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Alexander M, Edelman JJ, Yong G. Hybrid Transcatheter Approach to an Iatrogenic Left Ventricle-Coronary Sinus Fistula. JACC Case Rep 2024; 29:102330. [PMID: 38601844 PMCID: PMC11004884 DOI: 10.1016/j.jaccas.2024.102330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/14/2023] [Indexed: 04/12/2024]
Abstract
This clinical case describes a subacute presentation of decompensated heart failure secondary to an iatrogenic left ventricle-to-coronary sinus fistula after sequential mitral valve surgical procedures. Computed tomography was used to select an unconventional hybrid transapical access approach and facilitate successful closure using a vascular plug.
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Affiliation(s)
- Mikhail Alexander
- Department of Cardiology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - J. James Edelman
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Gerald Yong
- Department of Cardiology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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Edelman JJ, Yadav P, Thourani VH. Commentary: Explanting a transcatheter aortic valve replacement prosthesis: A future necessary evil? J Thorac Cardiovasc Surg 2023; 166:1431-1432. [PMID: 35115140 DOI: 10.1016/j.jtcvs.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/02/2022] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Affiliation(s)
- J James Edelman
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, University of Western Australia, Perth, Australia
| | - Pradeep Yadav
- Department of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga.
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3
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Lan NSR, Edelman JJ, Erickson M. External compression of saphenous vein graft by surgical pericardial drain. J Cardiovasc Med (Hagerstown) 2022; 23:819-820. [PMID: 36219156 DOI: 10.2459/jcm.0000000000001379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Nick S R Lan
- Department of Cardiology, Fiona Stanley Hospital.,Internal Medicine, Medical School, The University of Western Australia
| | - J James Edelman
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Thourani VH, Brennan JM, Edelman JJ, Thibault D, Jawitz OK, Bavaria JE, Higgins RSD, Sabik JF, Prager RL, Dearani JA, MacGillivray TE, Badhwar V, Svensson LG, Reardon MJ, Shahian DM, Jacobs JP, Ailawadi G, Szeto WY, Desai N, Roselli EE, Woo YJ, Vemulapalli S, Carroll JD, Yadav P, Malaisrie SC, Russo M, Nguyen TC, Kaneko T, Tang G, Ruel M, Chikwe J, Lee R, Habib RH, George I, Leon MB, Mack MJ. Association of Volume and Outcomes in 234,556 Patients Undergoing Surgical Aortic Valve Replacement. Ann Thorac Surg 2021; 114:1299-1306. [PMID: 34785247 DOI: 10.1016/j.athoracsur.2021.06.095] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/26/2021] [Accepted: 06/30/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND The relationship between institutional volume and operative mortality following SAVR remains unclear. METHODS From 1/2013 to 6/2018, 234,556 patients underwent isolated SAVR (n=144,177) or SAVR+CABG (n=90,379) within the STS ACSD. The association between annualized SAVR volume [Group 1 (1-25 SAVR), Group 2 (26-50 SAVR), Group 3 (51-100 SAVR), and Group 4 (>100 SAVR)] and operative mortality and composite major morbidity/mortality was assessed. Random effects models were used to evaluate whether historic (2013-2015) SAVR volume or risk-adjusted outcomes explained future (2016-2018) risk-adjusted outcomes. RESULTS The annualized median number of SAVRs per site was 35 [IQR: 22-59, isolated AVR: 20, AVR+CABG: 13]. Among isolated SAVR cases, the mean operative mortality and composite morbidity/mortality were 1.5% and 9.7%, respectively, at the highest volume sites (Group 4); with significantly higher rates among progressively lower volume groups (p-trend<0.001). After adjustment, lower volume centers experienced increased odds of operative mortality [Group 1 vs. 4 (Ref): AOR (SAVR), 2.24 (1.91-2.64); AOR (SAVR+CABG), 1.96 (1.67-2.30)] and major morbidity/mortality [AOR (SAVR), 1.53 (1.39-1.69); AOR (SAVR+CABG), 1.46 (1.32-1.61)] compared to the highest volume institutions. Substantial variation in outcomes was observed across hospitals within each volume category and prior outcomes explained a greater proportion of hospital operative outcomes than prior volume. CONCLUSIONS Operative outcomes following SAVR±CABG is inversely associated with institutional procedure volumes; however, prior outcomes are more predictive than prior volume of future outcomes. Given excellent outcomes observed at many lower volume hospitals, procedural outcomes may be preferable to procedural volumes as a quality metric.
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Affiliation(s)
- Vinod H Thourani
- Department of Cardiovascular Surgery and Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA.
