1
|
Welle GA, Hahn RT, Lindenfeld J, Lin G, Nkomo VT, Hausleiter J, Lurz PC, Pislaru SV, Davidson CJ, Eleid MF. New Approaches to Assessment and Management of Tricuspid Regurgitation Before Intervention. JACC Cardiovasc Interv 2024; 17:837-858. [PMID: 38599687 DOI: 10.1016/j.jcin.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/22/2024] [Accepted: 02/13/2024] [Indexed: 04/12/2024]
Abstract
Severe tricuspid regurgitation (TR) is a progressive condition associated with substantial morbidity, poor quality of life, and increased mortality. Patients with TR commonly have coexisting conditions including congestive heart failure, pulmonary hypertension, chronic lung disease, atrial fibrillation, and cardiovascular implantable electronic devices, which can increase the complexity of medical and surgical TR management. As such, the optimal timing of referral for isolated tricuspid valve (TV) intervention is undefined, and TV surgery has been associated with elevated risk of morbidity and mortality. More recently, an unprecedented growth in TR treatment options, namely the development of a wide range of transcatheter TV interventions (TTVI) is stimulating increased interest and referral for TV intervention across the entire medical community. However, there are no stepwise algorithms for the optimal management of symptomatic severe TR before TTVI. This article reviews the contemporary assessment and management of TR with addition of a medical framework to optimize TR before referral for TTVI.
Collapse
Affiliation(s)
- Garrett A Welle
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. https://twitter.com/GarrettWelleMD
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA. https://twitter.com/hahn_rt
| | - Joann Lindenfeld
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Charles J Davidson
- Division of Cardiology, Northwestern University Medical Center, Chicago, Illinois, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| |
Collapse
|
2
|
Kim M, Kang DY, Ahn JM, Kim JB, Yeung AC, Nishi T, Fearon WF, Cantey EP, Flaherty JD, Davidson CJ, Malaisrie SC, Kim HJ, Lee J, Park J, Kim H, Cho S, Choi Y, Park SJ, Park DW. Sex-Specific Disparities in Clinical Outcomes After Transcatheter Aortic Valve Replacement Among Different Racial Populations. JACC Asia 2024; 4:292-302. [PMID: 38660112 PMCID: PMC11035955 DOI: 10.1016/j.jacasi.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 04/26/2024]
Abstract
Background Sex-related disparities in clinical outcomes following transcatheter aortic valve replacement (TAVR) and the impact of sex on clinical outcomes after TAVR among different racial groups are undetermined. Objectives This study assessed whether sex-specific differences in baseline clinical and anatomical characteristics affect clinical outcomes after TAVR and investigated the impact of sex on clinical outcomes among different racial groups. Methods The TP-TAVR (Trans-Pacific TAVR) registry is a multinational cohort study of patients with severe aortic stenosis who underwent TAVR at 2 major centers in the United States and 1 major center in South Korea. The primary outcome was a composite of death from any cause, stroke, or rehospitalization after 1 year. Results The incidence of the primary composite outcome was not significantly different between sexes (27.9% in men vs 28% in women; adjusted HR: 0.97; 95% CI: 0.79-1.20). This pattern was consistent in Asian (23.5% vs 23.3%; adjusted HR: 0.99; 95% CI: 0.69-1.41) and non-Asian (30.8% vs 31.6%; adjusted HR: 0.95; 95% CI: 0.72-1.24) cohorts, without a significant interaction between sex and racial group (P for interaction = 0.74). The adjusted risk for all-cause mortality was similar between sexes, regardless of racial group. However, the adjusted risk of stroke was significantly lower in male patients than in female patients, which was more prominent in the non-Asian cohort. Conclusions Despite significantly different baseline and procedural characteristics, there were no sex-specific differences in the adjusted 1-year rates of primary composite outcomes and all-cause mortality, regardless of different racial groups. (Transpacific TAVR registry [TP-TAVR]; NCT03826264).
Collapse
Affiliation(s)
- Mijin Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Juyong Brian Kim
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Alan C. Yeung
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Takeshi Nishi
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - William F. Fearon
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Eric P. Cantey
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - James D. Flaherty
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - Charles J. Davidson
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - S. Christopher Malaisrie
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - Hwa Jung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinho Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinsun Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hoyun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Suji Cho
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yeonwoo Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| |
Collapse
|
3
|
Appadurai V, Ayuba G, Flaherty JD, Malaisrie SC, Meng Z, Baldridge AS, Chen C, Slostad B, McCarthy P, Puthumana J, Davidson CJ, Narang A. Temporal Trends in Right Ventricular to Pulmonary Artery Coupling in Patients Undergoing Transcatheter Mitral Valve-in-Valve Replacement for Degenerated Mitral Bioprostheses. J Am Soc Echocardiogr 2024; 37:471-473. [PMID: 38237692 DOI: 10.1016/j.echo.2023.12.014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 12/27/2023] [Accepted: 12/30/2023] [Indexed: 02/23/2024]
Affiliation(s)
- Vinesh Appadurai
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Gloria Ayuba
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - James D Flaherty
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - S Christopher Malaisrie
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Zhiying Meng
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Abigail S Baldridge
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Chen Chen
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Brody Slostad
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Patrick McCarthy
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Jyothy Puthumana
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Charles J Davidson
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611
| | - Akhil Narang
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg Pavilion, Suite 8-503G, 201 E. Huron Street Chicago, IL 60611.
| |
Collapse
|
4
|
Mehta CK, Liu TX, Bonnell L, Habib RH, Kaneko T, Flaherty JD, Davidson CJ, Thomas JD, Rigolin VH, Bonow RO, Pham DT, Johnston DR, McCarthy PM, Malaisrie SC. Age-Stratified Surgical Aortic Valve Replacement for Aortic Stenosis. Ann Thorac Surg 2024:S0003-4975(24)00068-7. [PMID: 38286202 DOI: 10.1016/j.athoracsur.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND The management of aortic stenosis has evolved to stratification by age as reflected in recent societal guidelines. We evaluated age-stratified surgical aortic valve replacement (SAVR) trends and outcomes in patients with bicuspid aortic valve (BAV) or tricuspid aortic valve (TAV) from The Society of Thoracic Surgeons Adult Cardiac Surgery Database. METHODS This cohort included adults (≥18 years) undergoing SAVR for severe aortic stenosis between July 2011 and December 2022. Comparisons were stratified by age (<65 years, 65-79 years, ≥80 years) and BAV or TAV status. Primary end points included operative mortality, composite morbidity and mortality, and permanent stroke. Observed to expected ratios by The Society of Thoracic Surgeons predicted risk of mortality were calculated. RESULTS In total, 200,849 SAVR patients (55,326 BAV [27.5%], 145,526 TAV [72.5%]) from 1238 participating hospitals met study criteria. Annual SAVR volumes decreased by 45% (19,560 to 10,851) during the study period. The decrease was greatest (96%) for patients ≥80 years of age (4914 to 207). The relative prevalence of BAV was greater in younger patients (<65 years, 69,068 [49.5% BAV]; 65-79 years, 104,382 [19.1% BAV]; ≥80 years, 27,399 [4.5% BAV]). The observed mortality in <80-year-old BAV patients (<65 years, 1.08; 65-79 years, 1.21; ≥80 years, 3.68) was better than the expected mortality rate (<65 years, 1.22; 65-79 years, 1.54; ≥80 years, 3.14). CONCLUSIONS SAVR volume in the transcatheter era has decreased substantially, particularly for patients ≥80 years old and for those with TAV. Younger patients with BAV have better than expected outcomes, which should be carefully considered during shared decision-making in the treatment of aortic stenosis. SAVR should remain the preferred therapy in this population.
Collapse
Affiliation(s)
- Christopher K Mehta
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois.
| | - Tom X Liu
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois
| | - Levi Bonnell
- The Society of Thoracic Surgeons Research and Analytic Center, Chicago, Illinois
| | - Robert H Habib
- The Society of Thoracic Surgeons Research and Analytic Center, Chicago, Illinois
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Washington University in St Louis, St Louis, Missouri
| | - James D Flaherty
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois
| | - Charles J Davidson
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois
| | - James D Thomas
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois
| | - Vera H Rigolin
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois
| | - Robert O Bonow
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois
| | - Duc Thinh Pham
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois
| | - Douglas R Johnston
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois
| | - Patrick M McCarthy
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois
| |
Collapse
|
5
|
Kodali S, Hahn RT, Makkar R, Makar M, Davidson CJ, Puthumana JJ, Zahr F, Chadderdon S, Fam N, Ong G, Yadav P, Thourani V, Vannan MA, O'Neill WW, Wang DD, Tchétché D, Dumonteil N, Bonfils L, Lepage L, Smith R, Grayburn PA, Sharma RP, Haeffele C, Babaliaros V, Gleason PT, Elmariah S, Inglessis-Azuaje I, Passeri J, Herrmann HC, Silvestry FE, Lim S, Fowler D, Webb JG, Moss R, Modine T, Lafitte S, Latib A, Ho E, Goldberg Y, Shah P, Nyman C, Rodés-Cabau J, Bédard E, Brugger N, Sannino A, Mack MJ, Leon MB, Windecker S. Transfemoral tricuspid valve replacement and one-year outcomes: the TRISCEND study. Eur Heart J 2023; 44:4862-4873. [PMID: 37930776 DOI: 10.1093/eurheartj/ehad667] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/28/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND AND AIMS For patients with symptomatic, severe tricuspid regurgitation (TR), early results of transcatheter tricuspid valve (TV) intervention studies have shown significant improvements in functional status and quality of life associated with right-heart reverse remodelling. Longer-term follow-up is needed to confirm sustained improvements in these outcomes. METHODS The prospective, single-arm, multicentre TRISCEND study enrolled 176 patients to evaluate the safety and performance of transcatheter TV replacement in patients with ≥moderate, symptomatic TR despite medical therapy. Major adverse events, reduction in TR grade and haemodynamic outcomes by echocardiography, and clinical, functional, and quality-of-life parameters are reported to one year. RESULTS Enrolled patients were 71.0% female, mean age 78.7 years, 88.0% ≥ severe TR, and 75.4% New York Heart Association classes III-IV. Tricuspid regurgitation was reduced to ≤mild in 97.6% (P < .001), with increases in stroke volume (10.5 ± 16.8 mL, P < .001) and cardiac output (0.6 ± 1.2 L/min, P < .001). New York Heart Association class I or II was achieved in 93.3% (P < .001), Kansas City Cardiomyopathy Questionnaire score increased by 25.7 points (P < .001), and six-minute walk distance increased by 56.2 m (P < .001). All-cause mortality was 9.1%, and 10.2% of patients were hospitalized for heart failure. CONCLUSIONS In an elderly, highly comorbid population with ≥moderate TR, patients receiving transfemoral EVOQUE transcatheter TV replacement had sustained TR reduction, significant increases in stroke volume and cardiac output, and high survival and low hospitalization rates with improved clinical, functional, and quality-of-life outcomes to one year. Funded by Edwards Lifesciences, TRISCEND ClinicalTrials.gov number, NCT04221490.
Collapse
Affiliation(s)
- Susheel Kodali
- Division of Cardiology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, NewYork, NY 10032, USA
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, NewYork, NY 10032, USA
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Moody Makar
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Firas Zahr
- Oregon Health & Science University, Portland, OR, USA
| | | | - Neil Fam
- St. Michael's Hospital, Toronto, ON, Canada
| | | | - Pradeep Yadav
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Vinod Thourani
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Mani A Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | | | | | | | | | | | | | - Robert Smith
- Baylor Scott & White: The Heart Hospital Plano, Dallas, TX, USA
| | - Paul A Grayburn
- Baylor Scott & White: The Heart Hospital Plano, Dallas, TX, USA
- Baylor Scott and White Research Institute Cardiac Imaging Core Laboratory, Plano, TX, USA
| | | | | | | | | | - Sammy Elmariah
- Massachusetts General Hospital, Boston, MA, USA
- University of California San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Scott Lim
- University of Virginia, Charlottesville, VA, USA
| | - Dale Fowler
- University of Virginia, Charlottesville, VA, USA
| | | | | | - Thomas Modine
- Hôpital Haut Lévêque, Pessac, France
- Bordeaux University Hospital, Bordeaux, France
| | | | - Azeem Latib
- Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Edwin Ho
- Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Ythan Goldberg
- Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA
- Lenox Hill Hospital, New York, NY, USA
| | - Pinak Shah
- Brigham and Women's Hospital, Boston, MA, USA
| | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Elisabeth Bédard
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | | | - Anna Sannino
- Baylor Scott and White Research Institute Cardiac Imaging Core Laboratory, Plano, TX, USA
| | - Michael J Mack
- Baylor Scott & White: The Heart Hospital Plano, Dallas, TX, USA
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, NewYork, NY 10032, USA
| | | |
Collapse
|
6
|
Feingold KL, Moskowitz JT, Elenbaas C, Andrei AC, Victorson D, Kruse J, Grote V, Patil KD, Shafiro T, Grimone A, Lin F, Davidson CJ, Ring M, McCarthy PM. Acupuncture after valve surgery is feasible and shows promise in reducing postoperative atrial fibrillation: The ACU-Heart pilot trial. JTCVS Open 2023; 16:321-332. [PMID: 38204624 PMCID: PMC10774881 DOI: 10.1016/j.xjon.2023.05.010] [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: 02/20/2023] [Revised: 04/26/2023] [Accepted: 05/09/2023] [Indexed: 01/12/2024]
Abstract
Objective Acupuncture is an effective treatment for arrythmias and postoperative symptoms but has not been investigated after cardiac surgery. Acupuncture After Heart Surgery is a prospective, randomized, controlled pilot trial of daily inpatient acupuncture or standard care after valve surgery with the primary end point being feasibility and secondary end points being reduction in postoperative atrial fibrillation incidence and postoperative symptoms. Methods A total of 100 patients without a history of atrial fibrillation underwent primary valve surgery via sternotomy and randomized 1:1 to acupuncture (51) or standard care (49). The acupuncture group received daily inpatient sessions starting on postoperative day 1. Postoperative symptoms (pain, nausea, stress, anxiety) were assessed once daily in the standard care group and before/after daily intervention in the acupuncture group. The groups were comparable except for age (acupuncture: 55.6 ± 11.4 years, standard care: 61.0 ± 9.3 years; P = .01). Results The Acupuncture After Heart Surgery pilot trial met primary and secondary end points. There were no adverse events. An average of 3.8 (±1.1) acupuncture sessions were delivered per patient during a mean hospital stay of 4.6 days (±1.3). Acupuncture was associated with a reduction in pain, nausea, stress, and anxiety after each session (P < .0001), and patients receiving acupuncture had reduced postoperative stress and anxiety across admission compared with standard care (P = .049 and P = .036, respectively). Acupuncture was associated with reduced postoperative atrial fibrillation incidence (acupuncture: 7 [13.7%], standard care: 16 [32.7%]; P = .028), fewer discharges on amiodarone (acupuncture: 5 [9.8%], standard care: 13 [26.5%]; P = .03), and fewer hours in the intensive care unit (acupuncture: 30.3 ± 10.0, standard care: 37.0 ± 22.5; P = .057). Conclusions Acupuncture after valve surgery is feasible, is well tolerated, and has clinical benefit. The reduction noted in postoperative atrial fibrillation incidence will inform larger trials designed to further investigate the impact of acupuncture on postoperative atrial fibrillation and medical outcomes.
