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Mehta H, Chan WC, Aday AW, Jones WS, Parmar GM, Hance K, Thors A, Alli A, Wiley M, Tadros P, Gupta K. Outcomes of peripheral artery disease and polyvascular disease in patients with end-stage kidney disease. J Vasc Surg 2024; 79:1170-1178.e10. [PMID: 38244643 DOI: 10.1016/j.jvs.2024.01.016] [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] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE Patients with peripheral artery disease (PAD) and end-stage kidney disease are a high-risk population, and concomitant atherosclerosis in coronary arteries (CAD) or cerebral arteries (CVD) is common. The aim of the study was to assess long-term outcomes of PAD and the impact of coexistent CAD and CVD on outcomes. METHODS The United States Renal Data System was used to identify patients with PAD within 6 months of incident dialysis. Four groups were formed: PAD alone, PAD with CAD, PAD with CVD, and PAD with CAD and CVD. PAD-specific outcomes (chronic limb-threatening ischemia, major amputation, percutaneous/surgical revascularization, and their composite, defined as major adverse limb events [MALE]) as well as all-cause mortality, myocardial infarction, and stroke were studied. RESULTS The study included 106,567 patients (mean age, 71.2 years; 40.8% female) with a median follow-up of 546 days (interquartile range, 214-1096 days). Most patients had PAD and CAD (49.8%), 25.8% had PAD alone, and 19.2% had all three territories involved. MALE rate in patients with PAD was 22.3% and 35.0% at 1 and 3 years, respectively. In comparison to PAD alone, the coexistence of both CAD and CVD (ie, polyvascular disease) was associated with a higher adjusted rates of all-cause mortality (hazard ratio [HR], 1.28; 95% confidence interval [CI], 1.24-1.31), myocardial infarction (HR, 1.78; 95% CI, 1.69-1.88), stroke (HR, 1.66; 95% CI, 1.52,1.80), and MALE (HR, 1.07; 95% CI, 1.04-1.11). CONCLUSIONS Patients with end-stage kidney disease have a high burden of PAD with poor long-term outcomes, which worsen, in an incremental fashion, with the involvement of each additional diseased arterial bed.
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Affiliation(s)
- Harsh Mehta
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Wan-Chi Chan
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Aaron W Aday
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - W Schuyler Jones
- Department of Medicine, Duke University Health System, Durham, NC
| | - Gaurav M Parmar
- Section of Vascular Medicine, Massachusetts General Hospital, Boston, MA
| | - Kirk Hance
- Department of Surgery, University of Kansas School of Medicine, Kansas City, KS
| | - Axel Thors
- Department of Surgery, University of Kansas School of Medicine, Kansas City, KS
| | - Adam Alli
- Department of Radiology, University of Kansas School of Medicine, Kansas City, KS
| | - Mark Wiley
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Peter Tadros
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Kamal Gupta
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, KS.
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Jiwani S, Chan WC, Majmundar M, Patel KN, Mehta H, Sharma A, Parmar G, Wiley M, Tadros P, Hockstad E, Yarlagadda SG, Gupta A, Gupta K. Impact of preexisting coronary artery and peripheral artery disease on outcomes in diabetic patients after kidney transplant. Vasc Med 2024; 29:135-142. [PMID: 37936422 DOI: 10.1177/1358863x231205574] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Atherosclerotic cardiovascular disease is highly prevalent in patients with end-stage kidney disease (ESKD). Kidney transplant (KT) improves patient survival and cardiovascular outcomes. The impact of preexisting coronary artery disease (CAD) and peripheral artery disease (PAD) on posttransplant outcomes remains unclear. METHODS This is a retrospective study utilizing the United States Renal Data System. Adult diabetic dialysis patients who underwent first KT between 2006 and 2017 were included. The study population was divided into four cohorts based on presence of CAD/PAD: (1) polyvascular disease (CAD + PAD); (2) CAD without PAD; (3) PAD without CAD; (4) no CAD or PAD (reference cohort). The primary outcome was 3-year all-cause mortality. Secondary outcomes were incidence of posttransplant myocardial infarction (MI), cerebrovascular accidents (CVA), and graft failure. RESULTS The study population included 19,329 patients with 64.4% men, mean age 55.4 years, and median dialysis duration of 2.8 years. Atherosclerotic cardiovascular disease was present in 28% of patients. The median follow up was 3 years. All-cause mortality and incidence of posttransplant MI were higher with CAD and highest in patients with polyvascular disease. The cohort with polyvascular disease had twofold higher all-cause mortality (16.7%, adjusted hazard ratio (aHR) 1.5, p < 0.0001) and a fourfold higher incidence of MI (12.7%, aHR 3.3, p < 0.0001) compared to the reference cohort (8.0% and 3.1%, respectively). There was a higher incidence of posttransplant CVA in the cohort with PAD (3.4%, aHR 1.5, p = 0.01) compared to the reference cohort (2.0%). The cohorts had no difference in graft failure rates. CONCLUSIONS Preexisting CAD and/or PAD result in worse posttransplant survival and cardiovascular outcomes in patients with diabetes mellitus and ESKD without a reduction in graft survival.
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Affiliation(s)
- Sania Jiwani
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Wan-Chi Chan
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Monil Majmundar
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kunal N Patel
- Department of Cardiovascular Medicine, West Virginia University Hospital, Morgantown, WV, USA
| | - Harsh Mehta
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Aditya Sharma
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA
| | - Gaurav Parmar
- Section of Vascular Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Mark Wiley
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Peter Tadros
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Eric Hockstad
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Sri G Yarlagadda
- Department of Internal Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS, USA
| | - Aditi Gupta
- Department of Internal Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kamal Gupta
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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Vasudeva R, Mehta H, Chan WC, Majmundar M, Yarlagadda SG, Downey P, Daon E, Muehlebach G, Danter M, Zorn G, Wiley M, Tadros P, Hockstad E, Gupta K. Nationwide Trends and Outcomes for Coronary Artery Bypass Grafting in End-Stage Kidney Disease and Stable Coronary Artery Disease. Am J Cardiol 2024; 210:37-43. [PMID: 38682717 DOI: 10.1016/j.amjcard.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/10/2023] [Accepted: 10/02/2023] [Indexed: 05/01/2024]
Abstract
Patients with end-stage kidney disease (ESKD) on dialysis have an increased burden of coronary artery disease (CAD). This study assessed the trend and outcomes for coronary artery bypass surgery (CABG) in patients with ESKD and stable CAD. We conducted a longitudinal study using the United States Renal Data System of patients with ESKD and stable CAD who underwent CABG from the years 2009 to 2017. The outcomes included in-hospital, long-term mortality, and repeat revascularization. The follow-up was until death, end of Medicare AB coverage, or December 31, 2018. A total of 11,952 patients were identified. The mean age was 62.8 years, 68% were male, and 67% were white. The common co-morbidities included hypertension (97%), diabetes mellitus (75%), and congestive heart failure (53%). A significant decrease in CABG procedures from 2.9 to 1.3 procedures per 1,000 patients with ESKD (p <0.001) was noted during the years studied. The overall in-hospital mortality rate was 5.9%, and there was a significant decrease over the study period (p = 0.01). Although the 30-day mortality rate was 6.9% and remained steady (p = 0.14), the 1-year mortality rate was 22.8% and decreased significantly (p <0.001). At 5 years, the overall survival rate was 35%, and patients with internal mammary artery grafts showed better survival than those without (36% vs 25%). In conclusion, there has been a decrease in CABG procedures performed in patients with ESKD with stable CAD with decreasing in-hospital and 1-year mortality. Those with an internal mammary artery graft do better, but the overall long-term survival remains dismal in this population. There remains need for caution and individualization of revascularization decisions in this high-risk population.
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Affiliation(s)
- Rhythm Vasudeva
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Harsh Mehta
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Wan-Chi Chan
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Monil Majmundar
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Sri G Yarlagadda
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Peter Downey
- Department of Cardiovascular and Thoracic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Emmanuel Daon
- Department of Cardiovascular and Thoracic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Greg Muehlebach
- Department of Cardiovascular and Thoracic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Matthew Danter
- Department of Cardiovascular and Thoracic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - George Zorn
- Department of Cardiovascular and Thoracic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Mark Wiley
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Peter Tadros
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Eric Hockstad
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Kamal Gupta
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas.
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Sorajja P, Whisenant B, Hamid N, Naik H, Makkar R, Tadros P, Price MJ, Singh G, Fam N, Kar S, Schwartz JG, Mehta S, Bae R, Sekaran N, Warner T, Makar M, Zorn G, Spinner EM, Trusty PM, Benza R, Jorde U, McCarthy P, Thourani V, Tang GHL, Hahn RT, Adams DH. Transcatheter Repair for Patients with Tricuspid Regurgitation. N Engl J Med 2023; 388:1833-1842. [PMID: 36876753 DOI: 10.1056/nejmoa2300525] [Citation(s) in RCA: 144] [Impact Index Per Article: 144.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Severe tricuspid regurgitation is a debilitating condition that is associated with substantial morbidity and often with poor quality of life. Decreasing tricuspid regurgitation may reduce symptoms and improve clinical outcomes in patients with this disease. METHODS We conducted a prospective randomized trial of percutaneous tricuspid transcatheter edge-to-edge repair (TEER) for severe tricuspid regurgitation. Patients with symptomatic severe tricuspid regurgitation were enrolled at 65 centers in the United States, Canada, and Europe and were randomly assigned in a 1:1 ratio to receive either TEER or medical therapy (control). The primary end point was a hierarchical composite that included death from any cause or tricuspid-valve surgery; hospitalization for heart failure; and an improvement in quality of life as measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ), with an improvement defined as an increase of at least 15 points in the KCCQ score (range, 0 to 100, with higher scores indicating better quality of life) at the 1-year follow-up. The severity of tricuspid regurgitation and safety were also assessed. RESULTS A total of 350 patients were enrolled; 175 were assigned to each group. The mean age of the patients was 78 years, and 54.9% were women. The results for the primary end point favored the TEER group (win ratio, 1.48; 95% confidence interval, 1.06 to 2.13; P = 0.02). The incidence of death or tricuspid-valve surgery and the rate of hospitalization for heart failure did not appear to differ between the groups. The KCCQ quality-of-life score changed by a mean (±SD) of 12.3±1.8 points in the TEER group, as compared with 0.6±1.8 points in the control group (P<0.001). At 30 days, 87.0% of the patients in the TEER group and 4.8% of those in the control group had tricuspid regurgitation of no greater than moderate severity (P<0.001). TEER was found to be safe; 98.3% of the patients who underwent the procedure were free from major adverse events at 30 days. CONCLUSIONS Tricuspid TEER was safe for patients with severe tricuspid regurgitation, reduced the severity of tricuspid regurgitation, and was associated with an improvement in quality of life. (Funded by Abbott; TRILUMINATE Pivotal ClinicalTrials.gov number, NCT03904147.).
