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Jae K Oh
- Echocardiography Core Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Saki Ito
- Echocardiography Core Laboratory, Mayo Clinic, Rochester, Minnesota
| | - G Michael Deeb
- Department of Interventional Cardiology, University of Michigan Hospitals, Ann Arbor.,Department of Cardiac Surgery, University of Michigan Hospitals, Ann Arbor
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - David H Adams
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York
| | - Tanvir Bajwa
- Department of Cardiothoracic Surgery, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Neal S Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.,Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Stanley Chetcuti
- Department of Interventional Cardiology, University of Michigan Hospitals, Ann Arbor.,Department of Cardiac Surgery, University of Michigan Hospitals, Ann Arbor
| | - Lars Søndergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - 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
| | - John Heiser
- Department of Interventional Cardiology, Spectrum Health, Grand Rapids, Michigan.,Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan
| | - William M Merhi
- Department of Interventional Cardiology, Spectrum Health, Grand Rapids, Michigan.,Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan
| | - George Petrossian
- Department of Cardiothoracic and Vascular Surgery, Saint Francis Hospital, Roslyn, New York
| | - Newell Robinson
- Department of Cardiothoracic and Vascular Surgery, Saint Francis Hospital, Roslyn, New York
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York
| | - Joshua D Rovin
- Center for Advanced Valve and Structural Heart Care, Morton Plant Hospital, Clearwater, Florida
| | - Stephen H Little
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.,Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Renuka Jain
- Aurora Cardiovascular Services, Aurora-St. Luke's Medical Center, Milwaukee, Wisconsin
| | - Sarah Verdoliva
- Structural Heart and Aortic, Medtronic, Minneapolis, Minnesota
| | - Tim Hanson
- Structural Heart and Aortic, Medtronic, Minneapolis, Minnesota
| | - Shuzhen Li
- Structural Heart and Aortic, Medtronic, Minneapolis, Minnesota
| | - Jeffrey J Popma
- Structural Heart and Aortic, Medtronic, Minneapolis, Minnesota
| | - Michael J Reardon
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.,Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
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17
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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.
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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
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18
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Tuttle MK, Kiaii B, Van Mieghem NM, Laham RJ, Deeb GM, Windecker S, Chetcuti S, Yakubov SJ, Chawla A, Hockmuth D, Teefy P, Li S, Reardon MJ. Functional Status After Transcatheter and Surgical Aortic Valve Replacement: 2-Year Analysis From the SURTAVI Trial. JACC Cardiovasc Interv 2022; 15:728-738. [PMID: 35393106 DOI: 10.1016/j.jcin.2022.01.284] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 01/06/2022] [Accepted: 01/14/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study sought to evaluate patient-centered metrics in intermediate-surgical-risk aortic stenosis patients enrolled in the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial treated with self-expanding transcatheter aortic valve replacement (TAVR) or surgery. BACKGROUND Studies have shown TAVR to be an alternative to surgery in patients with severe symptomatic aortic stenosis but have focused on "hard endpoints," including all-cause mortality and stroke, rather than on comparative patient-centered metrics, such as functional status and symptom burden. METHODS The study analyzed functional status (6-minute walk test [6MWT]) and symptom burden (Kansas City Cardiomyopathy Questionnaire) in 1,492 patients from the SURTAVI trial at baseline, 30 days, 1 year, and 2 years. Patients were categorized by baseline functional status into tertiles of slow, medium, and fast walkers. RESULTS Patients with lowest capacity baseline functional status were commonly women, had higher Society of Thoracic Surgeons scores, and had more New York Heart Association functional class III or IV symptoms; reduced baseline functional status was associated with higher aortic valve- and heart failure-related hospitalization at 2 years. There was greater improvement in 6MWT distance in TAVR compared with surgery patients at 30 days (P < 0.001) and 1 year (P = 0.012), but at 2 years, both groups had similar improvement (P = 0.091). The percentage of patients with large improvement in 6MWT was greatest in patients categorized as slow walkers and lowest in fast walkers. Symptom burden improved after TAVR at 30 days and after both procedures at 1 and 2 years. CONCLUSIONS In this substudy of patients from the SURTAVI trial, patients receiving TAVR demonstrated a more rapid improvement in functional status and symptom burden compared with patients undergoing surgery; however, both groups had similar improvements in long-term follow-up. (Safety and Efficacy Study of the Medtronic CoreValve® System in the Treatment of Severe, Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement [SURTAVI]; NCT01586910).
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Affiliation(s)
- Mark K Tuttle
- CardioVascular Institute of North Colorado, Banner Health, Greeley, Colorado, USA.
| | - Bob Kiaii
- Department of Cardiothoracic Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Roger J Laham
- CardioVascular Institute of North Colorado, Banner Health, Greeley, Colorado, USA
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Stanley Chetcuti
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven J Yakubov
- Department of Cardiac Surgery, Riverside Methodist Hospital, Columbus, Ohio, USA; Department of Interventional Cardiology, Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Atul Chawla
- Department of Cardiology, Iowa Heart Center, Des Moines, Iowa, USA
| | - David Hockmuth
- Department of Cardiology, Iowa Heart Center, Des Moines, Iowa, USA
| | - Patrick Teefy
- Department of Medicine, Cardiology Division, London Health Sciences Centre, London, Ontario, Canada
| | - Shuzhen Li
- Coronary and Structural Heart, Medtronic, Minneapolis, Minnesota, USA
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA; Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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19
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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).
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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
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20
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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]
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21
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Ramlawi B, Deeb GM, Yakubov SJ, Markowitz AH, Hughes GC, Kiaii RB, Huang J, Kleiman NS, Reardon MJ. Mechanisms of death in low risk patients after transcatheter or surgical aortic valve replacement. Cardiovascular Revascularization Medicine 2022; 42:1-5. [DOI: 10.1016/j.carrev.2022.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/26/2021] [Accepted: 03/25/2022] [Indexed: 11/03/2022]
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22
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Yakubov SJ, Wittel J, Johnson G. CRT-700.20 Foldax TRIA TAVI: A Novel-Polymer Transcatheter Aortic Valve: Pilot Chronic Ovine Model Study. JACC Cardiovasc Interv 2022. [DOI: 10.1016/j.jcin.2022.01.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Tang GHL, Sengupta A, Alexis SL, Zaid S, Leipsic JA, Blanke P, Grubb KJ, Gada H, Yakubov SJ, Rogers T, Lerakis S, Khera S, Adams DH, Sharma SK, Kini A, Reardon MJ. Conventional versus modified delivery system technique in commissural alignment from the Evolut low-risk CT substudy. Catheter Cardiovasc Interv 2021; 99:924-931. [PMID: 34626449 DOI: 10.1002/ccd.29973] [Citation(s) in RCA: 4] [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: 08/23/2021] [Revised: 09/03/2021] [Accepted: 09/29/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES We assessed the impact of conventional delivery system (DS) insertion technique on "Hat-marker" orientation/commissural alignment in patients who underwent transcatheter aortic valve replacement (TAVR) in the Evolut Low Risk Trial CT substudy versus a modified technique. BACKGROUND Unlike surgical aortic valve replacement, where alignment of the surgical valve commissures with native commissures can be achieved virtually 100% of the time, commissural alignment during TAVR is not achieved consistently. This may subsequently impact the feasibility of both coronary access and reintervention after TAVR. METHODS "Hat-marker" orientations during deployment were characterized as outer curve (OC), center front (CF), inner curve, and center back. Severe commissure-to-CA overlap was 0-20°. "Hat-marker" orientations and CA overlap were compared to 240 patients from a single center using the modified 3-o'clock flush port DS technique. RESULTS In the CT substudy in which conventional DS insertion was performed (flush port at 12 o'clock); 154/249 had both analyzable CT and procedural fluoroscopy to validate "Hat-marker" to C-tab/commissural orientation. On post-TAVR CT, Evolut valve commissural orientation and coronary artery (CA) ostia were identified. Compared to conventional DS technique in the CT substudy, the modified technique had higher rates of "Hat-marker" at OC/CF orientation, improved commissural alignment and reduced severe CA overlap; (left main, 14.2 vs. 27.9%; right coronary artery, 11.7 vs. 27.3% both, 5.0 vs. 13.6%; 1 or both CA, 20.8 vs. 41.6%, all p < 0.01). CONCLUSIONS The modified technique improved initial "Hat-marker" orientation during Evolut deployment and resulted in better commissural alignment and reduced CA overlap.