Collapse
Affiliation(s)
- Kim L. Feingold
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine and the Bluhm Cardiovascular Institute, Chicago, Ill
| | - Judith T. Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Ill
- Osher Center for Integrative Health, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Christian Elenbaas
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine and the Bluhm Cardiovascular Institute, Chicago, Ill
| | - Adin-Cristian Andrei
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Jane Kruse
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine and the Bluhm Cardiovascular Institute, Chicago, Ill
| | - Veronika Grote
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Kaustubha D. Patil
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine and the Bluhm Cardiovascular Institute, Chicago, Ill
| | - Tatyana Shafiro
- Osher Center for Integrative Health, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Ania Grimone
- Osher Center for Integrative Health, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Fang Lin
- Osher Center for Integrative Health, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Charles J. Davidson
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine and the Bluhm Cardiovascular Institute, Chicago, Ill
| | - Melinda Ring
- Osher Center for Integrative Health, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Patrick M. McCarthy
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine and the Bluhm Cardiovascular Institute, Chicago, Ill
| |
Collapse
|
7
|
Hahn RT, Lawlor MK, Davidson CJ, Badhwar V, Sannino A, Spitzer E, Lurz P, Lindman BR, Topilsky Y, Baron SJ, Chadderdon S, Khalique OK, Tang GHL, Taramasso M, Grayburn PA, Badano L, Leipsic J, Lindenfeld J, Windecker S, Vemulapalli S, Redfors B, Alu MC, Cohen DJ, Rodés-Cabau J, Ailawadi G, Mack M, Ben-Yehuda O, Leon MB, Hausleiter J. Tricuspid Valve Academic Research Consortium Definitions for Tricuspid Regurgitation and Trial Endpoints. Eur Heart J 2023; 44:4508-4532. [PMID: 37793121 PMCID: PMC10645050 DOI: 10.1093/eurheartj/ehad653] [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: 03/22/2023] [Revised: 07/12/2023] [Accepted: 08/08/2023] [Indexed: 10/06/2023] Open
Abstract
Interest in the pathophysiology, etiology, management, and outcomes of patients with tricuspid regurgitation (TR) has grown in the wake of multiple natural history studies showing progressively worse outcomes associated with increasing TR severity, even after adjusting for multiple comorbidities. Historically, isolated tricuspid valve surgery has been associated with high in-hospital mortality rates, leading to the development of transcatheter treatment options. The aim of this first Tricuspid Valve Academic Research Consortium document is to standardize definitions of disease etiology and severity, as well as endpoints for trials that aim to address the gaps in our knowledge related to identification and management of patients with TR. Standardizing endpoints for trials should provide consistency and enable meaningful comparisons between clinical trials. A second Tricuspid Valve Academic Research Consortium document will focus on further defining trial endpoints and will discuss trial design options.
Collapse
Affiliation(s)
- Rebecca T Hahn
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
- Cardiovascular Research Foundation, New York, New York,USA
| | - Matthew K Lawlor
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Anna Sannino
- Baylor Research Institute, The Heart Hospital Baylor Plano, Plano, Texas, USA
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy
| | - Ernest Spitzer
- Cardialysis, Rotterdam, the Netherlands
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Brian R Lindman
- Structural Heart and Valve Center, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Suzanne J Baron
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
- Baim Institute of Clinical Research, Boston, Massachusetts, USA
| | - Scott Chadderdon
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Omar K Khalique
- Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | - Maurizio Taramasso
- Herzzentrum Hirslanden Zürich, Zürich, Switzerland
- University of Zürich, Zürich, Switzerland
| | - Paul A Grayburn
- Baylor Scott and White Heart and Vascular Hospital at Plano, Plano, Texas, USA
| | - Luigi Badano
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Jonathon Leipsic
- Department of Radiology and Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephan Windecker
- Department of Cardiology, University Cardiovascular Center, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Bjorn Redfors
- Cardiovascular Research Foundation, New York, New York,USA
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria C Alu
- Cardiovascular Research Foundation, New York, New York,USA
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York,USA
- Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Mack
- Baylor Scott and White Health, Dallas, Texas, USA
| | - Ori Ben-Yehuda
- Cardiovascular Research Foundation, New York, New York,USA
- University of California-San Diego, San Diego, California, USA
| | - Martin B Leon
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
- Cardiovascular Research Foundation, New York, New York,USA
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| |
Collapse
|
8
|
Hahn RT, Lawlor MK, Davidson CJ, Badhwar V, Sannino A, Spitzer E, Lurz P, Lindman BR, Topilsky Y, Baron SJ, Chadderdon S, Khalique OK, Tang GHL, Taramasso M, Grayburn PA, Badano L, Leipsic J, Lindenfeld J, Windecker S, Vemulapalli S, Redfors B, Alu MC, Cohen DJ, Rodés-Cabau J, Ailawadi G, Mack M, Ben-Yehuda O, Leon MB, Hausleiter J. Tricuspid Valve Academic Research Consortium Definitions for Tricuspid Regurgitation and Trial Endpoints. Ann Thorac Surg 2023; 116:908-932. [PMID: 37804270 DOI: 10.1016/j.athoracsur.2023.09.018] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 10/09/2023]
Abstract
Interest in the pathophysiology, etiology, management, and outcomes of patients with tricuspid regurgitation (TR) has grown in the wake of multiple natural history studies showing progressively worse outcomes associated with increasing TR severity, even after adjusting for multiple comorbidities. Historically, isolated tricuspid valve surgery has been associated with high in-hospital mortality rates, leading to the development of transcatheter treatment options. The aim of this first Tricuspid Valve Academic Research Consortium document is to standardize definitions of disease etiology and severity, as well as endpoints for trials that aim to address the gaps in our knowledge related to identification and management of patients with TR. Standardizing endpoints for trials should provide consistency and enable meaningful comparisons between clinical trials. A second Tricuspid Valve Academic Research Consortium document will focus on further defining trial endpoints and will discuss trial design options.
Collapse
Affiliation(s)
- Rebecca T Hahn
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York.
| | - Matthew K Lawlor
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York
| | | | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Anna Sannino
- Baylor Research Institute, The Heart Hospital Baylor Plano, Plano, Texas; Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Ernest Spitzer
- Cardialysis, Rotterdam, the Netherlands; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Brian R Lindman
- Structural Heart and Valve Center, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Suzanne J Baron
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts; Baim Institute of Clinical Research, Boston, Massachusetts
| | - Scott Chadderdon
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Omar K Khalique
- Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York
| | - Maurizio Taramasso
- Herzzentrum Hirslanden Zürich, Zürich, Switzerland; University of Zürich, Zürich, Switzerland
| | - Paul A Grayburn
- Baylor Scott and White Heart and Vascular Hospital at Plano, Plano, Texas
| | - Luigi Badano
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Jonathon Leipsic
- Department of Radiology and Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephan Windecker
- Department of Cardiology, University Cardiovascular Center, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Durham, North Carolina; Duke University School of Medicine, Durham, North Carolina
| | - Bjorn Redfors
- Cardiovascular Research Foundation, New York, New York; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria C Alu
- Cardiovascular Research Foundation, New York, New York
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York; Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Ori Ben-Yehuda
- Cardiovascular Research Foundation, New York, New York; University of California-San Diego, San Diego, California
| | - Martin B Leon
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| |
Collapse
|
9
|
Zahr F, Smith RL, Gillam LD, Chadderdon S, Makkar R, von Bardeleben RS, Ruf TF, Kipperman RM, Rassi AN, Szerlip M, Goldman S, Inglessis-Azuaje I, Yadav P, Lurz P, Davidson CJ, Mumtaz M, Gada H, Kar S, Kodali SK, Laham R, Hiesinger W, Fam NP, Keßler M, O'Neill WW, Whisenant B, Kliger C, Kapadia S, Rudolph V, Choo J, Hermiller J, Morse MA, Schofer N, Gafoor S, Latib A, Mahoney P, Kaneko T, Shah PB, Riddick JA, Muhammad KI, Boekstegers P, Price MJ, Praz F, Koulogiannis K, Marcoff L, Hausleiter J, Lim DS. One-Year Outcomes From the CLASP IID Randomized Trial for Degenerative Mitral Regurgitation. JACC Cardiovasc Interv 2023:S1936-8798(23)01358-4. [PMID: 37962288 DOI: 10.1016/j.jcin.2023.10.002] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND The CLASP IID (Edwards PASCAL TrAnScatheter Valve RePair System Pivotal Clinical) trial is the first randomized controlled trial comparing the PASCAL system and the MitraClip system in prohibitive risk patients with significant symptomatic degenerative mitral regurgitation (DMR). OBJECTIVES The study sought to report primary and secondary endpoints and 1-year outcomes for the full cohort of the CLASP IID trial. METHODS Prohibitive-risk patients with 3+/4+ DMR were randomized 2:1 (PASCAL:MitraClip). One-year assessments included secondary effectiveness endpoints (mitral regurgitation [MR] ≤2+ and MR ≤1+), and clinical, echocardiographic, functional, and quality-of-life outcomes. Primary safety (30-day composite major adverse events [MAE]) and effectiveness (6-month MR ≤2+) endpoints were assessed for the full cohort. RESULTS Three hundred patients were randomized (PASCAL: n = 204; MitraClip: n = 96). At 1 year, differences in survival, freedom from heart failure hospitalization, and MAE were nonsignificant (P > 0.05 for all). Noninferiority of the PASCAL system compared with the MitraClip system persisted for the primary endpoints in the full cohort (For PASCAL vs MitraClip, the 30-day MAE rates were 4.6% vs 5.4% with a rate difference of -0.8% and 95% upper confidence bound of 4.6%. The 6-month MR≤2+ rates were 97.9% vs 95.7% with a rate difference of 2.2% and 95% lower confidence bound (LCB) of -2.5%, for, respectively). Noninferiority was met for the secondary effectiveness endpoints at 1 year (MR≤2+ rates for PASCAL vs MitraClip were 95.8% vs 93.8% with a rate difference of 2.1% and 95% LCB of -4.1%. The MR≤1+ rates were 77.1% vs 71.3% with a rate difference of 5.8% and 95% LCB of -5.3%, respectively). Significant improvements in functional classification and quality of life were sustained in both groups (P <0.05 for all vs baseline). CONCLUSIONS The CLASP IID trial full cohort met primary and secondary noninferiority endpoints, and at 1 year, the PASCAL system demonstrated high survival, significant MR reduction, and sustained improvements in functional and quality-of-life outcomes. Results affirm the PASCAL system as a beneficial therapy for prohibitive-surgical-risk patients with significant symptomatic DMR.
Collapse
Affiliation(s)
- Firas Zahr
- Oregon Health and Science University, Portland, Oregon, USA.
| | - Robert L Smith
- Baylor Scott and White the Heart Hospital Plano, Plano, Texas, USA
| | - Linda D Gillam
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | | | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | - Robert M Kipperman
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Andrew N Rassi
- Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Molly Szerlip
- Baylor Scott and White the Heart Hospital Plano, Plano, Texas, USA
| | - Scott Goldman
- Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | | | | | | | | | | | - Hemal Gada
- UPMC Pinnacle, Harrisburg, Pennsylvania, USA
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | | | - Roger Laham
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Neil P Fam
- St. Michael's Hospital, Toronto, Ontario, Canada
| | | | | | | | - Chad Kliger
- Northwell-Lenox Hill, New York, New York, USA
| | | | - Volker Rudolph
- Ruhr-Universität Bochum, Bochum, Bad Oeynhausen, Germany
| | | | - James Hermiller
- St. Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | | | - Niklas Schofer
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | - Azeem Latib
- Montefiore Medical Center, Bronx, New York, USA
| | - Paul Mahoney
- Sentara Norfolk General Hospital, Norfolk, Virginia, USA
| | | | - Pinak B Shah
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - John A Riddick
- Tristar Centennial Medical Center, Nashville, Tennessee, USA
| | | | | | | | | | | | - Leo Marcoff
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | | | - D Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| |
Collapse
|
10
|
Hahn RT, Lawlor MK, Davidson CJ, Badhwar V, Sannino A, Spitzer E, Lurz P, Lindman BR, Topilsky Y, Baron SJ, Chadderdon S, Khalique OK, Tang GHL, Taramasso M, Grayburn PA, Badano L, Leipsic J, Lindenfeld J, Windecker S, Vemulapalli S, Redfors B, Alu MC, Cohen DJ, Rodés-Cabau J, Ailawadi G, Mack M, Ben-Yehuda O, Leon MB, Hausleiter J. Tricuspid Valve Academic Research Consortium Definitions for Tricuspid Regurgitation and Trial Endpoints. J Am Coll Cardiol 2023; 82:1711-1735. [PMID: 37804294 DOI: 10.1016/j.jacc.2023.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 03/22/2023] [Revised: 07/12/2023] [Accepted: 08/08/2023] [Indexed: 10/09/2023]
Abstract
Interest in the pathophysiology, etiology, management, and outcomes of patients with tricuspid regurgitation (TR) has grown in the wake of multiple natural history studies showing progressively worse outcomes associated with increasing TR severity, even after adjusting for multiple comorbidities. Historically, isolated tricuspid valve surgery has been associated with high in-hospital mortality rates, leading to the development of transcatheter treatment options. The aim of this first Tricuspid Valve Academic Research Consortium document is to standardize definitions of disease etiology and severity, as well as endpoints for trials that aim to address the gaps in our knowledge related to identification and management of patients with TR. Standardizing endpoints for trials should provide consistency and enable meaningful comparisons between clinical trials. A second Tricuspid Valve Academic Research Consortium document will focus on further defining trial endpoints and will discuss trial design options.