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Affiliation(s)
- Paul Sorajja
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Brian Whisenant
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Nadira Hamid
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Hursh Naik
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Raj Makkar
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Peter Tadros
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Matthew J Price
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Gagan Singh
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Neil Fam
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Saibal Kar
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Jonathan G Schwartz
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Shamir Mehta
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Richard Bae
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Nishant Sekaran
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Travis Warner
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Moody Makar
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - George Zorn
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Erin M Spinner
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Phillip M Trusty
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Raymond Benza
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Ulrich Jorde
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Patrick McCarthy
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Vinod Thourani
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Gilbert H L Tang
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - Rebecca T Hahn
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
| | - David H Adams
- From Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis (P.S., N.H., R. Bae); Intermountain Medical Center, Murray, UT (B.W., N.S.); St. Joseph's Hospital and Integrated Medical Services, Phoenix, AZ (H.N., T.W.); Cedars-Sinai Medical Center, Los Angeles (R.M., M.M.), Scripps Clinic Green Hospital, La Jolla (M.J.P.), UC Davis Medical Center, Sacramento (G.S.), Los Robles Regional Medical Center, Thousand Oaks (S.K.), and Abbott Structural Heart, Santa Clara (E.M.S., P.M.T.) - all in California; Kansas University Medical Center, Kansas City (P.T., G.Z.); St. Michael's Hospital, Toronto (N.F.), and McMaster University, Hamilton, ON (S.M.) - both in Canada; Carolinas Medical Center, Charlotte, NC (J.G.S.); Ohio State University, Columbus (R. Benza); Montefiore Medical Center, Bronx (U.J.), and Mount Sinai Health System (G.H.L.T., D.H.A.) and New York-Presbyterian Columbia University Medical Center (R.T.H.), New York - all in New York; Northwestern University, Chicago (P.M.); and Marcus Valve Center, Piedmont Heart Institute, Atlanta (V.T.)
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Vindhyal MR, Vasudeva R, Chan WC, Tadros P, Wiley M, Gunasekaran P, Daon E, Zorn G, Muehlebach G, Gupta K. Transcatheter edge to edge mitral valve repair in patients with end-stage renal disease on dialysis: an analysis from the United States Renal Data System. Ann Transl Med 2023; 11:277. [PMID: 37082679 PMCID: PMC10113080 DOI: 10.21037/atm-22-4063] [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] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/08/2023] [Indexed: 03/11/2023]
Affiliation(s)
- Mohinder R. Vindhyal
- Department of Cardiovascular Disease, Kansas University Medical Center, Kansas City, KS, USA
| | - Rhythm Vasudeva
- Department of Internal Medicine, Kansas University School of Medicine-Wichita, Wichita, KS, USA
| | - Wan-Chi Chan
- Department of Cardiovascular Disease, Kansas University Medical Center, Kansas City, KS, USA
| | - Peter Tadros
- Department of Cardiovascular Disease, Kansas University Medical Center, Kansas City, KS, USA
| | - Mark Wiley
- Department of Cardiovascular Disease, Kansas University Medical Center, Kansas City, KS, USA
| | - Prasad Gunasekaran
- Department of Cardiovascular Disease, Kansas University Medical Center, Kansas City, KS, USA
| | - Emmanuel Daon
- Department of Cardiovascular and Thoracic Surgery, Kansas University Medical Center, KS City, Kansas, USA
| | - George Zorn
- Department of Cardiovascular and Thoracic Surgery, Kansas University Medical Center, KS City, Kansas, USA
| | - Gregory Muehlebach
- Department of Cardiovascular and Thoracic Surgery, Kansas University Medical Center, KS City, Kansas, USA
| | - Kamal Gupta
- Department of Cardiovascular Disease, Kansas University Medical Center, Kansas City, KS, USA
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Forrest JK, Deeb GM, Yakubov SJ, Rovin JD, Mumtaz M, Gada H, O'Hair D, Bajwa T, Sorajja P, Heiser JC, Merhi W, Mangi A, Spriggs DJ, Kleiman NS, Chetcuti SJ, Teirstein PS, Zorn GL, Tadros P, Tchétché D, Resar JR, Walton A, Gleason TG, Ramlawi B, Iskander A, Caputo R, Oh JK, Huang J, Reardon MJ. 2-Year Outcomes After Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients. J Am Coll Cardiol 2022; 79:882-896. [PMID: 35241222 DOI: 10.1016/j.jacc.2021.11.062] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND The Evolut Low Risk Trial (Medtronic Evolut Transcatheter Aortic Valve Replacement in Low Risk Patients) showed that transcatheter aortic valve replacement (TAVR) with a supra-annular, self-expanding valve was noninferior to surgery for the primary endpoint of all-cause mortality or disabling stroke at 2 years. This finding was based on a Bayesian analysis performed after 850 patients had reached 1 year of follow-up. OBJECTIVES The goal of this study was to report the full 2-year clinical and echocardiographic outcomes for patients enrolled in the Evolut Low Risk Trial. METHODS A total of 1,414 low-surgical risk patients with severe aortic stenosis were randomized to receive TAVR or surgical AVR. An independent clinical events committee adjudicated adverse events, and a central echocardiographic core laboratory assessed hemodynamic endpoints. RESULTS An attempted implant was performed in 730 TAVR and 684 surgical patients from March 2016 to May 2019. The Kaplan-Meier rates for the complete 2-year primary endpoint of death or disabling stroke were 4.3% in the TAVR group and 6.3% in the surgery group (P = 0.084). These rates were comparable to the interim Bayesian rates of 5.3% with TAVR and 6.7% with surgery (difference: -1.4%; 95% Bayesian credible interval: -4.9% to 2.1%). All-cause mortality rates were 3.5% vs 4.4% (P = 0.366), and disabling stroke rates were 1.5% vs 2.7% (P = 0.119), respectively. Between years 1 and 2, there was no convergence of the primary outcome curves. CONCLUSIONS The complete 2-year follow-up from the Evolut Low Risk Trial found that TAVR is noninferior to surgery for the primary endpoint of all-cause mortality or disabling stroke, with event rates that were slightly better than those predicted by using the Bayesian analysis. (Medtronic Evolut Transcatheter Aortic Valve Replacement in Low Risk Patients [Evolut Low Risk Trial]; NCT02701283).
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Affiliation(s)
- John K Forrest
- Department of Internal Medicine (Cardiology), Yale University School of Medicine, New Haven, Connecticut, USA; Department of Surgery (Cardiac Surgery), Yale University School of Medicine, New Haven, Connecticut, USA.
| | - G Michael Deeb
- Department of Interventional Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan, USA; Department of Cardiovascular Surgery, University of Michigan Hospitals, Ann Arbor, Michigan, USA
| | - Steven J Yakubov
- Department of Interventional Cardiology, Riverside Methodist-OhioHealth, Columbus, Ohio, USA
| | - Joshua D Rovin
- Department of Cardiac Surgery, Morton Plant Hospital, Clearwater, Florida, USA
| | - Mubashir Mumtaz
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleyburg, Pennsylvania, USA; Department of Cardiovascular and Thoracic Surgery, University of Pittsburgh Medical Center Pinnacle, Wormleyburg, Pennsylvania, USA
| | - Hemal Gada
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleyburg, Pennsylvania, USA; Department of Cardiovascular and Thoracic Surgery, University of Pittsburgh Medical Center Pinnacle, Wormleyburg, Pennsylvania, USA
| | - Daniel O'Hair
- Department of Interventional Cardiology, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA; Department of Cardiovascular Surgery, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA
| | - Tanvir Bajwa
- Department of Interventional Cardiology, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA; Department of Cardiovascular Surgery, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA
| | - Paul Sorajja
- Department of Interventional Cardiology, Minneapolis Heart Institute-Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - John C Heiser
- Department of Interventional Cardiology, Spectrum Health, Grand Rapids, Michigan, USA; Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan, USA
| | - William Merhi
- Department of Interventional Cardiology, Spectrum Health, Grand Rapids, Michigan, USA; Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan, USA
| | - Abeel Mangi
- Department of Internal Medicine (Cardiology), Yale University School of Medicine, New Haven, Connecticut, USA; Department of Surgery (Cardiac Surgery), Yale University School of Medicine, New Haven, Connecticut, USA
| | - Douglas J Spriggs
- Department of Cardiac Surgery, Morton Plant Hospital, Clearwater, Florida, USA
| | - Neal S Kleiman
- Department of Interventional Cardiology, Houston Methodist-DeBakey Heart and Vascular Center, Houston, Texas, USA; Department of Cardiothoracic Surgery, Houston Methodist-DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Stanley J Chetcuti
- Department of Interventional Cardiology, University of Michigan Hospitals, Ann Arbor, Michigan, USA; Department of Cardiovascular Surgery, University of Michigan Hospitals, Ann Arbor, Michigan, USA
| | - Paul S Teirstein
- Department of Interventional Cardiology, Scripps Clinic, La Jolla, California, USA
| | - George L Zorn
- Department of Interventional Cardiology, University of Kansas, Kansas City, Kansas, USA; Department of Cardiac Surgery, University of Kansas, Kansas City, Kansas, USA
| | - Peter Tadros
- Department of Interventional Cardiology, University of Kansas, Kansas City, Kansas, USA; Department of Cardiac Surgery, University of Kansas, Kansas City, Kansas, USA
| | - Didier Tchétché
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Jon R Resar
- Department of Interventional Cardiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Antony Walton
