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Mall A, Girton TA, Yardley K, Ronn M, Cross E, Smith PJ, Rossman P, McEwen T, Ohman EM, Jones WS, Granger BB. Timing of sedation and patient-reported pain outcomes during cardiac catheterization: Results from the UNTAP-intervention study. Catheter Cardiovasc Interv 2023; 101:335-342. [PMID: 36640418 DOI: 10.1002/ccd.30535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 12/02/2022] [Accepted: 12/16/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Invasive cardiac catheterization (CC) temporarily increases pain, discomfort, and anxiety. Procedural sedation is deployed to mitigate these symptoms, though practice varies. Research evaluating peri-procedural patient-reported outcomes is lacking. METHODS AND RESULTS We randomized 175 patients undergoing CC to short interval ([SI] group, <6 min) or long interval ([LI] group, ≥6 min) time intervals between initial intravenous sedation and local anesthetic administration. Outcomes included: (1) total pain medication use, (2) patient-reported and behaviorally assessed pain and (3) patient satisfaction during outpatient CC. Generalized linear mixed effect models were used to evaluate the impact of treatment time interval on total medication utilization, pain, and satisfaction. Among enrollees the mean age was 62 (standard deviation [SD] = 13.4), a majority were male (66%), white (74%), and overweight (mean body mass index = 28.5 [SD = 5.6]). Total pain medication use did not vary between treatment groups (p = 0.257), with no difference in total fentanyl (p = 0.288) or midazolam (p = 0.292). Post-treatment pain levels and nurse-observed pain were not statistically significant between groups (p = 0.324 & p = 0.656, respectively. No significant differences with satisfaction with sedation were found between the groups (p = 0.95) Patient-reported pain, satisfaction and nurse-observed measures of pain did not differ, after adjustment for demographic and procedural factors. Analyses of treatment effect modification revealed that postprocedure self-reported pain levels varied systematically between individuals undergoing percutaneous coronary intervention (PCI) (SI = 2.2 [0.8, 3.6] vs. LI = 0.7 [-0.6, 2.0]) compared with participants not undergoing PCI (SI = 0.4 [-0.8, 1.7] vs. LI = 0.7 [-0.3, 1.6]) (p = 0.043 for interaction). CONCLUSION No consistent treatment differences were found for total medication dose, pain, or satisfaction regardless of timing between sedation and local anesthetic. Treatment moderations were seen for patients undergoing PCI. Further investigation of how procedural and individual factors impact the patient experience during CC is needed.
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Affiliation(s)
- Anna Mall
- Duke Heart Center, Duke University Health System, Durham, North Carolina, USA
| | - T Andrew Girton
- Duke Heart Center, Duke University Health System, Durham, North Carolina, USA
| | - Kevin Yardley
- Duke Heart Center, Duke University Health System, Durham, North Carolina, USA
| | - Meghan Ronn
- Duke Heart Center, Duke University Health System, Durham, North Carolina, USA
| | - Elinore Cross
- Duke Heart Center, Duke University Health System, Durham, North Carolina, USA
| | - Patrick J Smith
- Department of Psychiatry & Behavioral Sciences Duke University School of Medicine, Durham, North Carolina, USA
| | - Paige Rossman
- Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Tiffany McEwen
- Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - E Magnus Ohman
- Department of Medicine, FACC Duke Program for Advanced Coronary Disease, Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - W Schuyler Jones
- Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Bradi B Granger
- Duke School of Nursing, Duke University, Durham, North Carolina, USA
