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Shakeel I, Sharma H, Hodson J, Iqbal H, Tashfeen R, Ludman PF, Steeds RP, Townend JN, Doshi SN, Nadir MA. Prevalence and Impact of Concomitant Atrial Fibrillation in Patients Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction. J Clin Med 2024; 13:2318. [PMID: 38673591 PMCID: PMC11050934 DOI: 10.3390/jcm13082318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Concomitant atrial fibrillation (AF) is associated with an adverse prognosis in patients with acute myocardial infarction (MI). However, it remains unclear whether this is due to a causal effect of AF or whether AF acts as a surrogate marker for comorbidities in this population. Furthermore, there are limited data on whether coronary artery disease distribution impacts the risk of developing AF. Methods: Consecutive patients admitted with acute MI and treated using percutaneous coronary intervention (PCI) at a single centre were retrospectively identified. Associations between AF and major adverse cardiac and cerebrovascular events (MACCEs) over a median of five years of follow-up were assessed using Cox regression, with adjustment for confounding factors performed using both multivariable modelling and a propensity-score-matched analysis. Results: AF was identified in N = 65/1000 (6.5%) of cases; these patients were significantly older (mean: 73 vs. 65 years, p < 0.001), with lower creatinine clearance (p < 0.001), and were more likely to have a history of cerebrovascular disease (p = 0.011) than those without AF. In addition, patients with AF had a greater propensity for left main stem (p = 0.001) or left circumflex artery (p = 0.004) involvement. Long-term MACCE rates were significantly higher in the AF group than in the non-AF group (50.8% vs. 34.2% at five years), yielding an unadjusted hazard ratio (HR) of 1.86 (95% CI: 1.32-2.64, p < 0.001). However, after adjustment for confounding factors, AF was no longer independently associated with MACCEs, either on multivariable (adjusted HR: 1.25, 95% CI: 0.81-1.92, p = 0.319) or propensity-score-matched (HR: 1.04, 95% CI: 0.59-1.82, p = 0.886) analyses. Conclusions: AF is observed in 6.5% of patients admitted with acute MI, and those with AF are more likely to have significant diseases involving left main or circumflex arteries. Although unadjusted MACCE rates were significantly higher in patients with AF, this effect was not found to remain significant after adjustment for comorbidities. As such, this study provided no evidence to suggest that AF is independently associated with MACCEs.
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Affiliation(s)
- Iqra Shakeel
- College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK (H.S.); (H.I.); (R.T.); (R.P.S.); (J.N.T.); (S.N.D.)
| | - Harish Sharma
- College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK (H.S.); (H.I.); (R.T.); (R.P.S.); (J.N.T.); (S.N.D.)
- Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK
| | - James Hodson
- Research Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK
| | - Hamna Iqbal
- College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK (H.S.); (H.I.); (R.T.); (R.P.S.); (J.N.T.); (S.N.D.)
| | - Rashna Tashfeen
- College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK (H.S.); (H.I.); (R.T.); (R.P.S.); (J.N.T.); (S.N.D.)
| | - Peter F. Ludman
- College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK (H.S.); (H.I.); (R.T.); (R.P.S.); (J.N.T.); (S.N.D.)
- Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK
| | - Richard P. Steeds
- College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK (H.S.); (H.I.); (R.T.); (R.P.S.); (J.N.T.); (S.N.D.)
- Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK
| | - Jonathan N. Townend
- College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK (H.S.); (H.I.); (R.T.); (R.P.S.); (J.N.T.); (S.N.D.)
- Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK
| | - Sagar N. Doshi
- College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK (H.S.); (H.I.); (R.T.); (R.P.S.); (J.N.T.); (S.N.D.)
- Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK
| | - M. Adnan Nadir
- College of Medical and Dental Sciences, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK (H.S.); (H.I.); (R.T.); (R.P.S.); (J.N.T.); (S.N.D.)
- Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK
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Savvoulidis P, Nadir AM, Mechery A, Lawton E, Khan K, Maqableh GM, Raja W, Wong CW, Radhakrishnan A, Doshi SN. Routine postaccess-closure angiography to detect vascular complications following transfemoral TAVR. Catheter Cardiovasc Interv 2023; 102:1311-1316. [PMID: 37890001 DOI: 10.1002/ccd.30894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/03/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Vascular complications following transfemoral TAVR are associated with increased morbidity and mortality. Measures that may mitigate this risk are important. AIM To evaluate the utility of routine, access-vessel angiography post sheath-removal in the detection and management of complications in patients undergoing transcatheter aortic valve replacement (TAVR). METHODS This was a retrospective study of 512 consecutive patients who underwent transfemoral TAVR with routine post access-closure angiography from the radial artery. Rates of mild angiographically evident bleeding, bleeding requiring surgery/interventional-radiology, ischemia, 90-day access-site-related events, and major and minor vascular complications using Valve Academic Research Consortium 3 definitions were recorded. RESULTS Of 512 patients, digital subtraction angiography (DSA) was undertaken via the radial artery in 467 patients (91%). In the remaining patients (9%) DSA was either not attempted, due to concerns regarding kidney disease and contrast volume, or failed due to anatomical factors (aortic tortuosity/calcification). Significant chronic kidney disease was present at baseline in 72.4% of this cohort (stages III-IV or dialysis). Ninety-four percent of cases underwent TAVR using a balloon-expandable platform. Mild iliofemoral extravasation was observed in 7.7% of the DSA cases. These cases were managed by manual compression with none requiring any vascular intervention subsequently. Valve Academic Research Consortium 3 major and minor access-site-related complications were observed in 0.4% and 12.2%, respectively. Access-site-related bleeding and ischemic events requiring interventional-radiology or vascular-surgery were observed in 0.9% and 1.7% of the DSA cases, respectively. No new renal replacement therapy was needed in any of the DSA cases. Discharge to 90-day access-related complications was 0.8%. CONCLUSIONS Routine post access-closure angiography is feasible via the radial artery in patients undergoing transfemoral TAVR and appears safe. It facilitates early identification of complications and mitigates risk by enabling prompt action to be taken. Larger studies are needed to confirm these findings.
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Affiliation(s)
| | - Adnan M Nadir
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
- Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anthony Mechery
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
| | - Ewa Lawton
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
| | - Kumail Khan
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
| | - Ghaith M Maqableh
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
- Cardiology Department, Faculty of Medicine, Al Balqa Applied University, Amman, Jordan
| | - Waseem Raja
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
| | - Chun Wai Wong
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
| | | | - Sagar N Doshi
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
- Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
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Doshi SN, Savvoulidis P, Mechery A, Lawton E, Nadir MA. VersaCross Transseptal System for Mitral Transcatheter Edge-To-Edge Repair With the PASCAL Repair Platform. Struct Heart 2023; 7:100203. [PMID: 38046864 PMCID: PMC10692349 DOI: 10.1016/j.shj.2023.100203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 12/05/2023]
Abstract
Background VersaCross is a novel radiofrequency transseptal solution that may improve the efficiency and workflow of transseptal puncture (TSP). The aim of this study was to compare the VersaCross transseptal system with mechanical needle systems during mitral transcatheter edge-to-edge repair (M-TEER) with the PASCAL device. Methods This is a single-center retrospective study of consecutive patients who underwent M-TEER with the PASCAL. Transseptal puncture was undertaken with either a mechanical needle or the VersaCross wire. The primary endpoints were success of TSP and successful delivery of the Edwards sheath on the chosen delivery wire. Secondary endpoints included number of wires used, tamponade rate, interval from femoral venous access to TSP and first PASCAL device deployment, procedural death, and stroke. Results Thirty-three consecutive patients (10 with mechanical needle, 23 with VersaCross) who underwent M-TEER with the Edwards PASCAL device were identified. All patients had successful TSP. In the mechanical needle group, the Edwards sheath was successfully delivered on the Superstiff Amplatz wire in all cases. In the VersaCross arm, the radiofrequency wire was used successfully for delivery of the sheath in all cases. There were no cases of pericardial effusion/tamponade in either arm. Interval from femoral venous access to TSP and to deployment of the first PASCAL device was shorter with the VersaCross system. Significantly fewer wires were used with VersaCross. There were no procedural deaths or strokes in either group. Conclusions VersaCross appears a safe and effective method of TSP and for delivery of the 22Fr sheath for M-TEER with PASCAL.
