1
|
Choe JA, Uthamaraj S, Dragomir-Daescu D, Sandhu GS, Tefft BJ. Magnetic and Biocompatible Polyurethane Nanofiber Biomaterial for Tissue Engineering. Tissue Eng Part A 2023; 29:413-423. [PMID: 37130041 PMCID: PMC10442687 DOI: 10.1089/ten.tea.2022.0224] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/13/2023] [Indexed: 05/03/2023] Open
Abstract
Recruitment of endothelial cells to cardiovascular device surfaces could solve issues of thrombosis, neointimal hyperplasia, and restenosis. Since current targeting strategies are often nonspecific, new technologies to allow for site-specific cell localization and capture in vivo are needed. The development of cytocompatible superparamagnetic iron oxide nanoparticles has allowed for the use of magnetism for cell targeting. In this study, a magnetic polyurethane (PU)-2205 stainless steel (2205-SS) nanofibrous composite biomaterial was developed through analysis of composite sheets and application to stent-grafts. The PU nanofibers provide strength and elasticity while the 2205-SS microparticles provide ferromagnetic properties. Sheets were electrospun at mass ratios of 0-4:1 (2205-SS:PU) and stent-grafts with magnetic or nonmagnetic stents were coated at the optimal ratio of 2:1. These composite materials were characterized by microscopy, mechanical testing, a sessile drop test, magnetic field measurement, magnetic cell capture assays, and cytocompatibility after 14 days of culturing with endothelial cells. Results of this study show that an optimal ratio of 2:1 2205-SS:PU results in a hydrophobic material that balanced mechanical and magnetic properties and was cytocompatible up to 14 days. Significant cell capture required a thicker material of 0.5 mm thickness. Stent-grafts fabricated from a magnetic coating and a magnetic stent demonstrated uniform cell capture throughout the device surface. This novel biomaterial exhibits a combination of mechanical and magnetic properties that enables magnetic capture of cells and other therapeutic agents for vascular and other tissue engineering applications.
Collapse
Affiliation(s)
- Joshua A. Choe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Dan Dragomir-Daescu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Gurpreet S. Sandhu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Brandon J. Tefft
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biomedical Engineering, Medical College of Wisconsin and Marquette University, Milwaukee, Wisconsin, USA
| |
Collapse
|
2
|
Singh M, Sandhu GS, Lerman A, Gulati R, Lewis BR, Pellikka PA, Gelfman R. STRETCHING TO REDUCE MUSCULOSKELETAL PAIN AMONG PERSONNEL WORKING IN THE INTERVENTIONAL, RADIOLOGY, AND ECHOCARDIOGRAPHIC LABORATORY: A MAYO FOUNDATION STUDY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02225-8] [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]
|
3
|
Crestanello JA, Greason KL, Mathew J, Eleid MF, Nkomo VT, Rihal CS, Bagameri G, Holmes DR, Pislaru SV, Sandhu GS, Lee AT, King KS, Alkhouli M. The Interaction of FEV1 and NT-Pro-BNP with Outcomes after Transcatheter Aortic Valve Replacement. Eur J Cardiothorac Surg 2023; 63:6988033. [PMID: 36645236 DOI: 10.1093/ejcts/ezad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/29/2022] [Accepted: 01/14/2023] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Low forced expiratory volume in 1 second (FEV1) and elevated N-terminal Pro form B-type natriuretic peptide (NT-Pro-BNP) have been individually associated with poor outcomes after transcatheter aortic valve replacement (TAVR). We hypothesized a combination of the two would provide prognostic indication after TAVR. METHODS We categorized 871 patients who received TAVR from 2008 to 2018 into 4 groups according to baseline FEV1 (< or ≥ 60% predicted) and NT-Pro-BNP (< or ≥ 1601 pg/ml): group A (n = 312, high FEV1, low NT-Pro-BNP), group B (n = 275, high FEV1, high NT-Pro-BNP), group C (n = 123 low FEV1, low NT-Pro-BNP), and group D (n = 161, low FEV1, high NT-Pro-BNP). The primary endpoint was survival at 1 and 5 years. RESULTS Patients in group A had more severe aortic stenosis and achieved the best long-term survival at 1- (93% (95% CI: 90-96) and 5- years (45.3% (95% CI: 35.4-58). Low FEV1 and high NT-Pro-BNP (group D) patients had more severe symptoms, higher Society of Thoracic Surgeons predicted risk of operative mortality, lower ejection fraction and aortic valve gradient at baseline. They had the worst survival at 1- (76% (95% CI: 69-83) and at 5-years (13.1% (95% CI: 7-25), Hazard Ratio compared to group A: 2.29 (95% CI: 1.6-3.2, p < 0.001) with 25.7% of patients in NYHA class III-IV. Patients in groups B and C had intermediate outcomes. CONCLUSIONS The combination of FEV1 and NT-Pro-BNP stratify patients into 4 groups with distinct risk profiles and clinical outcomes. Patients with low FEV1 and high NT-Pro-BNP have increased comorbidities, poor functional outcomes, and decreased long term survival after TAVR.
Collapse
Affiliation(s)
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Jessey Mathew
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Alexander T Lee
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Katherine S King
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
4
|
Maughan EF, Hynds RE, Pennycuick A, Nigro E, Gowers KH, Denais C, Gómez-López S, Lazarus KA, Orr JC, Pearce DR, Clarke SE, Lee DDH, Woodall MN, Masonou T, Case KM, Teixeira VH, Hartley BE, Hewitt RJ, Al Yaghchi C, Sandhu GS, Birchall MA, O’Callaghan C, Smith CM, De Coppi P, Butler CR, Janes SM. Cell-intrinsic differences between human airway epithelial cells from children and adults. iScience 2022; 25:105409. [PMID: 36388965 PMCID: PMC9664344 DOI: 10.1016/j.isci.2022.105409] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
The airway epithelium is a protective barrier that is maintained by the self-renewal and differentiation of basal stem cells. Increasing age is a principle risk factor for chronic lung diseases, but few studies have explored age-related molecular or functional changes in the airway epithelium. We retrieved epithelial biopsies from histologically normal tracheobronchial sites from pediatric and adult donors and compared their cellular composition and gene expression profile (in laser capture-microdissected whole epithelium, fluorescence-activated cell-sorted basal cells, and basal cells in cell culture). Histologically, pediatric and adult tracheobronchial epithelium was similar in composition. We observed age-associated changes in RNA sequencing studies, including higher interferon-associated gene expression in pediatric epithelium. In cell culture, pediatric cells had higher colony formation ability, sustained in vitro growth, and outcompeted adult cells in a direct competitive proliferation assay. Our results demonstrate cell-intrinsic differences between airway epithelial cells from children and adults in both homeostatic and proliferative states.
Collapse
Affiliation(s)
- Elizabeth F. Maughan
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
- Epithelial Cell Biology in ENT Research (EpiCENTR) Group, Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1DZ, UK
| | - Robert E. Hynds
- Epithelial Cell Biology in ENT Research (EpiCENTR) Group, Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1DZ, UK
| | - Adam Pennycuick
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - Ersilia Nigro
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - Kate H.C. Gowers
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - Celine Denais
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - Sandra Gómez-López
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - Kyren A. Lazarus
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - Jessica C. Orr
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - David R. Pearce
- University College London Cancer Institute, University College London, London WC1E 6DD, UK
| | - Sarah E. Clarke
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - Dani Do Hyang Lee
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 1EH, UK
| | - Maximillian N.J. Woodall
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 1EH, UK
| | - Tereza Masonou
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 1EH, UK
| | - Katie-Marie Case
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 1EH, UK
| | - Vitor H. Teixeira
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | | | | | - Chadwan Al Yaghchi
- The National Centre for Airway Reconstruction, Department of Otolaryngology, Charing Cross Hospital, London W6 8RF, UK
| | - Gurpreet S. Sandhu
- The National Centre for Airway Reconstruction, Department of Otolaryngology, Charing Cross Hospital, London W6 8RF, UK
| | - Martin A. Birchall
- University College London Ear Institute, University College London, London WC1X 8EE, UK
| | - Christopher O’Callaghan
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 1EH, UK
| | - Claire M. Smith
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 1EH, UK
| | - Paolo De Coppi
- Stem Cell and Regenerative Medicine Section, University College London Great Ormond Street Institute of Child Health, University College London, London WC1N 1DZ, UK
| | - Colin R. Butler
- Epithelial Cell Biology in ENT Research (EpiCENTR) Group, Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1DZ, UK
- Tracheal Service, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Sam M. Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| |
Collapse
|
5
|
Prasad K, Prasad A, George M, Sandhu GS, Inojosa JRM, Bhagra A, Mahapatra S, Petterson TM, Lackore KA, Croghan IT, Bauer BA, Wahner-Roedler DL. Temporal Trends in Use of Complementary Therapies Among Patients With Cardiovascular Disorders. Am J Cardiol 2022; 167:118-124. [PMID: 35031110 DOI: 10.1016/j.amjcard.2021.11.050] [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] [Received: 09/15/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/15/2022]
Abstract
This study aimed to evaluate the use and frequency of complementary and integrative medicine (CIM) therapies in an outpatient cohort with cardiovascular disease (CVD) and compare trends over time. This cross-sectional point-of-care prospective study assessed patients attending a cardiology outpatient clinic. As in our 2009 cohort, data were collected with a 17-question survey on demographic characteristics, CVD history, current use and future interest in CIM. In total, 964 patients completed the survey. CIM use continues to be high (2009 vs 2018, 83.4% vs 81.8%) (p = 0.34), with dietary supplements the most common therapy (75% in both studies). We observed increased use of mind-body therapies (28.5% vs 23.9%, p = 0.02), especially meditation, yoga, and tai chi. Of the patients receiving CIM therapies, 41.9% reported using CIM for heart-related symptoms. Relaxation, stress management, and meditation were the top three mind-body therapies for CVD-related symptoms in both cohorts. Reporting of CIM use to clinicians is low (15%) and interest on future use is high (47%). In conclusion, CIM is highly used in cardiology patients-4 of 10 patients use CIM for CVD-related symptoms. Most take dietary supplements, with an increased use of mind-body therapies. Our data highlight the importance of documenting CIM use in practice and the need for research to document efficacy.
Collapse
Affiliation(s)
- Kavita Prasad
- Integrative Medicine Clinic, Zumbro Valley Health Center, Rochester, Minnesota
| | - Abhiram Prasad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Merit George
- Division of Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gurpreet S Sandhu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Anjali Bhagra
- Division of General Internal Medicine, Department of Medicine
| | | | - Tanya M Petterson
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Kandace A Lackore
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Ivana T Croghan
- Division of General Internal Medicine, Department of Medicine
| | - Brent A Bauer
- Division of General Internal Medicine, Department of Medicine
| | | |
Collapse
|
6
|
Vallabhajosyula S, Bhopalwala HM, Sundaragiri PR, Dewaswala N, Cheungpasitporn W, Doshi R, Prasad A, Sandhu GS, Jaffe AS, Bell MR, Holmes DR. Cardiogenic shock complicating non-ST-segment elevation myocardial infarction: An 18-year study. Am Heart J 2022; 244:54-65. [PMID: 34774802 DOI: 10.1016/j.ahj.2021.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 08/25/2020] [Accepted: 11/05/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the epidemiology and outcomes of non-ST-segment-elevation myocardial infarction-cardiogenic shock (NSTEMI-CS) in the United States. METHODS Adult (>18 years) NSTEMI-CS admissions were identified using the National Inpatient Sample (2000-2017) and classified by tertiles of admission year (2000-2005, 2006-2011 and 2012-2017). Outcomes of interest included temporal trends of prevalence and in-hospital mortality, use of cardiac procedures, in-hospital mortality, hospitalization costs, and length of stay. RESULTS In over 7.3 million NSTEMI admissions, CS was noted in 189,155 (2.6%). NSTEMI-CS increased from 1.5% in 2000 to 3.6% in 2017 (adjusted odds ratio 2.03 [95% confidence interval 1.97-2.09]; P < .001). Rates of non-cardiac organ failure and cardiac arrest increased during the study period. Between 2000 and 2017, coronary angiography (43.9%-63.9%), early coronary angiography (13.6%-25.6%), percutaneous coronary intervention (14.8%-31.6%), and coronary artery bypass grafting use (19.0%-25.8%) increased (P < .001). Over the study period, the use of intra-aortic balloon pump remained stable (28.6%-28.8%), and both percutaneous left ventricular assist devices (0%-9.1%) and extra-corporeal membrane oxygenation (0.1%-1.6%) increased (all P < .001). In hospital mortality decreased from 50.2% in 2000 to 32.3% in 2017 (adjusted odds ratio 0.27 [95% confidence interval 0.25-0.29]; P < .001). During the 18-year period, hospital lengths of stay decreased, and hospitalization costs increased. CONCLUSIONS In the United States, prevalence of CS in NSTEMI has increased 2-fold between 2000 and 2017, while in-hospital mortality has decreased during the study period. Use of coronary angiography and percutaneous coronary intervention increased during the study period.
