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Sugiura A, Yamamoto M, Saji M, Asami M, Enta Y, Nakashima M, Shirai S, Izumo M, Mizuno S, Watanabe Y, Amaki M, Kodama K, Yamaguchi J, Nakajima Y, Naganuma T, Bota H, Ohno Y, Yamawaki M, Ueno H, Mizutani K, Adachi Y, Otsuka T, Kubo S, Nickenig G, Hayashida K. Cardiac Damage in Degenerative Mitral Regurgitation Treated With Transcatheter Mitral Edge-to-Edge Repair. Circ Cardiovasc Interv 2024; 17:e013794. [PMID: 38629311 PMCID: PMC11177598 DOI: 10.1161/circinterventions.123.013794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/27/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND The extent of cardiac damage and its association with clinical outcomes in patients undergoing transcatheter edge-to-edge repair (TEER) for degenerative mitral regurgitation remains unclear. This study was aimed to investigate cardiac damage in patients with degenerative mitral regurgitation treated with TEER and its association with outcomes. METHODS We analyzed patients with degenerative mitral regurgitation treated with TEER in the Optimized Catheter Valvular Intervention-Mitral registry, which is a prospective, multicenter observational data collection in Japan. The study subjects were classified according to the extent of cardiac damage at baseline: no extravalvular cardiac damage (stage 0), mild left ventricular or left atrial damage (stage 1), moderate left ventricular or left atrial damage (stage 2), or right heart damage (stage 3). Two-year mortality after TEER was compared using Kaplan-Meier analysis. RESULTS Out of 579 study participants, 8 (1.4%) were classified as stage 0, 76 (13.1%) as stage 1, 319 (55.1%) as stage 2, and 176 (30.4%) as stage 3. Two-year survival was 100% in stage 0, 89.5% in stage 1, 78.9% in stage 2, and 75.3% in stage 3 (P=0.013). Compared with stage 0 to 1, stage 2 (hazard ratio, 3.34 [95% CI, 1.03-10.81]; P=0.044) and stage 3 (hazard ratio, 4.51 [95% CI, 1.37-14.85]; P=0.013) were associated with increased risk of 2-year mortality after TEER. Significant reductions in heart failure rehospitalization rate and New York Heart Association functional scale were observed following TEER (both, P<0.001), irrespective of the stage of cardiac damage. CONCLUSIONS Advanced cardiac damage is associated with an increased risk of mortality in patients undergoing TEER for degenerative mitral regurgitation. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: UMIN000023653.
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Affiliation(s)
- Atsushi Sugiura
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Germany (A.S., G.N.)
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Japan (M. Yamamoto, Y.A.)
- Department of Cardiology, Nagoya Heart Center, Japan (M. Yamamoto, Y.A.)
- Department of Cardiology, Gifu Heart Center, Japan (M. Yamamoto)
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan (M.S.)
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan (M.S.)
| | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan (M. Asami)
| | - Yusuke Enta
- Department of Cardiology, Sendai Kosei Hospital, Japan (Y.E., M.N.)
| | - Masaki Nakashima
- Department of Cardiology, Sendai Kosei Hospital, Japan (Y.E., M.N.)
| | - Shinichi Shirai
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (S.S.)
| | - Masaki Izumo
- Division of Cardiology, St. Marianna University School of Medicine Hospital, Kawasaki, Japan (M.I.)
| | - Shingo Mizuno
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan (S.M.)
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan (Y.W.)
| | - Makoto Amaki
- Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan (M. Amaki)
| | - Kazuhisa Kodama
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Japan (K.K.)
| | - Junichi Yamaguchi
- Department of Cardiology Tokyo Woman’s Medical University, Japan (J.Y.)
| | - Yoshifumi Nakajima
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Japan (Y.N.)