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Affiliation(s)
- Sagar N. Doshi
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
- Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Anthony Mechery
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
| | - Ewa Lawton
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
| | - M. Adnan Nadir
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
- Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
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Sharma H, Afzal S, Leick J, Werner N, Doshi SN, Nadir MA. Antithrombotic therapy following transcatheter aortic valve intervention. Pharmacol Ther 2023; 250:108509. [PMID: 37572882 DOI: 10.1016/j.pharmthera.2023.108509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 08/14/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is increasingly being performed to treat symptomatic patients with aortic stenosis and annual procedure volume has overtaken surgical aortic valve replacement in the United States. However, current international guidelines were written prior to the publication of several important recent studies. Furthermore, European and American guidelines differ in their recommendations of antithrombotic therapy following TAVR. Consequently, there is a need to examine the literature to provide clinicians guidance on the optimum antithrombotic strategy, particularly as different patient populations exist. In this review, we examine the data for antiplatelet and anticoagulation therapy post-TAVR.
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Affiliation(s)
- Harish Sharma
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Shazia Afzal
- Heartcenter Trier, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | - Jürgen Leick
- Heartcenter Trier, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | - Nikos Werner
- Heartcenter Trier, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | - Sagar N Doshi
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - M Adnan Nadir
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK.
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Savvoulidis P, Nadir MA, Moody WE, Steeds R, Ludman PF, Bradley JR, Singh A, Lawton E, Doshi SN. Intraprocedural versus next day transthoracic echocardiography following minimalist transfemoral TAVI. Echo Res Pract 2023; 10:14. [PMID: 37674237 PMCID: PMC10483768 DOI: 10.1186/s44156-023-00025-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/30/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Routine pre-discharge echocardiography (ECHO) is recommended post transcatheter aortic valve implantation (TAVI) as a baseline for future comparison. However, there is no clear guidance on the optimal timing of this study. AIM The purpose of this retrospective study was to investigate the safety and work-force efficiency of intraprocedural same-day ECHO versus next-day ECHO, following transfemoral TAVI. METHODS AND RESULTS In this retrospective study 100 consecutive patients who underwent intraprocedural ECHO only were compared with 100 consecutive patients undergoing both intraprocedural and routine next-day ECHO following elective transfemoral TAVI. All patients received the Sapien 3/Ultra transcatheter heart valve and were treated with a minimalist procedure with conscious sedation. The composite of in-hospital mortality, urgent ECHO and new tamponade after leaving the cath lab and before discharge was not different between the two groups (4 vs. 4%, P = 1). There was no paravalvular leak more than mild in any of the cases. Length of stay was similar (1 day). CONCLUSIONS Intraprocedural post-TAVI ECHO appears as safe as next day pre-discharge ECHO and obviates the need for a routine next day study, thereby reducing burden on echocardiography services and allows better utilisation of resources.
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Affiliation(s)
- Panagiotis Savvoulidis
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
| | - M Adnan Nadir
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
- Institute for Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - William E Moody
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
- Institute for Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Richard Steeds
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
- Institute for Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Peter F Ludman
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
- Institute for Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Joseph R Bradley
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
| | - Aldrin Singh
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
| | - Ewa Lawton
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
| | - Sagar N Doshi
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK.
- Institute for Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Savvoulidis P, Doshi SN, Nadir A. A Strategy to Facilitate Crossing of Bicuspid Aortic Valve for Balloon Aortic Valvuloplasty and TAVR. JACC Cardiovasc Interv 2023; 16:2047-2049. [PMID: 37480895 DOI: 10.1016/j.jcin.2023.06.017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/08/2023] [Accepted: 06/06/2023] [Indexed: 07/24/2023]
Affiliation(s)
- Panagiotis Savvoulidis
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, United Kingdom
| | - Sagar N Doshi
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, United Kingdom; Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Adnan Nadir
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, United Kingdom; Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
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Ali N, Hildick-Smith D, Parker J, Malkin CJ, Cunnington MS, Gurung S, Mailey J, MacCarthy PA, Bharucha A, Brecker SJ, Hoole SP, Dorman S, Doshi SN, Wiper A, Buch MH, Banning AP, Spence MS, Blackman DJ. Long-term durability of self-expanding and balloon-expandable transcatheter aortic valve prostheses: UK TAVI registry. Catheter Cardiovasc Interv 2023; 101:932-942. [PMID: 36924015 DOI: 10.1002/ccd.30627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/07/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND With expansion of transcatheter aortic valve implantation (TAVI) into younger patients, valve durability is critically important. AIMS We aimed to evaluate long-term valve function and incidence of severe structural valve deterioration (SVD) among patients ≥ 10-years post-TAVI and with echocardiographic follow-up at least 5-years postprocedure. METHODS Data on patients who underwent TAVI from 2007 to 2011 were obtained from the UK TAVI registry. Patients with paired echocardiograms postprocedure and ≥5-years post-TAVI were included. Severe SVD was determined according to European task force guidelines. RESULTS 221 patients (79.4 ± 7.3 years; 53% male) were included with median echocardiographic follow-up 7.0 years (range 5-13 years). Follow-up exceeded 10 years in 43 patients (19.5%). Valve types were the supra-annular self-expanding CoreValve (SEV; n = 143, 67%), balloon-expandable SAPIEN/XT (BEV; n = 67, 31%), Portico (n = 4, 5%) and unknown (n = 7, 3%). There was no difference between postprocedure and follow-up peak gradient in the overall cohort (19.3 vs. 18.4 mmHg; p = NS) or in those with ≥10-years follow-up (21.1 vs. 21.1 mmHg; p = NS). Severe SVD occurred in 13 patients (5.9%; median 7.8-years post-TAVI). Three cases (23.1%) were due to regurgitation and 10 (76.9%) to stenosis. Valve-related reintervention/death occurred in 5 patients (2.3%). Severe SVD was more frequent with BEV than SEV (11.9% vs. 3.5%; p = 0.02), driven by a difference in patients treated with small valves (BEV 28.6% vs. SEV 3.0%; p < 0.01). CONCLUSIONS Hemodynamic function of transcatheter heart valves remains stable up to more than 10 years post-TAVI. Severe SVD occurred in 5.9%, and valve-related death/reintervention in 2.3%. Severe SVD was more common with BEV than SEV.
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Affiliation(s)
- Noman Ali
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Jessica Parker
- Department of Cardiology, Royal Sussex County Hospital, Brighton, UK
| | | | | | - Shuslim Gurung
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jonathan Mailey
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK
| | | | - Apurva Bharucha
- Department of Cardiology, King's College Hospital, London, UK
| | | | - Stephen P Hoole
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Stephen Dorman
- Department of Cardiology, Bristol Heart Institute, Bristol, UK
| | - Sagar N Doshi
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
| | - Andrew Wiper
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool, UK
| | - Mamta H Buch
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Adrian P Banning
- Department of Cardiology, Oxford Universities Hospital, Oxford, UK
| | - Mark S Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK
| | - Daniel J Blackman
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Shakeel I, Sharma H, Hodson J, Iqbal H, Tashfeen R, Steeds RP, Doshi SN, Nadir A. LONG-TERM CLINICAL OUTCOMES OF PATIENTS WITH ATRIAL FIBRILLATION UNDERGOING PERCUTANEOUS CORONARY INTERVENTION FOR ACUTE MYOCARDIAL INFARCTION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01338-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Savvoulidis P, Nadir AM, Mechery A, Doshi SN. A very rare vascular complication of the Edwards expandable eSheath during transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2023; 101:660-667. [PMID: 36640417 DOI: 10.1002/ccd.30557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/03/2022] [Accepted: 01/02/2023] [Indexed: 01/15/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) has revolutionized the management of severe symptomatic aortic valve stenosis. TAVR is now indicated as an alternative to surgical replacement in a wide risk profile ranging from high to low surgical risk. Although vascular complications have decreased in frequency over time, with the introduction of lower profile delivery systems and sheaths, they remain one of the most frequently encountered and serious complications of TAVR. Patient-specific predisposing factors have been well characterized. However, much less is known about device-specific complications. Awareness of the possible device-related complications may lead to earlier identification, prompt management, and better outcomes. We report a previously unreported complication of the Edwards expandable eSheath that lead to avulsion of the external iliac artery following successful TAVR with a 29-mm Edwards Sapien 3 transcatheter heart valve. Bleeding was promptly controlled with an occlusion balloon and emergency surgical repair was required with a favorable outcome.