Collapse
Affiliation(s)
- Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.
| | | | - Pranathi R Sundaragiri
- Department of Primary Care Internal Medicine, Wake Forest Baptist Health, High Point, NC
| | - Nakeya Dewaswala
- Division of Cardiovascular Medicine, Department of Medicine, University of Kentucky College of Medicine, Lexington, KY
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Rajkumar Doshi
- Division of Cardiovascular Medicine, Department of Medicine, Saint Joseph University Medical Center, Paterson, NJ
| | - Abhiram Prasad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Allan S Jaffe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Malcolm R Bell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
7
|
Shradhanjali A, Uthamaraj S, Dragomir-Daescu D, Gulati R, Sandhu GS, Tefft BJ. Characterization of Blood Outgrowth Endothelial Cells (BOEC) from Porcine Peripheral Blood. J Vis Exp 2022:10.3791/63285. [PMID: 35068481 PMCID: PMC9645770 DOI: 10.3791/63285] [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] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The endothelium is a dynamic integrated structure that plays an important role in many physiological functions such as angiogenesis, hemostasis, inflammation, and homeostasis. The endothelium also plays an important role in pathophysiologies such as atherosclerosis, hypertension, and diabetes. Endothelial cells form the inner lining of blood and lymphatic vessels and display heterogeneity in structure and function. Various groups have evaluated the functionality of endothelial cells derived from human peripheral blood with a focus on endothelial progenitor cells derived from hematopoietic stem cells or mature blood outgrowth endothelial cells (or endothelial colony-forming cells). These cells provide an autologous resource for therapeutics and disease modeling. Xenogeneic cells may provide an alternative source of therapeutics due to their availability and homogeneity achieved by using genetically similar animals raised in similar conditions. Hence, a robust protocol for the isolation and expansion of highly proliferative blood outgrowth endothelial cells from porcine peripheral blood has been presented. These cells can be used for numerous applications such as cardiovascular tissue engineering, cell therapy, disease modeling, drug screening, studying endothelial cell biology, and in vitro co-cultures to investigate inflammatory and coagulation responses in xenotransplantation.
Collapse
Affiliation(s)
- Akankshya Shradhanjali
- Department of Biomedical Engineering, Medical College of Wisconsin & Marquette University
| | | | | | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic
| | | | - Brandon J. Tefft
- Department of Biomedical Engineering, Medical College of Wisconsin & Marquette University
| |
Collapse
|
8
|
Nan JZ, Jentzer JC, Ward RC, Le RJ, Prasad M, Barsness GW, Gulati R, Sandhu GS, Bell MR. Safe Triage of STEMI Patients to General Telemetry Units After Successful Primary Percutaneous Coronary Intervention. Mayo Clin Proc Innov Qual Outcomes 2021; 5:1118-1127. [PMID: 34877476 PMCID: PMC8633820 DOI: 10.1016/j.mayocpiqo.2021.09.009] [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] [Indexed: 11/25/2022] Open
Abstract
Objective To analyze outcomes of patients with ST-segment elevation myocardial infarction (STEMI) after successful primary percutaneous coronary intervention (PCI) triaged to the cardiac intensive care unit (CICU) vs a general telemetry unit by a Zwolle risk score–based algorithm. Methods We introduced a quality improvement protocol in 2014 encouraging admission of STEMI patients with Zwolle score of 3 or less to general telemetry units unless they were hemodynamically unstable. We subsequently conducted a retrospective single-center cohort study of consecutive STEMI patients who had undergone primary PCI from January 1, 2014, to December 31, 2018. Outcomes studied include immediate complications, need for urgent unplanned intervention, need for CICU care, length of hospitalization, and survival. Results We identified 547 patients, 406 with a Zwolle score of 3 or less. Of these, 192 (47.3%) were admitted to general telemetry and 214 (52.7%) to the CICU. Reasons for CICU admission included persistent chest pain, late presentation, and procedural complications. The average hospital length of stay was 2.1±1.4 days for non-CICU patients and 3.3±2.8 days for low-risk CICU patients (P<.001). Two patients initially admitted to general telemetry required transfer to the CICU. There were 26 patients who required unplanned cardiovascular intervention within 30 days, 5 from the general telemetry unit; 540 patients survived to discharge. One in-hospital death occurred among those initially triaged to the general telemetry unit, and this was due to a noncardiac cause. Conclusion A Zwolle score–based algorithm can be used to safely triage post-PCI STEMI patients to a general telemetry unit.
Collapse
Affiliation(s)
- John Z Nan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Robert C Ward
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Megha Prasad
- Division of Cardiology, Columbia University, New York, NY
| | | | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Malcolm R Bell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
9
|
Alkurashi AK, Pislaru SV, Thaden JJ, Collins JD, Foley TA, Greason KL, Eleid MF, Sandhu GS, Alkhouli MA, Asirvatham SJ, Cha YM, Williamson EE, Crestanello JA, Pellikka PA, Oh JK, Nkomo VT. Doppler Mean Gradient Is Discordant to Aortic Valve Calcium Scores in Patients with Atrial Fibrillation Undergoing Transcatheter Aortic Valve Replacement. J Am Soc Echocardiogr 2021; 35:116-123. [PMID: 34506919 DOI: 10.1016/j.echo.2021.08.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/26/2021] [Revised: 08/17/2021] [Accepted: 08/30/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Doppler mean gradient (MG) may underestimate aortic stenosis (AS) severity when obtained during atrial fibrillation (AF) because of lower forward flow compared with sinus rhythm (SR). Whether AS is more advanced at the time of referral for aortic valve intervention in AF compared with SR is unknown. The aim of this study was to examine flow-independent computed tomographic aortic valve calcium scores (AVCS) and their concordance to MG in AF versus SR in patients undergoing transcatheter aortic valve replacement (TAVR). METHODS Patients who underwent TAVR from 2016 to 2020 for native valve severe AS with left ventricular ejection fraction ≥ 50% were identified from an institutional TAVR database. MGs during AF and SR in high-gradient AS (HGAS) and low-gradient AS (LGAS) were compared with AVCS (AVCS/MG ratio). AVCS were obtained within 90 days of pre-TAVR echocardiography. RESULTS Six hundred thirty-three patients were included; median age was 82 years (interquartile range [IQR], 76-86 years), and 46% were women. AF was present in 109 (17%) and SR in 524 (83%) patients during echocardiography. Aortic valve area index was slightly smaller in AF versus SR (0.43 cm2/m2 [IQR, 0.39-0.47 cm2/m2] vs 0.46 cm2/m2 [IQR, 0.41-0.51 cm2/m2], P = .0003). Stroke volume index, transaortic flow rate, and MG were lower in AF (P < .0001 for all). AVCS were higher in men with AF compared with SR (3,510 Agatston units [AU] [IQR, 2,803-4,030 AU] vs 2,722 AU [IQR, 2,180-3,467 AU], P < .0001) in HGAS but not in LGAS. AVCS were not different in women with AF versus SR. Overall AVCS/MG ratios were higher in AF versus SR in HGAS and LGAS (P < .03 for all), except in women with LGAS. CONCLUSIONS AVCS were higher than expected by MG in AF compared with SR. The very high AVCS in men with AF and HGAS at the time of TAVR suggests late diagnosis of severe AS because of underestimated AS severity during progressive AS and/or late referral to TAVR. Additional studies are needed to examine the extent to which echocardiography may be underestimating AS severity in AF.
Collapse
Affiliation(s)
- Adham K Alkurashi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jeremy J Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Thomas A Foley
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gurpreet S Sandhu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mohamad A Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
10
|
El-Sabawi B, Welle GA, Cha YM, Espinosa RE, Gulati R, Sandhu GS, Greason KL, Crestanello JA, Friedman PA, Munger TM, Rihal CS, Eleid MF. Temporal Incidence and Predictors of High-Grade Atrioventricular Block After Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2021; 10:e020033. [PMID: 33960210 PMCID: PMC8200694 DOI: 10.1161/jaha.120.020033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background The temporal incidence of high‐grade atrioventricular block (HAVB) after transcatheter aortic valve replacement (TAVR) is uncertain. As a result, periprocedural monitoring and pacing strategies remain controversial. This study aimed to describe the temporal incidence of initial episode of HAVB stratified by pre‐ and post‐TAVR conduction and identify predictors of delayed events. Methods and Results Consecutive patients undergoing TAVR at a single center between February 2012 and June 2019 were retrospectively assessed for HAVB within 30 days. Patients with prior aortic valve replacement, permanent pacemaker (PPM), or conversion to surgical replacement were excluded. Multivariable logistic regression was performed to assess predictors of delayed HAVB (initial event >24 hours post‐TAVR). A total of 953 patients were included in this study. HAVB occurred in 153 (16.1%). After exclusion of those with prophylactic PPM placed post‐TAVR, the incidence of delayed HAVB was 33/882 (3.7%). Variables independently associated with delayed HAVB included baseline first‐degree atrioventricular block or right bundle‐branch block, self‐expanding valve, and new left bundle‐branch block. Forty patients had intraprocedural transient HAVB, including 16 who developed HAVB recurrence and 6 who had PPM implantation without recurrence. PPM was placed for HAVB in 130 (13.6%) (self‐expanding valve, 23.7% versus balloon‐expandable valve, 11.9%; P<0.001). Eight (0.8%) patients died by 30 days, including 1 unexplained without PPM present. Conclusions Delayed HAVB occurs with higher frequency in patients with baseline first‐degree atrioventricular block or right bundle‐branch block, new left bundle‐branch block, and self‐expanding valve. These findings provide insight into optimal monitoring and pacing strategies based on periprocedural ECG findings.
Collapse
Affiliation(s)
| | | | - Yong-Mei Cha
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Raúl E Espinosa
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Rajiv Gulati
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | | | - Kevin L Greason
- Department of Cardiovascular Surgery Mayo Clinic Rochester MN
| | | | - Paul A Friedman
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Thomas M Munger
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | | | - Mackram F Eleid
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| |
Collapse
|
11
|
Vallabhajosyula S, Verghese D, Bell MR, Murphree DH, Cheungpasitporn W, Miller PE, Dunlay SM, Prasad A, Sandhu GS, Gulati R, Singh M, Lerman A, Gersh BJ, Holmes DR, Barsness GW. Fibrinolysis vs. primary percutaneous coronary intervention for ST-segment elevation myocardial infarction cardiogenic shock. ESC Heart Fail 2021; 8:2025-2035. [PMID: 33704924 PMCID: PMC8120407 DOI: 10.1002/ehf2.13281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/27/2021] [Accepted: 02/12/2021] [Indexed: 12/29/2022] Open
Abstract
AIMS There are limited contemporary data on the use of initial fibrinolysis in ST-segment elevation myocardial infarction cardiogenic shock (STEMI-CS). This study sought to compare the outcomes of STEMI-CS receiving initial fibrinolysis vs. primary percutaneous coronary intervention (PPCI). METHODS Using the National (Nationwide) Inpatient Sample from 2009 to 2017, a comparative effectiveness study of adult (>18 years) STEMI-CS admissions receiving pre-hospital/in-hospital fibrinolysis were compared with those receiving PPCI. Admissions with alternate indications for fibrinolysis and STEMI-CS managed medically or with surgical revascularization (without fibrinolysis) were excluded. Outcomes of interest included in-hospital mortality, development of non-cardiac organ failure, complications, hospital length of stay, hospitalization costs, use of palliative care, and do-not-resuscitate status. RESULTS During 2009-2017, 5297 and 110 452 admissions received initial fibrinolysis and PPCI, respectively. Compared with those receiving PPCI, the fibrinolysis group was more often non-White, with lower co-morbidity, and admitted on weekends and to small rural hospitals (all P < 0.001). In the fibrinolysis group, 95.3%, 77.4%, and 15.7% received angiography, PCI, and coronary artery bypass grafting, respectively. The fibrinolysis group had higher rates of haemorrhagic complications (13.5% vs. 9.9%; P < 0.001). The fibrinolysis group had comparable all-cause in-hospital mortality [logistic regression analysis: 28.8% vs. 28.5%; propensity-matched analysis: 30.8% vs. 30.3%; adjusted odds ratio 0.97 (95% confidence interval 0.90-1.05); P = 0.50]. The fibrinolysis group had comparable rates of acute organ failure, hospital length of stay, rates of palliative care referrals, do-not-resuscitate status use, and lesser hospitalization costs. CONCLUSIONS The use of initial fibrinolysis had comparable in-hospital mortality than those receiving PPCI in STEMI-CS in the contemporary era in this large national observational study.