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Affiliation(s)
- Gilbert H L Tang
- Department of Cardiovascular Surgery and Cardiology, Mount Sinai Hospital, New York, New York, USA
| | - Aditya Sengupta
- Department of Cardiovascular Surgery and Cardiology, Mount Sinai Hospital, New York, New York, USA
| | - Sophia L Alexis
- Department of Cardiovascular Surgery and Cardiology, Mount Sinai Hospital, New York, New York, USA
| | - Syed Zaid
- Division of Cardiology, Westchester Medical Center, Valhalla, New York, USA
| | - Jonathan A Leipsic
- Center for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Center for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kendra J Grubb
- Department of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, USA
| | - Hemal Gada
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Harrisburg, Pennsylvania, USA
| | - Steven J Yakubov
- Department of Interventional Cardiology, OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Toby Rogers
- Medstar Heart and Vascular Institute, Washington, District of Columbia, USA
| | - Stamatios Lerakis
- Department of Cardiovascular Surgery and Cardiology, Mount Sinai Hospital, New York, New York, USA
| | - Sahil Khera
- Department of Cardiovascular Surgery and Cardiology, Mount Sinai Hospital, New York, New York, USA
| | - David H Adams
- Department of Cardiovascular Surgery and Cardiology, Mount Sinai Hospital, New York, New York, USA
| | - Samin K Sharma
- Department of Cardiovascular Surgery and Cardiology, Mount Sinai Hospital, New York, New York, USA
| | - Annapoorna Kini
- Department of Cardiovascular Surgery and Cardiology, Mount Sinai Hospital, New York, New York, USA
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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Lanz J, Reardon MJ, Pilgrim T, Stortecky S, Deeb GM, Chetcuti S, Yakubov SJ, Gleason TG, Huang J, Windecker S. Incidence and Outcomes of Infective Endocarditis After Transcatheter or Surgical Aortic Valve Replacement. J Am Heart Assoc 2021; 10:e020368. [PMID: 34581194 PMCID: PMC8649131 DOI: 10.1161/jaha.120.020368] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Data comparing the frequency and outcomes of infective endocarditis (IE) after transcatheter (TAVR) to surgical aortic valve replacement (SAVR) are scarce. The objective of this study is to compare the incidence and outcomes of IE after TAVR using a supra‐annular, self‐expanding platform (CoreValve and Evolut) to SAVR. Methods and Results Data of 3 randomized clinical trials comparing TAVR to SAVR and a prospective continued TAVR access study were pooled. IE was defined on the basis of the modified Duke criteria. The cumulative incidence of IE was determined by modeling the cause‐specific hazard. Estimates of all‐cause mortality were calculated by means of the Kaplan–Meier method. Outcomes are reported for the valve‐implant cohort. During a mean follow‐up time of 2.17±1.51 years, 12 (0.5%) of 2249 patients undergoing TAVR and 21 (1.1%) of 1828 patients undergoing SAVR developed IE. Patients with IE more frequently had diabetes mellitus than those without (57.6% versus 34.2%; P=0.005). The cumulative incidence of IE was 1.01% (95% CI, 0.47%–1.96%) after TAVR and 1.58% (95% CI, 0.97%–2.46%) after SAVR (P=0.047) at 5 years. Among patients with IE, the rate of all‐cause mortality was 27.3% (95% CI, 1.0%–53.6%) in the TAVR and 51.8% (95% CI, 28.2%–75.3%) in the SAVR group at 1 year (log‐rank P=0.15). Conclusions Pooled prospectively collected data comparing TAVR with a supra‐annular, self‐expanding device to SAVR showed a low cumulative risk of IE irrespective of treatment modality, although the risk was lower in the TAVR implant group. Once IE occurred, mortality was high. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01240902, NCT01586910, NCT02701283.
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Affiliation(s)
- Jonas Lanz
- Department of Cardiology InselspitalBern University Hospital Bern Switzerland
| | | | - Thomas Pilgrim
- Department of Cardiology InselspitalBern University Hospital Bern Switzerland
| | - Stefan Stortecky
- Department of Cardiology InselspitalBern University Hospital Bern Switzerland
| | | | | | | | - Thomas G Gleason
- Division of Cardiac Surgery, Brigham & Women's Hospital & Harvard Medical School Boston MA
| | - Jian Huang
- Department of Statistics Medtronic, plc Minneapolis MN
| | - Stephan Windecker
- Department of Cardiology InselspitalBern University Hospital Bern Switzerland
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Dallan LAP, Forrest JK, Reardon MJ, Szeto WY, George I, Kodali S, Kleiman NS, Yakubov SJ, Grubb KJ, Liu F, Baeza C, Attizzani GF. Transcatheter Aortic Valve Replacement With Self-Expandable Supra-Annular Valves for Degenerated Surgical Bioprostheses: Insights From Transcatheter Valve Therapy Registry. J Am Heart Assoc 2021; 10:e021871. [PMID: 34514840 PMCID: PMC8649494 DOI: 10.1161/jaha.121.021871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Transcatheter aortic valve replacement with supra‐annular transcatheter heart valves has been adopted in patients with degenerated surgical aortic valves. The next generation self‐expanding Evolut PRO valve has not been evaluated in patients with surgical valve failure. Methods and Results Patients undergoing transcatheter aortic valve replacement in degenerated surgical aortic valve procedures using the Evolut R or Evolut PRO transcatheter heart valves in the Society of Thoracic Surgeons and American College of Cardiology Transcatheter Valve Therapy Registry between April 2015 and June 2019 were evaluated. Transcatheter valve performance was evaluated by clinical site echocardiography. In‐hospital, 30‐day, and 1‐year clinical outcomes were based on the Society of Thoracic Surgeons‐American College of Cardiology‐Transcatheter Valve Therapy registry definitions. Transcatheter aortic valve replacement in degenerated surgical aortic valve was performed in 5897 patients (5061 [85.8%] patients received the Evolut R valve and 836 [14.2%] received the Evolut PRO valve). Thirty‐day transcatheter heart valves hemodynamic performance was excellent in both groups (mean gradient: Evolut PRO: 13.8±7.5 mm Hg; Evolut R: 14.5±8.1 mm Hg), while paravalvular regurgitation was significantly different between valve types (P=0.02). Clinical events were low at 30 days (Evolut PRO: for the all‐cause mortality, 2.8%, any stroke was 1.8%, new pacemaker implantation, 3.0%: Evolut R:all‐cause mortality, 2.5%, any stroke was 2.2%, new pacemaker implantation, 5.3%) and 1 year (Evolut PRO: all‐cause mortality, 9.2%; any stroke, 3.1%; Evolut R: all‐cause mortality, 9.8%; any stroke, 2.9%). Conclusions Transcatheter aortic valve replacement in degenerated surgical aortic valve with self‐expandable supra‐annular transcatheter heart valves is associated with excellent clinical outcomes and valve hemodynamics. Additional reductions in residual paravalvular regurgitation were obtained with the next generation Evolut PRO.