Collapse
Affiliation(s)
- Rebecca T Hahn
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA.
| | - Matthew K Lawlor
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Anna Sannino
- Baylor Research Institute, The Heart Hospital Baylor Plano, Plano, Texas, USA; Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy. https://twitter.com/AnnaSannino198
| | - Ernest Spitzer
- Cardialysis, Rotterdam, the Netherlands; Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Brian R Lindman
- Structural Heart and Valve Center, Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Suzanne J Baron
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA; Baim Institute of Clinical Research, Boston, Massachusetts, USA
| | - Scott Chadderdon
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA. https://twitter.com/PDXHeartValveMD
| | - Omar K Khalique
- Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | - Maurizio Taramasso
- Herzzentrum Hirslanden Zürich, Zürich, Switzerland; University of Zürich, Zürich, Switzerland
| | - Paul A Grayburn
- Baylor Scott and White Heart and Vascular Hospital at Plano, Plano, Texas, USA
| | - Luigi Badano
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Jonathon Leipsic
- Department of Radiology and Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephan Windecker
- Department of Cardiology, University Cardiovascular Center, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA
| | - Bjorn Redfors
- Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria C Alu
- Cardiovascular Research Foundation, New York, New York, USA
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Saint Francis Hospital and Catholic Health, Roslyn, New York, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Mack
- Baylor Scott and White Health, Dallas, Texas, USA
| | - Ori Ben-Yehuda
- Cardiovascular Research Foundation, New York, New York, USA; University of California-San Diego, San Diego, California, USA. https://twitter.com/oribenyehuda
| | - Martin B Leon
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| |
Collapse
|
11
|
Gerçek M, Goncharov A, Narang A, Körber ML, Friedrichs KP, Baldridge AS, Meng Z, Puthumana JJ, Davidson LJ, Malaisrie SC, Thomas JD, Rudolph TK, Pfister R, Rudolph V, Davidson CJ. Characterization of Screen Failures Among Patients Evaluated for Transcatheter Tricuspid Valve Repair (TriSelect-Study). JACC Cardiovasc Interv 2023; 16:1579-1589. [PMID: 37438025 DOI: 10.1016/j.jcin.2023.03.036] [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: 11/20/2022] [Revised: 03/09/2023] [Accepted: 03/21/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Transcatheter tricuspid valve repair (TTVr) has significantly expanded treatment options for tricuspid regurgitation (TR). However, a sizeable proportion of patients are still declined for TTVr and little is known about their clinical characteristics and cardiac morphology. OBJECTIVES This study sought to characterize patients who screen fail for TTVr with respect to their clinical characteristics and cardiac morphology. METHODS A total of 547 patients were evaluated for TTVr between January 2016 to December 2021 from 3 centers in the United States and Germany. Clinical records and echocardiographic studies were used to assess medical history and right ventricular (RV) and tricuspid valve (TV) characteristics. RESULTS Median age was 80 (IQR: 74-83) years and 60.0% were female. Over half (58.1%) were accepted for TTVr. Of those who were deemed unsuitable for TTVr (41.9%), the most common exclusion reasons were anatomical criteria (56.8%). In the regression analysis, RV and right atrial size, TV coaptation gap, and tethering area were identified as independent screen failure predictors. Other rejection reasons included clinical futility (17.9%), low symptom burden (12.7%), and technical limitations (12.7%). Most of the excluded patients (71.6%) were managed conservatively with medical therapy, while a small number either proceeded to TV surgery (22.3%) or subsequently became eligible for transcatheter tricuspid valve replacement in later available clinical trials in the United States (6.1%). CONCLUSIONS The majority of TTVr screen failure patients are excluded due to TV, right atrial, and RV enlargement. However, a significant proportion is excluded due to clinical futility. These identifiable anatomical and clinical characteristics emphasize the importance of earlier referral and intervention of TR and the need for continued innovation of Transcatheter tricuspid valve interventions.
Collapse
Affiliation(s)
- Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Arseniy Goncharov
- Clinic for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Akhil Narang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Maria L Körber
- Department for Internal Medicine III, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Kai P Friedrichs
- Clinic for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | | | - Zhiying Meng
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jyothy J Puthumana
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - James D Thomas
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tanja K Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Roman Pfister
- Department for Internal Medicine III, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
12
|
Gerçek M, Narang A, Puthumana JJ, Davidson CJ, Rudolph V. Secondary Mitral Regurgitation and Heart Failure: Current Advances in Diagnosis and Management. Heart Fail Clin 2023; 19:307-315. [PMID: 37230646 DOI: 10.1016/j.hfc.2023.02.010] [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: 05/27/2023]
Abstract
The causes of mitral regurgitation (MR) can be broadly divided into primary and secondary causes. Although primary MR is caused by degenerative alterations of the mitral valve and the mitral valve apparatus, secondary (functional) MR is multifactorial and related to dilation of the left ventricle and/or mitral annulus commonly resulting in concomitant restriction of the leaflets. Therefore, the treatment of secondary MR (SMR) is complex and includes guideline directed heart failure therapy along with surgical and transcatheter approaches that have shown effectiveness in certain subgroups. This review aims to provide insight into current advances in diagnosis and management of SMR.
Collapse
Affiliation(s)
- Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany; Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
| | - Akhil Narang
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| |
Collapse
|
13
|
Kim H, Kang DY, Ahn JM, Kim JB, Yeung AC, Nishi T, Fearon WF, Cantey EP, Flaherty JD, Davidson CJ, Malaisrie SC, Kim N, Kim M, Lee J, Park J, Choi Y, Park SJ, Park DW. Race-Specific Impact of Conventional Surgical Risk Score on 1-Year Mortality After Transcatheter Aortic Valve Replacement. JACC Asia 2023; 3:376-387. [PMID: 37323869 PMCID: PMC10261892 DOI: 10.1016/j.jacasi.2022.11.007] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/31/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
Background Interracial differences in the distribution and prognostic value of conventional Society of Thoracic Surgeons (STS) score on long-term mortality after transcatheter aortic valve replacement (TAVR) are uncertain. Objectives This study aims to compare the impact of STS scores on clinical outcomes at 1-year after TAVR between Asian and non-Asian populations. Methods We used the Trans-Pacific TAVR (TP-TAVR) registry, a multinational multicenter, observational registry involving patients undergoing TAVR at 2 major centers in the United States and 1 major center in Korea. Patients were classified into 3 groups (low, intermediate, and high-risk) according to the STS score and compared between STS risk groups and race. The primary outcome was all-cause mortality at 1-year. Results Among 1,412 patients, 581 were Asian and 831 were non-Asian. The distribution of the STS risk score group was different between Asian and non-Asian groups (62.5% low-, 29.8% intermediate-, and 7.7% high-risk in Asian vs 40.6% low-, 39.1% intermediate-, and 20.3% high-risk in non-Asian). In the Asian population, the all-cause mortality at 1-year was substantially higher in the high-risk STS group than in the low- and intermediate-risk groups (3.6% low-risk, 8.7% intermediate-risk, and 24.4% high-risk; log-rank P < 0.001), which was primarily driven by noncardiac mortality. In the non-Asian group, there was a proportional increase in all-cause mortality at 1-year according to the STS risk category (5.3% low-risk, 12.6% intermediate-risk, and 17.8% high-risk; log-rank P < 0.001). Conclusions In this multiracial registry of patients with severe aortic stenosis who underwent TAVR, we identified a differential proportion and prognostic impact of STS score on 1-year mortality between Asian and non-Asian patients (TP-TAVR [Transpacific TAVR Registry]; NCT03826264).
Collapse
Affiliation(s)
- Hoyun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Juyong Brian Kim
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Alan C. Yeung
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Takeshi Nishi
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - William F. Fearon
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Eric P. Cantey
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - James D. Flaherty
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - Charles J. Davidson
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - S. Christopher Malaisrie
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - Nayoung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mijin Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinho Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinsun Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yeonwoo Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| |
Collapse
|
14
|
Kodali SK, Hahn RT, Davidson CJ, Narang A, Greenbaum A, Gleason P, Kapadia S, Miyasaka R, Zahr F, Chadderdon S, Smith RL, Grayburn P, Kipperman RM, Marcoff L, Whisenant B, Gonzales M, Makkar R, Makar M, O'Neill W, Wang DD, Gray WA, Abramson S, Hermiller J, Mitchel L, Lim DS, Fowler D, Williams M, Pislaru SV, Dahou A, Mack MJ, Leon MB, Eleid MF. 1-Year Outcomes of Transcatheter Tricuspid Valve Repair. J Am Coll Cardiol 2023; 81:1766-1776. [PMID: 37137586 DOI: 10.1016/j.jacc.2023.02.049] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/14/2023] [Accepted: 02/21/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Surgical management of isolated tricuspid regurgitation (TR) is associated with high morbidity and mortality, thereby creating a significant need for a lower-risk transcatheter solution. OBJECTIVES The single-arm, multicenter, prospective CLASP TR (Edwards PASCAL TrAnScatheter Valve RePair System in Tricuspid Regurgitation [CLASP TR] Early Feasibility Study) evaluated 1-year outcomes of the PASCAL transcatheter valve repair system (Edwards Lifesciences) to treat TR. METHODS Study inclusion required a previous diagnosis of severe or greater TR and persistent symptoms despite medical treatment. An independent core laboratory evaluated echocardiographic results, and a clinical events committee adjudicated major adverse events. The study evaluated primary safety and performance outcomes, with echocardiographic, clinical, and functional endpoints. Study investigators report 1-year all-cause mortality and heart failure hospitalization rates. RESULTS Sixty-five patients were enrolled: mean age of 77.4 years; 55.4% female; and 97.0% with severe to torrential TR. At 30 days, cardiovascular mortality was 3.1%, the stroke rate was 1.5%, and no device-related reinterventions were reported. Between 30 days and 1 year, there were an additional 3 cardiovascular deaths (4.8%), 2 strokes (3.2%), and 1 unplanned or emergency reintervention (1.6%). One-year postprocedure, TR severity significantly reduced (P < 0.001), with 31 of 36 (86.0%) patients achieving moderate or less TR; 100% had at least 1 TR grade reduction. Freedom from all-cause mortality and heart failure hospitalization by Kaplan-Meier analyses were 87.9% and 78.5%, respectively. Their New York Heart Association functional class significantly improved (P < 0.001) with 92% in class I or II, 6-minute walk distance increased by 94 m (P = 0.014), and overall Kansas City Cardiomyopathy Questionnaire scores improved by 18 points (P < 0.001). CONCLUSIONS The PASCAL system demonstrated low complication and high survival rates, with significant and sustained improvements in TR, functional status, and quality of life at 1 year. (Edwards PASCAL TrAnScatheter Valve RePair System in Tricuspid Regurgitation [CLASP TR] Early Feasibility Study [CLASP TR EFS]; NCT03745313).
Collapse
Affiliation(s)
- Susheel K Kodali
- Columbia University Irving Medical Center, New York, New York, USA.
