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Lipiecki J, Rampat R, Piot C, Benamer H, Brunelle F, Lefèvre T, El Mahmoud R, Varenne O, Gommeaux A, Malquarti V, Angoulvant D, Cruchon C, Oldroyd K, Spaulding C. Clinical Outcomes in Patients Treated With Biodegradable-Polymer Biolimus-Eluting Stents and 6 Months of Dual-Antiplatelet Therapy: The French eBiomatrix 6-Month DAPT Registry. J Invasive Cardiol 2022; 34:E363-E368. [PMID: 35451995] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Dual-antiplatelet treatment (DAPT) has conventionally been prescribed for 1 year after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation. Recent evidence suggests that a duration of only 6 months may be equally safe and effective when using contemporary DES options. OBJECTIVE The aim of this study was to assess clinical outcomes in patients treated with the BioMatrix biodegradable-polymer coated biolimus-eluting stent (BP-BES; Biosensors International) who received only 6 months of DAPT. METHODS This prospective "all-comers" registry enrolled 2038 patients in France. Following PCI, DAPT was started for a recommended period of 6 months. Patients were followed up at 6 and 24 months. The primary endpoint of major adverse cardiac and cerebrovascular event (MACCE) was a composite of all-cause death, cerebrovascular accidents, non-fatal myocardial infarction, or clinically driven target-vessel revascularization. Secondary endpoints included stent thrombosis (ST) and major bleeding (MB). RESULTS The mean age of the study population was 67 ± 10.5 years and 77% of patients were male. Follow-up data were available in 96.9% and 95.3% of patients at 6 and 24 months, respectively. At 6 months, the incidences of MACCE, ST, and MB were 3.1%, 0.3%, and 0.4%, respectively. At 24 months, 21.2% of patients were still on DAPT and the cumulative incidences of MACCE, ST, and MB were 9.7%, 0.54%, and 0.79%, respectively. CONCLUSIONS In this unselected population of patients undergoing PCI with a BP-BES, a 6-month duration of DAPT after implantation is safe and effective.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Christian Spaulding
- Département de Cardiologie, Hôpital Européen Georges Pompidou, 20 rue Leblanc 75015 Paris, France.
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2
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Bradly K, Zeboulon P, Rampat R, Gatinel D. Surgical management, optical considerations and refractive outcomes in anterior lenticonus associated with Alport syndrome: A case report. J Fr Ophtalmol 2021; 44:e357-e360. [PMID: 33608171 DOI: 10.1016/j.jfo.2020.09.013] [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: 06/09/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 10/22/2022]
Affiliation(s)
- K Bradly
- Service d'ophtalmologie, Fondation Rothschild, Site Victor Horta: UVC Brugmann - Site Victor Horta, 25, rue Manin, 75019 Paris, France.
| | - P Zeboulon
- Service d'ophtalmologie, Fondation Rothschild, Site Victor Horta: UVC Brugmann - Site Victor Horta, 25, rue Manin, 75019 Paris, France
| | - R Rampat
- Service d'ophtalmologie, Fondation Rothschild, Site Victor Horta: UVC Brugmann - Site Victor Horta, 25, rue Manin, 75019 Paris, France
| | - D Gatinel
- Service d'ophtalmologie, Fondation Rothschild, Site Victor Horta: UVC Brugmann - Site Victor Horta, 25, rue Manin, 75019 Paris, France; CEROC (Center of Expertise and Research in Optics for Clinicians), Paris, France
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Hilling-Smith R, Kemp T, Dooley M, Rampat R, de Belder A, Hill A, Cockburn J, Trivedi U, Hildick-Smith D, Homsy M. Predicting the Need For Permanent Pacing After Implantation of the Repositionable Lotus Transcatheter Aortic Valve. J Invasive Cardiol 2020; 32:347-349. [PMID: 32653863] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The need for permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI) is a recognized complication due to compression of the cardiac conduction system. PPI rates vary according to type of TAVI device, implantation technique, and patient-related factors. METHODS We analyzed the baseline characteristics, and then the preprocedure and daily postprocedure electrocardiograms (ECGs) of 101 consecutive patients who underwent TAVI using the Lotus valve (Boston Scientific) between 2013 and 2015. RESULTS Mean patient age was 81.7 ± 7.7 years, 56% were male. and 21 patients were excluded because of baseline atrial fibrillation or a pre-existing PPI. Of the remaining 80 patients, a total of 28 (35%) underwent PPI at a mean 2.7 days after TAVI. There were no differences in development of new left bundle-branch block between the two groups (65% PPI group vs 74% no-PPI group; P=.37). The initial PR interval did not differ between groups (183 ms PPI group vs 184 ms no-PPI group). The PR interval increased by day 1 post procedure (232 ms PPI group vs 195 ms no-PPI group; P<.01) and day 2 (267 ms PPI group vs 211 ms no-PPI group; P<.05). CONCLUSIONS Patients with a PR interval ≤230 ms on day 1 or ≤260 ms on day 2 post TAVI using the Lotus device are at very low risk of requiring PPI, irrespective of the presence of left bundle-branch block, and can be safely discharged without prolonged monitoring.