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Affiliation(s)
- Luis Augusto P Dallan
- Department of Cardiovascular Medicine Harrington Heart and Vascular InstituteUniversity Hospitals Cleveland Medical Center Cleveland OH
| | - John K Forrest
- Departments of Internal Medicine (Cardiology) and Surgery (Cardiac Surgery) Yale University School of Medicine New Haven CT
| | - Michael J Reardon
- Department of Cardiothoracic Surgery Methodist DeBakey Heart and Vascular CenterHouston Methodist Houston TX
| | - Wilson Y Szeto
- University of Pennsylvania School of Medicine Philadelphia PA
| | - Isaac George
- Departments of Cardiology and Cardiac Surgery Columbia University-New York Presbyterian New York NY
| | - Susheel Kodali
- Departments of Cardiology and Cardiac Surgery Columbia University-New York Presbyterian New York NY
| | - Neal S Kleiman
- Department of Cardiothoracic Surgery Methodist DeBakey Heart and Vascular CenterHouston Methodist Houston TX
| | - Steven J Yakubov
- Departments of Cardiac Surgery and Interventional Cardiology Riverside Methodist HospitalOhioHealth Columbus OH
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery Emory University School of Medicine Atlanta GA
| | - Fang Liu
- Statistical Services MedtronicMounds View MN
| | - Cristian Baeza
- Department of Cardiovascular Medicine Harrington Heart and Vascular InstituteUniversity Hospitals Cleveland Medical Center Cleveland OH
| | - Guilherme F Attizzani
- Department of Cardiovascular Medicine Harrington Heart and Vascular InstituteUniversity Hospitals Cleveland Medical Center Cleveland OH
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26
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Naidu SS, Baron SJ, Eng MH, Sathanandam SK, Zidar DA, Feldman DN, Ing FF, Latif F, Lim MJ, Henry TD, Rao SV, Dangas GD, Hermiller JB, Daggubati R, Shah B, Ang L, Aronow HD, Banerjee S, Box LC, Caputo RP, Cohen MG, Coylewright M, Duffy PL, Goldsweig AM, Hagler DJ, Hawkins BM, Hijazi ZM, Jayasuriya S, Justino H, Klein AJ, Kliger C, Li J, Mahmud E, Messenger JC, Morray BH, Parikh SA, Reilly J, Secemsky E, Shishehbor MH, Szerlip M, Yakubov SJ, Grines CL, Alvarez-Breckenridge J, Baird C, Baker D, Berry C, Bhattacharya M, Bilazarian S, Bowen R, Brounstein K, Cameron C, Cavalcante R, Culbertson C, Diaz P, Emanuele S, Evans E, Fletcher R, Fortune T, Gaiha P, Govender D, Gutfinger D, Haggstrom K, Herzog A, Hite D, Kalich B, Kirkland A, Kohler T, Laurisden H, Livolsi K, Lombardi L, Lowe S, Marhenke K, Meikle J, Moat N, Mueller M, Patarca R, Popma J, Rangwala N, Simonton C, Stokes J, Taber M, Tieche C, Venditto J, West NEJ, Zinn L. Hot topics in interventional cardiology: Proceedings from the society for cardiovascular angiography and interventions (SCAI) 2021 think tank. Catheter Cardiovasc Interv 2021; 98:904-913. [PMID: 34398509 DOI: 10.1002/ccd.29898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 01/07/2023]
Abstract
The Society for Cardiovascular Angiography and Interventions (SCAI) Think Tank is a collaborative venture that brings together interventional cardiologists, administrative partners, and select members of the cardiovascular industry community annually for high-level field-wide discussions. The 2021 Think Tank was organized into four parallel sessions reflective of the field of interventional cardiology: (a) coronary intervention, (b) endovascular medicine, (c) structural heart disease, and (d) congenital heart disease. Each session was moderated by a senior content expert and co-moderated by a member of SCAI's Emerging Leader Mentorship program. This document presents the proceedings to the wider cardiovascular community in order to enhance participation in this discussion, create additional dialog from a broader base, and thereby aid SCAI, the industry community and external stakeholders in developing specific action items to move these areas forward.
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Affiliation(s)
- Srihari S Naidu
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Suzanne J Baron
- Division of Cardiology, Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Marvin H Eng
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Shyam K Sathanandam
- Department of Cardiology, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - David A Zidar
- Department of Cardiology, UH Harrington Heart & Vascular Institute, Cleveland, Ohio, USA
| | - Dmitriy N Feldman
- Department of Cardiology, Weill Cornell Medical Center, New York, USA
| | - Frank F Ing
- Department of Cardiology, UC Davis Medical Center, Sacramento, California, USA
| | - Faisal Latif
- Department of Cardiology, The University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | - Michael J Lim
- Department of Cardiology, St. Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Timothy D Henry
- Department of Cardiology, The Christ Hospital Health Network, Cincinnati, Ohio, USA
| | - Sunil V Rao
- Department of Cardiology, Duke University Health System, Durham, North Carolina, USA
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, USA
| | - James B Hermiller
- Department of Cardiology, Ascension St. Vincent Cardiovascular Research Institute, Carmel, Indiana, USA
| | - Ramesh Daggubati
- Department of Cardiology, The West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Binita Shah
- Department of Cardiology, NYU Grossman School of Medicine, New York, USA
| | - Lawrence Ang
- Division of Cardiovascular Medicine, The University of California, San Diego, California, USA
| | - Herbert D Aronow
- Department of Cardiology, Lifespan Cardiovascular Institute/Brown Medical School, Providence, Rhode Island, USA
| | - Subhash Banerjee
- Department of Cardiology, Dallas Veterans Affairs Medical Center, Dallas, Texas, USA
| | - Lyndon C Box
- Department of Cardiology, West Valley Medical Center, Caldwell, Idaho, USA
| | - Ronald P Caputo
- Department of Cardiology, Levine Heart and Wellness, Naples, Florida, USA
| | - Mauricio G Cohen
- Cardiac Catheterization Laboratory, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Megan Coylewright
- Department of Cardiology, Erlanger Health System, Chattanooga, Tennessee, USA
| | - Peter L Duffy
- Department of Cardiology, West Florida Hospital, Pensacola, Florida, USA
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine, The University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Donald J Hagler
- Division of Pediatric Cardiology and Department of Cardiovascular Diseases, Mayo Clinic Health System, Rochester, Minnesota, USA
| | - Beau M Hawkins
- Department of Cardiology, The University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | - Ziyad M Hijazi
- Cardiology, Weill Cornell Medical College, New York, USA.,Sidra Medicine, Doha, Qatar
| | - Sasanka Jayasuriya
- Cardiology, Ascension Columbia St. Mary's Hospital Milwaukee, Milwaukee, Wisconsin, USA
| | - Henri Justino
- Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Andrew J Klein
- Department of Cardiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Chad Kliger
- Department of Medicine, Division of Cardiovascular Medicine, Northwell Health Lenox Hill Hospital, New York, USA
| | - Jun Li
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ehtisham Mahmud
- Coronary Care Unit, University of California, San Diego, California, USA
| | - John C Messenger
- Department of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Brian H Morray
- Department of Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Sahil A Parikh
- Division of Cardiology and Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, New York, USA
| | - John Reilly
- Division of Cardiovascular Medicine, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Eric Secemsky
- Department of Internal Medicine, Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mehdi H Shishehbor
- Harrington Heart & Vascular Institute, UH Harrington Heart & Vascular Institute, Cleveland, Ohio, USA
| | - Molly Szerlip
- Division of Cardiology, Baylor Scott & White The Heart Hospital - Plano, Plano, Texas, USA
| | - Steven J Yakubov
- Department of Cardiology, OhioHealth Heart & Vascular Physicians, Columbus, Ohio, USA
| | - Cindy L Grines
- Department of Cardiology, Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA
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- TandemLife, LivaNova, Pittsburgh, Pennsylvania, USA
| | | | | | - David Baker
- Philips Healthcare, Cambridge, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | | | | - Erin Evans
- TandemLife, LivaNova, Pittsburgh, Pennsylvania, USA
| | | | | | - Priya Gaiha
- Siemens Medical Solutions USA, Malvern, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Neil Moat
- Abbott, Santa Clara, California, USA
| | | | | | | | | | | | - Jerry Stokes
- TandemLife, LivaNova, Pittsburgh, Pennsylvania, USA
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Yakubov SJ, Arshi A, Stiver K. #PCI2021: The Trend Is Our Friend. Cardiovasc Revasc Med 2021; 31:17-18. [PMID: 34391682 DOI: 10.1016/j.carrev.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Steven J Yakubov
- System Chief of Advanced Structural Heart Disease, OhioHealth, Riverside Methodist Hospital, United States of America.