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Costa G, D'Errigo P, Rosato S, Valvo R, Biancari F, Tamburino C, Cerza F, Cicala SD, Seccareccia F, Barbanti M. Long-term outcomes of self-expanding versus balloon-expandable transcatheter aortic valves: Insights from the OBSERVANT study. Catheter Cardiovasc Interv 2021; 98:1167-1176. [PMID: 33847447 DOI: 10.1002/ccd.29701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/19/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To compare clinical outcomes of balloon-expandable (BE) and self-expanding (SE) transcatheter aortic valves (TAVs) up to 5 years. BACKGROUND To date, no robust, comparative data of BE and SE TAVs at long-term are available. METHODS We considered a total of 1,440 patients enrolled in the multicenter OBSERVANT study and undergoing transfemoral transcatheter aortic valve implantation (TF-TAVI) with either supra-annular SE (n = 830, 57.6%) and intra-annular BE (n = 610, 42.4%) valves. Clinical outcomes of the two groups were compared after adjustment using inverse probability of treatment weighting (IPTW) and confirmed by sensitivity analysis with propensity score matching. RESULTS Patients receiving SE valve showed a higher all-cause mortality at 5 years (Kaplan-Meier estimates 52.3% vs. 47.7%; Hazard ratio [HR] 1.18, 95% confidence interval [CI] 1.01-1.38, p = .04). Landmark analyses showed that there was a not statistically significant reversal of risk excess against the BE group starting from 3 years after TAVI (3-5 years HR 0.97, 95% CI 0.76-1.25, p = .86). Post-procedural, moderate/severe paravalvular regurgitation (PVR)(HR 1.46, 95% CI 1.14-1.87; p < .01) and acute kidney injury (AKI)(HR 3.89, 95% CI 2.47-6.38; p < .01) showed to be independent predictors of 5-year all-cause mortality in multivariable analysis. CONCLUSIONS Considering the intrinsic limitations of the OBSERVANT study, we found that patients undergoing TF-TAVI with a supra-annular SE valve had a higher all-cause mortality compared to those receiving an intra-annular BE valve at 5 years. A late catch up phenomenon of patients receiving the BE valve was observed beyond 3 years. Post-procedural moderate/severe PVR seems to play a crucial role in determining this finding. Comparative studies of new generation devices with longer follow-up are needed to evaluate the benefit of each specific TAV type.
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Affiliation(s)
- Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Paola D'Errigo
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Rosato
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Roberto Valvo
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Fausto Biancari
- Department of Surgery, University of Oulu, Oulu, Finland.,Department of Surgery, University of Turku, Turku, Finland.,Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Francesco Cerza
- Italian National Agency for Regional Healthcare Services, Rome, Italy
| | | | - Fulvia Seccareccia
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
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Goldsweig AM, Galper BZ, Alraies C, Arnold SV, Daniels M, Capodanno D, Tarantini G, Cohen DJ, Aronow HD. #SoMe for #IC: Optimal use of social media in interventional cardiology. Catheter Cardiovasc Interv 2021; 98:97-106. [PMID: 33686726 DOI: 10.1002/ccd.29643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/01/2021] [Accepted: 02/25/2021] [Indexed: 12/26/2022]
Abstract
Social media allows interventional cardiologists to disseminate and discuss research and clinical cases in real-time, to demonstrate and learn innovative techniques, to build professional networks, and to reach out to patients and the general public. Social media provides a democratic platform for all participants to influence the conversation and demonstrate their expertise. This review addresses the use of social media for these purposes in interventional cardiology, as well as respect for patient privacy, how to get started on social media, the creation of high-impact social media content, and the role of traditional journals in the age of social media. In the future, we hope that interventional cardiology fellowship programs will incorporate social media training into their curricula. In addition, professional societies may adapt to the rapid dissemination of data on social media by developing processes to update guidelines more rapidly and more frequently.