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Affiliation(s)
| | | | | | | | | | | | | | | | - David Hildick-Smith
- Address for correspondence: David Hildick-Smith, MD, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, BN2 5BE United Kingdom.
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Bologna M, Migliori S, Montin E, Rampat R, Dubini G, Migliavacca F, Mainardi L, Chiastra C. Automatic segmentation of optical coherence tomography pullbacks of coronary arteries treated with bioresorbable vascular scaffolds: Application to hemodynamics modeling. PLoS One 2019; 14:e0213603. [PMID: 30870477 PMCID: PMC6417773 DOI: 10.1371/journal.pone.0213603] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 02/25/2019] [Indexed: 01/13/2023] Open
Abstract
Background / Objectives Automatic algorithms for stent struts segmentation in optical coherence tomography (OCT) images of coronary arteries have been developed over the years, particularly with application on metallic stents. The aim of this study is three-fold: (1) to develop and to validate a segmentation algorithm for the detection of both lumen contours and polymeric bioresorbable scaffold struts from 8-bit OCT images, (2) to develop a method for automatic OCT pullback quality assessment, and (3) to demonstrate the applicability of the segmentation algorithm for the creation of patient-specific stented coronary artery for local hemodynamics analysis. Methods The proposed OCT segmentation algorithm comprises four steps: (1) image pre-processing, (2) lumen segmentation, (3) stent struts segmentation, (4) strut-based lumen correction. This segmentation process is then followed by an automatic OCT pullback image quality assessment. This method classifies the OCT pullback image quality as ‘good’ or ‘poor’ based on the number of regions detected by the stent segmentation. The segmentation algorithm was validated against manual segmentation of 1150 images obtained from 23 in vivo OCT pullbacks. Results When considering the entire set of OCT pullbacks, lumen segmentation showed results comparable with manual segmentation and with previous studies (sensitivity ~97%, specificity ~99%), while stent segmentation showed poorer results compared to manual segmentation (sensitivity ~63%, precision ~83%). The OCT pullback quality assessment algorithm classified 7 pullbacks as ‘poor’ quality cases. When considering only the ‘good’ classified cases, the performance indexes of the scaffold segmentation were higher (sensitivity >76%, precision >86%). Conclusions This study proposes a segmentation algorithm for the detection of lumen contours and stent struts in low quality OCT images of patients treated with polymeric bioresorbable scaffolds. The segmentation results were successfully used for the reconstruction of one coronary artery model that included a bioresorbable scaffold geometry for computational fluid dynamics analysis.
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Affiliation(s)
- Marco Bologna
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milan, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Susanna Migliori
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milan, Italy
| | - Eros Montin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- Center for Advanced Imaging Innovation and Research (CAI2R), and the Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, United States of America
| | - Rajiv Rampat
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Gabriele Dubini
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milan, Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milan, Italy
| | - Luca Mainardi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Claudio Chiastra
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milan, Italy
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
- * E-mail:
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Szijgyarto Z, Rampat R, Werner GS, Ho C, Reifart N, Lefevre T, Louvard Y, Avran A, Kambis M, Buettner HJ, Di Mario C, Gershlick A, Escaned J, Sianos G, Galassi A, Garbo R, Goktekin O, Meyer-Gessner M, Lauer B, Elhadad S, Bufe A, Boudou N, Sievert H, Martin-Yuste V, Thuesen L, Erglis A, Christiansen E, Spratt J, Bryniarski L, Clayton T, Hildick-Smith D. Derivation and Validation of a Chronic Total Coronary Occlusion Intervention Procedural Success Score From the 20,000-Patient EuroCTO Registry. JACC Cardiovasc Interv 2019; 12:335-342. [DOI: 10.1016/j.jcin.2018.11.020] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/09/2018] [Accepted: 11/13/2018] [Indexed: 12/25/2022]
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Rampat R, Williams T, Hildick-Smith D, Cockburn J. The effect of elective implantation of the ABSORB bioresorbable vascular scaffold on coronary microcirculation: Serial assessment using the index of microcirculatory resistance. Microcirculation 2019; 26:e12521. [PMID: 30561875 DOI: 10.1111/micc.12521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 12/10/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Stenting with metal stents can affect microcirculatory function. The impact of BVS on the microvascular network has not been studied. METHODS A total of 30 patients with bifurcation disease of Medina (X,X,0) scheduled for elective PCI with the ABSORB BVS were studied. Pressure wire studies were performed before and after scaffold implantation and at a mean follow-up of 9 months. At each time point, FFR, IMR, and CFR were calculated using the thermodilution method. RESULTS Following scaffold implantation, FFR change from pre-PCI, post-PCI and follow-up was 0.76, 0.92 and 0.91, respectively (P < 0.001 from pre to post-PCI and P = 0.91 from post-PCI to follow-up). There was a statistically significant improvement between pre- and post-procedural IMR (median 27.7 to 17.9, P = 0.02) and CFR (median 2.2 to 2.9, P = 0.02). Median IMR at follow-up (23.6) remained numerically lower than pre-procedure but this was not statistically significant (P = 0.05). Similarly, while median CFR at follow-up remained at post-procedural level (2.9), this effect did not reach statistical significance (P = 0.06). CONCLUSION There is an immediate reduction in microvascular resistance after elective BVS implantation but this effect is not sustained long term.
