1
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Mohananey D, Martin AK, Mandawat H, Hauser JM, Ramakrishna H. Analysis of the 2022 European Society of Cardiology/European Respiratory Society Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension. J Cardiothorac Vasc Anesth 2024; 38:534-541. [PMID: 38052693 DOI: 10.1053/j.jvca.2023.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Divyanshu Mohananey
- Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Archer K Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Jacksonville, FL
| | - Himani Mandawat
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Josh M Hauser
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MI
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MI.
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2
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Messiha H, Garster N, Lewandowski D, Pearson PJ, Mohananey D. Subvalvular Thrombosis of the Mitral Valve-A Rare Cause of Cardioembolic Stroke. CASE (Phila) 2023; 7:492-495. [PMID: 38197120 PMCID: PMC10772932 DOI: 10.1016/j.case.2023.09.004] [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] [Indexed: 01/11/2024]
Abstract
•MAC-associated subvalvular thrombosis is a rare cause of cardioembolic stroke. •Thorough evaluation of the MV is important when cardioembolic phenomena are suspected. •Surgical resection is an option in patients with high-risk thrombi.
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Affiliation(s)
- Heidi Messiha
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Noelle Garster
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David Lewandowski
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Paul J. Pearson
- Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Divyanshu Mohananey
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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3
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Shekhar S, Kansara T, Morozowich ST, Mohananey D, Agrawal A, Narasimhan S, Nelson JA, Ramakrishna H. Renal Outcomes Following Transcatheter Mitral Valve Repair - Analysis of COAPT Trial Data. J Cardiothorac Vasc Anesth 2023; 37:2119-2124. [PMID: 37210324 DOI: 10.1053/j.jvca.2023.04.026] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/22/2023]
Abstract
The prevalence of valvular heart disease in the United States has been estimated at 4.2-to-5.6 million, with mitral regurgitation (MR) being the most common lesion. Significant MR is associated with heart failure (HF) and death if left untreated. When HF is present, renal dysfunction (RD) is common and is associated with worse outcomes (ie, it is a marker of HF disease progression). Additionally, a complex interplay exists in patients with HF who also have MR, as this combination further impairs renal function, and the presence of RD further worsens prognosis and often limits guideline-directed management and therapy (GDMT). This has important implications in secondary MR because GDMT is the standard of care. However, with the development of minimally invasive transcatheter mitral valve repair, mitral transcatheter edge-to-edge repair (TEER) has become a new treatment option for secondary MR that is now incorporated into current guidelines published in 2020 that listed mitral TEER as a class 2a recommendation (moderate recommendation with benefit >> risk) as an addition to GDMT in a subset of patients with left ventricular ejection fraction <50%. The Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial, which demonstrated favorable outcomes in secondary MR by adding mitral TEER to GDMT versus GDMT alone, was the evidence base for these guidelines. Considering these guidelines and the understanding that concomitant RD often limits GDMT in secondary MR, there is emerging research studying the renal outcomes from the COAPT trial. This review analyzes this evidence, which could further influence current decision-making and future guidelines.
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Affiliation(s)
- Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Tikal Kansara
- Department of Hospital Medicine, Cleveland Clinic Union Hospital, Cleveland, Ohio
| | - Steven T Morozowich
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Divyanshu Mohananey
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Heart, and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - James A Nelson
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.
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4
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Ayoub M, Shah H, Nguyen BC, Mehdi M, Nagavally S, Dawson A, Al-Kindi S, Virani S, Mohananey D, Sharma A, Sinh P. Coronary Artery Plaque Assessment by CT Angiogram in Inflammatory Bowel Disease. Inflamm Bowel Dis 2023; 29:e22-e24. [PMID: 36827488 PMCID: PMC10233393 DOI: 10.1093/ibd/izad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- Malek Ayoub
- Department of Medicine, Washington University, St. Louis, MO, USA
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Harini Shah
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bao Chau Nguyen
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Maahum Mehdi
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sneha Nagavally
- Department of Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - April Dawson
- Department of Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sadeer Al-Kindi
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Salim Virani
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA
| | - Divyanshu Mohananey
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Abhinav Sharma
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Preetika Sinh
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
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5
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Lamberg M, Devine A, Jewulski J, Smith A, Garster N, Sharma A, Mason PJ, Lewandowski D, Widlansky M, Mohananey D. Degenerative Mitral Stenosis: A Case-Based Review. CASE 2023; 7:189-196. [PMID: 37325463 PMCID: PMC10264206 DOI: 10.1016/j.case.2022.12.014] [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] [Indexed: 06/17/2023]
Affiliation(s)
- Morgan Lamberg
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Adam Devine
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jacob Jewulski
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aaron Smith
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Noelle Garster
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Abhinav Sharma
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Peter J Mason
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David Lewandowski
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael Widlansky
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Divyanshu Mohananey
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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6
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Devine A, Aljadah M, Weiner R, Nemesh I, Mohananey D. A Triad of Pericarditis, Pericardial Effusion, and Pleural Effusion as the Predominant Presentation of Rheumatoid Arthritis - A Case Report. WMJ 2022; 121:e75-e78. [PMID: 36637851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
We describe a case of a 67-year-old African American man who presented to the emergency department with a sharp, pleuritic chest pain and shortness of breath. After several admissions and extensive workup, he ultimately was diagnosed with a persistent pleural effusion, pericardial effusion, and secondary constrictive pericarditis due to rheumatoid arthritis. By highlighting immunological disorders such as rheumatoid arthritis in the differential diagnosis, in the setting of a refractory pericardial effusion and serositis, this case report addresses key aspects of the presentation both in the emergency and inpatient settings, reviews the criteria for a rheumatoid arthritis diagnosis, and emphasizes areas of importance in predominantly cardiopulmonary extra-articular manifestations of a typically musculoskeletal disease.
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Affiliation(s)
- Adam Devine
- Department of Internal Medicine, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, Wisconsin,
| | - Michael Aljadah
- Department of Internal Medicine, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, Wisconsin
| | - Rebecca Weiner
- Department of Rheumatology, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, Wisconsin
| | - Iryna Nemesh
- Department of Rheumatology, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, Wisconsin
| | - Divyanshu Mohananey
- Department of Cardiology, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, Wisconsin
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Porter C, Azam TU, Mohananey D, Kumar R, Chu J, Lenihan D, Dent S, Ganatra S, Beasley GS, Okwuosa T. Permissive Cardiotoxicity. JACC CardioOncol 2022; 4:302-312. [PMID: 36213359 PMCID: PMC9537074 DOI: 10.1016/j.jaccao.2022.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/22/2022] [Accepted: 07/27/2022] [Indexed: 11/29/2022] Open
Abstract
The field of cardio-oncology was born from the necessity for recognition and management of cardiovascular diseases among patients with cancer. This need for this specialty continues to grow as patients with cancer live longer as a result of lifesaving targeted and immunologic cancer therapies beyond the usual chemotherapy and/or radiation therapy. Often, potentially cardiotoxic anticancer treatment is necessary in patients with baseline cardiovascular disease. Moreover, patients may need to continue therapy in the setting of incident cancer therapy–associated cardiotoxicity. Herein, we present and discuss the concept of permissive cardiotoxicity as a novel term that represents an essential concept in the field of cardio-oncology and among practicing cardio-oncology specialists. It emphasizes a proactive rather than reactive approach to continuation of lifesaving cancer therapies in order to achieve the best oncologic outcome while mitigating associated and potentially off-target cardiotoxicities. Permissive cardiotoxicity is a terminology that represents a vital concept in cardio-oncology It emphasizes continued cancer therapy if appropriate, while mitigating cardiotoxicities. Its application is guided by understanding the cancer treatment, alternatives, and prognosis.