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Affiliation(s)
- Panagiotis Savvoulidis
- Department of Cardiology, Queen Elizabeth University Hospital, Edgbaston, Birmingham, UK
| | - Adnan M Nadir
- Department of Cardiology, Queen Elizabeth University Hospital, Edgbaston, Birmingham, UK.,Institute for Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Anthony Mechery
- Department of Cardiology, Queen Elizabeth University Hospital, Edgbaston, Birmingham, UK
| | - Sagar N Doshi
- Department of Cardiology, Queen Elizabeth University Hospital, Edgbaston, Birmingham, UK.,Institute for Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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Savvoulidis P, Nadir AM, Mechery A, Lawton E, Doshi SN. Successful fracture of a trifecta bioprosthetic aortic valve. Hellenic J Cardiol 2022; 71:71-73. [PMID: 36503107 DOI: 10.1016/j.hjc.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/26/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Panagiotis Savvoulidis
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
| | - Adnan M Nadir
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK; Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Anthony Mechery
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
| | - Ewa Lawton
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
| | - Sagar N Doshi
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK; Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Savvoulidis P, Moody WE, Steeds R, Ludman PF, Bradley JR, Singh A, Lawton E, Nadir MA, Doshi SN. A time-efficient protocol for transthoracic echocardiography during transfemoral transcatheter aortic valve implantation: early identification and effective management of intraprocedural complications. Echo Res Pract 2022; 9:3. [PMID: 35974389 PMCID: PMC9382780 DOI: 10.1186/s44156-022-00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/28/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractTransfemoral transcatheter aortic valve implantation (TAVI) under conscious sedation is the most widely used method of implantation. Echocardiography is used to detect complications and to assess the implantation result. The aim of this paper is to provide a time-efficient protocol when transthoracic echocardiography (TTE) is used to guide TAVI procedures.
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Savvoulidis P, Nadir A, Ludman PF, Doshi SN. Early Acurate Neo transcatheter heart valve degeneration in a haemodialysis patient successfully managed with Sapien 3 Ultra: a case report. Eur Heart J Case Rep 2022; 6:ytac279. [PMID: 35854896 PMCID: PMC9290620 DOI: 10.1093/ehjcr/ytac279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/17/2022] [Accepted: 06/29/2022] [Indexed: 11/22/2022]
Abstract
Background Aortic valve disease is the most prevalent valvular abnormality in the developed world and carries a high risk of morbidity and mortality. Transcatheter aortic valve replacement (TAVR) is favoured over open-heart surgery in high-risk patient categories and is increasingly used in lower-risk groups. End stage kidney disease (ESKD) is associated with premature calcific degeneration of bioprosthetic heart valves. Redo-TAVR requires meticulous pre-procedural planning to avoid the important risks of sinus sequestration and impaired coronary access. Transcatheter aortic valve replacement with the Acurate Neo transcatheter heart valve (THV) has been clinically available for a short time only and there are limited reports describing redo-TAVR in the Acurate Neo. Case summary We present a case of early, rapid onset, structural valve degeneration in a Acurate Neo, supra-annular, self-expanding THV in a dialysis patient. The patient presented with chest pain and breathlessness 4 years after TAVR with a Acurate Neo for severe stenosis of a bicuspid aortic valve. Echocardiogram now showed severe stenosis of the THV and computed tomography revealed severe THV leaflet calcification but no pannus or leaflet thrombus. After careful pre-procedural planning a S3 Ultra balloon-expandable valve was selected and positioned relatively high to pin the first THV leaflets in a fully open position without compromising coronary artery flow or coronary access. Discussion End stage kidney disease may cause rapid, calcific degeneration of TAVR valves leading to presentation with severe aortic stenosis. Redo-TAVR in the Acurate Neo THV with a Sapien 3 Ultra is feasible with careful pre-procedural planning to mitigate the risks of sinus sequestration and impaired coronary access.
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Affiliation(s)
- Panagiotis Savvoulidis
- Department of Cardiology, Queen Elizabeth University Hospital , Mindelsohn Way, Edgbaston , Birmingham B15 2WB, UK
| | - Adnan Nadir
- Department of Cardiology, Queen Elizabeth University Hospital , Mindelsohn Way, Edgbaston , Birmingham B15 2WB, UK
- Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham , Edgbaston , Birmingham B15 2TT, UK
| | - Peter F Ludman
- Department of Cardiology, Queen Elizabeth University Hospital , Mindelsohn Way, Edgbaston , Birmingham B15 2WB, UK
- Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham , Edgbaston , Birmingham B15 2TT, UK
| | - Sagar N Doshi
- Department of Cardiology, Queen Elizabeth University Hospital , Mindelsohn Way, Edgbaston , Birmingham B15 2WB, UK
- Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham , Edgbaston , Birmingham B15 2TT, UK
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Ali U, Khalil A, Doshi SN, Nadir A. Reverse Takotsubo cardiomyopathy associated with tonic clonic seizure: a rare form of Takotsubo cardiomyopathy. BMJ Case Rep 2022; 15:15/7/e246703. [DOI: 10.1136/bcr-2021-246703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A woman in her 30s presented with generalised tonic clonic seizure secondary to known pilocytic astrocytoma. This seizure activity resolved spontaneously after 5 min. On clinical assessment, she was neurologically stable and further neurological investigations did not reveal progression of previously recognised pilocytic astrocytoma. Incidentally, she was found to have an elevated troponin, which significantly increased on serial assessment. ECG was unremarkable and echocardiography revealed regional wall motion abnormalities involving basal segments of the left ventricle with apical sparing. She underwent cardiac MRI, which confirmed the presence of regional wall motion abnormalities seen on echocardiography; however, there was no evidence of myocardial oedema or late gadolinium enhancement. Subsequently, she had an invasive coronary angiogram with intravascular ultrasound which ruled out acute coronary plaque event and coronary dissection. In view of the above, a diagnosis of reverse Takotsubo cardiomyopathy was made. This is a relatively rare entity characterised by the presence of akinesia/hypokinesia in the basal segments with preserved apical contractility; often seen in younger patients.
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Doshi SN, Savvoulidis P, Mechery A, Lawton E, Ludman PF, Nadir A. A modified buddy-wire technique for crossing of the interatrial septum with the Sapien3 valve during transseptal mitral valve-in-valve/ring procedures. CJC Open 2022; 4:886-893. [PMID: 36254330 PMCID: PMC9568716 DOI: 10.1016/j.cjco.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/03/2022] [Indexed: 11/03/2022] Open
Abstract
Background Crossing of the interatrial septum (IAS) with the Edwards Sapien-3 transcatheter heart valve (THV) may fail, despite preparatory balloon septostomy. A planned buddy guidewire placed in the left ventricle may help facilitate crossing of the IAS and mitral bioprosthesis with the THV. Methods A retrospective study of 12 consecutive patients undergoing transseptal, mitral valve-in-valve or valve-in-ring procedures using the Edwards Sapien-3 THV since 2018 with a planned buddy-wire technique. The primary endpoint was the composite of successful delivery of the buddy wire and deployment of the first intended Sapien 3 within the mitral valve without removal from the body, additional interatrial septal puncture, or placement of a further buddy wire. Secondary objectives included safety endpoints, as follows: access-site bleeding, tamponade, stroke, intraprocedural death, sustained ventricular arrhythmia, and 30-day vascular complications. Results From January 2018 to March 2022, a total of 12 consecutive patients who underwent transseptal mitral valve-in-valve (9) or valve-in-ring (3) procedures were identified. Three patients (25%) required repeat septostomy on the buddy wire after initial THV crossing failure. Crossing of the IAS and successful deployment in the mitral valve with the THV was achieved in all cases, without removal from the body or need for an additional wire or septal puncture. No access-site bleeding, stroke, tamponade, ventricular arrhythmia, intraprocedural death, or 30-day vascular complication occurred. Conclusions The planned buddy-wire technique was successful in all cases and facilitated successful crossing of the IAS and deployment of the THV in the mitral position without removal from the body, additional wires, or septal punctures, with no adverse events.