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Affiliation(s)
- Rajiv Rampat
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
| | - Timothy Williams
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | - James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
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Yoon SH, Bleiziffer S, Latib A, Eschenbach L, Ancona M, Vincent F, Kim WK, Unbehaum A, Asami M, Dhoble A, Silaschi M, Frangieh AH, Veulemans V, Tang GH, Kuwata S, Rampat R, Schmidt T, Patel AJ, Nicz PFG, Nombela-Franco L, Kini A, Kitamura M, Sharma R, Chakravarty T, Hildick-Smith D, Arnold M, de Brito FS, Jensen C, Jung C, Jilaihawi H, Smalling RW, Maisano F, Kasel AM, Treede H, Kempfert J, Pilgrim T, Kar S, Bapat V, Whisenant BK, Van Belle E, Delgado V, Modine T, Bax JJ, Makkar RR. Predictors of Left Ventricular Outflow Tract Obstruction After Transcatheter Mitral Valve Replacement. JACC Cardiovasc Interv 2019; 12:182-193. [DOI: 10.1016/j.jcin.2018.12.001] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/28/2018] [Accepted: 12/04/2018] [Indexed: 12/20/2022]
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8
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Rampat R, Mayo T, Hildick-Smith D, Cockburn J. In reply to: Letter by Dérimay et al. regarding the article, “A randomized trial comparing two stent sizing strategies in coronary bifurcation treatment with bioresorbable vascular scaffolds – The Absorb Bifurcation Coronary (ABC) trial” by Rampat et al. Cardiovascular Revascularization Medicine 2019; 20:86. [DOI: 10.1016/j.carrev.2018.11.002] [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] [Received: 11/02/2018] [Accepted: 11/05/2018] [Indexed: 11/26/2022]
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Dowling C, Firoozi S, Doyle N, Blackman DJ, Malkin CJ, Cunnington MS, Saraf S, Buch MH, Levy R, Chowdhary S, Spence MS, Manoharan G, Owens CG, Brennan PF, Roberts D, More R, Wiper A, Abdelaziz HK, Mylotte D, Neylon A, Martin N, Mercanti F, Dorman S, Panoulas V, Dalby M, Kashyap MN, Kabir T, Kovac J, Kontoprias K, Malik IS, Ghada MW, Sen S, Ruparelia N, Demir OM, Frame A, Uren NG, Anderson R, Rajathurai T, Tapp L, Deegan L, Grech E, Hall I, Neville M, Rampat R, Hildick-Smith D, Mullen M, Kennon S, Chandrala P, Doshi S, Brecker SJ. Initial experience of a large, self-expanding, and fully recapturable transcatheter aortic valve: The UK & Ireland Implanters' registry. Catheter Cardiovasc Interv 2018; 93:751-757. [PMID: 30394657 DOI: 10.1002/ccd.27934] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/04/2018] [Accepted: 09/23/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The UK & Ireland Implanters' registry is a multicenter registry which reports on real-world experience with novel transcatheter heart valves. BACKGROUND The 34 mm Evolut R transcatheter aortic valve is a self-expanding and fully recapturable transcatheter aortic valve, designed to treat patients with a large aortic annulus. METHODS Between January 2017 and April 2018, clinical, procedural and 30-day outcome data were prospectively collected from all patients receiving the 34 mm Evolut R valve across 17 participating centers in the United Kingdom and Ireland. The primary efficacy outcome was the Valve Academic Research Consortium-2(VARC-2)-defined endpoint of device success. The primary safety outcome was the VARC-2-defined composite endpoint of early safety at 30 days. RESULTS A total of 217 patients underwent attempted implant. Mean age was 79.5 ± 8.8 years and Society of Thoracic Surgeons Predicted Risk of Mortality Score 5.2% ± 3.4%. Iliofemoral access was used in 91.2% of patients. Device success was 79.7%. Mean gradient was 7.0 ± 4.6 mmHg and effective orifice area 2.0 ± 0.6 cm2 . Paravalvular regurgitation was more than mild in 7.2%. A new permanent pacemaker was implanted in 15.7%. Early safety was demonstrated in 91.2%. At 30 days, all-cause mortality was 3.2%, stroke 3.7%, and major vascular complication 2.3%. CONCLUSIONS Real-world experience of the 34 mm Evolut R transcatheter aortic valve demonstrated acceptable procedural success, safety, valve function, and incidence of new permanent pacemaker implantation.
