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Elkaryoni A, Huded CP, Saad M, Altibi AM, Chhatriwalla AK, Abbott JD, Arnold SV. Normal-Flow Low-Gradient Aortic Stenosis: Comparing the U.S. and European Guidelines. JACC Cardiovasc Imaging 2024:S1936-878X(24)00118-9. [PMID: 38703172 DOI: 10.1016/j.jcmg.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/12/2024] [Accepted: 03/06/2024] [Indexed: 05/06/2024]
Abstract
Patients with normal-flow low-gradient (NFLG) severe aortic stenosis present both diagnostic and management challenges, with debate about the whether this represents true severe stenosis and the need for valve replacement. Studies exploring the natural history without intervention have shown similar outcomes of patients with NFLG severe aortic stenosis to those with moderate aortic stenosis and better outcomes after valve replacement than those with low-flow low-gradient severe aortic stenosis. Most studies (all observational) have shown that aortic valve replacement was associated with a survival benefit vs surveillance. Based on available data, the European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines and European Association of Cardiovascular Imaging/American Society of Echocardiography suggest that these patients are more likely to have moderate aortic stenosis. This clinical entity is not mentioned in the American Heart Association/American College of Cardiology guidelines. Here we review the definition of NFLG severe aortic stenosis, potential diagnostic algorithms and points of error, the data supporting different management strategies, and the differing guidelines and outline the unanswered questions in the diagnosis and management of these challenging patients.
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Affiliation(s)
- Ahmed Elkaryoni
- Division of Cardiology, Warren Alpert Medical School of Brown University, Lifespan Cardiovascular Institute, Providence, Rhode Island, USA.
| | - Chetan P Huded
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Marwan Saad
- Division of Cardiology, Warren Alpert Medical School of Brown University, Lifespan Cardiovascular Institute, Providence, Rhode Island, USA
| | - Ahmed M Altibi
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - J Dawn Abbott
- Division of Cardiology, Warren Alpert Medical School of Brown University, Lifespan Cardiovascular Institute, Providence, Rhode Island, USA
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
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Kumbhani DJ, Manandhar P, Bavry AA, Chhatriwalla AK, Giri J, Mack M, Carroll J, Pandey A, Kosinski A, Peterson ED, Kaneko T, de Lemos JA, Vemulapalli S. National Variation in Hospital MTEER Outcomes and Correlation With TAVR Outcomes: STS/ACC TVT Registry Analysis. JACC Cardiovasc Interv 2024; 17:505-515. [PMID: 38340102 DOI: 10.1016/j.jcin.2023.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND A single, multitiered valve center designation has been proposed to publicly identify centers with expertise for all valve therapies. The correlation between transcatheter aortic valve replacement (TAVR) and mitral transcatheter edge-to-edge repair (MTEER) procedures is unknown. OBJECTIVES The authors sought to examine the relationship between site-level volumes and outcomes for TAVR and MTEER. We further explored variability between sites for MTEER outcomes. METHODS Using the STS/ACC TVT (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy) national registry, TAVR and MTEER procedures at sites offering both therapies from 2013 to 2022 were examined. Sites were ranked into deciles of adjusted in-hospital and 30-day outcomes separately for TAVR and MTEER and compared. Stepwise, hierarchical multivariable models were constructed for MTEER outcomes, and the median OR was calculated. RESULTS Between 2013 and 2022, 384,394 TAVRs and 53,274 MTEERs (median annualized volumes: 93.6 and 18.8, respectively) were performed across 453 U.S. sites. Annualized TAVR and MTEER volumes were moderately correlated (r = 0.48; P < 0.001). After adjustment, 14.3% of sites had the same decile rank for TAVR and MTEER 30-day composite outcome, 50.6% were within 2 decile ranks; 35% had more discordant outcomes for the 2 procedures (P = 0.0005). For MTEER procedures, the median OR for the 30-day composite outcome was 1.57 (95% CI: 1.51-1.64), indicating a 57% variability in outcome by site. CONCLUSIONS There is modest correlation between hospital-level volumes for TAVR and MTEER but low interprocedural correlation of outcomes. For similar patients, site-level variability for mortality/morbidity following MTEER was high. Factors influencing outcomes and "centers of excellence" as a whole may differ for TAVR and MTEER.
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Affiliation(s)
- Dharam J Kumbhani
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Pratik Manandhar
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Anthony A Bavry
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Jay Giri
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Mack
- Baylor Scott and White Heart Hospital, Plano, Texas, USA
| | - John Carroll
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Andrzej Kosinski
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Eric D Peterson
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tsuyoshi Kaneko
- Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri, USA
| | - James A de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
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Huded CP, Arnold SV, Cohen DJ, Chhatriwalla AK, Spertus JA. Reply: Transcatheter Aortic Valve Replacement in Asymptomatic Aortic Stenosis: "Primum non Nocere"? JACC Cardiovasc Interv 2024; 17:449. [PMID: 38355274 DOI: 10.1016/j.jcin.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 02/16/2024]
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Chhatriwalla AK, Cohen DJ, Vemulapalli S, Vekstein A, Huded CP, Gallup D, Kosinski AS, Brothers L, Lindenfeld J, Stone GW, Sorajja P. Transcatheter Edge-to-Edge Repair in COAPT-Ineligible Patients With Functional Mitral Regurgitation. J Am Coll Cardiol 2024; 83:488-499. [PMID: 38267110 DOI: 10.1016/j.jacc.2023.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Mitral valve transcatheter edge-to-edge repair (MTEER) was approved in the United States for treatment of functional mitral regurgitation (FMR) based on results from the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial. OBJECTIVES The authors sought to analyze outcomes of MTEER in FMR patients who would have been excluded from COAPT. METHODS MTEER procedures performed for FMR in the TVT (Transcatheter Valve Therapy) Registry between January 1, 2013, and April 30, 2020, were categorized as "trial-ineligible" if any of the following were present: cardiogenic shock, inotropic support, left ventricular ejection fraction <20%, left ventricular end-systolic dimension >7 cm, home oxygen use, or severe tricuspid regurgitation. Trial-ineligible and trial-eligible groups were compared through 1 year using multivariable models. The primary endpoint was 1-year death or heart failure hospitalization (HFH). RESULTS Of 6,675 patients who underwent MTEER for FMR, 3,721 (55.7%) were trial-eligible and 2,954 (44.3%) were trial-ineligible. Trial-ineligible patients had lower rates of technical procedural success (86.9% vs 92.6%; P < 0.001) and more frequent in-hospital complications (11.8% vs 5.7%; P < 0.001) compared with trial-eligible patients. A clinically meaningful improvement in health status at 30 days was observed in 78.9% and 77.0% of patients in the trial-ineligible and trial-eligible groups, respectively. There was a higher risk of 1-year death or HFH (HR: 1.73; 95% CI: 1.57-1.91; P < 0.001) in trial-ineligible patients. CONCLUSIONS Among patients who underwent MTEER for FMR in the TVT Registry, nearly one-half would have been ineligible for the COAPT trial. Health status improvement at 30 days was similar in COAPT-ineligible and COAPT-eligible patients, but trial-ineligible patients had higher 1-year rates of death or HFH.
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Affiliation(s)
- Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA.
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York, USA; St Francis Hospital and Heart Center, Roslyn, New York, USA
| | | | - Andrew Vekstein
- Duke University and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Chetan P Huded
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Dianne Gallup
- Duke University and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Andrzej S Kosinski
- Duke University and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Leo Brothers
- Duke University and Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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El-Zein RS, Malik AO, Cohen DJ, Spertus JA, Saxon JT, Pibarot P, Hahn RT, Alu MC, Shang K, Kodali SK, Thourani VH, Leon MB, Mack MJ, Chhatriwalla AK. Diastolic Dysfunction and Health Status Outcomes After Transcatheter Aortic Valve Replacement. Struct Heart 2024; 8:100225. [PMID: 38283566 PMCID: PMC10818150 DOI: 10.1016/j.shj.2023.100225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/16/2023] [Accepted: 08/24/2023] [Indexed: 01/30/2024]
Abstract
Background Baseline left ventricular diastolic dysfunction (LVDD) is associated with poor health status in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), but health status improvement after TAVR appears similar across all grades of LVDD. Here, we aim to examine the relationship between changes in LVDD severity and health status outcomes following TAVR. Methods Patients who underwent TAVR and had evaluable LVDD at both baseline and 1 year in the PARTNER (Placement of Aortic Transcatheter Valves) 2 SAPIEN 3 registries and PARTNER 3 trial were analyzed. LVDD grade was evaluated using echocardiography core lab data and an adapted definition of American Society of Echocardiography guidelines. Health status was assessed using the Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) score. The association between ΔLVDD severity and ΔKCCQ-OS was examined using linear regression models adjusted for baseline KCCQ-OS. Results Of 1100 patients, 724 (65.8%), 283 (25.7%), and 93 (8.5%) had grade 0/1, 2, and 3 LVDD at baseline, respectively. At 1 year, LVDD severity was unchanged in 790 (71.8%) patients, improved in 189 (17.2%), and worsened in 121 (11.0%). Among 376 patients with baseline grade 2 or 3 LVDD, 50.3% had improvement in LVDD. In the overall cohort, KCCQ-OS score improved by 21.9 points at 1 year. There was a statistically significant association between change in LVDD severity (improved, unchanged, and worsened) and ΔKCCQ-OS at 1 year (p = 0.007). Conclusions Change in LVDD grade was associated with change in health status 1 year following TAVR.
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Affiliation(s)
- Rayan S. El-Zein
- Division of Cardiology, University of Missouri-Kansas City, Missouri, USA
- Division of Cardiology, Saint Luke’s Mid America Heart Institute, Missouri, USA
| | - Ali O. Malik
- Division of Cardiology, University of Missouri-Kansas City, Missouri, USA
- Division of Cardiology, Saint Luke’s Mid America Heart Institute, Missouri, USA
| | - David J. Cohen
- Division of Cardiology, Saint Francis Hospital, New York, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA
| | - John A. Spertus
- Division of Cardiology, University of Missouri-Kansas City, Missouri, USA
- Division of Cardiology, Saint Luke’s Mid America Heart Institute, Missouri, USA
| | - John T. Saxon
- Division of Cardiology, Saint Luke’s Mid America Heart Institute, Missouri, USA
| | | | - Rebecca T. Hahn
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA
- Division of Cardiology, Columbia University Irving Medical Center, New York, USA
| | - Maria C. Alu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA
| | - Kan Shang
- Edwards Lifesciences, California, USA
| | - Susheel K. Kodali
- Division of Cardiology, Columbia University Irving Medical Center, New York, USA
| | - Vinod H. Thourani
- Division of Cardiothoracic Surgery, Piedmont Heart Institute, Georgia, USA
| | - Martin B. Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA
- Division of Cardiology, Columbia University Irving Medical Center, New York, USA
| | - Michael J. Mack
- Division of Cardiothoracic Surgery, Baylor Scott & White Health, Texas, USA
| | - Adnan K. Chhatriwalla
- Division of Cardiology, University of Missouri-Kansas City, Missouri, USA
- Division of Cardiology, Saint Luke’s Mid America Heart Institute, Missouri, USA
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Kumar K, Simpson TF, Golwala H, Chhatriwalla AK, Chadderdon SM, Smith RL, Song HK, Reeves RR, Sorajja P, Zahr FE. Mitral Valve Transcatheter Edge-to-Edge Repair Volumes and Trends. J Interv Cardiol 2023; 2023:6617035. [PMID: 38149109 PMCID: PMC10751158 DOI: 10.1155/2023/6617035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 08/10/2023] [Accepted: 11/06/2023] [Indexed: 12/28/2023] Open
Abstract
Background Despite an association between operator volumes and procedural success, there remains an incomplete understanding of the contemporary utilization and procedural volumes for mitral valve transcatheter edge-to-edge repair (MTEER). We aimed to identify annual operator procedural volumes, temporal trends, and geographic variability for MTEER among Medicare patients in the United States (US). Methods We queried the National Medicare Provider Utilization and Payment Database for a CPT code (33418) specific for MitraClip device from 2015 through 2019. We analyzed annual operator procedural volumes and incidence and identified longitudinal and geographic trends in MTEER utilization. Results From 2015 through 2019, a total of 27,034 MTEER procedures were performed among Medicare patients in the US. The nationwide incidence increased from 6.2 per 100,000 patients in 2015 to 23.8 per 100,000 patients in 2019, a 283% increase over the study period (Ptrend < 0.001). The incidence of MTEER by state varied by nearly 900% (range 5.5 to 54.9 per 100,000 person-years). In 2019, the mean annual MTEER operator annual volume was 9.1 MTEER procedures and had grown from 6.2 per year in 2015. Conclusions In this nationwide study of Medicare beneficiaries in the United States, we identified a significant and sustained increase in the utilization of MTEER devices and operators and growth in annual procedural volumes from 2015 through 2019 with considerable variability in utilization by state. Further studies are needed to understand the clinical impact of variability in utilization and the optimal procedural volumes to ensure high efficacy outcomes and maintain critical access to MTEER therapies.