Collapse
Affiliation(s)
- Saraschandra Vallabhajosyula
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA,Division of Pulmonary and Critical Care Medicine, Department of MedicineMayo ClinicRochesterMNUSA,Center for Clinical and Translational ScienceMayo Clinic Graduate School of Biomedical SciencesRochesterMNUSA,Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of MedicineEmory University School of Medicine1364 Clifton Road NEAtlantaGA30322USA,Department of MedicineAmita Health Saint Joseph HospitalChicagoILUSA
| | - Dhiran Verghese
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of MedicineEmory University School of Medicine1364 Clifton Road NEAtlantaGA30322USA,Department of MedicineAmita Health Saint Joseph HospitalChicagoILUSA
| | - Malcolm R. Bell
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA
| | | | - Wisit Cheungpasitporn
- Division of Nephrology, Department of MedicineUniversity of Mississippi School of MedicineJacksonMSUSA
| | - Paul Elliott Miller
- Division of Cardiovascular Medicine, Department of MedicineYale University School of MedicineNew HavenCTUSA
| | - Shannon M. Dunlay
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA,Department of Health Sciences ResearchMayo ClinicRochesterMNUSA
| | - Abhiram Prasad
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA
| | | | - Rajiv Gulati
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA
| | - Mandeep Singh
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA
| | - Amir Lerman
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA
| | | | - David R. Holmes
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA
| | | |
Collapse
|
12
|
Huang YL, Bansal A, Berg B, Sanvick C, Klavetter EW, Sandhu GS, Greason KL. An Algorithm for Pairing Interventionalists and Surgeons for the TAVR Procedure. J Med Syst 2021; 45:53. [PMID: 33704592 DOI: 10.1007/s10916-021-01722-x] [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: 05/06/2020] [Accepted: 02/08/2021] [Indexed: 11/29/2022]
Abstract
The Transcatheter Aortic Valve Replacement (TAVR) procedure requires an initial consultation and a subsequent procedure by an interventionalist (IC) and surgeon. The IC-surgeon pair coordination is extremely challenging, especially at Mayo Clinic due to provider time commitments distributed across practice, research, and education activities. Current practice aims to establish the coordination manually, resulting in a scheduling process that is cumbersome and time consuming for the schedulers. We develop an algorithm for pairing ICs and surgeons that minimizes the lead time (days elapsed between the clinic consult and procedure). As compared to current practice, this algorithm is able to reduce average lead time by 59% and increase possible IC-surgeon pairs by 7%. The proposed algorithm is shown to be flexible enough to incorporate practice variations such as lead time upper bound and two procedure days for a single consult day. Algorithm alternatives are also presented for practices who may find the proposed algorithm infeasible for their practice.
Collapse
Affiliation(s)
- Yu-Li Huang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Ankit Bansal
- Institute for Mathematics and its Applications, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Bjorn Berg
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Carrie Sanvick
- Department of Nursing, Mayo Clinic, Rochester, MN, 55905, USA
| | - Eric W Klavetter
- Department of Cardiology, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Kevin L Greason
- Cardiovascular Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| |
Collapse
|
13
|
Cain MT, Joyce D, Lahr BD, Day CN, Sandhu GS, Kushwaha S, Joyce LD. Do Right Heart Hemodynamic Improvements Persist After Pulmonary Thromboendarterectomy? Semin Thorac Cardiovasc Surg 2021; 34:80-89. [PMID: 33691188 DOI: 10.1053/j.semtcvs.2021.03.002] [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: 02/03/2021] [Accepted: 03/04/2021] [Indexed: 11/11/2022]
Abstract
The survival benefits of pulmonary thromboendarterectomy (PTE) for the treatment of chronic thromboembolic pulmonary hypertension have been well described. However, the significance of right heart hemodynamic changes and their impact on survival remains poorly understood. We sought to characterize the effects of these changes. We conducted a single center, retrospective review of 159 patients who underwent PTE between 1993 and 2015. Echocardiographic and right heart catheterization data were compared longitudinally before and after PTE in order to establish the extent of hemodynamic response to surgery. Kaplan Meier estimates were used to characterize patient survival over time. Univariable and multivariable Cox proportional hazards regression models were used to assess factors associated with long-term mortality. Among the 159 patients studied, 74 (46.5%) were male with a median age of 55 (IQR: 42-66). One-, 5-, 10-, and 15-year survival was 91.0% (95% CI: 86.6-95.6), 79.6% (73.5-86.3), 66.5% (59.2-74.7), and 56.2% (48.1-65.8). Of the 9 candidate risk factors that were evaluated, only advanced age and increased cardiopulmonary bypass time were found to be significantly associated with increased risk of mortality. Pre- and postsurgical echocardiographic imaging data, when available, revealed a median reduction in right ventricular systolic pressure of 29.0 mm Hg (P < 0.0001) and improvement of tricuspid regurgitation (P < 0.0001), both of which appeared to be sustained across long-term follow-up. Improvements in right heart hemodynamics and tricuspid valvular regurgitation persist on long term surveillance following PTE. While patient selection is often driven by the distribution of disease, close postoperative follow up may improve outcomes.
Collapse
Affiliation(s)
- Michael T Cain
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David Joyce
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brian D Lahr
- Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Courtney N Day
- Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Gurpreet S Sandhu
- Mayo Clinic Department of Cardiovascular Medicine, Rochester, Minnesota
| | - Sudhir Kushwaha
- Mayo Clinic Department of Cardiovascular Medicine, Rochester, Minnesota
| | - Lyle D Joyce
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
| |
Collapse
|
14
|
Eleid MF, Zheng PP, Gulati R, Bergman P, Kottenstette N, Li Y, Lerman A, Sandhu GS. Remote robotic percutaneous coronary intervention: An animal feasibility study. Catheter Cardiovasc Interv 2021; 97:E274-E279. [PMID: 32442332 DOI: 10.1002/ccd.28978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/14/2020] [Accepted: 05/04/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The purpose of this study was to explore the feasibility and safety of robotic PCI performed using an off-siteremote-control system in an animal model. BACKGROUND Access to primary percutaneous coronary intervention (PCI) remains a challenge in acute myocardial infarction management. The combination of telemedicine and robotic PCI allow the potential delivery of primary PCI to remote locations without the delay of transfer. METHODS This single-center prospective pilot preclinical feasibility study compared robotic PCI with remote PCI on swine across three stages (adjacent room, different floor of the same building, two different buildings). Latency up to 1,000 ms was introduced into the operating environment to simulate decreased network quality (blinded to operator). The primary outcome measures were technical success and acute safety. The secondary outcome measures included lesion wiring time, procedural time and qualitative scoring of the PCI experience by the operator. RESULTS Across 52 experiments in 15 animals, technical success was 100%. No procedural complications occurred during the study. No significant difference in lesion treatment time was detected between stages (p = .11) and between time per target vessel when latency up to 1,000 ms was introduced (p = .58). Injected delay >250 ms had the greatest impact on procedure perceived lag. Longer procedure time was associated with lower procedure impact score, regardless of injected latency. CONCLUSIONS Remote robotic PCI was feasible and safe in an animal model. Procedural duration was acceptable and unaffected by network latency. Future studies are needed to determine the safety and feasibility of remote PCI in humans.
Collapse
Affiliation(s)
- Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Park P Zheng
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Per Bergman
- Corindus Vascular Robotics, Waltham, Massachusetts, USA
| | | | - Yao Li
- Corindus Vascular Robotics, Waltham, Massachusetts, USA
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Gurpreet S Sandhu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
15
|
Kumar V, Sandhu GS, Harper CM, Ting HH, Rihal CS. Analysis of the Changing Economics of US Hospital Transcatheter Aortic Valve Replacement Programs. Mayo Clin Proc 2021; 96:174-182. [PMID: 33168158 DOI: 10.1016/j.mayocp.2020.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/06/2020] [Accepted: 04/15/2020] [Indexed: 11/16/2022]
Abstract
New technologies in medicine, even if they are promising medically, are often expensive and logistically difficult to implement at the hospital level. Transcatheter aortic valve replacement (TAVR) is a model technology that is revolutionary in treating aortic stenosis, but has been plagued with significant challenges with financial sustainability. In this article, a margin analysis at the hospital level was performed using literature data. A TAVR industry analysis was performed using Porter's Five Forces framework. The data indicate that TAVR is more expensive than surgical aortic valve replacement, although the cost of TAVR is declining with the use of an optimized minimalist protocol. The overall industry is growing as its clinical indications expand, and it will likely undergo significant reduction of costs when new valves enter the US market. As such, TAVR is a growing industry, with financial sustainability currently dependent on operational efficiency. A concluding list of specific program interventions is provided to help TAVR programs improve operational efficiency and clinical outcomes, as well as help decide whether to create, expand, or redirect funding for TAVR programs. Importantly, the frameworks used to analyze this rapidly evolving technology can be applied to other new technologies to determine financial sustainability.
Collapse
Affiliation(s)
| | | | | | - Henry H Ting
- Department of Cardiology, Mayo Clinic, Rochester, MN
| | | |
Collapse
|
16
|
Gharacholou SM, Del-Carpio Munoz F, Motiei A, Sandhu GS, Barsness GW, Gulati R, Wright RS, Pellikka PA, Lewis B, Johnson MP, Lane GE, Pollak PM, Pillai DP, Sabbagh AE, Paul TK, Pham SM, Singh M. Characteristics and Long-Term Outcomes of Patients With Prior Coronary Artery Bypass Grafting Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2020; 135:1-8. [PMID: 32866446 DOI: 10.1016/j.amjcard.2020.08.039] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 11/19/2022]
Abstract
Limited data are available on characteristics and long-term outcomes of patients with coronary artery bypass grafts (CABG) undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI). Between January 2000 to December 2014, we identified STEMI patients with prior CABG undergoing primary percutaneous coronary intervention from 3 sites. Kaplan-Meier methods to estimate survival and major adverse cardiac events (MACE) were employed and compared to a propensity matched cohort of non-CABG STEMI patients. Independent predictors of outcomes were analyzed with Cox modeling. Of the 3,212 STEMI patients identified, there were 296 (9.2%) CABG STEMI patients, having nearly similar frequencies of culprit graft (47.6%) versus culprit native (52.4%) as the infarct-related artery (IRA). At 10 years, the adjusted survival was 44% in CABG STEMI versus 55% in non-CABG STEMI (HR 1.26; 95%CI 0.86 to 1.87; p = 0.72). Survival free of MACE was lower for CABG STEMI (graft IRA, 37%; native IRA, 46%) as compared to non-CABG STEMI controls (63%) (p = 0.02). Neither CABG history nor IRA (native vs graft) was independently associated with death or MACE in multivariable analysis. Temporal trends showed no significant change in death or MACE rates of CABG STEMI patients over time. In conclusion, long term survival of CABG STEMI patients is not significantly different than matched STEMI patients without prior CABG; however, CABG STEMI patients were at significantly higher risk for MACE events.
