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Ragosta M. What's the Score?: Predicting Success or Failure in Chronic Total Occlusion Intervention. JACC Cardiovasc Interv 2024:S1936-8798(24)00632-0. [PMID: 38703150 DOI: 10.1016/j.jcin.2024.03.028] [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: 03/19/2024] [Accepted: 03/26/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Michael Ragosta
- University of Virginia Health System, Charlottesville, Virginia, USA.
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Wong N, Lim DS, Yount K, Yarboro L, Ailawadi G, Ragosta M. Preemptive alcohol septal ablation prior to transcatheter mitral valve replacement. Catheter Cardiovasc Interv 2023; 102:1341-1347. [PMID: 37855165 DOI: 10.1002/ccd.30879] [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: 06/23/2023] [Revised: 09/06/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Alcohol septal ablation (ASA) has been shown to increase the neo-left ventricular outflow tract (LVOT) area before transcatheter mitral valve replacement (TMVR) but there is little literature on its success and use with dedicated devices. AIMS To describe our experience with preemptive ASA to increase the predicted neo-LVOT area and its utility with both dedicated TMVR devices and balloon-expandable valves. METHODS All patients who underwent ASA for TMVR candidacy in our center between May 2018 and October 2022 and had computed tomography (CT) scans done before and after ASA were included. Each CT was assessed for the minimum predicted neo-LVOT area at end-systole, using a virtual valve of the desired TMVR device for each patient. The primary outcome was an increase in the predicted neo-LVOT area after ASA that was deemed sufficient for safe implantation of the desired TMVR device. The secondary outcome was the absence of acute LVOT obstruction after TMVR. RESULTS A total of 12 patients underwent ASA and all but 1 (n = 11, 91.6%) achieved the primary outcome of having sufficient predicted neo-LVOT area to proceed with TMVR. The mean increase in neo-LVOT area after ASA was 126 ± 64 mm2 (median 119.5, interquartile range: 65.0-163.5 mm2 ). Two patients (16.7%) required a permanent pacemaker after ASA. Nine patients went on and underwent TMVR with their respective devices and none had LVOT obstruction after the procedure. Among the remaining three patients, one had insufficient neo-LVOT clearance after ASA, one had unrelated mortality before TMVR, and one had advanced heart failure before TMVR. CONCLUSION In appropriately selected patients and at centers experienced with ASA, preemptive ASA can achieve sufficient neo-LVOT clearance for TMVR with a variety of devices in approximately 90% of patients.
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Affiliation(s)
- Ningyan Wong
- Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia, USA
- Department of Cardiology, National Heart Centre Singapore, Singapore City, Singapore
| | - D Scott Lim
- Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia, USA
| | - Kenan Yount
- Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia, USA
| | - Leora Yarboro
- Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia, USA
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Ragosta
- Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia, USA
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Fox WE, Marshall M, Walters SM, Mangunta VR, Ragosta M, Kleiman AM, McNeil JS. Bedside Clinician's Guide to Pulmonary Artery Catheters. Crit Care Nurse 2023; 43:9-18. [PMID: 37524367 DOI: 10.4037/ccn2023133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND Pulmonary artery catheters provide important information about cardiac function, mixed venous oxygenation, and right-sided pressures and potentially provide temporary pacing ability. OBJECTIVE To provide bedside clinicians with guidance for techniques to insert right heart monitors and devices, describe risk factors for difficult insertion and contraindications to placement, and provide updates on new technologies that may be encountered in the intensive care unit. METHODS An extensive literature review was performed. Experienced clinicians were asked to identify topics not addressed in the literature. RESULTS Advanced imaging techniques such as transesophageal echocardiography or fluoroscopy can supplement traditional pressure waveform-guided insertion when needed, and several other techniques can be used to facilitate passage into the pulmonary artery. Caution is warranted when attempting insertion in patients with right-sided masses or preexisting conduction abnormalities. New technologies include a pacing catheter that anchors to the right ventricle and a remote monitoring device that is implanted in the pulmonary artery. DISCUSSION Bedside clinicians should be aware of risk factors such as atrial fibrillation with dilated atria, decreased ventricular function, pulmonary hypertension, and right-sided structural abnormalities that can make pulmonary artery catheter insertion challenging. Clinicians should be familiar with advanced techniques and imaging options to facilitate placement. CONCLUSION The overall risk of serious complications with right heart catheter placement and manipulation is low and often outweighed by its benefits, specifically pressure monitoring and pacing.
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Affiliation(s)
- W Everett Fox
- W. Everett Fox is an anesthesiology resident, Department of Anesthesiology, University of Virginia Health System (UVA Health), Charlottesville, Virginia
| | - Michael Marshall
- Michael Marshall is a charge and bedside registered nurse, coronary care unit, UVA Health
| | - Susan M Walters
- Susan M. Walters is a cardiothoracic anesthesiologist and an assistant professor of anesthesiology, Department of Anesthesiology, UVA Health
| | - Venkat R Mangunta
- Venkat R. Mangunta is a cardiothoracic and intensive care anesthesiologist and an assistant professor of anesthesiology, Department of Anesthesiology, UVA Health
| | - Michael Ragosta
- Michael Ragosta is a professor of cardiology and the Medical Director of the cardiac catheterization laboratory and interventional cardiology fellowship, Cardiology Division, Department of Internal Medicine, UVA Health
| | - Amanda M Kleiman
- Amanda M. Kleiman is a cardiothoracic anesthesiologist and an associate professor of anesthesiology, Department of Anesthesiology, UVA Health
| | - John S McNeil
- John S. McNeil is a cardiothoracic anesthesiologist and an associate professor of anesthesiology, Department of Anesthesiology, UVA Health
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Ragosta M. Editorial: Coronary Atherectomy in Patients with Aortic Stenosis Appears Safe, but Is PCI Necessary Prior to Transcatheter Valve Replacement? Cardiovasc Revasc Med 2023; 53:20-21. [PMID: 37202332 DOI: 10.1016/j.carrev.2023.04.016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Michael Ragosta
- University of Virginia Health Systems, Charlottesville, VA, United States of America.
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Strobel RJ, Mehaffey JH, Hawkins RB, Young AM, Scott EJ, Quader M, Dehmer GJ, Rich JB, Ailawadi G, Kron IL, Ragosta M, Yarboro LT, Teman NR. Socioeconomic Distress Associated With Increased Use of Percutaneous Coronary Intervention Over Coronary Artery Bypass Grafting. Ann Thorac Surg 2023; 115:914-921. [PMID: 35868555 DOI: 10.1016/j.athoracsur.2022.06.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/01/2022] [Accepted: 06/18/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The influence of socioeconomic determinants of health on choice of percutaneous coronary intervention (PCI) vs coronary artery bypass grafting (CABG) for coronary artery disease is unknown. We hypothesized that higher Distressed Communities Index (DCI) scores, a comprehensive socioeconomic ranking by zip code, would be associated with more frequent PCI. METHODS All patients undergoing isolated CABG or PCI in a regional American College of Cardiology CathPCI registry and The Society of Thoracic Surgeons database (2018-2021) were assigned DCI scores (0 = no distress, 100 = severe distress) based on education level, poverty, unemployment, housing vacancies, median income, and business growth. Patients who presented with ST-segment elevation myocardial infarction or emergent procedures were excluded. The most distressed quintile (DCI ≥80) was compared with all other patients. Multivariable logistic regression analyzed the association between DCI and procedure type. RESULTS A total of 23 223 patients underwent either PCI (n = 16 079) or CABG (n = 7144) for coronary artery disease across 28 centers during the study period. Before adjustment, high socioeconomic distress occurred more frequently among CABG patients (DCI ≥80, 12.4% vs 8.42%; P < .001). After multivariable adjustment, high socioeconomic distress was associated with greater odds of receiving PCI, relative to CABG (odds ratio 1.26; 95% CI, 1.07-1.49; P = .007). High socioeconomic distress was significantly associated with postprocedural mortality (odds ratio 1.52; 95% CI, 1.02-2.26; P = .039). CONCLUSIONS High socioeconomic distress is associated with greater risk-adjusted odds of receiving PCI, relative to CABG, as well as higher postprocedural mortality. Targeted resource allocation in high DCI areas may help eliminate barriers to CABG.