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Affiliation(s)
- Kris Kumar
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
- Sulpizio Cardiovascular Center, University of California San Diego, La Jolla, CA, USA
| | - Timothy F. Simpson
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Harsh Golwala
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Adnan K. Chhatriwalla
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Scott M. Chadderdon
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | | | - Howard K. Song
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Ryan R. Reeves
- Sulpizio Cardiovascular Center, University of California San Diego, La Jolla, CA, USA
| | - Paul Sorajja
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Firas E. Zahr
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
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Huded CP, Arnold SV, Cohen DJ, Manandhar P, Vemulapalli S, Saxon JT, Chhatriwalla AK, Kosinski A, Spertus JA. Outcomes of Transcatheter Aortic Valve Replacement in Asymptomatic or Minimally Symptomatic Aortic Stenosis. JACC Cardiovasc Interv 2023; 16:2631-2641. [PMID: 37737793 DOI: 10.1016/j.jcin.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/26/2023] [Accepted: 07/11/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Little is known about the outcomes of transcatheter aortic valve replacement (TAVR) in minimally symptomatic patients. OBJECTIVES The authors aimed to evaluate the outcomes of patients with minimally symptomatic severe aortic stenosis treated with TAVR in the STS/ACC TVT registry. METHODS Minimally symptomatic status was defined as a baseline Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OS) ≥75. Clinical and health status outcomes of TAVR in patients with severe aortic stenosis and normal left ventricular ejection fraction were compared between minimally symptomatic patients and those with moderate or severe symptoms. RESULTS Among 231,285 patients who underwent TAVR between 2015 and 2021 (median age 80.0 years [IQR: 74.0-86.0 years], 47.5% female), 20.0% were minimally symptomatic before TAVR. Survival at 1 year was higher in minimally symptomatic patients vs those with moderate or severe symptoms (adjusted HR for death: 0.70 [95% CI: 0.66-0.75]). Mean KCCQ-OS increased by 2.7 points (95% CI: 2.6-2.9 points) at 30 days and 3.8 points (95% CI: 3.6-4.0 points) at 1 year in minimally symptomatic patients compared with increases of 32.2 points (95% CI: 32.0-32.3 points) at 30 days and 34.9 points (95% CI: 34.7-35.0 points) at 1 year in more symptomatic patients. Minimally symptomatic patients had higher odds of being alive and well at 1 year (OR: 1.19 [95% CI: 1.16-1.23]). CONCLUSIONS Although minimally symptomatic patients treated with TAVR experience only small improvements in health status, their overall outcomes are favorable with a higher likelihood of survival with good health status at 1 year compared with more symptomatic patients.
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Affiliation(s)
- Chetan P Huded
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri - Kansas City, Kansas City, Missouri, USA.
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri - Kansas City, Kansas City, Missouri, USA
| | - David J Cohen
- St. Francis Hospital and Heart Center, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | | | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Durham, North Carolina, USA; Duke University Medical Center, Durham, North Carolina, USA
| | - John T Saxon
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri - Kansas City, Kansas City, Missouri, USA
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri - Kansas City, Kansas City, Missouri, USA
| | | | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri - Kansas City, Kansas City, Missouri, USA
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Tang GH, Spencer J, Rogers T, Grubb KJ, Gleason P, Gada H, Mahoney P, Dauerman HL, Forrest JK, Reardon MJ, Blanke P, Leipsic JA, Abdel-Wahab M, Attizzani GF, Puri R, Caskey M, Chung CJ, Chen YH, Dudek D, Allen KB, Chhatriwalla AK, Htun WW, Blackman DJ, Tarantini G, Zhingre Sanchez J, Schwartz G, Popma JJ, Sathananthan J. Feasibility of Coronary Access Following Redo-TAVR for Evolut Failure: A Computed Tomography Simulation Study. Circ Cardiovasc Interv 2023; 16:e013238. [PMID: 37988439 PMCID: PMC10653288 DOI: 10.1161/circinterventions.123.013238] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/06/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Coronary accessibility following redo-transcatheter aortic valve replacement (redo-TAVR) is increasingly important, particularly in younger low-risk patients. This study aimed to predict coronary accessibility after simulated Sapien-3 balloon-expandable valve implantation within an Evolut supra-annular, self-expanding valve using pre-TAVR computed tomography (CT) imaging. METHODS A total of 219 pre-TAVR CT scans from the Evolut Low-Risk CT substudy were analyzed. Virtual Evolut and Sapien-3 valves were sized using CT-based diameters. Two initial Evolut implant depths were analyzed, 3 and 5 mm. Coronary accessibility was evaluated for 2 Sapien-3 in Evolut implant positions: Sapien-3 outflow at Evolut node 4 and Evolut node 5. RESULTS With a 3-mm initial Evolut implant depth, suitable coronary access was predicted in 84% of patients with the Sapien-3 outflow at Evolut node 4, and in 31% of cases with the Sapien-3 outflow at Evolut node 5 (P<0.001). Coronary accessibility improved with a 5-mm Evolut implant depth: 97% at node 4 and 65% at node 5 (P<0.001). When comparing 3- to 5-mm Evolut implant depth, sinus sequestration was the lowest with Sapien-3 outflow at Evolut node 4 (13% versus 2%; P<0.001), and the highest at Evolut node 5 (61% versus 32%; P<0.001). CONCLUSIONS Coronary accessibility after Sapien-3 in Evolut redo-TAVR relates to the initial Evolut implant depth, the Sapien-3 outflow position within the Evolut, and the native annular anatomy. This CT-based quantitative analysis may provide useful information to inform and refine individualized preprocedural CT planning of the initial TAVR and guide lifetime management for future coronary access after redo-TAVR. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02701283.
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Affiliation(s)
- Gilbert H.L. Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York (G.H.L.T.)
| | - Julianne Spencer
- Structural Heart & Aortic, Medtronic, Mounds View, MN (J. Spencer, J.Z.S., G.S., J.J.P.)
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC (T.R.)
| | - Kendra J. Grubb
- Division of Cardiothoracic Surgery (K.J.G.), Emory University, Atlanta, GA
- Structural Heart and Valve Center (K.J.G., P.G.), Emory University, Atlanta, GA
| | - Patrick Gleason
- Structural Heart and Valve Center (K.J.G., P.G.), Emory University, Atlanta, GA
- Division of Cardiology (P.G.), Emory University, Atlanta, GA
| | - Hemal Gada
- University of Pittsburgh Medical Center Pinnacle Health, PA (H.G.)
| | | | | | - John K. Forrest
- Division of Cardiology, Yale School of Medicine, New Haven, CT (J.K.F.)
| | | | - Philipp Blanke
- Center for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.A.L.)
| | - Jonathon A. Leipsic
- Center for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.A.L.)
| | | | - Guilherme F. Attizzani
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH (G.F.A.)
| | | | | | - Christine J. Chung
- Division of Cardiology, University of Washington Medical Center, Seattle (C.J.C.)
| | - Ying-Hwa Chen
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan (Y.-H.C.)
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Keith B. Allen
- St. Luke’s Mid America Heart Institute, Kansas City, MO (K.B.A., A.K.C.)
| | | | | | - Daniel J. Blackman
- Department of Cardiology, Leeds Teaching Hospitals, Leeds, United Kingdom (D.J.B.)
| | - Giuseppe Tarantini
- Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Italy (G.T.)
| | - Jorge Zhingre Sanchez
- Structural Heart & Aortic, Medtronic, Mounds View, MN (J. Spencer, J.Z.S., G.S., J.J.P.)
| | - Greta Schwartz
- Structural Heart & Aortic, Medtronic, Mounds View, MN (J. Spencer, J.Z.S., G.S., J.J.P.)
| | - Jeffrey J. Popma
- Structural Heart & Aortic, Medtronic, Mounds View, MN (J. Spencer, J.Z.S., G.S., J.J.P.)
| | - Janarthanan Sathananthan
- Center for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada (J. Sathananthan)
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Ubaid A, Kennedy KF, Chhatriwalla AK, Saxon JT, Hart A, Allen KB, Aberle C, Shatla I, Abumoawad A, Gunta SP, Skolnick D, Huded CP. Site Variability in Cerebral Embolic Protection for Transcatheter Aortic Valve Implantation and Association With Outcomes. Struct Heart 2023; 7:100202. [PMID: 38046858 PMCID: PMC10692348 DOI: 10.1016/j.shj.2023.100202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 12/05/2023]
Abstract
Background The effectiveness of cerebral embolic protection devices (CEPD) in mitigating stroke after transcatheter aortic valve implantation (TAVI) remains uncertain, and therefore CEPD may be utilized differently across US hospitals. This study aims to characterize the hospital-level pattern of CEPD use during TAVI in the US and its association with outcomes. Methods Patients treated with nontransapical TAVI in the 2019 Nationwide Readmissions Database were included. Hospitals were categorized as CEPD non-users and CEPD users. The following outcomes were compared: the composite of in-hospital stroke or transient ischemic attack (TIA), in-hospital ischemic stroke, death, and cost of hospitalization. Logistic regression models were used for risk adjustment of clinical outcomes. Results Of 41,822 TAVI encounters, CEPD was used in 10.6% (n = 4422). Out of 392 hospitals, 65.8% were CEPD non-user hospitals and 34.2% were CEPD users. No difference was observed between CEPD non-users and CEPD users in the risk of in-hospital stroke or TIA (adjusted odds ratio (OR) = 0.99 [0.86-1.15]), ischemic stroke (adjusted OR = 1.00 [0.85-1.18]), or in-hospital death (adjusted OR = 0.86 [0.71-1.03]). The cost of hospitalization was lower in CEPD non-users. Conclusions Two-thirds of hospitals in the US do not use CEPD for TAVI, and no significant difference was observed in neurologic outcomes among patients treated at CEPD non-user and CEPD user hospitals.
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Affiliation(s)
- Aamer Ubaid
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Kevin F. Kennedy
- Department of Cardiovascular Medicine, St Lukes Mid America Heart Institute, Kansas City, Missouri, USA
| | - Adnan K. Chhatriwalla
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
- Department of Cardiovascular Medicine, St Lukes Mid America Heart Institute, Kansas City, Missouri, USA
| | - John T. Saxon
- Department of Cardiovascular Medicine, St Lukes Mid America Heart Institute, Kansas City, Missouri, USA
| | - Anthony Hart
- Department of Cardiovascular Medicine, St Lukes Mid America Heart Institute, Kansas City, Missouri, USA
| | - Keith B. Allen
- Department of Cardiothoracic Surgery, St Lukes Mid America Heart Institute, Kansas City, Missouri, USA
| | - Corinne Aberle
- Department of Cardiothoracic Surgery, St Lukes Mid America Heart Institute, Kansas City, Missouri, USA
| | - Islam Shatla
- Department of Internal Medicine, Kansas University Medical Center, Kansas City, Missouri, USA
| | - Abdelrhman Abumoawad
- Department of Vascular Medicine, Boston University Medical Center, Boston, Massachusetts, USA
| | - Satya Preetham Gunta
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - David Skolnick
- Department of Cardiovascular Medicine, St Lukes Mid America Heart Institute, Kansas City, Missouri, USA
| | - Chetan P. Huded
- Department of Cardiovascular Medicine, St Lukes Mid America Heart Institute, Kansas City, Missouri, USA
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Allen KB, Watson D, Vora AN, Mahoney P, Chhatriwalla AK, Schwartz JG, Keller A, Sodhi N, Haugan D, Caskey M. Transcarotid versus transaxillary access for transcatheter aortic valve replacement with a self-expanding valve: A propensity-matched analysis. JTCVS Tech 2023; 21:45-55. [PMID: 37854813 PMCID: PMC10580150 DOI: 10.1016/j.xjtc.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/19/2023] [Accepted: 07/22/2023] [Indexed: 10/20/2023] Open
Abstract
Transaxillary access has been the most frequently used nonfemoral access route for transcatheter aortic valve replacement (TAVR) with a self-expanding valve. Use of transcarotid TAVR is increasing; however, comparative data on these methods are limited. We compared outcomes following transcarotid or transaxillary TAVR with a self-expanding, supra-annular valve. Methods The Transcatheter Valve Therapy Registry was queried for TAVR procedures using transaxillary and transcarotid access between July 2015 and June 2021. Patients received a self-expanding Evolut R, PRO, or PRO + valve (Medtronic) and had 1-year follow-up. Thirty-day and 1-year outcomes were compared in transcarotid and transaxillary groups after 1:2 propensity score-matching. Multivariable regression models were fitted to identify predictors of key end points. Results The propensity score-matched cohort included 576 patients receiving transcarotid and 1142 receiving transaxillary access. Median procedure time (99 vs 118 minutes; P < .001) and hospital stay (2 vs 3 days; P < .001) were shorter with transcarotid versus transaxillary access. At 30 days, patients with transcarotid access had similar mortality (Kaplan-Meier estimates 3.7% vs 4.3%, P = .57) but significantly lower stroke (3.1% vs 5.9%; P = .017) and mortality or stroke (6.0% vs 8.9%; P = .033) compared with patients receiving transaxillary access. Similar differences were observed at 1 year. Transaxillary access was associated with increased risk of 30-day stroke (hazard ratio, 2.14; 95% confidence interval, 1.27-3.58) by multivariable regression analysis. Conclusions Transcarotid versus transaxillary access for TAVR using a self-expanding valve is associated with procedural benefits and significantly lower stroke and mortality or stroke at 30 days. In patients with unsuitable femoral anatomy, transcarotid access may be the preferred delivery route for self-expanding valves.