Collapse
Affiliation(s)
| | | | - Arashk Motiei
- Department of Cardiovascular Medicine, Mayo Health System, Mankato, Minnesota
| | - Gurpreet S Sandhu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gregory W Barsness
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - R Scott Wright
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Bradley Lewis
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Matthew P Johnson
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Gary E Lane
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | - Peter M Pollak
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | - Dilip P Pillai
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | | | - Timir K Paul
- Division of Cardiology, East Tennessee State University, Johnson City, Tennessee
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
17
|
Eleid MF, Padang R, Pislaru SV, Greason KL, Crestanello J, Nkomo VT, Pellikka PA, Jentzer JC, Gulati R, Sandhu GS, Holmes DR, Nishimura RA, Rihal CS, Borlaug BA. Effect of Transcatheter Aortic Valve Replacement on Right Ventricular-Pulmonary Artery Coupling. JACC Cardiovasc Interv 2020; 12:2145-2154. [PMID: 31699376 DOI: 10.1016/j.jcin.2019.07.025] [Citation(s) in RCA: 32] [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: 05/16/2019] [Revised: 07/03/2019] [Accepted: 07/16/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to test the hypothesis that the acute left ventricular (LV) unloading effect of transcatheter aortic valve replacement (TAVR) would improve right ventricular (RV) function and RV-pulmonary artery (PA) coupling in patients with severe aortic stenosis (AS). BACKGROUND RV dysfunction is an ominous prognostic marker in patients undergoing TAVR, suggesting that relief of obstruction might be less beneficial in this cohort. However, the left ventricle and right ventricle influence each other through ventricular interaction, which could lead to improved RV function through LV unloading. METHODS Prospective invasive hemodynamic measurements with simultaneous echocardiography were performed in symptomatic patients with severe AS before and immediately after TAVR. RESULTS Forty-four patients (mean age 81 ± 8 years, 27% women) with severe AS underwent TAVR. At baseline, right atrial, PA mean (27 ± 7 mm Hg), and pulmonary capillary wedge (16 ± 4 mm Hg) pressures were mildly elevated, with a low normal cardiac index (2.3 l/min/m2). Pulmonary vascular resistance was mildly elevated (222 ± 133 dynes · s/cm5) and PA compliance mildly reduced (3.4 ± 01.4 ml/mm Hg). Following TAVR, aortic valve area increased (from 0.8 ± 0.3 to 2.7 ± 1.1 cm2; p < 0.001) with a reduction in mean aortic gradient (from 37 ± 11 to 7 ± 4 mm Hg; p < 0.001) and an increase in cardiac index (from 2.3 ± 0.5 to 2.5 ± 0.6 l/min/m2; p = 0.03). LV stroke work, end-systolic wall stress, and systolic ejection period decreased by 23% to 27% (p < 0.001 for all), indicating substantial LV unloading. RV stroke work (from 16 ± 7 to 18 ± 7 mm Hg · ml; p = 0.04) and tricuspid annular systolic velocities (from 9.5 ± 2.0 to 10.4 ± 3.5 cm/s; p = 0.01) increased, along with a decrease in PVR (194 ± 113 dynes · s/cm5; p = 0.03), indicating improvement in RV-PA coupling. Increased RV stroke work following TAVR directly correlated with the magnitude of increase in aortic valve area (r = 0.58; p < 0.001). CONCLUSIONS Acute relief in obstruction to LV ejection with TAVR is associated with improvements in RV function and RV-PA coupling. These findings provide new insights into the potential benefits of LV unloading with TAVR on RV dysfunction in patients with severe AS.
Collapse
Affiliation(s)
- Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Ratnasari Padang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gurpreet S Sandhu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
18
|
Zhang D, Guo W, Al-Hijji MA, El Sabbagh A, Lewis BR, Greason K, Sandhu GS, Eleid MF, Holmes DR, Herrmann J. Outcomes of Patients With Severe Symptomatic Aortic Valve Stenosis After Chest Radiation: Transcatheter Versus Surgical Aortic Valve Replacement. J Am Heart Assoc 2020; 8:e012110. [PMID: 31124737 PMCID: PMC6585322 DOI: 10.1161/jaha.119.012110] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Patients with symptomatic severe aortic stenosis and a history of chest radiation therapy represent a complex and challenging cohort. It is unknown how transcatheter aortic valve replacement ( TAVR ) compares with surgical aortic valve replacement in this group of patients, which was the objective of this study. Methods and Results We retrospectively reviewed all patients with severe aortic stenosis who underwent either TAVR or surgical aortic valve replacement at our institution with a history of mediastinal radiation (n=55 per group). End points were echocardiographic and clinical outcomes in-hospital, at 30 days, and at 1 year. Inverse propensity weighting analysis was used to account for intergroup baseline differences. TAVR patients had a higher STS score than surgical aortic valve replacement patients (5.1% [3.2, 7.7] versus 1.6% [0.8, 2.6], P<0.001) and more often ( P<0.01 for all) a history of atrial fibrillation (45.5% versus 12.7%), chronic lung disease (47.3% versus 7.3%), peripheral arterial disease (38.2% versus 7.3%), heart failure (58.2% versus 18.2%), and pacemaker therapy (23.6% versus 1.8%). Postoperative atrial fibrillation was less frequent (1.8% versus 27.3%; P<0.001) and hospital stay was shorter in TAVR patients (4.0 [2.0, 5.0] versus 6.0 [5.0, 8.0] days; P<0.001). The ratio of observed-to-expected 30-day mortality was lower after TAVR as was 30-day mortality in inverse propensity weighting-adjusted Kaplan-Meier analyses. Conclusions In patients with severe aortic stenosis and a history of chest radiation therapy, TAVR performs better than predicted along with less adjusted 30-day all-cause mortality, postoperative atrial fibrillation, and shorter hospitalization compared with surgical aortic valve replacement. These data support further studies on the preferred role of TAVR in this unique patient population.
Collapse
Affiliation(s)
- Dongfeng Zhang
- 1 Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing China
| | - Wei Guo
- 2 Department of Emergency Medicine Peking University People's Hospital Beijing China.,3 Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | | | | | | | - Kevin Greason
- 3 Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | | | - Mackram F Eleid
- 3 Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | - David R Holmes
- 3 Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | - Joerg Herrmann
- 3 Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| |
Collapse
|
19
|
Bennett CE, Anavekar NS, Gulati R, Singh M, Kane GC, Sandoval Y, Foley TA, Jaffe AS, Sandhu GS, Bell MR, Askew JW. ST-segment Elevation, Myocardial Injury, and Suspected or Confirmed COVID-19 Patients: Diagnostic and Treatment Uncertainties. Mayo Clin Proc 2020; 95:1107-1111. [PMID: 32414550 PMCID: PMC7151327 DOI: 10.1016/j.mayocp.2020.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 01/19/2023]
Affiliation(s)
| | - Nandan S Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Radiology, Mayo Clinic, Rochester, MN
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Yader Sandoval
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Allan S Jaffe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Malcolm R Bell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - J Wells Askew
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
20
|
Lopez-Jimenez F, Attia Z, Arruda-Olson AM, Carter R, Chareonthaitawee P, Jouni H, Kapa S, Lerman A, Luong C, Medina-Inojosa JR, Noseworthy PA, Pellikka PA, Redfield MM, Roger VL, Sandhu GS, Senecal C, Friedman PA. Artificial Intelligence in Cardiology: Present and Future. Mayo Clin Proc 2020; 95:1015-1039. [PMID: 32370835 DOI: 10.1016/j.mayocp.2020.01.038] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 02/06/2023]
Abstract
Artificial intelligence (AI) is a nontechnical, popular term that refers to machine learning of various types but most often to deep neural networks. Cardiology is at the forefront of AI in medicine. For this review, we searched PubMed and MEDLINE databases with no date restriction using search terms related to AI and cardiology. Articles were selected for inclusion on the basis of relevance. We highlight the major achievements in recent years in nearly all areas of cardiology and underscore the mounting evidence suggesting how AI will take center stage in the field. Artificial intelligence requires a close collaboration among computer scientists, clinical investigators, clinicians, and other users in order to identify the most relevant problems to be solved. Best practices in the generation and implementation of AI include the selection of ideal data sources, taking into account common challenges during the interpretation, validation, and generalizability of findings, and addressing safety and ethical concerns before final implementation. The future of AI in cardiology and in medicine in general is bright as the collaboration between investigators and clinicians continues to excel.
Collapse
Affiliation(s)
| | - Zachi Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Rickey Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
| | | | - Hayan Jouni
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Christina Luong
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | | | | | - Veronique L Roger
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | | | - Conor Senecal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
21
|
El-Sabawi B, Shadrin IS, Sandhu GS, Crestanello JA, Jaffe AS. Acute Myocardial Infarction Due to Fixed Coronary Artery Stenosis From Myocardial Bridging. Cardiovasc Revasc Med 2020; 21:91-93. [PMID: 32448775 DOI: 10.1016/j.carrev.2020.04.020] [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: 02/27/2020] [Revised: 04/04/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
Myocardial bridging is a common coronary abnormality often associated with left ventricular hypertrophy. It can be noted incidentally on coronary angiography by findings of systolic narrowing of the involved coronary artery. We present the case of a 59-year-old woman that presented with a non-ST elevation myocardial infarction. She had a history of angina and workup 9-months prior with CT coronary angiography that revealed an intra-myocardial course of the left anterior descending coronary artery (LAD) with minimal stenosis and no concomitant coronary artery disease. Invasive coronary angiography now demonstrated apparent myocardial bridging associated with a severe fixed stenosis of the LAD without change in diameter with nitroglycerin injection. Due to persistent symptoms, surgical myotomy was attempted and then aborted because of difficulty unroofing the LAD due to surrounding fibrosis. Coronary artery bypass grafting (CABG) was then successfully performed using a left internal mammary artery graft. The patient had complete resolution of her chest pain and was without functional limitation at 3-month follow-up. This case highlights possible sequelae of myocardial bridging and suggests that, in rare cases, fixed obstruction of the involved coronary artery may occur in the setting of fibrosis of the bridged segment. In such cases, surgical myotomy may not be feasible and CABG may be required.
Collapse
Affiliation(s)
| | - Ilya S Shadrin
- Department of Medicine, Mayo Clinic, United States of America
| | - Gurpreet S Sandhu
- Department of Cardiovascular Diseases, Mayo Clinic, United States of America
| | - Juan A Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, United States of America
| | - Allan S Jaffe
- Department of Cardiovascular Diseases, Mayo Clinic, United States of America; Department of Laboratory Medicine and Pathology, Mayo Clinic, United States of America.
| |
Collapse
|
22
|
Abstract
Transcatheter aortic valve replacement is a relatively recent revolutionary treatment that has now become a standard procedure for treating severe aortic stenosis. In this article, the authors review the clinical history of transcatheter aortic valve replacement, summarize the major clinical trials, and describe the evolution of the technique over time. In doing so, the authors hope to provide a clear and concise review of the history and clinical evidence behind transcatheter aortic valve replacement.
Collapse
Affiliation(s)
| | | | | | - Henry H Ting
- Department of Cardiology Mayo Clinic Rochester MN
| | | |
Collapse
|
23
|
Anand V, Ali MA, Naser J, Nkomo VT, Pellikka PA, Eleid MF, Sandhu GS, Greason KL, Pislaru SV. Incidence, Mechanisms, and Predictors of Mean Systolic Gradients ≥20 mm Hg after Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 125:941-947. [PMID: 31964503 DOI: 10.1016/j.amjcard.2019.12.023] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/03/2019] [Accepted: 12/09/2019] [Indexed: 11/28/2022]
Abstract
There is a significant increase in transvalvular gradients after transcatheter aortic valve implantation (TAVI) in some patients; however, mechanisms underlying the greater than expected gradients are unknown. We sought to determine the incidence and mechanisms of greater than expected gradients post-TAVI. A total of 424 patients who underwent TAVI at our institution between November 2008 and August 2015 and had at least 1 follow-up echocardiogram were included in the study. Greater than expected gradients were defined as mean systolic Doppler gradients ≥20 mm Hg. The primary end-point was incidence and mechanisms of mean systolic Doppler gradients ≥20 mm Hg. A total of 36 (8%) patients had mean systolic Doppler gradients ≥20 mm Hg. The mechanisms of mean systolic Doppler gradients ≥20 mm Hg were: patient prosthesis mismatch in 15 (42%) patients, high cardiac output in 13 (36%), prosthetic and periprosthetic regurgitation in 11 (31%), stenosis in 5 (14%), and multiple mechanisms in 8 (22%). Patients with mean systolic Doppler gradients ≥20 mm Hg had higher cardiac re-hospitalization rate, but no difference in mortality or major cardiovascular events when compared with the normal gradient group. Smaller prosthetic valve size (p <0.0001) and larger body mass index (p = 0.02) were associated with mean systolic Doppler gradients ≥20 mm Hg; warfarin therapy at discharge had no effect on gradients. In conclusion, about 8% patients had mean systolic Doppler gradients ≥20 mm Hg following TAVI, and patient-prosthesis mismatch was the most common mechanism. The mean systolic Doppler gradients ≥20 mm Hg after TAVI are not benign and warrant careful surveillance.