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Affiliation(s)
- Raymond J Strobel
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - J Hunter Mehaffey
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Robert B Hawkins
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Andrew M Young
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Erik J Scott
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Mohammed Quader
- Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Gregory J Dehmer
- Department of Medicine Carilion Clinic/Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Jeffrey B Rich
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Irving L Kron
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Michael Ragosta
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Leora T Yarboro
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Nicholas R Teman
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
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Megaly M, Gandolfo C, Zakhour S, Jiang M, Burgess K, Chetcuti S, Ragosta M, Adler E, Coletti A, O'Neill B, Alaswad K, Basir MB. Utilization of TandemHeart in cardiogenic shock: Insights from the THEME registry. Catheter Cardiovasc Interv 2023; 101:756-763. [PMID: 36748804 DOI: 10.1002/ccd.30582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/21/2023] [Accepted: 01/26/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND TandemHeart has been demonstrated to improve hemodynamic and metabolic complications in cardiogenic shock (CS). Contemporary outcomes have not been reported. OBJECTIVES To evaluate the outcomes of the TandemHeart (LivaNova) in contemporary real-world use. METHODS We analyzed baseline characteristics, hemodynamic changes, and outcomes of all patients treated with TandemHeart who were enrolled in the THEME registry, a multicenter, prospective, observational study. RESULTS Between May 2015 and June 2019, 50 patients underwent implantation of the TandemHeart device. 22% of patients had TandemHeart implanted within 12 h, 32% within 24 h, and 52% within 48 h of CS diagnosis. Cardiac index (CI) was significantly improved 24 h after implantation (median change 1.0, interquartile range (IQR) (0.5-1.4 L/min/m2 ). In survivors, there was a significant improvement in CI (1.0, IQR (0.5-2.25 L/min/m2 ) and lactate clearance -2.3 (-5.0 to -0.7 mmol/L). The 30-day and 180-day survival were 74% (95% confidence interval: 60%-85%) and 66% (95% confidence interval: 51%-79%), respectively. Survival was similarly high in those in whom TandemHeart has been used as a bridge to surgery (85% 180-day survival). CONCLUSION In a contemporary cohort of patients presenting in CS, the use of TandemHeart is associated with a 74% 30-day survival and a 66% 180-day survival.
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Affiliation(s)
- Michael Megaly
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Chaun Gandolfo
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Samer Zakhour
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | | | | | - Stanley Chetcuti
- Division of Cardiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Ragosta
- Division of Cardiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Eric Adler
- Division of Cardiology, University of California San Diego Medical Center, La Jolla, California, USA
| | - Andrew Coletti
- Division of Cardiology, Providence Sacred Heart Medical Center, Spokane, Washington, USA
| | - Brian O'Neill
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Khaldoon Alaswad
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Mir B Basir
- Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
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Sharma P, Shah K, Loomba J, Patel A, Mallawaarachchi I, Blazek O, Ratcliffe S, Breathett K, Johnson AE, Taylor AM, Salerno M, Ragosta M, Sodhi N, Addison D, Mohammed S, Bilchick KC, Mazimba S. The impact of COVID-19 on clinical outcomes among acute myocardial infarction patients undergoing early invasive treatment strategy. Clin Cardiol 2022; 45:1070-1078. [PMID: 36040721 PMCID: PMC9538930 DOI: 10.1002/clc.23908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 07/29/2022] [Accepted: 08/15/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The implications of coronavirus disease 2019 (COVID-19) infection on outcomes after invasive therapeutic strategies among patients presenting with acute myocardial infarction (AMI) are not well studied. HYPOTHESIS To assess the outcomes of COVID-19 patients presenting with AMI undergoing an early invasive treatment strategy. METHODS This study was a cross-sectional, retrospective analysis of the National COVID Cohort Collaborative database including all patients presenting with a recorded diagnosis of AMI (ST-elevation myocardial infarction (MI) and non-ST elevation MI). COVID-19 positive patients with AMI were stratified into one of four groups: (1a) patients who had a coronary angiogram with percutaneous coronary intervention (PCI) within 3 days of their AMI; (1b) PCI within 3 days of AMI with coronary artery bypass graft (CABG) within 30 days; (2a) coronary angiogram without PCI and without CABG within 30 days; and (2b) coronary angiogram with CABG within 30 days. The main outcomes were respiratory failure, cardiogenic shock, prolonged length of stay, rehospitalization, and death. RESULTS There were 10 506 COVID-19 positive patients with a diagnosis of AMI. COVID-19 positive patients with PCI had 8.2 times higher odds of respiratory failure than COVID-19 negative patients (p = .001). The odds of prolonged length of stay were 1.7 times higher in COVID-19 patients who underwent PCI (p = .024) and 1.9 times higher in patients who underwent coronary angiogram followed by CABG (p = .001). CONCLUSION These data demonstrate that COVID-19 positive patients with AMI undergoing early invasive coronary angiography had worse outcomes than COVID-19 negative patients.
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Affiliation(s)
- Prerna Sharma
- Division of Cardiovascular MedicineUniversity of Virginia Medical CenterCharlottesvilleVirginiaUSA
| | - Kajal Shah
- Department of Internal MedicineUniversity of Virginia Medical CenterCharlottesvilleVirginiaUSA
| | - Johanna Loomba
- Integrated Translational Health Research Institute (iTHRIV)University of VirginiaCharlottesvilleVirginiaUSA
| | - Arti Patel
- Integrated Translational Health Research Institute (iTHRIV)University of VirginiaCharlottesvilleVirginiaUSA
| | | | - Olivia Blazek
- Department of Internal MedicineUniversity of Virginia Medical CenterCharlottesvilleVirginiaUSA
- Division of CardiologyUniversity of Connecticut—Hartford HospitalMansfieldConnecticutUSA
| | - Sarah Ratcliffe
- Department of Public Health SciencesUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Khadijah Breathett
- Division of CardiologyUniversity of Arizona Medical CenterTucsonArizonaUSA
| | - Amber E. Johnson
- Division of Cardiology, University of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Angela M. Taylor
- Division of Cardiovascular MedicineUniversity of Virginia Medical CenterCharlottesvilleVirginiaUSA
| | - Michael Salerno
- Division of Cardiovascular MedicineUniversity of Virginia Medical CenterCharlottesvilleVirginiaUSA
| | - Michael Ragosta
- Division of Cardiovascular MedicineUniversity of Virginia Medical CenterCharlottesvilleVirginiaUSA
| | - Nishtha Sodhi
- Division of Cardiovascular MedicineUniversity of Virginia Medical CenterCharlottesvilleVirginiaUSA
| | - Daniel Addison
- Division of Cardiology, Ohio State University Wexner Medical CenterColumbusOhioUSA
| | - Selma Mohammed
- Division of CardiologyCreighton University School of MedicineOmahaNebraskaUSA
| | - Kenneth C. Bilchick
- Division of Cardiovascular MedicineUniversity of Virginia Medical CenterCharlottesvilleVirginiaUSA
| | - Sula Mazimba
- Division of Cardiovascular MedicineUniversity of Virginia Medical CenterCharlottesvilleVirginiaUSA
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Ghumman SS, Ibrahim S, Taylor AM, Fauber N, Ragosta M. The "July Effect" in the Cardiac Catheterization Laboratory. Am J Cardiol 2022; 170:160-165. [PMID: 35227502 DOI: 10.1016/j.amjcard.2022.01.032] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/29/2021] [Accepted: 01/12/2022] [Indexed: 11/26/2022]
Abstract
In Interventional Cardiology, the academic year and a new training cycle begin in July. It is unclear if patient outcomes are impacted by the time of year in the training cycle. The National Cardiovascular Data Registry collects outcomes related to percutaneous coronary interventions (PCIs). We used the database for our institution to review the relation between the time of year and patient outcomes. We performed a retrospective review of National Cardiovascular Data Registry data from 2011 to 2017. Outcomes were compared between the end (quarter 2 [Q2]) and the start of the academic year (quarter 3 [Q3]). Chi-square and Fisher's exact test was used: 1,041 (Q2) and 980 (Q3) patients underwent PCI. Patient characteristics were similar between the 2 quarters except for a higher rate of heart failure for patients in Q3 (250 [24%] vs 275 [29%], p = 0.03). There was no difference in overall nonfatal adverse events between Q2 and Q3 (53 [5.1%] vs 58 [5.9%], p = 0.41). Patients in Q3 experienced a higher incidence of stroke (1 [0.1%] vs 7 [0.7%], p = 0.03) and PCI risk-adjusted mortality (8.29 [0.8%] vs 18.13 [1.9%], p = 0.03). In conclusion, there does not appear to be a significant "July Effect" in an academic cardiac catheterization laboratory in terms of most complications with an observed higher incidence of stroke and PCI risk-adjusted mortality early in the year that may be related to a difference in the characteristics of the patient population.