| | - Arash Arshi
- Cardiac Catheterization Lab Director, OhioHealth Riverside Methodist Hospital, United States of America
| | - Kevin Stiver
- Cardiac Catheterization Lab Director, OhioHealth Doctor's Hospital, United States of America
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28
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Arnold SV, Petrossian G, Reardon MJ, Kleiman NS, Yakubov SJ, Wang K, Hermiller J, Harrison JK, Deeb GM, Huang J, Cohen DJ. Five-Year Clinical and Quality of Life Outcomes From the CoreValve US Pivotal Extreme Risk Trial. Circ Cardiovasc Interv 2021; 14:e010258. [PMID: 34092091 DOI: 10.1161/circinterventions.120.010258] [Citation(s) in RCA: 4] [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] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., K.W.).,Department of Medicine, University of Missouri-Kansas City (S.V.A.)
| | | | - Michael J Reardon
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX (M.J.R., N.S.K.)
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX (M.J.R., N.S.K.)
| | | | - Kaijun Wang
- Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., K.W.)
| | | | - J Kevin Harrison
- Department of Medicine, Duke University Medical Center, Durham, NC (J.K.H.)
| | - G Michael Deeb
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, MI (G.M.D.)
| | | | - David J Cohen
- Saint Francis Hospital, Roslyn, NY (G.P., D.J.C.).,Clinical Trials Center, Cardiovascular Research Foundation, NY (D.J.C.)
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29
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Chhatriwalla AK, Allen KB, Saxon JT, Cohen DJ, Nguyen TC, Loyalka P, Whisenant B, Yakubov SJ, Sanchez C, Sathananthan J, Stegman B, Harvey J, Garrett HE, Tseng E, Gerdisch M, Williams P, Kennedy KF, Webb J. 1-Year Outcomes following Bioprosthetic Valve Fracture to Facilitate Valve-in-Valve Transcatheter Aortic Valve Replacement. Structural Heart 2021. [DOI: 10.1080/24748706.2021.1895456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Adnan K. Chhatriwalla
- Department of Cardiology, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
- Department of Cardiology, University of Missouri, Kansas City, Missouri, USA
| | - Keith B. Allen
- Department of Cardiothoracic Surgery, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
- Department of Cardiothoracic Surgey, University of Missouri, Kansas City, Missouri, USA
| | - John T. Saxon
- Department of Cardiology, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
- Department of Cardiology, University of Missouri, Kansas City, Missouri, USA
| | - David J. Cohen
- Cardiovascular Research Foundation, New York, New York, USA
- Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Tom C. Nguyen
- Cardiothoracic Surgery, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Pranav Loyalka
- Department of Cardiology, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Brian Whisenant
- Department of Cardiology, Intermountain Medical Center, Salt Lake City, Utah, USA
| | | | - Carlos Sanchez
- Department of Cardiology, Riverside Hospital, Columbus, Ohio, USA
| | - Janarthanan Sathananthan
- Department of Cardiology, Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, British Columbiaa, Canada
| | - Brian Stegman
- Department of Cardiology, Centracare Heart and Vascular Center, St Cloud, Minnesota, USA
| | - James Harvey
- Department of Cardiology, Wellspan York Hospital, York, Pennsylvania, USA
| | - H. Edward Garrett
- Department of Cardiothoracic Surgery, Baptist Memorial Hospital, Memphis, Tennessee, USA
| | - Elaine Tseng
- Department of Cardiothoracic Surgery, VA Medical Center, San Francisco, California, USA
| | - Marc Gerdisch
- Department of Cardiothoracic Surgery, Franciscan Health Heart Center, Indianapolis, Indiana, USA
| | - Paul Williams
- Department of Cardiology, James Cook University Hospital, Middlesborough, UK
| | - Kevin F. Kennedy
- Department of Biostatistics, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
| | - John Webb
- Department of Cardiology, Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, British Columbiaa, Canada
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30
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Lam KY, Reardon MJ, Yakubov SJ, Modine T, Fremes S, Tonino PAL, Tan ME, Gleason TG, Harrison JK, Hughes GC, Oh JK, Head SJ, Huang J, Deeb GM. Surgical sutureless and sutured aortic valve replacement in low-risk patients. Ann Thorac Surg 2021; 113:616-622. [PMID: 33794164 DOI: 10.1016/j.athoracsur.2021.03.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 10/12/2020] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Randomized clinical trials have shown that transcatheter aortic valve replacement (TAVR) is noninferior to surgery in low surgical risk patients. We compared outcomes in patients treated with a sutured (stented or stentless) or sutureless surgical valve from the Evolut Low Risk Trial. METHODS The Evolut Low Risk Trial enrolled patients with severe aortic stenosis and low surgical risk. Patients were randomized to self-expanding TAVR or surgery. Use of sutureless or sutured valves was at the surgeons' discretion. RESULTS There were 680 patients who underwent surgical aortic valve implantation (205 sutureless, 475 sutured). The VARC-2 30-day safety composite endpoint was similar in the sutureless and sutured group (10.8% vs 11.0%, P=.93). All-cause mortality between groups was similar between groups at 30 days (0.5% vs 1.5%, P=.28) and 1 year (3.3% vs 2.6%, P=.74). Disabling stroke was also similar at 30 days (2.0% vs 1.5%, P=.65) and 1 year (2.6% vs 2.2%, P=.76). Permanent pacemaker implantation at 30 days was significantly higher in the sutureless compared with the sutured group (14.4% vs 2.9%, P<.001). AV-related hospitalizations occurred more often at 1 year with sutureless valves (9.1% vs 5.1%, P=.04). Mean gradients 1 year after sutureless and sutured AVR were 9.9±4.2 vs 11.7±4.7mm Hg (P<.001). CONCLUSIONS Among low-risk patients, sutureless versus sutured valve use did not demonstrate a benefit in terms of 30-day complications and produced marginally better hemodynamics, but with an increased rate of pacemaker implantation and valve-related hospitalizations.
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Affiliation(s)
- Ka Yan Lam
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands.