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Akhil Narang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | | | | | - Firas Zahr
- Oregon Health and Science University Hospital, Portland, Oregon, USA
| | - Scott Chadderdon
- Oregon Health and Science University Hospital, Portland, Oregon, USA
| | - Robert L Smith
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Paul Grayburn
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | | | - Leo Marcoff
- Morristown Medical Center, Morristown, New Jersey, USA
| | | | | | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Moody Makar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | | | | | - James Hermiller
- St Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | - Lucas Mitchel
- St Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | - D Scott Lim
- University of Virginia Health System, Charlottesville, Virginia, USA
| | - Dale Fowler
- University of Virginia Health System, Charlottesville, Virginia, USA
| | | | | | | | - Michael J Mack
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Martin B Leon
- Columbia University Irving Medical Center, New York, New York, USA
| | | |
Collapse
|
15
|
Stolz L, Weckbach LT, Hahn RT, Chatfield AG, Fam NP, von Bardeleben RS, Davidson CJ, Grayburn PA, Zahr F, Hausleiter J. 2-Year Outcomes Following Transcatheter Tricuspid Valve Replacement Using the EVOQUE System. J Am Coll Cardiol 2023:S0735-1097(23)05421-9. [PMID: 37191592 DOI: 10.1016/j.jacc.2023.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023]
|
16
|
Gerçek M, Narang A, Koerber MI, Friedrichs K, Puthumana JJ, Baldridge A, Meng Z, Davidson L, Malaisrie SC, Thomas JD, Rudolph T, Pfister R, Rudolph V, Davidson CJ. CHARACTERIZATION OF SCREEN FAILURES IN PATIENTS EVALUATED FOR TRANSCATHETER TRICUSPID VALVE INTERVENTION (TRISELECT-STUDY). J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01296-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
|
17
|
Weckbach LT, Stolz L, Chatfield AG, Fam NP, Stephan von Bardeleben R, Davidson CJ, Hahn RT, Hausleiter J. Right Ventricular Reverse Remodeling After Transcatheter Tricuspid Valve Replacement in Patients With Heart Failure. J Am Coll Cardiol 2023; 81:708-710. [PMID: 36792287 DOI: 10.1016/j.jacc.2022.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 09/06/2022] [Revised: 11/15/2022] [Accepted: 12/05/2022] [Indexed: 02/16/2023]
|
18
|
Lim DS, Smith RL, Gillam LD, Zahr F, Chadderdon S, Makkar R, von Bardeleben RS, Kipperman RM, Rassi AN, Szerlip M, Goldman S, Inglessis-Azuaje I, Yadav P, Lurz P, Davidson CJ, Mumtaz M, Gada H, Kar S, Kodali SK, Laham R, Hiesinger W, Fam NP, Keßler M, O'Neill WW, Whisenant B, Kliger C, Kapadia S, Rudolph V, Choo J, Hermiller J, Morse MA, Schofer N, Gafoor S, Latib A, Koulogiannis K, Marcoff L, Hausleiter J. Randomized Comparison of Transcatheter Edge-to-Edge Repair for Degenerative Mitral Regurgitation in Prohibitive Surgical Risk Patients. JACC Cardiovasc Interv 2022; 15:2523-2536. [PMID: 36121247 DOI: 10.1016/j.jcin.2022.09.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Severe symptomatic degenerative mitral regurgitation (DMR) has a poor prognosis in the absence of treatment, and new transcatheter options are emerging. OBJECTIVES The CLASP IID (Edwards PASCAL Transcatheter Valve Repair System Pivotal Clinical Trial) randomized trial (NCT03706833) is the first to evaluate the safety and effectiveness of the PASCAL system compared with the MitraClip system in patients with significant symptomatic DMR. This report presents the primary safety and effectiveness endpoints for the trial. METHODS Patients with 3+ or 4+ DMR at prohibitive surgical risk were assessed by a central screening committee and randomized 2:1 (PASCAL:MitraClip). Study oversight also included an echocardiography core laboratory and a clinical events committee. The primary safety endpoint was the composite major adverse event rate at 30 days. The primary effectiveness endpoint was the proportion of patients with mitral regurgitation (MR) ≤2+ at 6 months. RESULTS A prespecified interim analysis in 180 patients demonstrated noninferiority of the PASCAL system vs the MitraClip system for the primary safety and effectiveness endpoints of major adverse event rate (3.4% vs 4.8%) and MR ≤2+ (96.5% vs 96.8%), respectively. Functional and quality-of-life outcomes significantly improved in both groups (P < 0.05). The proportion of patients with MR ≤1+ was durable in the PASCAL group from discharge to 6 months (PASCAL, 87.2% and 83.7% [P = 0.317 vs discharge]; MitraClip, 88.5% and 71.2% [P = 0.003 vs discharge]). CONCLUSIONS The CLASP IID trial demonstrated safety and effectiveness of the PASCAL system and met noninferiority endpoints, expanding transcatheter treatment options for prohibitive surgical risk patients with significant symptomatic DMR.
Collapse
Affiliation(s)
- D Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA.
| | - Robert L Smith
- Baylor Scott and White: The Heart Hospital Plano, Plano, Texas, USA
| | - Linda D Gillam
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Firas Zahr
- Oregon Health & Science University, Portland, Oregon, USA
| | | | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Robert M Kipperman
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Andrew N Rassi
- Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Molly Szerlip
- Baylor Scott and White: The Heart Hospital Plano, Plano, Texas, USA
| | - Scott Goldman
- Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | | | | | | | | | | | - Hemal Gada
- UPMC Pinnacle, Harrisburg, Pennsylvania, USA
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | | | - Roger Laham
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Neil P Fam
- St. Michael's Hospital, Toronto, Ontario, Canada
| | | | | | | | - Chad Kliger
- Northwell-Lenox Hill, New York, New York, USA
| | | | - Volker Rudolph
- Ruhr-Universität Bochum, Bochum, Bad Oeynhausen, Germany
| | | | - James Hermiller
- St. Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | | | - Niklas Schofer
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | - Azeem Latib
- Montefiore Medical Center, Bronx, New York, USA
| | | | - Leo Marcoff
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | | | | |
Collapse
|
19
|
Gerçek M, Körber MI, Narang A, Friedrichs KP, Puthumana JJ, Rudolph TK, Thomas JD, Pfister R, Davidson CJ, Rudolph V. Echocardiographic Pulmonary Artery Systolic Pressure Is Not Reliable for RV-PA Coupling in Transcatheter Tricuspid Valve Annuloplasty. JACC Cardiovasc Interv 2022; 15:2578-2580. [PMID: 36543457 DOI: 10.1016/j.jcin.2022.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/06/2022] [Accepted: 09/13/2022] [Indexed: 12/23/2022]
|
20
|
Baman JR, Medhekar AN, Malaisrie SC, McCarthy P, Davidson CJ, Bonow RO. Management Challenges in Patients Younger Than 65 Years With Severe Aortic Valve Disease. JAMA Cardiol 2022; 8:281-289. [PMID: 36542365 DOI: 10.1001/jamacardio.2022.4770] [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: 12/24/2022]
Abstract
ImportanceThe management of aortic valve disease, including aortic stenosis and aortic regurgitation (AR), in younger adult patients (age &lt;65 years) is complex, and the optimal strategy is often unclear, contingent on multiple anatomic and holistic factors.ObservationsTraditional surgical approaches carry significant considerations, including compulsory lifelong anticoagulation for patients who receive a mechanical aortic valve replacement (AVR) and the risk of structural valvular deterioration and need for subsequent valve intervention in those who receive a bioprosthetic AVR. These factors are magnified in young adults who are considering pregnancy, for whom issues of anticoagulation and valve longevity are heightened. The Ross procedure has emerged as a promising alternative; however, its adoption is limited to highly specialized centers. Valve repair is an option for selected patients with AR. These treatment options offer varying degrees of durability and are associated with different risks and complications, especially for younger adult patients. Patient-centered care from a multidisciplinary valve team allows for discussion of the optimal timing of intervention and the advantages and disadvantages of the various treatment options.Conclusions and RelevanceThe management of severe aortic valve disease in adults younger than 65 years is complex, and there are numerous considerations with each management decision. While mechanical AVR and bioprosthetic AVR have historically been the standards of care, other options are emerging for selected patients but are not yet generalizable beyond specialized surgical centers. A detailed discussion by members of the multidisciplinary heart team and the patient is an integral part of the shared decision-making process.
Collapse
Affiliation(s)
- Jayson R. Baman
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ankit N. Medhekar
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - S. Chris Malaisrie
- Department of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Patrick McCarthy
- Department of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Charles J. Davidson
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert O. Bonow
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Editor, JAMA Cardiology
| |
Collapse
|
21
|
Gray WA, Abramson SV, Lim S, Fowler D, Smith RL, Grayburn PA, Kodali SK, Hahn RT, Kipperman RM, Koulogiannis KP, Eleid MF, Pislaru SV, Whisenant BK, McCabe JM, Liu J, Dahou A, Puthumana JJ, Davidson CJ. 1-Year Outcomes of Cardioband Tricuspid Valve Reconstruction System Early Feasibility Study. JACC Cardiovasc Interv 2022; 15:1921-1932. [DOI: 10.1016/j.jcin.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 10/14/2022]
|
22
|
Kodali S, Hahn RT, George I, Davidson CJ, Narang A, Zahr F, Chadderdon S, Smith R, Grayburn PA, O'Neill WW, Wang DD, Herrmann H, Silvestry F, Elmariah S, Inglessis I, Passeri J, Lim DS, Salerno M, Makar M, Mack MJ, Leon MB, Makkar R. Transfemoral Tricuspid Valve Replacement in Patients With Tricuspid Regurgitation: TRISCEND Study 30-Day Results. JACC Cardiovasc Interv 2022; 15:471-480. [PMID: 35272771 DOI: 10.1016/j.jcin.2022.01.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [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: 12/14/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The TRISCEND study (Edwards EVOQUE Tricuspid Valve Replacement: Investigation of Safety and Clinical Efficacy after Replacement of Tricuspid Valve with Transcatheter Device) is evaluating the safety and performance of transfemoral transcatheter tricuspid valve replacement in patients with clinically significant tricuspid regurgitation (TR) and elevated surgical risk. BACKGROUND Transcatheter valve replacement could lead to a paradigm shift in treating TR and improving patient quality of life. METHODS In the prospective, single-arm, multicenter TRISCEND study, patients with symptomatic moderate or greater TR, despite medical therapy, underwent percutaneous transcatheter tricuspid valve replacement with the EVOQUE system. A composite rate of major adverse events, echocardiographic parameters, and clinical, functional, and quality-of-life measures were assessed at 30 days. RESULTS Fifty-six patients (mean age of 79.3 years, 76.8% female, 91.1% TR severe or greater, 91.1% atrial fibrillation, and 87.5% New York Heart Association functional class III or IV) were treated. At 30 days, TR was reduced to mild or less in 98%. The composite major adverse events rate was 26.8% at 30 days caused by 1 cardiovascular death in a patient with a failed procedure, 2 reinterventions after device embolization, 1 major access site or vascular complication, and 15 severe bleeds, of which none were life-threatening or fatal. No myocardial infarction, stroke, renal failure, major cardiac structural complications, or device-related pulmonary embolism were observed. New York Heart Association significantly improved to functional class I or II (78.8%; P < 0.001), 6-minute walk distance improved 49.8 m (P < 0.001), and Kansas City Cardiomyopathy Questionnaire score improved 19 points (P < 0.001). CONCLUSIONS Early experience with the transfemoral EVOQUE system in patients with clinically significant TR demonstrated technical feasibility, acceptable safety, TR reduction, and symptomatic improvement at 30 days. The TRISCEND II randomized trial (NCT04482062) is underway.
Collapse
Affiliation(s)
- Susheel Kodali
- Columbia University Irving Medical Center, New York, New York, USA.
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Isaac George
- Columbia University Irving Medical Center, New York, New York, USA
| | | | | | - Firas Zahr
- Oregon Health and Science University, Portland, Oregon, USA
| | | | - Robert Smith
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
| | - Paul A Grayburn
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
| | | | | | - Howard Herrmann
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frank Silvestry
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sammy Elmariah
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - D Scott Lim
- University of Virginia, Charlottesville, VA, USA
| | | | - Moody Makar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael J Mack
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
| | - Martin B Leon
- Columbia University Irving Medical Center, New York, New York, USA
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | |
Collapse
|
23
|
Kang DY, Ahn JM, Kim JB, Yeung A, Nishi T, Fearon W, Cantey EP, Flaherty JD, Davidson CJ, Malaisrie SC, Park SY, Yun SC, Ko E, Park H, Lee SA, Kim DH, Kim HJ, Kim JB, Choo SJ, Park DW, Park SJ. Inter-racial differences in patients undergoing transcatheter aortic valve implantation. Heart 2022; 108:1562-1570. [PMID: 35110384 DOI: 10.1136/heartjnl-2021-320364] [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: 09/23/2021] [Accepted: 01/19/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Little information exists about inter-racial differences in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). We investigated whether differences in baseline characteristics between Asian and non-Asian population may contribute to disparities in clinical outcomes after TAVI. METHODS We performed a registry-based, multinational cohort study of patients with severe AS who underwent TAVI at two centres in the USA and one centre in South Korea. The primary outcome was a composite of death, stroke or rehospitalisation at 1 year. RESULTS Of 1412 patients, 581 patients were Asian and 831 were non-Asian (87.5% white, 1.7% black, 6.1% Hispanic or 4.7% others). There were substantial differences in baseline characteristics between two racial groups. The primary composite outcome was significantly lower in the Asian group than in the non-Asian group (26.0% vs 35.0%; HR 0.73; 95% CI 0.59 to 0.89; p=0.003). However, after adjustment of baseline covariates, the risk of primary composite outcome was not significantly different (HR 0.79; 95% CI 0.60 to 1.03; p=0.08). The all-cause mortality at 1 year was significantly lower in the Asian group than the non-Asian group (7.4% vs 12.5%; HR 0.60; 95% CI 0.41 to 0.88; p=0.009). After multivariable adjustment, the risk of all-cause mortality was also similar (HR 1.17; 95% CI 0.73 to 1.88; p=0.52). CONCLUSIONS There were significant differences in baseline and procedural factors among Asian and non-Asian patients who underwent TAVI. Observed inter-racial differences in clinical outcomes were largely explained by baseline differences in clinical, anatomical and procedural factors. TRIAL REGISTRATION NUMBER NCT03826264 (https://wwwclinicaltrialsgov).
Collapse
Affiliation(s)
- Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Juyong Brian Kim
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Alan Yeung
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Takeshi Nishi
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - William Fearon
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Eric Page Cantey
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - James D Flaherty
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Seo Young Park
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Cheol Yun
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Euihong Ko
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hanbit Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Ah Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ho Jin Kim
- Division of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon Bum Kim
- Division of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Suk Jung Choo
- Division of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| |
Collapse
|
24
|
Ranard LS, Vahl TP, Chung CJ, Sadri S, Khalique OK, Hamid N, Nazif T, George I, Ng V, Patel A, Rezende CP, Reisman M, Latib A, Hausleiter J, Sorajja P, Bapat VN, Tang GHL, Davidson CJ, Zahr F, Makkar R, Fam NP, Granada JF, Leon MB, Hahn RT, Kodali S. Impact of inferior vena cava entry characteristics on tricuspid annular access during transcatheter interventions. Catheter Cardiovasc Interv 2022; 99:1268-1276. [PMID: 35084803 DOI: 10.1002/ccd.30048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/01/2021] [Accepted: 12/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The purpose of this study was to characterize the anatomic relationship between the inferior vena cava (IVC) and tricuspid annulus (TA) and its potential impact on the performance of transcatheter TV interventions. BACKGROUND Transcatheter tricuspid valve (TV) interventions are emerging as a therapeutic alternative for the treatment of severe, symptomatic tricuspid regurgitation (TR). Progression of TR is associated with right heart dilatation. These anatomic changes may distort the IVC-TA relationship and impact successful implantation of transcatheter devices. METHODS Fifty patients who presented with symptomatic TR for consideration of transcatheter TV therapy with an available CT were included in the study. Comprehensive transesophageal echocardiogram and CT analyses were performed to assess the right-sided cardiac chambers, TA and IVC-TA relationship. RESULTS The mean age of the study cohort was 78.4 ± 8.9 years. Torrential TR was present in 54% (n = 27). There was considerable variation in the short axis mid-IVC to mid-TA offset (SAXMID 18.2 ± 7.9 mm, range 4.7-42.1 mm). CONCLUSIONS The IVC-to-TA relationship exhibits significant variability in patients with symptomatic TR. CT analysis of the tricuspid anatomy, including the relationship to the surrounding structures and the IVC, is essential for planning transcatheter TV interventions. Further studies are needed to define whether the IVC-to-TA relationship is a predictor of technical success in the context of specific transcatheter delivery systems.