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Affiliation(s)
- Cameron Dowling
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sami Firoozi
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Niamh Doyle
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Daniel J Blackman
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | | | | | - Smriti Saraf
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom.,Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Mamta H Buch
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Richard Levy
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Saqib Chowdhary
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Mark S Spence
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, United Kingdom
| | - Ganesh Manoharan
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, United Kingdom
| | - Colum G Owens
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, United Kingdom
| | - Paul F Brennan
- Belfast Heart Centre, Royal Victoria Hospital, Belfast, United Kingdom
| | - David Roberts
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Ranjit More
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Andrew Wiper
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Hesham K Abdelaziz
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom.,Cardiovascular Department, Ain Shams University, Cairo, Egypt
| | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Antoinette Neylon
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Niamh Martin
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Federico Mercanti
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Stephen Dorman
- Department of Cardiology, Bristol Heart Institute, Bristol, United Kingdom
| | | | - Miles Dalby
- Department of Cardiology, Harefield Hospital, London, United Kingdom
| | - Mavin N Kashyap
- Department of Cardiology, Harefield Hospital, London, United Kingdom
| | - Tito Kabir
- Department of Cardiology, Harefield Hospital, London, United Kingdom
| | - Jan Kovac
- Biomedical Research Unit, University of Leicester, Leicester, United Kingdom
| | - Kosmas Kontoprias
- Biomedical Research Unit, University of Leicester, Leicester, United Kingdom
| | - Iqbal S Malik
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mikhail W Ghada
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sayan Sen
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Neil Ruparelia
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ozan M Demir
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Angela Frame
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Neal G Uren
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Richard Anderson
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
| | | | - Luke Tapp
- Department of Cardiology, University Hospital, Coventry, United Kingdom
| | - Lauren Deegan
- Department of Cardiology, University Hospital, Coventry, United Kingdom
| | - Ever Grech
- Department of Cardiology, Northern General Hospital, Sheffield, United Kingdom
| | - Ian Hall
- Department of Cardiology, Northern General Hospital, Sheffield, United Kingdom
| | - Melanie Neville
- Department of Cardiology, Northern General Hospital, Sheffield, United Kingdom
| | - Rajiv Rampat
- Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - David Hildick-Smith
- Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Michael Mullen
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Simon Kennon
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Pavan Chandrala
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Sagar Doshi
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Stephen J Brecker
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
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10
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Yoon SH, Whisenant BK, Bleiziffer S, Delgado V, Dhoble A, Schofer N, Eschenbach L, Bansal E, Murdoch DJ, Ancona M, Schmidt T, Yzeiraj E, Vincent F, Niikura H, Kim WK, Asami M, Unbehaun A, Hirji S, Fujita B, Silaschi M, Tang GHL, Kuwata S, Wong SC, Frangieh AH, Barker CM, Davies JE, Lauten A, Deuschl F, Nombela-Franco L, Rampat R, Nicz PFG, Masson JB, Wijeysundera HC, Sievert H, Blackman DJ, Gutierrez-Ibanes E, Sugiyama D, Chakravarty T, Hildick-Smith D, de Brito FS, Jensen C, Jung C, Smalling RW, Arnold M, Redwood S, Kasel AM, Maisano F, Treede H, Ensminger SM, Kar S, Kaneko T, Pilgrim T, Sorajja P, Van Belle E, Prendergast BD, Bapat V, Modine T, Schofer J, Frerker C, Kempfert J, Attizzani GF, Latib A, Schaefer U, Webb JG, Bax JJ, Makkar RR. Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification. Eur Heart J 2018; 40:441-451. [DOI: 10.1093/eurheartj/ehy590] [Citation(s) in RCA: 201] [Impact Index Per Article: 33.5] [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: 08/07/2018] [Accepted: 09/06/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sung-Han Yoon
- Department of Interventional Cardiology, Cedars-Sinai Heart Institute, 8700 Beverly Blvd, Los Angeles, CA, USA
| | - Brian K Whisenant
- Division of Cardiovascular Diseases, Intermountain Heart Institute, Salt Lake City, UT, USA
| | - Sabine Bleiziffer
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, RC Leiden, The Netherlands
| | - Abhijeet Dhoble
- Department of Cardiology, University of Texas Health Science Center, 6431 Fannin St., MSB 1.224, Houston, TX, USA
| | - Niklas Schofer
- Department of General and interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Lena Eschenbach
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Eric Bansal
- The Valve and Structural Heart Interventional Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Dale J Murdoch
