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Krishnan P, Farhan S, Zidar F, Krajcer Z, Metzger C, Kapadia S, Moore E, Nazif T, Garland T, Zhang M, Khera S, Sharafuddin M, Patel VI, Bacharach JM, Coady P, Schermerhorn ML, Shames ML, Rahimi S, Panneton JM, Elkins C, Foteh M. Cross-Seal IDE Trial: Prospective, Multicenter, Single-Arm Study of the Cross-Seal Suture-Mediated Vascular Closure Device System. Circ Cardiovasc Interv 2024:e013842. [PMID: 38708595 DOI: 10.1161/circinterventions.123.013842] [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: 11/15/2023] [Accepted: 03/06/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND An increasing number of interventional procedures require large-sheath technology (>12F) with a favorable outcome with endovascular rather than open surgical access. However, vascular complications are a limitation for the management of these patients. This trial aimed to determine the effectiveness and safety of the Cross-Seal suture-mediated vascular closure device in obtaining hemostasis at the target limb access site following interventional procedures using 8F to 18F procedural sheaths. METHODS The Cross-Seal IDE trial (Investigational Device Exemption) was a prospective, single-arm, multicenter study in subjects undergoing percutaneous endovascular procedures utilizing 8F to 18F ID procedural sheaths. The primary efficacy end point was time to hemostasis at the target limb access site. The primary safety end point was freedom from major complications of the target limb access site within 30 days post procedure. RESULTS A total of 147 subjects were enrolled between August 9, 2019, and March 12, 2020. Transcatheter aortic valve replacement was performed in 53.7% (79/147) and percutaneous endovascular abdominal/thoracic aortic aneurysm repair in 46.3% (68/147) of subjects. The mean sheath ID was 15.5±1.8 mm. The primary effectiveness end point of time to hemostasis was 0.4±1.4 minutes. An adjunctive intervention was required in 9.2% (13/142) of subjects, of which 2.1% (3/142) were surgical and 5.6% (8/142) endovascular. Technical success was achieved in 92.3% (131/142) of subjects. Freedom from major complications of the target limb access site was 94.3% (83/88). CONCLUSIONS In selected patients undergoing percutaneous endovascular procedures utilizing 8F to 18F ID procedural sheath, Cross-Seal suture-mediated vascular closure device achieved favorable effectiveness and safety in the closure of the large-bore arteriotomy. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03756558.
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Affiliation(s)
- Prakash Krishnan
- Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (P.K., S.F., S. Khera)
| | - Serdar Farhan
- Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (P.K., S.F., S. Khera)
| | - Frank Zidar
- Department of Cardiology, Austin Heart, TX (F.Z.)
| | - Zvonimir Krajcer
- Department of Vascular Surgery, Texas Heart Institute, Houston (Z.K.)
| | - Christopher Metzger
- Department of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.)
| | - Samir Kapadia
- Department of Cardiology, Cleveland Clinic, OH (S. Kapadia)
| | - Erin Moore
- Department of Vascular Surgery, River City Clinical Research, Jacksonville, FL (E.M.)
| | - Tamim Nazif
- Department of Cardiology, Columbia University, New York, NY (T.N.)
| | - Ty Garland
- Department of Vascular Surgery, Vascular Institute of the Rockies, Denver, CO (T.G.)
| | - Ming Zhang
- Department of Cardiology, Swedish Medical Center, Seattle, WA (M.Z.)
| | - Sahil Khera
- Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (P.K., S.F., S. Khera)
| | - Mel Sharafuddin
- Department of Vascular Surgery, University of Iowa, Iowa City (M.S.)
| | - Virendra I Patel
- New York Presbyterian, Columbia University, New York, NY (V.I.P.)
| | | | - Paul Coady
- Department of Cardiology, Lankenau Medical Center, Wynnewood, PA (P.C.)
| | - Marc L Schermerhorn
- Department of Vascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (M.L. Schermerhorn)
| | - Murray L Shames
- Department of Vascular Surgery, University of South Florida, Tampa (M.L. Shames)
| | - Saum Rahimi
- Department of Vascular Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (S.R.)
| | - Jean M Panneton
- Department of Vascular Surgery, Sentara Vascular Specialists, Norfolk, VA (J.P.)
| | - Craig Elkins
- Department of Vascular Surgery, INTEGRIS Baptist Medical Center, Oklahoma City, OK (C.E.)
| | - Mazin Foteh
- Department of Vascular Surgery, Cardiothoracic and Vascular Surgeons, Austin, TX (M.F.)
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2
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Guerrero ME, Bapat VN, Mahoney P, Krishnaswamy A, Eleid MF, Eng MH, Yadav P, Coylewright M, Makkar R, Szerlip M, Nazif T, Kodali S, George I, Greenbaum A, Babaliaros V, Kapadia S, Rihal CS, Whisenant B, Thourani VH, McCabe JM. Contemporary 1-Year Outcomes of Mitral Valve-in-Ring With Balloon-Expandable Aortic Transcatheter Valves in the U.S. JACC Cardiovasc Interv 2024; 17:874-886. [PMID: 38599690 DOI: 10.1016/j.jcin.2024.02.012] [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: 08/16/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Adequate valve performance after surgical mitral valve repair with an annuloplasty ring is not always sustained over time. The risk of repeat mitral valve surgery may be high in these patients. Transcatheter mitral valve-in-ring (MViR) is emerging as an alternative for high-risk patients. OBJECTIVES The authors sought to assess contemporary outcomes of MViR using third-generation balloon-expandable aortic transcatheter heart valves. METHODS Patients who underwent MViR and were enrolled in the STDS/ACC TVT (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy) Registry between August 2015 and December 2022 were analyzed. RESULTS A total of 820 patients underwent MViR at 236 sites, mean age was 72.2 ± 10.4 years, 50.9% were female, mean STS score was 8.2% ± 6.9%, and most (78%) were in NYHA functional class III to IV. Mean left ventricular ejection fraction was 47.8% ± 14.2%, mean mitral gradient was 8.9 ± 7.0 mm Hg, and 75.5% had ≥ moderate mitral regurgitation. Access was transseptal in 93.9% with 88% technical success. All-cause mortality at 30 days was 8.3%, and at 1 year, 22.4%, with a reintervention rate of 9.1%. At 1-year follow-up, 75.6% were NYHA functional class I to II, Kansas City Cardiomyopathy Questionnaire score increased by 25.9 ± 29.1 points, mean mitral valve gradient was 8.4 ± 3.4 mm Hg, and 91.7% had ≤ mild mitral regurgitation. CONCLUSIONS MViR with third-generation balloon-expandable aortic transcatheter heart valves is associated with a significant reduction in mitral regurgitation and improvement in symptoms at 1 year, but with elevated valvular gradients and a high reintervention rate. MViR is a reasonable alternative for high-risk patients unable undergo surgery who have appropriate anatomy for the procedure. (STS/ACC TVT Registry Mitral Module [TMVR]; NCT02245763).
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Affiliation(s)
- Mayra E Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Vinayak N Bapat
- Department of Cardiothoracic Surgery, Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Paul Mahoney
- Division of Cardiology, Department of Cardiovascular Services, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | | | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Marvin H Eng
- Division of Cardiology, Banner University Medical Center, Phoenix, Arizona, USA
| | - Pradeep Yadav
- Division of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Megan Coylewright
- Division of Cardiology Erlanger Health System, Chattanooga, Tennessee, USA
| | - Raj Makkar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Molly Szerlip
- Baylor Scott and White, The Heart Hospital, Plano, Texas, USA
| | - Tamim Nazif
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Susheel Kodali
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Isaac George
- Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Adam Greenbaum
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vasilis Babaliaros
- Emory Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian Whisenant
- Division of Cardiology, Intermountain Heart Institute, Salt Lake City, Utah, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - James M McCabe
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
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3
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Gupta A, Mori M, Wang Y, Pawar SG, Vahl T, Nazif T, Onuma O, Yong CM, Sharma R, Kirtane AJ, Forrest JK, George I, Kodali S, Chikwe J, Geirsson A, Makkar R, Leon MB, Krumholz HM. Racial/Ethnic Disparities in Aortic Valve Replacement Among Medicare Beneficiaries in the United States, 2012-2019. Am J Med 2024; 137:321-330.e7. [PMID: 38190959 PMCID: PMC11019903 DOI: 10.1016/j.amjmed.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE There are concerns that transcatheter or surgical aortic valve replacement (TAVR/SAVR) procedures are preferentially available to White patients. Our objective was to examine differences in utilization of aortic valve replacement and outcomes by race/ethnicity in the US for patients with aortic stenosis. METHODS We performed a serial cross-sectional cohort study of 299,976 Medicare beneficiaries hospitalized with principal diagnosis of aortic stenosis between 2012 and 2019 stratified by self-reported race/ethnicity (Black, Hispanic, Asian, Native American, and White). Outcomes included aortic valve replacement rates within 6 months of index hospitalization and associated procedural outcomes, including 30-day readmission, 30-day and 1-year mortality. RESULTS Within 6 months of an index admission for aortic stenosis, 86.8% (122,457 SAVR; 138,026 TAVR) patients underwent aortic valve replacement. Overall, compared with White people, Black (HR 0.87 [0.85-0.89]), Hispanic (0.92 [0.88-0.96]), and Asian (0.95 [0.91-0.99]) people were less likely to receive aortic valve replacement. Among patients who were admitted emergently/urgently, White patients (41.1%, 95% CI, 40.7-41.4) had a significantly higher aortic valve replacement rate compared with Black (29.6%, 95% CI, 28.3-30.9), Hispanic (36.6%, 95% CI, 34.0-39.3), and Asian patients (35.4%, 95% CI, 32.3-38.9). Aortic valve replacement rates increased annually for all race/ethnicities. There were no significant differences in 30-day or 1-year mortality by race/ethnicity. CONCLUSIONS Aortic valve replacement rates within 6 months of aortic stenosis admission are lower for Black, Hispanic, and Asian people compared to White people. These race-related differences in aortic stenosis treatment reflect complex issues in diagnosis and management, warranting a comprehensive reassessment of the entire care spectrum for disadvantaged populations.
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Affiliation(s)
- Aakriti Gupta
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn
| | - Makoto Mori
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Division of Cardiac Surgery, Yale School of Medicine, New Haven, Conn
| | - Yun Wang
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Division of Cardiology, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Shubhadarshini G Pawar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Torsten Vahl
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Tamim Nazif
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Oyere Onuma
- Division of Cardiology, Department of Medicine, Yale University School of Medicine, New Haven, Conn
| | - Celina M Yong
- Division of Cardiology, Department of Medicine, Stanford Medical Center, California and Veterans Affairs Palo Alto Healthcare System, Palo Alto
| | - Rahul Sharma
- Division of Cardiology, Department of Medicine, Stanford Medical Center, California and Veterans Affairs Palo Alto Healthcare System, Palo Alto
| | - Ajay J Kirtane
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - John K Forrest
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Isaac George
- Cardiothoracic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Susheel Kodali
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Conn
| | - Raj Makkar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Martin B Leon
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT; Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn.
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4
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Vora AN, Gada H, Manandhar P, Kosinski A, Kirtane A, Nazif T, Reardon M, Kodali S, Cohen DJ, Thourani V, Sherwood M, Julien H, Vemulapalli S. National Variability in Pacemaker Implantation Rate Following TAVR: Insights From the STS/ACC TVT Registry. JACC Cardiovasc Interv 2024; 17:391-401. [PMID: 38355267 DOI: 10.1016/j.jcin.2023.12.005] [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: 07/04/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Although permanent pacemaker (PPM) implantation is a common complication of transcatheter aortic valve replacement (TAVR), hospital variation and change in PPM implantation rates are ill defined. OBJECTIVES The aim of this study was to determine hospital-level variation and temporal trends in the rate of PPM implantation following TAVR. METHODS Using the American College of Cardiology/Society of Thoracic Surgeons TVT (Transcatheter Valve Therapy) Registry, temporal changes in variation of in-hospital and 30-day PPM implantation were determined among 184,452 TAVR procedures across 653 sites performed from 2016 to 2020. The variation in PPM implantation adjusted for valve type by annualized TAVR volume was determined, and characteristics of sites below, within, and above the 95% boundary were identified. A series of stepwise multivariable hierarchical models were then fit, and the median OR was used to measure variation in pacemaker rates among sites. RESULTS From 2016 to 2020, the overall rate of PPM implantation was 11.3%, with wide variation across sites (range: 0%-36.4%); rates trended lower over time. Adjusted for annualized volume, there were 34 sites with PPM implantation rates above the 95th percentile CI and 28 with rates below, with wide variation among the remaining sites. After adjusting for patient-level covariates, there was variation among sites in the probability of PPM implantation (median OR: 1.39; 95% CI: 1.35-1.43, P < 0.001); although some of the variation was explained by the addition of valve type, residual variation in PPM implantation rates persisted in additional models incorporating site-level covariates (annualized volume, region, teaching status, hospital beds, etc). CONCLUSIONS Although PPM implantation rates have decreased over time, substantial site-level variation remains even after accounting for observed patient characteristics and site-level factors. As there are numerous outlier sites both above and below the 95% confidence limit, dissemination of best practices from high-performing sites to low-performing sites and guideline-based education may be important quality improvement initiatives to reduce rates of this common complication.