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist Debakey Heart and Vascular Center, Houston, TX
| | - Steven J Yakubov
- Department of Cardiology, Riverside Methodist - Ohio Health, Columbus, OH
| | - Thomas Modine
- Department of Cardiac Surgery, Lille University Hospital, Lille, France
| | - Stephen Fremes
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Pim A L Tonino
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - M Erwin Tan
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | | | | | | | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | | | - G Michael Deeb
- Departments of Cardiac Surgery, University of Michigan Hospitals, Ann Arbor, MI
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31
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Vora AN, Tang GHL, Reardon MJ, Deeb GM, Yakubov SJ, Huang J, Spencer J, Gada H. Transcatheter Aortic Valve Implant Depth Measurements Differ by Aortography Versus Computed Tomography. JACC Cardiovasc Interv 2021; 14:1045-1047. [PMID: 33744214 DOI: 10.1016/j.jcin.2020.12.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 10/21/2022]
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32
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Wyler von Ballmoos MC, Reardon MJ, Williams MR, Mangi AA, Kleiman NS, Yakubov SJ, Watson D, Kodali S, George I, Tadros P, Zorn GL, Brown J, Kipperman R, Oh JK, Qiao H, Forrest JK. Three-Year Outcomes With a Contemporary Self-Expanding Transcatheter Valve From the Evolut PRO US Clinical Study. Cardiovasc Revasc Med 2020; 26:12-16. [PMID: 33199247 DOI: 10.1016/j.carrev.2020.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/24/2020] [Revised: 10/01/2020] [Accepted: 11/06/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Paravalvular regurgitation (PVR) following transcatheter aortic valve replacement (TAVR) is associated with increased morbidity and mortality. PVR continues to plague TAVR jeopardizing long-term results. New device iterations, such as the self-expandable Evolut PRO valve, aim to decrease PVR while maintaining optimal hemodynamics. This study sought to evaluate clinical and hemodynamic performance of the Evolut PRO system at 3 years. METHODS The Evolut PRO US Clinical Study included 60 patients at high or extreme surgical risk undergoing TAVR with the Evolut PRO valve at 8 centers in the United States. Clinical outcomes were evaluated using Valve Academic Research Consortium (VARC)-2 criteria and included all-cause mortality, cardiovascular mortality, disabling stroke and valve complications. An independent core laboratory centrally assessed all echocardiographic measures. RESULTS At 3 years, all-cause mortality was 25.8% (cardiovascular mortality 16.5%) and the disabling stroke rate was 10.7%. There were no cases of repeat valve intervention, endocarditis or coronary obstruction. Valve thrombosis was identified in 1 patient 2 years post-procedure and was treated medically. Hemodynamics at 3 years included a mean gradient of 7.2 ± 4.5 mm Hg, an effective orifice area of 2.0 ± 0.5 cm2, and 88.2% of patients had no or trace PVR. The remaining patients had mild PVR. Most of the surviving patients (80.6%) had New York Heart Association class I symptoms at 3 years. CONCLUSION Outcomes at 3-years following TAVR with a contemporary self-expanding prosthesis are favorable, with no signal of valve deterioration, excellent hemodynamics including very low prevalence of PVR.
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Affiliation(s)
- Moritz C Wyler von Ballmoos
- Departments of Cardiovascular Surgery and Interventional Cardiology, Houston Methodist DeBakey Heart and Vascular Institute, 6550 Fannin Street, Smith Tower Suite 1401, Houston, TX 77030, United States of America.
| | - Michael J Reardon
- Departments of Cardiovascular Surgery and Interventional Cardiology, Houston Methodist DeBakey Heart and Vascular Institute, 6550 Fannin Street, Smith Tower Suite 1401, Houston, TX 77030, United States of America.
| | - Mathew R Williams
- Department of Cardiovascular Surgery, New York University-Langone Medical Center, 530 First Ave, Suite 9V, New York, NY 10016, United States of America.
| | - Abeel A Mangi
- Departments of Internal Medicine (Cardiology) and Surgery (Cardiac Surgery), Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, United States of America.
| | - Neal S Kleiman
- Departments of Cardiovascular Surgery and Interventional Cardiology, Houston Methodist DeBakey Heart and Vascular Institute, 6550 Fannin Street, Smith Tower Suite 1401, Houston, TX 77030, United States of America.
| | - Steven J Yakubov
- Departments of Interventional Cardiology and Cardiac Surgery, OhioHealth-Riverside Methodist Hospital, 3705 Olentangy River Rd Ste 100, Columbus, OH 43214, United States of America.
| | - Daniel Watson
- Departments of Interventional Cardiology and Cardiac Surgery, OhioHealth-Riverside Methodist Hospital, 3705 Olentangy River Rd Ste 100, Columbus, OH 43214, United States of America
| | - Susheel Kodali
- Structural Heart and Valve Center, Columbia University Irving Medical Center, Presbyterian, 161 Fort Washington Ave., (Corner of West 165th St.), New York, NY 10032, United States of America.
| | - Isaac George
- Structural Heart and Valve Center, Columbia University Irving Medical Center, Presbyterian, 161 Fort Washington Ave., (Corner of West 165th St.), New York, NY 10032, United States of America.
| | - Peter Tadros
- Departments of Cardiology and Cardiac Surgery, University of Kansas, 3901 Rainbow Blvd, Kansas City, KS 66160, United States of America
| | - George L Zorn
- Departments of Cardiology and Cardiac Surgery, University of Kansas, 3901 Rainbow Blvd, Kansas City, KS 66160, United States of America.
| | - John Brown
- Departments of Cardiology and Cardiac Surgery, Morristown Hospital, 100 Madison Ave, Morristown, NJ 07960, United States of America.
| | - Robert Kipperman
- Departments of Cardiology and Cardiac Surgery, Morristown Hospital, 100 Madison Ave, Morristown, NJ 07960, United States of America.
| | - Jae K Oh
- Department of Echocardiography, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States of America.
| | - Hongyan Qiao
- Statistical Services, 8200 Coral Sea Street, Mounds View, MN 55112, United States of America.
| | - John K Forrest
- Departments of Internal Medicine (Cardiology) and Surgery (Cardiac Surgery), Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, United States of America.
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Arshi A, Yakubov SJ, Stiver KL, Sanchez CE. Overcoming the transcatheter aortic valve replacement Achilles heel: coronary re-access. Ann Cardiothorac Surg 2020; 9:468-477. [PMID: 33312904 PMCID: PMC7724072 DOI: 10.21037/acs-2020-av-38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/09/2020] [Indexed: 01/30/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for the treatment of symptomatic severe aortic stenosis (AS). Coronary artery disease (CAD) is common in patients with severe AS. As the indications for TAVR extend to lower risk patients with longer life expectancy and as CAD is a progressive condition, coronary angiography will become increasingly common in patients who have had a previous TAVR. Coronary artery re-access after TAVR may be challenging but is possible in most cases. Commissural alignment of the prosthesis with the native coronary ostia plays an important role in successful coronary re-access. Coronary artery obstruction is a potentially devastating complication of TAVR, particularly in valve-in-valve procedures. In the present keynote lecture, we review techniques used to mitigate the risk of coronary obstruction, as well as catheter selection and strategies for selective coronary artery engagement for specific transcatheter aortic valve (TAV) bioprostheses.