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Affiliation(s)
- Andrew M Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Chadi Alraies
- Division of Cardiovascular Medicine, Detroit Medical Center, Detroit, Michigan
| | - Suzanne V Arnold
- Division of Cardiovascular Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Matthew Daniels
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, and Division of Cardiovascular Sciences, Manchester Academic Health Sciences Centre, and Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester, Manchester, UK
| | - Davide Capodanno
- Department of General Surgery and Medical-Surgical Subspecialties, University of Catania, Catania, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua Medical School, Padua, Italy
| | - David J Cohen
- Division of Cardiovascular Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Herbert D Aronow
- Division of Cardiovascular Medicine, Warren Alpert Medical School, Brown University, and Lifespan Cardiovascular Institute, Providence, Rhode Island
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4
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Mall A, Girton TA, Yardley K, Rossman P, Ohman EM, Jones WS, Granger BB. Understanding the patient experience of pain and discomfort during cardiac catheterization. Catheter Cardiovasc Interv 2020; 95:E196-E200. [PMID: 31313448 DOI: 10.1002/ccd.28403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/04/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Patient centeredness is an essential component of high-quality care, yet little is known regarding the patient experience during procedures performed in the cardiac catheterization lab. BACKGROUND Available literature focuses on the safe delivery of sedation, but does not address patient-reported satisfaction or comfort. Further delineation of how procedural factors impact the patient experience is needed. METHODS We conducted a retrospective, exploratory analysis of adult cardiac catheterization outpatients (n = 375) receiving physician ordered, nurse administered procedural sedation (benzodiazepine and/or opioids) between April and June, 2017. Data were abstracted from the procedural database, Electronic Health Record, and Press Ganey© surveys. RESULTS The mean age was 63 (SD 12.2), a majority were male (n = 226; 60%), white (n = 271; 73%), and overweight (mean body mass index = 29, SD 6.8). Patient-reported satisfaction with pain control and perceived staff concern for comfort were >75th percentile (Press Ganey© survey), with no difference in preprocedure and postprocedure pain scores (p = .596). Intraprocedural medication dose range and mean frequency were highly variable: midazolam (0.25-5.5 mg; 1.48); fentanyl (12.5-200 mcg; 1.63); and hydromorphone (0.5-2.5 mg; 1.33). Median time interval between administration of initial sedation and local anesthetic was 6 min. Patients with longer intervals had less frequent dosing (p < .001) and less total procedural sedation (p < .001). Sensitivity analysis revealed that trainee/fellow involvement (p = .001), younger age (p = .002), and shorter time intervals (p < .001) were associated with increased frequency and larger total dose. CONCLUSIONS Waiting to gain vascular access following administration of procedural was associated with less frequent subsequent dosing, lower overall administration, and similar patient satisfaction. Optimizing processes for administering periprocedural sedation may allow for less medication without impacting patient experience.
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Affiliation(s)
- Anna Mall
- Department of Nursing, Duke University Health System, Duke Heart Center, Department of Nursing, Durham, North Carolina
| | - T Andrew Girton
- Department of Nursing, Duke University Health System, Duke Heart Center, Department of Nursing, Durham, North Carolina
| | - Kevin Yardley
- Department of Nursing, Duke University Health System, Duke Heart Center, Department of Nursing, Durham, North Carolina
| | - Paige Rossman
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - E Magnus Ohman
- Duke Program for Advanced Coronary Disease, Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - William Schuyler Jones
- Division of Cardiology, Department of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Bradi B Granger
- Duke School of Nursing, Duke University, Durham, North Carolina
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5
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McCullough PA, Todoran TM, Brilakis ES, Ryan MP, Gunnarsson C. Rate of major adverse renal or cardiac events with iohexol compared to other low osmolar contrast media during interventional cardiovascular procedures. Catheter Cardiovasc Interv 2019; 93:E90-E97. [PMID: 30280476 PMCID: PMC6585608 DOI: 10.1002/ccd.27807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/29/2018] [Accepted: 07/12/2018] [Indexed: 12/02/2022]
Abstract
Objective This study assessed the rate of major adverse renal or cardiac events (MARCE) when iohexol is used during interventional cardiovascular procedures compared to other low osmolar contrast media (LOCMs). Background Interventional cardiovascular procedures are often essential for diagnosis and treatment, the risk of MARCE should be considered. Methods Data were derived from the Premier Hospital Database January 1, 2010 through September 30, 2015. Patient encounters with an inpatient primary interventional cardiovascular procedure with a single LOCM (iohexol, ioversol, ioxilan, ioxaglate, or iopamidol) were included. The primary outcome was a composite endpoint of MARCE, which included: renal failure with dialysis, acute kidney injury (AKI) with or without dialysis, contrast induced AKI, acute myocardial infarction, angina, stent occlusion/thrombosis, stroke, transient ischemic attack, or death. Multivariable regression analysis was performed using the hospital fixed‐effects specification to assess the relationship between MARCE and iohexol compared to other LOCMs, while controlling for patient demographics, comorbid conditions and reason for hospitalization. As a sensitivity analysis, direct comparisons of iohexol were made to other LOCMs. Results A total of 458,091 inpatient encounters met inclusion criteria of which 26% used iohexol and 74% used other LOCMs. Results of multivariable modeling revealed no differences in MARCE rates between iohexol and other LOCMs. When direct comparisons of iohexol vs. ioversol and iopamidol were modeled, no differences in MARCE nor the renal component of MARCE were found. Conclusions In this retrospective multicenter study, there were no differences in MARCE events with iohexol compared to other LOCMs during inpatient interventional cardiovascular procedures.