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Ragosta M. That "Bump" in Creatinine Post-PCI Might "Bump Off" Your Patient: Can We Prevent This? JACC Cardiovasc Interv 2022; 15:767-769. [PMID: 35305905 DOI: 10.1016/j.jcin.2021.12.019] [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: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Michael Ragosta
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA.
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Van Venrooy A, Ragosta M, Taylor AM, Yount K, Lim S. ROUTINE CAROTID ULTRASOUND PRIOR TO TRANSCATHETER AORTIC VALVE REPLACEMENT DOES NOT PREDICT PERI-PROCEDURAL STROKE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01748-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: 11/16/2022]
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Shields MC, Ouellette M, Kiefer N, Kohan L, Taylor AM, Ailawadi G, Ragosta M. Characteristics and outcomes of surgically ineligible patients with multivessel disease treated with percutaneous coronary intervention. Catheter Cardiovasc Interv 2021; 98:1223-1229. [PMID: 33533551 DOI: 10.1002/ccd.29508] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 11/10/2020] [Accepted: 12/29/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES In this study we evaluated the clinical characteristics and outcomes of surgically ineligible patients with coronary artery disease (CAD) who underwent multivessel percutaneous coronary intervention (PCI). BACKGROUND Patients with multivessel CAD who are surgically ineligible and undergo PCI are not well represented in large trials. METHODS Out of 1,061 consecutive patients who underwent a non-emergent PCI for unprotected left main or multivessel CAD at the University of Virginia Medical Center, 137 patients were determined to be surgically ineligible for coronary artery bypass graft (CABG) surgery by a heart team. The clinical characteristics and reasons for surgical ineligibility were collected. The coronary angiograms were reviewed and the SYNTAX score calculated. The Society of Thoracic Surgeons (STS) score was calculated. Outcomes were determined at 30 days and 1-year. RESULTS The mean age of the cohort was 71 and 59% were women. Hypertension, hyperlipidemia, tobacco abuse, and diabetes were common comorbidities. The average SYNTAX score was 22. The most commonly cited reasons for surgical ineligibility were advanced age, frailty, severe lung disease, ejection fraction ≤ 30% and STS score ≥ 8%. Outcomes at 30 days were excellent and better than those predicted by STS for surgery. Frailty and STS score predicted one-year outcomes. CONCLUSIONS Patients undergoing PCI for multivessel disease who are surgically ineligible have multiple risk factors and comorbidities. Frailty, lung disease, poor left ventricular function, and high STS score represent common reasons for surgical ineligibility. Frailty and the STS score better predict one-year outcomes after PCI compared to the SYNTAX score.
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Affiliation(s)
- Mary C Shields
- The Cardiovascular Division and Division of Cardiothoracic Surgery, University of Virginia Health Systems, Charlottesville, Virginia
| | - Michelle Ouellette
- The Cardiovascular Division and Division of Cardiothoracic Surgery, University of Virginia Health Systems, Charlottesville, Virginia
| | - Nicholas Kiefer
- The Cardiovascular Division and Division of Cardiothoracic Surgery, University of Virginia Health Systems, Charlottesville, Virginia
| | - Luke Kohan
- The Cardiovascular Division and Division of Cardiothoracic Surgery, University of Virginia Health Systems, Charlottesville, Virginia
| | - Angela M Taylor
- The Cardiovascular Division and Division of Cardiothoracic Surgery, University of Virginia Health Systems, Charlottesville, Virginia
| | - Gorav Ailawadi
- The Cardiovascular Division and Division of Cardiothoracic Surgery, University of Virginia Health Systems, Charlottesville, Virginia
| | - Michael Ragosta
- The Cardiovascular Division and Division of Cardiothoracic Surgery, University of Virginia Health Systems, Charlottesville, Virginia
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Ragosta M. Bare Metal Stents Are Obsolete and No Longer Have a Role in PCI. Stop Using Them! Cardiovasc Revasc Med 2020; 23:50-51. [PMID: 33257252 DOI: 10.1016/j.carrev.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Michael Ragosta
- Cardiac Catheterization Laboratories, University of Virginia Health System, Charlottesville, VA, United States of America.
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13
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Löffler AI, Gonzalez JA, Sundararaman SK, Mathew RC, Norton PT, Hagspiel KD, Kramer CM, Ragosta M, Rogers C, Shah NL, Salerno M. Coronary Computed Tomography Angiography Demonstrates a High Burden of Coronary Artery Disease Despite Low-Risk Nuclear Studies in Pre-Liver Transplant Evaluation. Liver Transpl 2020; 26:1398-1408. [PMID: 32772465 PMCID: PMC9014709 DOI: 10.1002/lt.25869] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/25/2020] [Accepted: 07/03/2020] [Indexed: 02/07/2023]
Abstract
We investigated the presence and severity of coronary artery disease (CAD) in orthotopic liver transplantation (OLT) candidates using coronary artery calcium score (CACS) and coronary computed tomography angiography (CCTA) as compared with the prevalence of normal and abnormal single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). A total of 140 prospective OLT candidates without known CAD underwent coronary artery calcium (CAC) scans with (n = 77) or without CCTA and coronary computed tomography angiography-derived fractional flow reserve (FFRCT ; n = 57) using a dual-source computed tomography (CT) and were followed for 2.6 ± 1.4 years. Coronary plaque was quantified using the segment-involvement score (SIS) and segment stenosis score (SSS). The mean age was 59 ± 6 years, and 65.0% of patients were male. Mean Agatston CACS was 367 ± 653, and 15.0% of patients had CACSs of 0; 83.6% received a SPECT MPI, of which 95.7% were interpreted as normal/probably normal. By CCTA, 9.1% had obstructive CAD (≥70% stenosis), 67.5% had nonobstructive CAD, and 23.4% had no CAD. Nonobstructive CAD was diffuse with mean SIS 3.0 ± 2.9 and SSS 4.5 ± 5.4. Only 14 patients had high risk-findings (severe 3v CAD, n = 4, CACS >1000 n = 10) that prompted X-ray angiography in 3 patients who had undergone CCTA, resulting in revascularization of a high-risk obstruction in 1 patient who had a normal SPECT study. Patients with end-stage liver disease have a high prevalence of nonobstructive CAD by CCTA, which is undiagnosed by SPECT MPI, potentially underestimating cardiovascular risk. Deferring X-ray angiography unless high-risk CCTA findings are present is a potential strategy for avoiding unnecessary X-ray angiography.
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Affiliation(s)
- Adrián I. Löffler
- Cardiovascular Division, Departments of Medicine, University of Virginia Health System, Charlottesville, VA
| | - Jorge A. Gonzalez
- Cardiovascular Division, Departments of Medicine, University of Virginia Health System, Charlottesville, VA,Division of Cardiovascular Disease, Scripps Clinic, La Jolla, CA
| | - Shriram K. Sundararaman
- Cardiovascular Division, Departments of Medicine, University of Virginia Health System, Charlottesville, VA
| | - Roshin C. Mathew
- Cardiovascular Division, Departments of Medicine, University of Virginia Health System, Charlottesville, VA
| | - Patrick T. Norton
- Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA
| | - Klaus D. Hagspiel
- Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA
| | - Christopher M. Kramer
- Cardiovascular Division, Departments of Medicine, University of Virginia Health System, Charlottesville, VA,Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA
| | - Michael Ragosta
- Cardiovascular Division, Departments of Medicine, University of Virginia Health System, Charlottesville, VA
| | | | - Neeral L. Shah
- Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA
| | - Michael Salerno
- Cardiovascular Division, Departments of Medicine, University of Virginia Health System, Charlottesville, VA,Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA,Biomedical Engineering, University of Virginia Health System, Charlottesville, VA
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14
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Ragosta M, Boehm R, Shields M, Taylor AM. Intentional removal of erroneously deployed coronary stents: A case series and review of the literature. Catheter Cardiovasc Interv 2020; 97:670-674. [PMID: 32865307 DOI: 10.1002/ccd.29256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/08/2020] [Accepted: 08/01/2020] [Indexed: 11/08/2022]
Abstract
Most reports of stent retrieval involve undeployed, embolized stents. While the retrieval of fully deployed stents has been sporadically reported, most of these were not intentional. The feasibility and safety of intentional retrieval of fully deployed, but erroneously placed stents have not been well described. We report four cases of successful, intentional stent retrieval for stents placed erroneously in an aorto-ostial position. The stents were retrieved at varying times after deployment, ranging from immediately to up to 5 years. In all cases, stents were retrieved successfully with no complication. We conclude that the intentional retrieval of fully deployed, but erroneously placed stents is feasible and safe when stenting involved an aorto-ostial location.
