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Shah AM, Almomani AA, Sako EY, Hui DS. Surgical and Transcatheter Mitral Valve Therapy: Medicare Utilization and Reimbursement. Ann Thorac Surg 2023:S0003-4975(23)00965-7. [PMID: 37741565 DOI: 10.1016/j.athoracsur.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 08/02/2023] [Accepted: 09/05/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND We aimed to examine trends in the utilization and reimbursement of surgical and transcatheter mitral valve therapies and their changing relationship. METHODS A query of administrative data on US Medicare beneficiaries undergoing mitral valve therapy was conducted from 2015 to 2020 using the Centers for Medicare and Medicaid Services Part B National Summary Data File. Inflation adjustment was to the 2020 Consumer Price Index. Trend analysis was quantified with growth rate and simple linear regression calculations. RESULTS The annual number of all mitral valve procedures remained constant. Transcatheter mitral valve therapies increased by 313% with an increase of 1552 cases per year (P < .001), whereas surgical mitral valve therapies decreased by 31.4% with a decline of 1446 procedures per year (P = .004). As a proportion of all mitral valve therapies, surgical therapies decreased from 91.8% to 65.0%. Annual Medicare reimbursements for transcatheter and surgical mitral valve therapies mirrored the annual procedural trends. For transcatheter mitral valve therapies, per-case reimbursement decreased by 14.1% ($1283.18 to $1102.88), and for surgical mitral valve therapies, per-case reimbursement decreased by 3.8% ($1480.65 to $1424.57). CONCLUSIONS Medicare utilization of mitral valve therapies has been stable in recent years, with growth of transcatheter volumes offset by a decrease in surgical volumes. This suggests that transcatheter therapy availability has not expanded the pool of patients with access to therapy. Nonetheless, case reimbursements decreased for both modalities.
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Affiliation(s)
- Aakash M Shah
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
| | - Ahmed A Almomani
- Division of Cardiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Edward Y Sako
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Dawn S Hui
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Surgical explantation of failed transcatheter heart valves: indications and results. Heart Vessels 2022; 37:2083-2092. [PMID: 35802181 PMCID: PMC9579090 DOI: 10.1007/s00380-022-02119-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/15/2022] [Indexed: 11/04/2022]
Abstract
Given the recent surge in transcatheter heart valve replacement (THVR), cardiac surgeons will surely face the challenge of eventual explantation. The aim of this study was to determine indications for reoperation, while exploring pertinent technical aspects and survival after THV explantation in a cohort originally deemed high risk or even inoperable. Between February 2008 and March 2019, 31 patients with failed transcatheter aortic valve replacement (TAVR) underwent surgical explantations at our facility. Data were prospectively collected for retrospective analysis of procedural indications, technical issues, and postoperative survival. The major reason for TAVR removal was bioprosthetic valve failure (BVF) due to infective endocarditis (IE: 16/31 [51.6%]), non-structural (NSVD: 14/31 [45.2%]) and structural (SVD: 1/31 [3.2%]) valve deterioration accounting for the rest. Mean age at THV explantation was 76.3 ± 8.3 years, and median time from TAVR to explantation was 153 days (0 days-56.6 months). Median ICU and hospital stay were 6 days (1-44 days) and 23 days (8-62 days), respectively. Thirty-day and 1-year survival rates were 74.2% and 67.2%, respectively. Median follow-up interval after explantation was 364 days (3 days-80 months). Mean cardiopulmonary bypass time was 124.6 ± 46.8 min, and mean aortic cross-clamp time was 84.3 ± 32.9 min. There was no need for unplanned aortic root repair owing to tissue damage during dissection of the TAVR from surrounding tissue. The most common reason for THV explantation was (a) BVF for IE and (b) BVF secondary to NSVD. Although 30-day and 1-year mortality rates in this multimorbid cohort were predictably high, no procedural mortalities occurred.
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Transfemoral versus transcarotid access for transcatheter aortic valve replacement. JTCVS Tech 2022; 15:46-53. [PMID: 36276673 PMCID: PMC9579710 DOI: 10.1016/j.xjtc.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/09/2022] [Accepted: 03/03/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives To compare the outcomes after transcatheter aortic valve replacement (TAVR) through a transfemoral (TF) and transcarotid (TC) access at our institution. Methods From January 2014 to January 2020, 62 TC-TAVR and 449 TF-TAVR were performed using 2 prosthesis devices (Edwards SAPIEN 3, n = 369; Medtronic Evolut R, n = 142). Propensity score matching was used to adjust for imbalance in the baseline characteristics of the study groups. Results Propensity score matching provided 62 matched pairs with comparable operative risk (mean European System for Cardiac Operative Risk Evaluation II, TC-TAVR 7.6% vs TF-TAVR 6.6%, P = .17). Thirty-day mortality (4.8% vs 3.2%, P = 1.00) and 2-year mortality (11.3% vs 12.9%, P = .64) after TC-TAVR were comparable with TF-TAVR. Strokes were numerically more frequent after TC-TAVR compared with TF-TAVR (3.2% vs 0%, P = .23), but the difference did not reach statistical significance. TF-TAVR was associated with a significantly greater risk of permanent pacemaker implantation (29.0% vs 12.9%, P = .04) compared with TC-TAVR. Other complications were not frequent and were similarly distributed between the matched groups. Conclusions TC access for TAVR was associated with satisfactory results compared to the femoral access. TC-TAVR could be considered a valid and safe alternative to TF-TAVR when femoral access is contraindicated.
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Abstract
Aortic stenosis (AS) of moderate or greater severity has an estimated prevalence of 5% in people older than 65 years. Survival is poor after onset of symptoms, and surgical aortic valve replacement was the gold-standard treatment for decades. However, more than one-third of patients with symptomatic AS were untreated due to high surgical risk, exposing a clinical need for a less invasive therapy for aortic valve stenosis. The PARTNER trials were pivotal in presenting robust evidence for the safety, feasibility, and efficacy of transcatheter aortic valve replacement in the management of AS and paved the way for clinical use worldwide.
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Affiliation(s)
- Ryan Markham
- Stanford Hospital, Palo Alto, CA, USA; Department of Cardiovascular Medicine, Stanford Hospital, 300 Pasteur Drive, Room H2103, Stanford, CA 94305, USA
| | - Rahul Sharma
- Stanford Hospital, Palo Alto, CA, USA; Department of Cardiovascular Medicine, Stanford Hospital, 300 Pasteur Drive, Room H2103, Stanford, CA 94305, USA.
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Joffe DC, Sheu R, Keeshan BC, Burbano-Vera N. The Role of Novel Transcatheter Procedures in Patients With Congenital Heart Disease. J Cardiothorac Vasc Anesth 2020; 35:2180-2193. [PMID: 32758406 DOI: 10.1053/j.jvca.2020.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 02/02/2023]
Abstract
The development of percutaneous structural interventions in patients with acquired heart disease is happening at an exponential rate, and some of this technology is being used to treat patients with congenital heart disease. This review describes the pathophysiology of valvular abnormalities specific to congenital heart disease and discusses the application of structural procedures in this population. Although the overall experience has been encouraging, especially in high-risk patients, this article will highlight the reasons that a cautious approach to adoption of this technology is necessary in these patients.