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Affiliation(s)
- Peter A McCullough
- Baylor University Medical Center, Dallas, Texas.,Baylor Heart and Vascular Institute, Dallas, Texas.,Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas.,Texas A&M Health Science Center College of Medicine, Dallas, Texas
| | - Thomas M Todoran
- Medical University of South Carolina, Charleston, South Carolina.,Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Minneapolis, Minnesota.,University of Texas, Southwestern Medical Center, Dallas, Texas
| | - Michael P Ryan
- Real World Evidence, CTI Clinical Trial & Consulting Services, Covington, Kentucky
| | - Candace Gunnarsson
- Real World Evidence, CTI Clinical Trial & Consulting Services, Covington, Kentucky
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6
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Cevallos PC, Armstrong AK, Glatz AC, Goldstein BH, Gudausky TM, Leahy RA, Petit CJ, Shahanavaz S, Trucco SM, Bergersen LJ. Radiation dose benchmarks in pediatric cardiac catheterization: A prospective multi-center C3PO-QI study. Catheter Cardiovasc Interv 2017; 90:269-280. [PMID: 28198573 DOI: 10.1002/ccd.26911] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/17/2016] [Accepted: 12/12/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study sought to update benchmark values to use a quality measure prospectively. BACKGROUND Congenital Cardiac Catheterization Outcomes Project - Quality Improvement (C3PO-QI), a multi-center registry, defined initial radiation dose benchmarks retrospectively across common interventional procedures. These data facilitated a dose metric endorsed by the American College of Cardiology in 2014. METHODS Data was collected prospectively by 9 C3PO-QI institutions with complete case capture between 1/1/2014 and 6/30/2015. Radiation was measured in total air kerma (mGy), dose area product (DAP) (µGy*M2 ), DAP per body weight, and fluoroscopy time (min), and reported by age group as median, 75th and 95th %ile for the following six interventional procedures: (1) atrial septal defect closure; (2) aortic valvuloplasty; (3) treatment of coarctation of the aorta; (4) patent ductus arteriosus closure; (5) pulmonary valvuloplasty; and (6) transcatheter pulmonary valve implantation. RESULTS The study was comprised of 1,680 unique cases meeting inclusion criteria. Radiation doses were lowest for pulmonary valvuloplasty (age <1 yrs, median mGy: 59, DAP: 249) and highest in transcatheter pulmonary valve implantation (age >15 yrs, median mGy: 1835, DAP: 17990). DAP/kg standardized outcome measures across weights within an age group and procedure type significantly more than DAP alone. Radiation doses decreased for all procedures compared to those reported previously by both median and median weight-based percentile curves. These differences in radiation exposure were observed without changes in median fluoroscopy time. CONCLUSIONS This study updates previously established benchmarks to reflect QI efforts over time. These thresholds can be applied for quality measurement and comparison. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Aimee K Armstrong
- Department of Cardiology, Nationwide Children's Hospital, Columbus, Ohio
| | - Andrew C Glatz
- Cardiac Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Bryan H Goldstein
- Department of Cardiology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Todd M Gudausky
- Division of Cardiology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Ryan A Leahy
- Department of Cardiology, Kosair Children's Hospital, Louisville, Kentucky
| | - Christopher J Petit
- Department of Cardiology, Children's Healthcare of Atlanta Sibley Heart Center, Atlanta
| | - Shabana Shahanavaz
- Division of Pediatric Cardiology, St. Louis Children's Hospital, St. Louis, Missouri
| | - Sara M Trucco
- Division of Pediatric Cardiology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lisa J Bergersen
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