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Affiliation(s)
- Amit N Vora
- UPMC Pinnacle Heart and Vascular Institute, Harrisburg, Pennsylvania, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA; Yale University School of Medicine, New Haven, CT.
| | - Hemal Gada
- UPMC Pinnacle Heart and Vascular Institute, Harrisburg, Pennsylvania, USA
| | - Pratik Manandhar
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Andrezej Kosinski
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Ajay Kirtane
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Tamim Nazif
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Michael Reardon
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Susheel Kodali
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | | | | | | | - Howard Julien
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
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5
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Dershowitz L, Lawlor MK, Hamid N, Kampaktsis P, Ning Y, Vahl TP, Nazif T, Khalique O, Ng V, Kurlansky P, Leon M, Hahn R, Kodali S, George I. Right ventricular remodeling and clinical outcomes following transcatheter tricuspid valve intervention. Catheter Cardiovasc Interv 2024; 103:367-375. [PMID: 37890014 DOI: 10.1002/ccd.30850] [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: 04/07/2023] [Revised: 08/20/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023]
Abstract
AIMS Characterize the impact of residual tricuspid regurgitation (TR) on right ventricle (RV) remodeling and clinical outcomes after transcatheter tricuspid valve intervention. METHODS We performed a single-center retrospective analysis of transcatheter tricuspid valve repair (TTVr) or replacement (TTVR) patients. The primary outcomes were longitudinal tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), pulmonary artery systolic pressure (PASP), and RV dimensions (RVd). We used multivariable linear mixed models to evaluate association with replacement versus repair and degree of TR reduction with changes in these echo measures over time. Multivariable Cox regression was used to identify associations between changes in these echo measures and a composite clinical outcome of death, heart failure hospitalization, or re-do tricuspid valve intervention. RESULTS We included a total of 61 patients; mean age was 77.5 ± 11.7 and 62% were female. TTVR was performed in 25 (41%) and TTVr in 36 (59%). Initially, 72% (n = 44) had ≤ severe TR and 28% (n = 17) had massive or torrential TR. The median number of follow up echos was 2: time to 1st follow-up was 50 days (interquartile range [IQR]: 20, 91) and last follow-up was 147 (IQR: 90, 327). Median TR reduction was 1 (IQR: 0, 2) versus 4 (IQR: 3, 6) grades in TTVr versus TTVR (p < 0.0001). In linear mixed modeling, TTVR was associated with decline in TAPSE and PASP, and TR reduction was associated with decreased RVd. In multivariable Cox regression, greater RVd was associated with the clinical outcome (hazard ratio: 9.27, 95% confidence interval: 1.23-69.88, p = 0.03). CONCLUSION Greater TR reduction is achieved by TTVR versus TTVr, which is in turn associated with RV reverse remodeling. RV dimension in follow-up is associated with increased risk of a composite outcome of death, heart failure hospitalization, or re-do tricuspid valve intervention.
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Affiliation(s)
- Lyle Dershowitz
- Division of Internal Medicine, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Matthew K Lawlor
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Nadira Hamid
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Polydoros Kampaktsis
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Yuming Ning
- Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York City, New York, USA
| | - Torsten P Vahl
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Tamim Nazif
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Omar Khalique
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Vivian Ng
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Paul Kurlansky
- Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York City, New York, USA
| | - Martin Leon
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Rebecca Hahn
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Susheel Kodali
- Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
| | - Isaac George
- Structural Heart & Valve Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA
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Avram R, Byrne J, So D, Iturriaga E, Lennon R, Murthy V, Geller N, Goodman S, Rihal C, Rosenberg Y, Bailey K, Farkouh M, Bell M, Cagin C, Chavez I, El-Hajjar M, Ginete W, Lerman A, Levisay J, Marzo K, Nazif T, Tanguay JF, Pletcher M, Marcus GM, Pereira NL, Olgin J. Digital Tool-Assisted Hospitalization Detection in the Tailored Antiplatelet Initiation to Lessen Outcomes due to Decreased Clopidogrel Response After Percutaneous Coronary Intervention Study Compared to Traditional Site-Coordinator Ascertainment: Intervention Study. J Med Internet Res 2023; 25:e47475. [PMID: 37948098 PMCID: PMC10674150 DOI: 10.2196/47475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/12/2023] [Accepted: 09/11/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Accurate, timely ascertainment of clinical end points, particularly hospitalizations, is crucial for clinical trials. The Tailored Antiplatelet Initiation to Lessen Outcomes Due to Decreased Clopidogrel Response after Percutaneous Coronary Intervention (TAILOR-PCI) Digital Study extended the main TAILOR-PCI trial's follow-up to 2 years, using a smartphone-based research app featuring geofencing-triggered surveys and routine monthly mobile phone surveys to detect cardiovascular (CV) hospitalizations. This pilot study compared these digital tools to conventional site-coordinator ascertainment of CV hospitalizations. OBJECTIVE The objectives were to evaluate geofencing-triggered notifications and routine monthly mobile phone surveys' performance in detecting CV hospitalizations compared to telephone visits and health record reviews by study coordinators at each site. METHODS US and Canadian participants from the TAILOR-PCI Digital Follow-Up Study were invited to download the Eureka Research Platform mobile app, opting in for location tracking using geofencing, triggering a smartphone-based survey if near a hospital for ≥4 hours. Participants were sent monthly notifications for CV hospitalization surveys. RESULTS From 85 participants who consented to the Digital Study, downloaded the mobile app, and had not previously completed their final follow-up visit, 73 (85.8%) initially opted in and consented to geofencing. There were 9 CV hospitalizations ascertained by study coordinators among 5 patients, whereas 8 out of 9 (88.9%) were detected by routine monthly hospitalization surveys. One CV hospitalization went undetected by the survey as it occurred within two weeks of the previous event, and the survey only allowed reporting of a single hospitalization. Among these, 3 were also detected by the geofencing algorithm, but 6 out of 9 (66.7%) were missed by geofencing: 1 occurred in a participant who never consented to geofencing, while 5 hospitalizations occurred among participants who had subsequently turned off geofencing prior to their hospitalization. Geofencing-detected hospitalizations were ascertained within a median of 2 (IQR 1-3) days, monthly surveys within 11 (IQR 6.5-25) days, and site coordinator methods within 38 (IQR 9-105) days. The geofencing algorithm triggered 245 notifications among 39 participants, with 128 (52.2%) from true hospital presence and 117 (47.8%) from nonhospital health care facility visits. Additional geofencing iterative improvements to reduce hospital misidentification were made to the algorithm at months 7 and 12, elevating the rate of true alerts from 35.4% (55 true alerts/155 total alerts before month 7) to 78.7% (59 true alerts/75 total alerts in months 7-12) and ultimately to 93.3% (14 true alerts/5 total alerts in months 13-21), respectively. CONCLUSIONS The monthly digital survey detected most CV hospitalizations, while the geofencing survey enabled earlier detection but did not offer incremental value beyond traditional tools. Digital tools could potentially reduce the burden on study coordinators in ascertaining CV hospitalizations. The advantages of timely reporting via geofencing should be weighed against the issue of false notifications, which can be mitigated through algorithmic refinements.
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Affiliation(s)
- Robert Avram
- University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Montréal Heart Institute, Université de Montreal, Montréal, QC, Canada
| | - Julia Byrne
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Derek So
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Erin Iturriaga
- University of Ottawa Heart Institute, Ottawa, MD, United States
| | - Ryan Lennon
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Vishakantha Murthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Nancy Geller
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Shaun Goodman
- St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Charanjit Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Yves Rosenberg
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Kent Bailey
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | | | - Malcolm Bell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Charles Cagin
- Mayo Clinic Health Systems, La Crosse, WI, United States
| | - Ivan Chavez
- Minneapolis Heart Institute, Minneapolis, MN, United States
| | | | - Wilson Ginete
- Essentia Institute of Rural Health, Duluth, MN, United States
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Justin Levisay
- NorthShore University Health System, Evanston, IL, United States
| | - Kevin Marzo
- Winthrop University Hospital, Mineola, NY, United States
| | - Tamim Nazif
- Columbia University Medical Center, New York, NY, United States
| | | | - Mark Pletcher
- University of California San Francisco, San Francisco, CA, United States
| | - Gregory M Marcus
- University of California San Francisco, San Francisco, CA, United States
| | - Naveen L Pereira
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jeffrey Olgin
- University of California San Francisco, San Francisco, CA, United States
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Blusztein D, Raney A, Walsh J, Nazif T, Woods C, Daniels D. Best Practices in Left Ventricular Pacing for Transcatheter Aortic Valve Replacement. Struct Heart 2023; 7:100213. [PMID: 38046859 PMCID: PMC10692352 DOI: 10.1016/j.shj.2023.100213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/12/2023] [Accepted: 06/22/2023] [Indexed: 12/05/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is continually evolving, with a recent emphasis on a "minimalist" approach toward reducing procedural invasiveness, duration, and recovery time. Whereas a better understanding of the relationship between TAVR and new conduction disturbances has led to improved periprocedural management, intraprocedural rapid-pacing techniques have not evolved beyond traditional right ventricular temporary pacing. An alternative strategy utilizing the left ventricular guidewire for rapid pacing has been developed with evidence supporting its safety, effectiveness, and potential reductions in procedure time and cost. This review will outline the current best practices in left ventricular pacing for TAVR, a practical technique that embraces the minimalist approach to TAVR and may be considered for routine use. It aims to explore the current evidence and combine this with expert opinion to offer a strategy for temporary pacing that encourages efficiencies for physicians and patients without compromising periprocedural safety.
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Affiliation(s)
- David Blusztein
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Aidan Raney
- Division of Cardiology, St. Joseph Hospital, Orange, California, USA
| | - Joe Walsh
- Division of Cardiology, St. Alphonsus Health System, Boise, Idaho, USA
| | - Tamim Nazif
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Christopher Woods
- Division of Cardiology, California Pacific Medical Center, San Francisco, California, USA
| | - David Daniels
- Division of Cardiology, California Pacific Medical Center, San Francisco, California, USA
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Lawlor MK, Ng V, Ahmed S, Dershowitz L, Brener MI, Kampaktsis P, Pitts A, Vahl T, Nazif T, Leon M, George I, Hahn RT, Kodali S. Baseline Characteristics and Clinical Outcomes of a Tricuspid Regurgitation Referral Population. Am J Cardiol 2023; 196:22-30. [PMID: 37058874 DOI: 10.1016/j.amjcard.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 02/22/2023] [Accepted: 03/08/2023] [Indexed: 04/16/2023]
Abstract
Adverse outcomes in tricuspid regurgitation (TR) have been associated with advanced regurgitation severity and right-sided cardiac remodeling, and late referrals for tricuspid valve surgery in TR have been associated with increase in postoperative mortality. The purpose of this study was to evaluate baseline characteristics, clinical outcomes, and procedural utilization of a TR referral population. We analyzed patients with a diagnosis of TR referred to a large TR referral center between 2016 and 2020. We evaluated baseline characteristics stratified by TR severity and analyzed time-to-event outcomes for a composite of overall mortality or heart-failure hospitalization. In total, 408 patients were referred with a diagnosis of TR: the median age of the cohort was 79 years (interquartile range 70 to 84), and 56% were female. In patients evaluated on a 5-grade scale, 10.2% had ≤moderate TR; 30.7% had severe TR; 11.4% had massive TR, and 47.7% had torrential TR. Increasing TR severity was associated with right-sided cardiac remodeling and altered right ventricular hemodynamics. In multivariable Cox regression analysis, New York Heart Association class symptoms, history of heart failure hospitalization, and right atrial pressure were associated with the composite outcome. One-third of patients referred underwent transcatheter tricuspid valve intervention (19%) or surgery (14%); patients who underwent transcatheter tricuspid valve intervention had greater preoperative risk than that of patients who underwent surgery. In conclusion, in patients referred for evaluation of TR, there were high rates of massive and torrential regurgitation and advanced right ventricle remodeling. Symptoms and right atrial pressure are associated with clinical outcomes in follow-up. There were significant differences in baseline procedural risk and eventual therapeutic modality.
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Affiliation(s)
| | - Vivian Ng
- Division of Cardiology; Structural Heart and Valve Center
| | | | | | | | | | - Amy Pitts
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Torsten Vahl
- Division of Cardiology; Structural Heart and Valve Center
| | - Tamim Nazif
- Division of Cardiology; Structural Heart and Valve Center
| | - Martin Leon
- Division of Cardiology; Structural Heart and Valve Center; Cardiovascular Research Foundation, New York, New York
| | - Isaac George
- Structural Heart and Valve Center; Division of Cardiothoracic & Vascular Surgery, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York
| | - Rebecca T Hahn
- Division of Cardiology; Structural Heart and Valve Center; Cardiovascular Research Foundation, New York, New York
| | - Susheel Kodali
- Division of Cardiology; Structural Heart and Valve Center.