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Affiliation(s)
- Denise C Joffe
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center and Seattle Children's Hospital, Seattle, WA.
| | - Richard Sheu
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center and Seattle Children's Hospital, Seattle, WA
| | - Britton C Keeshan
- Yale University Department of Pediatrics, Division of Pediatric Cardiology, Yale New Haven Hospital, New Haven, CT
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Kiefer NJ, Salber GC, Burke GM, Chang JD, Guibone KA, Popma JJ, Hahn RT, Pinto DS, Strom JB. The Impact of Basal Septal Hypertrophy on Outcomes after Transcatheter Aortic Valve Replacement. J Am Soc Echocardiogr 2019; 32:1416-1425. [PMID: 31466847 PMCID: PMC8479796 DOI: 10.1016/j.echo.2019.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 06/12/2019] [Accepted: 06/12/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND The role of basal septal hypertrophy (BSH) on preprocedural transthoracic echocardiography in transcatheter aortic valve replacement (TAVR) is unknown. METHODS Medical charts and preprocedural transthoracic echocardiograms of 378 patients who underwent TAVR were examined. The association between BSH and the primary composite outcome of valve pop-out, recapture, embolization, aborted procedure, conversion to open procedure, new conduction disturbance, or need for permanent pacemaker ≤30 days after TAVR was evaluated. Patients with preexisting pacemakers were excluded. Sensitivity analyses were performed varying the definition of BSH. RESULTS Of 296 TAVR patients (78.3%) with interpretable images, 55 (18.6%) had BSH at a median of 40 days (interquartile range, 19-62 days) before TAVR. Age and sex were similar among those with and without BSH. BSH patients received postdilation more frequently (BSH+ vs BSH-: 41.8% vs 29.9%, P = .04). A total of 50 individuals (16.9%) received pacemakers within 30 days, and 128 (43.2%) developed conduction disturbances (with left bundle branch block most common), without differences between groups. BSH was unrelated to the primary outcome on multivariate analysis (adjusted odds ratio BSH+ vs BSH-, 0.94; 95% CI, 0.42-2.11; P = .88). CONCLUSIONS In this convenience sample of TAVR recipients at a large academic medical center, patients with BSH were more likely to receive postdilation. BSH was not associated with procedural or conduction outcomes after TAVR in patients without preexisting pacemakers.
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Affiliation(s)
- Nicholas J Kiefer
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Gregory C Salber
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Gordon M Burke
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - James D Chang
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Kimberly A Guibone
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jeffrey J Popma
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Rebecca T Hahn
- Division of Cardiology, NewYork-Presbyterian Hospital, New York, New York
| | - Duane S Pinto
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jordan B Strom
- Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Kundi H, Cohen DJ, Strom JB, Valsdottir L, Shen C, Choi E, Popma JJ, Yeh RW. Trends in isolated aortic valve replacement in the United States in the early phase of expansion of TAVR. Int J Cardiol 2019; 292:68-72. [PMID: 31255451 DOI: 10.1016/j.ijcard.2019.06.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/18/2019] [Accepted: 06/21/2019] [Indexed: 12/01/2022]
Abstract
This study aimed to evaluate changes in volume, risk profile, and outcomes among elderly individuals undergoing isolated aortic valve replacement (AVR) after TAVR approval in the United States. Retrospective cohort study of patients ≥65 years old with at least one procedural code for isolated SAVR or TAVR among the Medicare beneficiaries between January 1, 2009 and December 31, 2014. A total of 137,563 hospitalizations for isolated AVR between 2009 and 2014 were included (SAVR: 102,968 [74.9%]; TAVR: 34,595 [25.1%]). Overall AVR volumes increased by 21.8% per year after TAVR introduction, compared with 2.3% prior (p ≪ 0.001). Changes in SAVR volumes were similar both before and after TAVR introduction, (2.3% per year growth before vs. 2.1% after, p = 0.24). Although patient risk profiles increased among the AVR population (predicted 30-day mortality 4.0% in 2009 vs. 5.4% in 2014; p for trend =0.048), observed 30-day mortality (4.0% in 2009 vs. 3.9% in 2014; p for trend =0.96) and 1-year mortality (10.8% in 2009 to 12.2% in 2014; p for trend =0.069) rates remained stable. Among elderly U.S. patients enrolled in the Medicare, the introduction and the dissemination in the early phase of TAVR was associated with an expansion of AVR to high risk patients, without an observed reduction in the use of SAVR. This expansion was associated with similar mortality among all AVR patients, despite an increase in patient risk.
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Affiliation(s)
- Harun Kundi
- Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, United States of America
| | - David J Cohen
- Saint Luke's Mid-America Heart Institute, Kansas City, MO, United States of America
| | - Jordan B Strom
- Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, United States of America
| | - Linda Valsdottir
- Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, United States of America
| | - Changyu Shen
- Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, United States of America
| | - Eunhee Choi
- Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, United States of America
| | - Jeffrey J Popma
- Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, United States of America
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, United States of America.
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Iung B, Delgado V, Rosenhek R, Price S, Prendergast B, Wendler O, De Bonis M, Tribouilloy C, Evangelista A, Bogachev-Prokophiev A, Apor A, Ince H, Laroche C, Popescu BA, Piérard L, Haude M, Hindricks G, Ruschitzka F, Windecker S, Bax JJ, Maggioni A, Vahanian A. Contemporary Presentation and Management of Valvular Heart Disease: The EURObservational Research Programme Valvular Heart Disease II Survey. Circulation 2019; 140:1156-1169. [PMID: 31510787 DOI: 10.1161/circulationaha.119.041080] [Citation(s) in RCA: 241] [Impact Index Per Article: 48.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Valvular heart disease (VHD) is an important cause of mortality and morbidity and has been subject to important changes in management. The VHD II survey was designed by the EURObservational Research Programme of the European Society of Cardiology to analyze actual management of VHD and to compare practice with guidelines. METHODS Patients with severe native VHD or previous valvular intervention were enrolled prospectively across 28 countries over a 3-month period in 2017. Indications for intervention were considered concordant if the intervention was performed or scheduled in symptomatic patients, corresponding to Class I recommendations specified in the 2012 European Society of Cardiology and in the 2014 American Heart Association/American College of Cardiology VHD guidelines. RESULTS A total of 7247 patients (4483 hospitalized, 2764 outpatients) were included in 222 centers. Median age was 71 years (interquartile range, 62-80 years); 1917 patients (26.5%) were ≥80 years; and 3416 were female (47.1%). Severe native VHD was present in 5219 patients (72.0%): aortic stenosis in 2152 (41.2% of native VHD), aortic regurgitation in 279 (5.3%), mitral stenosis in 234 (4.5%), mitral regurgitation in 1114 (21.3%; primary in 746 and secondary in 368), multiple left-sided VHD in 1297 (24.9%), and right-sided VHD in 143 (2.7%). Two thousand twenty-eight patients (28.0%) had undergone previous valvular intervention. Intervention was performed in 37.0% and scheduled in 26.8% of patients with native VHD. The decision for intervention was concordant with Class I recommendations in symptomatic patients with severe single left-sided native VHD in 79.4% (95% CI, 77.1-81.6) for aortic stenosis, 77.6% (95% CI, 69.9-84.0) for aortic regurgitation, 68.5% (95% CI, 60.8-75.4) for mitral stenosis, and 71.0% (95% CI, 66.4-75.3) for primary mitral regurgitation. Valvular interventions were performed in 2150 patients during the survey; of them, 47.8% of patients with single left-sided native VHD were in New York Heart Association class III or IV. Transcatheter procedures were performed in 38.7% of patients with aortic stenosis and 16.7% of those with mitral regurgitation. CONCLUSIONS Despite good concordance between Class I recommendations and practice in patients with aortic VHD, the suboptimal number in mitral VHD and late referral for valvular interventions suggest the need to improve further guideline implementation.
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Affiliation(s)
- Bernard Iung
- AP-HP, Cardiology Department, DHU Fire, Bichat Hospital, Université de Paris, France (B.I.)
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, The Netherlands (V.D., J.J.B.)
| | - Raphael Rosenhek
- Department of Cardiology, Medical University of Vienna, Austria (R.R.)
| | - Susanna Price
- Unit of Critical Care, Royal Brompton & Harefield NHS Trust, London, UK (S.P.)
| | | | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK (O.W.)
| | - Michele De Bonis
- Vita-Salute San Raffaele University, Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Milan, Italy (M.D.B.)
| | | | - Arturo Evangelista
- Department of Cardiology, Hospital Vall d'Hebron, Barcelona, Spain (A.E.)
| | - Alexander Bogachev-Prokophiev
- Heart Valves Surgery Department, Meshalkin National Medical Research Center, Novosibirsk, Russian Federation (A.B.-P.)
| | - Astrid Apor
- Heart and Vascular Center, Budapest, Hungary (A.A.)
| | - Hüseyin Ince
- Department of Cardiology, Rostock University Medical Center, Germany (H.I.)
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France (C.L., A.M.)
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Institute of Cardiovascular Diseases, Bucharest, Romania (B.A.P.)
| | - Luc Piérard
- Cardiology Department, University Hospital of Liege, Sart Tilman University Hospital Center, Liège, Belgium (L.P.)
| | - Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus, Germany (M.H.)
| | - Gerhard Hindricks
- Department of Electrophysiology, University Leipzig-Heart Center, Germany (G.H.)
| | - Frank Ruschitzka
- Clinic of Cardiology, University Heart Centre, University Hospital, Zurich, Switzerland (F.R.)
| | - Stefan Windecker
- Cardiology Department, Bern University Hospital, Switzerland (S.W.)