- Department of Cardiology, St Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, Canada
| | - Marco Ancona
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus & San Raffaele Scientific Institute, San Raffaele Hospital, Milan, Italy
| | - Tobias Schmidt
- Department of Cardiology, Asklepios Klink St. Georg, Lohmuehlenstrasse 5, Hamburg, Germany
| | - Ermela Yzeiraj
- Hamburg University Cardiovascular Center, Hamburg, Germany
| | - Flavien Vincent
- Department of Cardiology/Cardiac Surgery, CHU Lille, INSERM U1011-EGID, Institut Pasteur de Lille, Lille, France
| | - Hiroki Niikura
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 800 East 28th St, Minneapolis, MN, USA
| | - Won-Keun Kim
- Department of Cardiology/Cardiac Surgery, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, D-61231 Bad Nauheim, Germany
| | - Masahiko Asami
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, CH-3010 Bern, Switzerand
| | - Axel Unbehaun
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Augustenburger Platz 1, and DZHK (German Center for Cardiovascular Research), partner site Berlin, Germany
| | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women’s Hospital, 15 Francis Street, Boston, MA, USA
| | - Buntaro Fujita
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Miriam Silaschi
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube Str. 40, Halle, Germany
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, 1190 Fifth Avenue, GP2W, Box 1028, New York, NY, USA
| | - Shingo Kuwata
- University Heart Center, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - S Chiu Wong
- Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weil Cornell Medicine, New York, NY, USA
| | - Antonio H Frangieh
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
| | - Colin M Barker
- Department of Cardiology, Houston Methodist Hospital, Smith 1901, 6550 Fannin Street, Houston, TX, USA
| | - James E Davies
- Division of Cardiac and Thoracic Surgery, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Alexander Lauten
- Department of Cardiology, Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Florian Deuschl
- Department of General and interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Profesor Martin Lagos s/n, Madrid, Spain
| | - Rajiv Rampat
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Jean-Bernard Masson
- Division of Cardiology, Centre Hospitalier de l’université de Montreal, 1051 Sanguinet, Montreal, Quebec, Canada
| | - Harindra C Wijeysundera
- Division of Cardiology, Sunnybrook Health Science Centre, 2075 Bayview Avenue, Suite A202 Toronto, ON, Canada
| | | | | | - Enrique Gutierrez-Ibanes
- Instituto de Investigación Sanitaria Gregorio Marañón, Calle Dr Esquerdo 46, Madrid, CIBER CV, Spain
| | - Daisuke Sugiyama
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Tarun Chakravarty
- Department of Interventional Cardiology, Cedars-Sinai Heart Institute, 8700 Beverly Blvd, Los Angeles, CA, USA
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Fabio Sandoli de Brito
- Heart Institute of University of Sao Paulo Medical School, Av. Dr. Eneas Carvalho de Aguiar 44, São Paulo, Brazil
| | - Christoph Jensen
- Contilia Heart and Vascular Centre, Elisabeth Krankenhaus Essen, Essen, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstraβe 5, Düsseldorf, Germany
| | - Richard W Smalling
- Department of Cardiology, University of Texas Health Science Center, 6431 Fannin St., MSB 1.224, Houston, TX, USA
| | - Martin Arnold
- Department of Cardiology, University Hospital Erlangen, Erlangen, Germany
| | - Simon Redwood
- Cardiothoracic Department, St Thomas Hospital, Westminster Bridge Rd, London, UK
| | - Albert Markus Kasel
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
| | - Francesco Maisano
- University Heart Center, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Hendrik Treede
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube Str. 40, Halle, Germany
| | - Stephan M Ensminger
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Saibal Kar
- Department of Interventional Cardiology, Cedars-Sinai Heart Institute, 8700 Beverly Blvd, Los Angeles, CA, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women’s Hospital, 15 Francis Street, Boston, MA, USA
| | - Thomas Pilgrim
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, CH-3010 Bern, Switzerand
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 800 East 28th St, Minneapolis, MN, USA
| | - Eric Van Belle
- Department of Cardiology/Cardiac Surgery, CHU Lille, INSERM U1011-EGID, Institut Pasteur de Lille, Lille, France
| | | | - Vinayak Bapat
- Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Thomas Modine
- Department of Cardiology/Cardiac Surgery, CHU Lille, INSERM U1011-EGID, Institut Pasteur de Lille, Lille, France
| | | | - Christian Frerker
- Department of Cardiology, Asklepios Klink St. Georg, Lohmuehlenstrasse 5, Hamburg, Germany
| | - Joerg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Augustenburger Platz 1, and DZHK (German Center for Cardiovascular Research), partner site Berlin, Germany
| | - Guilherme F Attizzani
- The Valve and Structural Heart Interventional Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Azeem Latib
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus & San Raffaele Scientific Institute, San Raffaele Hospital, Milan, Italy
| | - Ulrich Schaefer
- Department of General and interventional Cardiology, University Heart Center, Hamburg, Germany
| | - John G Webb
- Department of Cardiology, St Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, Canada
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, RC Leiden, The Netherlands
| | - Raj R Makkar
- Department of Interventional Cardiology, Cedars-Sinai Heart Institute, 8700 Beverly Blvd, Los Angeles, CA, USA