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Savvoulidis P, Mechery A, Lawton E, Ludman PF, Sharma H, Thompson S, Khalil A, Kalogeropoulos A, Khan S, Nadir AM, Doshi SN. Comparison of left ventricular with right ventricular rapid pacing on tamponade during TAVI. Int J Cardiol 2022; 360:46-52. [PMID: 35597495 DOI: 10.1016/j.ijcard.2022.05.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/28/2022] [Accepted: 05/16/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Small studies have suggested left ventricular (LV) rapid pacing has similar safety and efficacy to conventional right ventricular (RV) rapid pacing in transcatheter aortic valve implantation (TAVI). However, there are limited data on the comparative rates of tamponade. The study compared the rate of cardiac tamponade between LV and RV-pacing during TAVI. METHODS Between 2008 and 2021, 1226 consecutive patients undergoing transfemoral or transaxillary TAVI were included. 470(38.3%) patients had TAVI deployment with RV-pacing and 756(61.7%) with LV-pacing. The primary outcome was the frequency and cause of cardiac tamponade. Secondary outcomes included efficacy, procedure duration and crossover rates. RESULTS There was a trend to less tamponade with LV-pacing, which did not reach statistical significance [11(2.3%) vs 11(1.5%);P = 0.27]. There was no significant difference in the frequency of tamponade due to annular tear [4(0.9%) vs 9(1.2%);P = 0.59] or LV free-wall perforation [1(0.2%) vs 2(0.3%);P = 0.86]. The frequency of tamponade due to RV perforation was significantly lower in the LV-pacing group [0 vs 6(2.3%);P < 0.005)]. Two patients with tamponade due to RV perforation required emergency sternotomy of whom one died. Deployment success was similar (99% vs 99.6%;P=NS). Procedure duration was shorter with LV-pacing (70 vs 80 mins;P < 0.005). Crossover to RV-pacing was low (0.9%). There were no embolizations caused by loss-of-capture in either group. CONCLUSIONS LV-pacing appears equally efficacious and is associated with a lower risk of tamponade due to RV perforation caused by the temporary pacing wire. LV-pacing was not associated with an increased risk of tamponade due to LV free-wall perforation.
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Affiliation(s)
- Panagiotis Savvoulidis
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Anthony Mechery
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Ewa Lawton
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Peter F Ludman
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Harish Sharma
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Sophie Thompson
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Arsalan Khalil
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | | | - Sohail Khan
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Adnan M Nadir
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Sagar N Doshi
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK..
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Umar H, Sharma H, Osheiba M, Roy A, Ludman PF, Townend JN, Nadir MA, Doshi SN, George S, Zaphiriou A, Khan SQ. Changing trends in the incidence, management and outcomes of coronary artery perforation over an 11-year period: single-centre experience. Open Heart 2022; 9:openhrt-2021-001916. [PMID: 35483748 PMCID: PMC9052042 DOI: 10.1136/openhrt-2021-001916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 04/05/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Coronary artery perforation (CP) is a rare but life-threatening complication of percutaneous coronary intervention (PCI). This study aimed to assess the incidence, management and outcomes of CP over time. Methods A single-centre retrospective cohort study of all PCIs performed between January 2010 and December 2020. Patients with CP were divided into two cohorts (A+B), representing the two halves of the 11-year study. Results The incidence of CP was 68 of 9701 (0.7%), with an increasing trend over the two 5.5-year periods studied (24 of 4661 (0.5%) vs 44 of 5040 (0.9%); p=0.035). Factors associated with CP included chronic total occlusions (CTOs) (16 of 68 (24%) vs 993 of 9633 (10%); p<0.001), type C lesions (44 of 68 (65%) vs 4280 of 9633 (44%); p<0.001), use of intravascular ultrasound (IVUS) (12 of 68 (18%) vs 541 of 9633 (6%); p<0.001), cutting balloon angioplasty (3 of 68 (4%) vs 98 of 9633 (1%); p<0.001) and hydrophilic wires (24 of 68 (35%) vs 1454 of 9633 (15%); p<0.001). Cohorts A and B were well matched with respect to age (69±11 vs 70±12 years; p=0.843), sex (males: 13 of 24 (54%) vs 31 of 44 (70%); p=0.179) and renal function (chronic kidney disease: 1 of 24 (4%) vs 4 of 44 (9%); p=0.457). In cohort A, CP was most frequently caused by post-dilatation with non-compliant balloons (10 of 24 (42%); p=0.009); whereas in cohort B, common causes included guidewire exits (23 of 44 (52%)), followed by stent implantation (10 of 44 (23%)). The most common treatment modality in cohorts A and B was balloon inflation, which accounted for 16 of 24 (67%) and 13 of 44 (30%), respectively. The use of covered stents (16%) and coronary coils (18%) during cohort B study period did not impact all-cause mortality, which occurred in 2 of 24 (8%) and 7 of 44 (16%) (p=0.378) in cohorts A and B, respectively. Conclusion The incidence of CP is increasing as more complex PCI is performed. Factors associated with perforation include CTO or type C lesions and use of IVUS, cutting balloon angioplasty or hydrophilic wires.
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Affiliation(s)
- Hamza Umar
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Cardiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Harish Sharma
- Cardiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK .,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Mohammed Osheiba
- Cardiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Ashwin Roy
- Cardiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Peter F Ludman
- Cardiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Jonathan N Townend
- Cardiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - M Adnan Nadir
- Cardiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Sagar N Doshi
- Cardiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Sudhakar George
- Cardiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Alex Zaphiriou
- Cardiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Sohail Q Khan
- Cardiology Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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Sharma H, Yuan M, Shakeel I, Hodson J, Radhakrishnan A, Brown S, May J, O’Connor K, Zia N, Doshi SN, Hothi SS, Townend JN, Myerson SG, Ludman PF, Steeds RP, Nadir MA. A Longitudinal Study of Mitral Regurgitation Detected after Acute Myocardial Infarction. J Clin Med 2022; 11:jcm11040965. [PMID: 35207254 PMCID: PMC8880345 DOI: 10.3390/jcm11040965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/01/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Mitral regurgitation (MR) is common following myocardial infarction (MI). However, the subsequent trajectory of MR, and its impact on long-term outcomes are not well understood. This study aimed to examine the change in MR severity and associated clinical outcomes following MI. Methods: Records of patients admitted to a single centre between 2016 and 2017 with acute MI treated by percutaneous coronary intervention (PCI) were retrospectively examined. Results: 294/1000 consecutive patients had MR on baseline (pre-discharge) transthoracic echocardiography (TTE), of whom 126 (mean age: 70.9 ± 11.4 years) had at least one follow-up TTE. At baseline, most patients had mild MR (n = 94; 75%), with n = 30 (24%) moderate and n = 2 (2%) severe MR. Significant improvement in MR was observed at the first follow-up TTE (median 9 months from baseline; interquartile range: 3–23), with 36% having reduced severity, compared to 10% having increased MR severity (p < 0.001). Predictors of worsening MR included older age (mean: 75.2 vs. 66.7 years; p = 0.003) and lower creatinine clearance (mean: 60 vs. 81 mL/min, p = 0.015). Change in MR severity was significantly associated with prognosis: 16% with improving MR reached the composite endpoint of death or heart failure hospitalisation at 5 years, versus 44% (p = 0.004) with no change, and 59% (p < 0.001) with worsening MR. Conclusions: Of patients with follow-up TTE after MI, MR severity improved from baseline in approximately one-third, was stable in around half, with the remainder having worsening MR. Patients with persistent or worsening MR had worse clinical outcomes than those with improving MR.
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Affiliation(s)
- Harish Sharma
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK; (A.R.); (S.N.D.); (S.S.H.); (J.N.T.); (P.F.L.); (R.P.S.); (M.A.N.)
- Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK; (M.Y.); (J.M.); (K.O.)
- Correspondence: ; Tel.: +44-121-371-4035
| | - Mengshi Yuan
- Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK; (M.Y.); (J.M.); (K.O.)
| | - Iqra Shakeel
- Medical and Dental School, University of Birmingham, Birmingham B15 2TT, UK; (I.S.); (S.B.); (N.Z.)
| | - James Hodson
- Institute of Translational Medicine, University Hospitals Birmingham, Birmingham B15 2TH, UK;
- Department of Health Informatics, University Hospitals Birmingham, Birmingham B15 2TH, UK
| | - Ashwin Radhakrishnan
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK; (A.R.); (S.N.D.); (S.S.H.); (J.N.T.); (P.F.L.); (R.P.S.); (M.A.N.)
- Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK; (M.Y.); (J.M.); (K.O.)
| | - Samuel Brown
- Medical and Dental School, University of Birmingham, Birmingham B15 2TT, UK; (I.S.); (S.B.); (N.Z.)
| | - John May
- Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK; (M.Y.); (J.M.); (K.O.)
| | - Kieran O’Connor
- Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK; (M.Y.); (J.M.); (K.O.)
| | - Nawal Zia
- Medical and Dental School, University of Birmingham, Birmingham B15 2TT, UK; (I.S.); (S.B.); (N.Z.)
| | - Sagar N. Doshi
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK; (A.R.); (S.N.D.); (S.S.H.); (J.N.T.); (P.F.L.); (R.P.S.); (M.A.N.)
- Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK; (M.Y.); (J.M.); (K.O.)
| | - Sandeep S. Hothi
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK; (A.R.); (S.N.D.); (S.S.H.); (J.N.T.); (P.F.L.); (R.P.S.); (M.A.N.)
- Department of Cardiology, Royal Wolverhampton NHS Hospitals Trust, Wolverhampton WV10 0QP, UK
| | - Jonathan N. Townend
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK; (A.R.); (S.N.D.); (S.S.H.); (J.N.T.); (P.F.L.); (R.P.S.); (M.A.N.)
- Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK; (M.Y.); (J.M.); (K.O.)
| | - Saul G. Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK;
| | - Peter F. Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK; (A.R.); (S.N.D.); (S.S.H.); (J.N.T.); (P.F.L.); (R.P.S.); (M.A.N.)
- Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK; (M.Y.); (J.M.); (K.O.)
| | - Richard P. Steeds
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK; (A.R.); (S.N.D.); (S.S.H.); (J.N.T.); (P.F.L.); (R.P.S.); (M.A.N.)
- Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK; (M.Y.); (J.M.); (K.O.)
| | - M. Adnan Nadir
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK; (A.R.); (S.N.D.); (S.S.H.); (J.N.T.); (P.F.L.); (R.P.S.); (M.A.N.)
- Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK; (M.Y.); (J.M.); (K.O.)
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Sharma H, Nadir MA, Steeds RP, Doshi SN. Transcatheter valve-in-ring and para-ring vascular plug implantation for severe tricuspid regurgitation following annuloplasty ring failure: a case report. Eur Heart J Case Rep 2022; 6:ytac041. [PMID: 35233492 PMCID: PMC8874955 DOI: 10.1093/ehjcr/ytac041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/19/2021] [Accepted: 01/25/2022] [Indexed: 11/30/2022]
Abstract
Background Moderate or severe tricuspid regurgitation (TR) recurs in up to one-third of patients within 8 years of surgical annuloplasty repair. Reoperation often carries high risk with poor outcomes. Transcatheter valve-in-ring repair is an emerging alternative treatment. However, residual regurgitation is frequent and may necessitate further procedures. Case summary A 52-year-old female was diagnosed with severe rheumatic valvular heart disease. The patient underwent mechanical aortic and mitral valve replacement. Additionally, tricuspid repair was performed using a semi-rigid annuloplasty ring (28 mm Edwards Physio Tricuspid). Within 2 years, the patient developed recurrent, isolated severe symptomatic TR, with progressive right ventricular dilatation. The patient was considered prohibitive risk for redo surgery and unsuitable for cardiac transplantation. She underwent percutaneous valve-in-ring transcatheter heart valve (THV) implantation using a 29 mm Sapien S3 (Edwards Lifesciences, CA, USA) valve. Persistent severe residual para-ring TR warranted a further procedure to deploy vascular plugs, significantly reducing the TR to a mild jet with symptomatic improvement. Discussion Valve-in-ring THV implantation for failed surgical tricuspid annuloplasty repair is a rare procedure reserved for symptomatic patients at high or prohibitive risk for reoperation. Significant residual TR is a commonly encountered problem with incomplete annuloplasty rings following valve-in-ring procedures and may occur either intra-ring between the THV and the ring or para-ring. Implantation of vascular occlusion devices can be used to successfully treat residual TR at either location with good outcomes at 6-month follow-up. Further work is required to determine the longevity of this treatment.
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Affiliation(s)
- Harish Sharma
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK
| | - M Adnan Nadir
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Richard P Steeds
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Sagar N Doshi
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK
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19
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Sharma H, Radhakrishnan A, Nightingale P, Brown S, May J, O'Connor K, Shakeel I, Zia N, Doshi SN, Townend JN, Myerson SG, Kirchhof P, Ludman PF, Adnan Nadir M, Steeds RP. The characteristics of mitral regurgitation: Data from patients admitted following acute myocardial infarction. Data Brief 2021; 39:107451. [PMID: 34703851 PMCID: PMC8526959 DOI: 10.1016/j.dib.2021.107451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/27/2021] [Accepted: 10/01/2021] [Indexed: 12/01/2022] Open
Abstract
Data were collected on patients admitted to the Queen Elizabeth Hospital Birmingham with type-1 myocardial infarction during 2016 and 2017 inclusively, who were treated by percutaneous intervention and had pre-discharge transthoracic echocardiography. The data were obtained from prospectively maintained hospital databases and records. Echocardiography was performed and reported contemporaneously by accredited echocardiographers. The purpose was to understand the prevalence and characteristics of mitral regurgitation (MR) after acute MI, including patients with ST-elevation (STEMI) and non-ST elevation MI (NSTEMI). MR was observed in 294/1000 patients with the following relative severities: mild = 76%, moderate = 21%, severe = 3% [1]. MR was graded by multiparametric quantification including proximal isolvelocity surface area (PISA), vena contracta (VC), effective regurgitant orifice area (EROA) and regurgitant volume (RVol). Amongst all patients with MR (n=294), PISA was performed in 89/294 (30%), VC 75/294 (26%), EROA in 53/294 (18%) and RVol in 26/294 (9%). Amongst patients with moderate or severe MR (n=70), PISA was performed in 57/70 (81%), VC in 55/70 (79%), EROA in 46/70 (66%) and RVol in 25/70 (36%). Characteristics of MR following acute MI were also assessed including frequency of reported leaflet thickness (259/294 = 88%) and mitral annular calcification (102/294 = 35%). Furthermore, the effect of MI on pre-existing MR was investigated and patients with pre-existing MR who continue to have MR after acute MI were found to have progression of MR by one grade in approximately 25% of cases. Finally, using Cox proportional hazards univariate analysis, significant factors associated with mortality in patients with MR post-MI include age (HR 1.065; 95% CI 1.035-1.096; p<0.001), creatinine clearance, (HR 0.981; 95% CI 0.971-0.991; p<0.001), left ventricular ejection fraction (LVEF) (HR 0.966; 95% CI 0.948-0.984; p<0.001), indexed left ventricular end-diastolic volume (LVEDVi) (HR 1.016; 95% CI 1.003-1.029; p=0.018), indexed left ventricular end-systolic volume (LVESVi) (HR 1.021; 95% CI 1.008-1.034; p=0.001), indexed left atrial volume (HR 1.026; 95% CI 1.012-1.039; p<0.001), and those with intermediate likelihood of pulmonary hypertension (pHTN) (HR 2.223; 95% CI 1.126-4.390; p=0.021); or high likelihood of pHTN (HR 5.626; 95% CI 2.189-14.461; p<0.001). Age and LVEF were found to be independent predictors of mortality on multivariate analysis [1].
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Affiliation(s)
- Harish Sharma
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, University Hospitals Birmingham, Birmingham, UK
| | | | - Peter Nightingale
- Institute of Translational Medicine, University Hospitals Birmingham, Birmingham, UK
| | - Samuel Brown
- Medical School, College of Medical and Dental Sciences, University of Birmingham, UK
| | - John May
- Department of Cardiology, University Hospitals Birmingham, Birmingham, UK
| | - Kieran O'Connor
- Department of Cardiology, University Hospitals Birmingham, Birmingham, UK
| | - Iqra Shakeel
- Medical School, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Nawal Zia
- Medical School, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Sagar N. Doshi
- Department of Cardiology, University Hospitals Birmingham, Birmingham, UK
| | - Jonathan N. Townend
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, University Hospitals Birmingham, Birmingham, UK
| | - Saul G. Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, University Heart and Vascular Center UKE Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Peter F. Ludman
- Department of Cardiology, University Hospitals Birmingham, Birmingham, UK
| | - M. Adnan Nadir
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, University Hospitals Birmingham, Birmingham, UK
| | - Richard P. Steeds
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, University Hospitals Birmingham, Birmingham, UK
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Sharma H, Nadir MA, Steeds RP, Doshi SN. Successful mitral valve-in-ring repair of mitral annuloplasty ring dehiscence causing severe mitral regurgitation: a case report. Eur Heart J Case Rep 2021; 5:ytab433. [PMID: 34917877 PMCID: PMC8669564 DOI: 10.1093/ehjcr/ytab433] [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: 06/30/2021] [Revised: 09/22/2021] [Accepted: 10/11/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Annuloplasty failure caused by ring dehiscence can lead to trans-ring and para-ring mitral regurgitation (MR). Transcatheter treatments are available for patients at prohibitive risk of surgery. In patients unsuitable for edge-to-edge repair, valve-in-ring (ViR) transcatheter mitral valve (MV) implantation has been described to treat trans-ring or para-ring jets but not both concurrently. CASE SUMMARY A 78-year-old male presented with severe MR due to dehiscence of a 34 mm Edwards Physio II mitral annuloplasty ring. Transoesophageal echocardiography showed two jets of regurgitation; trans-ring and para-ring. Repair was successfully undertaken with a ViR procedure (29 mm S3 Edwards Lifesciences). DISCUSSION Patients with failure of MV annuloplasty with trans-ring and para-ring regurgitation can be safely and effectively treated by ViR transcatheter MV implantation.