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9
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Ranard LS, Lebehn M, Ng V, Nazif T, Hahn RT, George I, Leon MB, Granada JF, Kodali SK, Vahl TP. Iatrogenic Atrial Septal Defects After Transseptal Transcatheter Mitral Valve Replacement With a Balloon-Expandable Valve. JACC Cardiovasc Interv 2023; 16:621-623. [PMID: 36764914 DOI: 10.1016/j.jcin.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 02/10/2023]
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10
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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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11
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Lawlor M, Ng VG, Ahmed S, Dershowitz L, Brener M, Kampaktsis P, Pitts A, Vahl TP, Nazif T, Leon MB, George I, Hahn RT, Kodali SK. RIGHT ATRIAL PRESSURE IN PULMONARY HYPERTENSION ASSESSMENT IN TRICUSPID REGURGITATION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02414-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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12
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Ranard LS, Khalique OK, Lebehn M, Agarwal V, Nazif T, Ng VG, George I, Hahn RT, Kodali SK, Leon MB, Vahl TP. CARDIAC CT PLANNING TO ACHIEVE COMMISSURAL ALIGNMENT WITH THE JENAVALVE TRILOGY TRANSCATHETER AORTIC VALVE DELIVERY SYSTEM. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01516-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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13
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Elias P, Poterucha TJ, Rajaram V, Moller LM, Rodriguez V, Bhave S, Hahn RT, Tison G, Abreau SA, Barrios J, Torres JN, Hughes JW, Perez MV, Finer J, Kodali S, Khalique O, Hamid N, Schwartz A, Homma S, Kumaraiah D, Cohen DJ, Maurer MS, Einstein AJ, Nazif T, Leon MB, Perotte AJ. Deep Learning Electrocardiographic Analysis for Detection of Left-Sided Valvular Heart Disease. J Am Coll Cardiol 2022; 80:613-626. [PMID: 35926935 DOI: 10.1016/j.jacc.2022.05.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 03/21/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Valvular heart disease is an important contributor to cardiovascular morbidity and mortality and remains underdiagnosed. Deep learning analysis of electrocardiography (ECG) may be useful in detecting aortic stenosis (AS), aortic regurgitation (AR), and mitral regurgitation (MR). OBJECTIVES This study aimed to develop ECG deep learning algorithms to identify moderate or severe AS, AR, and MR alone and in combination. METHODS A total of 77,163 patients undergoing ECG within 1 year before echocardiography from 2005-2021 were identified and split into train (n = 43,165), validation (n = 12,950), and test sets (n = 21,048; 7.8% with any of AS, AR, or MR). Model performance was assessed using area under the receiver-operating characteristic (AU-ROC) and precision-recall curves. Outside validation was conducted on an independent data set. Test accuracy was modeled using different disease prevalence levels to simulate screening efficacy using the deep learning model. RESULTS The deep learning algorithm model accuracy was as follows: AS (AU-ROC: 0.88), AR (AU-ROC: 0.77), MR (AU-ROC: 0.83), and any of AS, AR, or MR (AU-ROC: 0.84; sensitivity 78%, specificity 73%) with similar accuracy in external validation. In screening program modeling, test characteristics were dependent on underlying prevalence and selected sensitivity levels. At a prevalence of 7.8%, the positive and negative predictive values were 20% and 97.6%, respectively. CONCLUSIONS Deep learning analysis of the ECG can accurately detect AS, AR, and MR in this multicenter cohort and may serve as the basis for the development of a valvular heart disease screening program.
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Affiliation(s)
- Pierre Elias
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Timothy J Poterucha
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Vijay Rajaram
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Luca Matos Moller
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Victor Rodriguez
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Shreyas Bhave
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Rebecca T Hahn
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Geoffrey Tison
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Sean A Abreau
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Joshua Barrios
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | | | - J Weston Hughes
- Division of Cardiology, Stanford University, Palo Alto, California, USA
| | - Marco V Perez
- Division of Cardiology, Stanford University, Palo Alto, California, USA
| | - Joshua Finer
- NewYork-Presbyterian Hospital, New York, New York, USA
| | - Susheel Kodali
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Omar Khalique
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Nadira Hamid
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Allan Schwartz
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Shunichi Homma
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Deepa Kumaraiah
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Mathew S Maurer
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Andrew J Einstein
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Tamim Nazif
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Martin B Leon
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Adler J Perotte
- Department of Biomedical Informatics, Columbia University, New York, New York, USA.
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14
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Bernardi FLDM, Ribeiro HB, Nombela-Franco L, Cerrato E, Maluenda G, Nazif T, Lemos PA, Sztejfman M, Lamelas P, Echeverri D, Lopes MACQ, Brito FSD, Abizaid AA, Mangione JA, Eltchaninoff H, Søndergaard L, Rodes-Cabau J. Evolução e Estado Atual das Práticas de Implante Transcateter de Válvula Aórtica na América Latina – Estudo WRITTEN LATAM. Arq Bras Cardiol 2022; 118:1085-1096. [PMID: 35703645 PMCID: PMC9345155 DOI: 10.36660/abc.20210327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 09/01/2021] [Indexed: 12/25/2022] Open
Abstract
Fundamento: Implante transcateter de valva aórtica (TAVI) é um procedimento adotado em todo o mundo e suas práticas evoluem rapidamente. Variações regionais e temporais são esperadas. Objetivo: Comparar a prática de TAVI na América Latina com aquela no resto do mundo e avaliar suas mudanças na América Latina de 2015 a 2020. Método: A pesquisa foi realizada em centros de TAVI em todo o mundo entre março e setembro de 2015, e novamente nos centros latino-americanos entre julho de 2019 e janeiro de 2020. As seguintes questões foram abordadas: i) informação geral sobre os centros; ii) avaliação pré-TAVI; iii) técnicas do procedimento; iv) conduta pós-TAVI; v) seguimento. As respostas da pesquisa dos centros latino-americanos em 2015 (LATAM15) foram comparadas àquelas dos centros no resto do mundo (WORLD15) e ainda àquelas da pesquisa dos centros latino-americanos de 2020 (LATAM20). Adotou-se o nível de significância de 5% na análise estatística. Resultados: 250 centros participaram da pesquisa em 2015 (LATAM15=29; WORLD15=221) e 46 na avaliação LATAM20. No total, foram 73.707 procedimentos, sendo que os centros WORLD15 realizaram, em média, 6 e 3 vezes mais procedimentos do que os centros LATAM15 e LATAM20, respectivamente. Os centros latino-americanos realizaram menor número de TAVI minimalista do que os do restante do mundo, mas aumentaram significativamente os procedimentos menos invasivos após 5 anos. Quanto à assistência pós-procedimento, observaram-se menor tempo de telemetria e de manutenção do marca-passo temporário, além de menor uso de terapia dupla antiplaquetária nos centros LATAM20. Conclusão: A despeito do volume de procedimentos ainda significativamente menor, muitos aspectos da prática de TAVI nos centros latino-americanos evoluíram recentemente, acompanhando a tendência dos centros dos países desenvolvidos.
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15
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Shahim B, Redfors B, Lindman BR, Chen S, Dahlen T, Nazif T, Kapadia S, Gertz ZM, Crowley AC, Li D, Thourani VH, Kodali SK, Zajarias A, Babaliaros VC, Guyton RA, Elmariah S, Herrmann HC, Cohen DJ, Mack MJ, Smith CR, Leon MB, George I. Neutrophil-to-Lymphocyte Ratios in Patients Undergoing Aortic Valve Replacement: The PARTNER Trials and Registries. J Am Heart Assoc 2022; 11:e024091. [PMID: 35656983 PMCID: PMC9238729 DOI: 10.1161/jaha.121.024091] [Citation(s) in RCA: 8] [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 The neutrophil‐to‐lymphocyte ratio (NLR) as a marker of systemic inflammation has been associated with worse prognosis in several chronic disease states, including heart failure. However, few data exist on the prognostic impact of elevated baseline NLR or change in NLR levels during follow‐up in patients undergoing transcatheter or surgical aortic valve replacement (TAVR or SAVR) for aortic stenosis. Methods and Results NLR was available in 5881 patients with severe aortic stenosis receiving TAVR or SAVR in PARTNER (Placement of Aortic Transcatheter Valves) I, II, and S3 trials/registries (median [Q1, Q3] NLR, 3.30 [2.40, 4.90]); mean NLR, 4.10; range, 0.5–24.9) and was evaluated as continuous variable and categorical tertiles (low: NLR ≤2.70, n=1963; intermediate: NLR 2.70–4.20, n=1958; high: NLR ≥4.20, n=1960). No patients had known baseline infection. High baseline NLR was associated with increased risk of death or rehospitalization at 3 years (58.4% versus 41.0%; adjusted hazard ratio [aHR], 1.39; 95% CI, 1.18–1.63; P<0.0001) compared with those with low NLR, irrespective of treatment modality. In both patients treated with TAVR and patients treated with SAVR, NLR decreased between baseline and 2 years. A 1‐unit observed decrease in NLR between baseline and 1 year was associated with lower risk of death or rehospitalization between 1 year and 3 years (aHR, 0.86; 95% CI, 0.82–0.89; P<0.0001). Conclusions Elevated baseline NLR was independently associated with increased subsequent mortality and rehospitalization after TAVR or SAVR. The observed decrease in NLR after TAVR or SAVR was associated with improved outcomes. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00530894, NCT0134313, NCT02184442, NCT03225001, NCT0322141.
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Affiliation(s)
- Bahira Shahim
- Clinical Trials Center Cardiovascular Research Foundation New York NY
| | - Björn Redfors
- Clinical Trials Center Cardiovascular Research Foundation New York NY.,Division of Cardiology NewYork-Presbyterian Hospital/Columbia University Medical Center New York NY
| | - Brian R Lindman
- Structural Heart and Valve CenterVanderbilt University Medical Center Nashville TN
| | - Shmuel Chen
- Clinical Trials Center Cardiovascular Research Foundation New York NY.,Division of Cardiology NewYork-Presbyterian Hospital/Columbia University Medical Center New York NY
| | - Torsten Dahlen
- Department of Medicine Karolinska Institutet Solna Sweden
| | - Tamim Nazif
- Division of Cardiology NewYork-Presbyterian Hospital/Columbia University Medical Center New York NY
| | | | | | - Aaron C Crowley
- Clinical Trials Center Cardiovascular Research Foundation New York NY
| | - Ditian Li
- Clinical Trials Center Cardiovascular Research Foundation New York NY
| | - Vinod H Thourani
- Department of Cardiovascular Surgery Marcus Valve CenterPiedmont Heart Institute Atlanta GA
| | - Susheel K Kodali
- Division of Cardiology NewYork-Presbyterian Hospital/Columbia University Medical Center New York NY
| | - Alan Zajarias
- Washington University School of Medicine St. Louis MO
| | | | | | - Sammy Elmariah
- Massachussetts General Hospital and Harvard Medical School Boston MA
| | | | - David J Cohen
- Clinical Trials Center Cardiovascular Research Foundation New York NY.,St. Francis Hospital Roslyn NY
| | - Michael J Mack
- Baylor Scott & White Health The Heart Hospital Plano Plano TX
| | - Craig R Smith
- Division of Cardiology NewYork-Presbyterian Hospital/Columbia University Medical Center New York NY
| | - Martin B Leon
- Clinical Trials Center Cardiovascular Research Foundation New York NY.,Division of Cardiology NewYork-Presbyterian Hospital/Columbia University Medical Center New York NY
| | - Isaac George
- Division of Cardiology NewYork-Presbyterian Hospital/Columbia University Medical Center New York NY
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16
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Cahill TJ, Nazif T, Vahl T, Kodali S, Ng VG. Balloon-Assisted Perclose Suture Delivery for Large-Bore Vascular Access Closure After Transcatheter Aortic Valve Replacement. Struct Heart 2022; 6:100031. [PMID: 37273740 PMCID: PMC10236898 DOI: 10.1016/j.shj.2022.100031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/01/2022] [Accepted: 03/28/2022] [Indexed: 06/06/2023]
Affiliation(s)
| | | | | | | | - Vivian G. Ng
- Address correspondence to: Vivian G. Ng, MD, Structural Heart & Valve Center, NYP/Columbia University Medical Center, 177 Fort Washington Ave., 5th Floor, Room 5C-501, New York, NY 10032
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17
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Ben-Ami J, Madhavan M, Flattery E, Nazif T, Moses JW, Prasad M. BALLOON ASSISTED VALVULOPLASTY FOLLOWED BY IMPELLA PLACEMENT FOR HIGH-RISK PERCUTANEOUS CORONARY INTERVENTION IS FEASIBLE AND SAFE IN NONEMERGENT CASES. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02151-9] [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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18
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Tat E, Hamid N, Khalique O, Lehenbauer K, Sitticharoenchai P, Nazif T, Vahl T, Ng V, George I, Cahill T, Blusztein D, Mihatov N, Leon M, Kodali SK, Hahn RT. Impact of regurgitant orifice ellipticity on quantitation of tricuspid regurgitation using the proximal isovelocity surface area method. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.375] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The proximal isovelocity surface area (PISA) method to quantify tricuspid regurgitation (TR) severity relies on the geometric assumption of a circular, planar regurgitant orifice. However, the TR orifice is often non-circular resulting in underestimation of TR severity when calculating the effective regurgitant orifice area (EROA) and regurgitant volume (RegVol).
Purpose
To evaluate the effect of ellipticity of the tricuspid annulus on EROA-PISA correlation with quantitative Doppler (EROA-Dopp), and three-dimensional vena contracta area (VCA-3D).
Methods
Patients undergoing both transthoracic (TTE) and transesophageal (TEE) echo evaluation of TR severity were included in this study. Regurgitant orifice ellipticity was calculated as the ratio of the vena contracta maximum and minimum widths (VC-Ratio). Quantification of EROA and RegVol were performed on TTE for EROA-PISA and EROA-Dopp. Vena contract area was measured on TEE (VCA-3D).
Results
Of 44 total pts, the median age was 80 ± 9, 61% were female, 89% had atrial fibrillation, (86%) had functional TR, 32% were graded as severe, and 71% had a EROA-PISA ≥ 0.4 cm2. Median VC-Ratio was 1.3 (IQR 1.1-1.8) and was used to differentiate more circular orifices (VC-Ratio <1.3) from more elliptical orifices (VC-Ratio ≥1.3) (Table). EROA-PISA was significantly smaller compared to EROA-Dopp and VCA-3D in the whole group as well as elliptical subgroups (p < 0.0001 for all). There was no significant difference between EROA-Dopp and 3D-VCA for the whole group, or in circular or elliptical orifice subgroups (p > 0.5 for all). EROA-PISA correlated better with both EROA-Dopp and VCA-3D in circular compared to elliptical orifices (Table). EROA-Dopp and VCA-3D demonstrated high correlation for both circular and elliptical orifices (r = 0.76, p < 0.0001 and r = 0.77, p < 0.0001 respectively).