| | | | - J James Edelman
- Department of Cardiac Surgery, Fiona Stanley Hospital, Perth, Australia
| | | | | | - Joseph E Bavaria
- Division of Cardiothoracic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Robert S D Higgins
- Division of Cardiothoracic Surgery, Johns Hopkins University, Baltimore, MD
| | - Joseph F Sabik
- Division of Cardiac Surgery, Case Western University, Cleveland, OH
| | | | | | | | - Vinay Badhwar
- Division of Cardiothoracic Surgery, West Virginia University, Morgantown, WV
| | - Lars G Svensson
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH
| | | | - David M Shahian
- Division of Surgery, Massachusetts General Hospital, Harvard University, Boston, MA
| | - Jeffrey P Jacobs
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, MI
| | - Wilson Y Szeto
- Division of Cardiothoracic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Nimesh Desai
- Division of Cardiothoracic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Eric E Roselli
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Y Joseph Woo
- Department of Cardiac Surgery, Stanford University, Palo Alto, CA
| | | | - John D Carroll
- Division of Cardiology, University of Colorado, Aurora, CO
| | - Pradeep Yadav
- Department of Cardiovascular Surgery and Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA
| | | | - Mark Russo
- Division of Cardiac Surgery, RWJ Barnabas Health, New Brunswick, NJ
| | - Tom C Nguyen
- Division of Cardiac Surgery, University of California San Francisco, CA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard University, Boston, MA
| | - Gilbert Tang
- Department of Cardiac Surgery, Mt Sinai Medical Center, New York, NY
| | - Marc Ruel
- Department of Cardiac Surgery, Ottawa Heart Institute, Canada
| | - Joanna Chikwe
- Department of Cardiac Surgery, Cedars Sinai Heart Institute, Los Angeles, CA
| | - Richard Lee
- Department of Cardiac Surgery, Augusta University, Augusta, GA
| | | | - Isaac George
- Division of Cardiac Surgery, Columbia University, New York, NY
| | - Martin B Leon
- Division of Cardiology, Columbia University, New York, NY
| | - Michael J Mack
- Department of Cardiac Surgery, Baylor, Scott and White, Plano, Dallas, TX
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Thourani VH, Brennan JM, Edelman JJ, Chen Q, Boero IJ, Sarkar RR, Murphy SM, Leon MB, Kodali SK. Treatment Patterns, Disparities, and Management Strategies Impact Clinical Outcomes in Patients with Symptomatic Severe Aortic Regurgitation. Structural Heart 2021. [DOI: 10.1080/24748706.2021.1988779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Squiers JJ, Edelman JJ, Thourani VH, Mack MJ. Transseptal approach is preferred for transcatheter mitral valve-in-valve procedures. Ann Cardiothorac Surg 2021; 10:697-699. [PMID: 34733701 PMCID: PMC8505919 DOI: 10.21037/acs-2021-tviv-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/14/2021] [Indexed: 11/06/2022]
Affiliation(s)
| | - J. James Edelman
- Fiona Stanley Hospital, University of Western Australia, Perth, Australia
| | - Vinod H. Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Michael J. Mack
- Baylor Scott & White Research Institute, Plano, Texas, USA
- Department of Cardiothoracic Surgery, Baylor Scott & White, The Heart Hospital, Plano, Texas, USA
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Edelman JJ, Squiers JJ, Mack MJ, Thourani VH. Best transcatheter approach for a failed mitral valve ring. Ann Cardiothorac Surg 2021; 10:692-693. [PMID: 34733699 PMCID: PMC8505920 DOI: 10.21037/acs-2021-tviv-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/14/2021] [Indexed: 11/06/2022]
Affiliation(s)
- J. James Edelman
- Fiona Stanley Hospital, University of Western Australia, Perth, Australia
| | | | - Michael J. Mack
- Baylor Scott & White Research Institute, Plano, Texas, USA
- Department of Cardiothoracic Surgery, Baylor Scott & White, The Heart Hospital, Plano, Texas, USA
| | - Vinod H. Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
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8
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Edelman JJ, Thourani VH. Racial Disparity in the Treatment of Aortic Stenosis. J Am Heart Assoc 2021; 10:e019875. [PMID: 34261326 PMCID: PMC8483495 DOI: 10.1161/jaha.120.019875] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- J James Edelman
- Department of Cardiothoracic Surgery and Transplantation Fiona Stanley Hospital University of Western Australia Perth Australia
| | - Vinod H Thourani
- Department of Cardiovascular Surgery Marcus Valve Center Piedmont Heart Institute Atlanta GA
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Edelman JJ, Yadav PK, Thourani VH. Commentary: Transcarotid Access TAVR: Ready for Prime Time? Semin Thorac Cardiovasc Surg 2021; 34:477-478. [PMID: 34004314 DOI: 10.1053/j.semtcvs.2021.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/28/2021] [Indexed: 11/11/2022]
Affiliation(s)
- J James Edelman
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, University of Western Australia, Perth, Australia
| | - Pradeep K Yadav
- Department of Cardiology, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA.
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10
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Edelman JJ, Thourani VH. Commentary: American Heart Association/American College of Cardiology Valve guidelines: Starting point for discussion by the heart team or dictum? J Thorac Cardiovasc Surg 2021; 162:588-590. [PMID: 33773819 DOI: 10.1016/j.jtcvs.2021.02.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Affiliation(s)
- J James Edelman
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Australia
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga.
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Thourani VH, Edelman JJ, Holmes SD, Nguyen TC, Carroll J, Mack MJ, Kapadia S, Tang GHL, Kodali S, Kaneko T, Meduri CU, Forcillo J, Ferdinand FD, Fontana G, Suwalski P, Kiaii B, Balkhy H, Kempfert J, Cheung A, Borger MA, Reardon M, Leon MB, Popma JJ, Ad N. The International Society for Minimally Invasive Cardiothoracic Surgery Expert Consensus Statement on Transcatheter and Surgical Aortic Valve Replacement in Low- and Intermediate-Risk Patients: A Meta-Analysis of Randomized and Propensity-Matched Studies. Innovations (Phila) 2021; 16:3-16. [PMID: 33491539 DOI: 10.1177/1556984520978316] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE There is an increasing amount of evidence supporting use of transcatheter aortic valve replacement (TAVR) for treatment of aortic stenosis in patients at low or intermediate risk for surgical aortic valve replacement (SAVR). TAVR is now approved for use in all patient cohorts. Despite this, there remains debate about the relative efficacy of TAVR compared with SAVR in lower-risk cohorts and various subgroups of patients. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and propensity-matched trials to guide a consensus among expert cardiologists and surgeons. METHODS Studies comparing TAVR and SAVR in low- and intermediate-risk patients were identified by a thorough search of the major databases. Mortality, stroke, and other perioperative outcomes were assessed at 30 days and 1 year. RESULTS Early mortality was lower in TAVR compared to SAVR in RCTs, but not propensity-matched studies in low-risk cohorts (0.66% vs 1.5%; odds ratio [OR] = 0.44, 95% confidence interval [CI] 0.20 to 0.98, I2 = 0%). No difference in mortality between TAVR and SAVR was identified in intermediate-risk patients at early or later time points. Incidence of perioperative stroke in 3 low-risk RCTs was significantly lower in TAVR (0.4%) than SAVR (1.4%; OR = 0.33, 95% CI 0.13 to 0.81, I2 = 0%). There was no difference in stroke for intermediate-risk patients between TAVR and SAVR. The expert panel of cardiologists and cardiac surgeons provided recommendations for TAVR and SAVR in various clinical scenarios. CONCLUSIONS In RCTs comparing TAVR and SAVR in low-risk patients, early mortality and stroke were lower in TAVR, but did not differ at 1 year. There was no difference in mortality and stroke in intermediate-risk patients. The Multidisciplinary Heart Team must consider individual patient characteristics and preferences when recommending TAVR or SAVR. The decision must consider the long-term management of each patient's aortic valve disease.