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Affiliation(s)
- Charles Porter
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
- Address for correspondence: Dr Charles Porter, University of Kansas Medical Center, 4000 Cambridge, MS 1023, Kansas City, Kansas 66160, USA. @charlesporter99
| | - Tariq U. Azam
- Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Divyanshu Mohananey
- Division of Cardiology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Rohit Kumar
- Division of Medical Oncology, Department of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Jian Chu
- Department of Medicine, Rush University, Chicago, Illinois, USA
| | - Daniel Lenihan
- International Cardio-Oncology Society, Tampa, Florida, USA
| | - Susan Dent
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA
| | - Sarju Ganatra
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Gary S. Beasley
- Division of Cardiology, Department of Pediatrics, University of Iowa Stead Family Children’s Hospital, Iowa City, Iowa, USA
| | - Tochukwu Okwuosa
- Division of Cardiology, Department of Internal Medicine, Rush University, Chicago, Illinois, USA
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8
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Heybati K, Zhou F, Ali S, Deng J, Mohananey D, Villablanca P, Ramakrishna H. Outcomes of dexmedetomidine versus propofol sedation in critically ill adults requiring mechanical ventilation: a systematic review and meta-analysis of randomised controlled trials. Br J Anaesth 2022; 129:515-526. [PMID: 35961815 DOI: 10.1016/j.bja.2022.06.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/02/2022] [Accepted: 06/19/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Guidelines have recommended the use of dexmedetomidine or propofol for sedation after cardiac surgery, and propofol monotherapy for other patients. Further outcome data are required for these drugs. METHODS This systematic review and meta-analysis was prospectively registered on PROSPERO. The primary outcome was ICU length of stay. Secondary outcomes included duration of mechanical ventilation, ICU delirium, all-cause mortality, and haemodynamic effects. Intensive care patients were analysed separately as cardiac surgical, medical/noncardiac surgical, those with sepsis, and patients in neurocritical care. Subgroup analyses based on age and dosage were conducted. RESULTS Forty-one trials (N=3948) were included. Dexmedetomidine did not significantly affect ICU length of stay across any ICU patient subtype when compared with propofol, but it reduced the duration of mechanical ventilation (mean difference -0.67 h; 95% confidence interval: -1.31 to -0.03 h; P=0.041; low certainty) and the risk of ICU delirium (risk ratio 0.49; 95% confidence interval: 0.29-0.87; P=0.019; high certainty) across cardiac surgical patients. Dexmedetomidine was also associated with a greater risk of bradycardia across a variety of ICU patients. Subgroup analyses revealed that age might affect the incidence of haemodynamic side-effects and mortality among cardiac surgical and medical/other surgical patients. CONCLUSION Dexmedetomidine did not significantly impact ICU length of stay compared with propofol, but it significantly reduced the duration of mechanical ventilation and the risk of delirium in cardiac surgical patients. It also significantly increased the risk of bradycardia across ICU patient subsets.
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Affiliation(s)
- Kiyan Heybati
- Mayo Clinic Alix School of Medicine, Mayo Clinic - Rochester, Rochester, MN, USA
| | - Fangwen Zhou
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Saif Ali
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jiawen Deng
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic - Rochester, Rochester, MN, USA
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9
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Shah H, Ayoub M, Nguyen B, Nagavally S, Mohananey D, Sharma A, Virani S, Al-Kindi S, Sinh P. 466 Coronary Artery Plaque Assessment In Inflammatory Bowel Disease. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.077] [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: 12/01/2022]
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10
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Castellani C, Smith AAH, Mohananey D, Garster N. Trileaflet Mitral Valve in the Setting of Hypertrophic Cardiomyopathy: A Curious Rarity With a Possible Association. Circ Cardiovasc Imaging 2022; 15:e013772. [PMID: 35345893 DOI: 10.1161/circimaging.121.013772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carson Castellani
- Department of Medicine (C.C.), Medical College of Wisconsin, Milwaukee
| | - Aaron A H Smith
- Division of Cardiovascular Medicine, Department of Medicine (A.A.H.S., D.M., N.G.), Medical College of Wisconsin, Milwaukee
| | - Divyanshu Mohananey
- Division of Cardiovascular Medicine, Department of Medicine (A.A.H.S., D.M., N.G.), Medical College of Wisconsin, Milwaukee
| | - Noelle Garster
- Division of Cardiovascular Medicine, Department of Medicine (A.A.H.S., D.M., N.G.), Medical College of Wisconsin, Milwaukee
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11
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Mohananey D, Gomez J, Goodman RE, Kim H, Gaglianello N. INITIATION OF SACUBITRIL-VALSARTAN IN PATIENTS WITH CARDIOGENIC SHOCK OR LOW CARDIAC OUTPUT HEART FAILURE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01334-1] [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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12
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Lamberg M, Mohananey D, Cohen S. CARDIAC ARREST IN AEROBICS CLASS: A CASE OF ANOMALOUS LEFT CORONARY ARTERY FROM THE PULMONARY ARTERY (ALCAPA). J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03238-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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Goodman R, Mohananey D, Garster N, Gaglianello N. Incidental Finding of Traumatic Papillary Muscle Rupture on Intraoperative Transesophageal Echocardiogram following a Motor Vehicle Accident. CASE 2022; 6:21-23. [PMID: 35243195 PMCID: PMC8883070 DOI: 10.1016/j.case.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Traumatic papillary muscle rupture is a rare cause of acute MR. Acute MR is typically a low-velocity jet with a triangle-shaped Doppler spectrum. Methods of quantification using the continuity equation may not be accurate in acute MR. A high index of suspicion is required to detect acute papillary muscle rupture. Consider MR with a hyperdynamic LV, near-systolic LV obliteration, and pulmonary edema.