Conclusion
Our study demonstrated that there is a significant difference in quantitative measurements of tricuspid regurgitant orifice area, with EROA-PISA significantly underestimating both EROA-Dopp and VCA-3D. In more circular orifices, the EROA-PISA correlation was higher, however EROA-Dopp and VCA-3D were still significantly larger. Whether EROA-Dopp and VCA-3D are more predictive of outcomes requires further study. Abstract Table 1 Abstract Figure 1
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Affiliation(s)
- E Tat
- Columbia University Medical Center, New York, United States of America
| | - N Hamid
- Columbia University Medical Center, New York, United States of America
| | - O Khalique
- Columbia University Medical Center, New York, United States of America
| | - K Lehenbauer
- Columbia University Medical Center, New York, United States of America
| | | | - T Nazif
- Columbia University Medical Center, New York, United States of America
| | - T Vahl
- Columbia University Medical Center, New York, United States of America
| | - V Ng
- Columbia University Medical Center, New York, United States of America
| | - I George
- Columbia University Medical Center, New York, United States of America
| | - T Cahill
- Columbia University Medical Center, New York, United States of America
| | - D Blusztein
- Columbia University Medical Center, New York, United States of America
| | - N Mihatov
- Columbia University Medical Center, New York, United States of America
| | - M Leon
- Columbia University Medical Center, New York, United States of America
| | - SK Kodali
- Columbia University Medical Center, New York, United States of America
| | - RT Hahn
- Columbia University Medical Center, New York, United States of America
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19
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Tat E, Hamid N, Khalique O, Lehenbauer K, Sitticharoenchai P, Nazif T, Vahl T, Ng V, George I, Cahill T, Blusztein D, Mihatov N, Leon M, Kodali SK, Hahn RT. Correlation between standard and adjusted echocardiographic quantitative methods for evaluating tricuspid regurgitation severity. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.369] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Current guidelines advocate for a multi-parametric approach to echocardiographic quantitation of tricuspid regurgitation (TR). The primary quantitative measure of TR severity uses the proximal isovelocity surface area (PISA) method to calculate effective regurgitant orifice area (EROA) and regurgitant volume (RegVol). However, EROA-PISA may underestimate TR severity due to low flow and tethering of the tricuspid leaflets.
Purpose
The purpose of this study was to compare standard EROA-PISA quantitation of TR to alternative quantitative measures, including quantitative Doppler (EROA-Doppler), flow- and angle-corrected PISA method (EROA-Corrected), and three-dimensional vena contracta area (3D-VCA), in addition to the comparison of calculated RegVol-PISA, RegVol-Doppler, and RegVol-3DVCA.
Methods
Patients undergoing both transthoracic (TTE) and transesophageal (TEE) echocardiographic evaluation of TR severity for transcatheter treatment were included in this study. Patients were excluded if they had ≥ moderate aortic regurgitation. TTE measurements of EROA-PISA and RegVol-PISA were performed as per American Society of Echocardiography guidelines. EROA-Doppler was performed by quantifying RegVol-Doppler (diastolic stroke volume using biplane annular area, minus left ventricular outflow stroke volume) and deriving EROA. EROA-Corrected was calculated by adjusting for both aliasing velocity and leaflet angle as per published methods. 3D-VCA was measured on TEE performed within 14 days of TTE.
Results
Of 44 consecutive patients, the median age was 80 ± 9 years, 61% were female, and 89% had atrial fibrillation. Most patients (86%) had functional TR, 71% had a EROA-PISA ≥ 0.4 cm2. Table 1 shows the EROA and RegVol results for each method. EROA-PISA and RegVol-PISA were significantly lower than EROA-Doppler and RegVol-Doppler, as well as 3D-VCA and RegVol-3DVCA (all p < 0.0001). There was no significant difference between EROA-Doppler and 3D-VCA (p = 0.51), and RegVol-Doppler and RegVol-3DVCA (p = 0.66). EROA-Corrected reduced the absolute difference with EROA-Doppler (51% to 33%, p < 0.0001) and 3D-VCA (52% to 32%, p < 0.0001), but remained statistically lower than EROA-Doppler and 3D-VCA. Although EROA-PISA was strongly correlated to EROA-Doppler (r = 0.75, p < 0.0001) and 3D-VCA (r = 0.68, p < 0.0001), the correlation between EROA-Doppler and 3D-VCA was greatest (r = 0.77, p < 0.0001). Adjusting EROA-PISA for angle and flow demonstrated improved correlation to EROA-Doppler without affecting correlation to 3D-VCA (Figure 1).
Conclusion
Our study demonstrated that EROA-PISA significantly underestimates the severity of TR by EROA-Doppler and 3D-VCA. Although PISA correction methods reduced the underestimation, both EROA-Corrected and RegVol-Corrected remained significantly lower. EROA-Doppler and 3D-VCA and the calculated RegVol by each method, were closely correlated and not significantly different. Abstract Table 1 Abstract Figure 1
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Affiliation(s)
- E Tat
- Columbia University Medical Center, New York, United States of America
| | - N Hamid
- Columbia University Medical Center, New York, United States of America
| | - O Khalique
- Columbia University Medical Center, New York, United States of America
| | - K Lehenbauer
- Columbia University Medical Center, New York, United States of America
| | | | - T Nazif
- Columbia University Medical Center, New York, United States of America
| | - T Vahl
- Columbia University Medical Center, New York, United States of America
| | - V Ng
- Columbia University Medical Center, New York, United States of America
| | - I George
- Columbia University Medical Center, New York, United States of America
| | - T Cahill
- Columbia University Medical Center, New York, United States of America
| | - D Blusztein
- Columbia University Medical Center, New York, United States of America
| | - N Mihatov
- Columbia University Medical Center, New York, United States of America
| | - M Leon
- Columbia University Medical Center, New York, United States of America
| | - SK Kodali
- Columbia University Medical Center, New York, United States of America
| | - RT Hahn
- Columbia University Medical Center, New York, United States of America
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20
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Ranard LS, Vahl TP, Chung CJ, Sadri S, Khalique OK, Hamid N, Nazif T, George I, Ng V, Patel A, Rezende CP, Reisman M, Latib A, Hausleiter J, Sorajja P, Bapat VN, Tang GHL, Davidson CJ, Zahr F, Makkar R, Fam NP, Granada JF, Leon MB, Hahn RT, Kodali S. Impact of inferior vena cava entry characteristics on tricuspid annular access during transcatheter interventions. Catheter Cardiovasc Interv 2022; 99:1268-1276. [PMID: 35084803 DOI: 10.1002/ccd.30048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/01/2021] [Accepted: 12/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The purpose of this study was to characterize the anatomic relationship between the inferior vena cava (IVC) and tricuspid annulus (TA) and its potential impact on the performance of transcatheter TV interventions. BACKGROUND Transcatheter tricuspid valve (TV) interventions are emerging as a therapeutic alternative for the treatment of severe, symptomatic tricuspid regurgitation (TR). Progression of TR is associated with right heart dilatation. These anatomic changes may distort the IVC-TA relationship and impact successful implantation of transcatheter devices. METHODS Fifty patients who presented with symptomatic TR for consideration of transcatheter TV therapy with an available CT were included in the study. Comprehensive transesophageal echocardiogram and CT analyses were performed to assess the right-sided cardiac chambers, TA and IVC-TA relationship. RESULTS The mean age of the study cohort was 78.4 ± 8.9 years. Torrential TR was present in 54% (n = 27). There was considerable variation in the short axis mid-IVC to mid-TA offset (SAXMID 18.2 ± 7.9 mm, range 4.7-42.1 mm). CONCLUSIONS The IVC-to-TA relationship exhibits significant variability in patients with symptomatic TR. CT analysis of the tricuspid anatomy, including the relationship to the surrounding structures and the IVC, is essential for planning transcatheter TV interventions. Further studies are needed to define whether the IVC-to-TA relationship is a predictor of technical success in the context of specific transcatheter delivery systems.
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Affiliation(s)
- Lauren S Ranard
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Torsten P Vahl
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA.,Cardiovascular Research Foundation, New York, New York, USA
| | - Christine J Chung
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Shirin Sadri
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Omar K Khalique
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA.,Cardiovascular Research Foundation, New York, New York, USA
| | - Nadira Hamid
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA.,Cardiovascular Research Foundation, New York, New York, USA
| | - Tamim Nazif
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA.,Cardiovascular Research Foundation, New York, New York, USA
| | - Isaac George
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Vivian Ng
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Amisha Patel
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Carolina P Rezende
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Mark Reisman
- Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Paul Sorajja
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Vinayak N Bapat
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, New York, USA
| | - Charles J Davidson
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Firas Zahr
- Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Neil P Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Juan F Granada
- Cardiovascular Research Foundation, New York, New York, USA
| | - Martin B Leon
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA.,Cardiovascular Research Foundation, New York, New York, USA
| | - Rebecca T Hahn
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA.,Cardiovascular Research Foundation, New York, New York, USA
| | - Susheel Kodali
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA.,Cardiovascular Research Foundation, New York, New York, USA
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21
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Lawlor MK, Hamid N, Kampaktsis P, Ning Y, Wang V, Akkoc D, Dershowitz L, Placheril E, Vahl TP, Nazif T, Khalique O, Ng V, Brener MI, Burkhoff D, Dickstein M, Kurlansky P, Leon MB, Hahn RT, Kodali S, George I. Incidence and predictors of cardiogenic shock following surgical or transcatheter tricuspid valve intervention. Catheter Cardiovasc Interv 2022; 99:1668-1678. [DOI: 10.1002/ccd.30073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 12/26/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Matthew K. Lawlor
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Nadira Hamid
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
- Structural Heart & Valve Center, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Polydoros Kampaktsis
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Yuming Ning
- Divison of Cardiothoracic & Vascular Surgery, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Victoria Wang
- Divison of Cardiothoracic & Vascular Surgery, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Deniz Akkoc
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Lyle Dershowitz
- Vagelos College of Physicians and Surgeons Columbia University New York New York USA
| | - Elizabeth Placheril
- Divison of Cardiothoracic & Vascular Surgery, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Torsten P. Vahl
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
- Structural Heart & Valve Center, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Tamim Nazif
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
- Structural Heart & Valve Center, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Omar Khalique
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
- Structural Heart & Valve Center, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Vivian Ng
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
- Structural Heart & Valve Center, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Michael I. Brener
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | | | - Marc Dickstein
- Department of Anesthesiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Paul Kurlansky
- Columbia HeartSource, Center for Innovation and Outcomes Research Columbia University Irving Medical Center New York New York USA
| | - Martin B. Leon
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
- Structural Heart & Valve Center, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
- Cardiovascular Research Foundation New York New York USA
| | - Rebecca T. Hahn
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
- Structural Heart & Valve Center, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Susheel Kodali
- Division of Cardiology, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
- Structural Heart & Valve Center, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
| | - Isaac George
- Structural Heart & Valve Center, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
- Divison of Cardiothoracic & Vascular Surgery, New York Presbyterian Hospital Columbia University Irving Medical Center New York New York USA
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22
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Mori M, Gupta A, Wang Y, Vahl T, Nazif T, Kirtane AJ, George I, Yong CM, Onuma O, Kodali S, Geirsson A, Leon MB, Krumholz HM. Trends in Transcatheter and Surgical Aortic Valve Replacement Among Older Adults in the United States. J Am Coll Cardiol 2021; 78:2161-2172. [PMID: 34823659 DOI: 10.1016/j.jacc.2021.09.855] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/25/2021] [Accepted: 09/07/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recent trends, including survival beyond 30 days, in aortic valve replacement (AVR) following the expansion of indications for transcatheter aortic valve replacement (TAVR) are not well-understood. OBJECTIVES The authors sought to characterize the trends in characteristics and outcomes of patients undergoing AVR. METHODS The authors analyzed Medicare beneficiaries who underwent TAVR and SAVR in 2012 to 2019. They evaluated case volume, demographics, comorbidities, 1-year mortality, and discharge disposition. Cox proportional hazard models were used to assess the annual change in outcomes. RESULTS Per 100,000 beneficiary-years, AVR increased from 107 to 156, TAVR increased from 19 to 101, whereas SAVR declined from 88 to 54. The median [interquartile range] age remained similar from 77 [71-83] years to 78 [72-84] years for overall AVR, decreased from 84 [79-88] years to 81 [75-86] years for TAVR, and decreased from 76 [71-81] years to 72 [68-77] years for SAVR. For all AVR patients, the prevalence of comorbidities remained relatively stable. The 1-year mortality for all AVR decreased from 11.9% to 9.4%. Annual change in the adjusted odds of 1-year mortality was 0.93 (95% CI: 0.92-0.94) for TAVR and 0.98 (95% CI: 0.97-0.99) for SAVR, and 0.94 (95% CI: 0.93-0.95) for all AVR. Patients discharged to home after AVR increased from 24.2% to 54.7%, primarily driven by increasing home discharge after TAVR. CONCLUSIONS The advent of TAVR has led to about a 60% increase in overall AVR in older adults. Improving outcomes in AVR as a whole following the advent of TAVR with increased access is a reassuring trend.
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Affiliation(s)
- Makoto Mori
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Aakriti Gupta
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA; Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Yun Wang
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA; Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Torsten Vahl
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Tamim Nazif
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Ajay J Kirtane
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Isaac George
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Celina M Yong
- Department of Medicine (Cardiovascular Medicine), Stanford University School of Medicine, Stanford, California, USA; Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Oyere Onuma
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Susheel Kodali
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Martin B Leon
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA; Section of Cardiology, Yale School of Medicine, New Haven, Connecticut, USA; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA.