Collapse
Affiliation(s)
- Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mahmoud A Ali
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jwan Naser
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gurpreet S Sandhu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
24
|
Franchi F, Olthoff M, Krier J, Noble C, Al-Hijji M, Ramaswamy V, Witt T, Burke M, Benscoter M, Lerman A, Sandhu GS, Rodriguez-Porcel M. A Metabolic Intravascular Platform to Study FDG Uptake in Vascular Injury. Cardiovasc Eng Technol 2020; 11:328-336. [PMID: 32002814 DOI: 10.1007/s13239-020-00457-z] [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: 08/01/2019] [Accepted: 01/24/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Metabolic alterations underlie many pathophysiological conditions, and their understanding is critical for the development of novel therapies. Although the assessment of metabolic changes in vivo has been historically challenging, recent developments in molecular imaging have allowed us to study novel metabolic research concepts directly in the living subject, bringing us closer to patients. However, in many instances, there is need for sensors that are in close proximity to the organ under investigation, for example to study vascular metabolism. METHODS In this study, we developed and validated a metabolic detection platform directly in the living subject under an inflammatory condition. The signal collected by a scintillating fiber is amplified using a photomultiplier tube and decodified by an in-house tunable analysis platform. For in vivo testing, we based our experiments on the metabolic characteristics of macrophages, cells closely linked to inflammation and avid for glucose and its analog 18F-fluorodeoxyglucose (18F-FDG). The sensor was validated in New Zealand rabbits, in which inflammation was induced by either a) high cholesterol (HC) diet for 16 weeks or b) vascular balloon endothelial denudation followed by HC diet. RESULTS There was no difference in weight, hemodynamics, blood pressure, or heart rate between the groups. Vascular inflammation was detected by the metabolic sensor (Inflammation: 0.60 ± 0.03 AU vs. control: 0.48 ± 0.03 AU, p = 0.01), even though no significant inflammation/atherosclerosis was detected by intravascular ultrasound, underscoring the high sensitivity of the system. These findings were confirmed by the presence of macrophages on ex vivo aortic tissue staining. CONCLUSION In this study, we validated a tunable very sensitive metabolic sensor platform that can be used for the detection of vascular metabolism, such as inflammation. This sensor can be used not only for the detection of macrophage activity but, with alternative probes, it could allow the detection of other pathophysiological processes.
Collapse
Affiliation(s)
- F Franchi
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA.
| | - M Olthoff
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - J Krier
- Department of Physiology and Biomedical Engineering, Mayo Clinic School of Medicine Rochester, Rochester, MN, 55902, USA
| | - C Noble
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - M Al-Hijji
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - V Ramaswamy
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - T Witt
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - M Burke
- Division of Engineering, Mayo Clinic School of Medicine Rochester, Rochester, MN, 55902, USA
| | - M Benscoter
- Division of Engineering, Mayo Clinic School of Medicine Rochester, Rochester, MN, 55902, USA
| | - A Lerman
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - G S Sandhu
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA
| | - M Rodriguez-Porcel
- Department of Cardiovascular Medicine, Mayo Clinic School of Medicine Rochester, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic School of Medicine Rochester, Rochester, MN, 55902, USA
| |
Collapse
|
25
|
Sandhu GS, Nagrale HR. Computed Tomography Evaluation of Brain in Chronic Alcoholics. J Neurosci Rural Pract 2020; 11:63-71. [PMID: 32140005 PMCID: PMC7055608 DOI: 10.1055/s-0039-1700610] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background
Chronic alcoholism causes brain damage. Published data from rural India is scant. Our aim is to determine computed tomography (CT) changes in the brain of rural chronic alcoholics.
Methods
This prospective cross-sectional study was done in our tertiary care hospital on chronic alcoholic patients referred from deaddiction center over a period of 2 years. Age- and sex-matched nonalcoholic controls were included and Student’s
t
-test and chi-square test comparison was done. Correlation coefficient was obtained by Pearson’s correlation coefficient. Patients and the controls were studied in two age groups: 30 to 45 and 46 to 60 years. Noncontrast CT scan of head was done in each case and CT indices of brain damage were measured.
Results
The study included 106 alcoholics out of which 55 were in the younger age group (30–45 years) and 51 in the older age group (46–60 years). Seven hundred age-matched, nonalcoholic controls were included. Mean values of ethanol were higher in the older age group than in the younger age group. As compared with controls, various CT scan indices of ventricular changes, cortical changes, and subcortical changes were significantly higher in both age groups. In both age groups, there was a significant decrease in the mean values of hemoglobin and a significant increase in the mean values of indices of brain damage with increase in the grade of alcoholism.
Conclusion
The results of this prospective epidemiological study showed marked alterations in all CT indices of brain atrophy and were correlated to the duration and amount of ethanol consumption. This study highlights that chronic alcoholism is a significant risk factor for brain atrophy.
Collapse
Affiliation(s)
- Gurpreet S. Sandhu
- Department of Radiodiagnosis and Imaging, Jawaharlal Nehru Medical College, DMIMS, Maharashtra, India
| | - Hiresh R. Nagrale
- Department of Radiodiagnosis and Imaging, Jawaharlal Nehru Medical College, DMIMS, Maharashtra, India
| |
Collapse
|
26
|
Vallabhajosyula S, Prasad A, Bell MR, Sandhu GS, Eleid MF, Dunlay SM, Schears GJ, Stulak JM, Singh M, Gersh BJ, Jaffe AS, Holmes DR, Rihal CS, Barsness GW. Extracorporeal Membrane Oxygenation Use in Acute Myocardial Infarction in the United States, 2000 to 2014. Circ Heart Fail 2019; 12:e005929. [PMID: 31826642 DOI: 10.1161/circheartfailure.119.005929] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is increasingly used in acute myocardial infarction (AMI); however, there are limited large-scale national data. METHODS Using the National Inpatient Sample database from 2000 to 2014, a retrospective cohort of AMI utilizing ECMO was identified. Use of percutaneous coronary intervention, intra-aortic balloon pump, and percutaneous left ventricular assist device (LVAD) was also identified in this population. Outcomes of interest included temporal trends in utilization of ECMO alone and with concomitant procedures (percutaneous coronary intervention, intra-aortic balloon pump, and percutaneous LVAD), in-hospital mortality, and resource utilization. RESULTS In ≈9 million AMI admissions, ECMO was used in 2962 (<0.01%) and implanted a median of 1 day after admission. ECMO was used in 0.5% and 0.3% AMI admissions complicated by cardiogenic shock and cardiac arrest, respectively. ECMO was used more commonly in admissions that were younger, nonwhite, and with less comorbidity. ECMO use was 11× higher in 2014 as compared with 2000 (odds ratio, 11.37 [95% CI, 7.20-17.97]). Same-day percutaneous coronary intervention was performed in 23.1%; intra-aortic balloon pump/percutaneous LVAD was used in 57.9%, of which 30.3% were placed concomitantly. In-hospital mortality with ECMO was 59.2% overall but decreased from 100% (2000) to 45.1% (2014). Durable LVAD and cardiac transplantation were performed in 11.7% as an exit strategy. Of the hospital survivors, 40.8% were discharged to skilled nursing facilities. Older age, male sex, nonwhite race, and lower socioeconomic status were independently associated with higher in-hospital mortality with ECMO use. CONCLUSIONS In AMI admissions, a steady increase was noted in the utilization of ECMO alone and with concomitant procedures (percutaneous coronary intervention, intra-aortic balloon pump, and percutaneous LVAD). In-hospital mortality remained high in AMI admissions treated with ECMO.
Collapse
Affiliation(s)
- Saraschandra Vallabhajosyula
- Department of Cardiovascular Medicine (S.V., A.P., M.R.B., G.S.S., M.F.E., S.M.D., M.S., B.J.G., A.S.J., D.R.H., C.S.R., G.W.B.), Mayo Clinic, Rochester, MN.,Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.V.), Mayo Clinic, Rochester, MN.,Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN (S.V.)
| | - Abhiram Prasad
- Department of Cardiovascular Medicine (S.V., A.P., M.R.B., G.S.S., M.F.E., S.M.D., M.S., B.J.G., A.S.J., D.R.H., C.S.R., G.W.B.), Mayo Clinic, Rochester, MN
| | - Malcolm R Bell
- Department of Cardiovascular Medicine (S.V., A.P., M.R.B., G.S.S., M.F.E., S.M.D., M.S., B.J.G., A.S.J., D.R.H., C.S.R., G.W.B.), Mayo Clinic, Rochester, MN
| | - Gurpreet S Sandhu
- Department of Cardiovascular Medicine (S.V., A.P., M.R.B., G.S.S., M.F.E., S.M.D., M.S., B.J.G., A.S.J., D.R.H., C.S.R., G.W.B.), Mayo Clinic, Rochester, MN
| | - Mackram F Eleid
- Department of Cardiovascular Medicine (S.V., A.P., M.R.B., G.S.S., M.F.E., S.M.D., M.S., B.J.G., A.S.J., D.R.H., C.S.R., G.W.B.), Mayo Clinic, Rochester, MN
| | - Shannon M Dunlay
- Department of Cardiovascular Medicine (S.V., A.P., M.R.B., G.S.S., M.F.E., S.M.D., M.S., B.J.G., A.S.J., D.R.H., C.S.R., G.W.B.), Mayo Clinic, Rochester, MN.,Department of Health Science Research (S.M.D.), Mayo Clinic, Rochester, MN
| | - Gregory J Schears
- Division of Critical Care Anesthesiology, Department of Anesthesiology and Perioperative Medicine (G.J.S.), Mayo Clinic, Rochester, MN
| | - John M Stulak
- Department of Cardiovascular Surgery (J.M.S.), Mayo Clinic, Rochester, MN
| | - Mandeep Singh
- Department of Cardiovascular Medicine (S.V., A.P., M.R.B., G.S.S., M.F.E., S.M.D., M.S., B.J.G., A.S.J., D.R.H., C.S.R., G.W.B.), Mayo Clinic, Rochester, MN
| | - Bernard J Gersh
- Department of Cardiovascular Medicine (S.V., A.P., M.R.B., G.S.S., M.F.E., S.M.D., M.S., B.J.G., A.S.J., D.R.H., C.S.R., G.W.B.), Mayo Clinic, Rochester, MN
| | - Allan S Jaffe
- Department of Cardiovascular Medicine (S.V., A.P., M.R.B., G.S.S., M.F.E., S.M.D., M.S., B.J.G., A.S.J., D.R.H., C.S.R., G.W.B.), Mayo Clinic, Rochester, MN
| | - David R Holmes
- Department of Cardiovascular Medicine (S.V., A.P., M.R.B., G.S.S., M.F.E., S.M.D., M.S., B.J.G., A.S.J., D.R.H., C.S.R., G.W.B.), Mayo Clinic, Rochester, MN
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine (S.V., A.P., M.R.B., G.S.S., M.F.E., S.M.D., M.S., B.J.G., A.S.J., D.R.H., C.S.R., G.W.B.), Mayo Clinic, Rochester, MN
| | - Gregory W Barsness
- Department of Cardiovascular Medicine (S.V., A.P., M.R.B., G.S.S., M.F.E., S.M.D., M.S., B.J.G., A.S.J., D.R.H., C.S.R., G.W.B.), Mayo Clinic, Rochester, MN
| |
Collapse
|
27
|
Tian Y, Padmanabhan D, McLeod CJ, Zhang P, Xiao P, Sandhu GS, Greason KL, Gulati R, Nkomo VT, Rihal CS, Polk LE, Sanvick C, Liu XP, Friedman PA, Cha YM. Utility of 30-Day Continuous Ambulatory Monitoring to Identify Patients With Delayed Occurrence of Atrioventricular Block After Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2019; 12:e007635. [DOI: 10.1161/circinterventions.118.007635] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Mechanical injury in the conduction system requiring permanent pacemaker (PPM) associated with transcatheter aortic valve replacement (TAVR) procedure is a common complication. The objective of this study was to use ambulatory monitor BodyGuardian to assess late occurrence of atrioventricular block (AVB) after TAVR.