Collapse
Affiliation(s)
- Lauren S Ranard
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Torsten P Vahl
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA.,Cardiovascular Research Foundation, New York, New York, USA
| | - Christine J Chung
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Shirin Sadri
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Omar K Khalique
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA.,Cardiovascular Research Foundation, New York, New York, USA
| | - Nadira Hamid
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA.,Cardiovascular Research Foundation, New York, New York, USA
| | - Tamim Nazif
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA.,Cardiovascular Research Foundation, New York, New York, USA
| | - Isaac George
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Vivian Ng
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Amisha Patel
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Carolina P Rezende
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - Mark Reisman
- Division of Cardiology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Paul Sorajja
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Vinayak N Bapat
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, New York, USA
| | - Charles J Davidson
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Firas Zahr
- Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Neil P Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Juan F Granada
- Cardiovascular Research Foundation, New York, New York, USA
| | - Martin B Leon
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA.,Cardiovascular Research Foundation, New York, New York, USA
| | - Rebecca T Hahn
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA.,Cardiovascular Research Foundation, New York, New York, USA
| | - Susheel Kodali
- Division of Cardiology, Heart Valve Center and Center for Interventional Vascular Therapy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA.,Cardiovascular Research Foundation, New York, New York, USA
| |
Collapse
|
25
|
Park H, Ahn JM, Kang DY, Kim JB, Yeung AC, Nishi T, Fearon WF, Cantey EP, Flaherty JD, Davidson CJ, Malaisrie SC, Kim S, Yun SC, Ko E, Lee SA, Kim DH, Kim HJ, Kim JB, Choo SJ, Park DW, Park SJ. Racial Differences in the Incidence and Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2021; 14:2670-2681. [PMID: 34838464 DOI: 10.1016/j.jcin.2021.08.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/04/2021] [Accepted: 08/17/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to compare the incidence and prognostic significance of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) according to racial groups. BACKGROUND PPM after TAVR may be of more concern in Asian populations considering their relatively small annular and valve sizes compared with Western populations. METHODS TP-TAVR (Transpacific TAVR Registry) was an international multicenter cohort study of patients with severe aortic stenosis who underwent TAVR in the United States and South Korea from January 2015 to November 2019. PPM was defined as moderate (0.65-0.85 cm2/m2) or severe (<0.65 cm2/m2) at the indexed effective orifice area. The primary outcome was a composite of death, stroke, or rehospitalization at 1 year. RESULTS Among 1,101 eligible patients (533 Asian and 569 non-Asian), the incidence of PPM was significantly lower in the Asian population (33.6%; moderate, 26.5%; severe, 7.1%) than in the non-Asian population (54.5%; moderate, 29.8%; severe, 24.7%). The 1-year rate of the primary outcome was similar between the PPM and non-PPM groups (27.5% vs 28.1%; P = 0.69); this pattern was consistent between Asian (25.4% vs 25.2%; P = 0.31) and non-Asian (28.7% vs 32.1%; P = 0.97) patients. After multivariable adjustment, the risk for the primary outcome did not significantly differ between the PPM and non-PPM groups in the overall population (HR: 0.95; 95% CI: 0.74-1.21), in Asian patients (HR: 1.07; 95% CI: 0.74-1.55), and in non-Asian patients (HR: 0.86; 95% CI: 0.63-1.19). CONCLUSIONS In this study of patients with severe aortic stenosis who underwent TAVR, the incidence of PPM was significantly lower in Asian patients than in non-Asian patients. The 1-year risk for the primary composite outcome was similar between the PPM and non-PPM groups regardless of racial group. (Transpacific TAVR Registry [TP-TAVR]; NCT03826264).
Collapse
Affiliation(s)
- Hanbit Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Juyong Brian Kim
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Alan C Yeung
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Takeshi Nishi
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - William F Fearon
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Eric Page Cantey
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - James D Flaherty
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - Charles J Davidson
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - S Christopher Malaisrie
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - Sehee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Cheol Yun
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Euihong Ko
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Ah Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ho Jin Kim
- Division of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon Bum Kim
- Division of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Suk Jung Choo
- Division of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| |
Collapse
|
26
|
Affiliation(s)
- Charles J Davidson
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Laura Davidson
- Interventional Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
27
|
Kodali S, Hahn RT, Eleid MF, Kipperman R, Smith R, Lim DS, Gray WA, Narang A, Pislaru SV, Koulogiannis K, Grayburn P, Fowler D, Hawthorne K, Dahou A, Deo SH, Vandrangi P, Deuschl F, Mack MJ, Leon MB, Feldman T, Davidson CJ. Feasibility Study of the Transcatheter Valve Repair System for Severe Tricuspid Regurgitation. J Am Coll Cardiol 2021; 77:345-356. [PMID: 33509390 DOI: 10.1016/j.jacc.2020.11.047] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tricuspid regurgitation (TR) is a prevalent disease with limited treatment options. OBJECTIVES This is the first 30-day report of the U.S. single-arm, multicenter, prospective CLASP TR early feasibility study of the PASCAL transcatheter valve repair system in the treatment of TR. METHODS Patients with symptomatic TR despite optimal medical therapy, reviewed by the local heart team and central screening committee, were eligible for the study. Data were collected at baseline, discharge, and the 30-day follow-up and were reviewed by an independent clinical events committee and echocardiographic core laboratory. Feasibility endpoints included safety (composite major adverse event [MAE] rate), echocardiographic, clinical, and functional endpoints. RESULTS Of the 34 patients enrolled in the study, the mean age was 76 years, 53% were women, the mean Society of Thoracic Surgeons score was 7.3%, 88% had atrial fibrillation/flutter, 97% had severe or greater TR, and 79% had New York Heart Association (NYHA) functional class III/IV symptoms. Twenty-nine patients (85%) received implants; at 30 days, 85% of them achieved a TR severity reduction of at least 1 grade, with 52% with moderate or less TR (p < 0.001). The MAE rate was 5.9%, and none of the patients experienced cardiovascular mortality, stroke, myocardial infarction, renal complication, or reintervention. Eighty-nine percent of the patients improved to NYHA functional class I/II (p < 0.001), the mean 6-min walk distance improved by 71 m (p < 0.001), and the mean Kansas City Cardiomyopathy Questionnaire score improved by 15 points (p < 0.001). CONCLUSIONS In this early experience, the repair system performed as intended, with substantial TR reduction, favorable safety results with a low MAE rate, no mortality or reintervention, and significant improvements in functional status, exercise capacity, and quality of life. (Edwards CLASP TR EFS [CLASP TR EFS]; NCT03745313).
Collapse
Affiliation(s)
- Susheel Kodali
- Columbia University Medical Center, New York, New York, USA.
| | - Rebecca T Hahn
- Columbia University Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | | | - Robert Kipperman
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - Robert Smith
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - D Scott Lim
- University of Virginia Health System, Charlottesville, Virginia, USA
| | | | - Akhil Narang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | - Paul Grayburn
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Dale Fowler
- University of Virginia Health System, Charlottesville, Virginia, USA
| | | | | | | | | | | | - Michael J Mack
- Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Martin B Leon
- Columbia University Medical Center, New York, New York, USA
| | - Ted Feldman
- Edwards Lifesciences, Irvine, California, USA
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | |
Collapse
|
28
|
Davidson CJ, Lim DS, Smith RL, Kodali SK, Kipperman RM, Eleid MF, Reisman M, Whisenant B, Puthumana J, Abramson S, Fowler D, Grayburn P, Hahn RT, Koulogiannis K, Pislaru SV, Zwink T, Minder M, Dahou A, Deo SH, Vandrangi P, Deuschl F, Feldman TE, Gray WA. Early Feasibility Study of Cardioband Tricuspid System for Functional Tricuspid Regurgitation: 30-Day Outcomes. JACC Cardiovasc Interv 2021; 14:41-50. [PMID: 33413863 DOI: 10.1016/j.jcin.2020.10.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [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: 06/22/2020] [Revised: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The study reports for the first time the 30-day outcomes of the first U.S. study with the Cardioband tricuspid valve reconstruction system for the treatment of functional tricuspid regurgitation (TR). BACKGROUND Increasing severity of TR is associated with progressively higher morbidity and mortality; however, treatment options for isolated significant disease are limited. METHODS In this single-arm, multicenter, prospective Food and Drug Administration-approved early feasibility study (EFS), 30 patients with severe or greater symptomatic functional TR were enrolled who were deemed candidates for transcatheter tricuspid repair with the Cardioband tricuspid system by the local heart team and multidisciplinary screening committee. RESULTS The mean patient age was 77 years, 80% were women, 97% had atrial fibrillation, 70% were in New York Heart Association functional class III to IV with mean left ventricular ejection fraction of 58%, and 27% had severe, 20% massive, and 53% torrential TR. Device success was 93% and all patients were alive at 30 days. Between baseline and 30 days, septolateral tricuspid annular diameter was reduced by 13% (p < 0.001), 85% of patients had ≥1 grade TR reduction and 44% had ≤moderate TR, 75% were in New York Heart Association functional class I to II (p < 0.001), and overall Kansas City Cardiomyopathy Questionnaire score improved by 16 points (p < 0.001). CONCLUSIONS In patients with severe symptomatic functional TR, this is the first study in the United States with the Cardioband tricuspid system for direct transcatheter annular reduction. This early feasibility study demonstrates high procedural feasibility with no 30-day mortality. There is significant reduction of functional TR with clinically significant improvements in functional status and quality of life. (Edwards Cardioband Tricuspid Valve Reconstruction System Early Feasibility Study; NCT03382457).
Collapse
Affiliation(s)
- Charles J Davidson
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - D Scott Lim
- Department of Medicine, University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | - Robert L Smith
- Department of Cardiothoracic Surgery, The Heart Hospital Baylor, Texas, USA
| | - Susheel K Kodali
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Robert M Kipperman
- Department of Cardiovascular Surgery, Morristown Medical Center, Morristown, New Jersey, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark Reisman
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Brian Whisenant
- Division of Cardiovascular Diseases, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Jyothy Puthumana
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sandra Abramson
- Division of Cardiology, Main Line Health, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Dale Fowler
- Department of Medicine, University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | - Paul Grayburn
- Department of Cardiothoracic Surgery, The Heart Hospital Baylor, Texas, USA
| | - Rebecca T Hahn
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | | | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Todd Zwink
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Michael Minder
- Division of Cardiovascular Diseases, Intermountain Healthcare, Salt Lake City, Utah, USA
| | | | | | | | | | | | - William A Gray
- Division of Cardiology, Main Line Health, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | | |
Collapse
|
29
|
Abstract
IMPORTANCE More than 40 million people are living with either mitral or aortic valve disease worldwide, and more than 180 000 heart valve replacement surgeries are performed each year in the US. Transcatheter valve repair has emerged as an important therapeutic option for patients who are candidates for heart valve replacement. OBSERVATIONS All transcatheter valve therapies involve a multidisciplinary team of interventional cardiologists, cardiothoracic surgeons, radiologists, echocardiographers, nurses, and social workers, termed the heart team, to determine the optimal approach for managing each patient. Transcatheter aortic valve implantation (TAVI) is an aortic valve replacement procedure that is performed percutaneously and is currently approved for patients with severe, symptomatic aortic stenosis in all surgical risk categories. The TAVI procedure can be performed using a balloon-expandable or self-expanding valve. In a low-risk cohort of patients (PARTNER [Placement of Aortic Transcatheter Valves] 3 trial), the rates of death from any cause, stroke, or rehospitalization were 8.5% for patients receiving TAVI and 15.1% for patients undergoing surgical aortic valve replacement. Decision-making regarding therapy choice should be based on individual anatomy (including the number of leaflets, annular size, and peripheral arterial anatomy), comorbidities (including concomitant coronary artery disease and aortopathies), and patient preference guide. A mitral transcatheter edge-to-edge repair device is approved by the US Food and Drug Administration for high-risk patients with degenerative and functional mitral regurgitation that has excellent safety and efficacy in these populations. In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial, the annualized rate of all hospitalizations for heart failure was 35.8% among patients who underwent transcatheter edge-to-edge repair and received medical therapy compared with 67.9% among patients in the medical therapy alone group. Transcatheter tricuspid valve repair and replacement trials are ongoing and show promise for the treatment of patients with tricuspid regurgitation, which previously had limited therapeutic options. Multimodality imaging, which includes transthoracic echocardiography, transesophageal echocardiography, computed tomography, and intracardiac echocardiography, is important for preprocedural planning, device selection, and optimal outcomes. CONCLUSIONS AND RELEVANCE Approximately 78 000 TAVI procedures and 10 000 transcatheter mitral valve repairs take place yearly in the US to treat patients with severe, symptomatic aortic stenosis and mitral regurgitation, respectively. Transcatheter valve therapies have expanded therapeutic options for patients, including for those who previously had no viable surgical options.