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Shekhar S, Mohananey D, Villablanca P, Tyagi S, Crestanello JA, Gil IJN, Ramakrishna H. Revascularization Strategies for Stable Left Main Coronary Artery Disease: Analysis of Current Evidence. J Cardiothorac Vasc Anesth 2021; 36:3370-3378. [PMID: 35115224 DOI: 10.1053/j.jvca.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Divyanshu Mohananey
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
| | | | - Sudhi Tyagi
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
| | | | - Iván J Núñez Gil
- Interventional Cardiology Consultant, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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15
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Mohananey D, Villablanca P, Nunez-Gil I, Ramakrishna H. Percutaneous Intervention and In-Hospital Mortality: A Contemporary Risk-Prediction Model. J Cardiothorac Vasc Anesth 2021; 36:356-357. [PMID: 34635379 DOI: 10.1053/j.jvca.2021.08.102] [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: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Divyanshu Mohananey
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Pedro Villablanca
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI
| | - Ivan Nunez-Gil
- Division of Interventional Cardiology, Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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16
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Mohananey D, Reddy Manne JR, Lewandowski D, Garg J. B-PO03-213 USE OF M MODE TO DEMONSTRATE ABNORMAL VENTRICULAR CONTRACTION IN WOLFF-PARKINSON WHITE SYNDROME. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.686] [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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17
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Madan M, So D, Lennon R, Mathew V, Bae JH, Escobedo J, Jeong MH, Kim SW, Lim HS, Murthy V, Saucedo J, Mohananey D, Rihal C, Farkouh M, Pereira N, Goodman S. RACE AND CLINICAL OUTCOMES AFTER PERCUTANEOUS CORONARY INTERVENTION: OBSERVATIONS FROM THE TAILOR-PCI TRIAL. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02469-4] [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: 10/21/2022]
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18
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Mohananey D, Aljadah M, Smith AAH, Haines JF, Patel S, Villablanca P, Ramakrishna H. The 2020 ACC/AHA Guidelines for Management of Patients With Valvular Heart Disease: Highlights and Perioperative Implications. J Cardiothorac Vasc Anesth 2021; 36:1467-1476. [PMID: 34011447 DOI: 10.1053/j.jvca.2021.04.013] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/10/2021] [Indexed: 12/26/2022]
Abstract
Valvular heart disease contributes to a large burden of morbidity and mortality in the United States. During the last decade there has been a paradigm shift in the management of valve disease, primarily driven by the emergence of novel transcatheter technologies. In this article, the latest update of the American College of Cardiology/American Heart Association valve heart disease guidelines is reviewed.
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Affiliation(s)
- Divyanshu Mohananey
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Michael Aljadah
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Aaron A H Smith
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Jeremiah F Haines
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Sahishnu Patel
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI
| | | | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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19
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Mohananey D, Sarau A, Kumar R, Lewandowski D, Abreu-Sosa SM, Nathan S, Okwuosa TM. Role of Physical Activity and Cardiac Rehabilitation in Patients Undergoing Hematopoietic Stem Cell Transplantation. JACC CardioOncol 2021; 3:17-34. [PMID: 34396304 PMCID: PMC8352115 DOI: 10.1016/j.jaccao.2021.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 06/16/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 12/13/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) is a standard treatment for several malignancies, and >50,000 HSCT are performed annually worldwide. As survival after HSCT improves, cardiovascular disease and associated risk factors have gained importance as a significant cause of morbidity and mortality in this cohort. In this article, we detail the risk factors for cardiovascular disease and their impact in patients undergoing HSCT. Additionally, we critically review the data on the impact of physical exercise in patients undergoing HSCT. Although limited by significant heterogeneity in methodologies, small sample sizes, attrition, and lack of long-term cardiovascular follow-up, most of these studies reinforce the beneficial effects of physical activity and exercise in this patient population. Cardiac rehabilitation (CR) is a structured exercise and lifestyle modification program that is typically instituted in patients who experience acute cardiovascular events. We review the data on CR in the oncologic and nononcologic populations with an aim of building a framework for use of CR in HSCT patients. Patients surviving HSCT have a higher incidence of cardiovascular risk factors and cardiovascular disease than the general population. Physical activity can improve cardiovascular fitness, strength, and quality of life and decrease fatigue in HSCT patients and survivors. In addition to physical exercise, cardiac rehabilitation also involves dietary and smoking cessation counseling, medication management, and psychosocial support, and it may therefore offer a unique framework to mitigate cardiovascular risk in HSCT. Early referral, cardiovascular risk stratification, monitoring for complications, and multimodal lifestyle interventions should form the backbone of cardiac rehabilitation in this population. Outcome data on quality of life indices and survival as potential benefits of cardiac rehabilitation in HSCT are needed.
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Key Words
- ACSM, American College of Sports Medicine
- AHA, American Heart Association
- CR, cardiac rehabilitation
- CVD, cardiovascular disease
- GVHD, graft-versus-host disease
- HSCT, hematopoietic stem cell transplantation
- MFI, Multidimensional Fatigue Inventory
- MI, myocardial infarction
- PCI, percutaneous coronary interventions
- Vo2max, maximal oxygen consumption
- cardiac rehabilitation
- hematopoietic stem cell transplantation
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Affiliation(s)
- Divyanshu Mohananey
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Wisconsin, USA
| | - Alexandra Sarau
- Department of Internal Medicine, Rush University, Chicago, Illinois, USA
| | - Rohit Kumar
- Hematology and Medical Oncology Division, University of Louisville, Louisville, Kentucky, USA
| | - David Lewandowski
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Wisconsin, USA
| | - Sol M Abreu-Sosa
- Department of Physical Medicine and Rehabilitation, Rush University, Chicago, Illinois, USA
| | - Sunita Nathan
- Division of Hematology/Oncology and Cell Therapy, Rush University, Chicago, Illinois, USA
| | - Tochukwu M Okwuosa
- Division of Cardiovascular Medicine, Rush University, Chicago, Illinois, USA
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Mohananey D, Mewhort H, Shekhar S, Mohananey A, Chaudhary R, Gaglianello N, Ramakrishna H. Heart Failure Trial Update-Analysis of Recent Data. J Cardiothorac Vasc Anesth 2020; 35:2792-2800. [PMID: 33039289 DOI: 10.1053/j.jvca.2020.09.085] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 09/01/2020] [Indexed: 11/11/2022]
Abstract
The prevalence of heart failure (HF) continues to increase, and its economic effect is significant in the United States and globally. During the past 2 years, a number of high-quality clinical trials were published with the aim of addressing different stages of the disease process and improving outcomes for patients with preserved and depressed ejection fraction (EF). In this review, data from these trials are summarized and critically appraised. There are several important findings from these studies, including, but not limited to, the benefit of dapagliflozin in HF with reduced EF, sacubitril-valsartan in acute decompensated HF, thoracotomy in left ventricular assist device implantation, and the overall risk-benefit ratios of centrifugal pumps as opposed to continuous flow pumps. Effective therapies for HF with preserved EF continue to evolve for this varied group of high morbidity and mortality conditions.