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Affiliation(s)
- Arash Arshi
- OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | | | - Kevin L Stiver
- OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
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Van Mieghem NM, Reardon MJ, Yakubov SJ, Heiser J, Merhi W, Windecker S, Makkar RR, Cheng W, Robbins M, Fail P, Feinberg E, Stoler RC, Hebeler R, Serruys PW, Popma JJ. Clinical outcomes of TAVI or SAVR in men and women with aortic stenosis at intermediate operative risk: a post hoc analysis of the randomised SURTAVI trial. EUROINTERVENTION 2020; 16:833-841. [DOI: 10.4244/eij-d-20-00303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Arnold SV, Chinnakondepalli KM, Magnuson EA, Reardon MJ, Deeb GM, Gleason T, Yakubov SJ, Cohen DJ. Five-Year Health Status After Self-expanding Transcatheter or Surgical Aortic Valve Replacement in High-risk Patients With Severe Aortic Stenosis. JAMA Cardiol 2020; 6:97-101. [PMID: 32997095 DOI: 10.1001/jamacardio.2020.4397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance In the CoreValve High-Risk Trial, patients with severe symptomatic aortic stenosis had similar clinical outcomes with transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR) over 5 years of follow-up, with mortality rates of more than 50% in both groups. Objective To describe the long-term health status of surviving patients randomized to self-expanding TAVR vs SAVR. Design, Setting, and Participants This randomized clinical trial included patients at high surgical risk with severe aortic stenosis who completed a baseline Kansas City Cardiomyopathy Questionnaire (KCCQ) and were randomized to either self-expanding TAVR or SAVR from 45 US clinical sites. Patients were enrolled from February 2011 to September 2012. Analysis began May 2018 and ended June 2020. Main Outcomes and Measures Change in KCCQ and the 12-Item Short-Form Health Survey over 5 years, as assessed by repeated-measures analysis of covariance. Because there were significant interactions between access site and treatment for 1-month health status outcomes, all analyses were stratified by access site (iliofemoral or noniliofemoral). Results Of 713 patients, 377 (53%) were men, and the mean (SD) age was 83 (7) years. Prior to treatment, the mean (SD) KCCQ overall summary score (range, 0-100; higher score indicated better health status) was 47 (23), indicating substantial health status impairment. Among surviving patients, the KCCQ overall summary score increased significantly in both groups with greater early benefit with iliofemoral TAVR than SAVR (1-month difference, 16.8 points; 95% CI, 12.4-21.2). However, this early treatment difference between TAVR and SAVR was no longer apparent by 6 months, and there was no significant difference in health status between groups thereafter. At 5 years, 44% (134 of 305) of patients who underwent iliofemoral TAVR and 39% (105 of 266) who underwent SAVR were alive in this high-risk elderly cohort. Among surviving patients for whom health status data were available, 61% (48 of 79) in the TAVR group and 65% (46 of 71) in the SAVR group had KCCQ overall summary score more than 60 (P = .61). In the noniliofemoral cohort, there were no significant health status differences at any time between TAVR and SAVR. Results were similar for individual KCCQ domains and the Short-Form Health Survey. Conclusions and Relevance In high-risk patients with severe symptomatic aortic stenosis, there was an early health status benefit with self-expanding iliofemoral TAVR vs SAVR but no difference between groups in long-term health status. Although mortality at 5 years was high in this population, the majority of surviving patients continued to report reasonable health status. Trial Registration ClinicalTrials.gov Identifier: NCT01240902.
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Affiliation(s)
- Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,University of Missouri-Kansas City, Kansas City
| | | | - Elizabeth A Magnuson
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,University of Missouri-Kansas City, Kansas City
| | | | | | - Thomas Gleason
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Yakubov SJ, Basuray A, Sanchez CS. Cardiac Efficiency: Who's Got the Power? Cardiovasc Revasc Med 2020; 21:1334-1335. [PMID: 32859537 DOI: 10.1016/j.carrev.2020.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Steven J Yakubov
- OhioHealth Physician Group, Columbus, OH, United States of America.
| | - Anupam Basuray
- OhioHealth Physician Group, Columbus, OH, United States of America.
| | - Carlos S Sanchez
- OhioHealth Physician Group, Columbus, OH, United States of America.
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Attizzani GF, Dallan LAP, Markowitz A, Yakubov SJ, Deeb GM, Reardon MJ, Forrest JK, Mangi AA, Huang J, Popma JJ. Impact of Repositioning on Outcomes Following Transcatheter Aortic Valve Replacement With a Self-Expandable Valve. JACC Cardiovasc Interv 2020; 13:1816-1824. [PMID: 32763073 DOI: 10.1016/j.jcin.2020.04.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 12/19/2019] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study sought to compare outcomes following transcatheter aortic valve replacement when valve repositioning was performed (repositioned group) versus procedures without repositioning (nonrepositioned group). BACKGROUND The Evolut R and Evolut PRO valves were designed to allow repositioning during deployment, yet the effect of repositioning on clinical outcomes remains unclear. METHODS Patients implanted with the Evolut R or PRO valve from the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial continued access study and the Evolut Low Risk Trial between June 2016 and November 2018 were combined. Baseline multidetector computed tomography data were analyzed for the Evolut Low Risk Trial patients. The primary outcomes were the rate of all-cause mortality and the rate of disabling stroke 30 days. Secondary outcomes were per Valve Academic Research Consortium-2. RESULTS The Evolut R or PRO valve was implanted in 946 patients, and repositioning was performed in 318 (33.6%). Compared with patients in the nonrepositioned group, patients in the repositioned group had lower Society of Thoracic Surgeons score (2.3 ± 1.3% vs. 2.6 ± 1.4%; p < 0.001) and fewer prior percutaneous coronary interventions (11.9% vs. 19.7%; p = 0.003). There were no differences in baseline multidetector computed tomography parameters between groups. There were no differences in the primary outcome of death (0.3% vs. 0.3%; p = 0.99) or disabling stroke (0.3% vs. 0.5%; p = 0.71) at 30 days or 1 year (1.9% vs. 2.9%; p = 0.44; and 0.8% vs. 0.9%%; p = 0.79, respectively). CONCLUSIONS The utilization of the repositioning feature of the Evolut valves was safe, and no differences in death or disabling stroke were observed at 30 days or 1 year between groups. (Medtronic Evolut Transcatheter Aortic Valve Replacement in Low Risk Patients; NCT02701283; Safety and Efficacy Study of the Medtronic CoreValve® System In the Treatment of Severe, Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement [SURTAVI]; NCT01586910).