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.)
| | - Hiroki Bota
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Japan (H.B.)
| | - Yohei Ohno
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan. Department of Cardiology (Y.O.)
| | - Masahiro Yamawaki
- Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan (M. Yamawaki)
| | - Hiroshi Ueno
- Second Department of Internal Medicine, Toyama University Hospital, Japan (H.U.)
| | - Kazuki Mizutani
- Division of Cardiology, Department of Medicine, Kindai University Faculty of Medicine, Osaka, Japan (K.M.)
| | - Yuya Adachi
- Department of Cardiology, Toyohashi Heart Center, Japan (M. Yamamoto, Y.A.)
- Department of Cardiology, Nagoya Heart Center, Japan (M. Yamamoto, Y.A.)
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.)
| | - Shunsuke Kubo
- Department of Cardiology, Kurashiki Central Hospital, Japan (S.K.)
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Germany (A.S., G.N.)
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (K.H.)
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Grayburn PA, Mack MJ, Manandhar P, Kosinski AS, Sannino A, Smith RL, Szerlip M, Vemulapalli S. Comparison of Transcatheter Edge-to-Edge Mitral Valve Repair for Primary Mitral Regurgitation Outcomes to Hospital Volumes of Surgical Mitral Valve Repair. Circ Cardiovasc Interv 2024; 17:e013581. [PMID: 38436084 DOI: 10.1161/circinterventions.123.013581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/26/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Transcatheter edge-to-edge mitral valve (MV) repair (TEER) is an effective treatment for patients with primary mitral regurgitation at prohibitive risk for surgical MV repair (MVr). High-volume MVr centers and high-volume TEER centers have better outcomes than low-volume centers, respectively. However, whether MVr volume predicts TEER outcomes remains unknown. We hypothesized that high-volume MV surgical centers would have superior risk-adjusted outcomes for TEER than low-volume centers. METHODS We combined data from the American College of Cardiology/Society of Thoracic Surgeons Transcatheter Valve Therapy registry and the Society of Thoracic Surgeons adult cardiac surgery database. MVr was defined as leaflet resection or artificial chords with or without annuloplasty and was evaluated as a continuous variable and as predefined categories (<25, 25-49, and ≥50 MV repairs/year). A generalized linear mixed model was used to evaluate risk-adjusted in-hospital/30-day mortality, 30-day heart failure readmission, and TEER success (mitral regurgitation ≤2+ and gradient <5 mm Hg). RESULTS The study comprised 41 834 patients from 500 sites of which 332 (66.4%) were low, 102 (20.4%) intermediate, and 66 (13.2%) high-volume surgical centers (P<0.001). TEER success was 54.6% and was not statistically significantly different across MV surgical site volumes (P=0.4271). TEER mortality at 30 days was 3.5% with no significant difference across MVr volume on unadjusted (P=0.141) or adjusted (P=0.071) analysis of volume as a continuous variable. One-year mortality was 15.0% and was lower for higher MVr volume centers when adjusted for clinical and demographic variables (P=0.027). Heart failure readmission at 1 year was 9.4% and was statistically significantly lower in high-volume centers on both unadjusted (P=0.017) or adjusted (P=0.015) analysis. CONCLUSIONS TEER can be safely performed in centers with low volumes of MV repair. However, 1-year mortality and heart failure readmission are superior at centers with higher MVr volume.
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Affiliation(s)
- Paul A Grayburn
- Baylor Scott and White Heart Hospital Plano, TX (P.A.G., M.J.M., A.S., R.L.S., M.S.)
| | - Michael J Mack
- Baylor Scott and White Heart Hospital Plano, TX (P.A.G., M.J.M., A.S., R.L.S., M.S.)
| | | | | | - Anna Sannino
- Baylor Scott and White Heart Hospital Plano, TX (P.A.G., M.J.M., A.S., R.L.S., M.S.)
| | - Robert L Smith
- Baylor Scott and White Heart Hospital Plano, TX (P.A.G., M.J.M., A.S., R.L.S., M.S.)
| | - Molly Szerlip
- Baylor Scott and White Heart Hospital Plano, TX (P.A.G., M.J.M., A.S., R.L.S., M.S.)