- Department of Interventional Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Thomas G Gleason
- Department of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Basel Ramlawi
- Department of Cardiovascular Surgery, Valley Health System, Winchester, Virginia, USA
| | - Ayman Iskander
- Department of Interventional Cardiology, Saint Joseph's Hospital Health Center, Syracuse, New York, USA; Department of Cardiovascular Surgery, Saint Joseph's Hospital Health Center, Syracuse, New York, USA
| | - Ronald Caputo
- Department of Interventional Cardiology, Saint Joseph's Hospital Health Center, Syracuse, New York, USA; Department of Cardiovascular Surgery, Saint Joseph's Hospital Health Center, Syracuse, New York, USA
| | - Jae K Oh
- Division of Cardiovascular Ultrasound, Mayo Clinic, Rochester, Minnesota, USA
| | - Jian Huang
- Department of Statistics, Medtronic, Minneapolis, Minnesota, USA
| | - Michael J Reardon
- Department of Interventional Cardiology, Houston Methodist-DeBakey Heart and Vascular Center, Houston, Texas, USA; Department of Cardiothoracic Surgery, Houston Methodist-DeBakey Heart and Vascular Center, Houston, Texas, USA
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Safarova M, Goyal A, Bormann S, Tadros P, Zorn G, Gupta B. TRANSCATHETER REPLACEMENT OF THE SAPIEN 3 VALVE IN A SURGICALLY PLACED SAPIEN XT VALVE IN THE MITRAL POSITION AND ROLE OF PULMONARY ARTERY SENSOR MONITORING. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)04304-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sethi P, Parimi N, Acharya P, Goyal A, Daon E, Zorn G, Tadros P, Wiley M. LEFT ATRIAL PRESSURE CORRELATION WITH PERSISTENT IATROGENIC ATRIAL SEPTAL DEFECT AFTER MITRACLIP IMPLANTATION. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02559-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mumtaz M, Wyler von Ballmoos MC, Deeb GM, Popma JJ, Van Mieghem NM, Kleiman NS, Gleason TG, Chawla A, Hockmuth D, Zorn GL, Tadros P, Li S, Reardon MJ. The Impact of Transfusions on Mortality After Transcatheter or Surgical Aortic Valve Replacement. Ann Thorac Surg 2020; 112:778-785. [PMID: 33217396 DOI: 10.1016/j.athoracsur.2020.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/25/2020] [Accepted: 09/09/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND An increasing body of evidence suggests that packed red blood cell (PRBC) transfusion may be associated with increased morbidity and mortality after transcatheter and surgical aortic valve replacement. It remains unclear whether PRBC transfusion is a surrogate marker or truly an independent risk factor for mortality after aortic valve replacement in different populations. METHODS The Surgical Replacement and Transcatheter Aortic Valve Implantation (SURTAVI) trial randomized 1660 patients with symptomatic, severe aortic stenosis at intermediate risk for operative death to transcatheter aortic valve replacement or surgical aortic valve replacement. Baseline characteristics and outcomes including all-cause and cardiovascular mortality at 30 days and thereafter were compared between participants with and participants without PRBC transfusion. Cox proportional hazards models with time-varying covariates were fitted to estimate the effect of PRBC transfusion on mortality after adjustment for comorbidities and procedural complications. RESULTS Patients receiving PRBC were older, more commonly female and frail, with more comorbidities. The Society of Thoracic Surgeons Predicted Risk of Mortality baseline score was higher in the transfused group. After adjustment for these differences, PRBC transfusion was associated with mortality at 30 days, but not thereafter. The effect of PRBC on mortality (hazard ratio 1.04; 95% confidence interval, 0.96 to 1.11; P = .304) at 30 days was not independent of procedural complications (hazard ratio 21.04; 95% CI, 7.26 to 60.95; P < .001). CONCLUSIONS Poor health status, procedural complications, PRBC transfusion, and mortality are correlated with each other. Transfusion of PRBC did not independently increase risk for mortality. In this intermediate-risk population, transfusion appears to be a risk marker of chronic conditions and periprocedural complications as opposed to a risk factor for postprocedural mortality. (Clinical trial registration: www.clinicaltrials.gov NCT01586910.).
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Affiliation(s)
- Mubashir Mumtaz
- Department of Cardiovascular and Thoracic Surgery, University of Pittsburgh Medical Center, Pinnacle Heath, Harrisburg, Pennsylvania.
| | | | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan Hospitals, Ann Arbor, Michigan
| | - Jeffrey J Popma
- Department of Interventional Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Neal S Kleiman
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Thomas G Gleason
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | - George L Zorn
- University of Kansas Medical Center, Kansas City, Kansas
| | - Peter Tadros
- University of Kansas Medical Center, Kansas City, Kansas
| | - Shuzhen Li
- Department of Statistics, Medtronic, Mounds View, Minnesota
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
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10
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Wyler von Ballmoos MC, Reardon MJ, Williams MR, Mangi AA, Kleiman NS, Yakubov SJ, Watson D, Kodali S, George I, Tadros P, Zorn GL, Brown J, Kipperman R, Oh JK, Qiao H, Forrest JK. Three-Year Outcomes With a Contemporary Self-Expanding Transcatheter Valve From the Evolut PRO US Clinical Study. Cardiovasc Revasc Med 2020; 26:12-16. [PMID: 33199247 DOI: 10.1016/j.carrev.2020.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/01/2020] [Accepted: 11/06/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Paravalvular regurgitation (PVR) following transcatheter aortic valve replacement (TAVR) is associated with increased morbidity and mortality. PVR continues to plague TAVR jeopardizing long-term results. New device iterations, such as the self-expandable Evolut PRO valve, aim to decrease PVR while maintaining optimal hemodynamics. This study sought to evaluate clinical and hemodynamic performance of the Evolut PRO system at 3 years. METHODS The Evolut PRO US Clinical Study included 60 patients at high or extreme surgical risk undergoing TAVR with the Evolut PRO valve at 8 centers in the United States. Clinical outcomes were evaluated using Valve Academic Research Consortium (VARC)-2 criteria and included all-cause mortality, cardiovascular mortality, disabling stroke and valve complications. An independent core laboratory centrally assessed all echocardiographic measures. RESULTS At 3 years, all-cause mortality was 25.8% (cardiovascular mortality 16.5%) and the disabling stroke rate was 10.7%. There were no cases of repeat valve intervention, endocarditis or coronary obstruction. Valve thrombosis was identified in 1 patient 2 years post-procedure and was treated medically. Hemodynamics at 3 years included a mean gradient of 7.2 ± 4.5 mm Hg, an effective orifice area of 2.0 ± 0.5 cm2, and 88.2% of patients had no or trace PVR. The remaining patients had mild PVR. Most of the surviving patients (80.6%) had New York Heart Association class I symptoms at 3 years. CONCLUSION Outcomes at 3-years following TAVR with a contemporary self-expanding prosthesis are favorable, with no signal of valve deterioration, excellent hemodynamics including very low prevalence of PVR.
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Affiliation(s)
- Moritz C Wyler von Ballmoos
- Departments of Cardiovascular Surgery and Interventional Cardiology, Houston Methodist DeBakey Heart and Vascular Institute, 6550 Fannin Street, Smith Tower Suite 1401, Houston, TX 77030, United States of America.
| | - Michael J Reardon
- Departments of Cardiovascular Surgery and Interventional Cardiology, Houston Methodist DeBakey Heart and Vascular Institute, 6550 Fannin Street, Smith Tower Suite 1401, Houston, TX 77030, United States of America.
| | - Mathew R Williams
- Department of Cardiovascular Surgery, New York University-Langone Medical Center, 530 First Ave, Suite 9V, New York, NY 10016, United States of America.
| | - Abeel A Mangi
- Departments of Internal Medicine (Cardiology) and Surgery (Cardiac Surgery), Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, United States of America.
| | - Neal S Kleiman
- Departments of Cardiovascular Surgery and Interventional Cardiology, Houston Methodist DeBakey Heart and Vascular Institute, 6550 Fannin Street, Smith Tower Suite 1401, Houston, TX 77030, United States of America.
| | - Steven J Yakubov
- Departments of Interventional Cardiology and Cardiac Surgery, OhioHealth-Riverside Methodist Hospital, 3705 Olentangy River Rd Ste 100, Columbus, OH 43214, United States of America.
| | - Daniel Watson
- Departments of Interventional Cardiology and Cardiac Surgery, OhioHealth-Riverside Methodist Hospital, 3705 Olentangy River Rd Ste 100, Columbus, OH 43214, United States of America
| | - Susheel Kodali
- Structural Heart and Valve Center, Columbia University Irving Medical Center, Presbyterian, 161 Fort Washington Ave., (Corner of West 165th St.), New York, NY 10032, United States of America.
| | - Isaac George
- Structural Heart and Valve Center, Columbia University Irving Medical Center, Presbyterian, 161 Fort Washington Ave., (Corner of West 165th St.), New York, NY 10032, United States of America.
| | - Peter Tadros
- Departments of Cardiology and Cardiac Surgery, University of Kansas, 3901 Rainbow Blvd, Kansas City, KS 66160, United States of America
| | - George L Zorn
- Departments of Cardiology and Cardiac Surgery, University of Kansas, 3901 Rainbow Blvd, Kansas City, KS 66160, United States of America.
| | - John Brown
- Departments of Cardiology and Cardiac Surgery, Morristown Hospital, 100 Madison Ave, Morristown, NJ 07960, United States of America.
| | - Robert Kipperman
- Departments of Cardiology and Cardiac Surgery, Morristown Hospital, 100 Madison Ave, Morristown, NJ 07960, United States of America.
| | - Jae K Oh
- Department of Echocardiography, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States of America.
| | - Hongyan Qiao
- Statistical Services, 8200 Coral Sea Street, Mounds View, MN 55112, United States of America.
| | - John K Forrest
- Departments of Internal Medicine (Cardiology) and Surgery (Cardiac Surgery), Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, United States of America.