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Affiliation(s)
- Guilherme F Attizzani
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| | - Luis Augusto P Dallan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Alan Markowitz
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Steven J Yakubov
- Department of Interventional Cardiology, OhioHealth Riverside Methodist, Columbus, Ohio
| | - G Michael Deeb
- Departments of Cardiac Surgery, University of Michigan Hospitals, Ann Arbor, Michigan
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - John K Forrest
- Departments of Internal Medicine (Cardiology) and Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Abeel A Mangi
- Departments of Internal Medicine (Cardiology) and Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Jian Huang
- Department of Biostatistics, Medtronic Statistical Services, Minneapolis, Minnesota
| | - Jeffrey J Popma
- Department of Interventional Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Reardon MJ, Heijmen RH, Van Mieghem NM, Williams MR, Yakubov SJ, Watson D, Kleiman NS, Conte J, Chawla A, Hockmuth D, Petrossian G, Robinson N, Kappetein AP, Li S, Popma JJ. Comparison of Outcomes After Transcatheter vs Surgical Aortic Valve Replacement Among Patients at Intermediate Operative Risk With a History of Coronary Artery Bypass Graft Surgery: A Post Hoc Analysis of the SURTAVI Randomized Clinical Trial. JAMA Cardiol 2020; 4:810-814. [PMID: 31215985 DOI: 10.1001/jamacardio.2019.1856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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 Surgical aortic valve replacement (SAVR) has increased risk for patients with aortic stenosis (AS) and a history of coronary artery bypass graft (CABG) surgery. Transcatheter aortic valve replacement (TAVR) may be an alternative. Objective To compare TAVR with SAVR outcomes in patients at intermediate operative risk with prior CABG surgery. Design, Setting, and Participants In this post hoc analysis of the Surgical Replacement and Transcatheter Aortic Valve Implantation (SURTAVI) noninferiority randomized clinical trial, patients with severe, symptomatic AS at intermediate operative risk were enrolled from 87 centers across the United States, Europe, and Canada from June 2012 to June 2016 and followed-up with up to July 2017. Those with a history of CABG surgery were considered for analysis. Data were analyzed from September to December 2017. Interventions A total of 1746 patients were enrolled and randomized 1:1 to self-expanding TAVR or SAVR. An implant was attempted in 1660 patients, of whom 273 had prior CABG surgery, including 136 who underwent attempted TAVR and 137 who underwent attempted SAVR. Main Outcomes and Measures The primary outcome was all-cause mortality or disabling stroke at 1-year follow-up. Efficacy outcomes included quality of life, measured using the Kansas City Cardiomyopathy Questionnaire at 30 days, 6 months, and 1 year, and distance walked in 6 minutes, measured using the 6-minute walk test at 30 days and 1 year. Results Of the 136 patients in the TAVR cohort, 111 (81.6%) were male, and the mean (SD) age was 76.9 (6.5) years; of the 137 in the SAVR cohort, 117 (85.4%) were male, and the mean (SD) age was 76.6 (6.5) years. The mean (SD) Society of Thoracic Surgeons Predicted Risk of Mortality score was 5.0% (1.6%) in the TAVR cohort and 5.2% (1.7%) in the SAVR cohort. All-cause mortality or disabling stroke at 1-year follow-up was 8.9% (95% CI, 5.2-15.2) in the TAVR cohort and 6.7% (95% CI, 3.5-12.8) in the SAVR cohort (log-rank P = .53). Compared with patients receiving SAVR, the mean (SD) Kansas City Cardiomyopathy Questionnaire summary score was significantly better among patients receiving TAVR at 30 days (81.4 [19.2] vs 69.7 [22.6]; P < .001); treatments were similar at 1 year (85.7 [14.6] vs 82.8 [18.4]; P = .19). Compared with patients in the SAVR cohort, those in the TAVR cohort showed greater mean (SD) improvement in distance walked at 1 year (48.3 [120.6] m vs 16.8 [88.7] m; P = .04). Conclusions and Relevance Both TAVR and SAVR were safe for intermediate-risk patients with AS and prior CABG surgery. The transcatheter approach facilitated faster improvement in quality of life and better exercise capacity at 1-year follow-up. Trial Registration ClinicalTrials.gov identifier: NCT01586910.
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Affiliation(s)
| | | | | | | | | | - Daniel Watson
- OhioHeath Riverside Methodist Hospital, Columbus, Ohio
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - John Conte
- The Johns Hopkins University, Baltimore, Maryland
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Tang GH, Yakubov SJ, Sanchez Soto CE. 4-Dimensional Intracardiac Echocardiography in Transcatheter Tricuspid Valve Repair With the MitraClip System. JACC Cardiovasc Imaging 2020; 13:1591-1600. [DOI: 10.1016/j.jcmg.2019.10.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/21/2019] [Accepted: 10/30/2019] [Indexed: 11/30/2022]
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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.
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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
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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.
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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
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Abstract
Left atrial appendage closure (LAAC) is a safe and effective therapy for the prevention of stroke in patients with nonvalvular atrial fibrillation and high bleeding risk with oral anticoagulants. Multimodality imaging with transesophageal echocardiography and computed tomography angiography to define the anatomy and its implications on endocardial exclusion is becoming increasingly important. The only LAAC device currently approved for clinical use in the United States is the WATCHMAN device. Systematic assessment of the transseptal crossing site, left atrial appendage anatomy, adequate device size selection, and device postdeployment evaluation is essential for the safety and efficacy of the procedure.
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Affiliation(s)
- Carlos E Sanchez
- Advanced Structural Heart Disease, OhioHealth Riverside Methodist Hospital, 3705 Olentangy River Road Suite 100, Columbus, OH 43214, USA.
| | - Steven J Yakubov
- OhioHealth Riverside Methodist Hospital, 3705 Olentangy River Road Suite 100, Columbus, OH 43214, USA
| | - Anish Amin
- OhioHealth Riverside Methodist Hospital, 3705 Olentangy River Road Suite 100, Columbus, OH 43214, USA
| | - Arash Arshi
- OhioHealth Riverside Methodist Hospital, 3705 Olentangy River Road Suite 100, Columbus, OH 43214, USA
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Arnold S, Chinnakondepalli K, Magnuson E, Reardon M, Popma JJ, Deeb GM, Gleason TG, Yakubov SJ, Cohen DJ. 5-YEAR HEALTH STATUS OUTCOMES AFTER SELF-EXPANDING TRANSCATHETER OR SURGICAL AORTIC VALVE REPLACEMENT IN HIGH-RISK PATIENTS WITH SEVERE AORTIC STENOSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31736-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Forrest JK, Kaple RK, Tang GH, Yakubov SJ, Nazif TM, Williams MR, Zhang A, Popma JJ, Reardon MJ. Three Generations of Self-Expanding Transcatheter Aortic Valves. JACC Cardiovasc Interv 2020; 13:170-179. [DOI: 10.1016/j.jcin.2019.08.035] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/30/2019] [Accepted: 08/20/2019] [Indexed: 11/26/2022]