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Affiliation(s)
- Michael Ragosta
- Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Ryan Boehm
- Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Mary Shields
- Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Angela M Taylor
- Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
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15
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Ragosta M. Stenting Long Coronary Lesions: Can One Stent Do the Job of Two? Cardiovasc Revasc Med 2020; 21:1119-1120. [PMID: 32741588 DOI: 10.1016/j.carrev.2020.06.034] [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] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Michael Ragosta
- Cardiac Catheterization Laboratory, University of Virginia Health System, Charlottesville, VA, United States of America.
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16
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Hanson CA, Ragosta M. Typical angina in a patient with Takayasu arteritis. Catheter Cardiovasc Interv 2020; 95:1129-1132. [PMID: 31364802 DOI: 10.1002/ccd.28418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/27/2019] [Accepted: 07/17/2019] [Indexed: 11/11/2022]
Abstract
Takayasu arteritis (TA) is a well-reported form of large-vessel vasculitis that primarily affects the aorta and its major branches. Cardiac manifestations of TA have been reported and can include typical angina secondary to coronary artery involvement; however, typical angina in the setting normal coronary arteries is uncommon. We describe a case of typical angina in a patient with TA with normal coronary arteries secondary to diastolic hypotension, in the absence of significant aortic regurgitation, likely from poor aortic distensibility and elevated left ventricular end-diastolic pressure.
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Affiliation(s)
- Christopher A Hanson
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Michael Ragosta
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
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17
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Giustino G, Serruys PW, Sabik JF, Mehran R, Maehara A, Puskas JD, Simonton CA, Lembo NJ, Kandzari DE, Morice MC, Taggart DP, Gershlick AH, Ragosta M, Kron IL, Liu Y, Zhang Z, McAndrew T, Dressler O, Généreux P, Ben-Yehuda O, Pocock SJ, Kappetein AP, Stone GW. Mortality After Repeat Revascularization Following PCI or CABG for Left Main Disease: The EXCEL Trial. JACC Cardiovasc Interv 2020; 13:375-387. [PMID: 31954680 DOI: 10.1016/j.jcin.2019.09.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/04/2019] [Accepted: 09/10/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the incidence and impact on mortality of repeat revascularization after index percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD). BACKGROUND The impact on mortality of the need of repeat revascularization following PCI or CABG in patients with unprotected LMCAD is unknown. METHODS All patients with LMCAD and site-assessed low or intermediate SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) scores randomized to PCI (n = 948) or CABG (n = 957) in the EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial were included. Repeat revascularization events were adjudicated by an independent clinical events committee. The effect of repeat revascularization on mortality through 3-year follow-up was examined in time-varying Cox regression models. RESULTS During 3-year follow-up, there were 346 repeat revascularization procedures among 185 patients. PCI was associated with higher rates of any repeat revascularization (12.9% vs. 7.6%; hazard ratio: 1.73; 95% confidence interval: 1.28 to 2.33; p = 0.0003). Need for repeat revascularization was independently associated with increased risk for 3-year all-cause mortality (adjusted hazard ratio: 2.05; 95% confidence interval: 1.13 to 3.70; p = 0.02) and cardiovascular mortality (adjusted hazard ratio: 4.22; 95% confidence interval: 2.10 to 8.48; p < 0.0001) consistently after both PCI and CABG (pint = 0.85 for both endpoints). Although target vessel revascularization and target lesion revascularization were both associated with an increased risk for mortality, target vessel non-target lesion revascularization and non-target vessel revascularization were not. CONCLUSIONS In the EXCEL trial, repeat revascularization during follow-up was performed less frequently after CABG than PCI and was associated with increased mortality after both procedures. Reducing the need for repeat revascularization may further improve long-term survival after percutaneous or surgical treatment of LMCAD. (EXCEL Clinical Trial; NCT01205776).
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Affiliation(s)
- Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Patrick W Serruys
- Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - Joseph F Sabik
- Department of Surgery, UH Cleveland Medical Center, Cleveland, Ohio
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - John D Puskas
- Mount Sinai Heart at Mount Sinai St Luke's, New York, New York
| | | | - Nicholas J Lembo
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | | | | | - David P Taggart
- Department Cardiac Surgery, John Radcliffe Hospital, Oxford, United Kingdom
| | | | - Michael Ragosta
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Irving L Kron
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Yangbo Liu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Zixuan Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Thomas McAndrew
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Ovidiu Dressler
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Philippe Généreux
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey; Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
| | - Ori Ben-Yehuda
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
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Cook D, Benjamin C, McNair P, Lim S, Ailawadi G, Ragosta M. TCT-697 Futility in the Modern Era of TAVR: Clinical Characteristics of High Risk Patients That Do Not Benefit From Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.826] [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: 10/25/2022]
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19
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Kuno T, Mehran R, Claessen B, Guedeney P, Serruys P, Sabik J, Milojevic M, Simonton C, Puskas J, Kandzari D, Morice MC, Taggart D, Gershlick A, Zhang Z, Ragosta M, Kron I, Dressler O, Leon M, Pocock S, Ben-Yehuda O, Kappetein AP, Stone G. TCT-307 Vascular Closure Device Use After PCI for Left Main Disease: Analysis From the EXCEL Trial. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.384] [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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20
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Ragosta M. The long arm of interventional cardiology: the promise and perils of coronary stenting over the internet using a robotic interface. EUROINTERVENTION 2019; 15:e479-e481. [PMID: 31395573 DOI: 10.4244/eijv15i6a86] [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] [Indexed: 11/23/2022]
Affiliation(s)
- Michael Ragosta
- Cardiac Catheterization Laboratories, University of Virginia Health System, Charlottesville, VA, USA
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21
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Doucet S, Jolicœur EM, Serruys PW, Ragosta M, Kron IL, Scholtz W, Börgermann J, Zhang Y, McAndrew T, Sabik JF, Kappetein AP, Stone GW. Outcomes of left main revascularization in patients with acute coronary syndromes and stable ischemic heart disease: Analysis from the EXCEL trial. Am Heart J 2019; 214:9-17. [PMID: 31150791 DOI: 10.1016/j.ahj.2019.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 04/25/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prompt revascularization is often required in acute coronary syndromes (ACS), whereas stable ischemic heart disease (SIHD) may allow for more measured procedural planning. Whether the acuity of presentation preferentially affects outcomes after coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with left main coronary artery disease (LMCAD) is unknown. We investigated whether the acuity of presentation discriminated patients who derived a differential benefit from PCI versus CABG in the randomized Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial. METHODS We used multivariable Cox models to assess the interaction between the acuity of presentation, type of revascularization and outcomes in patients with low or intermediate SYNTAX scores enrolled in EXCEL. RESULTS At baseline, 1151 patients (60.7%) presented with SIHD and 746 patients (39.3%) presented with an ACS. The acuity of presentation was not associated with the primary endpoint of all-cause death, MI, or stroke at 3 years (multivariable adjusted hazard ratio [HR] 0.94; 95% CI 0.70-1.26, P = .64). The primary endpoint rate was similar in patients assigned to PCI versus CABG whether they presented with SIHD (adjusted HR 1.04; 95% CI 0.73-1.48]) or with ACS (HR 0.82; 95% CI 0.54-1.26) (Pinteraction = .34). CONCLUSIONS The acuity of presentation did not predict outcomes in patients with LMCAD undergoing revascularization, nor did it discriminate patients who derive greater event-free survival from PCI versus CABG.