Methods:
This prospective study evaluated 365 patients who underwent TAVR at Mayo Clinic, Rochester, Minnesota between June 2016 and August 2017. Patients who received PPM for bradycardia after TAVR before discharge were considered as the PPM group. Those not requiring PPM received a BodyGuardian system (BodyGuardian group) for 30 days of continuous monitoring. Primary end point was Mobitz II or third-degree atrioventricular block (II/III AVB) at 30-day follow-up.
Results:
Of 365 patients, 74 who had a PPM or an implantable cardioverter-defibrillator before TAVR and 94 who were enrolled in other studies were excluded. Of 197 patients enrolled in the study, 70 (35.5%) received PPM and 127 had BodyGuardian before the hospital dismissal. Eleven of 127 (8.6%) BodyGuardian group required PPM within 30 days after TAVR for late occurrence of symptomatic bradycardia. In total, 33 of 197 (16.7%) patients developed II/III AVB (24 before and 9 after discharge). Thirty-four patients had preexisting right bundle branch block. Of them, 16 (47%) developed II/III AVB. Of 53 patients who developed new left bundle branch block after TAVR, 14% progressed to II/III AVB within 30 days.
Conclusions:
In patients without a standard post-TAVR pacing indication, yet a potential risk to develop AVB, a strategy of 30-day monitoring identifies additional patients who require permanent pacing.
Collapse
Affiliation(s)
- Ying Tian
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
- Department of Cardiovascular Diseases, Beijing Chaoyang Hospital, China (Y.T., X.-P.L.)
| | - Deepak Padmanabhan
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | | | - Pei Zhang
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Peilin Xiao
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Gurpreet S. Sandhu
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Kevin L. Greason
- Department of Cardiovascular Surgery (K.L.G.), Mayo Clinic, Rochester, MN
| | - Rajiv Gulati
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Vuyisile T. Nkomo
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Charanjit S. Rihal
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Lynn E. Polk
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Carrie Sanvick
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Xing-Peng Liu
- Department of Cardiovascular Diseases, Beijing Chaoyang Hospital, China (Y.T., X.-P.L.)
| | - Paul A. Friedman
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine (Y.T., D.P., P.Z., P.X., G.S.S., R.G., V.T.N., C.S.R., L.E.P., C.S., P.A.F., Y.-M.C.), Mayo Clinic, Rochester, MN
| |
Collapse
|
28
|
Anand V, Frantz RP, DuBrock H, Kane GC, Krowka M, Yanagisawa R, Sandhu GS. Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Hypertension: Initial Single-Center Experience. Mayo Clin Proc Innov Qual Outcomes 2019; 3:311-318. [PMID: 31485569 PMCID: PMC6713895 DOI: 10.1016/j.mayocpiqo.2019.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 05/14/2019] [Revised: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 01/08/2023] Open
Abstract
Objective To evaluate the safety and efficacy of balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) seen at a US medical center. Patients and Methods Patients with inoperable or residual postendarterectomy CTEPH who underwent BPA at Mayo Clinic in Rochester, Minnesota, between August 11, 2014, and May 17, 2018, were included. Invasive hemodynamic, clinical, laboratory, and echocardiographic data were collected and analyzed retrospectively. Results We identified 31 patients (26 with inoperable CTEPH and 5 with residual postendarterectomy CTEPH) who underwent 75 BPA procedures performed in a staged manner to reduce complications. The median number of sessions was 2 (interquartile range [IQR], 1-3) per patient, and the number of vessels treated per session was 3 (IQR, 2-3). Of the 31 patients, 24 (77.4%) were taking pulmonary vasodilators and 22 (71.0%) were taking riociguat. The mean pulmonary arterial pressure decreased from 40 mm Hg (IQR, 29-48 mm Hg) to 29 mm Hg (IQR, 25-37 mm Hg; P<.001); pulmonary vascular resistance decreased from 5.5 Wood units (WU) (IQR, 3.0-7.6 WU) to 3.3 WU (2.2-5.2 WU; P<.001). The follow-up 6-minute walk test was performed in 13 patients and improved from 402 m (IQR, 311-439 m) to 439 m (366-510 m; P=.001). Of the 31 patients, 19 (61.3%) had improvement in New York Heart Association functional class. The mean ± SD nadir of minute ventilation/carbon dioxide production decreased by 3.4±5.5 (P=.03), reflecting improved ventilatory efficiency. Complications included hemoptysis requiring overnight intensive care unit observation (n=1) and cardiac tamponade requiring pericardiocentesis (n=1). One patient had reperfusion injury requiring intubation, recovered, and was dismissed to home but died unexpectedly within less than 30 days of the procedure. Serious complications occurred in 3 of the 75 BPA procedures (4.0%). Conclusion Our experience with BPA revealed that this procedure has acceptable risk and improves hemodynamics, functional class, and exercise tolerance in patients with inoperable or residual CTEPH.
Collapse
Key Words
- 6MWD, 6-minute walk distance
- BPA, balloon pulmonary angioplasty
- CTEPH, chronic thromboembolic pulmonary hypertension
- ICU, intensive care unit
- IQR, interquartile range
- NT-proBNP, N-terminal pro-B-type natriuretic peptide
- NYHA, New York Heart Association
- PA, pulmonary artery
- PH, pulmonary hypertension
- RAP, right atrial pressure
- RHC, right-sided heart catheterization
- RV, right ventricular
- RVSP, right ventricular systolic pressure
- TAPSE, tricuspid annular plane systolic excursion
- WU, Wood units
Collapse
Affiliation(s)
- Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Robert P Frantz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Hilary DuBrock
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Michael Krowka
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | | |
Collapse
|
29
|
Sedeek AF, Greason KL, Sandhu GS, Dearani JA, Holmes DR, Schaff HV. Transcatheter Valve-in-Valve Vs Surgical Replacement of Failing Stented Aortic Biological Valves. Ann Thorac Surg 2019; 108:424-430. [DOI: 10.1016/j.athoracsur.2019.03.084] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 03/12/2019] [Accepted: 03/25/2019] [Indexed: 11/30/2022]
|
30
|
Vallabhajosyula S, Dunlay SM, Murphree DH, Barsness GW, Sandhu GS, Lerman A, Prasad A. Cardiogenic Shock in Takotsubo Cardiomyopathy Versus Acute Myocardial Infarction. JACC: Heart Failure 2019; 7:469-476. [DOI: 10.1016/j.jchf.2018.12.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/29/2018] [Accepted: 12/09/2018] [Indexed: 02/01/2023]
|
31
|
Sandhu GS, Gupta P, Yadav TD, Sinha SK. A rare complication of laparoscopic cholecystectomy. Acta Gastroenterol Belg 2019; 82:339. [PMID: 31314203] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- G S Sandhu
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, PGIMER, Chandigarh, India
| | - P Gupta
- Section of Radiology (Department of Gastroenterology), Postgraduate Institute of Medical Education and Research, PGIMER, Chandigarh, India
| | - T D Yadav
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, PGIMER, Chandigarh, India
| | - S K Sinha
- Section of Radiology (Department of Gastroenterology), Postgraduate Institute of Medical Education and Research, PGIMER, Chandigarh, India
| |
Collapse
|
32
|
Eleid MF, Padang R, Al-Hijji M, Pislaru SV, Greason KL, Maltais S, Pibarot P, Pellikka PA, Sandhu GS, Rihal CS, Nishimura RA, Borlaug BA. Hemodynamic Response in Low-Flow Low-Gradient Aortic Stenosis With Preserved Ejection Fraction After TAVR. J Am Coll Cardiol 2019; 73:1731-1732. [DOI: 10.1016/j.jacc.2019.01.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/08/2019] [Accepted: 01/15/2019] [Indexed: 11/16/2022]
|
33
|
Al-Hijji MA, Gulati R, Lennon RJ, Bell M, El Sabbagh A, Park JY, Slusser J, Sandhu GS, Reeder GS, Rihal CS, Singh M. Outcomes of Percutaneous Coronary Interventions in Patients With Anemia Presenting With Acute Coronary Syndrome. Mayo Clin Proc 2018; 93:1448-1461. [PMID: 30286831 DOI: 10.1016/j.mayocp.2018.03.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 01/24/2017] [Revised: 03/22/2018] [Accepted: 03/28/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To study the influence of anemia on long-term outcomes of patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI). PATIENTS AND METHODS The study included 5668 consecutive unique patients with acute coronary syndrome who underwent PCI at Mayo Clinic from January 1, 2004, through December 31, 2014. The patients were stratified on the basis of the presence (hemoglobin [Hgb] level, <13 g/dL in men and <12 g/dL in women) and severity (moderate to severe Hgb level, <11 g/dL in men and women) of pre-PCI anemia and compared with patients without anemia. The primary outcomes were in-hospital and long-term all-cause mortality after balancing baseline comorbidities using the inverse propensity weighting method. RESULTS Unadjusted all-cause in-hospital mortality (4.6% [84 of 1831] vs 2.0% [75 of 3837]) and 5-year follow-up mortality (44.4% [509] vs 15.4% [323]) were higher in patients with anemia than in those without anemia (P<.001 for both). After applying inverse propensity weighting analysis, the all-cause in-hospital mortality (2.0% [37] vs 2.0% [75]; P=.85) and 5-year mortality (17.8% [203] vs 15.4% [323]; P=.05) were not significantly different between patients with and without anemia; however, there were higher rates of all-cause 5-year mortality in patients with moderate to severe anemia (22.3% [113] vs 15.4% [323]; P<.001) compared with patients without anemia. The trend in 5-year mortality was driven by increased noncardiac mortality in patients with anemia (10.2% [91] vs 7.1% [148]; P=.04) and moderate to severe anemia (10.4% [52] vs 7.1% [148]; P=.006) when compared with nonanemic patients. CONCLUSION After accounting for differences in risk profiles of anemic and nonanemic patients, anemia appeared to be an independent risk factor for increased long-term all-cause and noncardiac mortality.
Collapse
Affiliation(s)
| | - Rajiv Gulati
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ryan J Lennon
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Malcolm Bell
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Jae Yoon Park
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Joshua Slusser
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | - Guy S Reeder
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Mandeep Singh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
| |
Collapse
|
34
|
Nakasu A, Greason KL, Nkomo VT, Eleid MF, Pochettino A, King KS, Sandhu GS, Williamson EE, Holmes DR. Transcatheter aortic valve insertion in patients with hostile ascending aorta calcification. J Thorac Cardiovasc Surg 2018; 156:1028-1034. [DOI: 10.1016/j.jtcvs.2018.03.125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 03/15/2018] [Accepted: 03/23/2018] [Indexed: 10/17/2022]
|
35
|
Gharacholou SM, Ijioma NN, Lennon RJ, Rihal CS, Bell MR, Brenes-Salazar JA, Sandhu GS, Gulati R, Pellikka PA, Pollak PM, Lane GE, Pillai DP, Munoz FDC, Motiei A, Singh M. Characteristics and long term outcomes of patients with acute coronary syndromes due to culprit left main coronary artery disease treated with percutaneous coronary intervention. Am Heart J 2018; 199:156-162. [PMID: 29754655 DOI: 10.1016/j.ahj.2018.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 02/17/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patients with acute coronary syndrome (ACS) due to unprotected culprit left main coronary artery disease (LMCAD) treated with percutaneous coronary intervention (PCI) are rare, high-risk, and not represented in trials. Data regarding long term outcome after PCI are limited. METHODS Between January 2000 and December 2014, there were 8,794 patients hospitalized with unstable angina/non-ST elevation myocardial infarction (UA/NSTEMI) or ST-elevation myocardial infarction (STEMI) treated with PCI at our institution; of these, 83 (0.94%) patients were identified as having culprit LMCAD ACS. RESULTS Of the 83 patients with unprotected LMCAD ACS, 40 patients presented with STEMI and 43 patients presented with UA/NSTEMI. As compared to LM UA/NSTEMI, LM STEMI patients were younger and had less hypertension, with a trend towards greater frequency of cardiogenic shock. Distal LM involvement was common in both groups and did not differ by ACS type. In-hospital mortality was 33% in LM STEMI and 9% in LM UA/NSTEMI (P = .009). Over median follow up of 6.3 years, long term survival rates in both groups were similar (46% for STEMI vs 51% for UA/NSTEMI; P = .50 by log-rank). CONCLUSIONS Unprotected culprit LMCAD ACS necessitating PCI is uncommon, occurring in <1% of cases, but is associated with reduced survival, with long term follow-up noting continued and similar risk of death regardless of index ACS type.