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Affiliation(s)
- Divyanshu Mohananey
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Holly Mewhort
- Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | | | | | - Rahul Chaudhary
- Division of Hospital Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Nunzio Gaglianello
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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21
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Kumar A, Sammour Y, Reginauld S, Sato K, Agrawal N, Lee JM, Meenakshisundaram C, Ramanan T, Kamioka N, Sawant AC, Mohananey D, Gleason PT, Devireddy C, Krishnaswamy A, Mavromatis K, Grubb K, Svensson LG, Tuzcu EM, Block PC, Iyer V, Babaliaros V, Kapadia S, Samady H. Adverse clinical outcomes in patients undergoing both PCI and TAVR: Analysis from a pooled multi-center registry. Catheter Cardiovasc Interv 2020; 97:529-539. [PMID: 32845036 DOI: 10.1002/ccd.29233] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/02/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is a paucity of data regarding the optimum timing of PCI in relation to TAVR. OBJECTIVE We compared the major adverse cardiovascular and cerebrovascular events (MACCE) rates among patients who underwent percutaneous coronary intervention (PCI) before transcatheter aortic valve replacement (TAVR) with those who received PCI with/after TAVR. METHODS In this multicenter study, we pooled all consecutive patients who underwent TAVR at three high volume centers. RESULTS Among 3,982 patients who underwent TAVR, 327 (8%) patients underwent PCI within 1 year before TAVR, 38 (1%) had PCI the same day as TAVR and 15 (0.5%) had PCI within 2 months after TAVR. Overall, among patients who received both PCI and TAVR (n = 380), history of previous CABG (HR:0.501; p = .001), higher BMI at TAVR (HR:0.970; p = .038), and statin therapy after TAVR (HR:0.660, p = .037) were independently associated with lower MACCE while warfarin therapy after TAVR was associated with a higher risk of MACCE (HR:1.779, p = .017). Patients who received PCI within 1 year before TAVR had similar baseline demographics, STS scores, clinical risk factors when compared to patients receiving PCI with/after TAVR. Both groups were similar in PCI (Syntax Score, ACC/AHA lesion class) and TAVR (valve types, access) related variables. There were no significant differences in terms of MACCE (log rank p = .550), all-cause mortality (log rank p = .433), strokes (log rank p = .153), and repeat PCI (log rank p = .054) in patients who underwent PCI with/after TAVR when compared to patients who received PCI before TAVR. CONCLUSION Among patients who underwent both PCI and TAVR, history of CABG, higher BMI, and statin therapy had lower, while those discharged on warfarin, had higher adverse event rates. Adverse events rates were similar regardless of timing of PCI.
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Affiliation(s)
- Arnav Kumar
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Yasser Sammour
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Shawn Reginauld
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Kimi Sato
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nikhil Agrawal
- Department of Medicine Division of Cardiology, State University of New York at Buffalo, Buffalo, New York
| | - Joo Myung Lee
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | | | - Thammi Ramanan
- Department of Medicine Division of Cardiology, State University of New York at Buffalo, Buffalo, New York
| | - Norihiko Kamioka
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Abhishek C Sawant
- Department of Medicine Division of Cardiology, State University of New York at Buffalo, Buffalo, New York
| | | | - Patrick T Gleason
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Chandan Devireddy
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Amar Krishnaswamy
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Kreton Mavromatis
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Kendra Grubb
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Lars G Svensson
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - E Murat Tuzcu
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Peter C Block
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Vijay Iyer
- Department of Medicine Division of Cardiology, State University of New York at Buffalo, Buffalo, New York
| | - Vasilis Babaliaros
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Samir Kapadia
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Habib Samady
- Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia
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22
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Mohananey D, Ramakrishna H. Point-of-Care Ultrasound in Critically Ill Patients-Assessing Value in an Ever-Changing Environment. J Cardiothorac Vasc Anesth 2020; 34:2689-2690. [PMID: 32620490 PMCID: PMC7284231 DOI: 10.1053/j.jvca.2020.06.012] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/04/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Divyanshu Mohananey
- Department of Cardiovascular Medicine, Medical College of Wisconsin,Milwaukee, WI
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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Sharma T, Chaudhary R, Garg J, Kondur A, Mohananey D, Chaudhary R. Six sigma approach to reduce door-to-balloon time for patients with STEMI. Am J Manag Care 2020; 26:e140-e141. [PMID: 32436681 DOI: 10.37765/ajmc.2020.43155] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Specific measures using a Six Sigma approach led to sustained reduction of door-to-balloon times among patients with ST-segment elevation myocardial infarction (STEMI) in a community setting.
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Affiliation(s)
| | | | | | | | | | - Rahul Chaudhary
- Department of Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
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24
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Nagaraja V, Mohananey D, Navia J, Harb SC, Miyasaka R, Krishnaswamy A, Kapadia S. Functional tricuspid regurgitation: Feasibility of transcatheter interventions. Cleve Clin J Med 2020; 87:4-14. [DOI: 10.3949/ccjm.87.s1.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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25
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Villablanca PA, Lemor A, So CY, Kang G, Jain T, Gupta T, Ando T, Mohananey D, Ranka S, Hernandez-Suarez DF, Michel P, Frisoli T, Wang DD, Eng M, O'Neill W, Ramakrishna H. Increased Risk of Perioperative Ischemic Stroke in Patients Who Undergo Noncardiac Surgery with Preexisting Atrial Septal Defect or Patent Foramen Ovale. J Cardiothorac Vasc Anesth 2020; 34:2060-2068. [PMID: 32127264 DOI: 10.1053/j.jvca.2020.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate whether a preoperative diagnosis of atrial septal defect (ASD) or patent foramen ovale (PFO) is associated with perioperative stroke in noncardiac surgery and their outcomes. DESIGN Retrospective cohort analysis. SETTING United States hospitals. PARTICIPANTS Adults patients (≥18 years old) who underwent major noncardiac surgery from 2010 to 2015 were identified using the Healthcare Cost and Utilization Project's National Readmission Database. INTERVENTIONS Preoperative diagnosis of ASD or patent foramen ovale. MEASUREMENTS AND MAIN RESULTS Among the 19,659,161 hospitalizations for major noncardiac surgery analyzed, 12,248 (0.06%) had a preoperative diagnosis of ASD/PFO. Perioperative ischemic stroke occurred in 723 (5.9%) of patients with ASD/PFO and 373,291 (0.02%) of those without ASD/PFO (adjusted odds ratio [aOR], 16.7; 95% confidence interval [CI]: 13.9-20.0). Amongst the different types of noncardiac surgeries, obstetric, endocrine, and skin and burn surgery were associated with higher risk of stroke in patients with pre-existing ASD/PFO. Moreover, patients with ASD/PFO also had an increased in-hospital mortality (aOR, 4.6, 95% CI: 3.6-6.0), 30-day readmission (aOR, 1.2, 95% CI: 1.04-1.38), and 30-day stroke (aOR, 7.2, 95% CI: 3.1-16.6). After adjusting for atrial fibrillation, ischemic stroke remained significantly high in the ASD/PFO group (aOR: 23.7, 95%CI 19.4-28.9), as well as in-hospital mortality (aOR: 5.6, 95% CI 4.1-7.7), 30-day readmission (aOR: 1.19, 95%CI 1.0-1.4), and 30-day stroke (aOR: 9.3, 95% CI 3.7-23.6). CONCLUSIONS Among adult patients undergoing major noncardiac surgery, pre-existing ASD/PFO is associated with increased risk of perioperative ischemic stroke, in-hospital mortality, 30-day stroke, and 30-day readmission after surgery.
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Affiliation(s)
| | - Alejandro Lemor
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI; Universidad de San Martín de Porres, Facultad de Medicina, Centro de Investigación de Epidemiología Clínica y Medicina Basada en la Evidencia, Lima, Peru
| | - Chak-Yu So
- Universidad de San Martín de Porres, Facultad de Medicina, Centro de Investigación de Epidemiología Clínica y Medicina Basada en la Evidencia, Lima, Peru; Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | - Guson Kang
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI
| | - Tarun Jain
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI
| | - Tanush Gupta
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY
| | - Tomo Ando
- Department of Cardiology, Wayne State University/Detroit Medical Center, Detroit, MI
| | | | - Sagar Ranka
- Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, IL
| | - Dagmar F Hernandez-Suarez
- Division of Cardiovascular Medicine, Department of Medicine, University of Puerto Rico School of Medicine, San Juan, PR
| | - Pablo Michel
- University of Texas Health Science Center San Antonio, San Antonio, TX
| | - Tiberio Frisoli
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI
| | - Marvin Eng
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI
| | - William O'Neill
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ.