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Affiliation(s)
- Keith B. Allen
- Department of Cardiovascular/Thoracic Surgery, St Luke’s Mid America Heart Institute, Kansas City, Mo
| | - Daniel Watson
- Department of Cardiovascular/Thoracic Surgery, Riverside Methodist Hospital, Columbus, Ohio
| | - Amit N. Vora
- Department of Cardiology, University of Pittsburgh Medical Center Pinnacle Heart and Vascular Institute, Wormleysburg, Pa
| | - Paul Mahoney
- Department of Cardiology, Sentara Heart Hospital, Norfolk, Va
| | | | - Jonathan G. Schwartz
- Department of Cardiology, Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC
| | - Antoine Keller
- Department of Cardiovascular/Thoracic Surgery, Ochsner Lafayette General Hospital, Lafayette, La
| | | | | | - Michael Caskey
- Department of Cardiovascular/Thoracic Surgery, Abrazo Arizona Heart Hospital, Phoenix, Ariz
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Elbadawi A, Dang AT, Hamed M, Ali A, Saad M, Jneid H, Chhatriwalla AK, Goel S, Bhatt A, Mani P, Bavry A, Kumbhani DJ. Transcatheter edge-to-edge repair for mitral regurgitation using PASCAL or MitraClip. Catheter Cardiovasc Interv 2023; 102:521-527. [PMID: 37493443 DOI: 10.1002/ccd.30772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/25/2023] [Accepted: 07/09/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND There is a paucity of data regarding the comparative efficacy and safety of Mitral valve transcatheter edge-to-edge repair (MTEER) using the PASCAL or MitraClip systems for patients with mitral regurgitation (MR). METHODS An electronic search was conducted for MEDLINE, COCHRANE, and EMBASE, through February 2023, for studies comparing the clinical outcomes of MTEER using PASCAL versus MitraClip systems among patients with severe MR. The primary study outcome was residual MR ≤ 2 at discharge. Data were pooled using a random-effects model. RESULTS The final analysis included six studies with a total of 1581 patients, with a weighted follow-up period of 3.5 months. Two studies only included patients with degenerative MR, while the remaining studies included both degenerative and functional MR. There was no significant difference in procedure duration between MTEER with the PASCAL or MitraClip systems. There was no difference in residual MR ≤ 2 at discharge (94.7% vs. 91.9%; odds ratio [OR]: 1.44; 95% confidence interval [CI]: 0.92-2.27) or residual MR ≤ 2 at the mid-term follow-up (94.6% vs. 91.0%, p = 0.05) among the PASCAL versus MitraClip systems. There was no difference between both groups in residual MR ≤ 1 at discharge (73.1% vs. 63.8%, p = 0.12), while there was greater incidence of residual MR ≤ 1 at midterm follow-up with the PASCAL system (71.3% vs. 56.2%, p < 0.001). There was no difference between the PASCAL and MitraClip MTEER systems in technical success (97.0% vs. 97.9%, p = 0.15), procedural success (89.1% vs. 87.1%, p = 0.78), single leaflet detachment (1.8% vs. 1.4%, p = 0.55), or all-cause mortality (3.6% vs. 4.6%, p = 0.71). CONCLUSION In this meta-analysis, we demonstrated comparable efficacy and safety between the PASCAL and MitraClip MTEER systems at short- and mid-term assessments. Randomized trials are warranted to evaluate the comparative long-term outcomes between both MTEER systems.
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Affiliation(s)
- Ayman Elbadawi
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alexander T Dang
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Mohamed Hamed
- Department of Internal Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Abdelrahman Ali
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marwan Saad
- Department of Medicine' Division of Cardiology, Alpert Medical School of Brown University, Lifespan Cardiovascular Institute, Providence, Rhode Island, USA
| | - Hani Jneid
- Division of Cardiology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Adnan K Chhatriwalla
- Division of Cardiology, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Sachin Goel
- Division of Cardiology, Houston Methodist, Houston, Texas, USA
| | - Anish Bhatt
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Preethi Mani
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Anthony Bavry
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Dharam J Kumbhani
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Abstract
INTRODUCTION Valve-in-valve (VIV) transcatheter valve replacement has emerged as a feasible and potentially safer treatment option for failed bioprosthetic surgical valves (BSVs). However, VIV procedure carries an inherent risk of prosthesis-patient mismatch (PPM). Bioprosthetic valve fracture (BVF) and bioprosthetic valve remodeling (BVR) by either fracturing or stretching the surgical valve ring, allows for a more optimal expansion of the transcatheter heart valve (THV) and beneficial effects on post-implant valve hemodynamics and perhaps long-term valve durability. AREAS COVERED This is an expanded overview of BVF and BVR to facilitate VIV transcatheter aortic valve replacement (TAVR), with detailed discussion on lessons learned from bench testing studies and translation to procedural technique, clinical experience incorporating up-todate evidence and experience with BVF in non-aortic positions. EXPERT OPINION BVF and BVR improve valve hemodynamics following VIV-TAVR with timing of BVF being an important determinant of procedure safety and efficacy; however longer-term data are needed to determine long-term clinical outcomes including mortality, valve hemodynamics, and valve reintervention. In addition, further research will be needed to understand the safety and efficacy of these procedures in any new generation BSV or THV and to better define the role of these techniques in the pulmonic, mitral, and tricuspid positions.
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Affiliation(s)
- Shiv Bagga
- Saint. Luke's Mid America Heart Institute and University of Missouri, Kansas City, Missouri
| | - Adnan K Chhatriwalla
- Saint. Luke's Mid America Heart Institute and University of Missouri, Kansas City, Missouri
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13
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Allen KB, Chhatriwalla AK. The 10 Commandments of Transcarotid Transcatheter Aortic Valve Replacement. Innovations (Phila) 2023; 18:217-222. [PMID: 37278401 DOI: 10.1177/15569845231174022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Keith B Allen
- Department of Cardiothoracic Surgery, St. Luke's Hospital, St. Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Adnan K Chhatriwalla
- Department of Cardiology, St. Luke's Hospital, St. Luke's Mid America Heart Institute, Kansas City, MO, USA
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14
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Chhatriwalla AK, Allen KB, Depta JP, Rodriguez E, Thourani VH, Whisenant BK, Zahr F, Bapat V, Garcia S. Outcomes of Bioprosthetic Valve Fracture in Patients Undergoing Valve-in-Valve TAVR. JACC Cardiovasc Interv 2023; 16:530-539. [PMID: 36922038 DOI: 10.1016/j.jcin.2022.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 03/18/2023]
Abstract
BACKGROUND Valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) is increasingly used to treat degenerated surgical bioprostheses. Bioprosthetic valve fracture (BVF) has been shown to improve hemodynamic status in VIV TAVR in case series. However, the safety and efficacy of BVF are unknown. OBJECTIVES The primary objective of this study was to assess the safety and efficacy of VIV TAVR using SAPIEN 3 and SAPIEN 3 Ultra valves with or without BVF using data from the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry. METHODS The primary outcome was in-hospital mortality. Secondary outcomes included echocardiography-derived valve gradient and aortic valve area. Inverse probability of treatment weighting was used to adjust for baseline characteristics. RESULTS A total of 2,975 patients underwent VIV TAVR from December 15, 2020, to March 31, 2022. BVF was attempted in 619 patients (21%). In adjusted analyses, attempted BVF was associated with higher in-hospital mortality (OR: 2.51; 95% CI: 1.30-4.84) and life-threatening bleeding (OR: 2.55; 95% CI: 1.44-4.50). At discharge, VIV TAVR with attempted BVF was associated with larger aortic valve area (1.6 cm2 vs 1.4 cm2; P < 0.01) and lower mean gradient (16.3 mm Hg vs 19.2 mm Hg; P < 0.01). When BVF was compared with no BVF according to timing (before vs after transcatheter heart valve implantation), BVF after transcatheter heart valve implantation was associated with improved hemodynamic status and similar mortality. CONCLUSIONS BVF as an adjunct to VIV TAVR with the SAPIEN 3 and SAPIEN 3 Ultra valves is associated with a higher risk for in-hospital mortality and significant bleeding and modest improvements in echocardiography-derived hemodynamic status. The timing of BVF is an important determinant of safety and efficacy.
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Affiliation(s)
- Adnan K Chhatriwalla
- St. Luke's Mid America Heart Institute and the University of Missouri, Kansas City, Missouri, USA.
| | - Keith B Allen
- St. Luke's Mid America Heart Institute and the University of Missouri, Kansas City, Missouri, USA
| | - Jeremiah P Depta
- Sands-Constellation Heart Institute/Rochester General Hospital, Rochester, New York, USA
| | | | | | | | - Firas Zahr
- Oregon Health and Science University, Portland, Oregon, USA
| | - Vinayak Bapat
- Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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15
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Meier D, Payne GW, Mostaço-Guidolin LB, Bouchareb R, Rich C, Lai A, Chatfield AG, Akodad M, Salcudean H, Lutter G, Puehler T, Pibarot P, Allen KB, Chhatriwalla AK, Sondergaard L, Wood DA, Webb JG, Leipsic JA, Sathananthan J, Sellers SL. Timing of bioprosthetic valve fracture in transcatheter valve-in-valve intervention: impact on valve durability and leaflet integrity. EUROINTERVENTION 2023; 18:1165-1177. [PMID: 36534495 PMCID: PMC9936256 DOI: 10.4244/eij-d-22-00644] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/07/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND Bioprosthetic valve fracture (BVF) can be used to improve transcatheter heart valve (THV) haemodynamics following a valve-in-valve (ViV) intervention. However, whether BVF should be performed before or after THV deployment and the implications on durability are unknown. Aims: We sought to assess the impact of BVF timing on long-term THV durability. METHODS The impact of BVF timing was assessed using small ACURATE neo (ACn) or 23 mm SAPIEN 3 (S3) THV deployed in 21 mm Mitroflow valves compared to no-BVF controls. Valves underwent accelerated wear testing up to 200 million (M) cycles (equivalent to 5 years). At 200M cycles, THV were evaluated by hydrodynamic testing, second-harmonic generation (SHG) microscopy, scanning electron microscopy (SEM) and histology. RESULTS At 200M cycles, the regurgitant fraction (RF) and effective orifice area (EOA) for the ACn were 8.03±0.30%/1.74±0.01 cm2 (no BVF), 12.48±0.70%/1.97±0.02 cm2 (BVF before ViV) and 9.29±0.38%/2.21±0.0 cm2 (BVF after ViV), respectively. For the S3 these values were 2.63±0.51%/1.26±0.01 cm2, 2.03±0.42%/1.65±0.01 cm2, and 1.62±0.38%/2.22±0.01 cm2, respectively. Further, SHG and SEM revealed a higher degree of superficial leaflet damage when BVF was performed after ViV for the ACn and S3. However, the histological analysis revealed significantly less damage, as determined by matrix density analysis, through the entire leaflet thickness when BVF was performed after ViV with the S3 and a similar but non-significant trend with the ACn. Conclusions: BVF performed after ViV appears to offer superior long-term EOA without increased RF. Ultrastructure leaflet analysis reveals that the timing of BVF can differentially impact leaflets, with more superficial damage but greater preservation of overall leaflet structure when BVF is performed after ViV.