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Affiliation(s)
- Serge Doucet
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Canada
| | - E Marc Jolicœur
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Canada
| | - Patrick W Serruys
- Imperial College of Science, Technology and Medicine, London, United Kingdom
| | | | - Irving L Kron
- University of Virginia Health System, Charlottesville, VA
| | - Werner Scholtz
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospital of the Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Jochen Börgermann
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospital of the Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Yiran Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY
| | - Thomas McAndrew
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY
| | - Joseph F Sabik
- Department of Surgery, UH Cleveland Medical Center, Cleveland, OH
| | | | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY; Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY.
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22
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Zhuo DX, Ragosta M, Patterson B. Tyrosine kinase inhibitor toxicity manifesting as comorbid Moyamoya syndrome and obstructive coronary artery disease: A case report and review of the literature. Catheter Cardiovasc Interv 2019; 94:117-119. [PMID: 30861282 DOI: 10.1002/ccd.28189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 02/28/2019] [Indexed: 11/11/2022]
Abstract
Tyrosine kinase inhibitors (TKIs) have assumed an increasingly vital role in treating various hematologic and oncologic malignancies. However, adverse effects with respect to vascular disease have been reported following administration of this class of medications. Here, we present a case report of TKI toxicity, manifesting as comorbid Moyamoya syndrome and obstructive coronary artery disease leading to a type 1 non-ST-elevation myocardial infarction. This patient eventually required percutaneous coronary intervention with drug-eluting stent placement in the right coronary artery. Given the expanding indications of TKI therapy, this case highlights a growing population subset which may require coronary and/or peripheral interventions to treat sequela from otherwise life-prolonging treatment.
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Affiliation(s)
- David X Zhuo
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Michael Ragosta
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Brandy Patterson
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
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23
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Ragosta M. The Bounce Back: Should Hospital Readmission Following Percutaneous Coronary Intervention Be the Next Focus of Our Quality Efforts? JACC Cardiovasc Interv 2019; 12:749-751. [PMID: 30928447 DOI: 10.1016/j.jcin.2018.12.041] [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: 12/03/2018] [Accepted: 12/26/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Michael Ragosta
- University of Virginia Health System, Charlottesville, Virginia.
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24
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McNair P, Robinson A, Ragosta M, Ailawadi G, Salerno M. HYBRID SURGICAL AND PERCUTANEOUS CORONARY INTERVENTION OF A GIANT CORONARY ARTERY ANEURYSM. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32757-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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25
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Ragosta M. “Doc, This Wall Stress Is Killing Me!”. JACC Cardiovasc Interv 2018; 11:2081-2083. [DOI: 10.1016/j.jcin.2018.07.048] [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] [Received: 07/24/2018] [Accepted: 07/31/2018] [Indexed: 11/16/2022]
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26
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Saji M, Katz MR, Ailawadi G, Welch TS, Fowler DE, Kennedy JLW, Bergin JD, Kuntjoro I, Dent JM, Ragosta M, Lim DS. 6-Minute walk test predicts prolonged hospitalization in patients undergoing transcatheter mitral valve repair by MitraClip. Catheter Cardiovasc Interv 2018; 92:566-573. [PMID: 29656614 DOI: 10.1002/ccd.27600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 01/29/2018] [Accepted: 02/23/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND The 6-minute walk test (6MWT) is a simple functional test that can predict exercise capacity and is widely employed to assess treatment outcomes. Although mortality with transcatheter mitral valve repair (TMVr) using the MitraClip (Abbott Vascular, Menlo Park, CA) is significantly less than for open mitral valve surgery in high-risk patients, identifying which patient will benefit the most from TMVr remains a concern. There are limited prognostic metrics guiding patient selection and, no studies have reported relationship between prolonged hospitalization and 6MWT. This study aimed to determine if the 6MWT can predict prolonged hospitalization in patients undergoing TMVr by MitraClip. METHODS We retrospectively reviewed 162 patients undergoing 6MWT before TMVr. Patients were divided into three groups according to the 6MWT distance (6MWTD) using the median (6MWTD ≥219 m, 6MWTD <219 m, and Unable to Walk). Multivariate logistic regression model was applied to select the demographic characteristics that were associated with the prolonged hospitalization defined as total length of stay ≥4 days in the study. RESULTS We found that 6MWT (odds ratio 3.64, 95% confidence interval 2.03-6.52, P < 0.001) was independently associated with prolonged hospitalization after adjustment in multivariate analysis. Area under the curve of 6MWT for predicting prolonged hospitalization was 0.79 (95% confidence interval 0.72-0.85). CONCLUSIONS Our study demonstrates that 6MWT was independently associated with prolonged hospitalization in patients with TMVr, and has a good discriminatory performance for predicting prolonged hospitalization.
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Affiliation(s)
- Mike Saji
- Advanced Cardiac Valve Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia.,Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Marc R Katz
- Department of Surgery, Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Gorav Ailawadi
- Advanced Cardiac Valve Center, Department of Surgery, Division of Cardiothoracic Surgery, University of Virginia, Charlottesville, Virginia
| | - Timothy S Welch
- Heart and Vascular Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Dale E Fowler
- Heart and Vascular Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Jamie L W Kennedy
- Heart and Vascular Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - James D Bergin
- Heart and Vascular Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Ivandito Kuntjoro
- Advanced Cardiac Valve Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia.,Department of Cardiology, National University Heart Center of Singapore, Singapore, Singapore
| | - John M Dent
- Advanced Cardiac Valve Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Michael Ragosta
- Advanced Cardiac Valve Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - D Scott Lim
- Advanced Cardiac Valve Center, Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
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27
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Giustino G, Mehran R, Serruys PW, Sabik JF, Milojevic M, Simonton CA, Puskas JD, Kandzari DE, Morice MC, Taggart DP, Gershlick AH, Généreux P, Zhang Z, McAndrew T, Redfors B, Ragosta M, Kron IL, Dressler O, Leon MB, Pocock SJ, Ben-Yehuda O, Kappetein AP, Stone GW. Left Main Revascularization With PCI or CABG in Patients With Chronic Kidney Disease. J Am Coll Cardiol 2018; 72:754-765. [DOI: 10.1016/j.jacc.2018.05.057] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/26/2018] [Accepted: 05/11/2018] [Indexed: 01/22/2023]
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28
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Smith L, Peters A, Mazimba S, Ragosta M, Taylor AM. Outcomes of patients with cardiogenic shock treated with TandemHeart ® percutaneous ventricular assist device: Importance of support indication and definitive therapies as determinants of prognosis. Catheter Cardiovasc Interv 2018; 92:1173-1181. [PMID: 29745477 DOI: 10.1002/ccd.27650] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 03/21/2018] [Accepted: 04/15/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The objective of this study was to review the characteristics of patients in cardiogenic shock treated with TandemHeart® percutaneous ventricular assist device (pVAD) to determine influential predictors of survival. BACKGROUND The TandemHeart® pVAD is used in the management of patients with cardiogenic shock resulting from a variety of conditions. Several studies have documented the efficacy of this therapy and outlined its complications. Still, there is little data to guide the effective and appropriate use of this resource. METHODS Patients referred for TandemHeart® pVAD implant for refractory cardiogenic shock at the University of Virginia between September 2007 and October 2015 were retrospectively analyzed. Univariate analysis was used to identify predictors of mortality. RESULTS Fifty-five patients underwent successful TandemHeart® implant. Hemodynamics significantly improved following TandemHeart® implant. Cardiac index increased from 1.8 ± 0.6 to 3.1 ± 1.0 L/min/m2 (P = 0.007) and pulmonary capillary wedge pressure decreased from 30. 5 ± 9.9 to 19.6 ± 7.4 mmHg (P =0.0007). Survival was significantly influenced by implant indication with 23.8% surviving in bridge to recovery vs. 51% in bridge to LVAD or surgery (P = 0.04). In patients who did not receive definitive therapy, only 4 (13.8%) were weaned from TandemHeart® support and survived to hospital discharge. Only younger age, 51.8 vs. 62.7 years, predicted survival to hospital discharge (P = 0.004). CONCLUSION Mortality from refractory cardiogenic shock is high even with TandemHeart® support. Our study found that patients with an exit strategy with either cardiac surgery or durable LVAD implant significantly influenced survival to hospital discharge.