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23
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Dershowitz L, Lawlor M, Hamid N, Kampaktsis P, Ning Y, Wang V, Akkoc D, Placheril E, Vahl T, Nazif T, Khalique O, Ng V, Brener M, Burkhoff D, Dickstein M, Kurlansky P, Leon M, Hahn R, Kodali S, George I. TCT-138 Right Ventricular Remodeling and Clinical Outcomes Following Transcatheter Tricuspid Valve Intervention. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.988] [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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24
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Vora A, Gada H, Manandhar P, Kosinski A, Kirtane A, Nazif T, Reardon M, Kodali S, Cohen D, Thourani V, Sherwood M, Julien H, Vemulapalli S. TCT-145 Temporal Trends and Hospital Variation in Pacemaker Implantation Following TAVR—Insights From the STS/ACC TVT Registry. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.995] [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: 10/19/2022]
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25
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Yamamoto K, Sato T, Matsumura M, Fall K, Kirtane A, Nazif T, Sethi S, Parikh S, Vahl T, Ali Z, Karmpaliotis D, Rabbani L, Leon M, Moses J, Mintz G, Maehara A. TCT-85 Mechanisms of In-Stent Restenosis in the Ostial Right Coronary Artery. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.935] [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: 10/19/2022]
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26
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Yamamoto K, Sato T, Matsumura M, Fall K, Kirtane A, Nazif T, Sethi S, Parikh S, Vahl T, Ali Z, Karmpaliotis D, Rabbani L, Leon M, Moses J, Mintz G, Maehara A. TCT-282 IVUS Assessment of De Novo Ostial RCA Lesion Morphology. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1135] [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: 10/20/2022]
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27
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Brener M, Hamandi M, Hong E, Pizano A, Harloff M, Garner E, El Sabbagh A, Kaple R, Deaton D, Islam A, Veeragandham R, Bapat V, Khalique O, Ning Y, Kurlansky P, Nazif T, Kodali S, Leon M, Borger M, Lee R, Kohli K, Yoganathan A, Guerrero M, Davies J, Eudailey K, Kaneko T, Nguyen T, Russell H, Smith R, George I. TCT-104 One-Year Clinical Outcomes Following Open Transatrial Transcatheter Mitral Valve Replacement in Patients With Severe Mitral Annular Calcification. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.954] [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: 11/29/2022]
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Avram R, So D, Iturriaga E, Byrne J, Lennon R, Murthy V, Geller N, Goodman S, Rihal C, Rosenberg Y, Bailey K, Farkouh M, Bell M, Cagin C, Chavez I, El-Hajjar M, Ginete W, Lerman A, Levisay J, Marzo K, Nazif T, Olgin J, Pereira N. Patient Onboarding and Engagement to Build a Digital Registry after Enrollment in a Clinical Trial: Results of the TAILOR-PCI Digital Study (Preprint). JMIR Form Res 2021; 6:e34080. [PMID: 35699977 PMCID: PMC9237778 DOI: 10.2196/34080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background The Tailored Antiplatelet Initiation to Lessen Outcomes Due to Decreased Clopidogrel Response After Percutaneous Coronary Intervention (TAILOR-PCI) Digital Study is a novel proof-of-concept study that evaluated the feasibility of extending the TAILOR-PCI randomized controlled trial (RCT) follow-up period by using a remote digital platform. Objective The aim of this study is to describe patients’ onboarding, engagement, and results in a digital study after enrollment in an RCT. Methods In this intervention study, previously enrolled TAILOR-PCI patients in the United States and Canada within 24 months of randomization were invited by letter to download the study app. Those who did not respond to the letter were contacted by phone to survey the reasons for nonparticipation. A direct-to-patient digital research platform (the Eureka Research Platform) was used to onboard patients, obtain consent, and administer activities in the digital study. The patients were asked to complete health-related surveys and digitally provide follow-up data. Our primary end points were the consent rate, the duration of participation, and the monthly activity completion rate in the digital study. The hypothesis being tested was formulated before data collection began. Results After the parent trial was completed, letters were mailed to 907 eligible patients (representing 18.8% [907/4837] of total enrolled in the RCT) within 15.6 (SD 5.2) months of randomization across 24 sites. Among the 907 patients invited, 290 (32%) visited the study website and 110 (12.1%) consented—40.9% (45/110) after the letter, 33.6% (37/110) after the first phone call, and 25.5% (28/110) after the second call. Among the 47.4% (409/862) of patients who responded, 41.8% (171/409) declined to participate because of a lack of time, 31.2% (128/409) declined because of the lack of a smartphone, and 11.5% (47/409) declined because of difficulty understanding what was expected of them in the study. Patients who consented were older (aged 65.3 vs 62.5 years; P=.006) and had a lower prevalence of diabetes (19% vs 30%; P=.02) or tobacco use (6.4% vs 24.8%; P<.001). A greater proportion had bachelor’s degrees (47.2% vs 25.7%; P<.001) and were more computer literate (90.5% vs 62.3% of daily internet use; P<.001) than those who did not consent. The average completion rate of the 920 available monthly electronic visits was 64.9% (SD 7.6%); there was no decrease in this rate throughout the study duration. Conclusions Extended follow-up after enrollment in an RCT by using a digital study was technically feasible but was limited because of the inability to contact most eligible patients or a lack of time or access to a smartphone. Among the enrolled patients, most completed the required electronic visits. Enhanced recruitment methods, such as the introduction of a digital study at the time of RCT consent, smartphone provision, and robust study support for onboarding, should be explored further. Trial Registration Clinicaltrails.gov NCT01742117; https://clinicaltrials.gov/ct2/show/NCT01742117
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Affiliation(s)
- Robert Avram
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Derek So
- Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Erin Iturriaga
- Department of Medicine, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Julia Byrne
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, United States
| | - Ryan Lennon
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, United States
| | - Vishakantha Murthy
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, United States
| | - Nancy Geller
- Department of Medicine, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Shaun Goodman
- Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Charanjit Rihal
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, United States
| | - Yves Rosenberg
- Department of Medicine, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Kent Bailey
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, United States
| | - Michael Farkouh
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Malcolm Bell
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, United States
| | - Charles Cagin
- Department of Medicine, Mayo Clinic Health System, La Crosse, WI, United States
| | - Ivan Chavez
- Department of Medicine, Minneapolis Heart Institute, Minneapolis, MN, United States
| | - Mohammad El-Hajjar
- Department of Medicine, Albany Medical College, Albany, NY, United States
| | - Wilson Ginete
- Department of Medicine, Essentia Institute of Rural Health, Duluth, MN, United States
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, United States
| | - Justin Levisay
- Department of Medicine, Northshore University Health System, Evanston, IL, United States
| | - Kevin Marzo
- Department of Medicine, Winthrop University Hospital, Mineola, NY, United States
| | - Tamim Nazif
- Department of Medicine, Columbia University Medical Center, New York, NY, United States
| | - Jeffrey Olgin
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Naveen Pereira
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, United States
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29
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Lansky AJ, Makkar R, Nazif T, Messé S, Forrest J, Sharma R, Schofer J, Linke A, Brown D, Dhoble A, Horwitz P, Zang M, DeMarco F, Rajagopal V, Dwyer MG, Zivadinov R, Stella P, Rovin J, Parise H, Kodali S, Baumbach A, Moses J. A randomized evaluation of the TriGuard™ HDH cerebral embolic protection device to Reduce the Impact of Cerebral Embolic LEsions after TransCatheter Aortic Valve ImplanTation: the REFLECT I trial. Eur Heart J 2021; 42:2670-2679. [PMID: 34000004 DOI: 10.1093/eurheartj/ehab213] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/12/2021] [Indexed: 12/12/2022] Open
Abstract
AIMS The REFLECT I trial investigated the safety and effectiveness of the TriGuard™ HDH (TG) cerebral embolic deflection device in patients undergoing transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS This prospective, multicentre, single-blind, 2:1 randomized (TG vs. no TG) study aimed to enrol up to 375 patients, including up to 90 roll-in patients. The primary combined safety endpoint (VARC-2 defined early safety) at 30 days was compared with a performance goal. The primary efficacy endpoint was a hierarchical composite of (i) all-cause mortality or any stroke at 30 days, (ii) National Institutes of Health Stroke Scale (NIHSS) worsening at 2-5 days or Montreal Cognitive Assessment worsening at 30 days, and (iii) total volume of cerebral ischaemic lesions detected by diffusion-weighted magnetic resonance imaging at 2-5 days. Cumulative scores were compared between treatment groups using the Finkelstein-Schoenfeld method. A total of 258 of the planned, 375 patients (68.8%) were enrolled (54 roll-in and 204 randomized). The primary safety outcome was met compared with the performance goal (21.8% vs. 35%, P < 0.0001). The primary hierarchical efficacy endpoint was not met (mean efficacy score, higher is better: -5.3 ± 99.8 TG vs. 11.8 ± 96.4 control, P = 0.31). Covert central nervous system injury was numerically lower with TG both in-hospital (46.1% vs. 60.3%, P = 0.0698) and at 5 days (61.7 vs. 76.2%, P = 0.054) compared with controls. CONCLUSION REFLECT I demonstrated that TG cerebral protection during TAVR was safe in comparison with historical TAVR data but did not meet the predefined effectiveness endpoint compared with unprotected TAVR controls.
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Affiliation(s)
- Alexandra J Lansky
- Division of Cardiology, Yale School of Medicine, 135 College Street, Suite 101, New Haven, CT 06510, USA.,Barts Heart Centre, London and Queen Mary University of London, London, UK
| | | | - Tamim Nazif
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Steven Messé
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - John Forrest
- Division of Cardiology, Yale School of Medicine, 135 College Street, Suite 101, New Haven, CT 06510, USA
| | - Rahul Sharma
- Division of Cardiology, Stanford University, Stanford, CA, USA
| | | | - Axel Linke
- University Hospital Dresden Heart Center, Dresden,DE
| | | | | | - Phillip Horwitz
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Ming Zang
- Swedish Medical Center, Seattle, WA, USA
| | | | | | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Pieter Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Helen Parise
- Division of Cardiology, Yale School of Medicine, 135 College Street, Suite 101, New Haven, CT 06510, USA
| | - Susheel Kodali
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Andreas Baumbach
- Division of Cardiology, Yale School of Medicine, 135 College Street, Suite 101, New Haven, CT 06510, USA.,Barts Heart Centre, London and Queen Mary University of London, London, UK
| | - Jeffrey Moses
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
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30
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Schlotter F, Miura M, Kresoja KP, Alushi B, Alessandrini H, Attinger-Toller A, Besler C, Biasco L, Braun D, Brochet E, Connelly K, de Bruijn S, Denti P, Estévez-Loureiro R, Fam NP, Gavazzoni M, Himbert D, Ho E, Juliard JM, Kalbacher D, Kaple R, Kreidel F, Latib A, Lubos E, Ludwig S, Mehr M, Monivas V, Nazif T, Nickenig G, Pedrazzini G, Pozzoli A, Praz F, Puri R, Rodés-Cabau J, Rommel KP, Schäfer U, Schofer J, Sievert H, Tang G, Thiele H, Unterhuber M, Vahanian A, von Bardeleben R, von Roeder M, Webb J, Weber M, Wild MG, Windecker S, Zuber M, Hausleiter J, Maisano F, Leon MB, Hahn RT, Lauten A, Taramasso M, Lurz P. Outcomes of transcatheter tricuspid valve intervention by right ventricular function: a multicentre propensity-matched analysis. EUROINTERVENTION 2021; 17:e343-e352. [PMID: 33956637 PMCID: PMC9724849 DOI: 10.4244/eij-d-21-00191] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Tricuspid regurgitation (TR) has a poor prognosis and limited treatment options and is frequently accompanied by right ventricular (RV) dysfunction. Transcatheter tricuspid valve interventions (TTVI) to reduce TR have been shown to be safe and feasible with encouraging early results. Patient selection for TTVI remains challenging, with the role of right ventricular (RV) function being unknown. AIMS The aims of this study were 1) to investigate survival in a TTVI-treated patient population and a conservatively treated TR population, and 2) to evaluate the outcome of TTVI as compared to conservative treatment stratified according to the degree of RV function. METHODS We studied 684 patients from the multicentre TriValve cohort (TTVI cohort) and compared them to 914 conservatively treated patients from two tertiary care centres. Propensity matching identified 213 pairs of patients with severe TR. As we observed a non-linear relationship of RV function and TTVI outcome, we stratified patients according to tricuspid annular plane systolic excursion (TAPSE) to preserved (TAPSE >17 mm), mid-range (TAPSE 13-17 mm) and reduced (TAPSE <13 mm) RV function. The primary outcome was one-year all-cause mortality. RESULTS TTVI was associated with a survival benefit in patients with severe TR when compared to matched controls (one-year mortality rate: 13.1% vs 25.8%; p=0.031). Of the three RV subgroups, only in patients with mid-range RV function was TTVI associated with an improved survival (p log-rank 0.004). In these patients, procedural success was associated with a reduced hazard ratio for all-cause mortality (HR 0.22; 95% CI: 0.09, 0.57). CONCLUSIONS TTVI is associated with reduced mortality compared to conservative therapy and might exert its highest treatment effect in patients with mid-range reduced RV function.