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Affiliation(s)
- David Meier
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Geoffrey W Payne
- University of Northern British Columbia, Prince George, BC, Canada
| | | | | | | | - Althea Lai
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Andrew G Chatfield
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Mariama Akodad
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Hannah Salcudean
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Georg Lutter
- Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Kiel/Hamburg, Hamburg, Germany
| | - Thomas Puehler
- Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Kiel/Hamburg, Hamburg, Germany
| | - Philippe Pibarot
- Québec Heart and Lung Institute, Department of Medicine, Laval University, Québec, QC, Canada
| | - Keith B Allen
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA
| | - Lars Sondergaard
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David A Wood
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jonathon A Leipsic
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Stephanie L Sellers
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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16
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Huded CP, Arnold SV, Chhatriwalla AK, Saxon JT, Kapadia S, Yu X, Webb JG, Thourani VH, Kodali SK, Smith CR, Mack MJ, Leon MB, Cohen DJ. Rehospitalization Events After Aortic Valve Replacement: Insights From the PARTNER Trial. Circ Cardiovasc Interv 2022; 15:e012195. [PMID: 36538580 DOI: 10.1161/circinterventions.122.012195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Rehospitalization is a common end point in clinical trials of structural heart interventions, but whether rehospitalization is clinically and prognostically relevant in these patients is uncertain. The aim of this study was to evaluate the risk of rehospitalization events after aortic valve replacement (AVR) and their association with mortality and health status. METHODS The study population included patients who underwent transcatheter or surgical AVR in the PARTNER I' II' and III trials (Placement of Aortic Transcatheter Valves). Health status was assessed with the Kansas City Cardiomyopathy Questionnaire-overall summary score. The primary analysis focused on heart failure hospitalization within 1 year after AVR and its association with mortality, poor outcome (death, Kansas City Cardiomyopathy Questionnaire-overall summary score <60 or decrease by ≥10), and health status at 1 year using adjusted models. Secondary analyses examined the prognostic associations of rehospitalization due to a composite of heart failure, valve-related, or procedure-related causes. RESULTS Among 3403 patients treated with AVR (2008 transcatheter AVR, 1395 surgical AVR), the 1-year incidence was 6.7% for heart failure hospitalization and 9.7% for rehospitalization due to a composite of heart failure, valve-related, or procedure-related causes. Heart failure hospitalization after AVR was associated with increased risk of 1-year mortality (hazard ratio, 3.97 [2.48 to 6.36]; P<0.001), poor outcome (OR, 2.76 [1.73 to 4.40]; P<0.001), and worse health status (Kansas City Cardiomyopathy Questionnaire-overall summary mean difference -9.8 points [-13.8 to -5.8]; P<0.001). Rehospitalization due to a composite of heart failure, valve-related, or procedure-related causes was similarly associated with increased 1-year mortality (hazard ratio, 4.64 [3.11 to 6.92]; P<0.001), poor outcome (OR, 2.06 [1.38 to 3.07]; P=0.0004), and worse health status (Kansas City Cardiomyopathy Questionnaire-overall summary mean difference -8.8 points [-11.8 to -5.7]; P<0.001). There was no effect modification by treatment type (transcatheter AVR versus surgical AVR) for these associations. CONCLUSIONS Heart failure hospitalization and rehospitalization after AVR are associated with increased risk of mortality and worse 1-year health status. These findings confirm the clinical and prognostic relevance of rehospitalization end points for trials of AVR. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT00530894.
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Affiliation(s)
- Chetan P Huded
- Saint Luke's Mid America Heart Institute, Kansas City, MO (C.P.H., S.V.A., A.K.C., J.T.S.)
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, Kansas City, MO (C.P.H., S.V.A., A.K.C., J.T.S.)
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute, Kansas City, MO (C.P.H., S.V.A., A.K.C., J.T.S.)
| | - John T Saxon
- Saint Luke's Mid America Heart Institute, Kansas City, MO (C.P.H., S.V.A., A.K.C., J.T.S.)
| | | | - Xiao Yu
- Edwards Lifesciences, Inc, Irvine, CA (X.Y.)
| | - John G Webb
- St. Paul's Hospital, Vancouver, BC, Canada (J.G.W.)
| | | | | | - Craig R Smith
- Columbia University Medical Center, New York (S.K.K., C.R.S.)
| | | | - Martin B Leon
- Cardiovascular Research Foundation, New York (M.B.L., D.J.C.)
| | - David J Cohen
- St. Francis Hospital and Heart Center, Roslyn, NY (D.J.C.).,Cardiovascular Research Foundation, New York (M.B.L., D.J.C.)
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17
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Ranka S, Lahan S, Chhatriwalla AK, Allen KB, Chiang M, O'Neill B, Verma S, Wang DD, Lee J, Frisoli T, Eng M, Bagur R, O'Neill W, Villablanca P. Network meta-analysis comparing the short and long-term outcomes of alternative access for transcatheter aortic valve replacement. Cardiovasc Revasc Med 2021; 40:1-10. [PMID: 34972667 DOI: 10.1016/j.carrev.2021.11.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/15/2021] [Accepted: 11/29/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Several studies have pair-wise compared access sites for transcatheter aortic valve replacement (TAVR) but pooled estimate of overall comparative efficacy and safety outcomes are not well known. We sought to compare short- and long-term outcomes following various alternative access routes for TAVR. METHODS Thirty-four studies with a pooled sample size of 32,756 patients were selected by searching PubMed and Cochrane library databases from inception through 11th June 2021 for patients undergoing TAVR via 1 of 6 different access sites: Transfemoral (TF), Transaortic (TAO), Transapical (TA), Transcarotid (TC), Transaxillary/Subclavian (TSA), and Transcaval (TCV). Data were extracted to conduct a frequentist network meta-analysis with a random-effects model using TF access as a reference group. RESULTS Compared with TF, both TAO [RR 1.91, 95% CI (1.46-2.50)] and TA access [RR 2.12, 95% CI (1.84-2.46)] were associated with an increased risk of 30-day mortality. No significant difference was observed for stroke, myocardial infarction, major bleeding, conversion to open surgery, and major adverse cardiovascular or cerebrovascular events at 30 days between different accesses. Major vascular complications were lower in TA [RR 0.43, (95% CI, 0.28-0.67)] and TC [RR 0.51, 95% CI (0.35-0.73)] access compared to TF. The 1-year mortality was higher in TAO [RR of 1.35, (95% CI, 1.01-1.81)] and TA [RR 1.44, (95% CI, 1.14-1.81)] groups. CONCLUSION Non-thoracic alternative access site utilization for TAVR implantation (TC, TSA and TCV) is associated with outcomes similar to conventional TF access. Thoracic TAVR access (TAO and TA) translates into increased short and long-term mortality.
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Affiliation(s)
- Sagar Ranka
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Shubham Lahan
- Division of Cardiovascular Prevention & Wellness, Department of Cardiology, Houston Methodist, Houston, TX, United States
| | - Adnan K Chhatriwalla
- Department of Cardiothoracic Surgery, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, United States
| | - Keith B Allen
- Department of Cardiothoracic Surgery, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, United States
| | - Michael Chiang
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Brian O'Neill
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Sadhika Verma
- Department of Family Medicine, Henry Ford Allegiance Health, Jackson, MI, United States
| | - Dee Dee Wang
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - James Lee
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Tiberio Frisoli
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Marvin Eng
- Department of Cardiology, Banner University Medical Center, Phoenix, AZ, United States
| | - Rodrigo Bagur
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - William O'Neill
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Pedro Villablanca
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States.
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Allen KB, Chhatriwalla AK, Saxon JT, Huded CP, Sathananthan J, Nguyen TC, Whisenant B, Webb JG. Bioprosthetic valve fracture: a practical guide. Ann Cardiothorac Surg 2021; 10:564-570. [PMID: 34733685 DOI: 10.21037/acs-2021-tviv-25] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/18/2021] [Indexed: 11/06/2022]
Abstract
Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) is currently indicated for the treatment of failed surgical tissue valves in patients determined to be at high surgical risk for re-operative surgical valve replacement. VIV TAVR, however, often results in suboptimal expansion of the transcatheter heart valve (THV) and can result in patient-prosthesis mismatch (PPM), particularly in small surgical valves. Bioprosthetic valve fracture (BVF) and bioprosthetic valve remodeling (BVR) can facilitate VIV TAVR by optimally expanding the THV and reducing the residual transvalvular gradient by utilizing a high-pressure inflation with a non-compliant balloon to either fracture or stretch the surgical valve ring, respectively. This article, along with the supplemental video, will provide patient selection, procedural planning and technical insights for performing BVF and BVR.
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Affiliation(s)
- Keith B Allen
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Missouri, USA
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Missouri, USA
| | - John T Saxon
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Missouri, USA
| | - Chetan P Huded
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Missouri, USA
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation and Centre for Heart Valve Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, Canada
| | | | | | - John G Webb
- Centre for Cardiovascular Innovation and Centre for Heart Valve Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, Canada
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19
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Elkaryoni A, Chhatriwalla AK, Kennedy KF, Saxon JT, Lopez JJ, Cohen DJ, Arnold SV. Impact of Transcatheter Aortic Valve Replacement on Hospitalization Rates: Insights From Nationwide Readmission Database. J Am Heart Assoc 2021; 10:e022910. [PMID: 34713717 PMCID: PMC8751839 DOI: 10.1161/jaha.121.022910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Hospitalization rates after transcatheter aortic valve replacement (TAVR) remain high, given the age and comorbidities of patients undergoing TAVR. To better understand the impact of TAVR on hospitalization, we sought to compare hospitalization rates before and after TAVR and to examine if underlying patient comorbidities are associated with a differential effect of TAVR on hospitalizations. Methods and Results We used the Nationwide Readmissions Database to identify patients who underwent TAVR. As Nationwide Readmissions Database data do not cross over calendar years, we limited our index admission to hospitalizations during April to September of each calendar year to allow 90 days of observation before and after TAVRs. We calculated the daily risk of all‐cause hospitalization and used a mixed‐effects logistic regression model to explore interactions between patient characteristics, TAVR, and hospitalization risk. Among 39 249 patients who underwent TAVR in 2014 to 2017 (median age, 82 years [interquartile range, 76–87 years]; 45.7% women), 32.0% had at least one hospitalization in the 90 days before TAVR compared with 23.2% in the 90 days post‐TAVR (relative reduction, 27.5%; P<0.001). In the mixed‐effects logistic regression model, TAVR was associated with decreased all‐cause hospitalization rate after TAVR in all comorbidity subgroups. However, younger patients and those with heart failure and reduced ejection fraction appeared to have more robust reduction in hospitalizations. Conclusions Although patients who are treated with TAVR have high rates of rehospitalization, TAVR is associated with an overall reduction in all‐cause hospitalizations regardless of underlying patient comorbidities.
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Affiliation(s)
- Ahmed Elkaryoni
- Division of Cardiovascular Disease Loyola University Medical CenterLoyola Stritch School of Medicine Maywood IL
| | - Adnan K Chhatriwalla
- Cardiovascular Disease Saint Luke's Mid America Heart Institute Kansas City MO.,Cardiovascular Disease University of Missouri-Kansas City Kansas City MO
| | - Kevin F Kennedy
- Cardiovascular Disease Saint Luke's Mid America Heart Institute Kansas City MO
| | - John T Saxon
- Cardiovascular Disease Saint Luke's Mid America Heart Institute Kansas City MO.,Cardiovascular Disease University of Missouri-Kansas City Kansas City MO
| | - John J Lopez
- Division of Cardiovascular Disease Loyola University Medical CenterLoyola Stritch School of Medicine Maywood IL
| | - David J Cohen
- Cardiovascular Disease St. Francis Hospital & Heart Center Roslyn NY.,Cardiovascular Disease Cardiovascular Research Foundation New York NY
| | - Suzanne V Arnold
- Cardiovascular Disease Saint Luke's Mid America Heart Institute Kansas City MO.,Cardiovascular Disease University of Missouri-Kansas City Kansas City MO
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20
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Saxon JT, Cohen DJ, Chhatriwalla AK, Kotinkaduwa LN, Kar S, Lim DS, Abraham WT, Lindenfeld J, Mack MJ, Arnold SV, Stone GW. Impact of COPD on Outcomes After MitraClip for Secondary Mitral Regurgitation: The COAPT Trial. JACC Cardiovasc Interv 2021; 13:2795-2803. [PMID: 33303119 DOI: 10.1016/j.jcin.2020.09.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/03/2020] [Accepted: 09/15/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of this study was to examine the relationship between chronic obstructive pulmonary disease (COPD) and outcomes after transcatheter mitral valve repair (TMVr) for severe secondary mitral regurgitation. BACKGROUND TMVr with the MitraClip improves clinical and health-status outcomes in patients with heart failure and severe (3+ to 4+) secondary mitral regurgitation. Whether these benefits are modified by COPD is unknown. METHODS COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) was an open-label, multicenter, randomized trial of TMVr plus guideline-directed medical therapy (GDMT) versus GDMT alone. Patients on corticosteroids or continuous oxygen were excluded. Multivariable models were used to examine the associations of COPD with mortality, heart failure hospitalization (HFH), and health status and to test whether COPD modified the benefit of TMVr compared with GDMT. RESULTS Among 614 patients, 143 (23.2%) had COPD. Among patients treated with TMVr, unadjusted analyses demonstrated increased 2-year mortality in those with COPD (hazard ratio [HR]: 2.08; 95% confidence interval [CI]: 1.33 to 3.26), but this association was attenuated after risk adjustment (adjusted HR: 1.48; 95% CI: 0.87 to 2.52). Although TMVr led to reduced 2-year mortality among patients without COPD (adjusted HR: 0.47; 95% CI: 0.33 to 0.67), for patients with COPD, 2-year all-cause mortality was similar after TMVr versus GDMT alone (adjusted HR: 0.94; 95% CI: 0.54 to 1.65; pint = 0.04), findings that reflect offsetting effects on cardiovascular and noncardiovascular mortality. In contrast, TMVr reduced HFH (adjusted HR: 0.48 [95% CI: 0.28 to 0.83] vs. 0.46 [95% CI: 0.34 to 0.63]; pint = 0.89) and improved both generic and disease-specific health status to a similar extent compared with GDMT alone in patients with and without COPD (pint >0.30 for all scales). CONCLUSIONS In the COAPT trial, COPD was associated with attenuation of the survival benefit of TMVr versus GDMT compared with patients without COPD. However, the benefits of TMVr on both HFH and health status were similar regardless of COPD. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial] [COAPT]; NCT01626079).