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3
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Alkhouli M, Crestanello JA, Rihal CS. Universal Mastery in Valve Disease Treatment: Myth or Attainable Goal? JACC Cardiovasc Interv 2024; 17:516-519. [PMID: 38340103 DOI: 10.1016/j.jcin.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
| | - Juan A Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Gedela M, Cangut B, Safi L, Krishnamoorthy P, Pandis D, El-Eshmawi A, Tang GHL. Mitral Valve Intervention in Elderly or High-Risk Patients: A Review of Current Surgical and Interventional Management. Can J Cardiol 2024; 40:250-262. [PMID: 38042339 DOI: 10.1016/j.cjca.2023.11.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 11/25/2023] [Accepted: 11/26/2023] [Indexed: 12/04/2023] Open
Abstract
Mitral regurgitation is a prevalent valvular disease, and its management has gained increasing importance because of the aging population. Although traditional surgery remains the gold standard, the field of transcatheter therapies, including transcatheter edge-to-edge repair and, more recently transcatheter mitral valve replacement are advancing and are being explored as viable alternatives, particularly for patients at high surgical risk. It is essential to emphasize the necessity of a multidisciplinary team approach, involving specialized valve teams, imaging experts, cardiac anaesthesiologists, and other relevant specialists, is crucial in achieving optimal outcomes. Furthermore, proper execution of procedures, postprocedural care, and diligent follow-up for these patients are essential components for successful results. It is essential to underscore that traditional mitral valve surgery continues to play a significant role. Simultaneously, it is important to acknowledge the expanding array of transcatheter interventions available for this specific patient population.
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Affiliation(s)
- Maheedhar Gedela
- Heartland Cardiology, Wesley Medical Center, Wichita, Kansas, USA
| | - Busra Cangut
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lucy Safi
- Division of Cardiology, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Parasuram Krishnamoorthy
- Division of Cardiology, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dimosthenis Pandis
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ahmed El-Eshmawi
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Wyler von Ballmoos MC, Kaneko T, Iribarne A, Kim KM, Arghami A, Fiedler A, Habib R, Parsons N, Elhalabi Z, Krohn C, Bowdish ME. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2023 Update on Procedure Data and Research. Ann Thorac Surg 2024; 117:260-270. [PMID: 38040323 DOI: 10.1016/j.athoracsur.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/09/2023] [Accepted: 11/18/2023] [Indexed: 12/03/2023]
Abstract
The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database is one of the largest and most comprehensive contemporary clinical databases in use. It now contains >9 million procedures from 1010 participants and 3651 active surgeons. Using audited data collection, it has provided the foundation for multiple risk models, performance metrics, health policy decisions, and a trove of research studies to improve the care of patients in need of cardiac surgical procedures. This annual report provides an update on the current status of the database and summarizes the development of new risk models and the STS Online Risk Calculator. Further, it provides insights into current practice patterns, such as the change in the demographics among patients undergoing aortic valve replacement, the use of minimally invasive techniques for valve and bypass surgery, or the adoption of surgical ablation and left atrial appendage ligation among patients with atrial fibrillation. Lastly, an overview of the research conducted using the STS Adult Cardiac Surgery Database and future directions for the database are provided.