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Affiliation(s)
- Florian Schlotter
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Mizuki Miura
- Division of Cardiac Surgery, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Karl-Patrik Kresoja
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Brunilda Alushi
- HELIOS Klinikum Erfurt, Department of General and Interventional Cardiology & Rhythmology, Erfurt, Germany,Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, and German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | | | | | - Christian Besler
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Luigi Biasco
- Cardiology Department, Cardiocentro, Lugano, Switzerland
| | - Daniel Braun
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Eric Brochet
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | - Kim Connelly
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, ON, Canada
| | - Sabine de Bruijn
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | | | - Neil P. Fam
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, ON, Canada
| | - Mara Gavazzoni
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Dominique Himbert
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | - Edwin Ho
- Cardiology Department, Montefiore Medical Center, New York, NY, USA
| | | | | | - Ryan Kaple
- Division of Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Felix Kreidel
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Azeem Latib
- Cardiology Department, Montefiore Medical Center, New York, NY, USA
| | - Edith Lubos
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | | | - Michael Mehr
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Vanessa Monivas
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Tamim Nazif
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Georg Nickenig
- Cardiology Department, Universitaetsklinikum Bonn, Bonn, Germany
| | | | - Alberto Pozzoli
- Division of Cardiac Surgery, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fabien Praz
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Josep Rodés-Cabau
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Karl-Philipp Rommel
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Ulrich Schäfer
- Cardiology, Angiology and Intensive Care Medicine, Catholic Marienhospital, Hamburg, Germany
| | - Joachim Schofer
- MVZ Department Structural Heart Disease, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Horst Sievert
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Gilbert Tang
- Cardiac Surgery Department, Mount Sinai Hospital, New York, NY, USA
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Matthias Unterhuber
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Alec Vahanian
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | | | - Maximilian von Roeder
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - John Webb
- Cardiology Department, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Marcel Weber
- Cardiology Department, Universitaetsklinikum Bonn, Bonn, Germany
| | - Mirjam G. Wild
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michel Zuber
- Division of Cardiac Surgery, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jörg Hausleiter
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | | | - Martin B. Leon
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Rebecca T. Hahn
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Alexander Lauten
- HELIOS Klinikum Erfurt, Department of General and Interventional Cardiology & Rhythmology, Erfurt, Germany,Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, and German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Maurizio Taramasso
- Division of Cardiac Surgery, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Struempellstr. 39, 04289 Leipzig, Germany
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31
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Sharma A, Alvarez A, Nazif T, Kodali S, Marboe C, George I. Tale of a Black Heart! Ann Thorac Surg 2021; 113:e163-e165. [PMID: 34147491 DOI: 10.1016/j.athoracsur.2021.05.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/01/2022]
Abstract
Alkaptonuria is a rare condition of inborn error of metabolism. Association with aortic stenosis has been described; however, diagnosis at the time of valve replacement is infrequent. Recognition of this condition has potential management implications as the durability of prosthetic valves in such cases is unknown. We describe a case report which depicts these unique aspects.
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Affiliation(s)
- Anjali Sharma
- Division of Cardiology, Columbia University College of Physicians and Surgeons, New York
| | - Andrea Alvarez
- Division of Pathology and Cell Biology, Columbia University Vagelos College of Physicians and Surgeons, New York
| | - Tamim Nazif
- Division of Cardiology, Columbia University College of Physicians and Surgeons, New York
| | - Susheel Kodali
- Division of Cardiology, Columbia University College of Physicians and Surgeons, New York
| | - Charles Marboe
- Division of Pathology and Cell Biology, Columbia University Vagelos College of Physicians and Surgeons, New York
| | - Isaac George
- Division of Cardiac, Thoracic & Vascular Surgery, Columbia University College of Physicians and Surgeons, New York.
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32
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Chen S, Redfors B, Nazif T, Kirtane A, Crowley A, Ben-Yehuda O, Kapadia S, Finn MT, Goel S, Lindman BR, Alu MC, Chau KH, Thourani VH, Vahl TP, Douglas PS, Kodali SK, Leon MB. Impact of renin-angiotensin system inhibitors on clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement: an analysis of from the PARTNER 2 trial and registries. Eur Heart J 2021; 41:943-954. [PMID: 31711153 DOI: 10.1093/eurheartj/ehz769] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 04/10/2019] [Revised: 07/08/2019] [Accepted: 10/15/2019] [Indexed: 01/09/2023] Open
Abstract
AIMS Left ventricular pressure overload is associated with activation of the cardiac renin-angiotensin system, which may contribute to myocardial fibrosis and worse clinical outcomes. We sought to assess the association between treatment with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) at baseline and clinical outcomes in patients with symptomatic, severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) in the PARTNER 2 trial and registries. METHODS AND RESULTS A total of 3979 intermediate, high, or prohibitive risk patients who underwent TAVR in the PARTNER 2 trial and registries (excluding the valve in valve registry) were included in the study. Clinical outcomes at 2 years were compared according to baseline ACEI/ARB treatment status using Kaplan-Meier event rates and study-stratified multivariable Cox proportional hazards regression models. Sensitivity analysis was conducted using propensity score matching. Of 3979 patients who were included in the current analysis, 1736 (43.6%) were treated and 2243 (56.4%) were not treated with ACEI/ARB at baseline. Treatment with ACEI/ARB was associated with lower 2-year all-cause mortality (18.6% vs. 27.5%, P < 0.0001), cardiovascular mortality (12.3% vs. 17.9%, P < 0.0001), and non-cardiovascular mortality (7.2% vs. 11.7%, P < 0.0001). Angiotensin-converting enzyme inhibitor/ARB treatment at baseline remained independently associated with a lower hazard of 2-year all-cause and cardiovascular mortality after multivariable adjustment, and propensity score matching. CONCLUSION In a large cohort of patients with severe symptomatic AS from the PARTNER 2 trial and registries, ACEI/ARB treatment at baseline was independently associated with a lower risk of 2-year all-cause and cardiovascular mortality.
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Affiliation(s)
- Shmuel Chen
- Cardiovascular Research Foundation, 1700 Broadway, Floor 9, New York, NY 10019, USA.,Center for Interventional Vascular Therapy, Columbia University Irving Medical Center/ NewYork-Presbyterian Hospital, 161 Ft. Washington Ave. HIP-6, New York, NY 10032, USA
| | - Bjorn Redfors
- Cardiovascular Research Foundation, 1700 Broadway, Floor 9, New York, NY 10019, USA.,Center for Interventional Vascular Therapy, Columbia University Irving Medical Center/ NewYork-Presbyterian Hospital, 161 Ft. Washington Ave. HIP-6, New York, NY 10032, USA.,Department of Cardiology, Sahlgrenska University Hospital, Bruna Straket 16, 413 45 Gothenburg, Sweden
| | - Tamim Nazif
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center/ NewYork-Presbyterian Hospital, 161 Ft. Washington Ave. HIP-6, New York, NY 10032, USA
| | - Ajay Kirtane
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center/ NewYork-Presbyterian Hospital, 161 Ft. Washington Ave. HIP-6, New York, NY 10032, USA
| | - Aaron Crowley
- Cardiovascular Research Foundation, 1700 Broadway, Floor 9, New York, NY 10019, USA
| | - Ori Ben-Yehuda
- Cardiovascular Research Foundation, 1700 Broadway, Floor 9, New York, NY 10019, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Matthew T Finn
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center/ NewYork-Presbyterian Hospital, 161 Ft. Washington Ave. HIP-6, New York, NY 10032, USA
| | - Sachin Goel
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Brian R Lindman
- Structural Heart and Valve Center, Cardiovascular Medicine Division, Vanderbilt University Medical Center, 1161 21st Ave S., Nashville, TN 37232, USA
| | - Maria C Alu
- Cardiovascular Research Foundation, 1700 Broadway, Floor 9, New York, NY 10019, USA.,Center for Interventional Vascular Therapy, Columbia University Irving Medical Center/ NewYork-Presbyterian Hospital, 161 Ft. Washington Ave. HIP-6, New York, NY 10032, USA
| | - Katherine H Chau
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center/ NewYork-Presbyterian Hospital, 161 Ft. Washington Ave. HIP-6, New York, NY 10032, USA
| | - Vinod H Thourani
- Department of Cardiac Surgery, Piedmont Heart Institute, 95 Collier Road NW, Atlanta, GA 30309, USA
| | - Torsten P Vahl
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center/ NewYork-Presbyterian Hospital, 161 Ft. Washington Ave. HIP-6, New York, NY 10032, USA
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, 300 W Morgan St, Durham NC 27701, USA
| | - Susheel K Kodali
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center/ NewYork-Presbyterian Hospital, 161 Ft. Washington Ave. HIP-6, New York, NY 10032, USA
| | - Martin B Leon
- Cardiovascular Research Foundation, 1700 Broadway, Floor 9, New York, NY 10019, USA.,Center for Interventional Vascular Therapy, Columbia University Irving Medical Center/ NewYork-Presbyterian Hospital, 161 Ft. Washington Ave. HIP-6, New York, NY 10032, USA
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33
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Chau K, George I, Vemulapalli S, Wegermann Z, Forrest J, Yakubov S, Williams M, Manandhar P, Vahl T, Leon M, Kodali S, Kirtane A, Nazif T. NATIONAL TRENDS OF PERMANENT PACEMAKER IMPLANTATION AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT: AN ANALYSIS FROM THE STS/ACC TVT REGISTRY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02277-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Hamid N, Ranard L, Khalique O, Hahn R, Nazif T, George I, Ng V, Patel A, Cahill T, Chen S, Rahim H, Sharma A, Nemshah Y, Bapat V, Leon M, Kodali S, Vahl T. COMMISSURAL ALIGNMENT AFTER TRANSFEMORAL DELIVERY OF THE JENAVALVE TRANSCATHETER AORTIC VALVE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02336-6] [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: 11/29/2022]
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Baudhuin L, Train L, Goodman S, Lane G, Lennon R, Mathew V, Murthy V, Nazif T, So D, Sweeney J, Wu A, Rihal C, Farkouh M, Pereira N. VALIDATION AND PERFORMANCE OF POINT-OF-CARE RAPID CYP2C19 GENOTYPING IN THE TAILOR-PCI MULTICENTER INTERNATIONAL RANDOMIZED CLINICAL TRIAL. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01386-3] [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: 10/21/2022]
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36
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Généreux P, Piazza N, Alu MC, Nazif T, Hahn RT, Pibarot P, Bax JJ, Leipsic JA, Blanke P, Blackstone EH, Finn MT, Kapadia S, Linke A, Mack MJ, Makkar R, Mehran R, Popma JJ, Reardon M, Rodes-Cabau J, Van Mieghem NM, Webb JG, Cohen DJ, Leon MB. Valve Academic Research Consortium 3: updated endpoint definitions for aortic valve clinical research. Eur Heart J 2021; 42:1825-1857. [DOI: 10.1093/eurheartj/ehaa799] [Citation(s) in RCA: 126] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/22/2020] [Accepted: 09/24/2020] [Indexed: 12/17/2022] Open
Abstract
Abstract
Aims
The Valve Academic Research Consortium (VARC), founded in 2010, was intended to (i) identify appropriate clinical endpoints and (ii) standardize definitions of these endpoints for transcatheter and surgical aortic valve clinical trials. Rapid evolution of the field, including the emergence of new complications, expanding clinical indications, and novel therapy strategies have mandated further refinement and expansion of these definitions to ensure clinical relevance. This document provides an update of the most appropriate clinical endpoint definitions to be used in the conduct of transcatheter and surgical aortic valve clinical research.
Methods and results
Several years after the publication of the VARC-2 manuscript, an in-person meeting was held involving over 50 independent clinical experts representing several professional societies, academic research organizations, the US Food and Drug Administration (FDA), and industry representatives to (i) evaluate utilization of VARC endpoint definitions in clinical research, (ii) discuss the scope of this focused update, and (iii) review and revise specific clinical endpoint definitions. A writing committee of independent experts was convened and subsequently met to further address outstanding issues. There were ongoing discussions with FDA and many experts to develop a new classification schema for bioprosthetic valve dysfunction and failure. Overall, this multi-disciplinary process has resulted in important recommendations for data reporting, clinical research methods, and updated endpoint definitions. New definitions or modifications of existing definitions are being proposed for repeat hospitalizations, access site-related complications, bleeding events, conduction disturbances, cardiac structural complications, and bioprosthetic valve dysfunction and failure (including valve leaflet thickening and thrombosis). A more granular 5-class grading scheme for paravalvular regurgitation (PVR) is being proposed to help refine the assessment of PVR. Finally, more specific recommendations on quality-of-life assessments have been included, which have been targeted to specific clinical study designs.
Conclusions
Acknowledging the dynamic and evolving nature of less-invasive aortic valve therapies, further refinements of clinical research processes are required. The adoption of these updated and newly proposed VARC-3 endpoints and definitions will ensure homogenous event reporting, accurate adjudication, and appropriate comparisons of clinical research studies involving devices and new therapeutic strategies.