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26
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Ranka S, Mohananey D, Agarwal N, Verma BR, Villablanca P, Mewhort HE, Ramakrishna H. Chronic Thromboembolic Pulmonary Hypertension-Management Strategies and Outcomes. J Cardiothorac Vasc Anesth 2019; 34:2513-2523. [PMID: 31883688 DOI: 10.1053/j.jvca.2019.11.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 11/11/2022]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is rare but complex pathophysiological disease with hallmark features of chronic thrombotic mechanical obstruction, right ventricular dysfunction, and secondary pulmonary arteriopathy. It increasingly is being understood that chronic infection/inflammation, abnormal fibrinolysis, and cytokines play an important role in pathogenesis such that only a subset of patients with pulmonary embolism develop CTEPH. Diagnosis remains challenging given the lack of early clinical signs and overlap with other cardiopulmonary conditions. Pulmonary endarterectomy is the surgical procedure of choice with good postoperative survival and functional outcomes, especially when done at high-volume centers with a multidisciplinary approach. There has been a resurgence of balloon pulmonary angioplasty (BPA) as salvage therapy for inoperable CTEPH or in its newfound hybrid role for persistent postoperative pulmonary hypertension with excellent 1-year and 3-year survival. Use of riociguat has shown promising improvements in functional outcomes up to 2 years after initiation. Endothelin receptor antagonists serve a supplemental role postoperatively or in inoperable CTEPH. The role of drug therapy preoperatively or in tandem with BPA is currently under investigation.
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Affiliation(s)
- Sagar Ranka
- Department of Cardiovascular Medicine, Kansas University Medical Center, Kansas City, KS
| | - Divyanshu Mohananey
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Nikhil Agarwal
- Division of Cardiovascular Medicine, University of Buffalo, Buffalo, NY
| | - Beni Rai Verma
- Department of Cardiology, Cleveland Clinic, Cleveland, OH
| | | | | | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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27
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Khubber S, Bazarbashi N, Mohananey D, Kadri A, Gad MM, Kaur M, Sammour YM, Lyden M, Ahuja KR, Verma B, Menon V, Mick SL, Reed GW, Puri R, Svensson L, Navia JL, Tuzcu EM, Krishnaswamy A, Kapadia SR. Unilateral Access Is Safe and Facilitates Peripheral Bailout During Transfemoral-Approach Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 12:2210-2220. [DOI: 10.1016/j.jcin.2019.06.050] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/13/2019] [Accepted: 06/19/2019] [Indexed: 12/13/2022]
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28
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Krishnan S, Sharma A, Subramani S, Arora L, Mohananey D, Villablanca P, Ramakrishna H. Analysis of Neurologic Complications After Surgical Versus Transcatheter Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2019; 33:3182-3195. [DOI: 10.1053/j.jvca.2018.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Indexed: 11/11/2022]
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29
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Kumar A, Sato K, Narayanswami J, Banerjee K, Andress K, Lokhande C, Mohananey D, Anumandla AK, Khan AR, Sawant AC, Menon V, Krishnaswamy A, Tuzcu EM, Jaber WA, Mick S, Svensson LG, Kapadia SR. Current Society of Thoracic Surgeons Model Reclassifies Mortality Risk in Patients Undergoing Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2019; 11:e006664. [PMID: 30354591 DOI: 10.1161/circinterventions.118.006664] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Society of Thoracic Surgeons (STS) scores are used to screen patients for transcatheter aortic valve replacement (TAVR). The STS scores were also used to risk stratify patients in major TAVR trials. This study evaluates the reclassification of predicted risk of mortality by the currently available online STS score calculator compared with the 2008 STS risk model in patients undergoing TAVR. METHODS AND RESULTS All patients who underwent TAVR from 2006 to 2016 were included in the study. The STS scores for all included patients were calculated by applying the 2008 STS risk model and again using the current STS online calculator. Among 1209 patients who underwent TAVR, 30-day mortality was 27 (2.2%). The overall predicted risk of mortality estimated by using the current online STS risk calculator was significantly lower than the 2008 STS risk model (6.3±4.4 vs 7.3±4.9; P<0.001). A total of 235 (19%) patients were reclassified into a lower risk category per the current STS risk model. In a multivariable logistic regression analysis, patients with persistent atrial fibrillation (odds ratio, 1.4; 95% CI, 1.0-1.9; P=0.03), chronic heart failure (odds ratio, 6.0; 95% CI, 3.8-10.1; P<0.001), and New York Heart Association class IV heart failure (odds ratio, 2.4; 95% CI, 1.3-4.4; P=0.007) were more likely to be reclassified into a lower risk category per the current STS risk model. CONCLUSIONS The current STS calculation method produces significantly lower predicted risk of mortality than the 2008 calculator, more pronounced in patients with certain comorbid conditions. These results should be considered while evaluating data from prior studies of TAVR.
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Affiliation(s)
- Arnav Kumar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Kimi Sato
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Jyoti Narayanswami
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Kinjal Banerjee
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Krystof Andress
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Chetan Lokhande
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Divyanshu Mohananey
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Anil Kumar Anumandla
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Abdur Rahman Khan
- Division of Cardiovascular Medicine, University of Louisville, KY (A.R.K.)
| | - Abhishek C Sawant
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Vivek Menon
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - E Murat Tuzcu
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Stephanie Mick
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Lars G Svensson
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
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Kadri AN, Menon V, Sammour YM, Gajulapalli RD, Meenakshisundaram C, Nusairat L, Mohananey D, Hernandez AV, Navia J, Krishnaswamy A, Griffin B, Rodriguez L, Harb SC, Kapadia S. Outcomes of patients with severe tricuspid regurgitation and congestive heart failure. Heart 2019; 105:1813-1817. [DOI: 10.1136/heartjnl-2019-315004] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/23/2019] [Accepted: 07/11/2019] [Indexed: 11/04/2022] Open
Abstract
ObjectivesA substantial number of patients with severe tricuspid regurgitation (TR) and congestive heart failure (CHF) are medically managed without undergoing corrective surgery. We sought to assess the characteristics and outcomes of CHF patients who underwent tricuspid valve surgery (TVS), compared with those who did not.MethodsRetrospective observational study involving 2556 consecutive patients with severe TR from the Cleveland Clinic Echocardiographic Database. Cardiac transplant patients or those without CHF were excluded. Survival difference between patients who were medically managed versus those who underwent TVS was compared using Kaplan-Meier survival curves. Multivariate analysis was performed to identify variables associated with poor outcomes.ResultsAmong a total of 534 patients with severe TR and CHF, only 55 (10.3%) patients underwent TVS. Among the non-surgical patients (n=479), 30% (n=143) had an identifiable indication for TVS. At 38 months, patients who underwent TVS had better survival than those who were medically managed (62% vs 35%; p<0.001). On multivariate analysis, advancing age (HR: 1.23; 95% CI 1.12 to 1.35 per 10-year increase in age), moderate (HR: 1.39; 95% CI 1.01 to 1.90) and severe (HR: 2; 95% CI 1.40 to 2.80) right ventricular dysfunction were associated with higher mortality. TVS was associated with lower mortality (HR: 0.44; 95% CI 0.27 to 0.71).ConclusionAlthough corrective TVS is associated with better outcomes in patients with severe TR and CHF, a substantial number of them continue to be medically managed. However, since the reasons for patients not being referred to surgery could not be ascertained, further randomised studies are needed to validate our findings before clinicians can consider surgical referral for these patients.