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11
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Rampat R, Mayo T, Hildick-Smith D, Cockburn J. A randomized trial comparing two stent sizing strategies in coronary bifurcation treatment with bioresorbable vascular scaffolds - The Absorb Bifurcation Coronary (ABC) trial. Cardiovasc Revasc Med 2018; 20:43-49. [PMID: 30170828 DOI: 10.1016/j.carrev.2018.08.007] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/23/2018] [Accepted: 08/10/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Limited information is available on the use of Bioresorbable Vascular Scaffold (BVS) in bifurcations involving significant side branches. When treating bifurcation disease with metal stents, the recommendation is to choose a stent diameter based on the distal main vessel diameter. Whether this sizing strategy is applicable to BVS is currently unknown. METHODS We randomised 37 patients undergoing elective PCI for 'false' bifurcation disease (Medina 0,1,0; 1,0,0; 1,1,0) to receive BVS based either on proximal or distal reference diameters. Optical Frequency Domain Imaging (OFDI) measurements were performed pre BVS insertion to obtain proximal and distal reference diameters and post implantation. BVS size was chosen according to the proximal or distal reference diameter as per randomisation. Implantation was performed using the PSP technique tailored to bifurcation stenting. OFDI was repeated post implantation to confirm satisfactory expansion and apposition. RESULTS Baseline demographics between the two groups were similar. Patients were aged 62.8 ± 3.3 years; 76% were male. Mean side branch diameter was 2.24 ± 0.13 mm. TIMI III flow in the main vessel was achieved in all cases. Side branch occlusion occurred in 1 case (2.7%). In the distal-sizing arm, there was a greater incidence of significant malapposition (>300 μm) at the proximal end of the scaffold on OCT (2.3% versus 0.8%, p 0.023). The incidence of distal edge dissections was numerically greater in the proximal-sizing group but this was not statistically significant (31.3% vs 11.8%, p 0.17). CONCLUSION Both proximal and distal sizing strategies have similar procedural complication rates when using the ABSORB BVS to treat coronary bifurcations. However a proximal sizing strategy is associated with less malapposition and may be preferable.
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Affiliation(s)
- Rajiv Rampat
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, BN2 5BE, UK; Brighton and Sussex Medical School, BN1 9PX, UK.
| | - Thomas Mayo
- Brighton and Sussex Medical School, BN1 9PX, UK
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, BN2 5BE, UK
| | - James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, BN2 5BE, UK
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Yeoh J, Pareek N, Arri S, Rampat R, Dworakowski R, Byrne J, Maccarthy P, Hill J. TCT-189 Extending Application of Intravascular Lithotripsy to a High Risk Real World Population. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1305] [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: 10/28/2022]
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13
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Kalra SS, Firoozi S, Yeh J, Blackman DJ, Rashid S, Davies S, Moat N, Dalby M, Kabir T, Khogali SS, Anderson RA, Groves PH, Mylotte D, Hildick-Smith D, Rampat R, Kovac J, Gunarathne A, Laborde JC, Brecker SJ. Initial Experience of a Second-Generation Self-Expanding Transcatheter Aortic Valve: The UK & Ireland Evolut R Implanters' Registry. JACC Cardiovasc Interv 2017; 10:276-282. [PMID: 28183467 DOI: 10.1016/j.jcin.2016.11.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [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: 07/19/2016] [Revised: 10/24/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The authors present the UK and Irish real-world learning curve experience of the Evolut R transcatheter heart valve. BACKGROUND The Evolut R is a self-expanding, repositionable, and fully recapturable second-generation transcatheter heart valve with several novel design features to improve outcomes and reduce complications. METHODS Clinical, procedural, and 30-day outcome data were prospectively collected for the first 264 patients to receive the Evolut R valve in the United Kingdom and Ireland. RESULTS A total of 264 consecutive Evolut R implantations were performed across 9 centers. The mean age was 81.1 ± 7.8 years, and the mean logistic European System for Cardiac Operative Risk Evaluation score was 19.9 ± 13.7%. Procedural indications included aortic stenosis (72.0%), mixed aortic valve disease (17.4%), and failing aortic valve bioprostheses (10.6%). Conscious sedation was used in 39.8% of patients and transfemoral access in 93.6%. The procedural success rate was 91.3%, and paravalvular leak immediately after implantation was mild or less in 92.3%. Major complications were rare: cardiac tamponade in 0.4%, conversion to sternotomy in 0.8%, annular rupture in 0.0%, coronary occlusion in 0.8%, major vascular in 5.3%, acute kidney injury in 6.1%, new permanent pacemaker implantation in 14.7%, and procedure-related death in 0.0%. At 30-day follow-up, survival was 97.7%, paravalvular leak was mild or less in 92.3%, and the stroke rate was 3.8%. CONCLUSIONS This registry represents the largest published real-world experience of the Evolut R valve. The procedural success rate was high and safety was excellent, comparable with previous studies of the Evolut R valve and other second-generation devices. The low rate of complications represents an improvement on first-generation devices.