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Affiliation(s)
- John T Saxon
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - David J Cohen
- University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Lak N Kotinkaduwa
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA; Bakersfield Heart Hospital, Bakersfield, California, USA
| | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, Virginia, USA
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA
| | | | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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21
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Chhatriwalla AK, Allen KB, Saxon JT, Cohen DJ, Nguyen TC, Loyalka P, Whisenant B, Yakubov SJ, Sanchez C, Sathananthan J, Stegman B, Harvey J, Garrett HE, Tseng E, Gerdisch M, Williams P, Kennedy KF, Webb J. 1-Year Outcomes following Bioprosthetic Valve Fracture to Facilitate Valve-in-Valve Transcatheter Aortic Valve Replacement. Structural Heart 2021. [DOI: 10.1080/24748706.2021.1895456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Adnan K. Chhatriwalla
- Department of Cardiology, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
- Department of Cardiology, University of Missouri, Kansas City, Missouri, USA
| | - Keith B. Allen
- Department of Cardiothoracic Surgery, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
- Department of Cardiothoracic Surgey, University of Missouri, Kansas City, Missouri, USA
| | - John T. Saxon
- Department of Cardiology, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
- Department of Cardiology, University of Missouri, Kansas City, Missouri, USA
| | - David J. Cohen
- Cardiovascular Research Foundation, New York, New York, USA
- Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Tom C. Nguyen
- Cardiothoracic Surgery, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Pranav Loyalka
- Department of Cardiology, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Brian Whisenant
- Department of Cardiology, Intermountain Medical Center, Salt Lake City, Utah, USA
| | | | - Carlos Sanchez
- Department of Cardiology, Riverside Hospital, Columbus, Ohio, USA
| | - Janarthanan Sathananthan
- Department of Cardiology, Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, British Columbiaa, Canada
| | - Brian Stegman
- Department of Cardiology, Centracare Heart and Vascular Center, St Cloud, Minnesota, USA
| | - James Harvey
- Department of Cardiology, Wellspan York Hospital, York, Pennsylvania, USA
| | - H. Edward Garrett
- Department of Cardiothoracic Surgery, Baptist Memorial Hospital, Memphis, Tennessee, USA
| | - Elaine Tseng
- Department of Cardiothoracic Surgery, VA Medical Center, San Francisco, California, USA
| | - Marc Gerdisch
- Department of Cardiothoracic Surgery, Franciscan Health Heart Center, Indianapolis, Indiana, USA
| | - Paul Williams
- Department of Cardiology, James Cook University Hospital, Middlesborough, UK
| | - Kevin F. Kennedy
- Department of Biostatistics, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
| | - John Webb
- Department of Cardiology, Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, British Columbiaa, Canada
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22
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Huded CP, Allen KB, Chhatriwalla AK. Counterpoint: challenges and limitations of transcatheter aortic valve implantation for aortic regurgitation. Heart 2021; 107:1942-1945. [PMID: 33863760 DOI: 10.1136/heartjnl-2020-318682] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/19/2021] [Accepted: 04/04/2021] [Indexed: 11/04/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) for isolated aortic regurgitation (AR) comprises <1.0% of all TAVI procedures performed in the USA. In this manuscript, we review the challenges, evidence and future directions of TAVI for isolated AR. There are no randomised clinical trials or mid-term data evaluating TAVI for isolated AR, and no commercially available devices are approved for this indication. Challenges in performing TAVI for isolated AR as opposed to aortic stenosis (AS) include: lack of a calcified anchoring zone for valve deployment, large and dynamic size of the aortic annulus and high stroke volume (during systole) and regurgitant volume (during diastole) across the aortic annulus during each cardiac cycle. Observational studies have shown that outcomes of TAVI for AR are worse than outcomes of TAVI for AS. However, newer generation TAVI devices may perform better than older generation devices in patients with AR. Two emerging valves (the JenaValve and the J-Valve) are designed with mechanisms to anchor in a non-calcified annulus, and these valves have shown promise for AR. Data on these devices are limited, and clinical investigation is ongoing. Randomised clinical trials are needed to establish TAVI as a safe and effective treatment for isolated AR.
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Affiliation(s)
- Chetan P Huded
- Department of Cardiology, Saint Luke's Hospital, Kansas City, Missouri, USA
| | - Keith B Allen
- Department of Cardiothoracic Surgery, Saint Luke's Hospital, Kansas City, Missouri, USA
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23
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Sheehy JP, Chhatriwalla AK. Effect of Operator Experience on Transcatheter Mitral Valve Repair Outcomes. US Cardiology Review 2021. [DOI: 10.15420/usc.2020.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Transcatheter mitral valve repair with MitraClip is a novel, intricate therapy for mitral regurgitation that improves survival and quality of life. Similar to other medical procedures, there is a relationship between procedural experience and clinical outcomes. MitraClip results and the efficiency and safety of the procedure all improved with increasing experience at both the institutional and operator level in two large studies from the Society of Thoracic Surgeons and American College of Cardiology Transcatheter Valve Therapy Registry. Patient selection was also found to have a significant role in procedure success. The old adage of “See one, do one, teach one” does not necessarily apply to complex interventions, such as MitraClip, given that the learning curve does not appear to plateau even as operators approach a 150-case experience.
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Affiliation(s)
| | - Adnan K Chhatriwalla
- University of Missouri-Kansas City, Kansas City, MO; Saint Luke’s Mid America Heart Institute, Kansas City, MO
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24
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Allen KB, Chhatriwalla AK, Saxon J, Hermiller J, Heimansohn D, Moainie S, McKay RG, Cheema M, Jones B, Hodson RW, Korngold E, Kirker E. Reply: Transcarotid trumps transapical/direct aortic access for transcatheter aortic valve replacement—It's a no brainer! J Thorac Cardiovasc Surg 2021; 164:e84-e86. [DOI: 10.1016/j.jtcvs.2021.01.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 11/28/2022]
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25
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Allen KB, Chhatriwalla AK, Saxon JT, Sathananthan J, Dvir D, Webb JG. Bioprosthetic valve fracture to facilitate valve-in-valve transcatheter aortic valve repair. Ann Cardiothorac Surg 2020; 9:528-530. [PMID: 33312917 DOI: 10.21037/acs-2020-av-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Keith B Allen
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - John T Saxon
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, Canada
| | - Danny Dvir
- Shaare Zedek Medical Centre, Hebrew University, Jerusalem, Israel.,University of Washington, Seattle, WA, USA
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, Canada
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Malik AO, Chhatriwalla AK, Saxon J, Hejjaji V, Stebbins A, Jones PG, Cohen DJ, Arnold SV, Vemulapalli S, Wegermann ZK, Kosinski A, Spertus JA. Site-Level Variability in 30-Day Patient Outcomes After Transcatheter Mitral Valve Repair in the United States. Circ Cardiovasc Qual Outcomes 2020; 13:e006878. [PMID: 33280434 DOI: 10.1161/circoutcomes.120.006878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical trials have demonstrated health status benefit of transcatheter mitral valve repair (TMVr) with MitraClip in patients with mitral valve regurgitation. Real-world site-level variability in health status outcomes for TMVr, and factors associated with this variability, are unknown. METHODS All patients undergoing TMVr procedure with MitraClip between November 2013 and March 2019 in the Transcatheter Valve Therapy Registry were included. Health status was measured at baseline and 30 days with the Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary (OS) score. Site-level variability in 30-day change in KCCQ-OS was examined by calculating the median odds ratio from a hierarchical logistic regression model, with ≥20-point improvement as the dependent variable. To define the extent to which patient characteristics, procedural characteristics (residual mitral valve regurgitation, periprocedural bleeding), site volume, and patients' baseline health status accounted for variability in outcomes, the proportion of variability (R2) explained by sequentially adding these variables to the model was quantified. RESULTS Across 339 sites, 12 415 patients (mean age 79.0±9.5 years, 46.1%. females, 89.5% White) completed baseline and 30-day health status assessments. Mean KCCQ-OS score was 43.0±24.4 at baseline and 67.0±24.9 at 30-day follow-up. Across sites, the proportion of patients achieving a ≥20-point improvement in KCCQ-OS ranged from 12.5% to 100% and the adjusted median odds ratio was 1.58 (95% CI, 1.46-1.69). The greatest contribution to the variability in health status outcomes was from patients' baseline KCCQ-OS score (R2=25%) with <1% of the variability explained by patient and procedural characteristics, and annual site volume. CONCLUSIONS There is moderate variation across sites in their patients' achievement of health status benefits from TMVr, with patient's baseline health status accounting for the largest proportion of this variation. This underscores the importance of patient selection in supporting more consistent health status benefit from TMVr.
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Affiliation(s)
- Ali O Malik
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., S.V.A., S.V.A., J.A.S.).,University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
| | - Adnan K Chhatriwalla
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., S.V.A., S.V.A., J.A.S.).,University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
| | - John Saxon
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., S.V.A., S.V.A., J.A.S.).,University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
| | - Vittal Hejjaji
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., S.V.A., S.V.A., J.A.S.).,University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
| | - Amanda Stebbins
- Duke Clinical Research Institute, Durham, NC (A.S., S.V., Z.K.W., A.K.)
| | - Philip G Jones
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., S.V.A., S.V.A., J.A.S.).,University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
| | - David J Cohen
- University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
| | - Suzanne V Arnold
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., S.V.A., S.V.A., J.A.S.).,University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
| | | | | | - Andrzej Kosinski
- Duke Clinical Research Institute, Durham, NC (A.S., S.V., Z.K.W., A.K.)
| | - John A Spertus
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., S.V.A., S.V.A., J.A.S.).,University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
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Bhardwaj B, Cohen DJ, Vemulapalli S, Kosinski AS, Xiang Q, Li Z, Allen KB, Kapadia S, Aggarwal K, Sorajja P, Chhatriwalla AK. Outcomes of transcatheter aortic valve replacement for patients with severe aortic stenosis and concomitant aortic insufficiency: Insights from the TVT Registry. Am Heart J 2020; 228:57-64. [PMID: 32828047 DOI: 10.1016/j.ahj.2020.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/14/2020] [Indexed: 11/25/2022]
Abstract
AIMS Data regarding outcomes for patients with severe aortic stenosis (AS) with concomitant aortic insufficiency (AI), undergoing transcatheter aortic valve replacement (TAVR) are limited. This study aimed to analyze the prevalence of severe AS with concomitant AI among patients undergoing TAVR and outcomes of TAVR in this patient group. METHODS AND RESULTS Using data from the STS/ACC-TVT Registry, we identified patients with severe AS with or without concomitant AI who underwent TAVR between 2011 and 2016. Patients were categorized based on the severity of pre-procedural AI. Multivariable proportional hazards regression models were used to examine all-cause mortality and heart failure (HF) hospitalization at 1-year. Among 54,535 patients undergoing TAVR, 42,568 (78.1%) had severe AS with concomitant AI. Device success was lower in patients with severe AS with concomitant AI as compared with isolated AS. The presence of baseline AI was associated with lower 1 year mortality (HR 0.94 per 1 grade increase in AI severity; 95% CI, 0.91-0.98, P < .001) and HF hospitalization (HR 0.87 per 1 grade increase in AI severity; 95% CI, 0.84-0.91, P < .001). CONCLUSIONS Severe AS with concomitant AI is common among patients undergoing TAVR, and is associated with lower 1 year mortality and HF hospitalization. Future studies are warranted to better understand the mechanisms underlying this benefit. SHORT ABSTRACT In this nationally representative analysis from the United States, 78.1% of patients undergoing TAVR had severe AS with concomitant AI. Device success was lower in patients with severe AS with concomitant AI as compared with isolated AS. The presence of baseline AI was associated with lower 1 year mortality (HR 0.94 per 1 grade increase in AI severity; 95% CI, 0.91-0.98, P < .001) and HF hospitalization (HR 0.87 per 1 grade increase in AI severity; 95% CI, 0.84-0.91, P < .001).
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Abstract
PURPOSE OF REVIEW To review the current status and indications of transcatheter edge-to-edge mitral valve repair. RECENT FINDINGS Mitral regurgitation remains a common valvular disease and can be classified as degenerative (primary) or functional (secondary). Randomized controlled trials have shown that transcatheter edge-to-edge mitral valve repair with MitraClip is successful, safe, and effective in reducing mitral regurgitation. The US Food and Drug Administration approved MitraClip in 2013 for treatment of patients with primary mitral regurgitation at prohibitive surgical risk and in 2019 for secondary mitral regurgitation. Several MitraClip generations exist (NT/R, XT/R, NTW, and XTW) with unique features and considerations. Additional edge-to-edge repair, non-edge-to-edge repair, and transcatheter valve replacement systems are under investigation as stand-alone or adjunctive therapy for patients with mitral regurgitation. Mitral regurgitation remains a significant health burden and many patients are not suitable for surgical repair or replacement. Transcatheter mitral valve therapies can be considered in selected patients and are safe and effective. More research is needed to understand how to best select devices and patients and optimize outcomes.
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Affiliation(s)
- Mohammed Qintar
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, MI, USA. .,Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, 4401 Wornall Road, Kansas City, MO, 64111, USA.