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Affiliation(s)
| | - Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
| | - Nicolo Piazza
- McGill University Health Centre, Montreal, QC, Canada
| | - Maria C Alu
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY, USA
| | - Tamim Nazif
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY, USA
| | - Rebecca T Hahn
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY, USA
| | - Philippe Pibarot
- Quebec Heart & Lung Institute, Laval University, Quebec, QC, Canada
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jonathon A Leipsic
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic and Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew T Finn
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Michael J Mack
- Baylor Scott & White Heart Hospital Plano, Plano, TX, USA
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | - John G Webb
- Department of Cardiology, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - David J Cohen
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Martin B Leon
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, NY, USA
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Généreux P, Piazza N, Alu MC, Nazif T, Hahn RT, Pibarot P, Bax JJ, Leipsic JA, Blanke P, Blackstone EH, Finn MT, Kapadia S, Linke A, Mack MJ, Makkar R, Mehran R, Popma JJ, Reardon M, Rodes-Cabau J, Van Mieghem NM, Webb JG, Cohen DJ, Leon MB. Valve Academic Research Consortium 3: Updated Endpoint Definitions for Aortic Valve Clinical Research. J Am Coll Cardiol 2021; 77:2717-2746. [PMID: 33888385 DOI: 10.1016/j.jacc.2021.02.038] [Citation(s) in RCA: 377] [Impact Index Per Article: 125.7] [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: 12/17/2022]
Abstract
AIMS The Valve Academic Research Consortium (VARC), founded in 2010, was intended to (i) identify appropriate clinical endpoints and (ii) standardize definitions of these endpoints for transcatheter and surgical aortic valve clinical trials. Rapid evolution of the field, including the emergence of new complications, expanding clinical indications, and novel therapy strategies have mandated further refinement and expansion of these definitions to ensure clinical relevance. This document provides an update of the most appropriate clinical endpoint definitions to be used in the conduct of transcatheter and surgical aortic valve clinical research. METHODS AND RESULTS Several years after the publication of the VARC-2 manuscript, an in-person meeting was held involving over 50 independent clinical experts representing several professional societies, academic research organizations, the US Food and Drug Administration (FDA), and industry representatives to (i) evaluate utilization of VARC endpoint definitions in clinical research, (ii) discuss the scope of this focused update, and (iii) review and revise specific clinical endpoint definitions. A writing committee of independent experts was convened and subsequently met to further address outstanding issues. There were ongoing discussions with FDA and many experts to develop a new classification schema for bioprosthetic valve dysfunction and failure. Overall, this multi-disciplinary process has resulted in important recommendations for data reporting, clinical research methods, and updated endpoint definitions. New definitions or modifications of existing definitions are being proposed for repeat hospitalizations, access site-related complications, bleeding events, conduction disturbances, cardiac structural complications, and bioprosthetic valve dysfunction and failure (including valve leaflet thickening and thrombosis). A more granular 5-class grading scheme for paravalvular regurgitation (PVR) is being proposed to help refine the assessment of PVR. Finally, more specific recommendations on quality-of-life assessments have been included, which have been targeted to specific clinical study designs. CONCLUSIONS Acknowledging the dynamic and evolving nature of less-invasive aortic valve therapies, further refinements of clinical research processes are required. The adoption of these updated and newly proposed VARC-3 endpoints and definitions will ensure homogenous event reporting, accurate adjudication, and appropriate comparisons of clinical research studies involving devices and new therapeutic strategies.
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Affiliation(s)
| | - Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Nicolo Piazza
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Maria C Alu
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York, USA
| | - Tamim Nazif
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York, USA
| | - Rebecca T Hahn
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York, USA
| | - Philippe Pibarot
- Quebec Heart & Lung Institute, Laval University, Quebec, Quebec, Canada
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jonathon A Leipsic
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic and Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew T Finn
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Michael J Mack
- Baylor Scott & White Heart Hospital Plano, Plano, Texas, USA
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeffrey J Popma
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michael Reardon
- Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Josep Rodes-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec, Quebec, Canada
| | | | - John G Webb
- Department of Cardiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - David J Cohen
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Martin B Leon
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and Cardiovascular Research Foundation, New York, New York, USA.
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Brener MI, George I, Kosmidou I, Nazif T, Zhang Z, Dizon JM, Garan H, Malaisrie SC, Makkar R, Mack M, Szeto WY, Fearon WF, Thourani VH, Leon MB, Kodali S, Biviano AB. Atrial Fibrillation Is Associated With Mortality in Intermediate Surgical Risk Patients With Severe Aortic Stenosis: Analyses From the PARTNER 2A and PARTNER S3i Trials. J Am Heart Assoc 2021; 10:e019584. [PMID: 33754803 PMCID: PMC8174321 DOI: 10.1161/jaha.120.019584] [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 The impact of atrial fibrillation (AF) in intermediate surgical risk patients with severe aortic stenosis who undergo either transcatheter or surgical aortic valve replacement (AVR) is not well established. Methods and Results Data were assessed in 2663 patients from the PARTNER (Placement of Aortic Transcatheter Valve) 2A or S3i trials. Analyses grouped patients into 3 categories according to their baseline and discharge rhythms (ie, sinus rhythm [SR]/SR, SR/AF, or AF/AF). Among patients with transcatheter AVR (n=1867), 79.2% had SR/SR, 17.6% had AF/AF, and 3.2% had SR/AF. Among patients with surgical AVR (n=796), 71.7% had SR/SR, 14.1% had AF/AF, and 14.2% had SR/AF. Patients with transcatheter AVR in AF at discharge had increased 2-year mortality (SR/AF versus SR/SR; hazard ratio [HR], 2.73; 95% CI, 1.68-4.44; P<0.0001; AF/AF versus SR/SR; HR, 1.56; 95% CI, 1.16-2.09; P=0.003); patients with SR/AF also experienced increased 2-year mortality relative to patients with AF/AF (HR, 1.77; 95% CI, 1.04-3.00; P=0.03). For patients with surgicalAVR, the presence of AF at discharge was also associated with increased 2-year mortality (SR/AF versus SR/SR; HR, 1.93; 95% CI, 1.25-2.96; P=0.002; and AF/AF versus SR/SR; HR, 1.67; 95% CI, 1.06-2.63; P=0.027). Rehospitalization and persistent advanced heart failure symptoms were also more common among patients with transcatheter AVR and surgical AVR discharged in AF, and major bleeding was more common in the transcatheter AVR cohort. Conclusions The presence of AF at discharge in patients with intermediate surgical risk aortic stenosis was associated with worse outcomes-especially in patients with baseline SR-including increased all-cause mortality at 2-year follow-up. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01314313 and NCT03222128.
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Affiliation(s)
- Michael I Brener
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | - Isaac George
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | - Ioanna Kosmidou
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY.,Cardiovascular Research Foundation New York NY
| | - Tamim Nazif
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | | | - Jose M Dizon
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | - Hasan Garan
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | | | - Raj Makkar
- Cedars-Sinai Medical Center Los Angeles CA
| | | | | | | | | | - Martin B Leon
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY.,Cardiovascular Research Foundation New York NY
| | - Susheel Kodali
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
| | - Angelo B Biviano
- Division of Cardiology NewYork Presbyterian-Columbia University Medical Center New York NY
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Saito Y, Nazif T, Baumbach A, Tchétché D, Latib A, Kaple R, Forrest J, Prendergast B, Lansky A. Adjunctive Antithrombotic Therapy for Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement. JAMA Cardiol 2021; 5:92-101. [PMID: 31721980 DOI: 10.1001/jamacardio.2019.4367] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Importance Transcatheter aortic valve replacement (TAVR) is an established alternative to surgery for patients with severe symptomatic aortic stenosis. Adjunctive antithrombotic therapy used to mitigate thrombotic risks in patients undergoing TAVR must be balanced against bleeding complications, since both are associated with increased mortality. Observation Stroke risk associated with TAVR is lower than that associated with surgical aortic valve replacement in recent trials including patients at intermediate or low risk, but it is constant beginning at the time of implant and accrues over time based on patient risk factors. Patients with aortic stenosis undergoing TAVR also have a sizable risk of life-threatening or major bleeding. Although dual antiplatelet therapy for 3 to 6 months after TAVR is the guideline-recommended regimen, this practice is not well supported by current evidence. In patients with no indication for oral anticoagulation, current registry-based evidence suggests that single antiplatelet therapy may be safer than dual antiplatelet therapy. Similarly, oral anticoagulation monotherapy appears superior to anticoagulation plus antiplatelet therapy in those where oral anticoagulant use is indicated. To date, no risk prediction models have been established to guide antithrombotic therapy. Conclusions and Relevance Despite the growing volume of TAVR procedures to treat patients with severe aortic stenosis, evidence for adjunctive antithrombotic therapy remains rather scarce. Ongoing clinical trials will provide better understanding to guide antithrombotic therapy.
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Affiliation(s)
- Yuichi Saito
- Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Tamim Nazif
- Columbia University Medical Center, New York, New York
| | - Andreas Baumbach
- Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.,Barts Heart Centre, London and Queen Mary University of London, London, United Kingdom
| | | | - Azeem Latib
- Montefiore Medical Center, New York, New York
| | - Ryan Kaple
- Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - John Forrest
- Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Alexandra Lansky
- Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.,Barts Heart Centre, London and Queen Mary University of London, London, United Kingdom
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Gupta A, Liao M, Smyth E, Vahl TP, Finn M, Fidlow K, Nazif T, Leon MB, Kodali SK, Kirtane AJ. Bleeding Outcomes in Patients Undergoing Combined Percutaneous Coronary Interventions+Transcatheter Aortic Valve Replacement: Time for an Adjustment to the CathPCI Bleeding Model? Circ Cardiovasc Interv 2020; 14:e009806. [PMID: 33355005 DOI: 10.1161/circinterventions.120.009806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Aakriti Gupta
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.).,Cardiovascular Research Foundation, New York, New York, United States (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.)
| | - Ming Liao
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.).,Cardiovascular Research Foundation, New York, New York, United States (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.)
| | - Emily Smyth
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.).,Cardiovascular Research Foundation, New York, New York, United States (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.)
| | - Torsten P Vahl
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.).,Cardiovascular Research Foundation, New York, New York, United States (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.)
| | - Matthew Finn
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.)
| | - Kathryn Fidlow
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.)
| | - Tamim Nazif
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.)
| | - Martin B Leon
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.).,Cardiovascular Research Foundation, New York, New York, United States (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.)
| | - Susheel K Kodali
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.).,Cardiovascular Research Foundation, New York, New York, United States (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.)
| | - Ajay J Kirtane
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.).,Cardiovascular Research Foundation, New York, New York, United States (A.G., M.L., E.S., T.P.V., M.F., K.F., T.N., M.B.L., S.K.K., A.J.K.)
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Kandzari DE, Kirtane AJ, Windecker S, Latib A, Kedhi E, Mehran R, Price MJ, Abizaid A, Simon DI, Worthley SG, Zaman A, Choi JW, Caputo R, Kanitkar M, McLaurin B, Potluri S, Smith T, Spriggs D, Tolleson T, Nazif T, Parke M, Lee LC, Lung TH, Stone GW. One-Month Dual Antiplatelet Therapy Following Percutaneous Coronary Intervention With Zotarolimus-Eluting Stents in High-Bleeding-Risk Patients. Circ Cardiovasc Interv 2020; 13:e009565. [PMID: 33167705 PMCID: PMC7665241 DOI: 10.1161/circinterventions.120.009565] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Despite treatment guidance endorsing shortened dual antiplatelet therapy (DAPT) duration in high bleeding risk (HBR) patients after drug-eluting stents, limited evidence exists to support these recommendations. The present study was designed to examine the safety and effectiveness of 1-month DAPT duration following percutaneous coronary intervention with zotarolimus-eluting stents in HBR patients. Methods: Onyx ONE Clear was a prospective, multicenter, nonrandomized study evaluating the safety and effectiveness of 1-month DAPT followed by single antiplatelet therapy in HBR patients undergoing percutaneous coronary intervention with Resolute Onyx drug-eluting stents. The primary analysis of cardiac death or myocardial infarction between 1 month and 1 year was performed in the prespecified one-month clear population of patients pooled from the Onyx ONE US/Japan study and Onyx ONE randomized controlled trial. One-month clear was defined as DAPT adherence and without major adverse events during the first month following percutaneous coronary intervention. Results: Among patients enrolled in Onyx ONE US/Japan (n=752) and Onyx ONE randomized controlled trial (n=1018), 1506 patients fulfilled one-month clear criteria. Mean HBR characteristics per patient was 1.6 with 44.7% having multiple risks. By 2 months and 1 year, respectively, 96.9% and 89.3% of patients were taking single antiplatelet therapy. Between 1 month and 1 year, the rate of the primary end point was 7.0%. The 1-sided upper 97.5% CI was 8.4%, less than the performance goal of 9.7% (P<0.001). Conclusions: Among HBR patients who were event free before DAPT discontinuation at 1 month, favorable safety and effectiveness through 1 year support treatment with Resolute Onyx drug-eluting stents as part of an individualized strategy for shortened DAPT duration following percutaneous coronary intervention. Registration: URL: https://www.clinicaltrials.gov; Unique identifier NCT03647475.
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Affiliation(s)
- David E Kandzari
- Department of Interventional Cardiology, Piedmont Heart Institute, Atlanta, GA (D.E.K.)
| | - Ajay J Kirtane
- Department of Interventional Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital (A.J.K., T.N.).,Cardiovascular Research Foundation, New York, NY (A.J.K., G.W.S.)
| | - Stephan Windecker
- Department of Cardiovascular Diseases, University Hospital, University of Bern, Switzerland (S.W.)
| | - Azeem Latib
- Department of Interventional Cardiology, Montefiore Medical Center, New York, NY (A.L.)
| | - Elvin Kedhi
- Department of Cardiology, Isala Zwolle, the Netherlands (E.K.)
| | - Roxana Mehran
- Department of Cardiology, School of Medicine at Mount Sinai, New York, NY (R.M., G.W.S.)
| | - Matthew J Price
- Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA (M.J.P.)
| | - Alexandre Abizaid
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil (A.A.)
| | - Daniel I Simon
- Department of Interventional Cardiology, University Hospitals Cleveland Medical Center, OH (D.I.S.)
| | | | - Azfar Zaman
- Department of Cardiology, Freeman Hospital and Newcastle University, Newcastle upon Tyne, United Kingdom (A.Z.)
| | - James W Choi
- Department of Interventional Cardiology, Baylor Scott and White Heart and Vascular Hospital, Dallas, TX (J.W.C.)
| | - Ronald Caputo
- Department of Interventional Cardiology, St. Joseph's Hospital, Syracuse, NY (R.C.)
| | - Mihir Kanitkar
- Department of Interventional Cardiology, Huntsville Hospital, AL (M.K.)
| | - Brent McLaurin
- Department of Interventional Cardiology, Anmed Health Medical Center, Anderson, SC (B.M.)
| | - Srinivasa Potluri
- Department of Interventional Cardiology, The Heart Hospital Baylor Plano, TX (S.P.)
| | - Timothy Smith
- Department of Interventional Cardiology, The Christ Hospital, Cincinnati, OH (T.S.)
| | - Douglas Spriggs
- Department of Interventional Cardiology, Morton Plant Hospital, Clearwater, FL (D.S.)
| | | | - Tamim Nazif
- Department of Interventional Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital (A.J.K., T.N.)
| | - Maria Parke
- Coronary and Structural Heart Division, Medtronic, Santa Rosa, CA (M.P., L.C.L., T.-H.L.)
| | - Lilian C Lee
- Coronary and Structural Heart Division, Medtronic, Santa Rosa, CA (M.P., L.C.L., T.-H.L.)
| | - Te-Hsin Lung
- Coronary and Structural Heart Division, Medtronic, Santa Rosa, CA (M.P., L.C.L., T.-H.L.)