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Affiliation(s)
- Vinod H Thourani
- 165591 Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart and Vascular Institute, Atlanta, GA, USA
| | - J James Edelman
- 2720 Department of Cardiac Surgery, Fiona Stanley Hospital, University of Western Australia, Perth, Australia
| | - Sari D Holmes
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tom C Nguyen
- Division of Adult Cardiothoracic Surgery, University of California, San Francisco, CA, USA
| | - John Carroll
- 1878 Division of Cardiology, University of Colorado, Denver, CO, USA
| | - Michael J Mack
- 384526 Department of Cardiology, Baylor Health Care System, Heart Hospital Baylor Plano, Dallas, TX, USA
| | - Samir Kapadia
- 2569 Department of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Gilbert H L Tang
- 5944 Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Susheel Kodali
- 5798 Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Tsuyoshi Kaneko
- 1861 Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Christopher U Meduri
- 165591 Division of Cardiology, Marcus Heart and Vascular Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Jessica Forcillo
- 5622 Department of Cardiac Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | - Francis D Ferdinand
- 6595 Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine & UPMC Hamot Heart and Vascular Institute, University of Pittsburgh Medical Center, PA, USA
| | - Gregory Fontana
- Cardiovascular Institute, Los Robles Hospital and Medical Center, Thousand Oaks, CA, USA
| | - Piotr Suwalski
- 359917 Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Bob Kiaii
- 8789 Cardiothoracic Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Husam Balkhy
- 12246 Section of Cardiac Surgery, University of Chicago Medicine, IL, USA
| | - Joerg Kempfert
- Department of Cardiac Surgery, German Heart Institute, Berlin, Germany
| | - Anson Cheung
- Department of Cardiac Surgery, The University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | | | - Michael Reardon
- Department of Cardiac Surgery, Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Martin B Leon
- 5798 Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Jeffrey J Popma
- 1859 Department of Interventional Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Niv Ad
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.,Cardiovascular Surgery, Adventist White Oak Medical Center, Silver Spring, MD, USA
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Edelman JJ, Thourani VH. Commentary: Robotic aortic valve replacement-fad or future? J Thorac Cardiovasc Surg 2021; 161:1763-1764. [PMID: 33461816 DOI: 10.1016/j.jtcvs.2020.11.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Affiliation(s)
- J James Edelman
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, University of Western Australia, Perth, Australia
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga.
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13
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Edelman JJ, Meduri CU, Yong G, Thourani VH. Transcatheter devices for direct annuloplasty and chordal replacement in degenerative mitral regurgitation. Ann Cardiothorac Surg 2021; 10:164-166. [PMID: 33575188 DOI: 10.21037/acs-2020-mv-108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- J James Edelman
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Australia
| | - Christopher U Meduri
- Department of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Gerald Yong
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
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Forcillo J, Edelman JJ, Thourani VH. Commentary: Yes! Size is important when performing aortic valve repair. J Thorac Cardiovasc Surg 2020; 164:1078-1079. [PMID: 33461815 DOI: 10.1016/j.jtcvs.2020.12.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Jessica Forcillo
- Cardiac Surgery Department, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, Québec, Canada
| | - J James Edelman
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, University of Western Australia, Perth, Australia
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga.
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15
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Edelman JJ, Khan JM. BASILICA to prevent coronary obstruction in transcatheter aortic valve replacement. Ann Cardiothorac Surg 2020; 9:508-509. [PMID: 33312913 DOI: 10.21037/acs-2020-av-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- J James Edelman
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital and University of Western Australia, Perth, Western Australia, Australia
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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16
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Edelman JJ, Meduri C, Yadav P, Thourani VH. Current Evidence for Alternative Access Transcatheter Aortic Valve Replacement. Structural Heart 2020. [DOI: 10.1080/24748706.2020.1821936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Edelman JJ, Thourani VH. Commentary: Transcatheter mitral valve-in-valve: Not yet a replacement for surgery. J Thorac Cardiovasc Surg 2020; 163:1813-1814. [PMID: 32977965 DOI: 10.1016/j.jtcvs.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 11/17/2022]
Affiliation(s)
- J James Edelman
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, University of Western Australia, Perth, Australia
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga.
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18
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Cohen BD, Napolitano MA, Edelman JJ, Thourani KV, Thourani VH. Contemporary Management of Mitral Valve Disease. Adv Surg 2020; 54:129-147. [PMID: 32713426 DOI: 10.1016/j.yasu.2020.05.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Brian D Cohen
- Department of Surgery, MedStar Georgetown/Washington Hospital Center, 3800 Reservoir Road Northwest, 2051 Gorman, Washington, DC 20007, USA
| | - Michael A Napolitano
- Department of Surgery, George Washington University, 1255 New Hampshire Avenue Northwest Apartment 1001, Washington, DC 20036, USA
| | - J James Edelman
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150, Australia
| | - Keegan V Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, 95 Collier Road, Suite 5015, Atlanta, GA 30342, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, 95 Collier Road, Suite 5015, Atlanta, GA 30342, USA.
