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Chavarria J, Falcao F, Dutra G, Sathananthan J, Wood D, Duovi G, Natarajan M, Jaffer I, Velianou J, Sheth T. Bespoke valve sizing avoids annular rupture in patients treated with a balloon‐expandable transcatheter heart valve. Catheter Cardiovasc Interv 2022; 100:823-831. [DOI: 10.1002/ccd.30402] [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: 06/23/2022] [Revised: 08/13/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Jorge Chavarria
- Division of Cardiology, Hamilton Health Sciences McMaster University Hamilton Canada
| | - Felipe Falcao
- Division of Cardiology, Hamilton Health Sciences McMaster University Hamilton Canada
| | - Gustavo Dutra
- Division of Cardiology, Hamilton Health Sciences McMaster University Hamilton Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital University of British Columbia Vancouver British Columbia Canada
| | - David Wood
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital University of British Columbia Vancouver British Columbia Canada
| | - Georgia Duovi
- Division of Cardiology, Hamilton Health Sciences McMaster University Hamilton Canada
| | - Madhu Natarajan
- Division of Cardiology, Hamilton Health Sciences McMaster University Hamilton Canada
- Population Health Research Institute Hamilton Canada
| | - Iqbal Jaffer
- Division of Cardiology, Hamilton Health Sciences McMaster University Hamilton Canada
| | - James Velianou
- Division of Cardiology, Hamilton Health Sciences McMaster University Hamilton Canada
| | - Tej Sheth
- Division of Cardiology, Hamilton Health Sciences McMaster University Hamilton Canada
- Population Health Research Institute Hamilton Canada
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Alrashidi S, d’Entremont MA, Alansari O, Winter J, Brochu B, Heenan L, Skuriat E, Tyrwhitt J, Raco M, Tsang MB, Valettas N, Velianou J, Sheth T, Sibbald M, Mehta SR, Pinilla-Echeverri N, Schwalm JD, Natarajan MK, Kelly A, Akl E, Tawadros S, Camargo M, Faidi W, Dutra G, Jolly SS. Design and Rationale of Routine Ultrasou Nd Gu Idance for Vascular Acc Ess fo R Cardiac Procedure s: A Randomized Tria L (UNIVERSAL). CJC Open 2022; 4:1074-1080. [PMID: 36562014 PMCID: PMC9764117 DOI: 10.1016/j.cjco.2022.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/22/2022] [Indexed: 12/25/2022] Open
Abstract
Background A significant limitation of femoral artery access for cardiac interventions is the increased risk of vascular complications and bleeding compared to radial access. Ultrasound (US)-guided femoral access may reduce major vascular complications and bleeding. We aim to determine whether routinely using US guidance for femoral arterial access for coronary angiography or intervention will reduce Bleeding Academic Research Consortium (BARC) 2, 3, or 5 bleeding or major vascular complications. Methods The Ultrasound Guidance for Vascular Access for Cardiac Procedures: A Randomized Trial (UNIVERSAL) is a multicentre, prospective, open-label, randomized trial with blinded outcomes assessment. Patients undergoing coronary angiography with or without intervention via a femoral approach with fluoroscopic guidance will be randomized 1:1 to US-guided femoral access, compared to no US. The primary outcome is the composite of major bleeding based on the BARC 2, 3, or 5 criteria or major vascular complications within 30 days. The trial is designed to have 80% power and a 2-sided alpha level of 5% to detect a 50% relative risk reduction for the primary outcome based on a control event rate of 14%. Results We completed enrollment on April 29, 2022, with 621 randomized patients. The patients had a mean age of 71 years (25.4% female), with a high rate of comorbidities, as follows: 45% had a prior percutaneous coronary intervention; 57% had previous coronary artery bypass surgery; and 18% had peripheral vascular disease. Conclusions The UNIVERSAL trial will be one of the largest randomized trials of US-guided femoral access and has the potential to change guidelines and increase US uptake for coronary procedures worldwide.