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, The Netherlands (V.D., J.J.B.)
| | - Aldo Maggioni
- EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France (C.L., A.M.)
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He C, Xiao L, Liu J. Safety and efficacy of self-expandable Evolut R vs. balloon-expandable Sapien 3 valves for transcatheter aortic valve implantation: A systematic review and meta-analysis. Exp Ther Med 2019; 18:3893-3904. [PMID: 31602250 PMCID: PMC6777306 DOI: 10.3892/etm.2019.8000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/09/2019] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to systematically search literature and conduct a meta-analysis comparing the clinical efficacy and safety of Evolut R and Sapien 3 valves for transcatheter aortic valve implantation (TAVI). The PubMed, Biomed Central, Scopus, Cochrane library and Google scholar databases were searched for articles published up to June, 2019. A total of 5 studies were included. In total, 795 patients underwent TAVI with Evolut R, while 665 patients received the Sapien 3 valve in the included studies. Overall device success with Evolut R was 95.7% and with Sapien 3 was 94.2%. Pooled data indicated no significant differences between the 2 valves (OR, 1.12; 95% CI, 0.66–1.89; P=0.68; I2=0%). No significant differences were observed in the incidence of none to mild paravalvular leakage between the 2 groups (OR, 1.71; 95% CI, 0.83–3.54; P=0.14; I2=0%). Both mean [random; mean difference (MD) = −3.96; 95% CI, −4.61 to −3.31; P<0.00001, I2=0%] and peak (random; MD = −6.85; 95% CI, −8.22 to −5.48; P<0.00001, I2=0%) aortic valve gradients were significantly lower with Evolut R. No significant differences were observed in the 30-day mortality (OR, 1.32; 95% CI, 0.45–3.87; P=0.62; I2=0%) or 30-day stroke outcomes (OR, 0.76; 95% CI, 0.32–1.81; P=0.54; I2=0%) between the 2 devices. On the whole, the findings of this study indicate that Evolut R and Sapien 3 valves may be comparable in terms of device success and short-term complications. The differences between the 2 devices for post-operative moderate to severe paravalvular leak and permanent pacemaker implantation remain unclear. There is thus a need for a large multi-center randomized controlled trial to provide stronger evidence on this subject.
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Affiliation(s)
- Chenglin He
- Department of Cardiovascular Medicine, Hanchuan People's Hospital, Hanchuan, Hubei 431600, P.R. China
| | - Lang Xiao
- Department of Haematology, Hanchuan Hospital of Traditional Chinese Medicine, Hanchuan, Hubei 431600, P.R. China
| | - Junli Liu
- Department of Critical Care Medicine, Hanchuan People's Hospital, Hanchuan, Hubei 431600, P.R. China
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Arora S, Strassle PD, Kolte D, Ramm CJ, Falk K, Jack G, Caranasos TG, Cavender MA, Rossi JS, Vavalle JP. Length of Stay and Discharge Disposition After Transcatheter Versus Surgical Aortic Valve Replacement in the United States. Circ Cardiovasc Interv 2019; 11:e006929. [PMID: 30354596 DOI: 10.1161/circinterventions.118.006929] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND As transcatheter aortic valve replacement (TAVR) extends its reach to lower surgical risk patients, the differences between resource utilization for TAVR and surgical AVR (SAVR) will become increasingly important. METHODS AND RESULTS AVR procedures between January 2012 and September 2015 at hospitals performing TAVR were identified using the National Inpatient Sample databases. Adults aged ≥50 years with aortic stenosis who underwent isolated TAVR or SAVR were eligible for inclusion. Standardized morbidity ratio weights were calculated using patient demographics, comorbidities, and hospital characteristics. Weighted linear and generalized logistic regression models were used to estimate the effect of undergoing TAVR, compared with undergoing SAVR, on length of stay (LOS) and discharge disposition. In TAVR-performing hospitals, 7266 (40%) patients underwent TAVR (6107 endovascular approach and 1159 transapical approach), while 10 833 (60%) underwent isolated SAVR. Patients undergoing TAVR were older, more likely to be female, and had more comorbidities. From 2012 to 2015, average LOS declined for both TAVR (6.3 days to 4.6 days; P<0.0001) and SAVR (7.5 days to 6.8 days; P<0.0001), with greater reduction in the TAVR group ( P<0.0001). An increase in home/home health discharge was noted with TAVR (67.7%-77.4%; P<0.0001) but not with SAVR (76.8%-79.5%; P=0.25). After standardizing, patients undergoing TAVR had significantly shorter LOS (change in estimate, -2.93, 95% CI, -3.26 to -2.60) and lower incidence of transfer to skilled nursing facility (odds ratio, 0.45; 95% CI, 0.40-0.51) but no difference in in-hospital mortality (odds ratio, 0.85; 95% CI, 0.61-1.20) compared with if they had undergone SAVR. As compared with SAVR, patients who had TAVR performed via an endovascular approach had shorter LOS and lower rates of skilled nursing facility transfer, whereas in the transapical cohort, LOS, and skilled nursing facility transfer were similar to SAVR. CONCLUSIONS As compared with if they undergo SAVR, patients undergoing TAVR (by a nontransapical approach) had a shorter LOS and higher likelihood of home discharge, as opposed to skilled nursing facility. From 2012 to 2015, there was a greater trend towards a reduction of LOS and more home discharges among TAVR, as opposed to SAVR. These data have important implications in the era of constrained resources with a growing emphasis on reducing health care costs.
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Affiliation(s)
- Sameer Arora
- Division of Cardiology (S.A., C.J.R., M.A.C., J.S.R., J.P.V.), University of North Carolina, Chapel Hill.,Division of Epidemiology, Gillings School of Public Health (S.A., P.D.S.), University of North Carolina, Chapel Hill
| | - Paula D Strassle
- Division of Cardiology (S.A., C.J.R., M.A.C., J.S.R., J.P.V.), University of North Carolina, Chapel Hill.,Division of Surgery (P.D.S., T.G.C.), University of North Carolina, Chapel Hill
| | - Dhaval Kolte
- Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI (D.K.)
| | - Cassandra J Ramm
- Division of Cardiology (S.A., C.J.R., M.A.C., J.S.R., J.P.V.), University of North Carolina, Chapel Hill
| | - Kristine Falk
- Department of Internal Medicine (K.F., G.J.), University of North Carolina, Chapel Hill
| | - Godly Jack
- Department of Internal Medicine (K.F., G.J.), University of North Carolina, Chapel Hill
| | - Thomas G Caranasos
- Division of Surgery (P.D.S., T.G.C.), University of North Carolina, Chapel Hill
| | - Matthew A Cavender
- Division of Cardiology (S.A., C.J.R., M.A.C., J.S.R., J.P.V.), University of North Carolina, Chapel Hill
| | - Joseph S Rossi
- Division of Cardiology (S.A., C.J.R., M.A.C., J.S.R., J.P.V.), University of North Carolina, Chapel Hill
| | - John P Vavalle
- Division of Cardiology (S.A., C.J.R., M.A.C., J.S.R., J.P.V.), University of North Carolina, Chapel Hill
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Cox J, Noveras J, Harrell T, Nayak KR. When the pressure drops: A case of vasoplegia during a structural heart intervention. Catheter Cardiovasc Interv 2019; 94:280-284. [PMID: 31025531 DOI: 10.1002/ccd.28214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 02/07/2019] [Accepted: 03/16/2019] [Indexed: 01/21/2023]
Abstract
A 67-year-old male underwent general anesthesia for left atrial appendage occlusion. During the procedure, the patient developed catecholamine refractory hypotension requiring the administration of several vasopressin boluses to maintain adequate perfusion pressure. At the conclusion of the procedure, mild venous bleeding necessitated the administration of protamine. This led to a further decrease in the patient's blood pressure. Tamponade and continued volume loss were quickly ruled out leading to a diagnosis of vasoplegia syndrome (VS). The patient was appropriately treated with a vasopressin infusion with normalization of blood pressure and no significant morbidity or adverse outcome. With the use of general anesthesia during structural heart interventions on the rapid rise, we discuss the two common causes for vasoplegia along with evidence-based treatments and possible prevention strategies.