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11
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Sami F, Hosseini Dehkordi SH, Masoomi R, Lippmann M, Alhawasli H, Kaine S, Rosamond T, Nath J, Hockstad E, Tadros P. Transcatheter Approach to a Dual Drainage Anomalous Pulmonary Venous Return. J Invasive Cardiol 2020; 32:E224-E225. [PMID: 32737274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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12
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Ndunda PM, Tadros P, Wiley M, Zorn G, Muehlebach G, Okut H, Vindhyal M, Fanari Z. VALIDATION OF CHADS2, CHA2DS2VASC AND R2CHA2DS2VASC SCORES FOR PREDICTING STROKE ONE YEAR AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32120-3] [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: 10/24/2022]
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13
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Ndunda PM, Tadros P, Wiley M, Muehlebach G, Zorn G, Okut H, Ablah E, James KK, Fanari Z. PERFORMANCE OF A NEW RISK PREDICTION SCORE FOR STROKE ONE YEAR AFTER TAVR COMPARED WITH CHADS2AND CHA2DS2VASC SCORES. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32119-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Ndunda PM, Tadros P, Wiley M, Muehlebach G, Zorn G, Fanari Z. Abstract TP321: Performance of R
2
Cha
2
Ds
2
Vasc, Cha
2
Ds
2
Vasc, R
2
Chads
2
, and Chads
2
Scores for Predicting Stroke One Year After Transcatheter Aortic Valve Replacement. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tp321] [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:
Stroke after transcatheter aortic valve replacement (TAVR) is a significant cause of morbidity and mortality. It increases the risk of mortality threefold, within one year of TAVR. It is also associated with significant disability and increased health care costs. A validated risk prediction tool for stroke one year after TAVR may be useful in risk stratification to guide decisions at the point of clinical care and in research. The objective of this study was to assess the calibration and discriminative ability of the R
2
CHA
2
DS
2
VASc, CHA
2
DS
2
VASc, R
2
CHADS
2
, and CHADS
2
scores for predicting stroke within one year of TAVR.
Methods:
This was a retrospective cohort study using data from a midwestern academic center TAVR program. Patients who underwent TAVR from 2012 to the first quarter of 2018 who had one-year follow-up data were included in the study. The model discrimination and calibration were assessed using the area under the receiver operating characteristic curve (c-statistic) and the Hosmer-Lemeshow test respectively.
Results:
Six hundred and sixty four patients met the inclusion criteria and 3.4% had stroke within one year of undergoing TAVR. They had a median age of 81 years and a mean STS score of 6.3. The R
2
CHA
2
DS
2
VASc, CHA
2
DS
2
VASc, R
2
CHADS
2
, and CHADS
2
scores had c-statistics of 0.591, 0.596, 0.607, and 0.622, respectively. The Hosmer-Lemeshow χ
2
p-values were 0.762, 0.422, 0.463 and 0.146 respectively.
Conclusion:
The CHADS
2
score had the best discriminative ability for stroke prediction one year after TAVR. All the four scores were well calibrated.
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Affiliation(s)
| | | | - Mark Wiley
- Cardiology, Univ of Kansas Sch of Med, Kansas City, KS
| | | | | | - Zaher Fanari
- Univ of Kansas Sch of Med-Wichita/Heartland Cardiology, Wichita, KS
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15
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Amr BS, Lippmann M, Tobbia P, Isom N, Dalia T, Buechler T, Pierpoline M, Patel N, Hockstad E, Wiley M, Tadros P, Mehta A, Earnest M, Chen JG, Gupta K. Impact of short term oral steroid use for intravenous contrast media hypersensitivity prophylaxis in diabetic patients undergoing nonemergent coronary angiography or interventions. Catheter Cardiovasc Interv 2019; 96:1392-1398. [PMID: 31769132 DOI: 10.1002/ccd.28618] [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: 07/22/2018] [Revised: 10/22/2019] [Accepted: 11/12/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Oral steroids are routinely administered in the United States for prophylaxis of iodinated contrast media hypersensitivity (ICMH). We studied the impact of short-term steroid use in diabetic patients with ICMH undergoing nonemergent coronary angiography. METHODS We retrospectively analyzed records of diabetic patients with and without ICMH who underwent nonemergent coronary angiography at our center. Primary study endpoint was 30-day major adverse cardiac events (MACE) and secondary endpoints were pre- and postprocedure fasting blood glucose (FBG), highest in hospital blood glucose, pre- and postprocedure systolic blood pressure (SBP), and use of intravenous insulin and antihypertensive medications. RESULTS A total of 88 diabetics with ICMH (study group) and 76 diabetics without ICMH (control group) undergoing angiography were enrolled. Demographics and hemoglobin A1c values were similar in both groups. Preprocedural FBG was significantly higher in the study group. The study group had significantly higher post angiography FBG (239.93 + 96.88 mg/dl vs. 156.6 + 59.88 mg/dl) and greater use of intravenous (IV) insulin (67.27% vs. 32.43%). Further, those who received steroids had significantly higher systolic SBP postprocedure (146.16 + 25.35 mmHg vs. 130.8 + 21.59 mmHg), a higher incidence of severe hypertension and use of IV antihypertensive medications (80.95% vs. 19.05%) periprocedurally. There were no differences in 30-day MACE between groups. CONCLUSION Short-term steroid use for ICMH results in a significant increase in surrogate markers for adverse clinical events after coronary procedures. Study findings highlight the need for better periprocedural management of these patients and to limit steroid prophylaxis to those with only true ICMH.
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Affiliation(s)
- Bashar S Amr
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Matthew Lippmann
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Patrick Tobbia
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Nicholas Isom
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Tarun Dalia
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Tyler Buechler
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Michael Pierpoline
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Nilay Patel
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Eric Hockstad
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Mark Wiley
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Peter Tadros
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Ashwani Mehta
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Matthew Earnest
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - John G Chen
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Kamal Gupta
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
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16
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Patel N, Sharma A, Dalia T, Rali A, Earnest M, Tadros P, Wiley M, Hockstad E, Mehta A, Thors A, Hance K, Gupta K. Vascular complications associated with percutaneous left ventricular assist device placement: A 10-year US perspective. Catheter Cardiovasc Interv 2019; 95:309-316. [PMID: 31638737 DOI: 10.1002/ccd.28560] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 12/26/2018] [Revised: 09/24/2019] [Accepted: 10/09/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Over the last decade, there has been a significant increase in the use of percutaneous left ventricular assist devices(p-LVADs). p-LVADs are being increasingly used during complex coronary interventions and for acute cardiogenic shock. These large bore percutaneous devices have a higher risk of vascular complications. We examined the vascular complication rates from the use of p-LVAD in a national database. METHODS We conducted a secondary analysis of the National In-patient Sample (NIS) dataset from 2005 till 2015. We used the ICD-9-CM procedure codes 37.68 and 37.62 for p-LVAD placement regardless of indications. We investigated common vascular complications, defining them by the validated ICD 9 CM codes. χ2 test and t test were used for categorical and continuous variables, respectively for comparison. RESULTS A total of 31,263 p-LVAD placements were identified during the period studied. A majority of patients were male (72.68%) and 64.44% were white. The overall incidence of vascular complications was 13.53%, out of which 56% required surgical treatment. Acute limb thromboembolism and bleeding requiring transfusion accounted for 27.6% and 21.8% of all vascular complications. Occurrence of a vascular complication was associated with significantly higher in-hospital mortality (37.77% vs. 29.95%, p < .001), length of stay (22.7 vs. 12.2 days, p < .001) and cost of hospitalization ($ 161,923 vs. $ 95,547, p < .001). CONCLUSIONS There is a high incidence of vascular complications with p-LVAD placement including need for vascular surgery. These complications are associated with a higher in-hospital, LOS and hospitalization costs. These findings should be factored into the decision-making for p-LVAD placement.
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Affiliation(s)
- Nilay Patel
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
| | - Akshit Sharma
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
| | - Tarun Dalia
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
| | - Aniket Rali
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
| | - Matthew Earnest
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
| | - Peter Tadros
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
| | - Mark Wiley
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
| | - Eric Hockstad
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
| | - Ashwani Mehta
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
| | - Axel Thors
- Vascular Surgery Division, University of Kansas Medical Center, Kansas City, Kansas
| | - Kirk Hance
- Vascular Surgery Division, University of Kansas Medical Center, Kansas City, Kansas
| | - Kamal Gupta
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
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17
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Søndergaard L, Popma JJ, Reardon MJ, Van Mieghem NM, Deeb GM, Kodali S, George I, Williams MR, Yakubov SJ, Kappetein AP, Serruys PW, Grube E, Schiltgen MB, Chang Y, Engstrøm T, Sorajja P, Sun B, Agarwal H, Langdon T, den Heijer P, Bentala M, O’Hair D, Bajwa T, Byrne T, Caskey M, Paulus B, Garrett E, Stoler R, Hebeler R, Khabbaz K, Scott Lim D, Bladergroen M, Fail P, Feinberg E, Rinaldi M, Skipper E, Chawla A, Hockmuth D, Makkar R, Cheng W, Aji J, Bowen F, Schreiber T, Henry S, Hengstenberg C, Bleiziffer S, Harrison JK, Hughes C, Joye J, Gaudiani V, Babaliaros V, Thourani V, Dauerman H, Schmoker J, Skelding K, Casale A, Kovac J, Spyt T, Seshiah P, Smith JM, McKay R, Hagberg R, Matthews R, Starnes V, O’Neill W, Paone G, García JMH, Such M, de la Tassa CM, Cortina JCL, Windecker S, Carrel T, Whisenant B, Doty J, Resar J, Conte J, Aharonian V, Pfeffer T, Rück A, Corbascio M, Blackman D, Kaul P, Kliger C, Brinster D, Teefy P, Kiaii B, Leya F, Bakhos M, Sandhu G, Pochettino A, Piazza N, de Varennes B, van Boven A, Boonstra P, Waksman R, Bafi A, Asgar A, Cartier R, Kipperman R, Brown J, Lin L, Rovin J, Sharma S, Adams D, Katz S, Hartman A, Al-Jilaihawi H, Crestanello J, Lilly S, Ghani M, Bodenhamer RM, Rajagopal V, Kauten J, Mumtaz M, Bachinsky W, Nickenig G, Welz A, Olsen P, Watson D, Chhatriwalla A, Allen K, Teirstein P, Tyner J, Mahoney P, Newton J, Merhi W, Keiser J, Yeung A, Miller C, Berg JT, Heijmen R, Petrossian G, Robinson N, Brecker S, Jahangiri M, Davis T, Batra S, Hermiller J, Heimansohn D, Radhakrishnan S, Fremes S, Maini B, Bethea B, Brown D, Ryan W, Kleiman N, Spies C, Lau J, Herrmann H, Bavaria J, Horlick E, Feindel C, Neumann FJ, Beyersdorf F, Binder R, Maisano F, Costa M, Markowitz A, Tadros P, Zorn G, de Marchena E, Salerno T, Chetcuti S, Labinz M, Ruel M, Lee JS, Gleason T, Ling F, Knight P, Robbins M, Ball S, Giacomini J, Burdon T, Applegate R, Kon N, Schwartz R, Schubach S, Forrest J, Mangi A. Comparison of a Complete Percutaneous Versus Surgical Approach to Aortic Valve Replacement and Revascularization in Patients at Intermediate Surgical Risk: Results From the Randomized SURTAVI Trial. Circulation 2019; 140:1296-1305. [PMID: 31476897 DOI: 10.1161/circulationaha.118.039564] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND For patients with severe aortic stenosis and coronary artery disease, the completely percutaneous approach to aortic valve replacement and revascularization has not been compared with the standard surgical approach. METHODS The prospective SURTAVI trial (Safety and Efficiency Study of the Medtronic CoreValve System in the Treatment of Severe, Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement) enrolled intermediate-risk patients with severe aortic stenosis from 87 centers in the United States, Canada, and Europe between June 2012 and June 2016. Complex coronary artery disease with SYNTAX score (Synergy Between PCI with Taxus and Cardiac Surgery Trial) >22 was an exclusion criterion. Patients were stratified according to the need for revascularization and then randomly assigned to treatment with transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). Patients assigned to revascularization in the TAVR group underwent percutaneous coronary intervention, whereas those in the SAVR group had coronary artery bypass grafting. The primary end point was the rate of all-cause mortality or disabling stroke at 2 years. RESULTS Of 1660 subjects with attempted aortic valve implants, 332 (20%) were assigned to revascularization. They had a higher Society of Thoracic Surgeons risk score for mortality (4.8±1.7% versus 4.4±1.5%; P<0.01) and were more likely to be male (65.1% versus 54.2%; P<0.01) than the 1328 patients not assigned to revascularization. After randomization to treatment, there were 169 patients undergoing TAVR and percutaneous coronary intervention, 163 patients undergoing SAVR and coronary artery bypass grafting, 695 patients undergoing TAVR, and 633 patients undergoing SAVR. No significant difference in the rate of the primary end point was found between TAVR and percutaneous coronary intervention and SAVR and coronary artery bypass grafting (16.0%; 95% CI, 11.1-22.9 versus 14.0%; 95% CI, 9.2-21.1; P=0.62), or between TAVR and SAVR (11.9%; 95% CI, 9.5-14.7 versus 12.3%; 95% CI, 9.8-15.4; P=0.76). CONCLUSIONS For patients at intermediate surgical risk with severe aortic stenosis and noncomplex coronary artery disease (SYNTAX score ≤22), a complete percutaneous approach of TAVR and percutaneous coronary intervention is a reasonable alternative to SAVR and coronary artery bypass grafting. CLINICAL TRIAL REGISTRATION URL: https://www. CLINICALTRIALS gov. Unique identifier: NCT01586910.