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Edelman JJ, Badhwar V, Larbalestier R, Yadav P, Thourani VH. Contemporary Surgical and Transcatheter Management of Mitral Annular Calcification. Ann Thorac Surg 2020; 111:390-397. [PMID: 32798455 DOI: 10.1016/j.athoracsur.2020.04.148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/18/2020] [Accepted: 04/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The presence of mitral annular calcification (MAC) in patients with mitral valve (MV) stenosis or regurgitation is a difficult scenario for surgeons and the heart team. Patients with MAC most often have a significant number of comorbidities that exclude them as surgical candidates. This review highlights the various contemporary techniques available to manage MAC during treatment of the MV. METHODS This study is a focused review of the anatomy, pathology, and management of MAC. The review describes the surgical and transcatheter techniques with outcomes, where available. RESULTS The incidence of MAC is between 5% and 42% in patients with severe MV disease. The pathophysiology underlying MAC is not yet clear, but it most likely is related to processes of inflammation and atherosclerosis. Surgical techniques can be grouped into those in which the MAC is completely resected en bloc and those in which the MAC is incompletely resected or left in situ. Transcatheter therapies are feasible in some patients, but they have been limited by the anatomic constraints of MAC; most importantly left ventricular outflow tract obstruction and paravalvular regurgitation. CONCLUSIONS Surgeons as part of the heart team now have a range of techniques to manage MAC in those patients with severe MV disease. Transcatheter therapies may increase the options for patients whose surgical risk is too high.
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Affiliation(s)
- J James Edelman
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Perth, Australia
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Robert Larbalestier
- Department of Cardiothoracic Surgery and Transplantation, Fiona Stanley Hospital, Perth, Australia
| | - Pradeep Yadav
- Department of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia.
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20
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Edelman JJ, Thourani VH. Commentary: Surgical explant of TAVR prostheses. JTCVS Tech 2020; 3:75-76. [PMID: 34317820 PMCID: PMC8303050 DOI: 10.1016/j.xjtc.2020.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 06/22/2020] [Accepted: 06/27/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- J James Edelman
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga
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21
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Edelman JJ, Thourani VH. Transcatheter Aortic Valve Replacement for Aortic Regurgitation? An Unmet Need. Ann Thorac Surg 2020; 110:1966. [PMID: 32585197 DOI: 10.1016/j.athoracsur.2020.04.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 04/30/2020] [Indexed: 10/24/2022]
Affiliation(s)
- J James Edelman
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Australia
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart Institute, 95 Collier Rd, Ste 5015, Atlanta, GA 30309.
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22
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Edelman JJ, Thourani VH. Commentary: Mitral valve surgery in the new paradigm. J Thorac Cardiovasc Surg 2020; 160:100-101. [PMID: 32539992 DOI: 10.1016/j.jtcvs.2020.04.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 11/28/2022]
Affiliation(s)
- J James Edelman
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Australia
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga.
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23
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Edelman JJ, Kauten J, Thourani VH. Commentary: Transapical transapical mitral valve replacement: Here to stay or a gateway procedure? JTCVS Tech 2020; 2:34-35. [PMID: 34317741 PMCID: PMC8299038 DOI: 10.1016/j.xjtc.2020.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 11/01/2022] Open
Affiliation(s)
- J James Edelman
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Australia
| | - James Kauten
- Department of Cardiovascular Surgery, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Ga
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Ga
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24
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Edelman JJ, Yadav PK, Thourani VH. Commentary: Surgical mitral-in-mitral annular calcification: Progress but not the solution. JTCVS Tech 2020; 3:138-139. [PMID: 34317845 PMCID: PMC8302860 DOI: 10.1016/j.xjtc.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/06/2020] [Accepted: 03/08/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- J James Edelman
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Pradeep K Yadav
- Division of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga
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25
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Khalid N, Javed H, Ahmad SA, Edelman JJ, Shlofmitz E, Chen Y, Musallam A, Rogers T, Hashim H, Bernardo NL, Waksman R. Analysis of the Food and Drug Administration Manufacturer and User Facility Device Experience Database for Patient- and Circuit-Related Adverse Events Involving Extracorporeal Membrane Oxygenation. Cardiovascular Revascularization Medicine 2020; 21:230-234. [DOI: 10.1016/j.carrev.2019.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
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26
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Elbatarny M, Tam DY, Edelman JJ, Rocha RV, Chu MWA, Peterson MD, El-Hamamsy I, Appoo JJ, Friedrich JO, Boodhwani M, Yanagawa B, Ouzounian M. Valve-Sparing Root Replacement Versus Composite Valve Grafting in Aortic Root Dilation: A Meta-Analysis. Ann Thorac Surg 2020; 110:296-306. [PMID: 31981499 DOI: 10.1016/j.athoracsur.2019.11.054] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 10/26/2019] [Accepted: 11/25/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Aortic valve-sparing operations theoretically have fewer stroke and bleeding complications but may increase late reoperation risk versus composite valve grafts. METHODS We meta-analyzed all studies comparing aortic valve-sparing (reimplantation and remodelling) and composite valve-grafting (bioprosthetic and mechanical) procedures. Early outcomes were all-cause mortality, reoperation for bleeding, myocardial infarction, and thromboembolism/stroke. Long-term outcomes included all-cause mortality, reintervention, bleeding, and thromboembolism/stroke. Studies exclusively investigating dissection or pediatric populations were excluded. RESULTS A total of 3794 patients who underwent composite valve grafting and 2424 who underwent aortic valve-sparing procedures were included from 9 adjusted and 17 unadjusted observational studies. Mean follow-up was 5.8 ± 3.0 years. Aortic valve sparing was not associated with any difference in early mortality, bleeding, myocardial infarction, or thromboembolic complications. Late mortality was significantly lower after valve sparing (incident risk ratio, 0.68; 95% confidence interval [CI], 0.54-0.87; P < .01). Late thromboembolism/stroke (incident rate ratio, 0.36; 95% CI, 0.22-0.60; P < .01) and bleeding (incident rate ratio, 0.21; 95% CI, 0.11-0.42; P < .01) risks were lower after valve sparing. Procedure type did not affect late reintervention. CONCLUSIONS Aortic valve sparing appears to be safe and associated with reduced late mortality, thromboembolism/stroke, and bleeding compared with composite valve grafting. Late durability is equivalent. Aortic valve sparing should be considered in patients with favorable aortic valve morphology.