Collapse
Affiliation(s)
- Laura J Davidson
- Bluhm Cardiovascular Institute and Departments of Medicine and Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Charles J Davidson
- Bluhm Cardiovascular Institute and Departments of Medicine and Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|
30
|
Panchal HB, Stone GW, Saxena A, Bursac Z, Veledar E, Nagabandi A, Davidson CJ, Leon MB, Beohar N. In-hospital outcomes after transcatheter edge-to-edge mitral valve repair in patients with chronic kidney disease: An analysis from the 2010-2016 National inpatient sample. Catheter Cardiovasc Interv 2021; 98:1177-1184. [PMID: 33856107 DOI: 10.1002/ccd.29712] [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: 12/03/2020] [Revised: 03/08/2021] [Accepted: 04/03/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To assess the outcomes following transcatheter edge-to-edge mitral valve repair (TMVr) in patients with chronic kidney disease (CKD). BACKGROUND Percutaneous TMVr is beneficial in high surgical risk patients with severe mitral regurgitation (MR). However, those with CKD are not well studied. METHODS Utilizing the International Classification of Disease (ninth and tenth revision, clinical modification codes) and the Nationwide Inpatient Sample database, we identified 9,228 patients who underwent TMVr during 2010-2016, including those with no or mild CKD (group 1, n = 6,654 [72.11%]), moderate or severe CKD (group 2, n = 2,125 [23.03%]) and end-stage renal disease (ESRD) on dialysis (group 3, n = 449 [4.86%]). In-hospital clinical outcomes, length of stay and cost were assessed. RESULTS In-hospital mortality increased numerically as CKD severity increased, but not statistically different between groups (1.8, 3.3, and 4.5% respectively in group 1, 2, and 3, p = .07). Moderate to severe CKD (group 2) was an independent predictor of acute renal failure requiring hemodialysis (ARFD) (OR: 3.51, CI: 2.33-5.28, p < .0001), the composite outcome of death, ARFD or stroke [OR: 3.15, 95% CI: 2.10-4.76, p < .0001] and extended length of stay [OR: 1.73, 95% CI: 1.24-2.42), p = .001] while ESRD (group 3) was an independent predictor of higher hospital cost [OR: 1.66, 95% CI: 1.01-2.74), p = .04] as compared with no or mild CKD (group 1). CONCLUSIONS High surgical risk patients with severe MR commonly have associated comorbidities including CKD. TMVr outcomes appear to worsen with worsening CKD and therefore careful clinical case selection and further studies evaluating TMVr outcomes in CKD patients is warranted.
Collapse
Affiliation(s)
| | - Gregg W Stone
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai and The Cardiovascular Research Foundation, New York, New York, USA
| | - Anshul Saxena
- Biostatistics and Predictive Analytics, Baptist Health South Florida, Miami, Florida, USA
| | - Zoran Bursac
- Department of Biostatistics, Florida International University, Miami, Florida, USA
| | - Emir Veledar
- Biostatistics and Predictive Analytics, Baptist Health South Florida, Miami, Florida, USA.,Department of Biostatistics, Florida International University, Miami, Florida, USA
| | | | - Charles J Davidson
- Department of Cardiology, Northwestern University, Chicago, Illinois, USA
| | - Martin B Leon
- Columbia University Medical Center and The Cardiovascular Research Foundation, New York, New York, USA
| | - Nirat Beohar
- Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, Florida, USA
| |
Collapse
|
31
|
Davidson CJ, Abramson S, Smith RL, Kodali SK, Kipperman RM, Eleid MF, Reisman M, Whisenant BK, Puthumana J, Fowler D, Grayburn PA, Hahn RT, Koulogiannis K, Pislaru SV, Zwink T, Minder M, Deuschl F, Feldman T, Gray WA, Lim DS. Transcatheter Tricuspid Repair With the Use of 4-Dimensional Intracardiac Echocardiography. JACC Cardiovasc Imaging 2021; 15:533-538. [PMID: 33744150 DOI: 10.1016/j.jcmg.2021.01.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Charles J Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | | | - Robert L Smith
- The Heart Hospital Baylor Scott & White, Plano, Texas, USA
| | | | | | | | - Mark Reisman
- University of Washington, Seattle, Washington, USA
| | | | - Jyothy Puthumana
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dale Fowler
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | | | - Rebecca T Hahn
- Columbia University Medical Center, New York, New York, USA
| | | | | | - Todd Zwink
- University of Washington, Seattle, Washington, USA
| | | | | | - Ted Feldman
- Edwards Lifesciences, Irvine, California, USA
| | | | - D Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | | |
Collapse
|
32
|
Kitamura M, Fam NP, Braun D, Ruf T, Sugiura A, Narang A, Connelly KA, Ho E, Nabauer M, Hausleiter J, Weber M, Nickenig G, Davidson CJ, Thiele H, von Bardeleben RS, Lurz P. 12-Month outcomes of transcatheter tricuspid valve repair with the PASCAL system for severe tricuspid regurgitation. Catheter Cardiovasc Interv 2021; 97:1281-1289. [PMID: 33660364 DOI: 10.1002/ccd.29583] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 11/02/2020] [Revised: 02/01/2021] [Accepted: 02/13/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES We investigated the durability of tricuspid regurgitation (TR) reduction and the clinical outcomes through 12 months after transcatheter tricuspid valve repair (TTVr) with the PASCAL Transcatheter Valve Repair System. BACKGROUND TTVr has rapidly developed and demonstrated favorable acute outcomes, but longer follow-up data are needed. METHODS Overall, 30 patients (age 77 ± 6 years; 57% female) received PASCAL implantation from September 2017 to May 2019 and completed a clinical follow-up at 12 months. RESULTS The TR etiology was functional in 25 patients (83%), degenerative in three (10%), and mixed in two (7%). All patients had TR severe or greater (massive or torrential in 80%) and heart failure symptoms (90% in NYHA III or IV) under optimal medical treatment. Single-leaflet device attachment occurred in two patients. Moderate or less TR was achieved in 23/28 patients (82%) at 30 days, which was sustained at 12 months (86%). Two patients underwent repeat TTVr due to residual torrential TR (day 173) and recurrence of severe TR (day 280), respectively. One-year survival rate was 93%; 6 patients required rehospitalization due to acute heart failure. NYHA functional class I or II was achieved in 90% and 6-minute walk distance improved from 275 ± 122 m at baseline to 347 ± 112 m at 12-month (+72 ± 82 m, p < .01). There was no stroke, endocarditis, or device embolization during the follow-up. CONCLUSIONS Twelve-month outcomes from this multicenter compassionate use experience with the PASCAL System demonstrated high procedural success, acceptable safety, and significant clinical improvement.
Collapse
Affiliation(s)
- Mitsunobu Kitamura
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Neil P Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Tobias Ruf
- Zentrum für Kardiologie, Universitätsmedizin Mainz, Johannes Gutenberg Universität Mainz, Mainz, Germany
| | - Atsushi Sugiura
- Medizinische Klinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Akhil Narang
- Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kim A Connelly
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Edwin Ho
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael Nabauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Marcel Weber
- Medizinische Klinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Georg Nickenig
- Medizinische Klinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Charles J Davidson
- Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| |
Collapse
|
33
|
Kislitsina ON, Szlapka M, McCarthy PM, Davidson CJ, Flaherty JD, Sweis RN, Kruse J, Andrei AC, Cox JL, Malaisrie SC. Unique technical challenges in patients undergoing TAVR for failed aortic homografts. J Card Surg 2020; 36:89-96. [PMID: 33170533 DOI: 10.1111/jocs.15176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/31/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Surgical reoperation for aortic homograft structural valve degeneration (SVD) is a high-risk procedure. Transcatheter aortic valve replacement (TAVR) for homograft-SVD is an alternative to reoperation, but descriptions of implantation techniques are limited. This study compares outcome in patients undergoing into two groups by the type of previously implanted aortic valve prosthesis: TAVR for failed aortic homografts (TAVR-H) or for stented aortic bioprostheses (TAVR-BP). METHODS From 2015 to 2017, TAVR was performed in 41 patients with SVD. Thirty-three patients in the TAVR-BP group (six for SVD of valved conduits), and eight patients in the TAVR-H group. The Valve Academic Research Consortium criteria were used for outcome reporting purposes. RESULTS The patients with TAVR-BP had predominant prosthetic stenosis (94%, p = .002), whereas TAVR-H individuals presented mostly with regurgitation (88%, p = <.001). Patients with TAVR-H received: Sapien-3 (6), Sapien-XT (1), and CoreValve (1) devices. Low, 40% ventricular fixation in relation to homograft annulus was attempted to anchor the prosthesis on the homograft suture-line. One patient with TAVR-BP experienced intraoperative distal prosthesis migration and Type-B aortic dissection, and two patients in the TAVR-H group had late postoperative proximal device migration. In both groups, there was zero 30-day mortality, stroke, or pacemaker implantation. CONCLUSIONS TAVR for failing aortic homografts may be a feasible and safe alternative to high-risk surgical reintervention. Precise, 40%-ventricular device positioning appears crucial for prevention of late paravalvular leak/late prosthesis migration and minimizing the risk of repeat surgical intervention.
Collapse
Affiliation(s)
- Olga N Kislitsina
- Divisions of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA.,Divisions of Cardiology, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| | - Michal Szlapka
- Divisions of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| | - Patrick M McCarthy
- Divisions of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| | - Charles J Davidson
- Divisions of Cardiology, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| | - James D Flaherty
- Divisions of Cardiology, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| | - Ranya N Sweis
- Divisions of Cardiology, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| | - Jane Kruse
- Divisions of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| | - Adin C Andrei
- Department of Preventive Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| | - James L Cox
- Divisions of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| | - S Christopher Malaisrie
- Divisions of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| |
Collapse
|
34
|
Aouad P, Jarvis KB, Botelho MF, Serhal A, Blaisdell J, Collins L, Giri S, Kim D, Markl M, Ricciardi MJ, Davidson CJ, Collins J, Carr J. Aortic annular dimensions by non-contrast MRI using k-t accelerated 3D cine b-SSFP in pre-procedural assessment for transcatheter aortic valve implantation: a technical feasibility study. Int J Cardiovasc Imaging 2020; 37:651-661. [PMID: 32968888 DOI: 10.1007/s10554-020-02038-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 09/18/2020] [Indexed: 11/24/2022]
Abstract
To evaluate k-t accelerated 3D cine b-SSFP (balanced steady state free precession) as magnetic resonance imaging (MRI) technique for aortic annular area measurement in transcatheter aortic valve replacement (TAVR) planning compared to computed tomography angiography (CTA) and other non-contrast MRI sequences with reduced imaging time and without contrast administration. 6 volunteers and 7 TAVR candidates were prospectively enrolled. The volunteers underwent an MRI while TAVR candidates underwent an MRI and CTA. The following non-contrast MRI sequences were obtained at the level of the aortic root: 2D cine b-SSFP [GRAPPA (GeneRalized Autocalibrating Partially Parallel Acquisitions), R = 2], 3D cine b-SSFP [GRAPPA R = 2], navigator triggered 3D b-SSFP MRA [GRAPPA, R = 2] and k-t accelerated 3D cine b-SSFP [PEAK GRAPPA, R = 5]. Qualitative analysis and aortic annular area measurements in systole and diastole were obtained. k-t accelerated 3D cine b-SSFP provided image quality that is acceptable for confident diagnosis with very good interrater agreement. There was no statistically significant difference in aortic annular measurements between k-t accelerated 3D cine b-SSFP and CTA or other MRI sequences (p > 0.05). Bland-Altman analysis showed no systemic difference of annular area measurements between k-t accelerated 3D cine b-SSFP and each of the other techniques. There was excellent inter-rater agreement on aortic annular area measurements during systolic (ICC = 0.976, p < 0.001) and diastolic (ICC = 0.971, p < 0.001) phases using k-t accelerated 3D cine b-SSFP. K-t accelerated 3D cine b-SSFP is a promising alternative for the assessment of annular sizing in pre-TAVR evaluation while offering a reasonable combination of imaging parameters during one breath-hold.
Collapse
Affiliation(s)
- Pascale Aouad
- Department of Radiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 N St Clair (Arkes) suite 800, Chicago, IL, 60611, USA.
| | - Kelly Brooke Jarvis
- Department of Radiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 N St Clair (Arkes) suite 800, Chicago, IL, 60611, USA
| | - Marcos Ferreira Botelho
- Department of Radiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 N St Clair (Arkes) suite 800, Chicago, IL, 60611, USA
| | - Ali Serhal
- Department of Radiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 N St Clair (Arkes) suite 800, Chicago, IL, 60611, USA
| | - Julie Blaisdell
- Department of Radiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 N St Clair (Arkes) suite 800, Chicago, IL, 60611, USA
| | - Louise Collins
- Department of Radiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 N St Clair (Arkes) suite 800, Chicago, IL, 60611, USA
| | | | - Daniel Kim
- Department of Radiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 N St Clair (Arkes) suite 800, Chicago, IL, 60611, USA
| | - Michael Markl
- Department of Radiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 N St Clair (Arkes) suite 800, Chicago, IL, 60611, USA
| | - Mark J Ricciardi
- Department of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Charles J Davidson
- Department of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jeremy Collins
- Department of Radiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 N St Clair (Arkes) suite 800, Chicago, IL, 60611, USA
| | - James Carr
- Department of Radiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 N St Clair (Arkes) suite 800, Chicago, IL, 60611, USA
| |
Collapse
|
35
|
Cantey EP, Chang KY, Blair JEA, Brummel K, Sweis RN, Pham DT, Adi AC, Churyla A, Ricciardi MJ, Malaisrie SC, Davidson CJ, Flaherty JD. Impact of Loop Diuretic Use on Outcomes Following Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 131:67-73. [PMID: 32723557 DOI: 10.1016/j.amjcard.2020.06.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 11/30/2022]
Abstract
The use of LDT may signify significant hemodynamic changes and left ventricular remodeling in severe aortic stenosis (AS). Therefore, we sought to determine whether loop diuretic therapy (LDT) is associated with adverse outcomes following transcatheter aortic valve implantation (TAVI) in patients with severe symptomatic AS. Subjects undergoing TAVI at a single institution from June 2008 to December 2017 were analyzed. LDT doses were normalized to oral furosemide daily equivalents. All outcomes were adjudicated using VARC2 criteria. Descriptive statistics, multivariate logistic regression, and propensity score matching were used. Of the 804 subjects studied, 48.3% were on pre-TAVI LDT with a mean dose of 51.1 mg furosemide dose-equivalents. Subjects on LDT were higher risk, frail patients with more co-morbidities including chronic kidney disease, coronary artery disease requiring prior bypass grafting, peripheral arterial disease, atrial fibrillation or flutter, and diabetes with more severe heart failure symptoms. Those on LDT also had worse left ventricular systolic function, lower transvalvular gradients, and markers of adverse left ventricular remodeling, including increased left ventricular mass index and higher rates of concentric and eccentric hypertrophy. On propensity-score matching, death within one year post-TAVI was borderline significantly higher in the pre-LDT as compared with no-LDT group (16.9% vs 10.4 %, p = 0.068). In conclusion, use of pre-TAVI LDT for severe symptomatic AS is associated with a trend towards worse 1-year mortality and is a marker of high-risk, frail individuals with advanced left ventricular remodeling.