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Affiliation(s)
- Justin Cox
- Department of Cardiology, Naval Medical Center San Diego, San Diego, California
| | - Janette Noveras
- Department of Medicine, Naval Medical Center San Diego, San Diego, California
| | - Travis Harrell
- Department of Cardiology, Naval Medical Center San Diego, San Diego, California
| | - Keshav R Nayak
- Department of Cardiology, Naval Medical Center San Diego, San Diego, California.,San Diego Heart and Vascular Associates, San Diego, California.,Department of Cardiology, Scripps Mercy Hospital, San Diego, California
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12
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Ahmad M, Patel JN, Loc BL, Vipparthy SC, Divecha C, Barzallo PX, Kim M, Baman T, Barzallo M, Mungee S. Association Between Body Mass Index and Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement (TAVR) with Edwards SAPIEN™ 3 TAVR Valves: A Single-Center Experience. Cureus 2019; 11:e5142. [PMID: 31328076 PMCID: PMC6634273 DOI: 10.7759/cureus.5142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) can be complicated with a high-degree atrioventricular block requiring a permanent pacemaker (PPM) in 5% - 25% of patients. Association between body mass index (BMI) and pacemaker implantation has not been extensively studied. We compared standard BMI classes with the odds of requiring a PPM implantation in patients undergoing TAVR with Edwards SAPIEN™ 3 valves (ESV3) (Edwards Lifesciences, Irvine, CA, USA). METHODS Our study involved a single-center retrospective cohort analysis of 449 patients undergoing TAVR from December 2012 to April 2018. First, we excluded patients with a TAVR procedure done with valves other than the ESV3 (127 patients). Second, patients with a prior PPM or an implantable cardioverter-defibrillator (37 patients) were excluded. Finally, patients with an aborted procedure and surgical conversion were excluded (16 patients). The final sample size was 269. The primary outcome was pacemaker implantation. Statistical analysis was done using the Chi-square test, T-test, and adjusted logistic regression. RESULTS Of the 269 patients (50.6% males; mean age of 79.5 ± 8.7 years; mean Society of Thoracic Surgeons (STS) score: 6.2), pacemaker implantation was performed in 17 patients (6.3%). Time to pacemaker implantation was 1.3 days. Patients were divided into four categories based on their BMI: as underweight (BMI < 25; 67 patients), normal (BMI: 25 to ≤ 30; 87 patients), overweight (BMI: 30 to ≤ 35; 60 patients), and obese (BMI ≥ 35; 55 patients). Pacemaker implantation was significantly higher in patients with a BMI of > 30 (13 vs. 4, p = 0.037). After logistic linear regression, the odds of getting a PPM after TAVR were significantly higher in patients who were overweight (odds ratio (OR): 12.77, p = 0.024; confidence interval (CI): 1.39 - 17.25) and obese (OR: 15.02, p = 0.036, CI: 1.19 - 19.92). CONCLUSIONS Our study demonstrates that increased BMI is a possible risk factor for a high-degree atrioventricular block in patients receiving ESV3.
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Affiliation(s)
- Mansoor Ahmad
- Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Jay N Patel
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Brian L Loc
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Sharath C Vipparthy
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Chirag Divecha
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Pablo X Barzallo
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Minchul Kim
- Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Timir Baman
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Marco Barzallo
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Sudhir Mungee
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
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13
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Kundi H, Popma JJ, Reynolds MR, Strom JB, Pinto DS, Valsdottir LR, Shen C, Choi E, Yeh RW. Frailty and related outcomes in patients undergoing transcatheter valve therapies in a nationwide cohort. Eur Heart J 2019; 40:2231-2239. [PMID: 30977798 PMCID: PMC6626614 DOI: 10.1093/eurheartj/ehz187] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/29/2018] [Accepted: 03/13/2019] [Indexed: 12/21/2022] Open
Abstract
AIMS We sought to identify the prevalence and related outcomes of frail individuals undergoing transcatheter mitral valve repair and transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS Patients aged 65 and older were included in the study if they had at least one procedural code for transcatheter mitral valve repair or TAVR between 1 January 2016 and 31 December 2016 in the Centers for Medicare and Medicaid Services Medicare Provider and Review database. The Hospital Frailty Risk Score, an International Classification of Diseases, Tenth Revision (ICD-10) claims-based score, was used to identify frailty and the primary outcome was all-cause 1-year mortality. A total of 3746 (11.6%) patients underwent transcatheter mitral valve repair and 28 531 (88.4%) underwent TAVR. In the transcatheter mitral valve repair and TAVR populations, respectively, there were 1903 (50.8%) and 14 938 (52.4%) patients defined as low risk for frailty (score <5), 1476 (39.4%) and 11 268 (39.5%) defined as intermediate risk (score 5-15), and 367 (9.8%) and 2325 (8.1%) defined as high risk (score >15). One-year mortality was 12.8% in low-risk patients, 29.7% in intermediate-risk patients, and 40.9% in high-risk patients undergoing transcatheter mitral valve repair (log rank P < 0.001). In patients undergoing TAVR, 1-year mortality rates were 7.6% in low-risk patients, 17.6% in intermediate-risk patients, and 30.1% in high-risk patients (log rank P < 0.001). CONCLUSIONS This study successfully identified individuals at greater risk of short- and long-term mortality after undergoing transcatheter valve therapies in an elderly population in the USA using the ICD-10 claims-based Hospital Frailty Risk Score.
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Affiliation(s)
- Harun Kundi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Ave, Fourth Floor, Boston, MA, USA
- Baim Institute for Clinical Research, 930 Commonwealth Avenue #3, Boston, MA, USA
| | - Jeffrey J Popma
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Ave, Fourth Floor, Boston, MA, USA
- Baim Institute for Clinical Research, 930 Commonwealth Avenue #3, Boston, MA, USA
| | - Matthew R Reynolds
- Baim Institute for Clinical Research, 930 Commonwealth Avenue #3, Boston, MA, USA
- Division of Cardiology, Lahey Hospital & Medical Center, 41 Burlington Mall Road, Burlington, MA, USA
| | - Jordan B Strom
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Ave, Fourth Floor, Boston, MA, USA
| | - Duane S Pinto
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Ave, Fourth Floor, Boston, MA, USA
| | - Linda R Valsdottir
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Ave, Fourth Floor, Boston, MA, USA
| | - Changyu Shen
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Ave, Fourth Floor, Boston, MA, USA
| | - Eunhee Choi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Ave, Fourth Floor, Boston, MA, USA
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Ave, Fourth Floor, Boston, MA, USA
- Baim Institute for Clinical Research, 930 Commonwealth Avenue #3, Boston, MA, USA
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14
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Carpenter AJ, Novick WM, Sade RM. The Devoted Grandma: Is a Social Indication for TAVR Acceptable? Ann Thorac Surg 2019; 108:5-10. [PMID: 30910658 PMCID: PMC6931012 DOI: 10.1016/j.athoracsur.2019.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Andrea J Carpenter
- Department of Surgery, University of Texas Health Sciences Center, San Antonio, Texas
| | - William M Novick
- Department of Surgery, University of Tennessee Health Sciences Center and Global Surgery Institute, Memphis, Tennessee
| | - Robert M Sade
- Department of Surgery and Institute of Human Values in Health Care, Medical University of South Carolina, Charleston, South Carolina.