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Affiliation(s)
- Malak Elbatarny
- Division of Cardiac Surgery, Department of Surgery, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada; Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Derrick Y Tam
- Division of Cardiac Surgery, Department of Surgery, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - J James Edelman
- Division of Cardiac Surgery, Department of Surgery, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Rodolfo V Rocha
- Division of Cardiac Surgery, Department of Surgery, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Michael W A Chu
- Division of Cardiac Surgery, Department of Surgery, London Health Sciences Center and University of Western Ontario, London, Ontario, Canada
| | - Mark D Peterson
- Division of Cardiac Surgery, Department of Surgery, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Ismail El-Hamamsy
- Division of Cardiac Surgery, Department of Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Jehangir J Appoo
- Division of Cardiac Surgery, Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Jan O Friedrich
- Department of Critical Care Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Munir Boodhwani
- Division of Cardiac Surgery, Department of Surgery, Ottawa Heart Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, Department of Surgery, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, Department of Surgery, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.
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27
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Edelman JJ, Khan JM, Thourani VH. Commentary: Predicting coronary obstruction-Better good than lucky. J Thorac Cardiovasc Surg 2020; 162:1084-1085. [PMID: 31928815 DOI: 10.1016/j.jtcvs.2019.10.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 11/17/2022]
Affiliation(s)
- J James Edelman
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
| | - Jaffar M Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC; Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart Institute, Atlanta, Ga.
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28
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Edelman JJ, Meduri CU, Thourani VH. Commentary: Aortic stenosis in young patients-planning a lifetime of aortic valve disease. J Thorac Cardiovasc Surg 2020; 162:548-549. [PMID: 32063356 DOI: 10.1016/j.jtcvs.2019.12.095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 12/31/2019] [Indexed: 11/25/2022]
Affiliation(s)
- J James Edelman
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Australia
| | - Christopher U Meduri
- Department of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga.
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29
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Abstract
See Article Qintar et al.
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Affiliation(s)
- J James Edelman
- Department of Cardiac Surgery MedStar Heart and Vascular Institute Georgetown University School of Medicine Washington DC
| | - Vinod H Thourani
- Department of Cardiac Surgery MedStar Heart and Vascular Institute Georgetown University School of Medicine Washington DC
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30
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Kitahara H, Edelman JJ, Thourani VH. Invited Commentary. Ann Thorac Surg 2019; 109:93. [PMID: 31344345 DOI: 10.1016/j.athoracsur.2019.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Hiroto Kitahara
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, 110 Irving St, Ste 6D15G, Washington, DC 20010
| | - J James Edelman
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, 110 Irving St, Ste 6D15G, Washington, DC 20010
| | - Vinod H Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, 110 Irving St, Ste 6D15G, Washington, DC 20010.
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31
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Edelman JJ, Khan JM, Rogers T, Shults C, Satler LF, Ben-Dor II, Waksman R, Thourani VH. Valve-in-Valve TAVR: State-of-the-Art Review. Innovations�(Phila) 2019; 14:299-310. [DOI: 10.1177/1556984519858020] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An increasing number of surgically implanted bioprostheses will require re-intervention for structural valve deterioration. Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) has become an alternative to reoperative surgery, currently approved for high-risk and inoperable patients. Challenges to the technique include higher rates of prosthesis–patient mismatch and coronary obstruction, compared to native valve TAVR. Herein, we review results of ViV TAVR and novel techniques to overcome the aforementioned challenges.
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Affiliation(s)
- J. James Edelman
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC, USA
| | - Jaffar M. Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christian Shults
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC, USA
| | - Lowell F. Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - I. Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Vinod H. Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC, USA
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32
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Edelman JJ, Kitahara H, Thourani VH. REPLY: Patch and unload. J Thorac Cardiovasc Surg 2019; 158:e98-e99. [PMID: 31277811 DOI: 10.1016/j.jtcvs.2019.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/01/2019] [Indexed: 11/19/2022]
Affiliation(s)
- J James Edelman
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC
| | - Hiroto Kitahara
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC
| | - Vinod H Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC
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33
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Kitahara H, Edelman JJ, Thourani VH. Commentary: From 2-dimensional to 3-dimensional-Tailor-made transcatheter aortic valve replacement to minimize complications. J Thorac Cardiovasc Surg 2019; 159:842-843. [PMID: 31204135 DOI: 10.1016/j.jtcvs.2019.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Hiroto Kitahara
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
| | - J James Edelman
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
| | - Vinod H Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC.
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34
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Edelman JJ, Kitahara H, Thourani VH. Transapical Approach for TAVR: Keep It in the Quiver. Semin Thorac Cardiovasc Surg 2019; 31:473-474. [PMID: 31153996 DOI: 10.1053/j.semtcvs.2019.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/28/2019] [Indexed: 11/11/2022]
Affiliation(s)
- J James Edelman
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, District of Columbia
| | - Hiroto Kitahara
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, District of Columbia
| | - Vinod H Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, District of Columbia.