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Affiliation(s)
- Sulaiman Alrashidi
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada
| | - Marc-André d’Entremont
- Population Health Research Institute, Hamilton, Ontario, Canada,Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada
| | - Omar Alansari
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada
| | - Jose Winter
- Clinica Alemana de Santiago, Santiago, Chile
| | - Bradley Brochu
- CK Hui Heart Centre, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Laura Heenan
- Population Health Research Institute, Hamilton, Ontario, Canada
| | | | | | - Michael Raco
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada
| | - Michael B. Tsang
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada
| | - Nicholas Valettas
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada
| | - James Velianou
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada
| | - Tej Sheth
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Matthew Sibbald
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada
| | - Shamir R. Mehta
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Natalia Pinilla-Echeverri
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jon David Schwalm
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Madhu K. Natarajan
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Andrew Kelly
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada
| | - Elie Akl
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Walaa Faidi
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Gustavo Dutra
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Sanjit S. Jolly
- McMaster University, Hamilton, Ontario, Canada,Hamilton Health Sciences, Hamilton, Ontario, Canada,Niagara Health, St. Catharines, Ontario, Canada,Population Health Research Institute, Hamilton, Ontario, Canada,Corresponding author: Dr Sanjit S. Jolly, Population Health Research Institute, Hamilton General Hospital, 237 Barton St. East, Hamilton, Ontario L8L 2X2, Canada. Tel.: +1-905-521-2100 ext. 40309.
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Chavarria J, Dutra G, Jaffer I, Natarajan M, Falcao F, Cirne F, Velianou J, Duovi G, Abdelkhalek M, Keshavarz-Motamed Z, Gu K, Sheth T. 605 Validation Of Aortic Valve Computed Tomography Calcium Quantification In Contrast Computed Tomography. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.073] [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: 11/28/2022]
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Viquez JC, Natarajan M, Velianou J, Sibbald M, Jaffer I, Smith A. TCT-343 A Computed Tomography Protocol to Evaluate Coronary Artery Disease Prior to Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chavarria J, Sibbald M, Velianou J, Natarajan M, Jaffer I, Smith A, Sheth T. A Computed Tomography Protocol to Evaluate Coronary Artery Disease Before Transcatheter Aortic Valve Replacement. Can J Cardiol 2021; 38:23-30. [PMID: 34688851 DOI: 10.1016/j.cjca.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/19/2021] [Accepted: 10/11/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) computed tomographic angiography (CTA) images can be used to evaluate coronary artery disease (CAD). METHODS We conducted a prospective cohort study of consecutive TAVR patients from November 2019 to February 2021 to evaluate TAVR CTA assessment of CAD on the rate of pre-TAVR invasive angiography. Patients had CTA first or invasive angiography first at the discretion of their treating physicians. TAVR CTA scans were categorised as normal/mild CAD, single-vessel disease, high risk (multivessel or left main disease), or nondiagnostic in patients without previous coronary artery bypass grafting (CABG) and as low risk or high risk in patients with previous CABG. Invasive angiography was recommended before TAVR for high-risk or nondiagnostic CTA findings. RESULTS TAVR was performed on 354 patients; CTA first was performed in 273 and invasive angiography first in 81. Among 231 patients without previous CABG who had CTA first, 22.1% (51/231) had pre-TAVR invasive angiography and 1.3% (3/231) had pre-TAVR revascularisation. Normal/mild CAD or single-vessel disease was found on CTA in 174 patients, of whom 0.5% (1/174) had high-risk disease on invasive angiography. Among 42 patients with previous CABG who had CTA first, 14.3% (6/42) had pre-TAVR invasive angiography and 2.4% (1/42) had pre-TAVR revascularisation. CONCLUSION TAVR CTA CAD evaluation can avoid pre-TAVR invasive angiography in more than 70% of patients while rarely missing high risk findings. A CTA-first strategy to assess CAD should be considered, especially among patients where conservative management of CAD is preferred.