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15
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Douglas PS, Leon MB, Mack MJ, Svensson LG, Webb JG, Hahn RT, Pibarot P, Weissman NJ, Miller DC, Kapadia S, Herrmann HC, Kodali SK, Makkar RR, Thourani VH, Lerakis S, Lowry AM, Rajeswaran J, Finn MT, Alu MC, Smith CR, Blackstone EH. Longitudinal Hemodynamics of Transcatheter and Surgical Aortic Valves in the PARTNER Trial. JAMA Cardiol 2019; 2:1197-1206. [PMID: 28973520 DOI: 10.1001/jamacardio.2017.3306] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Use of transcatheter aortic valve replacement (TAVR) for severe aortic stenosis is growing rapidly. However, to our knowledge, the durability of these prostheses is incompletely defined. Objective To determine the midterm hemodynamic performance of balloon-expandable transcatheter heart valves. Design, Setting, and Participants In this study, we analyzed core laboratory-generated data from echocardiograms of all patients enrolled in the Placement of Aortic Transcatheter Valves (PARTNER) 1 Trial with successful TAVR or surgical AVR (SAVR) obtained preimplantation and at 7 days, 1 and 6 months, and 1, 2, 3, 4, and 5 years postimplantation. Patients from continued access observational studies were included for comparison. Interventions Successful implantation after randomization to TAVR vs SAVR (PARTNER 1A; TAVR, n = 321; SAVR, n = 313), TAVR vs medical treatment (PARTNER 1B; TAVR, n = 165), and continued access (TAVR, n = 1996). Five-year echocardiogram data were available for 424 patients after TAVR and 49 after SAVR. Main Outcomes and Measures Death or reintervention for aortic valve structural indications, measured using aortic valve mean gradient, effective orifice area, Doppler velocity index, and evidence of hemodynamic deterioration by reintervention, adverse hemodynamics, or transvalvular regurgitation. Results Of 2795 included patients, the mean (SD) age was 84.5 (7.1) years, and 1313 (47.0%) were female. Population hemodynamic trends derived from nonlinear mixed-effects models showed small early favorable changes in the first few months post-TAVR, with a decrease of -2.9 mm Hg in aortic valve mean gradient, an increase of 0.028 in Doppler velocity index, and an increase of 0.09 cm2 in effective orifice area. There was relative stability at a median follow-up of 3.1 (maximum, 5) years. Moderate/severe transvalvular regurgitation was noted in 89 patients (3.7%) after TAVR and increased over time. Patients with SAVR showed no significant changes. In TAVR, death/reintervention was associated with lower ejection fraction, stroke volume index, and aortic valve mean gradient up to 3 years, with no association with Doppler velocity index or valve area. Reintervention occurred in 20 patients (0.8%) after TAVR and in 1 (0.3%) after SAVR and became less frequent over time. Reintervention was caused by structural deterioration of transcatheter heart valves in only 5 patients. Severely abnormal hemodynamics on echocardiograms were also infrequent and not associated with excess death or reintervention for either TAVR or SAVR. Conclusions and Relevance This large, core laboratory-based study of transcatheter heart valves revealed excellent durability of the transcatheter heart valves and SAVR. Abnormal findings in individual patients, suggestive of valve thrombosis or structural deterioration, were rare in this protocol-driven database and require further investigation. Trial Registration clinicaltrials.gov Identifier: NCT00530894.
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Affiliation(s)
| | - Martin B Leon
- New York Presbyterian Hospital, Columbia University Medical Center, New York
| | | | | | - John G Webb
- St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rebecca T Hahn
- New York Presbyterian Hospital, Columbia University Medical Center, New York
| | - Philippe Pibarot
- Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | | | | | | | | | - Susheel K Kodali
- New York Presbyterian Hospital, Columbia University Medical Center, New York
| | - Raj R Makkar
- Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | | | | | - Matthew T Finn
- New York Presbyterian Hospital, Columbia University Medical Center, New York
| | - Maria C Alu
- New York Presbyterian Hospital, Columbia University Medical Center, New York
| | - Craig R Smith
- New York Presbyterian Hospital, Columbia University Medical Center, New York
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16
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Popma JJ, Deeb GM, Yakubov SJ, Mumtaz M, Gada H, O'Hair D, Bajwa T, Heiser JC, Merhi W, Kleiman NS, Askew J, Sorajja P, Rovin J, Chetcuti SJ, Adams DH, Teirstein PS, Zorn GL, Forrest JK, Tchétché D, Resar J, Walton A, Piazza N, Ramlawi B, Robinson N, Petrossian G, Gleason TG, Oh JK, Boulware MJ, Qiao H, Mugglin AS, Reardon MJ. Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients. N Engl J Med 2019; 380:1706-1715. [PMID: 30883053 DOI: 10.1056/nejmoa1816885] [Citation(s) in RCA: 2264] [Impact Index Per Article: 452.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Transcatheter aortic-valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis who are at increased risk for death from surgery; less is known about TAVR in low-risk patients. METHODS We performed a randomized noninferiority trial in which TAVR with a self-expanding supraannular bioprosthesis was compared with surgical aortic-valve replacement in patients who had severe aortic stenosis and were at low surgical risk. When 850 patients had reached 12-month follow-up, we analyzed data regarding the primary end point, a composite of death or disabling stroke at 24 months, using Bayesian methods. RESULTS Of the 1468 patients who underwent randomization, an attempted TAVR or surgical procedure was performed in 1403. The patients' mean age was 74 years. The 24-month estimated incidence of the primary end point was 5.3% in the TAVR group and 6.7% in the surgery group (difference, -1.4 percentage points; 95% Bayesian credible interval for difference, -4.9 to 2.1; posterior probability of noninferiority >0.999). At 30 days, patients who had undergone TAVR, as compared with surgery, had a lower incidence of disabling stroke (0.5% vs. 1.7%), bleeding complications (2.4% vs. 7.5%), acute kidney injury (0.9% vs. 2.8%), and atrial fibrillation (7.7% vs. 35.4%) and a higher incidence of moderate or severe aortic regurgitation (3.5% vs. 0.5%) and pacemaker implantation (17.4% vs. 6.1%). At 12 months, patients in the TAVR group had lower aortic-valve gradients than those in the surgery group (8.6 mm Hg vs. 11.2 mm Hg) and larger effective orifice areas (2.3 cm2 vs. 2.0 cm2). CONCLUSIONS In patients with severe aortic stenosis who were at low surgical risk, TAVR with a self-expanding supraannular bioprosthesis was noninferior to surgery with respect to the composite end point of death or disabling stroke at 24 months. (Funded by Medtronic; ClinicalTrials.gov number, NCT02701283.).
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Affiliation(s)
- Jeffrey J Popma
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - G Michael Deeb
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Steven J Yakubov
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Mubashir Mumtaz
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Hemal Gada
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Daniel O'Hair
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Tanvir Bajwa
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - John C Heiser
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - William Merhi
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Neal S Kleiman
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Judah Askew
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Paul Sorajja
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Joshua Rovin
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Stanley J Chetcuti
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - David H Adams
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Paul S Teirstein
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - George L Zorn
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - John K Forrest
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Didier Tchétché
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Jon Resar
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Antony Walton
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Nicolo Piazza
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Basel Ramlawi
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Newell Robinson
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - George Petrossian
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Thomas G Gleason
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Jae K Oh
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Michael J Boulware
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Hongyan Qiao
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Andrew S Mugglin
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
| | - Michael J Reardon
- From Beth Israel Deaconess Medical Center, Boston (J.J.P.); University of Michigan Hospitals, Ann Arbor (G.M.D., S.J.C.), and Spectrum Health Hospitals, Grand Rapids (J.C.H., W.M.) - both in Michigan; Riverside Methodist-Ohio Health, Columbus (S.J.Y.); University of Pittsburgh Medical Center Pinnacle Health, Harrisburg (M.M., H.G.), and the University of Pittsburgh, Pittsburgh (T.G.G.) - both in Pennsylvania; Aurora-Saint Luke's Medical Center, Milwaukee (D.O., T.B.); Houston Methodist Debakey Heart and Vascular Center, Houston (N.S.K., M.J.R.); Abbott Northwestern Hospital (J.A., P.S.) and Medtronic (M.J.B., H.Q.), Minneapolis, Mayo Clinic, Rochester (J.K.O.), and Paradigm Biostatistics, Anoka (A.S.M.) - all in Minnesota; Morton Plant Hospital, Clearwater, FL (J. Rovin); Mount Sinai Health System, New York (D.H.A.), and Saint Francis Hospital, Roslyn (N.R., G.P.) - both in New York; Scripps Clinic and Research Foundation, La Jolla, CA (P.S.T.); University of Kansas Hospital, Kansas City (G.L.Z.); Yale New Haven Hospital, New Haven, CT (J.K.F.); Clinique Pasteur, Toulouse, France (D.T.); Johns Hopkins Hospital, Baltimore (J. Resar); Alfred Hospital, Melbourne, VIC, Australia (A.W.); McGill University Health Centre, Montreal (N.P.); and Winchester Medical Center, Winchester, VA (B.R.)