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Affiliation(s)
- Harish Sharma
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Cardiology, University Hospitals Birmingham, Birmingham, B15 2TH, UK
| | - M Adnan Nadir
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Cardiology, University Hospitals Birmingham, Birmingham, B15 2TH, UK
| | - Richard P Steeds
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Cardiology, University Hospitals Birmingham, Birmingham, B15 2TH, UK
| | - Sagar N Doshi
- Department of Cardiology, University Hospitals Birmingham, Birmingham, B15 2TH, UK
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21
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Sharma H, Radhakrishnan A, Nightingale P, Brown S, May J, O'Connor K, Shakeel I, Zia N, Doshi SN, Townend JN, Myerson SG, Kirchhof P, Ludman PF, Adnan Nadir M, Steeds RP. Mitral Regurgitation Following Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention-Prevalence, Risk factors, and Predictors of Outcome. Am J Cardiol 2021; 157:22-32. [PMID: 34417016 DOI: 10.1016/j.amjcard.2021.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 12/13/2022]
Abstract
Mitral regurgitation (MR) following acute myocardial infarction (AMI) worsens prognosis and reports of prevalence vary significantly. The objective was to determine prevalence, risk factors, and outcomes related to MR following AMI. We identified 1000 consecutive patients admitted with AMI in 2016/17 treated by percutaneous coronary intervention with pre-discharge transthoracic echocardiography. MR was observed in 294 of 1000 (29%), graded as mild (n = 224 [76%]), moderate (n = 61 [21%]) and severe (n = 9 [3%]). Compared with patients without MR, patients with MR were older (70 ± 12 vs 63 ± 13 years; p <0.001), with worse left ventricular ejection fraction (LVEF) (52 ± 15% vs 55 ± 11%; p <0.001) and creatinine clearance (69 ± 33 ml/min vs 90 ± 39 ml/min; p <0.001). They also had higher rates of hypertension (64% vs 55%; p = 0.012), heart failure (3.4% vs 1.1%; p = 0.014), previous MI (28% vs 20%; p = 0.005) and severe flow-limitation in the circumflex (50% vs 33%; p <0.001) or right coronary artery (51% vs 42%; p = 0.014). Prevalence and severity of MR were unaffected by AMI subtype. Revascularization later than 72 hours from symptom-onset was associated with increased likelihood of MR (33% vs 25%; p = 0.036) in patients with non-ST elevation myocardial infarction (NSTEMI). After a mean of 3.2 years, 56 of 288 (19%) patients with untreated MR died. Age and LVEF independently predicted mortality. The presence of even mild MR was associated with increased mortality (p = 0.029), despite accounting for confounders. In conclusion, MR is observed in over one-quarter of patients after AMI and associated with lower survival, even when mild. Prevalence and severity are independent of MI subtype, but MR was more common with delayed revascularization following NSTEMI.
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22
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Leelo N, Mortimer N, Townend JN, Doshi SN, Nadir MA. Routine versus clinically indicated use of chest X-rays in patients presenting with ST-elevation myocardial infarction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
National Institute of Clinical Excellence (NICE) guidelines recommend consideration of Chest X-rays (CXRs) in patients presenting with chest pain to exclude non-cardiac causes of chest pains. However, patients with ST-segment elevation myocardial infarction (STEMI) have a clear diagnosis, rendering the rationale for routine CXRs in this cohort of patients unclear. However, this remains a common practice across the health service.
Methods
We performed a retrospective study use of CXRs in consecutive patients admitted with STEMI undergoing primary percutaneous coronary intervention in a single UK tertiary cardiac center. We aimed to investigate if CXRs added clinical and diagnostic value by comparing routine vs. clinically indicated use.
Results
A total of 122 patients (Mean Age 63±12, 87% Male) were admitted with STEMI during the study period and 114/122 (93.4%) patients received at least one CXR during their in-patient stay. All but 2/114 were portable thus resource-intensive. Of these, 75/114 (65.8%) were routine while 39/114 (34.2%) were clinically indicated. Although CXRs were performed in almost all the patients, only 56/114 (49.1%) of patients had the findings of CXRs documented in the clinical records.
The diagnostic efficacy for CXR abnormalities was significantly higher in the clinically indicated CXR group (76.9%) rather than the routine CXR group (2.7%) (p=<0.001). The therapeutic efficacy was 53.8% for clinically indicated CXRs, whereas the routine CXRs had a therapeutic efficacy of 1.3% (p=<0.001). There was a significant association between CXR findings and whether the CXR requested was routine or not (χ2(1)=70.07, p<0.001) and also management changes (χ2(1)=45.43, p<0.001).
Conclusions
Routine CXR in patient admitted with STEMI are often unnecessary and may add very little clinical value. On the other hand, selective post-procedural CXRs have a significantly higher diagnostic and therapeutic yield. Our study questions the rationale behind routine CXRs in the care of patients with STEMIs.
Funding Acknowledgement
Type of funding sources: None. Table 1
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Affiliation(s)
- N Leelo
- University Hospital Birmingham, Birmingham, United Kingdom
| | - N Mortimer
- University Hospital Birmingham, Birmingham, United Kingdom
| | - J N Townend
- University Hospital Birmingham, Birmingham, United Kingdom
| | - S N Doshi
- University Hospital Birmingham, Birmingham, United Kingdom
| | - M A Nadir
- University Hospital Birmingham, Birmingham, United Kingdom
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23
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Patterson T, Clayton T, Dodd M, Khawaja Z, Morice MC, Wilson K, Kim WK, Meneveau N, Hambrecht R, Byrne J, Carrié D, Fraser D, Roberts DH, Doshi SN, Zaman A, Banning AP, Eltchaninoff H, Le Breton H, Smith D, Cox I, Frank D, Gershlick A, de Belder M, Thomas M, Hildick-Smith D, Prendergast B, Redwood S. ACTIVATION (PercutAneous Coronary inTervention prIor to transcatheter aortic VAlve implantaTION): A Randomized Clinical Trial. JACC Cardiovasc Interv 2021; 14:1965-1974. [PMID: 34556269 DOI: 10.1016/j.jcin.2021.06.041] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 06/22/2021] [Accepted: 06/29/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study sought to determine if percutaneous coronary intervention (PCI) prior to transcatheter aortic valve replacement (TAVR) in patients with significant coronary artery disease would produce noninferior clinical results when compared with no PCI (control arm). BACKGROUND PCI in patients undergoing TAVR is not without risk, and there are no randomized data to inform clinical practice. METHODS Patients with severe symptomatic aortic stenosis and significant coronary artery disease with Canadian Cardiovascular Society class ≤2 angina were randomly assigned to receive PCI or no PCI prior to TAVR. The primary endpoint was a composite of all-cause death or rehospitalization at 1 year. Noninferiority testing (prespecified margin of 7.5%) was performed in the intention-to-treat population. RESULTS At 17 centers, 235 patients underwent randomization. At 1 year, the primary composite endpoint occurred in 48 (41.5%) of the PCI arm and 47 (44.0%) of the no-PCI arm. The requirement for noninferiority was not met (difference: -2.5%; 1-sided upper 95% confidence limit: 8.5%; 1-sided noninferiority test P = 0.067). On analysis of the as-treated population, the difference was -3.7% (1-sided upper 95% confidence limit: 7.5%; P = 0.050). Mortality was 16 (13.4%) in the PCI arm and 14 (12.1%) in the no-PCI arm. At 1 year, there was no evidence of a difference in the rates of stroke, myocardial infarction, or acute kidney injury, with higher rates of any bleed in the PCI arm (P = 0.021). CONCLUSIONS Observed rates of death and rehospitalization at 1 year were similar between PCI and no PCI prior to TAVR; however, the noninferiority margin was not met, and PCI resulted in a higher incidence of bleeding. (Assessing the Effects of Stenting in Significant Coronary Artery Disease Prior to Transcatheter Aortic Valve Implantation; ISRCTN75836930).