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Affiliation(s)
- Jorge Chavarria
- McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Matt Sibbald
- McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - James Velianou
- McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Madhu Natarajan
- McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
| | - Iqbal Jaffer
- McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Amanda Smith
- McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Tej Sheth
- McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
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Natarajan MK, Sheth T, Wijeysundera H, Velianou J, Newman T, Rodes-Cabau J, Smith A, Wong J, Schwalm JD, Healey J. REMOTE ECG MONITORING TO REDUCE COMPLICATIONS FOLLOWING TRANSCATHETER AORTIC VALVE IMPLANTATIONS - THE REDIRECT TAVI STUDY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02485-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tsang MB, Schwalm JD, Gandhi S, Sibbald MG, Gafni A, Mercuri M, Salehian O, Lamy A, Pericak D, Jolly S, Sheth T, Ainsworth C, Velianou J, Valettas N, Mehta S, Pinilla N, Yanagawa B, Zhang L, Chu V, Parry D, Whitlock R, Dyub A, Cybulsky I, Semelhago L, Ioannou K, Hameed A, Wright D, Mulji A, Darvish-Kazem S, Gupta N, Alshatti A, Natarajan MK. Comparison of Heart Team vs Interventional Cardiologist Recommendations for the Treatment of Patients With Multivessel Coronary Artery Disease. JAMA Netw Open 2020; 3:e2012749. [PMID: 32777060 PMCID: PMC7417969 DOI: 10.1001/jamanetworkopen.2020.12749] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
IMPORTANCE Although the heart team approach is recommended in revascularization guidelines, the frequency with which heart team decisions differ from those of the original treating interventional cardiologist is unknown. OBJECTIVE To examine the difference in decisions between the heart team and the original treating interventional cardiologist for the treatment of patients with multivessel coronary artery disease. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, 245 consecutive patients with multivessel coronary artery disease were recruited from 1 high-volume tertiary care referral center (185 patients were enrolled through a screening process, and 60 patients were retrospectively enrolled from the center's database). A total of 237 patients were included in the final virtual heart team analysis. Treatment decisions (which comprised coronary artery bypass grafting, percutaneous coronary intervention, and medication therapy) were made by the original treating interventional cardiologists between March 15, 2012, and October 20, 2014. These decisions were then compared with pooled-majority treatment decisions made by 8 blinded heart teams using structured online case presentations between October 1, 2017, and October 15, 2018. The randomized members of the heart teams comprised experts from 3 domains, with each team containing 1 noninvasive cardiologist, 1 interventional cardiologist, and 1 cardiovascular surgeon. Cases in which all 3 of the heart team members disagreed and cases in which procedural discordance occurred (eg, 2 members chose coronary artery bypass grafting and 1 member chose percutaneous coronary intervention) were discussed in a face-to-face heart team review in October 2018 to obtain pooled-majority decisions. Data were analyzed from May 6, 2019, to April 22, 2020. MAIN OUTCOMES AND MEASURES The Cohen κ coefficient between the treatment recommendation from the heart team and the treatment recommendation from the original treating interventional cardiologist. RESULTS Among 234 of 237 patients (98.7%) in the analysis for whom complete data were available, the mean (SD) age was 67.8 (10.9) years; 176 patients (75.2%) were male, and 191 patients (81.4%) had stenosis in 3 epicardial coronary vessels. A total of 71 differences (30.3%; 95% CI, 24.5%-36.7%) in treatment decisions between the heart team and the original treating interventional cardiologist occurred, with a Cohen κ of 0.478 (95% CI, 0.336-0.540; P = .006). The heart team decision was more frequently unanimous when it was concordant with the decision of the original treating interventional cardiologist (109 of 163 cases [66.9%]) compared with when it was discordant (28 of 71 cases [39.4%]; P < .001). When the heart team agreed with the original treatment decision, there was more agreement between the heart team interventional cardiologist and the original treating interventional cardiologist (138 of 163 cases [84.7%]) compared with when the heart team disagreed with the original treatment decision (14 of 71 cases [19.7%]); P < .001). Those with an original treatment of coronary artery bypass grafting, percutaneous coronary intervention, and medication therapy, 32 of 148 patients [22.3%], 32 of 71 patients [45.1%], and 6 of 15 patients [40.0%], respectively, received a different treatment recommendation from the heart team than the original treating interventional cardiologist; the difference across the 3 groups was statistically significant (P = .002). CONCLUSIONS AND RELEVANCE The heart team's recommended treatment for patients with multivessel coronary artery disease differed from that of the original treating interventional cardiologist in up to 30% of cases. This subset of cases was associated with a lower frequency of unanimous decisions within the heart team and less concordance between the interventional cardiologists; discordance was more frequent when percutaneous coronary intervention or medication therapy were considered. Further research is needed to evaluate whether heart team decisions are associated with improvements in outcomes and, if so, how to identify patients for whom the heart team approach would be beneficial.