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Affiliation(s)
- Lars Søndergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (L.S., T.E.)
| | - Jeffrey J. Popma
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Michael J. Reardon
- Department of Cardiovascular Surgery, Methodist DeBakey Heart and Vascular Center, Houston, TX (M.J.R.)
| | - Nicolas M. Van Mieghem
- Departments of Cardiology and Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands (N.M.V.M., A.P.K.)
| | - G. Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor (G.M.D.)
| | - Susheel Kodali
- Department of Surgery, Columbia University Medical Center, New York (S.K., I.G.)
| | - Isaac George
- Department of Surgery, Columbia University Medical Center, New York (S.K., I.G.)
| | - Mathew R. Williams
- Departments of Medicine (Cardiology) and Cardiothoracic Surgery, NYU-Langone Medical Center, New York (M.R.W.)
| | - Steven J. Yakubov
- Department of Cardiology, OhioHealth Riverside Methodist Hospital, Columbus (S.J.Y.)
| | - Arie P. Kappetein
- Departments of Cardiology and Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands (N.M.V.M., A.P.K.)
- Structural Heart, Medtronic plc, Minneapolis, MN (A.P.K., M.B.S., Y.C.)
| | - Patrick W. Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Eberhard Grube
- Department of Medicine II, Heart Center Bonn, Germany (E.G.)
| | | | - Yanping Chang
- Structural Heart, Medtronic plc, Minneapolis, MN (A.P.K., M.B.S., Y.C.)
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (L.S., T.E.)
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Gleason TG, Reardon MJ, Popma JJ, Deeb GM, Yakubov SJ, Lee JS, Kleiman NS, Chetcuti S, Hermiller JB, Heiser J, Merhi W, Zorn GL, Tadros P, Robinson N, Petrossian G, Hughes GC, Harrison JK, Conte JV, Mumtaz M, Oh JK, Huang J, Adams DH. 5-Year Outcomes of Self-Expanding Transcatheter Versus Surgical Aortic Valve Replacement in High-Risk Patients. J Am Coll Cardiol 2018; 72:2687-2696. [DOI: 10.1016/j.jacc.2018.08.2146] [Citation(s) in RCA: 173] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 08/27/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
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Gunasekaran P, Stanojevic D, Drees T, Fritzlen J, Haghnegahdar M, McCullough M, Barua R, Mehta A, Hockstad E, Wiley M, Earnest M, Tadros P, Genton R, Gupta K. Prognostic significance, angiographic characteristics and impact of antithrombotic and anticoagulant therapy on outcomes in high versus low grade coronary artery ectasia: A long-term follow-up study. Catheter Cardiovasc Interv 2018; 93:1219-1227. [DOI: 10.1002/ccd.27929] [Citation(s) in RCA: 11] [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: 06/02/2018] [Accepted: 09/23/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Prasad Gunasekaran
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Dusan Stanojevic
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Taylor Drees
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - John Fritzlen
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Megan Haghnegahdar
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Matthew McCullough
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Rajat Barua
- Division of Cardiology; Kansas City Veterans Affairs Medical Center; Kansas City Missouri
| | - Ashwani Mehta
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Eric Hockstad
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Mark Wiley
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Matthew Earnest
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Peter Tadros
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Randall Genton
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Kamal Gupta
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
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Reardon MJ, Kleiman NS, Adams DH, Yakubov SJ, Coselli JS, Deeb GM, O'Hair D, Gleason TG, Lee JS, Hermiller JB, Chetcuti S, Heiser J, Merhi W, Zorn GL, Tadros P, Robinson N, Petrossian G, Hughes GC, Harrison JK, Maini B, Mumtaz M, Conte JV, Resar JR, Aharonian V, Pfeffer T, Oh JK, Huang J, Popma JJ. Outcomes in the Randomized CoreValve US Pivotal High Risk Trial in Patients With a Society of Thoracic Surgeons Risk Score of 7% or Less. JAMA Cardiol 2018; 1:945-949. [PMID: 27541162 DOI: 10.1001/jamacardio.2016.2257] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Transcatheter aortic valve replacement (TAVR) is now a well-accepted alternative to surgical AVR (SAVR) for patients with symptomatic aortic stenosis at increased operative risk. There is interest in whether TAVR would benefit patients at lower risk. Objective The Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) has trended downward in US TAVR trials and the STS/American College of Cardiology Transcatheter Valve Therapy Registry. We hypothesized that if the Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) alone is sufficient to define decreased risk, the contribution to survival based on the degree of invasiveness of the TAVR procedure will decrease, making it more difficult to show improved survival and benefit over SAVR. Design, Setting, and Participants The CoreValve US Pivotal High Risk Trial was a multicenter, randomized, noninferiority trial. This retrospective analysis evaluated patients who underwent an attempted implant and had an STS PROM of 7% or less. The trial was performed at 45 US sites. Patients had severe aortic stenosis and were at increased surgical risk based on their STS PROM score and other risk factors. Interventions Eligible patients were randomly assigned (1:1) to self-expanding TAVR or to SAVR. Main Outcomes and Measures We retrospectively stratified patients by the overall median STS PROM score (7%) and analyzed clinical outcomes and quality of life using the Kansas City Cardiomyopathy Questionnaire in patients with an STS PROM score of 7% or less. Results The mean (SD) ages were 81.5 (7.6) years for the TAVR group and 81.2 years (6.6) for the SAVR group. A little more than half were men (57.9% in the TAVR group and 55.8% in the SAVR group). Of 750 patients who underwent attempted implantation, 383 (202 TAVR and 181 SAVR) had an STS PROM of 7% or less (median [interquartile range]: TAVR, 5.3% [4.3%-6.1%]; SAVR, 5.3% [4.1%-5.9%]). Two-year all-cause mortality for TAVR vs SAVR was 15.0% (95% CI, 8.9-10.0) vs 26.3% (95% CI, 19.7-33.0) (log rank P = .01). The 2-year rate of stroke for TAVR vs SAVR was 11.3% vs 15.1% (log rank P = .50). Quality of life by the Kansas City Cardiomyopathy Questionnaire summary score showed significant and equivalent increases in both groups at 2 years (mean [SD] TAVR, 20.0 [25.0]; SAVR, 18.6 [23.6]; P = .71; both P < .001 compared with baseline). Medical benefit, defined as alive with a Kansas City Cardiomyopathy Questionnaire summary score of at least 60 and a less than 10-point decrease from baseline, was similar between groups at 2 years (TAVR, 51.0%; SAVR, 44.4%; P = .28). Conclusions and Relevance Self-expanding TAVR compares favorably with SAVR in high-risk patients with STS PROM scores traditionally considered intermediate risk. Trial Registration Clinicaltrials.gov Identifier: NCT01240902.