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Affiliation(s)
- Sundeep S Kalra
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust & St. George's University of London, London, United Kingdom
| | - Sami Firoozi
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust & St. George's University of London, London, United Kingdom
| | - James Yeh
- Cardiology Department, Royal Brompton and Harefield NHS Trust, London, United Kingdom
| | - Daniel J Blackman
- Cardiology Department, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Shabnam Rashid
- Cardiology Department, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Simon Davies
- Cardiology Department, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Neil Moat
- Cardiology Department, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Miles Dalby
- Cardiology Department, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Tito Kabir
- Cardiology Department, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Saib S Khogali
- Cardiology Department, The Royal Wolverhampton Hospitals, Wolverhampton, United Kingdom
| | - Richard A Anderson
- Cardiology Department, University Hospital of Wales, Cardiff, United Kingdom
| | - Peter H Groves
- Cardiology Department, University Hospital of Wales, Cardiff, United Kingdom
| | - Darren Mylotte
- Cardiology Department, University Hospital Galway, Galway, Ireland
| | - David Hildick-Smith
- Cardiology Department, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Rajiv Rampat
- Cardiology Department, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Jan Kovac
- Cardiology Department, Glenfield Hospital, Leicester, United Kingdom
| | - Ashan Gunarathne
- Cardiology Department, Glenfield Hospital, Leicester, United Kingdom
| | - Jean-Claude Laborde
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust & St. George's University of London, London, United Kingdom
| | - Stephen J Brecker
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust & St. George's University of London, London, United Kingdom.
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Yoon SH, Whisenant BK, Bleiziffer S, Delgado V, Schofer N, Eschenbach L, Fujita B, Sharma R, Ancona M, Yzeiraj E, Cannata S, Barker C, Davies JE, Frangieh AH, Deuschl F, Podlesnikar T, Asami M, Dhoble A, Chyou A, Masson JB, Wijeysundera HC, Blackman DJ, Rampat R, Taramasso M, Gutierrez-Ibanes E, Chakravarty T, Attizzani GF, Kaneko T, Wong SC, Sievert H, Nietlispach F, Hildick-Smith D, Nombela-Franco L, Conradi L, Hengstenberg C, Reardon MJ, Kasel AM, Redwood S, Colombo A, Kar S, Maisano F, Windecker S, Pilgrim T, Ensminger SM, Prendergast BD, Schofer J, Schaefer U, Bax JJ, Latib A, Makkar RR. Transcatheter Mitral Valve Replacement for Degenerated Bioprosthetic Valves and Failed Annuloplasty Rings. J Am Coll Cardiol 2017; 70:1121-1131. [DOI: 10.1016/j.jacc.2017.07.714] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/29/2017] [Accepted: 07/04/2017] [Indexed: 11/25/2022]
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Rampat R, Khawaja MZ, Hilling-Smith R, Byrne J, MacCarthy P, Blackman DJ, Krishnamurthy A, Gunarathne A, Kovac J, Banning A, Kharbanda R, Firoozi S, Brecker S, Redwood S, Bapat V, Mullen M, Aggarwal S, Manoharan G, Spence MS, Khogali S, Dooley M, Cockburn J, de Belder A, Trivedi U, Hildick-Smith D. Conduction Abnormalities and Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement Using the Repositionable LOTUS Device. JACC Cardiovasc Interv 2017. [DOI: 10.1016/j.jcin.2017.03.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rampat R, Khawaja MZ, Byrne J, MacCarthy P, Blackman DJ, Krishnamurthy A, Gunarathne A, Kovac J, Banning A, Kharbanda R, Firoozi S, Brecker S, Redwood S, Bapat V, Mullen M, Aggarwal S, Manoharan G, Spence MS, Khogali S, Dooley M, Cockburn J, de Belder A, Trivedi U, Hildick-Smith D. Transcatheter Aortic Valve Replacement Using the Repositionable LOTUS Valve. JACC Cardiovasc Interv 2016; 9:367-372. [DOI: 10.1016/j.jcin.2015.12.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/24/2015] [Accepted: 12/03/2015] [Indexed: 02/07/2023]
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Abstract
Left main stem (LMS) disease is associated with significant morbidity and mortality. Traditionally coronary artery bypass grafting (CABG) has been the gold standard for treatment of these lesions. However over the past decade, percutaneous coronary intervention (PCI) has assumed a more prominent role in the treatment of LMS disease. With the advent of newer drug-eluting stents (DES) with an improved risk factor profile, better intravascular imaging modalities and careful patient selection, the use of PCI in this cohort is expanding. We review the current data to support this and discuss the on-going trials that will hopefully shed more light into the management of this complex disease.