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Affiliation(s)
- LaVone Smith
- Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - Anthony Peters
- Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - Sula Mazimba
- Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - Michael Ragosta
- Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
| | - Angela M Taylor
- Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia
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29
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Ragosta M. The Heart or the Brain? JACC Cardiovasc Interv 2018; 11:257-259. [DOI: 10.1016/j.jcin.2017.10.009] [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] [Received: 10/02/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
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30
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Doucet S, Jolicoeur M, Serruys P, Ragosta M, Scholtz W, Zhang Y, Sabik J, McAndrew T, Kappetein AP, Stone G. TCT-3 Outcomes of Left Main Revascularization in Patients with Acute Coronary Syndrome vs. Stable Angina: Analysis from the EXCEL Trial. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kapadia SR, Kodali S, Makkar R, Mehran R, Lazar RM, Zivadinov R, Dwyer MG, Jilaihawi H, Virmani R, Anwaruddin S, Thourani VH, Nazif T, Mangner N, Woitek F, Krishnaswamy A, Mick S, Chakravarty T, Nakamura M, McCabe JM, Satler L, Zajarias A, Szeto WY, Svensson L, Alu MC, White RM, Kraemer C, Parhizgar A, Leon MB, Linke A, Makkar R, Al-Jilaihawi H, Kapadia S, Krishnaswamy A, Tuzcu EM, Mick S, Kodali S, Nazif T, Thourani V, Babaliaros V, Devireddy C, Mavromatis K, Waksman R, Satler L, Pichard A, Szeto W, Anwaruddin S, Vallabhajosyula P, Giri J, Herrmann H, Zajarias A, Lasala J, Greenbaum A, O’Neill W, Eng M, Rovin J, Lin L, Spriggs D, Wong SC, Bergman G, Salemi A, Smalling R, Kar B, Loyalka P, Lim DS, Ragosta M, Reisman M, McCabe J, Don C, Sharma S, Kini A, Dangas G, Mahoney P, Morse A, Stankewicz M, Rodriguez E, Linke A, Mangner N, Woitek F, Frerker C, Cohen D. Protection Against Cerebral Embolism During Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2017; 69:367-377. [DOI: 10.1016/j.jacc.2016.10.023] [Citation(s) in RCA: 265] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 10/21/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022]
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Saji M, Lim DS, Ragosta M, LaPar DJ, Downs E, Ghanta RK, Kern JA, Dent JM, Ailawadi G. Usefulness of Psoas Muscle Area to Predict Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement. Am J Cardiol 2016; 118:251-7. [PMID: 27236254 DOI: 10.1016/j.amjcard.2016.04.043] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/26/2016] [Accepted: 04/26/2016] [Indexed: 01/17/2023]
Abstract
Frailty has become high-priority theme in cardiovascular diseases because of aging and increasingly complex nature of patients. Low muscle mass is characteristic of frailty, in which invasive interventions are avoided if possible because of decreased physiological reserve. This study aimed to determine if the psoas muscle area (PMA) could predict mortality and to investigate its utility in patients who underwent transcatheter aortic valve replacement (TAVR). We retrospectively reviewed 232 consecutive patients who underwent TAVR. Cross-sectional areas of the psoas muscles at the level of fourth lumbar vertebra were measured by computed tomography and normalized to body surface area. Patients were divided into tertiles according to the normalized PMA for each gender (men: tertile 1, 1,708 to 1,178 mm(2)/m(2); tertile 2, 1,176 to 1,011 mm(2)/m(2); and tertile 3, 1,009 to 587 mm(2)/m(2); women: tertile 1, 1,436 to 962 mm(2)/m(2); tertile 2, 952 to 807 mm(2)/m(2); and tertile 3, 806 to 527 mm(2)/m(2)). Smaller normalized PMA was independently correlated with women and higher New York Heart Association classification. After adjustment for multiple confounding factors, the normalized PMA tertile was independently associated with mortality at 6 months (adjusted hazard ratio 1.53, 95% confidence interval 1.06 to 2.21). Kaplan-Meier analysis showed that tertile 3 had higher mortality rates than tertile 1 at 6 months (14% and 31%, respectively, p = 0.029). Receiver-operating characteristic analysis showed that normalized PMA provided the increase of C-statistics for predicting mortality for a clinical model and gait speed. In conclusion, PMA is an independent predictor of mortality after TAVR and can complement a clinical model and gait speed.
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Affiliation(s)
- Mike Saji
- Division of Cardiovascular Medicine, Department of Medicine, Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia; Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - D Scott Lim
- Division of Cardiovascular Medicine, Department of Medicine, Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia
| | - Michael Ragosta
- Division of Cardiovascular Medicine, Department of Medicine, Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia
| | - Damien J LaPar
- Division of Cardiothoracic Surgery, Department of Surgery, Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia
| | - Emily Downs
- Division of Cardiothoracic Surgery, Department of Surgery, Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia
| | - Ravi K Ghanta
- Division of Cardiothoracic Surgery, Department of Surgery, Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia
| | - John A Kern
- Division of Cardiothoracic Surgery, Department of Surgery, Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia
| | - John M Dent
- Division of Cardiovascular Medicine, Department of Medicine, Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia
| | - Gorav Ailawadi
- Division of Cardiothoracic Surgery, Department of Surgery, Advanced Cardiac Valve Center, University of Virginia, Charlottesville, Virginia.
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Ragosta M. Bleeding Versus Clotting? Both Are Equally Bad After Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2016; 9:1358-60. [PMID: 27388823 DOI: 10.1016/j.jcin.2016.05.019] [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: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Michael Ragosta
- Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia.
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Saji M, Ailawadi G, Welch TS, Downs E, LaPar DJ, Ghanta R, Kennedy JL, Abuannadi M, Buda AJ, Bergin JD, Kern JA, Dent JM, Ragosta M, Lim DS. Pre-Procedural 6-Min Walk Test as a Mortality Predictor in Patients Undergoing Transcatheter Mitral Valve Repair. J Am Coll Cardiol 2016; 67:2083-4. [DOI: 10.1016/j.jacc.2016.02.032] [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] [Received: 11/16/2015] [Revised: 01/28/2016] [Accepted: 02/03/2016] [Indexed: 10/21/2022]
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Ailawadi G, Downs E, Mehta G, Kern JA, Ragosta M, Lim DS. Retrieval of Embolized Transcatheter Aortic Valves in Left Ventricle Through Apical Ventriculotomy. J Card Surg 2016; 31:203-5. [PMID: 26846685 DOI: 10.1111/jocs.12701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Transcatheter valve placement complicated by left ventricular embolization is often treated with sternotomy, valve removal through the aorta, and conventional aortic valve replacement. We report three cases of ventricular embolization of aortic valves during deployment. We successfully placed a second transcatheter aortic valve in the correct position and retrieved the embolized valve through an apical ventriculotomy. All patients recovered well and survived for more than one year. doi: 10.1111/jocs.12701 (J Card Surg 2016;31:203-205).
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Affiliation(s)
- Gorav Ailawadi
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Emily Downs
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Gaurav Mehta
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - John A Kern
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Michael Ragosta
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - D Scott Lim
- Department of Medicine, University of Virginia, Charlottesville, Virginia
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Johansen MC, Worrall BB, Southerland AM, Hodges MA, Ragosta M, Solenski NJ. Abstract TP299: The Feasibility of the Aldrete-FAST Screening Tool to Detect Stroke in the Post Cardiac Catheterization Setting: FAST-PC Study. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.tp299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Peri-procedural cardiac catheterization related stroke (CRS) remains a feared complication. Risk estimates reach 7% but vary widely by institution and operator experience. Given the volume (>2 million/yr in US), the impact of CRS is substantial. Evidence-based data on diagnosis/treatment are lacking for these patients despite being ideal targets for acute stroke treatment. Many CRS go undetected due to a lack of a standardized assessment tool.
Hypothesis:
A novel screening tool will be feasible to perform and effective in standardizing rapid diagnosis of CRS.
Methods:
Two validated tools form the basis of this screen 1) Aldrete score: 10-pt scale used in anesthesia cases to assess activity, respiration, circulation, consciousness and color 2)FAST screen designed to reliably diagnose stroke in < 1 min: Facial droop, Arm weakness, Speech changes, Time. Patients are assessed pre/post procedure and catheterization sheath left in place until protocol completion to allow for CRS IA therapy. Feasibility criteria: Excellent if ≥80%; moderate if ≥50% had successful completion. Uni/multivariable logistic regression analysis assessed interaction with age, sedation & sheath location.