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35
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36
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Kitahara H, Edelman JJ, Thourani VH. Commentary: Technology to make the invisible "visible": Novel optical visualization system for off-pump artificial chordae implantation. J Thorac Cardiovasc Surg 2019; 158:1341-1342. [PMID: 31014663 DOI: 10.1016/j.jtcvs.2019.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Hiroto Kitahara
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
| | - J James Edelman
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
| | - Vinod H Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC.
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37
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Kitahara H, Edelman JJ, Thourani VH. Commentary: Blood transfusions in transcatheter aortic valve replacement-Less is more. J Thorac Cardiovasc Surg 2019; 159:112-113. [PMID: 31101351 DOI: 10.1016/j.jtcvs.2019.03.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Hiroto Kitahara
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
| | - J James Edelman
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
| | - Vinod H Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC.
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38
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Edelman JJ, Kitahara H, Thourani VH. Commentary: Left ventricular free wall rupture: Patch and unload? J Thorac Cardiovasc Surg 2019; 158:778-779. [PMID: 30955957 DOI: 10.1016/j.jtcvs.2019.02.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 02/25/2019] [Indexed: 11/28/2022]
Affiliation(s)
- J James Edelman
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC
| | - Hiroto Kitahara
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC
| | - Vinod H Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC.
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39
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Edelman JJ, Khan JM, Thourani VH. Progress for mitral replacement in mitral annular calcification. J Thorac Cardiovasc Surg 2019; 157:919-920. [PMID: 30612753 DOI: 10.1016/j.jtcvs.2018.11.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
Affiliation(s)
- J James Edelman
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC
| | - Jaffar M Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC; Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md
| | - Vinod H Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC.
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40
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Zhao DF, Edelman JJ, Seco M, Bannon PG, Vallely MP. Mortality Following Off-Pump Versus On-Pump Coronary Artery Bypass Grafting at Five-Year Follow-Up: A Meta-Analysis. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.02.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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41
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Rogers T, Khan JM, Edelman JJ, Waksman R. Summary of the 2018 Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) for transcatheter aortic valve replacement. Cardiovascular Revascularization Medicine 2018; 19:964-970. [DOI: 10.1016/j.carrev.2018.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 10/05/2018] [Indexed: 11/28/2022]
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42
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Edelman JJ, Thourani VH. Transcatheter aortic valve replacement and surgical aortic valve replacement: Both excellent therapies. J Thorac Cardiovasc Surg 2018; 156:2135-2137. [PMID: 30449571 DOI: 10.1016/j.jtcvs.2018.07.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 07/21/2018] [Indexed: 11/16/2022]
Affiliation(s)
- J James Edelman
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
| | - Vinod H Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
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43
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Edelman JJ, Khan JM, Thourani VH. Commentary: A glimpse into the future for transcatheter mitral valve replacement in mitral annular calcification. J Thorac Cardiovasc Surg 2018; 157:e141-e142. [PMID: 30414768 DOI: 10.1016/j.jtcvs.2018.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 10/28/2022]
Affiliation(s)
- J James Edelman
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC
| | - Jaffar M Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC; Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Md
| | - Vinod H Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC.
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44
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Zhao DF, Edelman JJ, Seco M, Bannon PG, Vallely MP. Stroke Risk Following Anaortic Off-Pump CABG Versus PCI. J Am Coll Cardiol 2018; 72:2679-2680. [DOI: 10.1016/j.jacc.2018.08.2194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 10/27/2022]
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45
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Thourani VH, Edelman JJ, Satler LF, Weintraub WS. Surgical Aortic Valve Replacement in the Transcatheter Aortic Valve Replacement Era: Implications for the Heart Team. JACC Cardiovasc Interv 2018; 11:2157-2159. [PMID: 30343021 DOI: 10.1016/j.jcin.2018.07.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 07/31/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Vinod H Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute and Georgetown University, Washington, DC.
| | - J James Edelman
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute and Georgetown University, Washington, DC
| | - Lowell F Satler
- Department of Cardiology, MedStar Heart and Vascular Institute and Georgetown University, Washington, DC
| | - William S Weintraub
- Department of Cardiology, MedStar Heart and Vascular Institute and Georgetown University, Washington, DC
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Zhao DF, Edelman JJ, Seco M, Bannon PG, Vallely MP. Long-Term Outcomes Following Off-Pump Coronary Artery Bypass Grafting: Fixed-Effects Versus Random-Effects Models. J Am Coll Cardiol 2018; 72:345-347. [PMID: 30012329 DOI: 10.1016/j.jacc.2018.04.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/12/2018] [Indexed: 10/28/2022]
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Zhao DF, Edelman JJ, Seco M, Bannon PG, Wilson MK, Byrom MJ, Thourani V, Lamy A, Taggart DP, Puskas JD, Vallely MP. Coronary Artery Bypass Grafting With and Without Manipulation of the Ascending Aorta: A Network Meta-Analysis. J Am Coll Cardiol 2017; 69:924-936. [PMID: 28231944 DOI: 10.1016/j.jacc.2016.11.071] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [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: 07/11/2016] [Revised: 11/25/2016] [Accepted: 11/29/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) remains the standard of treatment for 3-vessel and left main coronary disease, but is associated with an increased risk of post-operative stroke compared to percutaneous coronary intervention. It has been suggested that CABG techniques that eliminate cardiopulmonary bypass and reduce aortic manipulation may reduce the incidence of post-operative stroke. OBJECTIVES A network meta-analysis was performed to compare post-operative outcomes between all CABG techniques, including anaortic off-pump CABG (anOPCABG), off-pump with the clampless Heartstring device (OPCABG-HS), off-pump with a partial clamp (OPCABG-PC), and traditional on-pump CABG with aortic cross-clamping. METHODS A systematic search of 6 electronic databases was performed to identify all publications reporting the outcomes of the included operations. Studies reporting the primary endpoint, 30-day post-operative stroke rate, were included in a Bayesian network meta-analysis. RESULTS There were 13 included studies with 37,720 patients. At baseline, anOPCABG patients had higher previous stroke than did the OPCABG-PC (7.4% vs. 6.5%; p = 0.02) and CABG (7.4% vs. 3.2%; p = 0.001) patients. AnOPCABG was the most effective treatment for decreasing the risk of post-operative stroke (-78% vs. CABG, 95% confidence interval [CI]: 0.14 to 0.33; -66% vs. OPCABG-PC, 95% CI: 0.22 to 0.52; -52% vs. OPCABG-HS, 95% CI: 0.27 to 0.86), mortality (-50% vs. CABG, 95% CI: 0.35 to 0.70; -40% vs. OPCABG-HS, 95% CI: 0.38 to 0.94), renal failure (-53% vs. CABG, 95% CI: 0.31 to 0.68), bleeding complications (-48% vs. OPCABG-HS, 95% CI: 0.31 to 0.87; -36% vs. CABG, 95% CI: 0.42 to 0.95), atrial fibrillation (-34% vs. OPCABG-HS, 95% CI: 0.49 to 0.89; -29% vs. CABG, 95% CI: 0.55 to 0.87; -20% vs. OPCABG-PC, 95% CI: 0.68 to 0.97), and shortening the length of intensive care unit stay (-13.3 h; 95% CI: -19.32 to -7.26; p < 0.0001). CONCLUSIONS Avoidance of aortic manipulation in anOPCABG may decrease the risk of post-operative stroke, especially in patients with higher stroke risk. In addition, the elimination of cardiopulmonary bypass may reduce the risk of short-term mortality, renal failure, atrial fibrillation, bleeding, and length of intensive care unit stay.