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Affiliation(s)
- Michael B. Tsang
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - J. D. Schwalm
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sumeet Gandhi
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Trillium Health Partners, Mississauga, Ontario, Canada
| | - Matthew G. Sibbald
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Amiram Gafni
- Center for Health Economics and Policy Analysis, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mathew Mercuri
- Division of Cardiovascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Omid Salehian
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Andre Lamy
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Dan Pericak
- Division of Cardiovascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Sanjit Jolly
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Tej Sheth
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Craig Ainsworth
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - James Velianou
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nicholas Valettas
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shamir Mehta
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Natalia Pinilla
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Bobby Yanagawa
- Division of Cardiovascular Surgery, St Michael’s Hospital, Toronto, Ontario, Canada
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Li Zhang
- Division of Cardiovascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Victor Chu
- Division of Cardiovascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Dominic Parry
- Division of Cardiovascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Dunedin Hospital, Otago, New Zealand
| | - Richard Whitlock
- Division of Cardiovascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Adel Dyub
- Division of Cardiovascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Irene Cybulsky
- Division of Cardiovascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lloyd Semelhago
- Division of Cardiovascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kostas Ioannou
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Adnan Hameed
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Douglas Wright
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Amin Mulji
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Saeed Darvish-Kazem
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Brampton Civic Hospital, William Osler Health System, Brampton, Ontario, Canada
| | - Nandini Gupta
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed Alshatti
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Madhu K. Natarajan
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Winter J, Sheth T, Healey J, Velianou J, Schwalm JD, Smith A, Schwenger S, Poulin J, Reza S, Natarajan M. FEASIBILITY AND EFFECT OF REMOTE AMBULATORY HEART RHYTHM MONITORING PRE AND POST TAVI. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32635-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sathananthan J, Webb J, Lauck S, Cairns J, Murdoch D, Cook R, Humphries K, Park J, Zhao Y, Welsh R, Leipsic J, Genereux P, Tyrrell B, Alqoofi F, Velianou J, Natarajan M, Wijeysundera H, Radhakrishnan S, Horlick E, Osten M, Asgar A, Kodali S, Nazif T, Thourani V, Babaliaros V, Cohen D, Masson J, Klein R, Rondi K, Umedaly H, Leon M, Wood D. IMPACT OF LEVEL OF ANAESTHESIA USING THE VANCOUVER CLINICAL PATHWAY FOR TRANSCATHETER AORTIC VALVE REPLACEMENT: INSIGHTS FROM THE 3M TAVR STUDY. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Sathananthan J, Lauck S, Cairns J, Humphries K, Murdoch D, Hensey M, Cook R, Guan M, Park J, Zhao Y, Welsh R, Leipsic J, Dvir D, Tyrrell B, Afilalo J, Alqoofi F, Velianou J, Natarajan M, Wijeysundera H, Radhakrishnan S, Horlick E, Asgar A, Masson JB, Kodali S, Nazif T, Thourani V, Babaliaros V, Cohen D, Leon M, Webb J, Wood D. TCT-225 Impact of frailty on a minimalist approach and early discharge following TAVR: insights from the 3M TAVR Study. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1348] [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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Gandhi S, Ganame J, Whitlock R, Natarajan M, Velianou J. SUCCESSFUL VALVE-IN-VALVE TAVI IN PREGNANCY FOR SEVERE DEGENERATIVE BIOPROSTHETIC AORTIC VALVE STENOSIS. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31016-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Alazzoni A, Gordon CL, Syed J, Natarajan MK, Rokoss M, Schwalm JD, Mehta SR, Sheth T, Valettas N, Velianou J, Pandie S, Al Khdair D, Tsang M, Meeks B, Colbran K, Waller E, Fu Lee S, Marsden T, Jolly SS. Randomized Controlled Trial of Radiation Protection With a Patient Lead Shield and a Novel, Nonlead Surgical Cap for Operators Performing Coronary Angiography or Intervention. Circ Cardiovasc Interv 2015; 8:e002384. [DOI: 10.1161/circinterventions.115.002384] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ashraf Alazzoni
- From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.)
| | - Chris L. Gordon
- From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.)
| | - Jaffer Syed
- From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.)
| | - Madhu K. Natarajan
- From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.)
| | - Michael Rokoss
- From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.)
| | - Jon-David Schwalm
- From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.)
| | - Shamir R. Mehta
- From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.)
| | - Tej Sheth
- From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.)
| | - Nicholas Valettas
- From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.)
| | - James Velianou
- From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.)
| | - Shaheen Pandie
- From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.)
| | - Darar Al Khdair
- From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.)