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Sanchez CE, Dota A, Badhwar V, Kliner D, Smith AJC, Chu D, Toma C, Wei L, Marroquin OC, Schindler J, Lee JS, Mulukutla SR. Revascularization heart team recommendations as an adjunct to appropriate use criteria for coronary revascularization in patients with complex coronary artery disease. Catheter Cardiovasc Interv 2015; 88:E103-E112. [PMID: 26527352 DOI: 10.1002/ccd.26276] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 10/03/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To evaluate how a comprehensive evidence-based clinical review by a multidisciplinary revascularization heart team on treatment decisions for revascularization in patients with complex coronary artery disease using SYNTAX scores combined with Society of Thoracic Surgeons-derived clinical variables can be additive to the utilization of Appropriate Use Criteria for coronary revascularization. BACKGROUND Decision-making regarding the use of revascularization for coronary artery disease has come under major scrutiny due to inappropriate overuse of revascularization. There is little data in routine clinical practice evaluating how a structured, multidisciplinary heart team approach may be used in combination with the Appropriate Use Criteria for revascularization. METHODS From May 1, 2012 to January 1, 2015, multidisciplinary revascularization heart team meetings were convened to discuss evidence-based management of 301 patients with complex coronary artery disease. Heart team recommendations were adjudicated with the Appropriate Use Criteria for coronary revascularization for each clinical scenario using the Society for Cardiovascular Angiography and Interventions' Quality Improvement Toolkit (SCAI-QIT) Appropriate Use Criteria App. RESULTS Concordance of the Heart Team to Appropriate Use Criteria had a 99.3% appropriate primary indication for coronary revascularization. Among patients who underwent percutaneous revascularization, 34.9% had an inappropriate or uncertain indication as recommended by the Heart Team. Patients with uncertain or inappropriate percutaneous coronary interventions had significantly higher SYNTAX score (27.3 ± 6.6; 28.5 ± 5.5; 19.2 ± 6; P < 0.0001) and Society of Thoracic Surgeons-Predicted Risk of Mortality (6.1% ± 4.7%; 8.1% ± 6.3%; 3.7% ± 4.1%; P < 0.0081) compared to appropriate indications, frequently had concomitant forms of advanced comorbidities and frailty in the setting of symptomatic coronary artery disease. CONCLUSIONS A formal, multidisciplinary revascularization heart team can provide proper validation for clinical decisions and should be considered in combination with the Appropriate Use Criteria for coronary revascularization to formulate revascularization strategies for individuals in a patient-centered fashion. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Carlos E Sanchez
- Department of Internal Medicine, Division of Cardiology, Riverside Methodist Hospital, Columbus, Ohio
| | - Anthony Dota
- Department of Internal Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Vinay Badhwar
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania
| | - Dustin Kliner
- Department of Internal Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - A J Conrad Smith
- Department of Internal Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Danny Chu
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania
| | - Catalin Toma
- Department of Internal Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Lawrence Wei
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania
| | - Oscar C Marroquin
- Department of Internal Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John Schindler
- Department of Internal Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Joon S Lee
- Department of Internal Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Suresh R Mulukutla
- Department of Internal Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. .,Department of Internal Medicine, Division of Cardiology, VA Medical Center, Pittsburgh, Pennsylvania.