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DeAndrade DS, Smith NF, McHugh SM. Airway Compression During Transcatheter Aortic Valve Replacement via Subclavian Artery Approach: A Case Report. A A Pract 2019; 12:329-331. [PMID: 30431441 DOI: 10.1213/xaa.0000000000000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is an alternative to traditional surgery in patients considered to be at high or intermediate risk for open surgical repair of aortic stenosis. Despite its overall safety and efficacy, TAVR is associated with potentially serious complications including major vascular injury. Tracheal compression resulting from vascular pathology has been previously reported; however, airway compromise secondary to vascular injury during TAVR has not been described. We report a case of airway compression and respiratory compromise resulting from injury to the right subclavian artery during TAVR.
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Affiliation(s)
- Diana S DeAndrade
- From the Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nicholas F Smith
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephen M McHugh
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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18
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Williams JV, Flynn Makic MB. Postoperative Care for Transcatheter Aortic Valve Replacement. J Perianesth Nurs 2019; 34:431-434. [PMID: 30819598 DOI: 10.1016/j.jopan.2018.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 12/31/2018] [Indexed: 11/28/2022]
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19
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Henn MC, Zajarias A, Quader N, Sintek M, Lasala JM, Koogler K, Damiano MS, Kachroo P, Miller DC, King CR, Melby SJ, Moon MR, Damiano RJ, Maniar HS. Observed to expected 30-day mortality as a benchmark for transcatheter aortic valve replacement. J Thorac Cardiovasc Surg 2019; 157:874-882.e8. [DOI: 10.1016/j.jtcvs.2018.06.097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/08/2018] [Accepted: 06/27/2018] [Indexed: 11/30/2022]
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20
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Teitelbaum M, Kotronias RA, Sposato LA, Bagur R. Cerebral Embolic Protection in TAVI: Friend or Foe. ACTA ACUST UNITED AC 2019; 14:22-25. [PMID: 30858888 PMCID: PMC6406126 DOI: 10.15420/icr.2018.32.2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Cerebrovascular accidents including stroke or transient ischaemic attack are one of the most feared complications after transcatheter aortic valve implantation. Transcatheter aortic valve implantation procedures have been consistently associated with silent ischaemic cerebral embolism as assessed by diffusion-weighted MRI. To reduce the risk of cerebrovascular accidents and silent emboli, cerebral embolic protection devices were developed with the aim of preventing procedural debris reaching the cerebral vasculature. The authors summarise the available data regarding cerebral embolic protection devices and its clinical significance.
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Affiliation(s)
| | - Rafail A Kotronias
- Oxford University Clinical Academic Graduate School, University of Oxford Oxford, UK.,Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust Oxford, UK.,Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele Stoke-on-Trent, UK
| | - Luciano A Sposato
- Department of Clinical Neurological Sciences, Stroke, Dementia & Heart Disease Laboratory London, Ontario, Canada
| | - Rodrigo Bagur
- London Health Sciences Centre London, Ontario, Canada.,Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele Stoke-on-Trent, UK.,Department of Epidemiology and Biostatistics, Western University London, Ontario, Canada
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21
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Miyasaka M, Yoon SH, Sharma RP, Maeno Y, Jaideep S, Taguri M, Kato S, Kawamori H, Nomura T, Ochiai T, Nemanpour S, Chakravarty T, Nakamura M, Wen C, Makkar R. Clinical Outcomes of Transcatheter Aortic Valve Implantation in Patients With Extremely Large Annulus and SAPIEN 3 Dimensions Based on Post-Procedural Computed Tomography. Circ J 2019; 83:672-680. [DOI: 10.1253/circj.cj-18-1059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | | | - Masataka Taguri
- Department of Data Science, Yokohama City University School of Data Science
- Sendai Kosei Hospital, Cardiovascular Center
| | - Shigeaki Kato
- Sendai Kosei Hospital, Cardiovascular Center
- Center for Regional Cooperation Iwaki, Meisei University
| | | | | | | | | | | | | | - Cheng Wen
- Cedars-Sinai Medical Center, Heart Institute
| | - Raj Makkar
- Cedars-Sinai Medical Center, Heart Institute
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22
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Abstract
Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure to treat severe symptomatic aortic stenosis. While the TAVI procedure can be performed safely and provide excellent 5-year results, little is known about long-term durability. TAVI valves are composed of bioprosthetic leaflets are prone to deterioration, which are categorized as structural valve deterioration (SVD) and non-SVD. SVD refers to an intrinsic pathology of the leaflets or stent structure with mechanisms that include leaflet calcification, leaflet tear, stent fracture, or stent creep. Non-SVD processes include valve thrombosis, infective endocarditis and patient prosthesis mismatch. TAVI valves degenerate by similar mechanisms as bioprosthetic surgical aortic valves. Unique mechanisms that contribute to TAVI degeneration include valve crimpling, balloon expansion, stent under-expansion and valve thrombosis. The absence of a universally accepted definition of SVD poses a challenge in estimating valve durability. Traditional surgical bioprosthetic aortic valves have demonstrated excellent durability with clinically relevant SVD of 6.6% at 10-year follow up. Long-term durability of TAVI valves, however, remain poorly defined. From meta-analysis TAVI trials, SVD was estimated at 7% at 5 years. With iterative improvements in TAVI valve construction and deployment techniques, long-term durability may improve. Until long-term outcomes are better understood, TAVI should be used with caution in younger patients.
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Affiliation(s)
- Akash Kataruka
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, WA, USA
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Kundi H, Strom JB, Valsdottir LR, Elmariah S, Popma JJ, Shen C, Yeh RW. Trends in Isolated Surgical Aortic Valve Replacement According to Hospital-Based Transcatheter Aortic Valve Replacement Volumes. JACC Cardiovasc Interv 2018; 11:2148-2156. [DOI: 10.1016/j.jcin.2018.07.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/21/2018] [Accepted: 07/03/2018] [Indexed: 11/29/2022]
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24
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Transcatheter Valve Procedures and the Anesthesiologist. Int Anesthesiol Clin 2018; 56:74-97. [PMID: 30204609 DOI: 10.1097/aia.0000000000000208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Shahian DM, Gleason TG, Shemin RJ, Carroll JD, Mack MJ. TAVR 2.0: Professional Societies Collaborating to Measure, Assure, and Improve Quality. Ann Thorac Surg 2018; 107:329-330. [PMID: 30076794 DOI: 10.1016/j.athoracsur.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 07/21/2018] [Indexed: 11/17/2022]
Affiliation(s)
- David M Shahian
- Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Thomas G Gleason
- Division of Cardiac Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Richard J Shemin
- Division of Cardiac Surgery, Department of Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - John D Carroll
- Division of Cardiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Michael J Mack
- Cardiothoracic Surgery, Baylor Scott & White Health, Plano, Texas
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Akinseye OA, Shahreyar M, Nwagbara CC, Nayyar M, Salem SA, Morsy M, Khouzam RN, Ibebuogu UN. Modifiable Predictors of In-Hospital Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement. Am J Med Sci 2018; 356:135-140. [DOI: 10.1016/j.amjms.2018.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 03/30/2018] [Accepted: 04/10/2018] [Indexed: 11/16/2022]
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27
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Fanaroff AC, Manandhar P, Holmes DR, Cohen DJ, Harrison JK, Hughes GC, Thourani VH, Mack MJ, Sherwood MW, Jones WS, Vemulapalli S. Peripheral Artery Disease and Transcatheter Aortic Valve Replacement Outcomes: A Report From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Therapy Registry. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.005456. [PMID: 29042398 DOI: 10.1161/circinterventions.117.005456] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 09/14/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Peripheral artery disease (PAD) is associated with increased cardiovascular mortality, and PAD risk factors overlap with those for aortic stenosis. The prevalence and outcomes associated with PAD in a population undergoing transcatheter aortic valve replacement (TAVR) are unknown. METHODS AND RESULTS Using the Society of Thoracic Surgeons/Transcatheter Valve Therapy Registry linked to Medicare claims data, we identified patients ≥65 years old undergoing TAVR from 2011 to 2015. We calculated hazard ratios for 1-year adverse outcomes, including mortality, readmission, and bleeding, for patients with PAD compared with those without, adjusting for baseline characteristics and postprocedure medications. Analyses were performed separately by access site (transfemoral and nontransfemoral). Of 19 660 patients undergoing transfemoral TAVR, 4810 (24.5%) had PAD; 3730 (47.9%) of 7780 patients undergoing nontransfemoral TAVR had PAD. In both groups, patients with PAD were significantly more likely to have coronary and carotid artery diseases. At 1-year follow-up, patients with PAD undergoing TAVR via transfemoral access had a higher incidence of death (16.8% versus 14.4%; adjusted hazard ratio, 1.14; P=0.01), readmission (45.5% versus 42.1%; hazard ratio, 1.11; P<0.001), and bleeding (23.1% versus 19.7%; hazard ratio, 1.18; P<0.001) compared with patients without PAD. Patients with PAD undergoing TAVR via nontransfemoral access did not have significantly higher rates of 1-year mortality or readmission compared with patients without PAD. CONCLUSIONS PAD is common among patients undergoing commercial TAVR via transfemoral and nontransfemoral access. Among patients undergoing transfemoral TAVR, PAD is associated with a higher incidence of 1-year adverse outcomes compared with absence of PAD. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01737528.