| | - Michael Tsang
- From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.)
| | - Brandi Meeks
- From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.)
| | - Kiersten Colbran
- From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.)
| | - Ed Waller
- From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.)
| | - Shun Fu Lee
- From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.)
| | - Tamara Marsden
- From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.)
| | - Sanjit S. Jolly
- From the Department of Medicine and the Population Health Research Institute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (A.A., C.L.G., J.S., M.K.N., M.R., J.-D.S., S.R.M., T.S., N.V., J.V., S.P., D.A.K., M.T., B.M., K.C., S.F.L., T.M., S.S.J.); and Faculty of Energy Systems and Nuclear Science, Institute of Technology, University of Ontario, Oshawa, Ontario, Canada (E.W.)
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Bagur R, Webb J, Gurvitch R, Dumont É, Velianou J, Manazzoni J, Toggweiler S, Cheung A, Ye J, Natarajan M, Bainey K, De Larochellière R, Doyle D, Pibarot P, Côté M, Philippon F, Rodés-Cabau J. 664 Incidence and predictive factors of permanent pacemaker implantation following transcatheter aortic valve implantation with a balloon-expandable valve. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Alazzoni A, Velianou J, Jolly SS. Left main thrombus as a complication of thrombectomy during primary percutaneous coronary intervention. J Invasive Cardiol 2011; 23:E9-E11. [PMID: 21297218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Small randomized trials in patients with ST-elevation myocardial infarction have shown that aspiration thrombectomy improves angiographic outcomes and may improve clinical outcomes. However, there remains a lack of reports on device-related complications. We report a case of a device complication involving the left main coronary artery where a large burden of thrombus was brought back into the left main coronary artery from the circumflex during aspiration thrombectomy.
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Affiliation(s)
- Ashraf Alazzoni
- Hamilton Health Sciences, McMaster University Medicine, DBCVSRI Building Rm C3-118, 237 Barton St. East, Hamilton General Hospital, Hamilton, Ontario, L8L 2X2, Canada
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Sheth T, Amlani S, Lou Ellins M, Mehta S, Velianou J, Cappelli G, Yang S, Natarajan M. Computed tomographic coronary angiographic assessment of high-risk coronary anatomy in patients with suspected coronary artery disease and intermediate pretest probability. Am Heart J 2008; 155:918-23. [PMID: 18440342 DOI: 10.1016/j.ahj.2007.11.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Accepted: 11/09/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND It is unclear if computed tomographic coronary angiography (CTA), an evolving technique for the evaluation of coronary artery disease (CAD), can identify patients with high-risk coronary anatomy. METHODS Among patients referred for invasive angiography at Hamilton Health Sciences (Hamilton, Ontario, Canada), those with an intermediate pretest probability (25%-60% likelihood of a significant stenosis) were prospectively identified using a multivariate risk score and were studied on a 64-detector Toshiba Aquilion scanner (Toshiba Medical Systems, Tokyo, Japan) before invasive angiography. Patients with high-risk anatomy (left main, 3-vessel CAD, or 2-vessel CAD involving the proximal left anterior descending artery) or at least 1 significant stenosis were identified on CTA and invasive angiography, and the results of these modalities were compared on a per patient basis. RESULTS Eighty patients were enrolled in the study (mean age 56 +/- 9 years, male-female ratio 43:37). Nondiagnostic scan results were obtained in 5 patients (6%). By CTA, 13 patients had high-risk anatomy and 31 patients had at least 1 significant stenosis. For the per patient detection of high-risk anatomy, CTA had 100% sensitivity (95% CI 69%-100%), 95% specificity (95% CI 86%-95%), a positive likelihood ratio of 18.0 (95% CI 6.4-50.3), and a negative likelihood ratio of 0.05 (95% CI 0-0.072). Revascularization was performed in 100% of patients with high-risk anatomy on CTA, 83% with at least 1 significant stenosis on CTA, and 0% without a significant stenosis on CTA. CONCLUSION In appropriately selected patients, CTA is a highly sensitive and specific technique for the detection of high-risk anatomy and maybe a valuable method for noninvasive risk stratification.
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Cantor WJ, Puley G, Natarajan M, Dzavik V, Madan M, Fry A, Pirani N, Kim HH, Velianou J, Strauss BH, Chisholm RJ. 1004-48 Randomized trial of radial versus femoral access for primary and rescue angioplasty. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)90123-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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