Collapse
|
36
|
Greason KL, Eleid MF, Nkomo VT, King KS, Williamson EE, Sandhu GS, Holmes DR. Predictors of 1-year mortality after transcatheter aortic valve replacement. J Card Surg 2018; 33:243-249. [DOI: 10.1111/jocs.13574] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kevin L. Greason
- Department of Cardiovascular Surgery; Mayo Clinic; Rochester Minnesota
| | - Mackram F. Eleid
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Vuyisile T. Nkomo
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Katherine S. King
- Biomedical Statistics and Informatics; Mayo Clinic; Rochester Minnesota
| | | | | | - David R. Holmes
- Department of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| |
Collapse
|
37
|
Tefft BJ, Uthamaraj S, Harbuzariu A, Harburn JJ, Witt TA, Newman B, Psaltis PJ, Hlinomaz O, Holmes DR, Gulati R, Simari RD, Dragomir-Daescu D, Sandhu GS. Nanoparticle-Mediated Cell Capture Enables Rapid Endothelialization of a Novel Bare Metal Stent. Tissue Eng Part A 2018; 24:1157-1166. [PMID: 29431053 DOI: 10.1089/ten.tea.2017.0404] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Incomplete endothelialization of intracoronary stents has been associated with stent thrombosis and recurrent symptoms, whereas prolonged use of dual antiplatelet therapy increases bleeding-related adverse events. Facilitated endothelialization has the potential to improve clinical outcomes in patients who are unable to tolerate dual antiplatelet therapy. The objective of this study was to demonstrate the feasibility of magnetic cell capture to rapidly endothelialize intracoronary stents in a large animal model. A novel stent was developed from a magnetizable duplex stainless steel (2205 SS). Polylactic-co-glycolic acid and magnetite (Fe3O4) were used to synthesize biodegradable superparamagnetic iron oxide nanoparticles, and these were used to label autologous blood outgrowth endothelial cells. Magnetic 2205 SS and nonmagnetic 316L SS control stents were implanted in the coronary arteries of pigs (n = 11), followed by intracoronary delivery of magnetically labeled cells to 2205 SS stents. In this study, we show extensive endothelialization of magnetic 2205 SS stents (median 98.4% cell coverage) within 3 days, whereas the control 316L SS stents exhibited significantly less coverage (median 48.9% cell coverage, p < 0.0001). This demonstrates the ability of intracoronary delivery of magnetic nanoparticle labeled autologous endothelial cells to improve endothelialization of magnetized coronary stents within 3 days of implantation.
Collapse
Affiliation(s)
- Brandon J Tefft
- 1 Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
| | | | - Adriana Harbuzariu
- 1 Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
| | - J Jonathan Harburn
- 3 School of Pharmacy & Institute of Cellular Medicine, Newcastle University , Newcastle-upon-Tyne, United Kingdom
| | - Tyra A Witt
- 1 Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
| | - Brant Newman
- 2 Division of Engineering, Mayo Clinic , Rochester, Minnesota
| | - Peter J Psaltis
- 4 Vascular Research Centre, South Australian Health and Medical Research Institute , Adelaide, Australia .,5 School of Medicine, University of Adelaide , Adelaide, Australia
| | - Ota Hlinomaz
- 6 Department of Cardioangiology, St. Anne's University Hospital , Brno, Czech Republic
| | - David R Holmes
- 1 Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
| | - Rajiv Gulati
- 1 Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
| | - Robert D Simari
- 1 Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
| | - Dan Dragomir-Daescu
- 7 Department of Physiology and Biomedical Engineering, Mayo Clinic , Rochester, Minnesota
| | - Gurpreet S Sandhu
- 1 Department of Cardiovascular Medicine, Mayo Clinic , Rochester, Minnesota
| |
Collapse
|
38
|
Sandhu GS, Rihal CS. Portico at 1 Year: "There is Nothing Like First-Hand Evidence"-Sir Arthur Conan Doyle. A Study in Scarlet, 1887. Circ Cardiovasc Interv 2018; 11:e006335. [PMID: 29445005 DOI: 10.1161/circinterventions.118.006335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Gurpreet S Sandhu
- From the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Charanjit S Rihal
- From the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
39
|
Fender EA, Chandrashekar P, Liang JJ, Dhar PR, Sio TT, Stulak JM, Lennon RJ, Slusser JP, Ashman JB, Miller RC, Herrmann J, Prasad A, Sandhu GS. Coronary artery bypass grafting in patients treated with thoracic radiation: a case-control study. Open Heart 2018. [PMID: 29531769 PMCID: PMC5845399 DOI: 10.1136/openhrt-2017-000766] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background and aim Thoracic radiation therapy (XRT) for cancer is associated with the development of significant coronary artery disease that may require coronary artery bypass grafting surgery (CABG). Contemporary acute surgical outcomes and long-term postoperative survival of patients with prior XRT have not been well characterised. Methods This was a retrospective, single-centre study of patients with a history of thoracic XRT who required CABG and who were propensity matched against 141 controls who underwent CABG over the same time period. The objectives were to assess early CABG outcomes and long-term survival in patients with prior XRT. Results Thirty-eight patients with a history of previous thoracic XRT underwent CABG from 1994 to 2013. The median time from XRT exposure to surgery was 7.9 years (IQR: 2.5–18.4 years). Perioperative adverse events were similar in the XRT group and controls; however, there was a trends lower utilisation of internal mammary artery (IMA) grafts in the XRT group (89%vs98%, P=0.13). After a median postoperative follow-up of 5.4 years (IQR 0.9–9.4 years), no difference in long-term all-cause mortality was observed. Conclusion Patients with prior thoracic XRT who undergo CABG have similar long-term all-cause mortality compared with controls. Isolated CABG after thoracic XRT is not associated with higher perioperative complications, but IMA graft use may be limited by prior XRT.
Collapse
Affiliation(s)
- Erin Amanda Fender
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jackson J Liang
- Division of Cardiovascular Disease, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Priyank R Dhar
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - John M Stulak
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan J Lennon
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Joshua P Slusser
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan B Ashman
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Robert C Miller
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Joerg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Gurpreet S Sandhu
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
40
|
Greason KL, Sandhu GS, Nkomo VT, King KS, Joyce DL, Williamson EE, Holmes DR. Transcatheter aortic valve insertion after previous mitral valve operation. J Thorac Cardiovasc Surg 2017; 154:810-815. [DOI: 10.1016/j.jtcvs.2017.03.118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 02/11/2017] [Accepted: 03/15/2017] [Indexed: 11/26/2022]
|
41
|
Affiliation(s)
- Elad Maor
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Mackram F Eleid
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Rajiv Gulati
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | |
Collapse
|
42
|
Alkhouli M, Zack CJ, Sarraf M, Bashir R, Nishimura RA, Eleid MF, Nkomo VT, Sandhu GS, Gulati R, Greason KL, Holmes DR, Rihal CS. Morbidity and Mortality Associated With Balloon Aortic Valvuloplasty. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004481. [DOI: 10.1161/circinterventions.116.004481] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 03/15/2017] [Indexed: 11/16/2022]
Abstract
Background—
The introduction of transcatheter aortic valve replacement (TAVR) led to renewed interest in balloon aortic valvuloplasty (BAV). We sought to assess contemporary trends in BAV utilization and their outcomes.
Methods and Results—
The Nationwide Inpatient Sample was used to identify patients who underwent BAV between 2004 and 2013. In-hospital morbidity and mortality, and predictors of death after BAV were assessed. Outcomes of propensity-matched groups of patients undergoing elective BAV or TAVR were evaluated. BAV utilization increased from 707 cases in 2004 to 3715 cases in 2013 (national estimates). Procedural and in-hospital mortality were 1.4% and 8.5%, respectively. Vascular complications occurred in 7.0% of cases, blood transfusion in 17.5%, clinical stroke in 1.8%, and pacemaker implantation in 3.0%. The strongest predictors of in-hospital death were cardiogenic shock (odds ratio, 6.01; 95% confidence interval, 4.19–8.61;
P
<0.001), need for left ventricular assist device (odds ratio, 3.48; 95% confidence interval, 2.25–5.36;
P
<0.001), coagulopathy (odds ratio, 2.19; 95% confidence interval, 1.51–3.18;
P
<0.001), and low institutional volume of BAV (odds ratio, 1.58; 95% confidence interval, 1.06–2.37;
P
=0.03). In propensity-matched patients undergoing elective BAV or TAVR, rates of in-hospital mortality (2.9% versus 3.5%;
P
=0.60), clinical stroke (1.6% versus 3.1%;
P
=0.10), and vascular complications (8.2% versus 10.9%;
P
=0.14) were similar. However, BAV was associated with lower rates of pacemaker implantation (2.9% versus 8.0%;
P
<0.001) and blood transfusion (12.8% versus 22.9%;
P
<0.001).
Conclusions—
In a contemporary national registry, BAV is associated with significant morbidity and mortality that are similar to TAVR. With the substantial increase in BAV utilization and the continuous improvement in TAVR outcomes, these data have important implications to aid clinicians in the selection of appropriate BAV candidates.
Collapse
Affiliation(s)
- Mohamad Alkhouli
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Chad J. Zack
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Mohammad Sarraf
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Riyaz Bashir
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Rick A. Nishimura
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Mackram F. Eleid
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Vuyisile T. Nkomo
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Gurpreet S. Sandhu
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Rajiv Gulati
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Kevin L. Greason
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - David R. Holmes
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| | - Charanjit S. Rihal
- From the Department of Cardiovascular Diseases (M.A., C.J.Z., M.S., R.A.N., M.F.E., V.T.N., G.S.S., R.G., D.R.H., C.S.R.) and Division of Cardiac Surgery, Department of Surgery (K.L.G.), Mayo Clinic College of Medicine, Rochester, MN; and Division of Cardiovascular Diseases, Department of Medicine, Temple University School of Medicine, Philadelphia, PA (R.B.)
| |
Collapse
|
43
|
Fender EA, Liang JJ, Sio TT, Stulak JM, Lennon RJ, Slusser JP, Ashman JB, Miller RC, Herrmann J, Prasad A, Sandhu GS. Percutaneous revascularization in patients treated with thoracic radiation for cancer. Am Heart J 2017; 187:98-103. [PMID: 28454813 DOI: 10.1016/j.ahj.2017.02.014] [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: 08/02/2016] [Accepted: 02/11/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess coronary revascularization outcomes in patients with previous thoracic radiation therapy (XRT). BACKGROUND Previous chest radiation has been reported to adversely affect long term survival in patients with coronary disease treated with percutaneous coronary interventions (PCI). METHODS Retrospective, single center cohort study of patients previously treated with thoracic radiation and PCI. Patients were propensity matched against control patients without radiation undergoing revascularization during the same time period. RESULTS We identified 116 patients with radiation followed by PCI (XRT-PCI group) and 408 controls. Acute procedural complications were similar between groups. There were no differences in all-cause and cardiac mortality between groups (all-cause mortality HR 1.31, P=.078; cardiac mortality 0.78, P=.49). CONCLUSION Patients with prior thoracic radiation and coronary disease treated with PCI have similar procedural complications and long term mortality when compared to control subjects.