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Affiliation(s)
- Rajiv Rampat
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, U
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, U
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Wynne DG, Rampat R, Trivedi U, de Belder A, Hill A, Hutchinson N, Hildick-Smith D. Transradial Secondary Arterial Access for Transcatheter Aortic Valve Implantation: Experience and Limitations. Heart Lung Circ 2014; 24:682-5. [PMID: 25637250 DOI: 10.1016/j.hlc.2014.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 11/11/2014] [Revised: 12/05/2014] [Accepted: 12/09/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The transradial approach limits vascular complications in coronary interventions. The same may be true for transcatheter aortic valve implantation (TAVI). We present our experience using secondary transradial arterial access. METHODS Secondary transradial arterial access has been our default strategy for TAVI since 2007. Procedural data is collected prospectively. We assessed procedural success and complications. RESULTS Data from 282 patients aged 81±5.2 yrs was examined. Secondary arterial access was transradial (74%), femoral (24%) and none (2%). Secondary femoral access was reserved for failed radial access (3%), anatomical anomalies (4%), operator preference (7%), trial requirements (6%) or proctor preference (4%). The principal pathology was aortic stenosis (90.8%), aortic regurgitation (6.7%) or a combination (2.5%). CoreValve (91.4%), Edwards (7%) or Lotus valves (1.7%) were delivered via transfemoral (88.6%), direct aortic (5.3%), subclavian (3.9%) or transapical approaches (1.8%). Significant vascular complications occurred in 25 cases (9.4%), including surgical repair of a failed percutaneous closure device (n=16), ilio-femoral dissection (n=3), iliac perforations (n=3), plaque disruption (n=1) and false aneurysm (n=2), one of which was from the secondary femoral access site. There was no local vascular complication from the secondary radial site. CONCLUSIONS The transradial secondary access route for TAVI is safe and effective. The transradial route may limit vascular access complications from secondary transfemoral access.
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Affiliation(s)
- Dylan G Wynne
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, East Sussex BN25BE, United Kingdom
| | - Rajiv Rampat
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, East Sussex BN25BE, United Kingdom.
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, East Sussex BN25BE, United Kingdom
| | - Adam de Belder
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, East Sussex BN25BE, United Kingdom
| | - Andrew Hill
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, East Sussex BN25BE, United Kingdom
| | - Nevil Hutchinson
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, East Sussex BN25BE, United Kingdom
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, East Sussex BN25BE, United Kingdom
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Abstract
A 67-year-old Caucasian woman presented to clinic with a 2-month history of worsening shortness of breath on exertion and a single episode of chest pain 1 week before. Her ECG in clinic showed ST elevation inferiorly and she was admitted from clinic for further investigations as inpatient. She was initiated on the acute coronary syndrome protocol and underwent emergency left heart catheterisation on the day of admission. The coronary angiogram revealed large aneurysmal dilations in the right coronary artery and left main stem. A ventriculogram showed poor left ventricular (LV) systolic function in line with subsequent transthoracic echocardiogram, which revealed her to have an left ventricular ejection-fraction (LVEF) of approximately 20%. It was agreed with the cardiothoracic surgeons to treat the aneurysms non-operatively and start low-molecular weight heparin. Furthermore the underlying biventricular impairment was treated with ACE-inhibitors, β-blockers and diuretic therapy (loop and potassium-sparing). The strategy was to prevent further thrombus formation with the aneurysmal vessels and to achieve this the patient was initiated on lifelong warfarin. Other medical risk factors were optimised and patient started on statin medication. The aneurysm was monitored with serial CTs with a view to reconsider surgical intervention if any evidence of dilation. This case highlights an unusual cause of ST elevation myocardial infarction.
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20
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Qureshi AC, Rampat R, Harwood SM, Roughton M, Yaqoob MM, Kapur A. 23 Serum ngal identifies contrast nephropathy early in patients with diabetes mellitus and chronic kidney disease undergoing coronary angiography and angioplasty. Heart 2011. [DOI: 10.1136/heartjnl-2011-300198.23] [Citation(s) in RCA: 3] [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] [Indexed: 11/03/2022] Open
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21
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Rampat R, Lumbers R, Gallagher S, Williams S, Gadhvi S, Qureshi A, Kapur A. 122 Oral Nurse-Led Risk Factor Management in Specialist Clinics for Diabetic Patients with known or Suspected Coronary Artery Disease is Highly Effective at Reducing Cardiovascular Risk. Eur J Cardiovasc Nurs 2010. [DOI: 10.1016/s1474-5151(10)60093-x] [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] [Indexed: 10/19/2022]
Affiliation(s)
- R. Rampat
- Newham University Hospital, London, United Kingdom
| | | | - S. Gallagher
- The London Chest Hospital, London, United Kingdom
| | - S. Williams
- Newham University Hospital, London, United Kingdom
| | - S. Gadhvi
- Newham University Hospital, London, United Kingdom
| | - A.C. Qureshi
- The London Chest Hospital, London, United Kingdom
| | - A. Kapur
- The London Chest Hospital, London, United Kingdom
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