Results:
906 patients were enrolled over 7 months. Mean age was 64.9±13.6; 65% male. 727 cases completed 100% of Aldrete-FAST (80.2%, 95% CI: 77.5% - 82.8%). High dose Midazolam (>2mg) was associated with completion of Aldrete-FAST (P<0.001, OR 3.14 CI:1.79-5.52) while Fentanyl (100-200mcg) was a deterrent (P 0.027, OR 0.45 CI: 0.22-0.91). Fentanyl >200mcg had no association (30 patients). 748 maintained the sheath (88.0%, 95%CI: 85.6%-90.1%). There was no association between age, sex or access site location (femoral, radial or both) on outcomes.
Conclusions:
This single-center prospective study demonstrates that the Aldrete-FAST score is a simple, safe screening tool with excellent feasibility to evaluate for CRS. No association between age, sex or access site implies generalizability. We found an interaction with sedation as midazolam and fentanyl had an inverse relationship regarding successful completion of the score. Further study is warranted to determine the optimal anesthesia for high risk patients undergoing cardiac catheterization.
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Saji M, Ailawadi G, Conant PA, Downs E, Kern J, Dent J, Ragosta M, Lim S. TCT-151 Cross-sectional Psoas Muscle Area Detected by Computed Tomography as a Measure of Frailty and Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.162] [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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Dixon AJ, Kilroy JP, Dhanaliwala AH, Chen JL, Phillips LC, Ragosta M, Klibanov AL, Wamhoff BR, Hossack JA. Microbubble-mediated intravascular ultrasound imaging and drug delivery. IEEE Trans Ultrason Ferroelectr Freq Control 2015; 62:1674-1685. [PMID: 26415129 DOI: 10.1109/tuffc.2015.007143] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Intravascular ultrasound (IVUS) provides radiation-free, real-time imaging and assessment of atherosclerotic disease in terms of anatomical, functional, and molecular composition. The primary clinical applications of IVUS imaging include assessment of luminal plaque volume and real-time image guidance for stent placement. When paired with microbubble contrast agents, IVUS technology may be extended to provide nonlinear imaging, molecular imaging, and therapeutic delivery modes. In this review, we discuss the development of emerging imaging and therapeutic applications that are enabled by the combination of IVUS imaging technology and microbubble contrast agents.
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Downs E, Lim S, Ragosta M, Yount K, Yarboro L, Ghanta R, Kern J, Kron I, Ailawadi G. The influence of a percutaneous mitral repair program on surgical mitral valve volume. J Thorac Cardiovasc Surg 2015; 150:1093-7. [PMID: 26349597 DOI: 10.1016/j.jtcvs.2015.08.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/19/2015] [Accepted: 08/08/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Percutaneous mitral repair with the MitraClip system (Abbott Vascular, Santa Clara, Calif) has been available in trials since 2006 and is currently approved for patients with degenerative mitral valve disease at prohibitive risk for surgery. There has been concern that novel transcatheter approaches may detract from mitral valve surgical volumes. We sought to evaluate the influence of our MitraClip program on our surgical mitral valve volumes and outcomes. METHODS All patients referred for MitraClip underwent evaluation by a multidisciplinary team. Patients were screened for surgical candidacy and suitable valve anatomy for transcatheter repair. The fate of patients referred for MitraClip as well as the overall surgical mitral volumes and outcomes were evaluated. RESULTS From July 2007 to December 2014, 468 patients were referred for the MitraClip procedure at our institution. Of these, 156 patients (33.3%) received a MitraClip (including 45 implanted by surgeons), whereas 82 patients (17.5%) underwent surgical interventions. During this timeframe, the volume of isolated mitral valve operations increased from 50 procedures in 2007 to 93 in 2014 (80% increase; R(2) = 0.89). Importantly, operative mortality for all patients undergoing isolated mitral surgery from 2008 to 2014 was 2.6%, with an observed to expected ratio of 0.64. CONCLUSIONS The availability of MitraClip resulted in an increase in our mitral valve referrals. Despite seeing an increase in higher risk referrals, operative mortality for mitral surgery remained excellent. Multidisciplinary evaluation, including input from experienced mitral surgeons, is necessary to have a successful percutaneous and surgical mitral valve program.
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Affiliation(s)
- Emily Downs
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Scott Lim
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Va
| | - Michael Ragosta
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Va
| | - Kenan Yount
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Leora Yarboro
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Ravi Ghanta
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - John Kern
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Irving Kron
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
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Saji M, Rossi AM, Ailawadi G, Dent J, Ragosta M, Scott Lim D. Adjunctive intracardiac echocardiography imaging from the left ventricle to guide percutaneous mitral valve repair with the mitraclip in patients with failed prior surgical rings. Catheter Cardiovasc Interv 2015; 87:E75-82. [DOI: 10.1002/ccd.25981] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 02/20/2015] [Accepted: 04/04/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Mike Saji
- Advanced Cardiac Valve Center; Department of Medicine; Division of Cardiovascular Medicine; University of Virginia; Virginia
- Department of Cardiology; Sakakibara Heart Institute; Tokyo
| | - Ann M. Rossi
- Advanced Cardiac Valve Center; Department of Medicine; Division of Cardiovascular Medicine; University of Virginia; Virginia
| | - Gorav Ailawadi
- Advanced Cardiac Valve Center; Department of Surgery; Division of Cardiothoracic Surgery; University of Virginia; Virginia
| | - John Dent
- Advanced Cardiac Valve Center; Department of Medicine; Division of Cardiovascular Medicine; University of Virginia; Virginia
| | - Michael Ragosta
- Advanced Cardiac Valve Center; Department of Medicine; Division of Cardiovascular Medicine; University of Virginia; Virginia
| | - D. Scott Lim
- Advanced Cardiac Valve Center; Department of Medicine; Division of Cardiovascular Medicine; University of Virginia; Virginia
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Taylor AM, Ragosta M. Understanding Left Main Disease: Will the Right SYNTAX Help Us EXCEL in (PRE)COMBAT? J Cardiovasc Transl Res 2015; 8:209-10. [PMID: 26031243 DOI: 10.1007/s12265-015-9635-3] [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: 05/04/2015] [Accepted: 05/07/2015] [Indexed: 11/29/2022]
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Saji M, Ragosta M, Dent J, Lim DS. Use of intracardiac echocardiography to guide percutaneous transluminal mitral commissurotomy. Catheter Cardiovasc Interv 2015; 87:E69-74. [DOI: 10.1002/ccd.25943] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 03/14/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Mike Saji
- Advanced Cardiac Valve Center; Department of Medicine; University of Virginia; Charlottesville Virginia
| | - Michael Ragosta
- Advanced Cardiac Valve Center; Department of Medicine; University of Virginia; Charlottesville Virginia
| | - John Dent
- Advanced Cardiac Valve Center; Department of Medicine; University of Virginia; Charlottesville Virginia
| | - D. Scott Lim
- Advanced Cardiac Valve Center; Department of Medicine; University of Virginia; Charlottesville Virginia
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Ragosta M, D'Emilio M, Giorgio GA. Input strategy analysis for an air quality data modelling procedure at a local scale based on neural network. Environ Monit Assess 2015; 187:307. [PMID: 25925158 DOI: 10.1007/s10661-015-4556-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 04/21/2015] [Indexed: 06/04/2023]
Abstract
In recent years, a significant part of the studies on air pollutants has been devoted to improve statistical techniques for forecasting the values of their concentrations in the atmosphere. Reliable predictions of pollutant trends are essential not only for setting up preventive measures able to avoid risks for human health but also for helping stakeholders to take decision about traffic limitations. In this paper, we present an operating procedure, including both pollutant concentration measurements (CO, SO₂, NO₂, O₃, PM10) and meteorological parameters (hourly data of atmospheric pressure, relative humidity, wind speed), which improves the simple use of neural network for the prediction of pollutant concentration trends by means of the integration of multivariate statistical analysis. In particular, we used principal component analysis in order to define an unconstrained mix of variables able to improve the performance of the model. The developed procedure is particularly suitable for characterizing the investigated phenomena at a local scale.