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Affiliation(s)
- Moritz C Wyler von Ballmoos
- Department of Cardiovascular Surgery, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
| | - Tsuyoshi Kaneko
- Division of Cardiothoracic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Alexander Iribarne
- Department of Cardiothoracic Surgery, Staten Island University Hospital, Staten Island, New York
| | - Karen M Kim
- Institute for Cardiovascular Health, UT Health Austin, Austin, Texas
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Amy Fiedler
- Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Robert Habib
- The Society of Thoracic Surgeons, Chicago, Illinois
| | | | | | - Carole Krohn
- The Society of Thoracic Surgeons, Chicago, Illinois
| | - Michael E Bowdish
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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6
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Liu Z, Wei P, Jiang H, Zhang F, Ouyang W, Wang S, Fang F, Pan X. Alerting trends in epidemiology for non-rheumatic degenerative mitral valve disease, 1990-2019: An age-period-cohort analysis for the Global Burden of Disease Study 2019. Int J Cardiol 2024; 395:131561. [PMID: 37913964 DOI: 10.1016/j.ijcard.2023.131561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/05/2023] [Accepted: 10/27/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND The global and national burden of rheumatic mitral valve disease (MVD) has been well studied and estimated before. However, little is known about non-rheumatic degenerative MVD. Therefore, this study aimed to assess the trends in non-rheumatic degenerative MVD (NRDMVD) epidemiology, with an emphasis on NRDMVD mortality, leading risk factors, and their associations with age, period, and birth cohort. METHODS Using the data derived from the Global Burden of Disease Study 2019, including prevalence, mortality, and disability-adjusted life years, we analyzed the burden of NRDMVD and the detailed trends of NRDMVD mortality over the past 30 years in 204 countries and territories by implementing the age-period-cohort framework. RESULTS Globally, the number of deaths due to NRDMVD increased from 5695.89 (95% uncertainty interval [UI]: 5405.19 to 5895.4) × 1000 in 1990 to 9137.79 (95% UI: 8395.68 to 9743.55) × 1000 in 2019. The all-age mortality rate increased from 106.47 (95% UI: 101.03 to 110.2) per 100,000 to 118.1 (95% UI: 108.51 to 125.93) per 100,000, whereas the age-standardized mortality rate decreased from 170.45 (95% UI: 159.61 to 176.94) per 100,000 to 117.95 (95% UI: 107.83 to 125.92) per 100,000. The estimated net drift of mortality per year was -1.1% (95% confidence interval: -1.17 to -1.04). The risk of death due to NRDMVD increased with age, reaching its peak after 85 years old globally. Despite female patients being associated with lower local drift than male patients, no significant gender differences were observed in the age effect across countries and regions for all sociodemographic index (SDI) levels, except low-SDI regions. CONCLUSIONS We estimated the global disease prevalence of and mortality due to NRDMVD over approximately a 30-year period. The health-related burden of NRDMVD has declined worldwide; however, the condition persisted in low-SDI regions. Moreover, higher attention should be paid to female patients.
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Affiliation(s)
- Zeye Liu
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Peijian Wei
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hong Jiang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fengwen Zhang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wenbin Ouyang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shouzheng Wang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fang Fang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiangbin Pan
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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7
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Slostad B, Ayuba G, Puthumana JJ. Primary Mitral Regurgitation and Heart Failure: Current Advances in Diagnosis and Management. Heart Fail Clin 2023; 19:297-305. [PMID: 37230645 DOI: 10.1016/j.hfc.2023.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Primary mitral regurgitation is a frequent etiology of congestive heart failure and is best treated with intervention when patients are symptomatic or when additional risk factors exist. Surgical intervention improves outcomes in appropriately selected patients. However, for those at high surgical risk, transcatheter intervention provides less invasive repair and replacement options while providing comparable outcomes to surgery. The excess mortality and high prevalence of heart failure in untreated mitral regurgitation illuminate the need for further developments in mitral valve intervention ideally fulfilled by expanding these types of procedures and eligibility to these procedures beyond only those at high surgical risk.
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Affiliation(s)
- Brody Slostad
- Bluhm Cardiovascular Institute, Northwestern University, 675 North St Clair Street Ste 19-100, Galter Pavilion, Chicago, IL 60611, USA
| | - Gloria Ayuba
- Bluhm Cardiovascular Institute, Northwestern University, 675 North St Clair Street Ste 19-100, Galter Pavilion, Chicago, IL 60611, USA
| | - Jyothy J Puthumana
- Bluhm Cardiovascular Institute, Northwestern University, 675 North St Clair Street Ste 19-100, Galter Pavilion, Chicago, IL 60611, USA.
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8
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Sherwood MW, Batchelor WB. TEER Programs at Mitral Surgery Centers: When One Hand Washes the Other. J Am Coll Cardiol 2023; 81:533-536. [PMID: 36754513 DOI: 10.1016/j.jacc.2022.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Matthew W Sherwood
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA; Duke University Clinical Research Institute, Durham, North Carolina, USA.
| | - Wayne B Batchelor
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA. https://twitter.com/_WayneBatchelor
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