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Kumar A, Sato K, Jobanputra Y, Betancor J, Halane M, George R, Banerjee K, Mohananey D, Menon V, Sammour YM, Krishnaswamy A, Jaber WA, Mick S, Svensson LG, Kapadia SR. Time-Integrated Aortic Regurgitation Index Helps Guide Balloon Postdilation During Transcatheter Aortic Valve Replacement and Predicts Survival. J Am Heart Assoc 2019; 8:e012430. [PMID: 31269863 PMCID: PMC6662132 DOI: 10.1161/jaha.119.012430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Balloon postdilation (BPD) has emerged as an effective strategy to reduce paravalvular regurgitation (PVR) during transcatheter aortic valve replacement (TAVR). We investigated the utility of a time‐integrated aortic regurgitation index (TIARI) to guide balloon postdilation (BPD) after valve deployment. Methods and Results All consecutive patients who had echocardiography, aortography, and hemodynamic tracings recorded immediately after valve deployment during TAVR were included in the study. Catheter‐derived invasive hemodynamic parameters were calculated offline. Among 157 patients who underwent TAVR, 49 (32%) patients required BPD to reduce significant PVR after valve deployment. Two experienced operators decided whether the patients required BPD for significant PVR. Median TIARI measured immediately after valve deployment was significantly lower in patients who required BPD when compared with patients who did not require BPD (P<0.001). In a multivariable analysis, lower TIARI (odds ratio: 0.81; P=0.003) and higher PVR grade on aortography and echocardiography (P<0.001 for both) were associated with BPD. Adding TIARI to echocardiography and aortographic PVR assessment resulted in a significant increase in global χ2 (P<0.001), an integrated discrimination index of 9% (P=0.002), and combined C‐statistics of 0.99 for predicting BPD. Higher TIARI after valve deployment was associated with better survival (hazard ratio: 0.94, P=0.014), while other hemodynamic and imaging parameters did not predict mortality after TAVR. Conclusions Among patients undergoing TAVR, a TIARI measured immediately after valve deployment adds incremental value to guide BPD over aortography and echocardiography. Higher residual TIARI is associated with better survival after TAVR.
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Affiliation(s)
- Arnav Kumar
- Division of CardiologyAndreas Gruentzig Cardiovascular CenterEmory University School of MedicineAtlantaGA
| | - Kimi Sato
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Yash Jobanputra
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Jorge Betancor
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Mohamed Halane
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Robin George
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Kinjal Banerjee
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | | | - Vivek Menon
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | | | | | - Wael A. Jaber
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Stephanie Mick
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Lars G. Svensson
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Samir R. Kapadia
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
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Mohananey D, Narayanswami J, Kumar A, Sammour Y, Mick S, Navia J, Tuzcu EM, Krishnaswamy A, Kapadia S. Association of a Novel Hemodynamic Index With Aortic Regurgitation After TAVR With the Edwards SAPIEN Valve. JACC Cardiovasc Interv 2019; 12:1194-1195. [DOI: 10.1016/j.jcin.2019.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/25/2019] [Accepted: 03/04/2019] [Indexed: 11/27/2022]
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Mohananey D, Villablanca P, Gupta T, Ranka S, Bhatia N, Adegbala O, Ando T, Wang DD, Wiley JM, Eng M, Kalra A, Ramakrishna H, Shah B, O'Neill W, Saucedo J, Bhatt DL. Association of peripheral artery disease with in-hospital outcomes after endovascular transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2019; 94:249-255. [PMID: 31025488 DOI: 10.1002/ccd.28310] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/10/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim of this study was to determine the prevalence of peripheral artery disease (PAD) and its association with in-hospital outcomes after endovascular transcatheter aortic valve replacement (EV-TAVR). BACKGROUND TAVR is an established treatment for patients at prohibitive, high, or intermediate surgical risk. PAD is a significant comorbidity in the determination of surgical risk. However, data on association of PAD with outcomes after EV-TAVR are limited. METHODS Patients in the National Inpatient Sample who underwent EV-TAVR between January 1, 2012 and September 30, 2015 were evaluated. The primary outcome was in-hospital mortality. RESULTS A total of 51,685 patients underwent EV-TAVR during the study period. Of these, 12,740 (24.6%) had a coexisting diagnosis of PAD. The adjusted odds for in-hospital mortality [OR 1.08 (95% CI 0.83-1.41)], permanent pacemaker implantation [OR 0.98 (0.85-1.14)], conversion to open aortic valve replacement [OR 1.05 (0.49-2.26)], or acute myocardial infarction [OR 1.31(0.99-1.71)] were not different in patients with versus without PAD. However, patients with PAD had greater adjusted odds of vascular complications [OR 1.80 (1.50-2.16)], major bleeding [OR 1.20 (1.09-1.34)], acute kidney injury (AKI) [OR 1.19 (1.05-1.36)], cardiac complications [aOR 1.21 (1.01-1.44)], and stroke [OR 1.39(1.10-1.75)] compared with patients without PAD. Length of stay (LOS) was significantly longer for patients with PAD [7.23 (0.14) days vs. 7.11 (0.1) days, p < 0.001]. CONCLUSION Of patients undergoing EV-TAVR, ~25% have coexisting PAD. PAD was not associated with increased risk of in-hospital mortality but was associated with higher risk of vascular complications, major bleeding, AKI, stroke, cardiac complications, and longer LOS.
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Affiliation(s)
- Divyanshu Mohananey
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pedro Villablanca
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan
| | - Tanush Gupta
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Sagar Ranka
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
| | - Nirmanmoh Bhatia
- Division of Cardiovascular Medicine, Vanderbilt, University Medical Center, Nashville, Tennessee
| | - Oluwole Adegbala
- Department of Internal Medicine, Englewood Hospital and Medical Center, Seton Hall University-Hackensack Meridian School of Medicine, South Orange, New Jersey
| | - Tomo Ando
- Division of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan
| | - Jose M Wiley
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Marvin Eng
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - Binita Shah
- Leon H. Charney Division of Cardiology, New York University, New York, New York
| | - William O'Neill
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan
| | - Jorge Saucedo
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
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Sharma A, Arora L, Subramani S, Simmons J, Mohananey D, Ramakrishna H. Analysis of the 2018 American Heart Association Focused Update on Advanced Cardiovascular Life Support Use of Antiarrhythmic Drugs During and Immediately After Cardiac Arrest. J Cardiothorac Vasc Anesth 2019; 34:537-544. [PMID: 31097339 DOI: 10.1053/j.jvca.2019.03.069] [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: 03/28/2019] [Accepted: 03/31/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Archit Sharma
- Divisions of Cardiothoracic Anesthesiology Solid Organ Transplant and Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Lovkesh Arora
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Sudhakar Subramani
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Jonathan Simmons
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Divyanshu Mohananey
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ.