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Affiliation(s)
- Dong Fang Zhao
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Baird Institute of Applied Heart and Lung Surgical Research, Sydney, New South Wales, Australia
| | - J James Edelman
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Baird Institute of Applied Heart and Lung Surgical Research, Sydney, New South Wales, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michael Seco
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Baird Institute of Applied Heart and Lung Surgical Research, Sydney, New South Wales, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Paul G Bannon
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Baird Institute of Applied Heart and Lung Surgical Research, Sydney, New South Wales, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Sydney Heart and Lung Surgeons, Sydney, New South Wales, Australia
| | - Michael K Wilson
- Baird Institute of Applied Heart and Lung Surgical Research, Sydney, New South Wales, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Sydney Heart and Lung Surgeons, Sydney, New South Wales, Australia
| | - Michael J Byrom
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Baird Institute of Applied Heart and Lung Surgical Research, Sydney, New South Wales, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Sydney Heart and Lung Surgeons, Sydney, New South Wales, Australia
| | - Vinod Thourani
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Andre Lamy
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - David P Taggart
- Department of Cardiovascular Surgery, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - John D Puskas
- Department of Cardiac Surgery, Mt. Sinai Hospital, New York, New York
| | - Michael P Vallely
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Baird Institute of Applied Heart and Lung Surgical Research, Sydney, New South Wales, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Sydney Heart and Lung Surgeons, Sydney, New South Wales, Australia.
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Cheng YY, Wright CM, Kirschner MB, Williams M, Sarun KH, Sytnyk V, Leshchynska I, Edelman JJ, Vallely MP, McCaughan BC, Klebe S, van Zandwijk N, Lin RCY, Reid G. KCa1.1, a calcium-activated potassium channel subunit alpha 1, is targeted by miR-17-5p and modulates cell migration in malignant pleural mesothelioma. Mol Cancer 2016; 15:44. [PMID: 27245839 PMCID: PMC4888473 DOI: 10.1186/s12943-016-0529-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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: 10/01/2015] [Accepted: 05/20/2016] [Indexed: 01/22/2023] Open
Abstract
Background Malignant pleural mesothelioma (MPM) is an aggressive, locally invasive, cancer elicited by asbestos exposure and almost invariably a fatal diagnosis. To date, we are one of the leading laboratory that compared microRNA expression profiles in MPM and normal mesothelium samples in order to identify dysregulated microRNAs with functional roles in mesothelioma. We interrogated a significant collection of MPM tumors and normal pleural samples in our biobank in search for novel therapeutic targets. Methods Utilizing mRNA-microRNA correlations based on differential gene expression using Gene Set Enrichment Analysis (GSEA), we systematically combined publicly available gene expression datasets with our own MPM data in order to identify candidate targets for MPM therapy. Results We identified enrichment of target binding sites for the miR-17 and miR-30 families in both MPM tumors and cell lines. RT-qPCR revealed that members of both families were significantly downregulated in MPM tumors and cell lines. Interestingly, lower expression of miR-17-5p (P = 0.022) and miR-20a-5p (P = 0.026) was clearly associated with epithelioid histology. We interrogated the predicted targets of these differentially expressed microRNA families in MPM cell lines, and identified KCa1.1, a calcium-activated potassium channel subunit alpha 1 encoded by the KCNMA1 gene, as a target of miR-17-5p. KCa1.1 was overexpressed in MPM cells compared to the (normal) mesothelial line MeT-5A, and was also upregulated in patient tumor samples compared to normal mesothelium. Transfection of MPM cells with a miR-17-5p mimic or KCNMA1-specific siRNAs reduced mRNA expression of KCa1.1 and inhibited MPM cell migration. Similarly, treatment with paxilline, a small molecule inhibitor of KCa1.1, resulted in suppression of MPM cell migration. Conclusion These functional data implicating KCa1.1 in MPM cell migration support our integrative approach using MPM gene expression datasets to identify novel and potentially druggable targets. Electronic supplementary material The online version of this article (doi:10.1186/s12943-016-0529-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yuen Yee Cheng
- Asbestos Diseases Research Institute, Gate 3, Hospital Road, Concord, Sydney, NSW, 2139, Australia
| | - Casey M Wright
- Asbestos Diseases Research Institute, Gate 3, Hospital Road, Concord, Sydney, NSW, 2139, Australia
| | - Michaela B Kirschner
- Asbestos Diseases Research Institute, Gate 3, Hospital Road, Concord, Sydney, NSW, 2139, Australia.,Division of Thoracic Surgery, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Marissa Williams
- Asbestos Diseases Research Institute, Gate 3, Hospital Road, Concord, Sydney, NSW, 2139, Australia.,School of Medicine, University of Sydney, Sydney, NSW, 2006, Australia
| | - Kadir H Sarun
- Asbestos Diseases Research Institute, Gate 3, Hospital Road, Concord, Sydney, NSW, 2139, Australia
| | - Vladimir Sytnyk
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Iryna Leshchynska
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, 2052, Australia
| | - J James Edelman
- Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital; The Baird Institute and Faculty of Medicine, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Michael P Vallely
- Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital; The Baird Institute and Faculty of Medicine, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Brian C McCaughan
- Sydney Cardiothoracic Surgeons, RPA Medical Centre, Sydney, NSW, 2050, Australia
| | - Sonja Klebe
- Department of Anatomical Pathology, Flinders Medical Centre, Adelaide, SA, 5042, Australia
| | - Nico van Zandwijk
- Asbestos Diseases Research Institute, Gate 3, Hospital Road, Concord, Sydney, NSW, 2139, Australia.,School of Medicine, University of Sydney, Sydney, NSW, 2006, Australia
| | - Ruby C Y Lin
- Asbestos Diseases Research Institute, Gate 3, Hospital Road, Concord, Sydney, NSW, 2139, Australia. .,School of Medical Sciences, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Glen Reid
- Asbestos Diseases Research Institute, Gate 3, Hospital Road, Concord, Sydney, NSW, 2139, Australia. .,School of Medicine, University of Sydney, Sydney, NSW, 2006, Australia.
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Edelman JJ, Okiwelu N, Anvardeen K, Joshi P, Murphy B, Sanders LH, Newman MA, Passage J. Surgical Pulmonary Embolectomy: Experience in a Series of 37 Consecutive Cases. Heart Lung Circ 2016; 25:1240-1244. [PMID: 27423976 DOI: 10.1016/j.hlc.2016.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 03/21/2016] [Accepted: 03/24/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Massive pulmonary embolism is a poorly tolerated condition. Treatment options in this condition include anticoagulation and primary reperfusion therapy - systemic thrombolysis, catheter based treatments or surgical embolectomy. There is little data on the relative efficacy of each treatment. METHODS The preoperative characteristics and outcomes of patients referred for surgical embolectomy between 2000-2014 was reviewed. Echocardiography was performed in the majority of patients before and after surgery. RESULTS Thirty-seven patients underwent pulmonary embolectomy between 2000-2014. One patient died within 30 days, another before leaving hospital. All other patients were alive at the time of follow-up (survival 94.6% at median 36 months). Median ventilation time was 24hours. Median hospital length of stay was 10.5 days. There was echocardiographic evidence of severe right ventricular strain (increased size and decreased function) before surgery, which was significantly improved to within the normal range by discharge, and follow-up. CONCLUSIONS Surgical embolectomy is a safe procedure, with low mortality, improved postoperative right ventricular function and pulmonary pressure, and good long-term outcome. Early relief of a large proportion of the clot burden can be life-saving. There should be consideration for its use as an initial treatment strategy in patients with massive or submassive pulmonary embolus with a large burden of proximal clot. A multidisciplinary approach for the treatment of these patients is required.
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Affiliation(s)
- J J Edelman
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia; The Baird Institute, Sydney, NSW, Australia
| | - N Okiwelu
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - K Anvardeen
- Department of Cardiovascular Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - P Joshi
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia; The Baird Institute, Sydney, NSW, Australia
| | - B Murphy
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - L H Sanders
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - M A Newman
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - J Passage
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia; The Baird Institute, Sydney, NSW, Australia; School of Medicine, Fremantle - The University of Notre Dame.
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Edelman JJ, Tatoulis J, Hayward PA, Smith JA, Costa RJ, Vallely MP, Bannon PG. ANZSCTS Response to the Discussion Paper: Proposed Recommendations for Myocardial Revascularisation. Heart Lung Circ 2015; 24:646-8. [PMID: 25637251 DOI: 10.1016/j.hlc.2014.11.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 11/26/2014] [Indexed: 11/28/2022]
Affiliation(s)
- J J Edelman
- Australian and New Zealand Society of Cardiac and Thoracic Surgeons, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital; The Baird Institute; University of Sydney, Sydney, Australia
| | - J Tatoulis
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital; Department of Surgery, University of Melbourne
| | - P A Hayward
- Australian and New Zealand Society of Cardiac and Thoracic Surgeons, Sydney, Australia; Victorian Heart Centre, Epworth Hospital; Department of Cardiac Surgery, Austin Hospital; University of Melbourne, Melbourne, Australia
| | - J A Smith
- Australian and New Zealand Society of Cardiac and Thoracic Surgeons, Sydney, Australia; Department of Cardiothoracic Surgery, Monash Health and Department of Surgery (Monash Medical Centre), Monash University, Clayton, Victoria, Australia
| | - R J Costa
- Australian and New Zealand Society of Cardiac and Thoracic Surgeons, Sydney, Australia; Department of Cardiothoracic Surgery, Westmead Hospital, Sydney, Australia
| | - M P Vallely
- Australian and New Zealand Society of Cardiac and Thoracic Surgeons, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital; The Baird Institute; University of Sydney, Sydney, Australia
| | - P G Bannon
- Australian and New Zealand Society of Cardiac and Thoracic Surgeons, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital; The Baird Institute; University of Sydney, Sydney, Australia.
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