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Affiliation(s)
- M Ragosta
- Engineering School, University of Basilicata, V.le dell'Ateneo Lucano, 85100, Potenza, Italy,
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Brooks C, Ma JZ, Burks SG, Simon RM, Stebbins A, Ailawadi G, Ragosta M, Lim DS, Kern J, Kron I. ACUTE KIDNEY INJURY WITH TRANSCATHETER AORTIC VALVE REPLACEMENT IN THE U.S.: CAN WE REDUCE THE RISK? J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61788-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Left main coronary disease is seen in 4%-6% of patients undergoing coronary angiography for an ischemic evaluation and is a potentially fatal condition if not promptly identified and treated. Recent studies have increased our understanding of the complexity of left main coronary artery disease. This lesion subset offers numerous challenges in diagnosis and management. Fractional flow reserve and intravascular ultrasound are important adjuncts to angiography to determine the significance of ambiguous lesions of the left main coronary artery. Surgery is associated with much better outcomes than medical therapy and is considered by many to be the standard of care in patients who are surgical candidates. Recent studies comparing surgery with percutaneous coronary intervention (PCI) have defined subgroups with lesser extent of disease burden that may do just as well with PCI. Challenges remain in the management of bifurcation disease, and the interventional community anxiously awaits the results of the large-scale randomized trials comparing PCI with surgery.
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Salerno M, Taylor A, Yang Y, Kuruvilla S, Ragosta M, Meyer CH, Kramer CM. Adenosine stress cardiovascular magnetic resonance with variable-density spiral pulse sequences accurately detects coronary artery disease: initial clinical evaluation. Circ Cardiovasc Imaging 2014; 7:639-46. [PMID: 24759900 DOI: 10.1161/circimaging.113.001584] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Adenosine stress cardiovascular magnetic resonance perfusion imaging can be limited by motion-induced dark-rim artifacts, which may be mistaken for true perfusion abnormalities. A high-resolution variable-density spiral pulse sequence with a novel density compensation strategy has been shown to reduce dark-rim artifacts in first-pass perfusion imaging. We aimed to assess the clinical performance of adenosine stress cardiovascular magnetic resonance using this new perfusion sequence to detect obstructive coronary artery disease. METHODS AND RESULTS Cardiovascular magnetic resonance perfusion imaging was performed during adenosine stress (140 μg/kg per minute) and at rest on a Siemens 1.5-T Avanto scanner in 41 subjects with chest pain scheduled for coronary angiography. Perfusion images were acquired during injection of 0.1 mmol/kg Gadolinium-diethylenetriaminepentacetate at 3 short-axis locations using a saturation recovery interleaved variable-density spiral pulse sequence. Significant stenosis was defined as >50% by quantitative coronary angiography. Two blinded reviewers evaluated the perfusion images for the presence of adenosine-induced perfusion abnormalities and assessed image quality using a 5-point scale (1 [poor] to 5 [excellent]). The prevalence of obstructive coronary artery disease by quantitative coronary angiography was 68%. The average sensitivity, specificity, and accuracy were 89%, 85%, and 88%, respectively, with a positive predictive value and negative predictive value of 93% and 79%, respectively. The average image quality score was 4.4±0.7, with only 1 study with more than mild dark-rim artifacts. There was good inter-reader reliability with a κ statistic of 0.67. CONCLUSIONS Spiral adenosine stress cardiovascular magnetic resonance results in high diagnostic accuracy for the detection of obstructive coronary artery disease with excellent image quality and minimal dark-rim artifacts.
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Affiliation(s)
- Michael Salerno
- From the Cardiovascular Division, Department of Medicine (M.S., A.T., S.K., M.R., C.M.K.) and Department of Radiology and Medical Imaging (M.S., C.H.M., C.M.K.), University of Virginia Health System, Charlottesville; and Department of Biomedical Engineering, University of Virginia, Charlottesville (M.S., Y.Y., C.H.M.).
| | - Angela Taylor
- From the Cardiovascular Division, Department of Medicine (M.S., A.T., S.K., M.R., C.M.K.) and Department of Radiology and Medical Imaging (M.S., C.H.M., C.M.K.), University of Virginia Health System, Charlottesville; and Department of Biomedical Engineering, University of Virginia, Charlottesville (M.S., Y.Y., C.H.M.)
| | - Yang Yang
- From the Cardiovascular Division, Department of Medicine (M.S., A.T., S.K., M.R., C.M.K.) and Department of Radiology and Medical Imaging (M.S., C.H.M., C.M.K.), University of Virginia Health System, Charlottesville; and Department of Biomedical Engineering, University of Virginia, Charlottesville (M.S., Y.Y., C.H.M.)
| | - Sujith Kuruvilla
- From the Cardiovascular Division, Department of Medicine (M.S., A.T., S.K., M.R., C.M.K.) and Department of Radiology and Medical Imaging (M.S., C.H.M., C.M.K.), University of Virginia Health System, Charlottesville; and Department of Biomedical Engineering, University of Virginia, Charlottesville (M.S., Y.Y., C.H.M.)
| | - Michael Ragosta
- From the Cardiovascular Division, Department of Medicine (M.S., A.T., S.K., M.R., C.M.K.) and Department of Radiology and Medical Imaging (M.S., C.H.M., C.M.K.), University of Virginia Health System, Charlottesville; and Department of Biomedical Engineering, University of Virginia, Charlottesville (M.S., Y.Y., C.H.M.)
| | - Craig H Meyer
- From the Cardiovascular Division, Department of Medicine (M.S., A.T., S.K., M.R., C.M.K.) and Department of Radiology and Medical Imaging (M.S., C.H.M., C.M.K.), University of Virginia Health System, Charlottesville; and Department of Biomedical Engineering, University of Virginia, Charlottesville (M.S., Y.Y., C.H.M.)
| | - Christopher M Kramer
- From the Cardiovascular Division, Department of Medicine (M.S., A.T., S.K., M.R., C.M.K.) and Department of Radiology and Medical Imaging (M.S., C.H.M., C.M.K.), University of Virginia Health System, Charlottesville; and Department of Biomedical Engineering, University of Virginia, Charlottesville (M.S., Y.Y., C.H.M.)
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Ragosta M. Multi-modality imaging of the aortic valve in the era of transcatheter aortic valve replacement: a guide for patient selection, valve selection, and valve delivery. J Cardiovasc Transl Res 2013; 6:665-74. [PMID: 23943424 DOI: 10.1007/s12265-013-9490-z] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 06/14/2013] [Indexed: 12/19/2022]
Abstract
Aortic stenosis is a common condition traditionally treated surgically. Transcatheter aortic valve replacement (TAVR) is an exciting and new method allowing treatment of high risk and inoperable patients. Multimodality imaging is extremely important in the preprocedural evaluation, the performance of the procedure, and the post-procedural assessment and includes transthoracic echocardiography, transesophageal echocardiography, conventional angiography, multi-detector computed tomography, and cardiac magnetic resonance. This paper will review the role of various imaging modalities during the phases of the TAVR procedure with an emphasis on the advantages and limitations of each approach.
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Affiliation(s)
- Michael Ragosta
- Cardiac Catheterization Laboratories, University of Virginia Health System, Charlottesville, VA, USA,
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Bhamidipati CM, Scott Lim D, Ragosta M, Ailawadi G. Percutaneous transjugular implantation of MELODY® valve into tricuspid bioprosthesis. J Card Surg 2013; 28:391-3. [PMID: 23772880 DOI: 10.1111/jocs.12128] [Citation(s) in RCA: 6] [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] [Indexed: 12/17/2022]
Abstract
We present the technique of transcatheter balloon expandable (MELODY®) valve-in-valve deployment in a frail octogenarian with a failed previous tricuspid bioprosthesis. In patients who are not candidates for conventional surgery, transcatheter approach provides an alternative that warrants careful consideration.
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Affiliation(s)
- Castigliano M Bhamidipati
- Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia 22908, USA
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Ragosta M. The Complexity Involved in Assessment of Left Main Coronary Artery Disease. JACC Cardiovasc Interv 2012; 5:1026-8. [DOI: 10.1016/j.jcin.2012.07.006] [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] [Received: 07/06/2012] [Revised: 07/11/2012] [Accepted: 07/19/2012] [Indexed: 10/27/2022]
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