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Affiliation(s)
- Tiffany Patterson
- Cardiovascular Department, St Thomas' Hospital, Kings College London, London, United Kingdom
| | - Tim Clayton
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matthew Dodd
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Zeeshan Khawaja
- Cardiology Department, Lewisham and Greenwich NHS Foundation Trust, United Kingdom
| | - Marie Claude Morice
- Institut Cardiovasculaire Paris Sud, Massy, France; Cardiovascular European Research Center, Massy, France
| | - Karen Wilson
- Cardiovascular Department, St Thomas' Hospital, Kings College London, London, United Kingdom
| | - Won-Keun Kim
- Cardiology Department, Kerckhoff-Klinik Bad Nauheim Abteilung Kardiologie, Bad Nauheim, Germany
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France; EA3920, University of Burgundy Franche-Comté, Besançon, France
| | - Rainer Hambrecht
- Cardiology Department, Klinikum Links der Weser GmbH, Bremen, Germany
| | - Jonathan Byrne
- Cardiothoracic Department, King's College Hospital, London, United Kingdom
| | - Didier Carrié
- Cardiology Department, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Doug Fraser
- Cardiology Department, Manchester Royal Infirmary, Manchester, United Kingdom
| | - David H Roberts
- Lancashire Cardiac Centre, Blackpool Victoria Hospital NHS Trust, Blackpool, United Kingdom
| | - Sagar N Doshi
- Cardiology Department, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Azfar Zaman
- Cardiology Department, Newcastle upon Tyne Hospitals NHS Foundation Trust of the Freeman Hospital, Newcastle, United Kingdom
| | - Adrian P Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Hélène Eltchaninoff
- Cardiology Department, Hôpital Charles-Nicolle, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Hervé Le Breton
- Service de Cardiologie, Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - David Smith
- Cardiology Department, Morriston Hospital, Swansea, United Kingdom
| | - Ian Cox
- Cardiology Department, Derriford Hospital, Plymouth, United Kingdom
| | - Derk Frank
- Cardiology Department, Oberarzt Facharzt für Innere Medizin und Kardiologie, Kiel, Germany
| | - Anthony Gershlick
- Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, Leicester, United Kingdom
| | - Mark de Belder
- Cardiology Department, Barts Heart Centre, London, United Kingdom
| | | | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Bernard Prendergast
- Cardiovascular Department, St Thomas' Hospital, Kings College London, London, United Kingdom
| | - Simon Redwood
- Cardiovascular Department, St Thomas' Hospital, Kings College London, London, United Kingdom.
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Jawad-Ul-Qamar M, Sharma H, Vetrugno V, Sandhu K, Ludman PF, Doshi SN, Townend JN, Osheiba M, Zaphiriou A, Khan SQ. Contemporary use of excimer laser in percutaneous coronary intervention with indications, procedural characteristics, complications and outcomes in a university teaching hospital. Open Heart 2021; 8:openhrt-2020-001522. [PMID: 33863837 PMCID: PMC8055138 DOI: 10.1136/openhrt-2020-001522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 11/28/2022] Open
Abstract
Background Excimer laser coronary atherectomy (ELCA) can be used as an adjunctive percutaneous coronary intervention treatment for challenging, heavily calcified lesions. Although previous studies have documented high rates of complication and restenosis, these predate the introduction of the smaller 0.9 mm laser catheter. As the coronary complexity has increased, there has been a renewed interest in the ELCA. This study investigates the indications, procedural characteristics, complications and outcomes of ELCA in a contemporary coronary interventional practice. Methods This single-centre study retrospectively analysed 50 patients treated with ELCA between January 2013 and January 2019. Results Patients had a mean age of 67.9±11.4 years with a male predominance (65.3%). 25 (50%) cases were performed in patients with stable angina. Failure to deliver the smallest available balloon/microcatheter was the most frequent indication in 32 (64%) cases for ELCA use. 30 (60%) of the procedures were performed via radial access. The 0.9 mm X-80 catheter was used in 41 (82%) of cases, delivering on average 9000±3929 pulses. ELCA-related complications included 2 coronary dissections and 1 perforation, all of which were covered with stents. No major complications could be directly attributed to the use of ELCA. There was one death and one case of stent thrombosis within 30 days of the procedure. Conclusion ELCA can be performed safely via the radial approach with a 0.9 mm catheter with a high success rate by suitably trained operators. The low procedure-related complications with contemporary techniques make this a very useful tool for complex coronary interventions, especially for difficult to dilate lesions and chronic total occlusion vessels.
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Affiliation(s)
- Muhammad Jawad-Ul-Qamar
- Department of interventional cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Harish Sharma
- Department of interventional cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Vincenzo Vetrugno
- Department of interventional cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,Cardiology Division, Azienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Modena, Italy
| | - Kully Sandhu
- Department of interventional cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Peter F Ludman
- Department of interventional cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Sagar N Doshi
- Department of interventional cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Jonathan N Townend
- Department of interventional cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Mohammed Osheiba
- Department of interventional cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Alex Zaphiriou
- Department of interventional cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Sohail Q Khan
- Department of interventional cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK .,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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Doshi SN, Nadir A, Moody W, Townend JN. Acute Presentation of Structural Valve Degeneration in a Transcatheter Heart Valve (Sapien XT) at 7.5 Years; Successful Redo TAVR With a Sapien 3 Ultra. CJC Open 2021; 3:383-386. [PMID: 33778458 PMCID: PMC7984999 DOI: 10.1016/j.cjco.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/02/2020] [Indexed: 11/06/2022] Open
Abstract
Little is known about the presentation of structural valve degeneration complicating transcatheter heart valves (THVs). We report a case of acute heart failure, secondary to leaflet prolapse, in a previously well 77-year-old man, 7.5 years after successful transcatheter aortic valve replacement with a 26-mm balloon-expandable Sapien XT (Edwards Lifesciences, Irvine, CA) THV. This case highlights that structural valve degeneration complicating THVs might lead to acute presentation with little warning from previous echocardiograms. Calcification might be absent on imaging. Redo transcatheter aortic valve replacement is feasible and appears safe. Post deployment optimization with a highly noncompliant balloon might improve full expansion of the newly implanted THV and improve valve performance.
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Affiliation(s)
- Sagar N Doshi
- Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Adnan Nadir
- Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom
| | - William Moody
- Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Jonathan N Townend
- Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom
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26
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Montone RA, Vetrugno V, Camilli M, Russo M, Fracassi F, Khan SQ, Doshi SN, Townend JN, Ludman PF, Trani C, Niccoli G, Crea F. Macrophage infiltrates in coronary plaque erosion and cardiovascular outcome in patients with acute coronary syndrome. Atherosclerosis 2020; 311:158-166. [PMID: 32948317 DOI: 10.1016/j.atherosclerosis.2020.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/21/2020] [Accepted: 08/21/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Plaque erosion (PE) is responsible for at least one-third of acute coronary syndrome (ACS), and inflammation plays a key role in plaque instability. We assessed the presence of optical coherence tomography (OCT)-defined macrophage infiltrates (MØI) at the culprit site in ACS patients with PE, evaluating their clinical and OCT correlates, along with their prognostic value. METHODS ACS patients undergoing OCT imaging and presenting PE as culprit lesion were retrospectively selected. Presence of MØI at culprit site was assessed. The incidence of major adverse cardiac events (MACEs), defined as the composite of cardiac death, recurrent myocardial infarction and target-vessel revascularization (TVR), was assessed [follow-up median (interquartile range, IQR) time 2.5 (2.03-2.58) years]. RESULTS We included 153 patients [median age (IQR) 64 (53-75) years, 99 (64.7%) males]. Fifty-one (33.3%) patients presented PE with MØI and 102 (66.7%) PE without MØI. Patients having PE with MØI compared with PE patients without MØI had more vulnerable plaque features both at culprit site and at non-culprit segments. MACEs were significantly more frequent in PE with MØI patients compared with PE without MØI [11 (21.6%) vs. 6 (5.9%), p = 0.008], mainly driven by a higher risk of cardiac death and TVR. At multivariable Cox regression, PE with MØI was an independent predictor of MACEs [HR = 2.95, 95% CI (1.09-8.02), p = 0.034]. CONCLUSIONS Our study demonstrates that among ACS patients with PE the presence of MØI at culprit lesion is associated with more vulnerable plaque features, along with a worse prognosis at a long-term follow-up.