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8
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Aral M, Mullen M. The Flatstent versus the conventional umbrella devices in the percutaneous closure of patent foramen ovale. Catheter Cardiovasc Interv 2014; 85:1058-65. [PMID: 25413379 DOI: 10.1002/ccd.25750] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 11/15/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patent foramen ovale (PFO) has been associated with paradoxical embolism leading to stroke/transient ischemic attack, migraine, and neurological decompression sickness. In search for the optimal device that would achieve effective clinical closure with minimal complications, a better device selection based on PFO anatomy and improvements in device design is needed. The Flatstent is a new device designed to treat the highly prevalent long-tunnel PFOs from within, minimizing the amount of material left behind in an attempt to reduce device-related complications. The objective is to compare the safety and efficacy of the novel Flatstent versus the conventional umbrella devices in the transcatheter closure of PFO in a nonrandomized, retrospective, single-center study. METHODS Between March 2010 and March 2013, 88 patients underwent PFO closure at The Heart Hospital, London with either the novel Flatstent or one of the four conventionally used umbrella devices (GORE Helex Septal Occluder, Occlutech Figulla Flex, Biostar Septal Occluder, and Amplatzer PFO Occluder) depending on their PFO anatomy. Patients were then evaluated with contrast transthoracic echocardiography (TTE) and/or transoesophageal echocardiography (TOE) at 6 weeks and 1 year after the procedure. The residual shunt and complication rates between the Flatstent and umbrella devices were compared. RESULTS The Flatstent was used in 27 patients (30.7%), whereas 61 patients (69.3%) received one of the four umbrella devices. Primary efficacy point of clinical closure defined as grade 0 or grade 1; residual shunt was achieved in 81.3% in the Flatstent cohort and 80.3% in the umbrella device group at 6 weeks follow-up. At 1 year, the clinical closure rates reached 92.6 and 91.8%. There were two device embolizations, one in each cohort during the immediate postoperative period (<24 hrs), with successful retrieval. One patient in the umbrella device group developed transient atrial fibrillation, which was controlled medically. Event recurrence rate was 0% at 1 year. CONCLUSION No difference was found in closure or complication rates between the Flatstent and the umbrella devices. With appropriate preassessment of the PFO anatomy, the Flatstent works as a safe and effective method of treating the PFO from within the tunnel, especially in those with long-tunnel PFOs. Longer follow-up is needed to establish superiority.
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Affiliation(s)
- Mert Aral
- University College London, Institute of Cardiovascular Science, London, United Kingdom
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9
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Kapadia SR, Svensson LG, Roselli E, Schoenhagen P, Popovic Z, Alfirevic A, Barzilai B, Krishnaswamy A, Stewart W, Mehta A, Lal Poddar K, Parashar A, Modi D, Ozkan A, Khot U, Lytle BW, Murat Tuzcu E. Single center TAVR experience with a focus on the prevention and management of catastrophic complications. Catheter Cardiovasc Interv 2014; 84:834-42. [PMID: 24407775 PMCID: PMC4231228 DOI: 10.1002/ccd.25356] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 12/13/2013] [Accepted: 01/03/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is an important treatment option for patients with severe symptomatic aortic stenosis (AS) who are inoperable or at high risk for complications with surgical aortic valve replacement. We report here our single-center data on consecutive patients undergoing transfemoral (TF) TAVR since the inception of our program, with a special focus on minimizing and managing complications. METHODS The patient population consists of all consecutive patients who underwent an attempted TF-TAVR at our institution, beginning with the first proctored case in May 2006, through December 2012. Clinical, procedural, and echocardiographic data were collected by chart review and echo database query. All events are reported according to Valve Academic Research Consortium-2. RESULTS During the study period, 255 patients with AS had attempted TF-TAVR. The procedure was successful in 244 (95.7%) patients. Serious complications including aortic annular rupture (n = 2), coronary occlusion (n = 2), iliac artery rupture (n = 1), and ventricular embolization (n = 1) were successfully managed. Death and stroke rate at 30 days was 0.4% and 1.6%, respectively. One-year follow-up was complete in 171 (76%) patients. One-year mortality was 17.5% with a 3.5% stroke rate. Descending aortic rupture, while advancing the valve, was the only fatal procedural event. There were 24.4% patients with ≥2+ aortic regurgitation. CONCLUSIONS TAVR can be accomplished with excellent safety in a tertiary center with a well-developed infrastructure for the management of serious complications. The data presented here provide support for TAVR as an important treatment option, and results from randomized trials of patients with lower surgical risk are eagerly awaited.
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Affiliation(s)
- Samir R Kapadia
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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