Collapse
Affiliation(s)
- Eric P Cantey
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiothoraci, Depatment of Medicine, Chicago, Illinois
| | - Kevin Y Chang
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - John E A Blair
- University of Chicago Medicine, Section of Cardiology, Department of Medicine, Chicago, Illinois
| | - Kent Brummel
- University of Chicago Medicine, Section of Cardiology, Department of Medicine, Chicago, Illinois
| | - Ranya N Sweis
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiothoraci, Depatment of Medicine, Chicago, Illinois
| | - Duc T Pham
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiothoraci, Depatment of Medicine, Chicago, Illinois
| | - Adin-Christian Adi
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiothoraci, Depatment of Medicine, Chicago, Illinois
| | - Andrei Churyla
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiothoraci, Depatment of Medicine, Chicago, Illinois
| | - Mark J Ricciardi
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiothoraci, Depatment of Medicine, Chicago, Illinois
| | - S Chris Malaisrie
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiothoraci, Depatment of Medicine, Chicago, Illinois
| | - Charles J Davidson
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiothoraci, Depatment of Medicine, Chicago, Illinois
| | - James D Flaherty
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiothoraci, Depatment of Medicine, Chicago, Illinois.
| |
Collapse
|
36
|
Gong FF, Peters AC, Malaisrie SC, Davidson CJ, Flaherty JD, Mehlman DJ, Narang A, Puthumana JJ. Optimal Imaging Guidance During Transcatheter Mitral Valve-in-Valve Replacement in Bioprostheses With Radiolucent Sewing Rings. JACC Case Rep 2020; 2:1129-1134. [PMID: 34317432 PMCID: PMC8311896 DOI: 10.1016/j.jaccas.2020.05.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/06/2020] [Accepted: 05/20/2020] [Indexed: 11/18/2022]
Abstract
Transcatheter mitral valve-in-valve replacement (TMVR) offers a less invasive strategy for managing bioprosthetic mitral valve dysfunction. TMVR positioning is challenging in the setting of a radiolucent bioprosthetic sewing ring. We present 2 cases demonstrating the roles of fluoroscopy and echocardiography in guiding TMVR placement within bioprostheses with radiolucent sewing rings. (Level of Difficulty: Intermediate.).
Collapse
Key Words
- LV, left ventricle
- LVOT, left-ventricular outflow tract
- MPR, multiplanar reconstruction
- MR, mitral regurgitation
- MV, mitral valve
- Medtronic Mosaic
- RV, right ventricle
- S3, Edwards SAPIEN 3 valve
- TEE, transesophageal echocardiography
- TMVR, transcatheter mitral valve-in-valve replacement
- TTE, transthoracic echocardiography
- bioprosthetic valve dysfunction
- mitral valve
- transcatheter valve replacement
Collapse
Affiliation(s)
- Fei Fei Gong
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Address for correspondence: Dr. Fei Fei Gong, Division of Cardiology, Northwestern Medicine, 676 North St. Clair Street, Suite 600, Chicago, Illinois 60611.
| | - Andrew C. Peters
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - S. Chris Malaisrie
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Charles J. Davidson
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James D. Flaherty
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David J. Mehlman
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Akhil Narang
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jyothy J. Puthumana
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
37
|
McCarthy PM, Davidson CJ, Kruse J, Lerner DJ, Braid-Forbes MJ, McCrea MM, Elmouelhi AM, Ferguson MA. Prevalence of atrial fibrillation before cardiac surgery and factors associated with concomitant ablation. J Thorac Cardiovasc Surg 2020; 159:2245-2253.e15. [DOI: 10.1016/j.jtcvs.2019.06.062] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 06/07/2019] [Accepted: 06/07/2019] [Indexed: 01/28/2023]
|
38
|
Peters AC, Unger E, Gong FF, El Hangouche N, Puthumana JJ, Thomas JD, Fusari M, Davidson CJ, Ricciardi MJ, Pham D, Flaherty JD, Narang A. Multimodality imaging to guide transcatheter treatment of severe degenerative tricuspid regurgitation with tricuspid valve-in-ring implantation and paravalvular leak closure. Echocardiography 2020; 37:913-916. [PMID: 32472553 DOI: 10.1111/echo.14743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 11/30/2022] Open
Abstract
Tricuspid valve (TV) degeneration after surgical repair with an annuloplasty ring is problematic as redo operation carries high mortality. This can be addressed with transcatheter therapies to implant a valve within in prior ring (tricuspid valve-in-ring). When an incomplete ring is present, paravalvular leak is commonly encountered after tricuspid valve-in-ring (TViR) implant; however, this can be addressed with paravalvular leak closure devices. Multimodality imaging including cardiac computed tomography and three-dimensional (3D) transesophageal echocardiography (TEE) are important for successful TViR implant. We report a case of tricuspid regurgitation after tricuspid repair with an incomplete annuloplasty ring and subsequent paravalvular leak closure.
Collapse
Affiliation(s)
- Andrew C Peters
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Erin Unger
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Fei Fei Gong
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - James D Thomas
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Mark J Ricciardi
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Duc Pham
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James D Flaherty
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Akhil Narang
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
39
|
Unger ED, Davidson CJ. TA or not TA: That is the Question. Cardiovasc Revasc Med 2020; 21:610-611. [PMID: 32340852 DOI: 10.1016/j.carrev.2020.02.022] [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] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Erin D Unger
- Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 2300, Chicago, IL 60611, United States of America
| | - Charles J Davidson
- Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 2300, Chicago, IL 60611, United States of America.
| |
Collapse
|
40
|
Howard TM, Cantey EP, Abutaleb AA, Ricciardi MJ, Sweis RN, Pham DT, Churyla A, Malaisrie SC, Davidson CJ, Flaherty JD. Transcatheter Aortic Valve Replacement Outcomes Based on the Presence of Chronic Total Occlusion. Cardiovasc Revasc Med 2020; 21:1305-1310. [PMID: 32192912 DOI: 10.1016/j.carrev.2020.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/06/2020] [Accepted: 03/05/2020] [Indexed: 11/29/2022]
Abstract
AIMS Chronic total occlusion (CTO) has been linked to worse survival. While controversial and limited to observational data, successful CTO percutaneous coronary intervention (PCI) has been associated with improved left ventricular (LV) function and mortality. However, the role of CTO PCI prior to transcatheter aortic valve replacement (TAVR) is not clear. We sought to explore the prognostic impact of a pre-TAVR CTO on post-TAVR outcomes. METHODS AND RESULTS We retrospectively reviewed 783 consecutive TAVR cases performed at a single tertiary care medical center. Pre-TAVR angiograms were analyzed for the presence of a CTO. At the time of TAVR, 12.6% (n = 99) patients had a CTO. At one-year post-TAVR, there was no significant association between the presence of a CTO and death (14.2% vs 13.1%, p = 0.75), functional status, quality of life, or adverse events. There was also no difference in long-term survival (4.1 years vs 4.1 years, p = 0.55). LV ejection fraction was lower in the CTO group at baseline and one year (p < 0.01). CONCLUSIONS The presence of a CTO did not have any prognostic impact on mortality, change in LV function, or improvement in functional status and angina scores following TAVR in our cohort of elderly, high-risk patients. CTO before TAVR was associated with decreased ejection fraction at baseline and at one year.
Collapse
Affiliation(s)
- Travis M Howard
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Eric P Cantey
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - AbdulRahman A Abutaleb
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mark J Ricciardi
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ranya N Sweis
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Duc T Pham
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrei Churyla
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Charles J Davidson
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James D Flaherty
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| |
Collapse
|
41
|
Kislitsina ON, Smith D, Sherwani SS, Pham DT, Churyla A, Ricciardi MJ, Davidson CJ, Flaherty JD, Sweis RN, Kruse J, Andrei AC, McCarthy PM, Chris Malaisrie S. Comparison of Monitored Anesthesia Care and General Anesthesia for Transcatheter Aortic Valve Replacement. Innovations�(Phila) 2019; 14:436-444. [DOI: 10.1177/1556984519872463] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Transcatheter aortic valve replacement is a safe, minimally invasive treatment for severe aortic stenosis in patients with moderate-to-high surgical risk. Monitored anesthesia is administered by an anesthesiologist. This study compares transcatheter aortic valve outcomes under monitored anesthesia vs general anesthesia. Methods Data were prospectively collected for 286 patients undergoing transcatheter aortic valve replacement at a single academic hospital from March 2012 to August 2016. The patients were grouped by type of anesthesia: monitored vs general. A propensity score match was performed to compare intraoperative and post-operative outcomes between groups. Results General anesthesia was used in 102 patients and moderate sedation in 184. Propensity score matching produced 80 pairs. Compared to procedures under general anesthesia, patients receiving monitored anesthesia had shorter procedure (1.6 [1.4, 2.0] vs 2.0 [1.6, 2.5] hours; P < 0.001) and fluoroscopy times (17 [14.5, 22.5] vs 25 [17.9, 30.3] minutes; P < 0.001) and shorter hospital length-of-stay (3 [2.0, 4.0] vs 5 [3.0, 7.0] days; P < 0.001) but no difference in intensive care unit length-of-stay. Blood transfusion was more common in patients undergoing general anesthesia, but there was no difference in stroke, renal failure, postoperative atrial fibrillation, or need for permanent pacemaker. More patients were discharged to home after monitored anesthesia (90% vs 64%; P < 0.001). There was no difference in 30-day mortality (0% vs 3%; P = 0.15). Conclusions Transcatheter aortic valve replacement under monitored anesthesia provides the safety of anesthesia-led sedation without intubation and general anesthetic. We found no compromise in patient safety or clinical outcomes.
Collapse
Affiliation(s)
- Olga N. Kislitsina
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Danielle Smith
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Saadia S. Sherwani
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Duc Thinh Pham
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Andrei Churyla
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mark J. Ricciardi
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Charles J. Davidson
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - James D. Flaherty
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ranya N. Sweis
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jane Kruse
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Adin-Chistian Andrei
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Patrick M. McCarthy
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - S. Chris Malaisrie
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
42
|
Davidson LJ, Davidson CJ. CAD strategy in the TAVR era. Catheter Cardiovasc Interv 2019; 93:553-554. [PMID: 30770663 DOI: 10.1002/ccd.28135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 11/07/2022]
Abstract
The optimal revascularization strategy for CAD in the TAVR population is not well-defined and decisions about which patients require PCI have been largely operator dependent or based on SYNTAX score. In a TAVR population, complete revascularization does not improve short or long term mortality, but is associated with decreased acute myocardial infarction and revascularization, when compared with incomplete revascularization. Future prospective studies should evaluate revascularization strategies in TAVR patients, including considering functional lesion assessment with fractional flow reserve, especially as TAVR indications are likely to soon expand to a younger and healthier cohort.