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Affiliation(s)
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | | | | | - Joseph S Coselli
- Texas Heart Institute, CHI St. Luke's Health, Baylor St. Luke's Medical Center, Houston
| | | | - Daniel O'Hair
- St. Luke's Medical Center/Aurora Health Care, Milwaukee, Wisconsin
| | - Thomas G Gleason
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Joon Sup Lee
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | - John Heiser
- Spectrum Health Hospitals, Grand Rapids, Michigan
| | | | | | | | | | | | - G Chad Hughes
- Duke University Medical Center, Durham, North Carolina
| | | | - Brijeshwar Maini
- Pinnacle Health, Wormleysburg, Pennsylvania14Tenet Florida, Coral Springs, Florida
| | - Mubashir Mumtaz
- Pinnacle Health, Wormleysburg, Pennsylvania14Tenet Florida, Coral Springs, Florida
| | | | | | - Vicken Aharonian
- Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California
| | - Thomas Pfeffer
- Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California
| | - Jae K Oh
- Mayo Clinic, Rochester, Minnesota
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Fanari Z, Gunasekaran PC, Shaukat A, Hammami S, Dawn B, Wiley M, Tadros P. Safety and utility of dobutamine and pressure wire use in the hemodynamic assessment of low-flow, low-gradient aortic stenosis with reduced left ventricular ejection fraction. Cardiovascular Revascularization Medicine 2018; 19:438-443. [DOI: 10.1016/j.carrev.2017.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
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Gunasekaran PC, Drees T, Fritzlen J, Haghnegahdar M, Earnest M, Mehta A, Hockstad E, Wiley M, Tadros P, Dawn B, Gupta K. DUAL ANTIPLATELET THERAPY OR ORAL ANTICOAGULATION REDUCES THE INCIDENCE OF ACUTE CORONARY SYNDROMES IN PATIENTS WITH CORONARY ARTERY ECTASIA. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31947-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Masoomi R, Tadros P, Wiley M, Hockstad E, Earnest M, Mehta A, Gupta K. NATIONAL TRENDS AND OUTCOMES OF PERCUTANEOUS ASD/PFO CLOSURE: A REPORT FROM THE NATIONAL INPATIENT SAMPLE. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31632-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Amr B, Lippman M, Patel N, Tobbia P, Pierpoline M, Buechler T, Dalia T, Isom N, Tadros P, Hockstad E, Earnest M, Mehta A, Wiley M, Chen J, Gupta K. IMPACT OF ACUTE ADMINISTRATION OF CORTICOSTEROIDS PRIOR TO PERCUTANEOUS CORONARY ANGIOGRAPHY IN DIABETIC PATIENTS WITH CONTRAST ALLERGY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31901-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Forrest JK, Mangi AA, Popma JJ, Khabbaz K, Reardon MJ, Kleiman NS, Yakubov SJ, Watson D, Kodali S, George I, Tadros P, Zorn GL, Brown J, Kipperman R, Saul S, Qiao H, Oh JK, Williams MR. Early Outcomes With the Evolut PRO Repositionable Self-Expanding Transcatheter Aortic Valve With Pericardial Wrap. JACC Cardiovasc Interv 2018; 11:160-168. [DOI: 10.1016/j.jcin.2017.10.014] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/05/2017] [Accepted: 10/10/2017] [Indexed: 11/29/2022]
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Kleiman NS, Maini BJ, Reardon MJ, Conte J, Katz S, Rajagopal V, Kauten J, Hartman A, McKay R, Hagberg R, Huang J, Popma J, Ad N, Aharonian V, Anderson WD, Applegate R, Bafi A, Bajwa T, Bakhos M, Ball S, Batra S, Beohar N, Brachinsky W, Brinster D, Brown J, Byrne J, Byrne T, Casale A, Caskey M, Chawla A, Cohen H, Coselli J, Costa M, Cheatham J, Chetcuti SJ, Crestanello J, Davis T, Michael Deeb G, Diez J, Dauerman H, Elefteriades J, Fail P, Feinberg E, Fontana G, Forrest JL, Galloway A, Giacomini J, Gleason TG, Guadiani V, Harrison JK, Hebeler R, Heimansohn D, Heiser J, Heller L, Henry S, Hermiller J, Hockmuth D, Hughes GC, Joye J, Kafi A, Kar B, Khabbaz K, Kipperman R, Kliger C, Kon N, Lamelas J, Lee JS, Leya F, Londono JC, Macheers S, Mangi A, de Marchena E, Markowitz A, Matthews R, Merhi W, Mumtaz M, O’Hair D, Petrossian G, Pfeffer T, Raybuck B, Resar J, Robbins M, Robbins R, Robinson N, Ring M, Salerno T, Schreiber T, Schmoker J, Sharma S, Siwek L, Skelding K, Slater J, Starnes V, Stoler R, Subramanian V, Tadros P, Thompson C, Waksman R, Watson D, Yakubov S, Zhao D, Zorn GL. Neurological Events Following Transcatheter Aortic Valve Replacement and Their Predictors: A Report From the CoreValve Trials. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003551. [PMID: 27601429 DOI: 10.1161/circinterventions.115.003551] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [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: 09/09/2015] [Accepted: 07/15/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The risk for stroke after transcatheter aortic valve replacement (TAVR) is an important concern. Identification of predictors for stroke is likely to be a critical factor aiding patient selection and management as TAVR use becomes widespread. METHODS AND RESULTS Patients enrolled in the CoreValve US Extreme Risk and High Risk Pivotal Trials or Continued Access Study treated with the self-expanding CoreValve bioprosthesis were included in this analysis. The 1-year stroke rate after TAVR was 8.4%. Analysis of the stroke hazard rate identified an early phase (0-10 days; 4.1% of strokes) and a late phase (11-365 days; 4.3% of strokes). Baseline predictors of early stroke included National Institutes of Health stroke scale score >0, prior stroke, prior transient ischemic attack, peripheral vascular disease, absence of prior coronary artery bypass surgery, angina, low body mass index (<21 kg/m(2)), and falls within the past 6 months. Significant procedural predictors were total time in the catheterization laboratory or operating room, delivery catheter in the body time, rapid pacing used during valvuloplasty, and repositioning of the prosthesis. Predictors of stroke between 11 and 365 days were small body surface area, severe aortic calcification, and falls within the past 6 months. There were no significant imaging predictors of early or late stroke. CONCLUSIONS Predictors of early stroke after TAVR included clinical and procedural factors; predictors of later stroke were limited to patient but not anatomic characteristics. These findings indicate that further refinement of imaging to identify anatomic factors predisposing to embolization may help improve stroke prediction in patients undergoing TAVR. CLINICAL TRIAL REGISTRATIONS URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01240902, NCT01531374.
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Affiliation(s)
- Neal S Kleiman
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.).
| | - Brijeshwar J Maini
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Michael J Reardon
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - John Conte
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Stanley Katz
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Vivek Rajagopal
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - James Kauten
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Alan Hartman
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Raymond McKay
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Robert Hagberg
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Jian Huang
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Jeffrey Popma
- From the Houston Methodist DeBakey Heart and Vascular Institute, TX (N.S.K., M.J.R.); Tenet Healthcare Corporation, Delray Beach, FL (B.J.M.); Johns Hopkins University, Baltimore, MD (J.C.); Hofstra North Shore University Hospital, New Hyde Park, NY (S.K., A.H.); Hartford Hospital, CT (R.M., R. H.); Piedmont Heart Institute, Atlanta, GA (V.R., J.K.); Medtronic, Minneapolis, MN (J.H.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | | | | | | | | | | | - Amar Bafi
- Washington Hospital Center/Georgetown Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Joseph Coselli
- Texas Heart Institute at St Lukes Episcopal Hospital/Baylor College of Medicine
| | | | | | | | | | | | | | - Jose Diez
- Texas Heart Institute at St Lukes Episcopal Hospital/Baylor College of Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Scott Henry
- Detroit Medical Center Cardiovascular Institute
| | | | | | | | | | - Ali Kafi
- Detroit Medical Center Cardiovascular Institute
| | - Biswajit Kar
- Texas Heart Institute at St Lukes Episcopal Hospital/Baylor College of Medicine
| | | | | | | | - Neal Kon
- Wake Forest University Baptist Medical Center
| | | | | | | | | | | | | | | | | | - Ray Matthews
- University of Southern California University Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lee Siwek
- Providence Sacred Heart Medical Center
| | | | | | | | | | | | | | | | - Ron Waksman
- Washington Hospital Center/Georgetown Hospital
| | - Daniel Watson
- Riverside Methodist Hospital/Ohio Health Research Institute
| | - Steven Yakubov
- Riverside Methodist Hospital/Ohio Health Research Institute
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Fanari Z, Gunasekaran P, Shaukat A, Thapa J, Persad P, Hammamo S, Dawn B, Wiley M, Weintraub W, Doorey A, Tadros P. P1636Utility and safety of pressure wires use in hemodynamic assessment of paradoxical low flow low gradient aortic stenosis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1636] [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: 11/13/2022] Open
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Fanari Z, Gunasekaran P, Shaukat A, Wiley M, Dawn B, Weintraub W, Tadros P, Marshall E. P1646Paradoxical low flow low gradient severe aortic stenosis with preserved left ventricular ejection fraction. impact of medical, transcatheter and surgical management. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1646] [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: 11/13/2022] Open
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Lippmann M, Patel J, Kvapil J, Westover D, Pierpoline M, Tadros P, Wiley M, Zorn G, Muehlebach G, Mehta A, Hockstad E, Earnest M, Gupta K. Safety and Feasibility of Rotational Atherectomy in Elderly Patients With Severe Aortic Stenosis. J Invasive Cardiol 2017; 29:271-275. [PMID: 28756420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) followed by transcatheter aortic valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis (AS) and coronary artery disease (CAD). In many, the coronary arteries are severely calcified and best treated with rotational atherectomy (RA). However, RA is not routinely performed in severe AS patients due to safety concerns. There is a paucity of data on the safety of RA in severe AS patients with calcific CAD. METHODS We retrospectively analyzed the medical records of 29 patients with severe AS who underwent elective RA-facilitated PCI at our center between January 1, 2011 and December 31, 2015. RESULTS Twenty-nine patients (mean age, 79.8 ± 8.8 years) were enrolled. Mean aortic valve area was 0.71 ± 0.20 cm², mean aortic valve gradient was 40.32 ± 9.88 mm Hg. All PCIs were successful (mean diameter stenosis, 86.3 ± 7.6%; mean burr size, 1.62 ± 0.19 mm). Nineteen patients (65.5%) required temporary pacemaker. Eight patients (27.6%) required vasopressors during PCI. There was a significant reduction in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) during RA, but without clinical events. No procedure was aborted and there were no deaths or clinical myocardial infarctions. CONCLUSION RA-facilitated PCI can be safely performed in elderly patients with severe AS and severely calcified CAD with low risk of complications. There was a significant but transient drop in SBP, DBP, MAP, and HR during RA. However, this was not associated with clinically significant adverse events.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Kamal Gupta
- Division of Cardiovascular Diseases, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160 USA.