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Affiliation(s)
- Alexander C Fanaroff
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.).
| | - Pratik Manandhar
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - David R Holmes
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - David J Cohen
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - J Kevin Harrison
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - G Chad Hughes
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - Vinod H Thourani
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - Michael J Mack
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - Matthew W Sherwood
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - W Schuyler Jones
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - Sreekanth Vemulapalli
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
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Andrew BY, Cherry AD, Hauck JN, Nicoara A, Maxwell CD, Konoske RM, Thompson A, Kartha LD, Swaminathan M, Stafford-Smith M. The Association of Aortic Valve Pathology With Renal Resistive Index as a Kidney Injury Biomarker. Ann Thorac Surg 2018; 106:107-114. [PMID: 29427619 DOI: 10.1016/j.athoracsur.2018.01.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/14/2017] [Accepted: 01/03/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common serious complication after cardiac surgery. Doppler-determined renal resistive index (RRI) is a promising early AKI biomarker in this population. However, the relationship between aortic valve pathology (insufficiency and/or stenosis) and RRI is unknown. This study aimed to investigate RRI variability related to aortic valve pathology. METHODS In a retrospective review of cardiac surgery patients, RRI and aortic valve pathology were assessed prior to cardiopulmonary bypass using transesophageal echocardiography. Aortic valve status was categorized into four subgroups: normal (insufficiency and stenosis, none/trace/mild), insufficiency (insufficiency, moderate/severe; stenosis, none/trace/mild), combined insufficiency/stenosis (insufficiency and stenosis, moderate/severe), or stenosis (insufficiency, none/trace/mild; stenosis, moderate/severe). RRI and time-matched hemodynamic and Doppler measurements were compared among subgroups. RESULTS Of 175 patients, 60 had aortic valve pathology (16 insufficiency, 18 insufficiency/stenosis, 26 stenosis). Compared with the normal subgroup, patients with aortic insufficiency had lower diastolic blood pressure and trough renal Doppler velocities, and higher RRI (0.77 versus 0.69; p < 0.001); patients with combined insufficiency/stenosis also had higher RRI (0.72 versus 0.69, p = 0.042). CONCLUSIONS Patients with aortic insufficiency and combined insufficiency/stenosis had higher median RRI values compared with normal patients. For these individuals, diastolic flow differences related to aortic insufficiency may explain why their presurgery RRI values often exceeded postoperative thresholds typically associated with AKI. Strategies to account for the potentially confounding effects of aortic insufficiency on renal flow patterns, independent of renal injury, may add to the value of RRI as an early AKI biomarker.
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Affiliation(s)
- Benjamin Y Andrew
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina; Clinical Research Training Program, Duke University School of Medicine, Durham, North Carolina
| | - Anne D Cherry
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Jennifer N Hauck
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Alina Nicoara
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Cory D Maxwell
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Ryan M Konoske
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Annemarie Thompson
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Lakshmi D Kartha
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Madhav Swaminathan
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Mark Stafford-Smith
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
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Mangi AA, Ramchandani M, Reardon M. Surgical Removal and Replacement of Chronically Implanted Transcatheter Aortic Prostheses: How I Teach It. Ann Thorac Surg 2018; 105:12-14. [DOI: 10.1016/j.athoracsur.2017.08.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 07/19/2017] [Accepted: 08/07/2017] [Indexed: 11/27/2022]
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The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2018 Update on Outcomes and Quality. Ann Thorac Surg 2018; 105:15-23. [DOI: 10.1016/j.athoracsur.2017.10.035] [Citation(s) in RCA: 238] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 10/21/2017] [Indexed: 11/22/2022]
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31
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Antonides CFJ, Mack MJ, Kappetein AP. Approaches to the Role of The Heart Team in Therapeutic Decision Making for Heart Valve Disease. STRUCTURAL HEART 2017. [DOI: 10.1080/24748706.2017.1380377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Christiaan F. J. Antonides
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center Rotterdam, Thoraxcentrum, Rotterdam, The Netherlands
| | - Michael J. Mack
- Baylor Scott and White Healthcare System, Baylor University Medical Center, Baylor Heart and Vascular Hospital, Dallas, Texas, USA
- The Heart Hospital Baylor Plano, Plano, Texas, USA
| | - A. Pieter Kappetein
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center Rotterdam, Thoraxcentrum, Rotterdam, The Netherlands
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Mack MJ, Acker MA, Gelijns AC, Overbey JR, Parides MK, Browndyke JN, Groh MA, Moskowitz AJ, Jeffries NO, Ailawadi G, Thourani VH, Moquete EG, Iribarne A, Voisine P, Perrault LP, Bowdish ME, Bilello M, Davatzikos C, Mangusan RF, Winkle RA, Smith PK, Michler RE, Miller MA, O’Sullivan KL, Taddei-Peters WC, Rose EA, Weisel RD, Furie KL, Bagiella E, Moy CS, O’Gara PT, Messé SR. Effect of Cerebral Embolic Protection Devices on CNS Infarction in Surgical Aortic Valve Replacement: A Randomized Clinical Trial. JAMA 2017; 318:536-547. [PMID: 28787505 PMCID: PMC5808875 DOI: 10.1001/jama.2017.9479] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Stroke is a major complication of surgical aortic valve replacement (SAVR). OBJECTIVE To determine the efficacy and adverse effects of cerebral embolic protection devices in reducing ischemic central nervous system (CNS) injury during SAVR. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial of patients with calcific aortic stenosis undergoing SAVR at 18 North American centers between March 2015 and July 2016. The end of follow-up was December 2016. INTERVENTIONS Use of 1 of 2 cerebral embolic protection devices (n = 118 for suction-based extraction and n = 133 for intra-aortic filtration device) vs a standard aortic cannula (control; n = 132) at the time of SAVR. MAIN OUTCOMES AND MEASURES The primary end point was freedom from clinical or radiographic CNS infarction at 7 days (± 3 days) after the procedure. Secondary end points included a composite of mortality, clinical ischemic stroke, and acute kidney injury within 30 days after surgery; delirium; mortality; serious adverse events; and neurocognition. RESULTS Among 383 randomized patients (mean age, 73.9 years; 38.4% women; 368 [96.1%] completed the trial), the rate of freedom from CNS infarction at 7 days was 32.0% with suction-based extraction vs 33.3% with control (between-group difference, -1.3%; 95% CI, -13.8% to 11.2%) and 25.6% with intra-aortic filtration vs 32.4% with control (between-group difference, -6.9%; 95% CI, -17.9% to 4.2%). The 30-day composite end point was not significantly different between suction-based extraction and control (21.4% vs 24.2%, respectively; between-group difference, -2.8% [95% CI, -13.5% to 7.9%]) nor between intra-aortic filtration and control (33.3% vs 23.7%; between-group difference, 9.7% [95% CI, -1.2% to 20.5%]). There were no significant differences in mortality (3.4% for suction-based extraction vs 1.7% for control; and 2.3% for intra-aortic filtration vs 1.5% for control) or clinical stroke (5.1% for suction-based extraction vs 5.8% for control; and 8.3% for intra-aortic filtration vs 6.1% for control). Delirium at postoperative day 7 was 6.3% for suction-based extraction vs 15.3% for control (between-group difference, -9.1%; 95% CI, -17.1% to -1.0%) and 8.1% for intra-aortic filtration vs 15.6% for control (between-group difference, -7.4%; 95% CI, -15.5% to 0.6%). Mortality and overall serious adverse events at 90 days were not significantly different across groups. Patients in the intra-aortic filtration group vs patients in the control group experienced significantly more acute kidney injury events (14 vs 4, respectively; P = .02) and cardiac arrhythmias (57 vs 30; P = .004). CONCLUSIONS AND RELEVANCE Among patients undergoing SAVR, cerebral embolic protection devices compared with a standard aortic cannula did not significantly reduce the risk of CNS infarction at 7 days. Potential benefits for reduction in delirium, cognition, and symptomatic stroke merit larger trials with longer follow-up. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02389894.