Collapse
Affiliation(s)
- Erin A Fender
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Jackson J Liang
- Division of Cardiovascular Disease, University of Pennsylvania, Philadelphia, PA, USA
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - John M Stulak
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ryan J Lennon
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Joshua P Slusser
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - Robert C Miller
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - Joerg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Gurpreet S Sandhu
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
44
|
Tefft BJ, Uthamaraj S, Harburn JJ, Hlinomaz O, Lerman A, Dragomir-Daescu D, Sandhu GS. Magnetizable stent-grafts enable endothelial cell capture. J Magn Magn Mater 2017; 427:100-104. [PMID: 28286359 PMCID: PMC5341609 DOI: 10.1016/j.jmmm.2016.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Emerging nanotechnologies have enabled the use of magnetic forces to guide the movement of magnetically-labeled cells, drugs, and other therapeutic agents. Endothelial cells labeled with superparamagnetic iron oxide nanoparticles (SPION) have previously been captured on the surface of magnetizable 2205 duplex stainless steel stents in a porcine coronary implantation model. Recently, we have coated these stents with electrospun polyurethane nanofibers to fabricate prototype stent-grafts. Facilitated endothelialization may help improve the healing of arteries treated with stent-grafts, reduce the risk of thrombosis and restenosis, and enable small-caliber applications. When placed in a SPION-labeled endothelial cell suspension in the presence of an external magnetic field, magnetized stent-grafts successfully captured cells to the surface regions adjacent to the stent struts. Implantation within the coronary circulation of pigs (n=13) followed immediately by SPION-labeled autologous endothelial cell delivery resulted in widely patent devices with a thin, uniform neointima and no signs of thrombosis or inflammation at 7 days. Furthermore, the magnetized stent-grafts successfully captured and retained SPION-labeled endothelial cells to select regions adjacent to stent struts and between stent struts, whereas the non-magnetized control stent-grafts did not. Early results with these prototype devices are encouraging and further refinements will be necessary in order to achieve more uniform cell capture and complete endothelialization. Once optimized, this approach may lead to more rapid and complete healing of vascular stent-grafts with a concomitant improvement in long-term device performance.
Collapse
Affiliation(s)
- Brandon J. Tefft
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN., USA
| | | | - J. Jonathan Harburn
- School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
| | - Ota Hlinomaz
- Department of Cardioangiology, St. Anne’s University Hospital, Brno, Czech Republic
| | - Amir Lerman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN., USA
| | - Dan Dragomir-Daescu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN., USA
| | - Gurpreet S. Sandhu
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St. SW, Rochester, MN., USA
- Corresponding Author: phone: (507) 255-2440 fax: (507)
255-2550
| |
Collapse
|
45
|
Yanagisawa R, Fetterly KA, Johnson GB, Foley TA, Williamson EE, Gulati R, Sandhu GS, Frantz RP. Integrated Use of Perfusion SPECT/CTA Fusion Imaging and Pulmonary Balloon Angioplasty for Chronic Pulmonary Thromboembolism. JACC Cardiovasc Interv 2017; 10:532-534. [DOI: 10.1016/j.jcin.2016.12.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 12/15/2016] [Indexed: 11/28/2022]
|
46
|
Wang F, Gulati R, Lennon RJ, Lewis BR, Park J, Sandhu GS, Wright RS, Lerman A, Herrmann J. Cancer History Portends Worse Acute and Long-term Noncardiac (but Not Cardiac) Mortality After Primary Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction. Mayo Clin Proc 2016; 91:1680-1692. [PMID: 27916154 DOI: 10.1016/j.mayocp.2016.06.029] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [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: 03/11/2016] [Revised: 06/24/2016] [Accepted: 06/27/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To define the effect of a history of cancer on in-hospital and long-term mortality after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). PATIENTS AND METHODS In this retrospective cohort study of 2346 patients with STEMI enrolled in the Mayo Clinic PCI registry from November 1, 2000, through October 31, 2010, we identified 261 patients (11.1%) with a history of cancer. The in-hospital and long-term outcomes (median follow-up, 6.2 years; interquartile range=4.3-8.5 years), including cardiac and noncardiac death and heart failure hospitalization, of these patients were compared with those of 1313 cancer-negative patients matched on age, sex, family history of coronary artery disease, and date of STEMI. RESULTS Patients with cancer had higher in-hospital noncardiac (1.9% vs 0.4%; P=.03) but similar cardiac (5.8% vs 4.6%; P=.37) mortality as matched controls. The group at highest acute mortality risk were those diagnosed as having cancer within 6 months before STEMI (hazard ratio [HR]=7.0; 95% CI, 1.4-34.4; P=.02). At 5 years, patients with cancer had similar cardiac mortality (4.2% vs 5.8%; HR=1.27; 95% CI, 0.77-2.10; P=.35) despite more heart failure hospitalizations (15% vs 10%; HR=1.72; 95% CI, 1.18-2.50; P=.01) but faced higher noncardiac mortality (30.0% vs 11.0%; HR=3.01; 95% CI, 2.33-3.88; P<.001) than controls, attributable solely to cancer-related deaths. CONCLUSION One in 10 patients in this contemporary registry of patients undergoing primary PCI for STEMI has a history of cancer. These patients have more than a 3 times higher acute in-hospital and long-term noncardiac mortality risk but no increased acute or long-term cardiac mortality risk with guideline-recommended cardiac care.
Collapse
Affiliation(s)
- Feilong Wang
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Rajiv Gulati
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ryan J Lennon
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Bradley R Lewis
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Jae Park
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - R Scott Wright
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Joerg Herrmann
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
| |
Collapse
|
47
|
Goel K, Gulati R, Reeder GS, Lennon RJ, Lewis BR, Behfar A, Sandhu GS, Rihal CS, Singh M. Low Body Mass Index, Serum Creatinine, and Cause of Death in Patients Undergoing Percutaneous Coronary Intervention. J Am Heart Assoc 2016; 5:JAHA.116.003633. [PMID: 27799234 PMCID: PMC5210329 DOI: 10.1161/jaha.116.003633] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Low body mass index (BMI) and serum creatinine are surrogate markers of frailty and sarcopenia. Their relationship with cause-specific mortality in elderly patients undergoing percutaneous coronary intervention is not well studied. METHODS AND RESULTS We determined long-term cardiovascular and noncardiovascular mortality in 9394 consecutive patients aged ≥65 years who underwent percutaneous coronary intervention from 2000 to 2011. BMI and serum creatinine were divided into 4 categories. During a median follow-up of 4.2 years (interquartile range 1.8-7.3 years), 3243 patients (33.4%) died. In the multivariable model, compared with patients with normal BMI, patients with low BMI had significantly increased all-cause mortality (hazard ratio [HR] 1.4, 95% CI 1.1-1.7), which was related to both cardiovascular causes (HR 1.4, 95% CI 1.0-1.8) and noncardiovascular causes (HR 1.4, 95% CI 1.06-1.9). Compared with normal BMI, significant reduction was noted in patients who were overweight and obese in terms of cardiovascular mortality (overweight: HR 0.77, 95% CI 0.67-0.88; obese: HR 0.80, 95% CI 0.70-0.93) and noncardiovascular mortality (overweight: HR 0.85, 95% CI 0.74-0.97; obese: HR 0.82, 95% CI 0.72-0.95). In a multivariable model, in patients with normal BMI, low creatinine (≤0.70 mg/dL) was significantly associated with increased all-cause mortality (HR 1.8, 95% CI 1.3-2.5) and cardiovascular mortality (HR 2.3, 95% CI 1.4-3.8) compared with patients with normal creatinine (0.71-1.0 mg/dL); however, this was not observed in other BMI categories. CONCLUSIONS We identified a new subgroup of patients with low serum creatinine and normal BMI that was associated with increased all-cause mortality and cardiovascular mortality in elderly patients undergoing percutaneous coronary intervention. Low BMI was associated with increased cardiovascular and noncardiovascular mortality. Nutritional support, resistance training, and weight-gain strategies may have potential roles for these patients undergoing percutaneous coronary intervention.
Collapse
Affiliation(s)
- Kashish Goel
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Rajiv Gulati
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Guy S Reeder
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Ryan J Lennon
- Division of Biostatistics, Mayo Clinic, Rochester, MN
| | | | - Atta Behfar
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | | | - Mandeep Singh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| |
Collapse
|
48
|
Uthamaraj S, Tefft BJ, Jana S, Hlinomaz O, Kalra M, Lerman A, Dragomir-Daescu D, Sandhu GS. Fabrication of Small Caliber Stent-grafts Using Electrospinning and Balloon Expandable Bare Metal Stents. J Vis Exp 2016. [PMID: 27805589 DOI: 10.3791/54731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Stent-grafts are widely used for the treatment of various conditions such as aortic lesions, aneurysms, emboli due to coronary intervention procedures and perforations in vasculature. Such stent-grafts are manufactured by covering a stent with a polymer membrane. An ideal stent-graft should have a biocompatible stent covered by a porous, thromboresistant, and biocompatible polymer membrane which mimics the extracellular matrix thereby promoting injury site healing. The goal of this protocol is to manufacture a small caliber stent-graft by encapsulating a balloon expandable stent within two layers of electrospun polyurethane nanofibers. Electrospinning of polyurethane has been shown to assist in healing by mimicking native extracellular matrix, thereby promoting endothelialization. Electrospinning polyurethane nanofibers on a slowly rotating mandrel enabled us to precisely control the thickness of the nanofibrous membrane, which is essential to achieve a small caliber balloon expandable stent-graft. Mechanical validation by crimping and expansion of the stent-graft has shown that the nanofibrous polyurethane membrane is sufficiently flexible to crimp and expand while staying patent without showing any signs of tearing or delamination. Furthermore, stent-grafts fabricated using the methods described here are capable of being implanted using a coronary intervention procedure using standard size guide catheters.
Collapse
Affiliation(s)
| | | | - Soumen Jana
- Department of Cardiovascular Diseases, Mayo Clinic
| | - Ota Hlinomaz
- Department of Cardioangiology, ICRC, St. Anne's University Hospital
| | | | - Amir Lerman
- Department of Cardiovascular Diseases, Mayo Clinic
| | - Dan Dragomir-Daescu
- Division of Engineering, Mayo Clinic; Department of Physiology and Biomedical Engineering, Mayo Clinic
| | | |
Collapse
|
49
|
Ito S, Pislaru SV, Soo WM, Huang R, Greason KL, Mathew V, Sandhu GS, Eleid MF, Suri RM, Oh JK, Nkomo VT. Impact of right ventricular size and function on survival following transcatheter aortic valve replacement. Int J Cardiol 2016; 221:269-74. [DOI: 10.1016/j.ijcard.2016.07.085] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 07/04/2016] [Indexed: 01/09/2023]
|
50
|
Long KH, Moriarty JP, Ransom JE, Lennon RJ, Mathew V, Gulati R, Sandhu GS, Rihal CS. Economic and clinical impact of routine weekend catheterization services. Am J Manag Care 2016; 22:e233-e240. [PMID: 27442306] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To assess the impact of weekend cardiac catheterization (cath) services for nonemergent inpatients. STUDY DESIGN Retrospective cohort study of patients undergoing cath before and after Saturday cath service availability (CSA). METHODS Cohorts included Friday and Saturday admissions with cath (with or without revascularization) on the subsequent Monday from January 1, 2007, to December 31, 2008 (pre-CSA events), and Friday or Saturday admissions undergoing cath the subsequent or same Saturday from January 1, 2009, to December 31, 2010 (post-CSA events). Administrative and registry data provided demographics, comorbidities, percutaneous coronary intervention (PCI) details, adverse events, hospital length of stay (LOS), and inpatient expenditures. We used generalized linear modeling to predict LOS and costs, and logistic regression to estimate the likelihood of adverse events during follow-up. RESULTS We identified 331 pre-CSA cases (327 patients) and 244 post-CSA cases (243 patients). Cohorts were similar in age (66 years), sex (59% male), and level of comorbidity. PCI use was higher following CSA (42% vs 26%; P <.001), with procedural success accomplished in 95% and 94% of pre- and post-CSA patients, respectively. Adjusted clinical outcomes were similar (odds ratio [OR] for in-hospital mortality, 0.67 post-CSA vs pre-CSA; P = .55; OR for 30-day revascularization, 1.14; P = .68). Models predict an average LOS reduction of 1.7 days following CSA (5.7 vs 4.0 days; P <.001) yet inpatient costs were similar ($24,817 vs $24,753; 95% CI of difference, -$3611 to $3576). CONCLUSIONS Weekend CSA for routine inpatients was clinically safe and effective, and reduced hospital LOS. Similar inpatient costs likely reflect a shift in case mix in this nonrandomized study.
Collapse
Affiliation(s)
- Kristen Hall Long
- Long Health Economics Consulting LLC, 855 Village Center Dr #111, St. Paul, MN 55127. E-mail:
| | | | | | | | | | | | | | | |
Collapse
|