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, 4401 Wornall Road, Kansas City, MO, 64111, USA
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Sathananthan J, Fraser R, Hatoum H, Barlow AM, Stanová V, Allen KB, Chhatriwalla AK, Rieu R, Pibarot P, Dasi LP, Søndergaard L, Wood DA, Webb JG. A bench test study of bioprosthetic valve fracture performed before versus after transcatheter valve-in-valve intervention. EUROINTERVENTION 2020; 15:1409-1416. [DOI: 10.4244/eij-d-19-00939] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Chhatriwalla AK, Decker C, Gialde E, Catley D, Goggin K, Jaschke K, Jones P, deBronkart D, Sun T, Spertus JA. Developing and Testing a Personalized, Evidence-Based, Shared Decision-Making Tool for Stent Selection in Percutaneous Coronary Intervention Using a Pre-Post Study Design. Circ Cardiovasc Qual Outcomes 2020; 12:e005139. [PMID: 30764654 PMCID: PMC6383794 DOI: 10.1161/circoutcomes.118.005139] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Drug-eluting stents reduce the risk of restenosis in patients undergoing percutaneous coronary intervention, but their use necessitates prolonged dual antiplatelet therapy, which increases costs and bleeding risk, and which may delay elective surgeries. While >80% of patients in the United States receive drug-eluting stents, less than a third report that their physicians discussed options with them. Methods and Results An individualized shared decision-making (SDM) tool for stent selection was designed and implemented at 2 US hospitals. In the postimplementation phase, all patients received the SDM tool before their procedure, with or without decision coaching from a trained nurse. All patients were interviewed with respect to their knowledge of stents, their participation in SDM, and their stent preference. Between May 2014 and December 2016, 332 patients not receiving the SDM tool, 113 receiving the SDM tool with coaching, and 136 receiving the tool without coaching were interviewed. Patients receiving the SDM tool + coaching, as compared with usual care, demonstrated higher knowledge scores (mean difference +1.8; P<0.001), reported more frequent participation in SDM (odds ratio=2.96; P<0.001), and were more likely to state a stent preference (odds ratio=2.00; P<0.001). No significant differences were observed between the use of the SDM tool without coaching and usual care. For patients who voiced a stent preference, concordance between stent desired and stent received was 98% for patients who preferred a drug-eluting stent and 50% for patients who preferred a bare metal stent. The SDM tool (with or without coaching) had no impact on stent selection or concordance. Conclusions An SDM tool for stent selection was associated with improvements in patient knowledge and SDM only when accompanied by decision coaching. However, the SDM tool (with or without coaching) had no impact on stent selection or concordance between patients' stent preference and stent received, suggesting that physician-level barriers to SDM may exist. Clinical Trial Information URL: https://www.clinicaltrials.gov . Unique Identifier: NCT02046902.
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Affiliation(s)
- Adnan K Chhatriwalla
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C., C.D., E.G., K.J., P.J., J.A.S.).,Department of Medicine, Division of Cardiology, University of Missouri-Kansas City, Kansas City, MO (A.K.C., C.D., J.A.S.)
| | - Carole Decker
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C., C.D., E.G., K.J., P.J., J.A.S.).,Department of Medicine, Division of Cardiology, University of Missouri-Kansas City, Kansas City, MO (A.K.C., C.D., J.A.S.)
| | - Elizabeth Gialde
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C., C.D., E.G., K.J., P.J., J.A.S.)
| | - Delwyn Catley
- Center for Children's Healthy Lifestyles & Nutrition, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO (D.C.).,University of Missouri-Kansas City School of Medicine (D.C.)
| | - Kathy Goggin
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO (K.G.).,University of Missouri-Kansas City Schools of Medicine and Pharmacy, Kansas City, MO (K.G.)
| | - Katie Jaschke
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C., C.D., E.G., K.J., P.J., J.A.S.)
| | - Philip Jones
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C., C.D., E.G., K.J., P.J., J.A.S.)
| | - Dave deBronkart
- Society for Participatory Medicine, Newburyport, MA (D.d.B.)
| | - Tony Sun
- United Healthcare, Overland Park, KS (T.S.)
| | - John A Spertus
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C., C.D., E.G., K.J., P.J., J.A.S.).,Department of Medicine, Division of Cardiology, University of Missouri-Kansas City, Kansas City, MO (A.K.C., C.D., J.A.S.)
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Malik AO, Omer M, Pflederer MC, Almomani A, Gosch KL, Jones PG, Peri-Okonny PA, Al Badarin F, Brandt HA, Arnold SV, Main ML, Cohen DJ, Spertus JA, Chhatriwalla AK. Association Between Diastolic Dysfunction and Health Status Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 12:2476-2484. [PMID: 31786216 DOI: 10.1016/j.jcin.2019.08.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to assess the association of baseline left ventricular diastolic dysfunction (LVDD) with health status outcomes of patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND Although LVDD in patients with aortic stenosis is associated with higher mortality after TAVR, it is unknown if it is also associated with health status recovery. METHODS In a cohort of 304 patients with interpretable echocardiograms, undergoing TAVR, LVDD was categorized at baseline as absent (grade 0), mild (grade 1), moderate (grade 2), or severe (grade 3). Disease-specific health status was assessed using the 12-item Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OS) at baseline and at 1-month and 12-month follow-up. Association of baseline LVDD with health status at baseline and follow-up after TAVR was assessed using a linear trend test, and association with health status recovery (change in KCCQ-OS) was examined using a linear mixed model adjusting for baseline KCCQ-OS. RESULTS Twenty-four (7.9%), 54 (17.8%), 186 (61.2%), and 40 (13.2%) patients had LVDD grades of 0, 1, 2, and 3, respectively. Baseline KCCQ-OS was 61.3 ± 22.7, 51.0 ± 26.1, 44.7 ± 25.7, and 44.4 ± 21.9 (p = 0.004) in patients with LVDD grades of 0, 1,2 and 3. At 1 and 12 months after TAVR, LVDD was not associated with KCCQ-OS. Recovery in KCCQ-OS after TAVR was substantial and similar in patients across all severities of LVDD. CONCLUSIONS Although LVDD is associated with health status prior to TAVR, patients across all severities of LVDD have similar recovery in health status after TAVR.
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Affiliation(s)
- Ali O Malik
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
| | - Mohamed Omer
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Mathew C Pflederer
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Ahmed Almomani
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Kensey L Gosch
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Philip G Jones
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Poghni A Peri-Okonny
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Firas Al Badarin
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Hunter A Brandt
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Suzanne V Arnold
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Michael L Main
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - David J Cohen
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - John A Spertus
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Adnan K Chhatriwalla
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
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Chhatriwalla AK, Vemulapalli S, Szerlip M, Kodali S, Hahn RT, Saxon JT, Mack MJ, Ailawadi G, Rymer J, Manandhar P, Kosinski AS, Sorajja P. Operator Experience and Outcomes of Transcatheter Mitral Valve Repair in the United States. J Am Coll Cardiol 2019; 74:2955-2965. [DOI: 10.1016/j.jacc.2019.09.014] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/14/2019] [Indexed: 11/28/2022]
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Elkaryoni A, Chhatriwalla AK, Kennedy KF, Saxon JT, Cohen DJ, Arnold SV. Change in Hospitalization Rates Following Transcatheter Mitral Valve Repair. Circ Cardiovasc Interv 2019; 12:e008342. [DOI: 10.1161/circinterventions.119.008342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ahmed Elkaryoni
- Division of Internal Medicine, University of Missouri-Kansas City (A.E., A.K.C., J.T.S., D.J.C., S.V.A.)
- Division of Cardiovascular Disease, Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.K.C., K.F.K., J.T.S., S.V.A.)
| | - Adnan K. Chhatriwalla
- Division of Internal Medicine, University of Missouri-Kansas City (A.E., A.K.C., J.T.S., D.J.C., S.V.A.)
| | - Kevin F. Kennedy
- Division of Cardiovascular Disease, Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.K.C., K.F.K., J.T.S., S.V.A.)
| | - John T. Saxon
- Division of Internal Medicine, University of Missouri-Kansas City (A.E., A.K.C., J.T.S., D.J.C., S.V.A.)
- Division of Cardiovascular Disease, Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.K.C., K.F.K., J.T.S., S.V.A.)
| | - David J. Cohen
- Division of Internal Medicine, University of Missouri-Kansas City (A.E., A.K.C., J.T.S., D.J.C., S.V.A.)
| | - Suzanne V. Arnold
- Division of Internal Medicine, University of Missouri-Kansas City (A.E., A.K.C., J.T.S., D.J.C., S.V.A.)
- Division of Cardiovascular Disease, Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.K.C., K.F.K., J.T.S., S.V.A.)
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Allen KB, Brovman EY, Chhatriwalla AK, Greco KJ, Rao N, Kumar A, Urman RD. Opioid-Related Adverse Events: Incidence and Impact in Patients Undergoing Cardiac Surgery. Semin Cardiothorac Vasc Anesth 2019; 24:219-226. [DOI: 10.1177/1089253219888658] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Purpose. Opioid-related adverse drug events (ORADEs) increase patient length of stay (LOS) and health care costs. However, ORADE rates may be underreported. This study attempts to understand the degree to which ORADEs are underreported in Medicare patients undergoing cardiac surgery. Materials and Methods. The Center for Medicare and Medicaid Services administrative claims database was used to identify ORADEs in 110 158 Medicare beneficiaries who underwent cardiac valve (n = 50 525) or coronary bypass (n = 59 633) surgery between April 2016 and March 2017. The International Classification of Disease (ICD)-10 codes specifically linked to ORADEs were used to identify an actual ORADE rate, while additional ICD codes, clinically associated with butas not specific to adverse drug events were analyzed as potential ORADEs. Length of stay (LOS) and hospital daily revenue were analyzed among patients with or without a potential ORADE. Results. Among patients undergoing valve or bypass surgery, the documented ORADE rate was 0.7% (743/110 158). However, potential ORADEs may have occurred in up to 32.4% (35 658/110 158) of patients. In patients with a potential ORADE, mean LOS was longer (11.4 vs 8.2 days; P < .0001) and mean Medicare revenue/day was lower ($4016 vs $4412; P < .0001). The mean net difference in revenue/day between patients with and without an ORADE varied between $231 and $1145, depending on the Diagnosis-Related Group analyzed. Conclusions. ORADEs are likely underreported following cardiac surgery. ORADEs can be associated with increased LOS and decreased hospital revenue. Understanding the incidence and economic impact of ORADEs may expedite changes to postoperative pain management. Adopting multimodal pain management strategies that reduce exposure to opioids may improve outcomes by reducing complications, side effects, and health care costs.
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Affiliation(s)
- Keith B. Allen
- Saint Luke’s Hospital, Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
| | - Ethan Y. Brovman
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Adnan K. Chhatriwalla
- Saint Luke’s Hospital, Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
| | | | | | | | - Richard D. Urman
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Allen KB, Chhatriwalla AK, Saxon JT, Cohen DJ, Nguyen TC, Webb J, Loyalka P, Bavry AA, Rovin JD, Whisenant B, Dvir D, Kennedy KF, Thourani V, Lee R, Aggarwal S, Baron S, Hart A, Davis JR, Borkon AM, Janarthanan S, Beaver T, Karimi A, Gory D, Lin L, Spriggs D, Ofenloch J, Dhoble A, Loyalka P, Hummel B, Russo M, Haik B, Lim M, Babaliaros V, Greenbaum A, O'Neill W, Karha J, Park D, Garrett E, Pak A, Hawa Z, Mitchell J, Unbehaun A, Tandar A, Yadav P, Ricci J, Yeung A. Bioprosthetic valve fracture: Technical insights from a multicenter study. J Thorac Cardiovasc Surg 2019; 158:1317-1328.e1. [DOI: 10.1016/j.jtcvs.2019.01.073] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 01/09/2019] [Accepted: 01/21/2019] [Indexed: 11/26/2022]
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Sathananthan J, Hensey M, Sellers S, Barlow AM, Chhatriwalla AK, Allen KB, Cheung A, Søndergaard L, Blanke P, Ye J, Leipsic J, Wood D, Webb J. Performance of the TRUE dilatation balloon valvuloplasty catheter beyond rated burst pressure: A bench study. Catheter Cardiovasc Interv 2019; 96:E187-E195. [PMID: 31566873 DOI: 10.1002/ccd.28503] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/05/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We undertook an independent bench test assessing the performance of the TRUE dilatation (TD) balloon valvuloplasty catheter (Bard Vascular Inc., Tempe, AZ) beyond its rated burst pressure (RBP). BACKGROUND The TD balloon has a RBP of six atmospheres (atm), and its performance beyond this RBP is poorly understood. Techniques such as bioprosthetic valve fracture require inflation pressures beyond manufacturer recommendations. METHODS A 20, 22, 24, 26, and 28 mm TD balloon were inflated to increasing pressures in increments of 3 atm until balloon failure. Measurements were performed at the proximal, middle, and distal balloon segments with scientific digital calipers. Z-MED balloons (Braun Interventional Systems Inc., Bethlehem, PA) were used as a comparator. RESULTS The mean diameter at the middle of the 20, 22, 24, 26, and 28 mm TD balloon at nominal pressure (3 atm) was 20.02 ± 0.09, 21.77 ± 0.07, 23.9 ± 0.06, 25.82 ± 0.08, and 27.62 ± 0.08 mm, respectively. The maximal mean diameter at the middle of the 20, 22, 24, 26, and 28 mm TD balloon was 20.39 ± 0.03 mm (15 atm), 22.35 ± 0.03 mm (15 atm), 24.55 ± 0.02 mm (15 atm), 26.48 ± 0.02 mm (12 atm), and 28.39 ± 0.03 mm (12 atm), respectively. The 20/22/24 and 26/28 mm balloon failed when inflated beyond 15 atm and 12 atm, respectively. Failure was due to either leakage or longitudinal balloon rupture. TD balloons were more likely to maintain dimensions similar to their labeled size and less likely to fail at higher pressures as compared to Z-MED balloons. CONCLUSION The TD balloon catheter maintains a similar diameter to its labeled size, when inflated beyond its RBP. When inflated beyond 12 atm, the TD balloon can fail due to either leakage or rupture. This has implications for percutaneous structural heart interventions.