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Kaw R, Nagarajan V, Jaikumar L, Halkar M, Mohananey D, Hernandez AV, Ramakrishna H, Wijeysundera D. Predictive Value of Stress Testing, Revised Cardiac Risk Index, and Functional Status in Patients Undergoing Noncardiac Surgery. J Cardiothorac Vasc Anesth 2019; 33:927-932. [DOI: 10.1053/j.jvca.2018.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Indexed: 11/11/2022]
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Villablanca PA, Lemor A, Gupta T, Mohananey D, Michel P, Frisoli T, Wang DD, Eng M, Ramakrishna H, O'Neill W. INCREASED RISK OF PERIOPERATIVE ISCHEMIC STROKE IN PATIENTS WHO UNDERGO NON-CARDIAC SURGERY WITH PREEXISTING PATENT FORAMEN OVALE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31230-6] [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: 10/27/2022]
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Kumar A, Sato K, Jobanputra Y, Betancor J, Halane M, George R, Banerjee K, Mohananey D, Menon V, Sammour Y, Krishnaswamy A, Jaber W, Mick S, Svensson L, Kapadia S. TIME-INTEGRATED AORTIC REGURGITATION INDEX HELPS IN THE REAL-TIME ASSESSMENT OF PARAVALVULAR REGURGITATION DURING TAVR. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31862-5] [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: 10/27/2022]
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Mohananey D, Ramakrishna H. Consensus-Based Clinical Outcomes Research: Coming of Age. J Cardiothorac Vasc Anesth 2019; 33:1440-1441. [PMID: 30704829 DOI: 10.1053/j.jvca.2019.01.012] [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: 12/18/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Divyanshu Mohananey
- Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ
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Fatima B, Mohananey D, Khan FW, Jobanputra Y, Tummala R, Banerjee K, Krishnaswamy A, Mick S, Tuzcu EM, Blackstone E, Svensson L, Kapadia S. Durability Data for Bioprosthetic Surgical Aortic Valve. JAMA Cardiol 2019; 4:71-80. [DOI: 10.1001/jamacardio.2018.4045] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Benish Fatima
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Divyanshu Mohananey
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Fazal W. Khan
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Yash Jobanputra
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ramyashree Tummala
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kinjal Banerjee
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stephanie Mick
- Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - E. Murat Tuzcu
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene Blackstone
- Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars Svensson
- Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Kumar A, Sato K, Verma BR, Ala CK, Betancor J, Yzeiraj E, Lin L, Mohananey D, Qamruddin S, Kontzias A, Bolen MA, Imazio MM, Kwon DH, Hachamovitch R, Klein AL. Quantitative assessment of pericardial delayed hyperenhancement helps identify patients with ongoing recurrences of pericarditis. Open Heart 2018; 5:e000944. [PMID: 30613419 PMCID: PMC6307595 DOI: 10.1136/openhrt-2018-000944] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 10/19/2018] [Accepted: 11/12/2018] [Indexed: 11/04/2022] Open
Abstract
Objectives Recurrences of pericarditis (RP) are often difficult to diagnose due to lack of clinical signs and symptoms during subsequent episodes. We aimed to investigate the value of quantitative assessment of pericardial delayed hyperenhancement (DHE) in diagnosing ongoing recurrences of pericarditis. Methods Quantitative DHE was measured in 200 patients with established diagnosis of RP using cardiac MRI. Conventional clinical criteria for diagnosis of pericarditis were ≥2 of the following: chest pain, pericardial rub, ECG changes and new or worsening pericardial effusion. Results A total of 67 (34%) patients were identified as having ongoing episode of recurrence at the time of DHE measurements. In multivariable analysis, chest pain (OR: 10.9, p<0.001) and higher DHE (OR: 1.32, p<0.001) were associated with ongoing recurrence of RP. Addition of DHE to conventional clinical criteria significantly increased the ability to diagnose ongoing recurrence (net reclassification improvement (NRI): 0.80, p<0.001; integrated discrimination improvement (IDI): 0.12, p<0.001). Among 150 patients with history of RP who presented with chest pain, higher DHE was still independently associated with ongoing recurrence (OR: 1.28, p<0.001), showed incremental value over clinical criteria (NRI: 0.76, p<0.001; IDI: 0.13, p<0.001) and demonstrated a sensitivity of 70% and specificity of 74%. Conclusion Among patients with RP, quantitative DHE provided incremental information to diagnose ongoing recurrences over conventional clinical criteria of pericarditis. Quantitative DHE demonstrated acceptable test characteristics to diagnose ongoing recurrence even in RP patients presenting with chest pain.
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Affiliation(s)
- Arnav Kumar
- Andreas Gruentzig Cardiovascular Center, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kimi Sato
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Beni Rai Verma
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chandra Kanth Ala
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jorge Betancor
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Edlira Yzeiraj
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lin Lin
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Divyanshu Mohananey
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Salima Qamruddin
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Massimo M Imazio
- University Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Deborah H Kwon
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rory Hachamovitch
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Allan L Klein
- Department of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Martin AK, Mohananey D, Ranka S, Riha H, Núñez-Gil IJ, Ramakrishna H. The 2017 European Society of Cardiology (ESC)/European Association of Cardiothoracic Surgeons (EACTS) Guidelines for Management of Valvular Heart Disease—Highlights and Perioperative Implications. J Cardiothorac Vasc Anesth 2018; 32:2810-2816. [DOI: 10.1053/j.jvca.2018.05.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Indexed: 12/21/2022]
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Kumar A, Sato K, Banerjee K, Narayanswami J, Betancor J, Menon V, Mohananey D, Anumandla AK, Sawant AC, Krishnaswamy A, Tuzcu EM, Jaber W, Mick S, Svensson LG, Popović ZB, Blackstone EH, Kapadia SR. Hemodynamic durability of transcatheter aortic valves using the updated Valve Academic Research Consortium‐2 criteria. Catheter Cardiovasc Interv 2018; 93:729-738. [DOI: 10.1002/ccd.27927] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 09/24/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Arnav Kumar
- Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio
| | - Kimi Sato
- Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio
| | - Kinjal Banerjee
- Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio
| | | | - Jorge Betancor
- Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio
| | - Vivek Menon
- Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio
| | | | | | | | | | - E. Murat Tuzcu
- Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio
| | - Wael Jaber
- Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio
| | - Stephanie Mick
- Heart and Vascular Institute, Cleveland Clinic Cleveland Ohio
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Mohananey D, Heidari-Bateni G, Villablanca PA, Iturrizaga Murrieta JC, Vlismas P, Agrawal S, Bhatia N, Mookadam F, Ramakrishna H. Heart Failure With Preserved Ejection Fraction—A Systematic Review and Analysis of Perioperative Outcomes. J Cardiothorac Vasc Anesth 2018; 32:2423-2434. [DOI: 10.1053/j.jvca.2017.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Indexed: 12/18/2022]