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York, NY (A.J.K., G.W.S.).,Department of Cardiology, School of Medicine at Mount Sinai, New York, NY (R.M., G.W.S.)
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Shahim B, Malaisrie SC, George I, Thourani V, Russo M, Biviano A, Mack M, Brown DL, Babaliaros V, Guyton R, Kodali S, Nazif T, Genereux P, Makkar R, Williams M, McCabe J, Webb J, Lu M, Yu X, Leon M, Kosmidou I. TCT CONNECT-468 Postoperative Atrial Fibrillation or Flutter Following Transcatheter or Surgical Aortic Valve Replacement for Severe Aortic Stenosis in Patients at Low Surgical Risk: An Analysis From the PARTNER 3 Trial. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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Lawlor M, Kampaktsis P, Wang V, Ning Y, Placheril E, Brener M, Ng V, Patel A, Nazif T, Vahl T, Khalique O, Hahn R, Leon M, Kurlansky P, Hamid N, Kodali S, George I. TCT CONNECT-497 Incidence and Predictors of Cardiogenic Shock Following Tricuspid Valve Repair or Replacement. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rosenblum H, Masri A, Narotsky DL, Goldsmith J, Hamid N, Hahn RT, Kodali S, Vahl T, Nazif T, Khalique OK, Bokhari S, Soman P, Cavalcante JL, Maurer MS, Castaño A. Unveiling outcomes in coexisting severe aortic stenosis and transthyretin cardiac amyloidosis. Eur J Heart Fail 2020; 23:250-258. [PMID: 32729170 DOI: 10.1002/ejhf.1974] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [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: 04/08/2020] [Revised: 07/01/2020] [Accepted: 07/26/2020] [Indexed: 01/08/2023] Open
Abstract
AIMS Advances in diagnostic imaging have increased the recognition of coexisting transthyretin cardiac amyloidosis (ATTR-CA) and severe aortic stenosis (AS), with a reported prevalence between 8-16%. In this prospective study, we aimed to evaluate the implications of ATTR-CA on outcomes after transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS At two academic centres, we screened patients with severe AS undergoing TAVR for ATTR-CA. Using Kaplan-Meier analysis, we compared survival free from death and a combined endpoint of death and first heart failure hospitalization between patients with and without ATTR-CA. Cox proportional-hazards models were used to determine the association of ATTR-CA with these endpoints. The rate of heart failure hospitalization was compared amongst those with and without ATTR-CA. Overall, 204 patients (83 years, 65% male, Society of Thoracic Surgeons score 6.6%, 72% New York Heart Association class III/IV) were included, 27 (13%) with ATTR-CA. Over a median follow-up of 2.04 years, there was no difference in mortality (log rank, P = 0.99) or the combined endpoint (log rank, P = 0.79) between patients with and without ATTR-CA. In Cox proportional-hazards models, the presence of ATTR-CA was not associated with death. However, patients with ATTR-CA had increased rates of heart failure hospitalization at 1 year (0.372 vs. 0.114 events/person-year, P < 0.004) and 3 years (0.199 vs. 0.111 events/person-year, P = 0.087) following TAVR. CONCLUSION In moderate-risk patients with severe AS undergoing TAVR, there was a 13% prevalence of ATTR-CA, which did not affect mortality. The observed increase in heart failure hospitalization following TAVR in those with ATTR-CA suggests the consequences of the underlying infiltrative myopathy.
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Affiliation(s)
- Hannah Rosenblum
- Center for Cardiac Amyloidosis, Division of Cardiology, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Ahmad Masri
- The Amyloidosis Center, Division of Cardiology, Oregon Health & Sciences University, Portland, OR, USA
| | - David L Narotsky
- Center for Cardiac Amyloidosis, Division of Cardiology, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Jeff Goldsmith
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Nadira Hamid
- Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Rebecca T Hahn
- Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Susheel Kodali
- Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Torsten Vahl
- Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Tamim Nazif
- Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Omar K Khalique
- Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Sabahat Bokhari
- Laboratory of Nuclear Cardiology, Division of Cardiology, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Prem Soman
- Division of Cardiology and the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburg, PA, USA
| | - João L Cavalcante
- Cardiovascular Imaging Research Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Mathew S Maurer
- Center for Cardiac Amyloidosis, Division of Cardiology, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Adam Castaño
- Center for Cardiac Amyloidosis, Division of Cardiology, Columbia University College of Physicians & Surgeons, New York, NY, USA.,Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
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Sathananthan J, Webb JG, Lauck SB, Cairns J, Humphries KH, Nazif T, Thourani VH, Cohen DJ, Leon MB, Wood DA. Impact of Local Anesthesia Only Versus Procedural Sedation Using the Vancouver Clinical Pathway for TAVR: Insights From the 3M TAVR Study. JACC Cardiovasc Interv 2020; 12:1000-1001. [PMID: 31122345 DOI: 10.1016/j.jcin.2019.02.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 02/12/2019] [Indexed: 11/29/2022]
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Chen S, Redfors B, Crowley A, Ben‐Yehuda O, Summers M, Hahn RT, Jaber WA, Pibarot P, Alu MC, Chau KH, Kapadia S, Nazif T, Vahl TP, Thourani V, Kodali S, Leon M. Impact of recent heart failure hospitalization on clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement: an analysis from the
PARTNER
2 trial and registries. Eur J Heart Fail 2020; 22:1866-1874. [DOI: 10.1002/ejhf.1841] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/31/2020] [Accepted: 04/13/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Shmuel Chen
- Cardiovascular Research Foundation New York NY USA
- Columbia University Medical Center/New York‐Presbyterian Hospital New York NY USA
| | - Bjorn Redfors
- Cardiovascular Research Foundation New York NY USA
- Columbia University Medical Center/New York‐Presbyterian Hospital New York NY USA
| | | | | | | | - Rebecca T. Hahn
- Cardiovascular Research Foundation New York NY USA
- Columbia University Medical Center/New York‐Presbyterian Hospital New York NY USA
| | | | | | - Maria C. Alu
- Cardiovascular Research Foundation New York NY USA
- Columbia University Medical Center/New York‐Presbyterian Hospital New York NY USA
| | - Katherine H. Chau
- Columbia University Medical Center/New York‐Presbyterian Hospital New York NY USA
| | | | - Tamim Nazif
- Columbia University Medical Center/New York‐Presbyterian Hospital New York NY USA
| | - Torsten P. Vahl
- Columbia University Medical Center/New York‐Presbyterian Hospital New York NY USA
| | | | - Susheel Kodali
- Columbia University Medical Center/New York‐Presbyterian Hospital New York NY USA
| | - Martin Leon
- Cardiovascular Research Foundation New York NY USA
- Columbia University Medical Center/New York‐Presbyterian Hospital New York NY USA
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Haiman G, Nazif T, Moses JW, Ashkenazi A, Margolis P, Lansky AJ. Reduction of Cerebral Emboli: In vitro Study with a Novel Cerebral Embolic Protection Device. Med Devices (Auckl) 2020; 13:67-73. [PMID: 32210643 PMCID: PMC7075333 DOI: 10.2147/mder.s234961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/29/2020] [Indexed: 11/24/2022] Open
Abstract
Aim To assess the efficacy of the TriGUARD 3™, a novel cerebral embolic protection (CEP) device in reducing cerebral embolization by deflecting embolic debris away from the cerebral circulation using a quantitative in vitro model. Methods and Results This in vitro study assessed the ability of a cerebral embolic protection device to deflect embolic debris, by measuring the percent of particles and air bubbles, 200 µm and 300 µm in size, from entering the cerebral circulation compared to unprotected controls. A 3D printed silicone model of the ascending aorta, the aortic arch with its three major cerebral arteries and the descending aorta was connected to a custom-made simulator that mimics physiological pulsatile flow patterns of the left ventricle. Comparative analyses were used to assess the efficacy of the cerebral embolic protection device to deflect particles and air bubbles away from the major cerebral arteries. The percent of particles and air bubbles entering the major cerebral arteries was significantly lower with cerebral embolic protection compared to unprotected controls (p<0.0001). Cerebral protection resulted in 97.4–100% reduction in air bubble counts, and 97.4–97.8% reduction in particle counts compared to unprotected controls. Conclusion This in vitro study used simulated physiologic flow conditions in an aortic arch model to demonstrate >97% efficacy of the TriGUARD 3 CEP device, in reducing cerebral embolization of particulate and air bubbles of 200 µm to 300 µm in size.
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Affiliation(s)
| | - Tamim Nazif
- Department of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Jeffrey W Moses
- Department of Cardiology, Columbia University Medical Center, New York, NY, USA
| | | | | | - Alexandra J Lansky
- Division of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Department of Cardiology, Yale Cardiovascular Research Group, New Haven, CT, USA
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Jin G, Mintz G, Fall K, Ali Z, Kirtane A, Nazif T, Rabbani L, Green P, Parikh M, Collins M, Karmpaliotis D, Moses J, Maehara A. MECHANICAL CAUSE OF EARLY OCCLUSION AFTER SUCCESSFUL PERCUTANEOUS CORONARY INTERVENTION EVALUATED BY IVUS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32073-8] [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: 10/24/2022]
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Salem H, Mintz G, Matsumura M, Zhang M, Fall K, Ali Z, Kirtane A, Nazif T, Parikh M, Collins M, Moses J, Karmpaliotis D, Maehara A. THE MECHANISM OF BALLOON UNCROSSABILITY ASSESSED BY INTRAVASCULAR ULTRASOUND. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32074-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Faroux L, Chen S, Muntané-Carol G, Regueiro A, Philippon F, Sondergaard L, Jørgensen TH, Lopez-Aguilera J, Kodali S, Leon M, Nazif T, Rodés-Cabau J. Clinical impact of conduction disturbances in transcatheter aortic valve replacement recipients: a systematic review and meta-analysis. Eur Heart J 2020; 41:2771-2781. [DOI: 10.1093/eurheartj/ehz924] [Citation(s) in RCA: 92] [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] [Received: 07/27/2019] [Revised: 09/26/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
The clinical impact of new-onset persistent left bundle branch block (NOP-LBBB) and permanent pacemaker implantation (PPI) on transcatheter aortic valve replacement (TAVR) recipients remains controversial. We aimed to evaluate the impact of (i) periprocedural NOP-LBBB and PPI post-TAVR on 1-year all-cause death, cardiac death, and heart failure hospitalization and (ii) NOP-LBBB on the need for PPI at 1-year follow-up.
Methods and results
We performed a systematic search from PubMed and EMBASE databases for studies reporting raw data on 1-year clinical impact of NOP-LBBB or periprocedural PPI post-TAVR. Data from 30 studies, including 7792 patients (12 studies) and 42 927 patients (21 studies) for the evaluation of the impact of NOP-LBBB and PPI after TAVR were sourced, respectively. NOP-LBBB was associated with an increased risk of all-cause death [risk ratio (RR) 1.32, 95% confidence interval (CI) 1.17–1.49; P < 0.001], cardiac death (RR 1.46, 95% CI 1.20–1.78; P < 0.001), heart failure hospitalization (RR 1.35, 95% CI 1.05–1.72; P = 0.02), and PPI (RR 1.89, 95% CI 1.58–2.27; P < 0.001) at 1-year follow-up. Periprocedural PPI after TAVR was associated with a higher risk of all-cause death (RR 1.17, 95% CI 1.11–1.25; P < 0.001) and heart failure hospitalization (RR 1.18, 95% CI 1.03–1.36; P = 0.02). Permanent pacemaker implantation was not associated with an increased risk of cardiac death (RR 0.84, 95% CI 0.67–1.05; P = 0.13).
Conclusion
NOP-LBBB and PPI after TAVR are associated with an increased risk of all-cause death and heart failure hospitalization at 1-year follow-up. Periprocedural NOP-LBBB also increased the risk of cardiac death and PPI within the year following the procedure. Further studies are urgently warranted to enhance preventive measures and optimize the management of conduction disturbances post-TAVR.
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Affiliation(s)
- Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec G1V4G5, Canada
| | - Shmuel Chen
- Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
| | - Guillem Muntané-Carol
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec G1V4G5, Canada
| | - Ander Regueiro
- Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Carrer de Villaroel, 170, 08036 Barcelona, Spain
| | - Francois Philippon
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec G1V4G5, Canada
| | - Lars Sondergaard
- Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Troels H Jørgensen
- Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - José Lopez-Aguilera
- Hospital Reina Sofia of Cordoba, Avenida Menendez Pidal, 14004 Cordoba, Spain
| | - Susheel Kodali
- Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
| | - Martin Leon
- Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
| | - Tamim Nazif
- Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec G1V4G5, Canada
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