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Søndergaard L, Popma JJ, Reardon MJ, Van Mieghem NM, Deeb GM, Kodali S, George I, Williams MR, Yakubov SJ, Kappetein AP, Serruys PW, Grube E, Schiltgen MB, Chang Y, Engstrøm T, Sorajja P, Sun B, Agarwal H, Langdon T, den Heijer P, Bentala M, O’Hair D, Bajwa T, Byrne T, Caskey M, Paulus B, Garrett E, Stoler R, Hebeler R, Khabbaz K, Scott Lim D, Bladergroen M, Fail P, Feinberg E, Rinaldi M, Skipper E, Chawla A, Hockmuth D, Makkar R, Cheng W, Aji J, Bowen F, Schreiber T, Henry S, Hengstenberg C, Bleiziffer S, Harrison JK, Hughes C, Joye J, Gaudiani V, Babaliaros V, Thourani V, Dauerman H, Schmoker J, Skelding K, Casale A, Kovac J, Spyt T, Seshiah P, Smith JM, McKay R, Hagberg R, Matthews R, Starnes V, O’Neill W, Paone G, García JMH, Such M, de la Tassa CM, Cortina JCL, Windecker S, Carrel T, Whisenant B, Doty J, Resar J, Conte J, Aharonian V, Pfeffer T, Rück A, Corbascio M, Blackman D, Kaul P, Kliger C, Brinster D, Teefy P, Kiaii B, Leya F, Bakhos M, Sandhu G, Pochettino A, Piazza N, de Varennes B, van Boven A, Boonstra P, Waksman R, Bafi A, Asgar A, Cartier R, Kipperman R, Brown J, Lin L, Rovin J, Sharma S, Adams D, Katz S, Hartman A, Al-Jilaihawi H, Crestanello J, Lilly S, Ghani M, Bodenhamer RM, Rajagopal V, Kauten J, Mumtaz M, Bachinsky W, Nickenig G, Welz A, Olsen P, Watson D, Chhatriwalla A, Allen K, Teirstein P, Tyner J, Mahoney P, Newton J, Merhi W, Keiser J, Yeung A, Miller C, Berg JT, Heijmen R, Petrossian G, Robinson N, Brecker S, Jahangiri M, Davis T, Batra S, Hermiller J, Heimansohn D, Radhakrishnan S, Fremes S, Maini B, Bethea B, Brown D, Ryan W, Kleiman N, Spies C, Lau J, Herrmann H, Bavaria J, Horlick E, Feindel C, Neumann FJ, Beyersdorf F, Binder R, Maisano F, Costa M, Markowitz A, Tadros P, Zorn G, de Marchena E, Salerno T, Chetcuti S, Labinz M, Ruel M, Lee JS, Gleason T, Ling F, Knight P, Robbins M, Ball S, Giacomini J, Burdon T, Applegate R, Kon N, Schwartz R, Schubach S, Forrest J, Mangi A. Comparison of a Complete Percutaneous Versus Surgical Approach to Aortic Valve Replacement and Revascularization in Patients at Intermediate Surgical Risk: Results From the Randomized SURTAVI Trial. Circulation 2019; 140:1296-1305. [PMID: 31476897 DOI: 10.1161/circulationaha.118.039564] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND For patients with severe aortic stenosis and coronary artery disease, the completely percutaneous approach to aortic valve replacement and revascularization has not been compared with the standard surgical approach. METHODS The prospective SURTAVI trial (Safety and Efficiency Study of the Medtronic CoreValve System in the Treatment of Severe, Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement) enrolled intermediate-risk patients with severe aortic stenosis from 87 centers in the United States, Canada, and Europe between June 2012 and June 2016. Complex coronary artery disease with SYNTAX score (Synergy Between PCI with Taxus and Cardiac Surgery Trial) >22 was an exclusion criterion. Patients were stratified according to the need for revascularization and then randomly assigned to treatment with transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). Patients assigned to revascularization in the TAVR group underwent percutaneous coronary intervention, whereas those in the SAVR group had coronary artery bypass grafting. The primary end point was the rate of all-cause mortality or disabling stroke at 2 years. RESULTS Of 1660 subjects with attempted aortic valve implants, 332 (20%) were assigned to revascularization. They had a higher Society of Thoracic Surgeons risk score for mortality (4.8±1.7% versus 4.4±1.5%; P<0.01) and were more likely to be male (65.1% versus 54.2%; P<0.01) than the 1328 patients not assigned to revascularization. After randomization to treatment, there were 169 patients undergoing TAVR and percutaneous coronary intervention, 163 patients undergoing SAVR and coronary artery bypass grafting, 695 patients undergoing TAVR, and 633 patients undergoing SAVR. No significant difference in the rate of the primary end point was found between TAVR and percutaneous coronary intervention and SAVR and coronary artery bypass grafting (16.0%; 95% CI, 11.1-22.9 versus 14.0%; 95% CI, 9.2-21.1; P=0.62), or between TAVR and SAVR (11.9%; 95% CI, 9.5-14.7 versus 12.3%; 95% CI, 9.8-15.4; P=0.76). CONCLUSIONS For patients at intermediate surgical risk with severe aortic stenosis and noncomplex coronary artery disease (SYNTAX score ≤22), a complete percutaneous approach of TAVR and percutaneous coronary intervention is a reasonable alternative to SAVR and coronary artery bypass grafting. CLINICAL TRIAL REGISTRATION URL: https://www. CLINICALTRIALS gov. Unique identifier: NCT01586910.
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Affiliation(s)
- Lars Søndergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (L.S., T.E.)
| | - Jeffrey J. Popma
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Michael J. Reardon
- Department of Cardiovascular Surgery, Methodist DeBakey Heart and Vascular Center, Houston, TX (M.J.R.)
| | - Nicolas M. Van Mieghem
- Departments of Cardiology and Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands (N.M.V.M., A.P.K.)
| | - G. Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor (G.M.D.)
| | - Susheel Kodali
- Department of Surgery, Columbia University Medical Center, New York (S.K., I.G.)
| | - Isaac George
- Department of Surgery, Columbia University Medical Center, New York (S.K., I.G.)
| | - Mathew R. Williams
- Departments of Medicine (Cardiology) and Cardiothoracic Surgery, NYU-Langone Medical Center, New York (M.R.W.)
| | - Steven J. Yakubov
- Department of Cardiology, OhioHealth Riverside Methodist Hospital, Columbus (S.J.Y.)
| | - Arie P. Kappetein
- Departments of Cardiology and Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands (N.M.V.M., A.P.K.)
- Structural Heart, Medtronic plc, Minneapolis, MN (A.P.K., M.B.S., Y.C.)
| | - Patrick W. Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Eberhard Grube
- Department of Medicine II, Heart Center Bonn, Germany (E.G.)
| | | | - Yanping Chang
- Structural Heart, Medtronic plc, Minneapolis, MN (A.P.K., M.B.S., Y.C.)
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (L.S., T.E.)
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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.
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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.)
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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.
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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.
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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.).
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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.)
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Yakubov SJ, Sanchez CE. Acute Coronary Syndrome in Transcatheter Aortic Valve Replacement: Defend the Coronary Circulation. JACC Cardiovasc Interv 2018; 11:2534-2536. [PMID: 30573062 DOI: 10.1016/j.jcin.2018.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/02/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Steven J Yakubov
- Department of Cardiology, OhioHealth, Riverside Methodist Hospital, Columbus, Ohio.
| | - Carlos E Sanchez
- Department of Cardiology, OhioHealth, Riverside Methodist Hospital, Columbus, Ohio
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Amrane H, Deeb GM, Popma JJ, Yakubov SJ, Gleason TG, Van Mieghem NM, Reardon MJ. Causes of death in intermediate-risk patients: The Randomized Surgical Replacement and Transcatheter Aortic Valve Implantation Trial. J Thorac Cardiovasc Surg 2018; 158:718-728.e3. [PMID: 30709668 DOI: 10.1016/j.jtcvs.2018.11.129] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 04/24/2018] [Revised: 10/31/2018] [Accepted: 11/05/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Examine the causes and timing of death in the Surgical Replacement and Transcatheter Aortic Valve Implantation intermediate-risk randomized trial for transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). METHODS Causes of death were adjudicated by an independent clinical event committee and by post-hoc hierarchical classification. Causes of death were evaluated and characteristics and procedural parameters compared between patients who died and survivors for 3 time periods: early (0-30 days), recovery (31-120 days), and late (121-365 days). RESULTS All-cause mortality at 1 year was 6.5% after TAVR and 6.7% after SAVR. There were no differences in mortality rates between TAVR and SAVR for any of the 3 time periods. Early mortality was primarily due to technical, procedure-related problems in TAVR and due to complications in SAVR. For TAVR and SAVR, most deaths during recovery were caused by complications. Other causes, including comorbid conditions, accounted for most late deaths. CONCLUSIONS Mortality rates were similar for patients treated with TAVR or SAVR at any time period including at 1 year. Early cause of death was more commonly technical failure after TAVR and due to complications after SAVR. Recovery phase cause of death was dominated by complications from TAVR and SAVR. Late cause of death appeared to be independent of the procedure in both groups.
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Affiliation(s)
- Hafid Amrane
- Department of Cardiac and Thoracic Surgery, Medisch Centrum Leeuwarden, The Netherlands
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan Hospitals, Ann Arbor, Mich
| | - Jeffrey J Popma
- Department of Interventional Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Steven J Yakubov
- Department of Interventional Cardiology; Riverside Methodist-Ohio Health, Columbus, Ohio
| | - Thomas G Gleason
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Eramus Medical Center, Rotterdam, The Netherlands
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex.
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