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Mohananey D, Sankaramangalam K, Kumar A, Jobanputra Y, Villablanca P, Krishnaswamy A, Mick S, Svensson LG, Tuzcu EM, Kapadia SR. Safety and efficacy of cerebral protection devices in transcatheter aortic valve replacement: A clinical end-points meta-analysis. Cardiovascular Revascularization Medicine 2018; 19:785-791. [DOI: 10.1016/j.carrev.2018.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/11/2018] [Accepted: 02/12/2018] [Indexed: 11/26/2022]
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Tower-Rader A, Mohananey D, To A, Lever HM, Popovic ZB, Desai MY. Prognostic Value of Global Longitudinal Strain in Hypertrophic Cardiomyopathy: A Systematic Review of Existing Literature. JACC Cardiovasc Imaging 2018; 12:1930-1942. [PMID: 30219395 DOI: 10.1016/j.jcmg.2018.07.016] [Citation(s) in RCA: 90] [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: 05/21/2018] [Revised: 07/13/2018] [Accepted: 07/19/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The association of left ventricular global longitudinal strain (LV-GLS) with clinical outcomes in patients with hypertrophic cardiomyopathy (HCM) has been examined in multiple studies. The authors conducted a systematic review aimed at summarizing and critically appraising the current evidence. BACKGROUND HCM is a common genetic cardiovascular disease with an estimated prevalence of 1 in 500 patients. LV-GLS derived from speckle tracking echocardiography is a sensitive noninvasive method of assessing regional left ventricular function. Several studies have suggested association of abnormal LV-GLS with outcomes in HCM patients. METHODS A computerized literature search of all English language publications in the PubMed and EMBASE databases was made looking at all randomized and nonrandomized studies conducted on patients with HCM where association of LV-GLS with clinical outcomes was studied. We then manually searched the reference lists of included articles. The Preferred Reporting Items for Systematic reviews and Meta-Analyses statement (PRISMA) of reporting systematic reviews was used. RESULTS Our search yielded a total of 14 observational studies published between 2009 and 2017 with a total of 3,154 patients with HCM. Eleven of the 14 studies included a composite cardiac outcome which included mortality as their primary outcome of interest and 3 of the 14 studies looked at association of LV-GLS with ventricular arrhythmias and/or implantable cardiac defibrillator discharge. We noted wide variability in inclusion, methodology, follow-up, and consequently effect estimates, which was not conducive to performing a meta-analysis. However, despite the variation, all studies revealed a degree of association of abnormal LV-GLS with poor cardiac outcomes. CONCLUSIONS Our systematic review of more than 3000 HCM patients suggests an association of abnormal LV-GLS with adverse composite cardiac outcomes and ventricular arrhythmias.
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Affiliation(s)
| | | | - Andrew To
- Hypertrophic Cardiomyopathy Center, Cleveland Clinic, Cleveland, Ohio; Northshore Hospital, Auckland, New Zealand
| | - Harry M Lever
- Hypertrophic Cardiomyopathy Center, Cleveland Clinic, Cleveland, Ohio
| | - Zoran B Popovic
- Hypertrophic Cardiomyopathy Center, Cleveland Clinic, Cleveland, Ohio
| | - Milind Y Desai
- Hypertrophic Cardiomyopathy Center, Cleveland Clinic, Cleveland, Ohio.
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Gupta T, Kolte D, Khera S, Goel K, Villablanca P, Velagapudi P, Mohananey D, Kalra A, Abbott JD, Elmariah S, Fonarow G, Rihal C, Weisz G, Bhatt D. TCT-838 The Changing Landscape of Aortic Valve Replacement in the United States: Insights from a National Database. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.2082] [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: 10/28/2022]
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Villablanca P, Adegbala O, Ando T, Mohananey D, Gupta T, Ranka S, Chiang V, Smilowitz N, Basir M, Greenbaum A, Eng M, Ramakrishna H, mark menegus, Shah B, Bhatt D, O'Neill W. TCT-605 Sex Based Differences in In-Hospital Outcomes of Patients With Cardiogenic Shock Treated With Percutaneous Mechanical Circulatory Support in the United States. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Smilowitz NR, Mohananey D, Razzouk L, Weisz G, Slater JN. Impact and trends of intravascular imaging in diagnostic coronary angiography and percutaneous coronary intervention in inpatients in the United States. Catheter Cardiovasc Interv 2018; 92:E410-E415. [PMID: 30019831 DOI: 10.1002/ccd.27673] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [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: 01/18/2018] [Revised: 04/04/2018] [Accepted: 04/25/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Intravascular imaging with intravascular ultrasound (IVUS) and optical coherence tomography (OCT) is an important adjunct to invasive coronary angiography. OBJECTIVES The primary objective was to examine the frequency of intravascular coronary imaging, trends in imaging use, and outcomes of patients undergoing angiography and/or percutaneous coronary intervention (PCI) in the United States. METHODS Adult patients ≥18 years of age undergoing in-hospital cardiac catheterization from January 2004 to December 2014 were identified from the National Inpatient Sample (NIS). International Classification of Diseases, Ninth Revision (ICD-9) diagnosis and procedure codes were used to identify IVUS and OCT use during diagnostic angiography and PCI. RESULTS Among 3,211,872 hospitalizations with coronary angiography, intracoronary imaging was performed in 88,775 cases (4.8% of PCI and 1.0% of diagnostic procedures), with IVUS in 98.9% and OCT in 1.1% of cases. Among patients undergoing PCI, the rate of intravascular coronary imaging increased from 2.1% in 2004-2005 to 6.6% in 2013-2014 (P < 0.001 for trend). Use of intravascular coronary imaging was associated with lower in-hospital mortality in patients undergoing PCI (adjusted OR 0.77; 95% CI 0.71-0.83). There was marked variability in intravascular imaging by hospital, with 63% and 13% of facilities using intravascular imaging in <5% and >15% of PCIs, respectively. CONCLUSIONS In a large administrative database from the United States, intravascular imaging use was low, increased over time, and imaging was associated with reduced in-hospital mortality. Substantial variation in the frequency of intravascular imaging by hospital was observed. Additional investigation to determine clinical benefits of IVUS and OCT are warranted.
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Affiliation(s)
- Nathaniel R Smilowitz
- Division of Cardiology, Department of Medicine, NYU School of Medicine, NYU Langone Health, New York, New York
| | | | - Louai Razzouk
- Division of Cardiology, Department of Medicine, NYU School of Medicine, NYU Langone Health, New York, New York
| | - Giora Weisz
- Division of Cardiology, Department of Medicine, Albert Einstein School of Medicine, Montefiore Medical Center, Bronx, New York
| | - James N Slater
- Division of Cardiology, Department of Medicine, NYU School of Medicine, NYU Langone Health, New York, New York
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Mohananey D, Sengodan P, Banerjee K, Kumar A, Jobanputra Y, Sankaramangalam K, Krishnaswamy A, Mick S, White JM, Svensson LG, Kapadia SR. Comparative analysis of cerebrovascular events in transcatheter and surgical aortic valve replacement: a systematic review and meta-analysis of randomised trials. EUROINTERVENTION 2018; 14:69-77. [DOI: 10.4244/eij-d-17-00732] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Devgun JK, Gul S, Mohananey D, Jones BM, Hussain MS, Jobanputra Y, Kumar A, Svensson LG, Tuzcu EM, Kapadia SR. Cerebrovascular Events After Cardiovascular Procedures. J Am Coll Cardiol 2018; 71:1910-1920. [DOI: 10.1016/j.jacc.2018.02.065] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/18/2018] [Accepted: 02/19/2018] [Indexed: 12/14/2022]
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