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Affiliation(s)
- Michael J. Mack
- Department of Cardiothoracic Surgery, Baylor Research Institute, Baylor Scott & White Health, Plano, Texas
| | - Michael A. Acker
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia
| | - Annetine C. Gelijns
- International Center for Health Outcomes and Innovation Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jessica R. Overbey
- International Center for Health Outcomes and Innovation Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael K. Parides
- International Center for Health Outcomes and Innovation Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeffrey N. Browndyke
- Division of Geriatric Behavioral Health, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Mark A. Groh
- Cardiovascular and Thoracic Surgery, Mission Health and Hospitals, Asheville, North Carolina
| | - Alan J. Moskowitz
- International Center for Health Outcomes and Innovation Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Neal O. Jeffries
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville
| | - Vinod H. Thourani
- Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Ellen G. Moquete
- International Center for Health Outcomes and Innovation Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexander Iribarne
- Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Pierre Voisine
- Institut Universitaire de Cardiologie de Québec, Hôpital Laval, Quebec, Quebec, Canada
| | - Louis P. Perrault
- Montréal Heart Institute, University of Montréal, Montreal, Quebec, Canada
| | - Michael E. Bowdish
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles
| | - Michel Bilello
- Department of Radiology, University of Pennsylvania, Philadelphia
| | | | - Ralph F. Mangusan
- Cardiovascular and Thoracic Surgery, Mission Health and Hospitals, Asheville, North Carolina
| | - Rachelle A. Winkle
- Department of Cardiothoracic Surgery, Baylor Research Institute, Baylor Scott & White Health, Plano, Texas
| | - Peter K. Smith
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Robert E. Michler
- Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
| | - Marissa A. Miller
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Karen L. O’Sullivan
- International Center for Health Outcomes and Innovation Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Wendy C. Taddei-Peters
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Eric A. Rose
- Department of Cardiac Surgery, Mount Sinai Health System, New York, New York
| | - Richard D. Weisel
- Peter Munk Cardiac Centre and Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network and the Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Karen L. Furie
- Department of Neurology, Rhode Island Hospital, Miriam Hospital and Bradley Hospital, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Emilia Bagiella
- International Center for Health Outcomes and Innovation Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Claudia Scala Moy
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Patrick T. O’Gara
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Steven R. Messé
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia
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Hawkins RB, Downs EA, Johnston LE, Mehaffey JH, Fonner CE, Ghanta RK, Speir AM, Rich JB, Quader MA, Yarboro LT, Ailawadi G. Impact of Transcatheter Technology on Surgical Aortic Valve Replacement Volume, Outcomes, and Cost. Ann Thorac Surg 2017; 103:1815-1823. [PMID: 28450137 PMCID: PMC5596915 DOI: 10.1016/j.athoracsur.2017.02.039] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/16/2017] [Accepted: 02/13/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) represents a disruptive technology that is rapidly expanding in use. We evaluated the effect on surgical aortic valve replacement (SAVR) patient selection, outcomes, volume, and cost. METHODS A total of 11,565 patients who underwent SAVR, with or without coronary artery bypass grafting (2002 to 2015), were evaluated from the Virginia Cardiac Services Quality Initiative database. Patients were stratified by surgical era: pre-TAVR era (2002 to 2008, n = 5,113), early-TAVR era (2009 to 2011, n = 2,709), and commercial-TAVR era (2012 to 2015, n = 3,743). Patient characteristics, outcomes, and resource utilization were analyzed by univariate analyses. RESULTS Throughout the study period, statewide SAVR volumes increased with median volumes of pre-TAVR: 722 cases/year, early-TAVR: 892 cases/year, and commercial-TAVR: 940 cases/year (p = 0.005). Implementation of TAVR was associated with declining Society of Thoracic Surgeons predicted risk of mortality among SAVR patients (3.7%, 2.6%, and 2.4%; p < 0.0001), despite increasing rates of comorbid disease. The mortality rate was lowest in the current commercial-TAVR era (3.9%, 4.3%, and 3.2%; p = 0.05), and major morbidity decreased throughout the time period (21.2%, 20.5%, and 15.2%; p < 0.0001). The lowest observed-to-expected ratios for both occurred in the commercial-TAVR era (0.9 and 0.9, respectively). Resource utilization increased generally, including total cost increases from $42,835 to $51,923 to $54,710 (p < 0.0001). CONCLUSIONS At present, SAVR volumes have not been affected by the introduction of TAVR. The outcomes for SAVR continue to improve, potentially due to availability of transcatheter options for high-risk patients. Despite rising costs for SAVR, open approaches still provide a significant cost advantage over TAVR.
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Affiliation(s)
- Robert B Hawkins
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Emily A Downs
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Lily E Johnston
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - J Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Clifford E Fonner
- Virginia Cardiac Services Quality Initiative, Falls Church, Virginia
| | - Ravi K Ghanta
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Alan M Speir
- INOVA Heart and Vascular Institute, Falls Church, Virginia
| | - Jeffrey B Rich
- Virginia Cardiac Services Quality Initiative, Falls Church, Virginia
| | - Mohammed A Quader
- Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Leora T Yarboro
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
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Bavaria JE, Prager RL, Naunheim KS, Allen MS, Higgins RSD, Thourani VH, MacGillivray TE, Boden N, Sabik JF. Surgeon Involvement in Transcatheter Aortic Valve Replacement in the United States: A 2016 Society of Thoracic Surgeons Survey. Ann Thorac Surg 2017; 104:1088-1093. [PMID: 28408203 DOI: 10.1016/j.athoracsur.2017.03.055] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The Society of Thoracic Surgeons (STS) surveyed cardiothoracic surgeon participants in its Adult Cardiac Surgery Database (ACSD) to learn the extent of surgeon involvement in transcatheter aortic valve replacement (TAVR) procedures. METHODS An electronic survey was delivered to 2,594 surgeons in June 2016. When the survey closed 2 weeks later, 487 completed surveys had been submitted for a response rate of 18.8%. RESULTS Among the 487 participants in the ACSD who responded to the survey, 410 (84.2%) reported that TAVR was performed at their institutions. Approximately three-quarters reported that they performed TAVR procedures as part of a heart team (77.5%; 313 of 404), cardiologists and cardiothoracic surgeons were jointly responsible for TAVR referrals (83.7%; 339 of 405), and TAVR programs were administered either jointly by the cardiology and cardiac surgery departments or exclusively by the cardiac surgery department (73.3%; 297 of 405). A majority were involved in the pre-, intra-, and postoperative care of patients undergoing TAVR, with 91.4% (370 of 405) reporting participation in multidisciplinary meetings, at least 50% regularly performing technical aspects in 10 of 11 conduct of operation categories, and 86.6% (266 of 307) caring for patients undergoing TAVR after the procedure. CONCLUSIONS Cardiac surgeons in the United States are active participants in the management of patients with aortic stenosis as part of the heart team. The STS survey found that not only were they actively involved in the treatment decision-making process but they also played a significant role in the valve procedure, including deployment and postprocedural care. The heart team model continues to evolve and should be expanded into other areas of structural heart disease.
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Affiliation(s)
- Joseph E Bavaria
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Richard L Prager
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Keith S Naunheim
- Department of Surgery, Saint Louis University Medical Center, St. Louis, Missouri
| | - Mark S Allen
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Robert S D Higgins
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vinod H Thourani
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | | | | | - Joseph F Sabik
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Ailawadi G, Iung B. The TVT Registry: Collaboration Leading to Quality Control. Ann Thorac Surg 2017; 103:693-694. [PMID: 28219542 DOI: 10.1016/j.athoracsur.2017.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 01/15/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Gorav Ailawadi
- Department of Surgery, University of Virginia, Charlottesville, Virginia.
| | - Bernard Iung
- Cardiology Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire Fibrosis, Inflammation, Remodeling in Cardiovascular, Respiratory and Renal Diseases, Paris-Diderot University, Paris, France
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