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Affiliation(s)
- Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Mark Hensey
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Stephanie Sellers
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Aaron M Barlow
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Adnan K Chhatriwalla
- Saint Luke's Hospital, St. Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Keith B Allen
- Saint Luke's Hospital, St. Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Anson Cheung
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | | | - Philipp Blanke
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Jian Ye
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Jonathan Leipsic
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - David Wood
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - John Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
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Allen KB, Chhatriwalla AK, Cohen D, Saxon J, Hawa Z, Kennedy KF, Aggarwal S, Davis R, Pak A, Borkon AM. Transcarotid Versus Transapical and Transaortic Access for Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2019; 108:715-722. [DOI: 10.1016/j.athoracsur.2019.02.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/18/2019] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
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Qintar M, Li Z, Vemulapalli S, Chhatriwalla AK, Baron SJ, Kosinski AS, Saxon JT, Spertus JA, Cohen DJ, Arnold SV. Association of Smoking Status With Long-Term Mortality and Health Status After Transcatheter Aortic Valve Replacement: Insights From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. J Am Heart Assoc 2019; 8:e011766. [PMID: 31423877 PMCID: PMC6759891 DOI: 10.1161/jaha.118.011766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Smoking is a significant risk factor for aortic stenosis but its impact on clinical and health status outcomes after transcatheter aortic valve replacement (TAVR) has not been described. Methods and Results Patients (n=72 165) undergoing TAVR at 457 US sites in the STS/ACC TVT (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy) Registry between November 2011 and June 2016 were categorized at the time of TAVR as current/recent smokers versus prior/nonsmokers. A series of multivariable models examined the association between smoking status and outcomes, including 1‐year mortality, rehospitalization, mean gradient, and health status (measured by the 12‐item Kansas City Cardiomyopathy Questionnaire–Overall Summary Score [KCCQ‐OS]) and in‐hospital outcomes. A total of 4063 patients (5.6%) were smokers. Smokers presented for TAVR at a younger age (75 [68–81] years versus 83 [77–88] years) but with a greater burden of cardiovascular and lung disease. In adjusted models, smoking was associated with lower in‐hospital mortality (relative risk, 0.74; 95% CI, 0.62–0.89 [P=0.001]) but not with in‐hospital stroke/transient ischemic attack or myocardial infarction. Smoking status had no association with postdischarge mortality, stroke, myocardial infarction, or heart failure (HF) but was associated with slightly lower 1‐year KCCQ‐OS scores (2.4‐point lower KCCQ‐OS; 95% CI, −4.6 to −0.2 [P=0.031]) and higher mean aortic valve gradients (11.1 versus 10.2 mm Hg, P<0.001) in adjusted models. Conclusions The current/recent smoking rate in US patients with TAVR is 5.6% and smokers present at a younger age for TAVR. Smoking was associated with lower in‐hospital but similar long‐term survival after TAVR, slightly worse long‐term health status, and marginally higher mean aortic valve gradients. Further research is needed to understand the effect of smoking cessation on outcomes. See Editorial Edelman and Thourani
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Affiliation(s)
- Mohammed Qintar
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City Kansas City MO
| | - Zhuokai Li
- Duke Clinical Research Institute and Division of Cardiology Duke University Medical Center Durham NC
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute and Division of Cardiology Duke University Medical Center Durham NC
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City Kansas City MO
| | - Suzanne J Baron
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City Kansas City MO
| | - Andrzej S Kosinski
- Duke Clinical Research Institute and Division of Cardiology Duke University Medical Center Durham NC
| | - John T Saxon
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City Kansas City MO
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City Kansas City MO
| | - David J Cohen
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City Kansas City MO
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City Kansas City MO
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Eshcol JO, Chhatriwalla AK. Selective Coronary Angiography Following Cardiac Arrest. Cardiovascular Innovations and Applications 2019. [DOI: 10.15212/cvia.2017.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Chhatriwalla AK, Vemulapalli S, Holmes DR, Dai D, Li Z, Ailawadi G, Glower D, Kar S, Mack MJ, Rymer J, Kosinski AS, Sorajja P. Institutional Experience With Transcatheter Mitral Valve Repair and Clinical Outcomes. JACC Cardiovasc Interv 2019; 12:1342-1352. [DOI: 10.1016/j.jcin.2019.02.039] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/26/2019] [Indexed: 10/26/2022]
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Wood DA, Krajcer Z, Sathananthan J, Strickman N, Metzger C, Fearon W, Aziz M, Satler LF, Waksman R, Eng M, Kapadia S, Greenbaum A, Szerlip M, Heimansohn D, Sampson A, Coady P, Rodriguez R, Krishnaswamy A, Lee JT, Ben-Dor I, Moainie S, Kodali S, Chhatriwalla AK, Yadav P, O’Neill B, Kozak M, Bacharach JM, Feldman T, Guerrero M, Nanjundappa A, Bersin R, Zhang M, Potluri S, Barker C, Bernardo N, Lumsden A, Barleben A, Campbell J, Cohen DJ, Dake M, Brown D, Maor N, Nardone S, Lauck S, O’Neill WW, Webb JG. Pivotal Clinical Study to Evaluate the Safety and Effectiveness of the MANTA Percutaneous Vascular Closure Device. Circ Cardiovasc Interv 2019; 12:e007258. [DOI: 10.1161/circinterventions.119.007258] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background:
Open surgical closure and small-bore suture-based preclosure devices have limitations when used for transcatheter aortic valve replacement, percutaneous endovascular abdominal aortic aneurysm repair, or percutaneous thoracic endovascular aortic aneurysm repair. The MANTA vascular closure device is a novel collagen-based technology designed to close large bore arteriotomies created by devices with an outer diameter ranging from 12F to 25F. In this study, we determined the safety and effectiveness of the MANTA vascular closure device.
Methods and Results:
A prospective, single arm, multicenter investigation in patients undergoing transcatheter aortic valve replacement, percutaneous endovascular abdominal aortic aneurysm repair, or thoracic endovascular aortic aneurysm repair at 20 sites in North America. The primary outcome was time to hemostasis. The primary safety outcomes were accessed site-related vascular injury or bleeding complications. A total of 341 patients, 78 roll-in, and 263 in the primary analysis cohort, were entered in the study between November 2016 and September 2017. For the primary analysis cohort, transcatheter aortic valve replacement was performed in 210 (79.8%), and percutaneous endovascular abdominal aortic aneurysm repair or thoracic endovascular aortic aneurysm repair was performed in 53 (20.2%). The 14F MANTA was used in 42 cases (16%), and the 18F was used in 221 cases(84%). The mean effective sheath outer diameter was 22F (7.3 mm). The mean time to hemostasis was 65±157 seconds with a median time to hemostasis of 24 seconds. Technical success was achieved in 257 (97.7%) patients, and a single device was deployed in 262 (99.6%) of cases. Valve Academic Research Consortium-2 major vascular complications occurred in 11 (4.2%) cases: 4 received a covered stent (1.5%), 3 had access site bleeding (1.1%), 2 underwent surgical repair (0.8%), and 2 underwent balloon inflation (0.8%).
Conclusions:
In a selected population, this study demonstrated that the MANTA percutaneous vascular closure device can safely and effectively close large bore arteriotomies created by current generation transcatheter aortic valve replacement, percutaneous endovascular abdominal aortic aneurysm repair, and thoracic endovascular aortic aneurysm repair devices.
Clinical Trial Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02908880.
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Affiliation(s)
- David A. Wood
- Center for Heart Valve Innovation, St Paul’s and Vancouver General Hospital, University of British Columbia, Vancouver, Canada (D.A.W., J.S., S.L., J.G.W.)
| | | | - Janarthanan Sathananthan
- Center for Heart Valve Innovation, St Paul’s and Vancouver General Hospital, University of British Columbia, Vancouver, Canada (D.A.W., J.S., S.L., J.G.W.)
| | | | | | - William Fearon
- Stanford University Medical Center, CA (W.F., J.T.L., M.D.)
| | - Mark Aziz
- Holston Valley Medical Center, TN (M.A.)
| | - Lowell F. Satler
- MedStar Washington Hospital Center, Washington DC (L.F.S., R.W., I.B.-D., N.B.)
| | - Ron Waksman
- MedStar Washington Hospital Center, Washington DC (L.F.S., R.W., I.B.-D., N.B.)
| | | | | | | | - Molly Szerlip
- The Heart Hospital Baylor Plano, TX (M.S., S.P., D.B.)
| | | | | | - Paul Coady
- Lankenau Medical Center, PA (P.C., R.R.)
| | | | | | - Jason T. Lee
- Stanford University Medical Center, CA (W.F., J.T.L., M.D.)
| | - Itsik Ben-Dor
- MedStar Washington Hospital Center, Washington DC (L.F.S., R.W., I.B.-D., N.B.)
| | | | | | | | - Pradeep Yadav
- Penn State Health/Hershey Medical Center, PA (P.Y., M.K.)
| | | | - Mark Kozak
- Penn State Health/Hershey Medical Center, PA (P.Y., M.K.)
| | | | | | | | | | | | - Ming Zhang
- Swedish Heart and Vascular, WA (R.B., M.Z.)
| | | | | | - Nelson Bernardo
- MedStar Washington Hospital Center, Washington DC (L.F.S., R.W., I.B.-D., N.B.)
| | | | | | | | - David J. Cohen
- Saint Luke’s Mid America Heart Institute, Kansas City (A.K.C., D.J.C.)
| | - Michael Dake
- Stanford University Medical Center, CA (W.F., J.T.L., M.D.)
| | - David Brown
- The Heart Hospital Baylor Plano, TX (M.S., S.P., D.B.)
| | | | | | - Sandra Lauck
- Center for Heart Valve Innovation, St Paul’s and Vancouver General Hospital, University of British Columbia, Vancouver, Canada (D.A.W., J.S., S.L., J.G.W.)
| | | | - John G. Webb
- Center for Heart Valve Innovation, St Paul’s and Vancouver General Hospital, University of British Columbia, Vancouver, Canada (D.A.W., J.S., S.L., J.G.W.)
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Chhatriwalla AK, Rader DJ. Intracoronary Imaging, Reverse Cholesterol Transport, and Transcriptomics: Precision Medicine in CAD? J Am Coll Cardiol 2019; 69:641-643. [PMID: 28183507 DOI: 10.1016/j.jacc.2016.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 12/06/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Adnan K Chhatriwalla
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; Department of Medicine, University of Missouri-Kansas City, Kansas City, Missouri.
| | - Daniel J Rader
- Departments of Genetics, Medicine, and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Elkaryoni A, Qintar M, Cohen DJ, Chhatriwalla AK, Arnold SV. Abstract 221: Transcatheter Aortic Valve Replacement is Associated with a Reduction in Hospitalization Rates: Insights from Nationwide Readmission Database. Circ Cardiovasc Qual Outcomes 2019. [DOI: 10.1161/hcq.12.suppl_1.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
In inoperable patients with severe aortic stenosis, transcatheter aortic valve replacement (TAVR) reduced mortality and hospitalization as compared with medical therapy. However, hospitalization rates after TAVR remain high, given the age and comorbidities of patients undergoing TAVR. Studies have thus far focused on rehospitalization after TAVR and have not examined the decline in hospitalizations achieved with TAVR. We sought to compare hospitalization rates in the 3 months before and after TAVR and further examine these changes in patients with and without LV dysfunction.
Methods:
We used the 2014 Nationwide Readmission Database (NRD) to identify patients who underwent TAVR between April and September, to allow for assessment of hospitalizations 3 months before and after TAVR. We compared hospitalization rates before and after TAVR using McNemar tests and also examined rates among patients with heart failure with reduced ejection fraction (HFrEF) and those without HFrEF.