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Forrest JK, Mangi A, Popma J, Khabbaz K, Reardon M, Kleiman N, Yakubov S, Watson D, Kodali S, George I, Tadros P, Zorn G, Brown J, Kipperman R, Staniloae C, Williams M. INITIAL USE OF THE EVOLUT PRO SELF-EXPANDING TRANSCATHETER AORTIC VALVE. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34677-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lippmann M, Patel J, Kvapil J, Pierpoline M, Tadros P, Wiley M, Earnest M, Mehta A, Hockstad E, Gupta K. SAFETY AND FEASIBILITY OF ROTATIONAL ATHERECTOMY IN ELDERLY PATIENTS WITH SEVERE AORTIC STENOSIS AND CALCIFIC CORONARY ARTERY DISEASE UNDERGOING EVALUATION FOR TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34650-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fanari Z, Gunasekaran P, Shaukat A, Thapa J, Persad K, Hammami S, West J, Wiley M, Dawn B, Weintraub W, Tadros P, Doorey AJ. HEMODYNAMIC ASSESSMENT OF LOW FLOW, LOW GRADIENT SEVERE AORTIC STENOSIS WITH PRESERVED EF USING A PRESSURE WIRE. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34631-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fanari Z, Gunasekaran P, Thapa J, Shaukat A, Persad K, Hammami S, Wiley M, Dawn B, West J, Weintraub W, Doorey A, Tadros P. THE IMPACT OF TRANSAORTIC GRADIENT AND TRANSAORTIC FLOW ON THE DISCREPANCY BETWEEN ECHOCARDIOGRAPHIC AND CARDIAC CATHETERIZATION EVALUATION OF SEVERE AORTIC STENOSIS WITH PRESERVED EJECTION FRACTION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34653-3] [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: 11/16/2022]
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Fanari Z, Shaukat A, Gunasekaran P, Hammami S, Dawn B, Wiley M, Tadros P. CRT-800.16 Utility Of Dobutamine and Pressure Wire Use in Assessing Low Flow Low Gradient Aortic Stenosis With Reduced EF. JACC Cardiovasc Interv 2017. [DOI: 10.1016/j.jcin.2016.12.223] [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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Fanari Z, Gunasekaran P, Shaukat A, Thapa J, Persad K, Hammami S, Weintraub W, Dawn B, Wiley M, Doorey A, Tadros P. CRT-800.10 Safety and Efficacy of Pressure Wire Use in Hemodynamic Assessment of Paradoxical Low Flow Low Gradient Aortic Stenosis. JACC Cardiovasc Interv 2017. [DOI: 10.1016/j.jcin.2016.12.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Stanojevic D, Gunasekaran P, Tadros P, Wiley M, Earnest M, Mehta A, Lippmann M, Levine M, Dawn B, Gupta K. Intravenous Adenosine Infusion is Safe and Well Tolerated During Coronary Fractional Flow Reserve Assessment in Elderly Patients With Severe Aortic Stenosis. J Invasive Cardiol 2016; 28:357-361. [PMID: 27315577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND This study assessed the safety of intravenous adenosine infusion during fractional flow reserve (FFR) evaluation of intermediate coronary lesions in severe aortic stenosis (AS). In severe AS, the extent of underlying coronary artery disease (CAD) can be an important determinant for deciding between surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). Hemodynamic assessment of coronary lesion severity using FFR may reduce the extent of revascularization needed and make TAVR more feasible in higher-risk patients (compared with coronary artery bypass surgery with SAVR). METHODS AND RESULTS We retrospectively analyzed the demographic, clinical, and hemodynamic parameters of 72 patients with severe AS who underwent FFR procedure with intravenous adenosine infusion for hemodynamic assessment of intermediate coronary artery lesions. Severe AS patients were elderly, predominantly male, and had a high prevalence of peripheral arterial disease, prior myocardial infarction, left ventricular hypertrophy, and chronic kidney disease. Mean aortic valve area in these patients was 0.71 ± 0.24 cm². No patient with severe AS required discontinuation of the adenosine and all patients tolerated the infusion well. We observed a statistically significant reduction in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) during adenosine infusion compared with the baseline values. However, no clinically significant adverse events occurred. CONCLUSION In elderly patients with severe AS, adenosine infusion is safe and well tolerated during FFR evaluation of intermediate coronary lesions. There was a significantly greater drop in SBP, DBP, MAP, and HR with adenosine infusion as compared with baseline values. This, however, was not associated with clinically significant adverse events.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Kamal Gupta
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Mail Stop 3006, 3901 Rainbow Boulevard, Kansas City, KS 66160 USA.
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Deeb GM, Reardon MJ, Chetcuti S, Patel HJ, Grossman PM, Yakubov SJ, Kleiman NS, Coselli JS, Gleason TG, Lee JS, Hermiller JB, Heiser J, Merhi W, Zorn GL, Tadros P, Robinson N, Petrossian G, Hughes GC, Harrison JK, Maini B, Mumtaz M, Conte J, Resar J, Aharonian V, Pfeffer T, Oh JK, Qiao H, Adams DH, Popma JJ. 3-Year Outcomes in High-Risk Patients Who Underwent Surgical or Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2016; 67:2565-74. [DOI: 10.1016/j.jacc.2016.03.506] [Citation(s) in RCA: 252] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 11/26/2022]
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Tobbia P, Kimber C, Jang B, Levine M, Abdoullayev A, Funk R, Jacobs D, Wiley M, Mehta A, Earnest M, Tadros P, Dawn B, Gupta K. THE ROLE OF REMOTE ISCHEMIC PRECONDITIONING IN THE PREVENTION OF CONTRAST INDUCED NEPHROPATHY. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32349-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: 11/28/2022]
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Shah Z, Masoomi R, Tadros P. Managing Antiplatelet Therapy and Anticoagulants in Patients with Coronary Artery Disease and Atrial Fibrillation. J Atr Fibrillation 2015; 8:1318. [PMID: 27957230 DOI: 10.4022/jafib.1318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 09/09/2015] [Accepted: 10/27/2015] [Indexed: 01/15/2023]
Abstract
Oral anticoagulation (OAC) is essential in patients with atrial fibrillation (AF). Interestingly coronary artery disease coexists in 20-30% of these patients.[1,2] Balancing the risk of bleeding and thromboembolism is very important for the management of patients on OAC, especially than when such patients require percutaneous coronary intervention (PCI). Lack of data and clear societal guidelines for peri-procedural and post-procedural management of anticoagulated patients has resulted in diverse clinical practices among clinicians, hospitals, and countries. Furthermore with expanding number of available oral antiplatelet and anticoagulant agents, the uncertainty regarding optimal combination therapy in this growing pool of the patients with overlapping clinical indications is also growing. Given the high proportion of patients with atherothrombosis and requiring OAC for conditions particularly like AF, it is important that physicians are aware of the clinical implications and management of these overlapping syndromes. In this article we discuss; this evolving dilemma of peri-procedural and post-procedural management of anticoagulated patient's, burden of the disease, available data, risk factors that could identify high risk patients and propose a well-balanced management strategy.
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Affiliation(s)
- Zubair Shah
- Division of Cardiovascular Diseases, Mid America Cardiology, University of Kansas Hospital and Medical Center, Kansas City, KS
| | - Reza Masoomi
- Division of Cardiovascular Diseases, Mid America Cardiology, University of Kansas Hospital and Medical Center, Kansas City, KS
| | - Peter Tadros
- Division of Cardiovascular Diseases, Mid America Cardiology, University of Kansas Hospital and Medical Center, Kansas City, KS
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Reardon MJ, Adams DH, Kleiman NS, Yakubov SJ, Coselli JS, Deeb GM, Gleason TG, Lee JS, Hermiller JB, Chetcuti S, Heiser J, Merhi W, Zorn GL, Tadros P, Robinson N, Petrossian G, Hughes GC, Harrison JK, Maini B, Mumtaz M, Conte JV, Resar JR, Aharonian V, Pfeffer T, Oh JK, Qiao H, Popma JJ. 2-Year Outcomes in Patients Undergoing Surgical or Self-Expanding Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2015; 66:113-21. [PMID: 26055947 DOI: 10.1016/j.jacc.2015.05.017] [Citation(s) in RCA: 326] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 04/21/2015] [Accepted: 05/05/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND The U.S. pivotal trial for the self-expanding valve found that among patients with severe aortic stenosis at increased risk for surgery, the 1-year survival rate was 4.9 percentage points higher in patients treated with a self-expanding transcatheter aortic valve bioprosthesis than in those treated with a surgical bioprosthesis. OBJECTIVES Longer-term clinical outcomes were examined to confirm if this mortality benefit is sustained. METHODS Patients with severe aortic stenosis who were at increased surgical risk were recruited. Eligible patients were randomly assigned in a 1:1 ratio to transcatheter aortic valve replacement with the self-expanding transcatheter valve (transcatheter aortic valve replacement [TAVR] group) or to aortic valve replacement with a surgical bioprosthesis (surgical group). The 2-year clinical and echocardiographic outcomes were evaluated in these patients. RESULTS A total of 797 patients underwent randomization at 45 centers in the United States. The rate of 2-year all-cause mortality was significantly lower in the TAVR group (22.2%) than in the surgical group (28.6%; log-rank test p < 0.05) in the as-treated cohort, with an absolute reduction in risk of 6.5 percentage points. Similar results were found in the intention-to-treat cohort (log-rank test p < 0.05). The rate of 2-year death or major stroke was significantly lower in the TAVR group (24.2%) than in the surgical group (32.5%; log-rank test p = 0.01). CONCLUSIONS In patients with severe aortic stenosis who are at increased surgical risk, the higher rate of survival with a self-expanding TAVR compared with surgery was sustained at 2 years. (Safety and Efficacy Study of the Medtronic CoreValve System in the Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very High Risk Subjects Who Need Aortic Valve Replacement; NCT01240902).