Collapse
Affiliation(s)
- Laura J Davidson
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Charles J Davidson
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
43
|
Kaplan RM, Yadlapati A, Cantey EP, Passman RS, Gajjar M, Knight BP, Sweis R, Ricciardi MJ, Pham DT, Churyla A, Malaisrie SC, Davidson CJ, Flaherty JD. Conduction recovery following pacemaker implantation after transcatheter aortic valve replacement. Pacing Clin Electrophysiol 2018; 42:146-152. [DOI: 10.1111/pace.13579] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 12/04/2018] [Accepted: 12/11/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Rachel M. Kaplan
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of MedicineNorthwestern University Chicago IL
| | - Ajay Yadlapati
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of MedicineNorthwestern University Chicago IL
| | - Eric P. Cantey
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of MedicineNorthwestern University Chicago IL
| | - Rod S. Passman
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of MedicineNorthwestern University Chicago IL
| | - Mark Gajjar
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of MedicineNorthwestern University Chicago IL
| | - Bradley P. Knight
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of MedicineNorthwestern University Chicago IL
| | - Ranya Sweis
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of MedicineNorthwestern University Chicago IL
| | - Mark J. Ricciardi
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of MedicineNorthwestern University Chicago IL
| | - Duc T. Pham
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of MedicineNorthwestern University Chicago IL
| | - Andrei Churyla
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of MedicineNorthwestern University Chicago IL
| | - S. Chris Malaisrie
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of MedicineNorthwestern University Chicago IL
| | - Charles J. Davidson
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of MedicineNorthwestern University Chicago IL
| | - James D. Flaherty
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of MedicineNorthwestern University Chicago IL
| |
Collapse
|
44
|
Dryer K, Gajjar M, Narang N, Lee M, Paul J, Shah AP, Nathan S, Butler J, Davidson CJ, Fearon WF, Shah SJ, Blair JEA. Coronary microvascular dysfunction in patients with heart failure with preserved ejection fraction. Am J Physiol Heart Circ Physiol 2018; 314:H1033-H1042. [PMID: 29424571 DOI: 10.1152/ajpheart.00680.2017] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
There are multiple proposed mechanisms for the pathophysiology of heart failure (HF) with preserved ejection fraction (HFpEF). We hypothesized that coronary microvascular dysfunction is common in these patients. In a prospective, observational study, patients undergoing cardiac catheterization with HFpEF [left ventricular (LV) ejection fraction ≥ 50% and with clinical HF] were compared with similar patients without HFpEF. Patients with ≥50% stenosis were excluded, and coronary flow reserve (CFR) and the index of microvascular resistance (IMR) were measured after adenosine administration using a guidewire, with CFR ≤ 2 and IMR ≥ 23 being abnormal. Baseline characteristics and CFR and IMR were compared in 30 HFpEF patients and 14 control subjects. Compared with control subjects, HFpEF patients were older (65.4 ± 9.6 vs. 55.1 ± 3.1 yr, P < 0.01), had higher numbers of comorbidities (4.4 ± 1.5 vs. 2.6 ± 1.9, P = 0.002), had higher median B-type natriuretic peptide [161 (interquartile range: 75-511) pg/dl vs. 37 (interquartile range: 18.5-111) pg/dl, P < 0.01], and had higher LV end-diastolic pressure (17.8 ± 4.2 vs. 8.4 ± 4.2, P < 0.01). HFpEF patients had lower CFR (2.55 ± 1.60 vs. 3.84 ± 1.89, P = 0.024) and higher IMR (26.7 ± 10.3 vs. 19.7 ± 9.7 units, P = 0.037) than control subjects. Most (71.4%) control subjects had normal coronary physiology, whereas 36.7% of HFpEF patients had both abnormal CFR and IMR and another 36.7% had either abnormal CFR or IMR. In conclusion, this is the first study that has reported invasively determined CFR and IMR in HFpEF patients. We demonstrated the presence of four distinct coronary physiology groups in HFpEF patients. Investigation into the potential mechanisms for these findings is needed. NEW & NOTEWORTHY In this prospective observational study of patients with heart failure with preserved ejection fraction (HFpEF), we found that patients with HFpEF had more abnormalities of coronary flow and resistance than asymptomatic control patients, indicating that coronary microvascular dysfunction may play a role in the HFpEF disease process.
Collapse
Affiliation(s)
- Kathryn Dryer
- Section of Cardiology, Department of Medicine, University of Chicago Pritzker School of Medicine , Chicago, Illinois
| | | | - Nikhil Narang
- Section of Cardiology, Department of Medicine, University of Chicago Pritzker School of Medicine , Chicago, Illinois
| | - Margaret Lee
- Section of Cardiology, Department of Medicine, University of Chicago Pritzker School of Medicine , Chicago, Illinois
| | - Jonathan Paul
- Section of Cardiology, Department of Medicine, University of Chicago Pritzker School of Medicine , Chicago, Illinois
| | - Atman P Shah
- Section of Cardiology, Department of Medicine, University of Chicago Pritzker School of Medicine , Chicago, Illinois
| | - Sandeep Nathan
- Section of Cardiology, Department of Medicine, University of Chicago Pritzker School of Medicine , Chicago, Illinois
| | - Javed Butler
- Division of Cardiovascular Medicine, Department of Medicine, Stony Brook University, Stony Brook, New York
| | - Charles J Davidson
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois
| | - William F Fearon
- Division of Cardiology, Department of Medicine, Stanford University , Stanford, California
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois
| | | |
Collapse
|
45
|
Gajjar M, Yadlapati A, Van Assche LM, Puthumana J, Malaisrie SC, Davidson CJ, Thomas J, Ricciardi MJ. Real-Time Continuous Left Atrial Pressure Monitoring During Mitral Valve Repair Using the MitraClip NT System. JACC Cardiovasc Interv 2017; 10:1466-1467. [DOI: 10.1016/j.jcin.2017.05.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 05/10/2017] [Accepted: 05/22/2017] [Indexed: 12/01/2022]
|
46
|
Narang N, Medvedofsky D, Dryer K, Shah SJ, Davidson CJ, Patel AR, Blair JEA. Microvascular dysfunction and cardiac fibrosis in heart failure with preserved ejection fraction: a case report. ESC Heart Fail 2017; 4:645-648. [PMID: 29154426 PMCID: PMC5695203 DOI: 10.1002/ehf2.12170] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 05/26/2017] [Accepted: 05/29/2017] [Indexed: 12/24/2022] Open
Abstract
We report the case of a 55‐year‐old woman with heart failure with preserved ejection fraction (HFpEF), who presented with hypertensive urgency and pulmonary oedema. The patient was medically optimized and underwent cardiac catheterization revealing pulmonary hypertension, elevated pulmonary capillary wedge pressure, normal cardiac index, and non‐obstructive coronary disease. Invasive evaluation of coronary flow revealed blunted coronary flow reserve and increased index of microvascular resistance. Cardiac magnetic resonance imaging demonstrated reduced global myocardial perfusion and diffuse interstitial fibrosis. This case exhibits a potential HFpEF phenotype associated with microvascular dysfunction, fibrosis, and elevated filling pressures.
Collapse
Affiliation(s)
- Nikhil Narang
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, 60637, USA
| | - Diego Medvedofsky
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, 60637, USA
| | - Kathryn Dryer
- Pritzker School of Medicine, University of Chicago, Chicago, IL, 60637, USA
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | | | - Amit R Patel
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, 60637, USA
| | - John E A Blair
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, 60637, USA
| |
Collapse
|
47
|
Huded CP, Benck LR, Stone NJ, Sweis RN, Ricciardi MJ, Malaisrie SC, Davidson CJ, Flaherty JD. Relation of Intensity of Statin Therapy and Outcomes After Transcatheter Aortic Valve Replacement. Am J Cardiol 2017; 119:1832-1838. [PMID: 28395888 DOI: 10.1016/j.amjcard.2017.02.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 12/31/2016] [Revised: 02/15/2017] [Accepted: 02/15/2017] [Indexed: 11/18/2022]
Abstract
Statin therapy is associated with improved survival in patients at high risk for cardiovascular mortality, but the impact of statin therapy in patients treated with transcatheter aortic valve replacement (TAVR) is unknown. We reviewed 294 consecutive cases of TAVR performed at a single tertiary care medical center. We defined high-intensity statin therapy as atorvastatin 40 to 80 mg/day or rosuvastatin 20 to 40 mg/day. Study outcomes included post-TAVR adverse events, 30-day mortality, and overall survival. At the time of TAVR, 14% (n = 41) were on high-intensity statin therapy, 59% (n = 173) were on low- or moderate-intensity statin therapy, and 27% (n = 80) were not on statin therapy. There was no association between statin therapy and the rate of post-TAVR stroke, myocardial infarction, acute kidney injury, in-hospital mortality, or 30-day mortality. At 2 years, 83% of patients in the high-intensity statin group were alive, 70% in the low/moderate-intensity statin group were alive, and 57% in the no statin group were alive (log-rank p = 0.016). In a risk-adjusted model, high-intensity statin therapy was associated with a 64% reduction in all-cause mortality (hazard ratio 0.36, 95% CI 0.14 to 0.90, p = 0.029) compared with no statin therapy. In conclusion, statin therapy is associated with improved overall survival after TAVR in a dose-dependent manner.
Collapse
Affiliation(s)
- Chetan P Huded
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lillian R Benck
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Neil J Stone
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ranya N Sweis
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mark J Ricciardi
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - S Chris Malaisrie
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Charles J Davidson
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James D Flaherty
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| |
Collapse
|
48
|
Hahn RT, Meduri CU, Davidson CJ, Lim S, Nazif TM, Ricciardi MJ, Rajagopal V, Ailawadi G, Vannan MA, Thomas JD, Fowler D, Rich S, Martin R, Ong G, Groothuis A, Kodali S. Early Feasibility Study of a Transcatheter Tricuspid Valve Annuloplasty. J Am Coll Cardiol 2017; 69:1795-1806. [DOI: 10.1016/j.jacc.2017.01.054] [Citation(s) in RCA: 188] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 11/30/2022]
|
49
|
Blair JEA, Atri P, Friedman JL, Thomas JD, Brummel K, Sweis RN, Mikati I, Malaisrie SC, Davidson CJ, Flaherty JD. Diastolic Function and Transcatheter Aortic Valve Replacement. J Am Soc Echocardiogr 2017; 30:541-551. [PMID: 28314622 DOI: 10.1016/j.echo.2017.01.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 02/04/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Little is known about baseline diastolic dysfunction and changes in diastolic dysfunction grade after transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS) and its impact on overall outcomes. The aim of this study was to describe baseline diastolic dysfunction and changes in diastolic dysfunction grade that occur with TAVR and their relationship to mortality and rehospitalization. METHODS This was a single-center study evaluating all TAVRs from January 2012 to June 2014. We compared parameters of diastolic dysfunction grade on pre-TAVR and 1 month post-TAVR echocardiograms for all patients undergoing the procedure. Descriptive statistics, Kaplan-Meier time-to-event analysis, and multivariate logistic regression were used. RESULTS Of a sample size of 120 patients undergoing TAVR for symptomatic severe AS, 90 were included in the final analysis after excluding significant mitral valve disease. There were improvements in individual parameters of diastolic dysfunction grade such as lateral e' velocity, E/lateral e', and left atrial volume index (nonsignificant trend) in the setting of improvement in aortic valve area and gradients and functional class pre- and post-TAVR. Multivariate analysis revealed that baseline diastolic dysfunction grade, but not post-TAVR or changes in diastolic dysfunction grade, was associated with 1-year death (hazard ratio, 1.163; 95% CI, 1.049-1.277, P = .005) and combined death/cardiovascular hospitalization (hazard ratio, 1.174; 95% CI, 1.032-1.318; P = .018). CONCLUSIONS In this single-center retrospective study of patients with symptomatic severe AS who underwent TAVR, several diastolic function parameters improved on echocardiography, but baseline diastolic dysfunction grade remained the most important echocardiographic factor associated with adverse 1-year outcomes.
Collapse
Affiliation(s)
- John E A Blair
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | | | - Julie L Friedman
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois
| | - James D Thomas
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois
| | - Kent Brummel
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois
| | - Ranya N Sweis
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois
| | - Issam Mikati
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois
| | - S Chris Malaisrie
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois
| | - Charles J Davidson
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois
| | - James D Flaherty
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois.
| |
Collapse
|
50
|
Quyyumi AA, Vasquez A, Kereiakes DJ, Klapholz M, Schaer GL, Abdel-Latif A, Frohwein S, Henry TD, Schatz RA, Dib N, Toma C, Davidson CJ, Barsness GW, Shavelle DM, Cohen M, Poole J, Moss T, Hyde P, Kanakaraj AM, Druker V, Chung A, Junge C, Preti RA, Smith RL, Mazzo DJ, Pecora A, Losordo DW. PreSERVE-AMI: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial of Intracoronary Administration of Autologous CD34+ Cells in Patients With Left Ventricular Dysfunction Post STEMI. Circ Res 2017; 120:324-331. [PMID: 27821724 PMCID: PMC5903285 DOI: 10.1161/circresaha.115.308165] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [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: 12/14/2015] [Revised: 10/04/2016] [Accepted: 11/07/2016] [Indexed: 12/21/2022]
Abstract
RATIONALE Despite direct immediate intervention and therapy, ST-segment-elevation myocardial infarction (STEMI) victims remain at risk for infarct expansion, heart failure, reinfarction, repeat revascularization, and death. OBJECTIVE To evaluate the safety and bioactivity of autologous CD34+ cell (CLBS10) intracoronary infusion in patients with left ventricular dysfunction post STEMI. METHODS AND RESULTS Patients who underwent successful stenting for STEMI and had left ventricular dysfunction (ejection fraction≤48%) ≥4 days poststent were eligible for enrollment. Subjects (N=161) underwent mini bone marrow harvest and were randomized 1:1 to receive (1) autologous CD34+ cells (minimum 10 mol/L±20% cells; N=78) or (2) diluent alone (N=83), via intracoronary infusion. The primary safety end point was adverse events, serious adverse events, and major adverse cardiac event. The primary efficacy end point was change in resting myocardial perfusion over 6 months. No differences in myocardial perfusion or adverse events were observed between the control and treatment groups, although increased perfusion was observed within each group from baseline to 6 months (P<0.001). In secondary analyses, when adjusted for time of ischemia, a consistently favorable cell dose-dependent effect was observed in the change in left ventricular ejection fraction and infarct size, and the duration of time subjects was alive and out of hospital (P=0.05). At 1 year, 3.6% (N=3) and 0% deaths were observed in the control and treatment group, respectively. CONCLUSIONS This PreSERVE-AMI (Phase 2, randomized, double-blind, placebo-controlled trial) represents the largest study of cell-based therapy for STEMI completed in the United States and provides evidence supporting safety and potential efficacy in patients with left ventricular dysfunction post STEMI who are at risk for death and major morbidity. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01495364.
Collapse
Affiliation(s)
- Arshed A Quyyumi
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.).
| | - Alejandro Vasquez
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Dean J Kereiakes
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Marc Klapholz
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Gary L Schaer
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Ahmed Abdel-Latif
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Stephen Frohwein
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Timothy D Henry
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Richard A Schatz
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Nabil Dib
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Catalin Toma
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Charles J Davidson
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Gregory W Barsness
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - David M Shavelle
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Martin Cohen
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Joseph Poole
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Thomas Moss
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Pamela Hyde
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Anna Maria Kanakaraj
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Vitaly Druker
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Amy Chung
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Candice Junge
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Robert A Preti
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Robin L Smith
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - David J Mazzo
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Andrew Pecora
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| | - Douglas W Losordo
- From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.)
| |
Collapse
|