Results:
Among 10416 who underwent TAVR between 4/1/14-9/30/14, mean age was 81.1 ± 8.4 years, 45.4% were men, mean number of chronic condition was 9.6 ± 3.1, and 40.6% had HFrEF. The rate of all-cause hospitalization in the 3 months before TAVR was 34.1%, which decreased to 25.5% in the 3 months after TAVR (p <0.001; Figure). Among patients with HFrEF, rates changed from 40.2% before TAVR to 26.8% after (p <0.001), as compared with 29.8% to 24.6% among patients without HFrEF (p<0.001). Mixed effects logistic regression to examine patient characteristics associated with change in hospitalization rates after TAVR will be performed.
Conclusion:
Although patients who are treated with TAVR have high rates of rehospitalization after the procedures, TAVR is associated with a reduction in all-cause hospitalization, which appears to be even more pronounced among patients with HFrEF. Further investigation is needed to better understand the patient factors associated with response to TAVR, in terms of hospitalization
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Affiliation(s)
- Ahmed Elkaryoni
- Saint Luke’s Mid America Heart Institute, Univ Of Missouri Kansas-City., Kansas City, MO
| | - Mohammed Qintar
- Saint Luke’s Mid America Heart Institute, Univ Of Missouri Kansas-City., Kansas City, MO
| | - David J Cohen
- Saint Luke’s Mid America Heart Institute, Univ Of Missouri Kansas-City., Kansas City, MO
| | - Adnan K Chhatriwalla
- Saint Luke’s Mid America Heart Institute, Univ Of Missouri Kansas-City., Kansas City, MO
| | - Suzanne V Arnold
- Saint Luke’s Mid America Heart Institute, Univ Of Missouri Kansas-City., Kansas City, MO
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Saxon JT, Allen KB, Cohen DJ, Whisenant B, Ricci J, Barb I, Gafoor S, Harvey J, Dvir D, Chhatriwalla AK. Complications of Bioprosthetic Valve Fracture as an Adjunct to Valve-in-Valve TAVR. Structural Heart 2019. [DOI: 10.1080/24748706.2019.1578446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- John T. Saxon
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
- University of Missouri–Kansas City, Kansas City, Missouri, USA
| | - Keith B. Allen
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
- University of Missouri–Kansas City, Kansas City, Missouri, USA
| | - David J. Cohen
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
- University of Missouri–Kansas City, Kansas City, Missouri, USA
| | | | - Jason Ricci
- McLaren Northern Michigan Hospital, Petoskey, Michigan, USA
| | - Ilie Barb
- Cardiac and Vascular Institute, Gainesville, Florida, USA
| | - Sameer Gafoor
- Swedish Medical Center, Seattle, Washington, USA
- Cardiovascular Center–Frankfurt, Frankfurt, Germany
| | | | - Danny Dvir
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Adnan K. Chhatriwalla
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
- University of Missouri–Kansas City, Kansas City, Missouri, USA
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Affiliation(s)
| | - Paul Sorajja
- Abbott Northwestern Hospital, Minneapolis, MN (P.S.)
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Chhatriwalla AK, Allen KB, Saxon JT, Cohen DJ, Aggarwal S, Hart AJ, Baron SJ, Dvir D, Borkon AM. Bioprosthetic Valve Fracture Improves the Hemodynamic Results of Valve-in-Valve Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005216. [DOI: 10.1161/circinterventions.117.005216] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/05/2017] [Indexed: 11/16/2022]
Abstract
Background—
Valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) may be less effective in small surgical valves because of patient/prosthesis mismatch. Bioprosthetic valve fracture (BVF) using a high-pressure balloon can be performed to facilitate VIV TAVR.
Methods and Results—
We report data from 20 consecutive clinical cases in which BVF was successfully performed before or after VIV TAVR by inflation of a high-pressure balloon positioned across the valve ring during rapid ventricular pacing. Hemodynamic measurements and calculation of the valve effective orifice area were performed at baseline, immediately after VIV TAVR, and after BVF. BVF was successfully performed in 20 patients undergoing VIV TAVR with balloon-expandable (n=8) or self-expanding (n=12) transcatheter valves in Mitroflow, Carpentier-Edwards Perimount, Magna and Magna Ease, Biocor Epic and Biocor Epic Supra, and Mosaic surgical valves. Successful fracture was noted fluoroscopically when the waist of the balloon released and by a sudden drop in inflation pressure, often accompanied by an audible snap. BVF resulted in a reduction in the mean transvalvular gradient (from 20.5±7.4 to 6.7±3.7 mm Hg,
P
<0.001) and an increase in valve effective orifice area (from 1.0±0.4 to 1.8±0.6 cm
2
,
P
<0.001). No procedural complications were reported.
Conclusions—
BVF can be performed safely in small surgical valves to facilitate VIV TAVR with either balloon-expandable or self-expanding transcatheter valves and results in reduced residual transvalvular gradients and increased valve effective orifice area.
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Affiliation(s)
- Adnan K. Chhatriwalla
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); University of Missouri, Kansas City (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); and St. Paul’s Hospital, British Columbia, Canada (D.D.)
| | - Keith B. Allen
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); University of Missouri, Kansas City (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); and St. Paul’s Hospital, British Columbia, Canada (D.D.)
| | - John T. Saxon
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); University of Missouri, Kansas City (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); and St. Paul’s Hospital, British Columbia, Canada (D.D.)
| | - David J. Cohen
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); University of Missouri, Kansas City (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); and St. Paul’s Hospital, British Columbia, Canada (D.D.)
| | - Sanjeev Aggarwal
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); University of Missouri, Kansas City (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); and St. Paul’s Hospital, British Columbia, Canada (D.D.)
| | - Anthony J. Hart
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); University of Missouri, Kansas City (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); and St. Paul’s Hospital, British Columbia, Canada (D.D.)
| | - Suzanne J. Baron
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); University of Missouri, Kansas City (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); and St. Paul’s Hospital, British Columbia, Canada (D.D.)
| | - Danny Dvir
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); University of Missouri, Kansas City (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); and St. Paul’s Hospital, British Columbia, Canada (D.D.)
| | - A. Michael Borkon
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); University of Missouri, Kansas City (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); and St. Paul’s Hospital, British Columbia, Canada (D.D.)
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Baron SJ, Arnold SV, Herrmann HC, Holmes DR, Szeto WY, Allen KB, Chhatriwalla AK, Vemulapali S, O'Brien S, Dai D, Cohen DJ. Impact of Ejection Fraction and Aortic Valve Gradient on Outcomes of Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2017; 67:2349-2358. [PMID: 27199058 DOI: 10.1016/j.jacc.2016.03.514] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 03/07/2016] [Accepted: 03/08/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND In patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), studies have suggested that reduced left ventricular (LV) ejection fraction (LVEF) and low aortic valve gradient (AVG) are associated with worse long-term outcomes. Because these conditions commonly coexist, the extent to which they are independently associated with outcomes after TAVR is unknown. OBJECTIVES The purpose of this study was to evaluate the impact of LVEF and AVG on clinical outcomes after TAVR and to determine whether the effect of AVG on outcomes is modified by LVEF. METHODS Using data from 11,292 patients who underwent TAVR as part of the Transcatheter Valve Therapies Registry, we examined rates of 1-year mortality and recurrent heart failure in patients with varying levels of LV dysfunction (LVEF <30% vs. 30% to 50% vs. >50%) and AVG (<40 mm Hg vs. ≥40 mm Hg). Multivariable models were used to estimate the independent effect of AVG and LVEF on outcomes. RESULTS During the first year of follow-up after TAVR, patients with LV dysfunction and low AVG had higher rates of death and recurrent heart failure. After adjustment for other clinical factors, only low AVG was associated with higher mortality (hazard ratio: 1.21; 95% confidence interval: 1.11 to 1.32; p < 0.001) and higher rates of heart failure (hazard ratio: 1.52; 95% confidence interval: 1.36 to 1.69; p <0.001), whereas the effect of LVEF was no longer significant. There was no evidence of effect modification between AVG and LVEF with respect to either endpoint. CONCLUSIONS In this series of real-world patients undergoing TAVR, low AVG, but not LV dysfunction, was associated with higher rates of mortality and recurrent heart failure. Although these findings suggest that AVG should be considered when evaluating the risks and benefits of TAVR for individual patients, neither severe LV dysfunction nor low AVG alone or in combination provide sufficient prognostic discrimination to preclude treatment with TAVR.
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Affiliation(s)
- Suzanne J Baron
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri
| | - Howard C Herrmann
- Hospital of the University of Pennsylvania, Philadelphia, Philadelphia
| | | | - Wilson Y Szeto
- Hospital of the University of Pennsylvania, Philadelphia, Philadelphia
| | - Keith B Allen
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri
| | | | - Sean O'Brien
- Duke Clinical Research Institute, Durham, North Carolina
| | - Dadi Dai
- Duke Clinical Research Institute, Durham, North Carolina
| | - David J Cohen
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri.
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Armstrong EJ, Chhatriwalla AK, Szerlip M, Swaminathan RV, Patel RAG. Late breaking trials of 2016 in structural heart disease and peripheral artery disease: Commentary covering ACC, EuroPCR, SCAI, TCT, VIVA, ESC, and AHA. Catheter Cardiovasc Interv 2017; 89:1093-1099. [PMID: 28303672 DOI: 10.1002/ccd.27004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 02/04/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Ehrin J Armstrong
- University of Colorado and Denver VA Medical Center, Denver, Colorado
| | | | | | - Rajesh V Swaminathan
- Division of Cardiology, Duke University Medical Center and the Duke Clinical Research Institute, Durham, North Carolina
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Qintar M, Chhatriwalla AK, Arnold SV, Tang F, Buchanan DM, Shafiq A, Pokharel Y, deBronkart D, Ashraf JM, Spertus JA. Beyond restenosis: Patients' preference for drug eluting or bare metal stents. Catheter Cardiovasc Interv 2017; 90:357-363. [PMID: 28168845 DOI: 10.1002/ccd.26946] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 12/22/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To assess patients' perspective about factors associated with stent choice. BACKGROUND Drug eluting stents (DES) markedly reduce the risk of repeat percutaneous coronary intervention (PCI), but necessitate a longer duration of dual anti-platelet therapy (DAPT) as compared with bare metal stents (BMS). Thus, understanding patients' perspective about factors associated with stent choice is paramount. METHODS Patients undergoing angiography rated, on a 10-point scale, the importance (1 = not important, 10 = most important) of avoiding repeat revascularization and avoiding the following potential DAPT drawbacks: bleeding/bruising, more pills/day, medication costs and delaying elective surgery. The factor, or group of factors, that was rated highest by each patient was identified. RESULTS Among 311 patients, repeat revascularization was the single most important consideration to 14.4% of patients, while 20.6% considered avoiding one of the DAPT drawbacks as most important. Most patients (65%) considered avoiding at least one DAPT drawback as important as avoiding repeat revascularization. In no subgroup of patients did more than a quarter of patients prefer avoiding repeat revascularization above all other concerns. Among patients undergoing PCI, more than three quarters received a DES, regardless of their stated preferences (DES use among those most valuing DES benefits, avoiding DAPT drawbacks, or both equally were 78.7%, 86.2%, and 85.6%, respectively, P = 0.56). CONCLUSION Most patients reported that avoiding DAPT drawbacks was as important as avoiding repeat revascularization. Eliciting patient preferences regarding stent type can enhance shared decision-making and allow physicians to better tailor stent choice to patients' goals and values. TRIAL REGISTRATION Developing and Testing a Personalized Evidence-based Shared Decision-making Tool for Stent Selection (DECIDE-PCI). ClinicalTrials.gov Identifier: NCT02046902. URL: https://clinicaltrials.gov/ct2/show/NCT02046902 © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Mohammed Qintar
- Saint Luke's Mid America Heart Institute, Division of Cardiology, Kansas City, MO.,Division of Medicine, University of Missouri at Kansas City, Kansas City, Missouri
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute, Division of Cardiology, Kansas City, MO.,Division of Medicine, University of Missouri at Kansas City, Kansas City, Missouri
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, Division of Cardiology, Kansas City, MO.,Division of Medicine, University of Missouri at Kansas City, Kansas City, Missouri
| | - Fengming Tang
- Saint Luke's Mid America Heart Institute, Division of Cardiology, Kansas City, MO
| | - Donna M Buchanan
- Saint Luke's Mid America Heart Institute, Division of Cardiology, Kansas City, MO.,Division of Medicine, University of Missouri at Kansas City, Kansas City, Missouri
| | - Ali Shafiq
- Saint Luke's Mid America Heart Institute, Division of Cardiology, Kansas City, MO.,Division of Medicine, University of Missouri at Kansas City, Kansas City, Missouri
| | - Yashashwi Pokharel
- Saint Luke's Mid America Heart Institute, Division of Cardiology, Kansas City, MO.,Division of Medicine, University of Missouri at Kansas City, Kansas City, Missouri
| | - Dave deBronkart
- e-Patient Dave LLC and Society for Participatory Medicine, Newburyport, MA
| | - Javed M Ashraf
- Division of Medicine, University of Missouri at Kansas City, Kansas City, Missouri
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Division of Cardiology, Kansas City, MO.,Division of Medicine, University of Missouri at Kansas City, Kansas City, Missouri
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