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Affiliation(s)
| | | | - Neal S Kleiman
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | | | - Joseph S Coselli
- Texas Heart Institute at St. Luke's Medical Center, Houston, Texas
| | - G Michael Deeb
- University of Michigan Medical Center, Ann Arbor, Michigan
| | - Thomas G Gleason
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Joon Sup Lee
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Stan Chetcuti
- University of Michigan Medical Center, Ann Arbor, Michigan
| | - John Heiser
- Spectrum Health System, Grand Rapids, Michigan
| | | | - George L Zorn
- The University of Kansas Hospital, Kansas City, Kansas
| | - Peter Tadros
- The University of Kansas Hospital, Kansas City, Kansas
| | | | | | - G Chad Hughes
- Duke University Medical Center, Durham, North Carolina
| | | | | | | | | | - Jon R Resar
- The Johns Hopkins Hospital, Baltimore, Maryland
| | - Vicken Aharonian
- Kaiser Permanente-Los Angeles Medical Center, Los Angeles, California
| | - Thomas Pfeffer
- Kaiser Permanente-Los Angeles Medical Center, Los Angeles, California
| | - Jae K Oh
- Mayo Clinic, Rochester, Minnesota
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Arnold S, Reynolds M, Wang K, Magnuson E, Baron S, Chinnakondepalli K, Reardon M, Tadros P, Zorn G, Maini B, Mumtaz M, Brown J, Kipperman R, Adams D, Popma J, Cohen D. HEALTH STATUS AFTER TRANSCATHETER OR SURGICAL AORTIC VALVE REPLACEMENT IN HIGH-RISK PATIENTS WITH SEVERE AORTIC STENOSIS: RESULTS FROM THE COREVALVE US PIVOTAL TRIAL. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61999-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Stanojevic DA, Gunasekaran P, Levine M, Reichuber M, Genton R, Mehta A, Earnest M, Wiley M, Tadros P, Dawn B, Gupta K. INTRAVENOUS ADENOSINE INFUSION IS SAFE AND WELL TOLERATED DURING CORONARY FRACTIONAL FLOW RESERVE ASSESSMENT IN SEVERE AORTIC STENOSIS. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61931-3] [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: 10/23/2022]
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Jeevanantham V, Chehab B, Austria E, Shrivastava R, Wiley M, Tadros P, Dawn B, Vacek JL, Gupta K. Comparison of accuracy of two different methods to determine ankle-brachial index to predict peripheral arterial disease severity confirmed by angiography. Am J Cardiol 2014; 114:1105-10. [PMID: 25129876 DOI: 10.1016/j.amjcard.2014.07.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 07/02/2014] [Accepted: 07/02/2014] [Indexed: 10/25/2022]
Abstract
Ankle-brachial index (ABI) is conventionally derived as the ratio of higher of the 2 systolic ankle blood pressures to the higher brachial pressure (HABI method). Alternatively, ABI may be derived using the lower of the 2 systolic ankle pressures (LABI method). The objective of this study was to assess the utility and difference between 2 techniques in predicting peripheral artery disease (PAD). Participants who underwent both ABI measurement and arteriography from July 2005 to June 2010 were reviewed. Angiographic disease burden was scored semiquantitatively (0=<50%, 1=50% to 75%, and 2=>75% stenosis of any lower extremity arterial segment), and PAD by angiography was defined as >50% stenosis of any 1 lower extremity arterial segment. A combined PAD disease score was calculated for each leg. A total of 130 patients were enrolled (260 limbs). The ABI was <0.9 (abnormal) in 68% of patients by HABI method and in 84% by LABI. LABI method had higher sensitivity and overall accuracy to detect PAD compared with the HABI method. Regression analysis showed that an abnormal ABI detected by LABI method is more likely to predict angiographic PAD and total PAD burden compared with HABI. Moreover, abnormal ABI by LABI method had higher sensitivity and accuracy to detect PAD in patients with diabetes and below knee PAD compared with the HABI method. In conclusion, ABI determined by the LABI method has higher sensitivity and is a better predictor of PAD compared with the conventional (HABI) method.
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Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, Gleason TG, Buchbinder M, Hermiller J, Kleiman NS, Chetcuti S, Heiser J, Merhi W, Zorn G, Tadros P, Robinson N, Petrossian G, Hughes GC, Harrison JK, Conte J, Maini B, Mumtaz M, Chenoweth S, Oh JK. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med 2014; 370:1790-8. [PMID: 24678937 DOI: 10.1056/nejmoa1400590] [Citation(s) in RCA: 2023] [Impact Index Per Article: 202.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND We compared transcatheter aortic-valve replacement (TAVR), using a self-expanding transcatheter aortic-valve bioprosthesis, with surgical aortic-valve replacement in patients with severe aortic stenosis and an increased risk of death during surgery. METHODS We recruited patients with severe aortic stenosis who were at increased surgical risk as determined by the heart team at each study center. Risk assessment included the Society of Thoracic Surgeons Predictor Risk of Mortality estimate and consideration of other key risk factors. Eligible patients were randomly assigned in a 1:1 ratio to TAVR with the self-expanding transcatheter valve (TAVR group) or to surgical aortic-valve replacement (surgical group). The primary end point was the rate of death from any cause at 1 year, evaluated with the use of both noninferiority and superiority testing. RESULTS A total of 795 patients underwent randomization at 45 centers in the United States. In the as-treated analysis, the rate of death from any cause at 1 year was significantly lower in the TAVR group than in the surgical group (14.2% vs. 19.1%), with an absolute reduction in risk of 4.9 percentage points (upper boundary of the 95% confidence interval, -0.4; P<0.001 for noninferiority; P = 0.04 for superiority). The results were similar in the intention-to-treat analysis. In a hierarchical testing procedure, TAVR was noninferior with respect to echocardiographic indexes of valve stenosis, functional status, and quality of life. Exploratory analyses suggested a reduction in the rate of major adverse cardiovascular and cerebrovascular events and no increase in the risk of stroke. CONCLUSIONS In patients with severe aortic stenosis who are at increased surgical risk, TAVR with a self-expanding transcatheter aortic-valve bioprosthesis was associated with a significantly higher rate of survival at 1 year than surgical aortic-valve replacement. (Funded by Medtronic; U.S. CoreValve High Risk Study ClinicalTrials.gov number, NCT01240902.).
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Affiliation(s)
- David H Adams
- From Mount Sinai Medical Center, New York (D.H.A.), and St. Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Beth Israel Deaconess Medical Center, Boston (J.J.P.); Houston Methodist DeBakey Heart and Vascular Center (M.J.R., N.S.K.), and Texas Heart Institute at St. Luke's Medical Center (J.S.C.) - both in Houston; Riverside Methodist Hospital, Columbus, OH (S.J.Y.); University of Michigan Medical Center, Ann Arbor (G.M.D., S. Chetcuti), and Spectrum Health Hospitals, Grand Rapids (J.H., W.M.) - both in Michigan; University of Pittsburgh Medical Center, Pittsburgh (T.G.G.); Palo Alto Veterans Affairs Medical Center, Palo Alto, CA (M.B.); St. Vincent Medical Center, Indianapolis (J.H.); University of Kansas Hospital, Kansas City (G.Z., P.T.); Duke University Medical Center, Durham, NC (G.C.H., J.K.H.); Johns Hopkins Hospital, Baltimore (J.C.); Pinnacle Health, Harrisburg, PA (B.M., M.M.); and Medtronic, Minneapolis (S. Chenoweth), and Mayo Clinical Foundation, Rochester (J.K.O.) - both in Minnesota
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Matthew Shurtleff E, Vanderhyde M, Fitzwater F, Chehab B, Maletsky L, Vamanan K, Thomas P, Tadros P, Gupta K. CONFORMATIONAL CHANGES IN COMMERCIALLY AVAILABLE NITINOL STENTS IMPLANTED IN THE FEMORO–POPLITEAL ARTERIAL SEGMENT IN A CADAVERIC MODEL. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61806-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jeevanantham V, Chehab B, Shrivastava R, Wiley M, Tadros P, Nath J, Dawn B, Gupta K. UTILITY OF TWO METHODS OF CALCULATING ANKLE BRACHIAL INDEX IN DETECTING BELOW KNEE PERIPHERAL ARTERIAL DISEASE CONFIRMED BY ANGIOGRAPHY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)62075-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Stanojevic DA, Sharma S, Jeevanantham V, Chehab B, McCullough M, Tadros P, Dawn B, Wiley M. EVALUATION OF MICRO CORONARY EDGE DISSECTION AND CORONARY ARTERY PLAQUE PROLAPSE POST CORONARY ARTERY PERCUTANEOUS INTERVENTION USING OPTICAL COHERENCE TOMOGRAPHY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61875-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Chehab BM, Jeevanantham V, Saad A, Vacek J, Gupta K, Dawn B, Tadros P, Wiley M. FEASIBILITY, SAFETY, AND OUTCOMES WITH A CORONARY PRESSURE WIRE SYSTEM USED FOR THE ASSESSMENT OF SEVERE AORTIC STENOSIS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60135-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chehab BM, Jeevanantham V, Nagavalli S, Austria E, Shrivastava R, Wiley M, Tadros P, Nath J, Dawn B, Gupta K. TWO METHODS OF CALCULATING ANKLE BRACHIAL INDEX: DIFFERENCES IN PREDICTING PERIPHERAL ARTERIAL DISEASE BURDEN. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)62128-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Steffen K, Zorn GT, Tadros P, Gupta K. Role of hybrid endovascular suite in improving outcomes of surgical ligation of coronary artery fistula. J Invasive Cardiol 2012; 24:E10-E12. [PMID: 22210590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Coronary artery fistulae are rare congenital or acquired coronary artery anomalies that can lead to significant cardiovascular morbidity and mortality. Surgical ligation has long been utilized in the treatment of these abnormalities. However, there is a high rate of recurrence due to incomplete closure of the fistulae, especially when multiple channels are present. Transcatheter techniques have become an acceptable alternative with good outcomes. Nevertheless, not all fistulae are amenable to the transcatheter approach and surgical repair is the treatment of choice. Intraoperative coronary angiography can improve the outcomes of surgery but has only sparingly been used due to the technical difficulties in a standard operating suite. Hybrid suites are becoming quite common these days with the emergence of procedures such as endovascular stent grafting and percutaneous valves. These suites have a complete imaging set up like a traditional catheterization laboratory and are also full operating suites. This case report discusses the use and potential benefits of performing intraoperative coronary angiography in a dedicated hybrid suite to help guide and ensure complete surgical closure of all fistulous connections.
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Affiliation(s)
- Kelly Steffen
- Division of Cardiovascular Diseases, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
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