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Affiliation(s)
- Rocco A Montone
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vincenzo Vetrugno
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Massimiliano Camilli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Michele Russo
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Fracassi
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Sohail Q Khan
- Department of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sagar N Doshi
- Department of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan N Townend
- Department of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Peter F Ludman
- Department of Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giampaolo Niccoli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
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27
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Saia F, Gandolfo C, Palmerini T, Berti S, Doshi SN, Laine M, Marcelli C, Piva T, Ribichini F, De Benedictis M, Cardaioli F, Cannata S, Tarantini G. In-hospital and thirty-day outcomes of the SAPIEN 3 Ultra balloon-expandable transcatheter aortic valve: the S3U registry. EUROINTERVENTION 2020; 15:1240-1247. [DOI: 10.4244/eij-d-19-00541] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lehru D, Mortimer N, Doshi SN, Zaphiriou A, George S, Khan SQ, Ludman PF, Townend JN, Nadir MA. P6150Clinical outcomes and downstream investigations following computed tomographic coronary angiography (CTCA) performed for evaluation of ambulatory patients with chest pain of recent onset. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
National Institute of Clinical Excellence guideline (NICE, CG95) recommends CTCA as a 1st line diagnostic test for evaluation of ambulatory patients with suspected stable angina based on its high sensitivity and low cost. This has led to increasing demand for CTCA across the National Health Service (NHS) in order to comply with the NICE recommendation.
Purpose
We studied the utility and effectiveness of CTCA in the evaluation of ambulatory patients with suspected stable angina attending rapid access chest pain clinic (RACPC) in a large tertiary hospital in the UK.
Methods
The study included consecutive patients attending RACPC over a pre-specified period of 6-months who were suspected of having stable angina and hence, referred for CTCA. The data were collected on demographics, CTCA results including incidental finding and downstream investigations. All patients had a minimum of 12-months follow up for clinical outcomes.
Results
A total of 170 patients were referred for CTCA (mean age = 56.8 years, male = 53.5%) out of the 388 consecutive patients who were reviewed in the RACPC during the 6-month period. CTCA was non-diagnostic in 48/170 (28.2%) cases (Breathing artefact 35%, Severe Coronary Calcification 31%, Elevated heart rate/Ectopy 30%) while 63/170 (37.1%) of patients had incidental extra-cardiac findings. Amongst patients with incidental findings, 17/63 (27.0%) underwent further investigations. A total of 54/170 (31.7%) of patients were recommended to have downstream cardiac investigations such as a stress test (DSE/MRI/MPS) (23/170, 15.8%) while 31/170 (18.2%) were referred for invasive coronary angiography. Revascularisation procedures (PCI n=7.6%, CABG n=4.7%) were required in 21/170 (12.4%) patients. Based on 2017 NHS tariffs, overall average cost-per-patient with the initial CTCA approach was £122.11 excluding downstream investigations and £548.43 including the cost of downstream cardiac investigations.
Incidental Findings after CTCA
Conclusions
Our study suggests that a CTCA based approach is associated with non-diagnostic information in at least 1:4 patients and incidental extracardiac findings in 1:3 patients. Further downstream cardiac investigations are required in around 1:3 patients after a CTCA carried out for evaluation suspected stable angina. The NICE recommendation is based on the low initial cost of CTCA and high sensitivity, however, taking in to account the additional cost of downstream investigations, the average cost per patient of this approach is significantly (4.5 times) higher.
Acknowledgement/Funding
None
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Affiliation(s)
- D Lehru
- University Hospital Birmingham, Birmingham, United Kingdom
| | - N Mortimer
- University Hospital Birmingham, Birmingham, United Kingdom
| | - S N Doshi
- University Hospital Birmingham, Birmingham, United Kingdom
| | - A Zaphiriou
- University Hospital Birmingham, Birmingham, United Kingdom
| | - S George
- University Hospital Birmingham, Birmingham, United Kingdom
| | - S Q Khan
- University Hospital Birmingham, Birmingham, United Kingdom
| | - P F Ludman
- University Hospital Birmingham, Birmingham, United Kingdom
| | - J N Townend
- University Hospital Birmingham, Birmingham, United Kingdom
| | - M A Nadir
- University Hospital Birmingham, Birmingham, United Kingdom
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Abstract
Abstract
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Affiliation(s)
- Jonathan N Townend
- Institute of Cardiovascular Sciences, University of Birmingham, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Peter F Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Sagar N Doshi
- Institute of Cardiovascular Sciences, University of Birmingham, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
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Blackman DJ, Saraf S, MacCarthy PA, Myat A, Anderson SG, Malkin CJ, Cunnington MS, Somers K, Brennan P, Manoharan G, Parker J, Aldalati O, Brecker SJ, Dowling C, Hoole SP, Dorman S, Mullen M, Kennon S, Jerrum M, Chandrala P, Roberts DH, Tay J, Doshi SN, Ludman PF, Fairbairn TA, Crowe J, Levy RD, Banning AP, Ruparelia N, Spence MS, Hildick-Smith D. Long-Term Durability of Transcatheter Aortic Valve Prostheses. J Am Coll Cardiol 2019; 73:537-545. [DOI: 10.1016/j.jacc.2018.10.078] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 10/23/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
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Doshi SN, George S, Kwok CS, Mechery A, Mamas M, Ludman PF, Townend JN, Bhabra M. A feasibility study of transaxillary TAVI with the lotus valve. Catheter Cardiovasc Interv 2017; 92:542-549. [DOI: 10.1002/ccd.27409] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 05/17/2017] [Revised: 10/03/2017] [Accepted: 10/14/2017] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Chun Shing Kwok
- Royal Stoke University Hospital; Stoke Staffordshire United Kingdom
| | | | - Mamas Mamas
- Royal Stoke University Hospital; Stoke Staffordshire United Kingdom
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Sagar VM, Steeds RP, Doshi SN, Shah T. Transcatheter valve implantation to inferior vena cava to control carcinoid symptoms. BMJ Case Rep 2017; 2017:bcr-2017-220888. [PMID: 29066637 PMCID: PMC5665334 DOI: 10.1136/bcr-2017-220888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Accepted: 10/05/2017] [Indexed: 11/04/2022] Open
Abstract
Severe carcinoid syndrome and carcinoid heart disease in neuroendocrine tumours can have a significant impact on a patient's quality of life and are a major cause of morbidity and mortality. We present a novel approach to managing a patient with medically uncontrollable carcinoid syndrome. Inferior and superior vena cava placement of transcatheter heart valves has been used to treat patients with right heart failure due to severe tricuspid and pulmonary regurgitation. However, this procedure has not been attempted to specifically reduce hormone secretion, primarily from the liver, in order to control carcinoid syndrome symptoms. We attempted this procedure in a patient with severe carcinoid disease and tricuspid regurgitation as a bridge to later definitive therapy. The procedure was technically successful, but did not improve carcinoid symptoms. The possible reasons for the failure are discussed here.
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Affiliation(s)
- Vandana M Sagar
- Department of Liver Medicine, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
| | - Richard P Steeds
- Department of Cardiology, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
| | - Sagar N Doshi
- Department of Cardiology, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
| | - Tahir Shah
- Department of Liver Medicine, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
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Martin GP, Sperrin M, Hulme W, Ludman PF, de Belder MA, Toff WD, Alabas O, Moat NE, Doshi SN, Buchan I, Deanfield JE, Gale CP, Mamas MA. Relative Survival After Transcatheter Aortic Valve Implantation: How Do Patients Undergoing Transcatheter Aortic Valve Implantation Fare Relative to the General Population? J Am Heart Assoc 2017; 6:JAHA.117.007229. [PMID: 29042426 PMCID: PMC5721896 DOI: 10.1161/jaha.117.007229] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Transcatheter aortic valve implantation (TAVI) is indicated for patients with aortic stenosis who are intermediate‐high surgical risk. Although all‐cause mortality rates after TAVI are established, survival attributable to the procedure is unclear because of competing causes of mortality. The aim was to report relative survival (RS) after TAVI, which accounts for background mortality risks in a matched general population. Methods and Results National cohort data (n=6420) from the 2007 to 2014 UK TAVI registry were matched by age, sex, and year to mortality rates for England and Wales (population, 57.9 million). The Ederer II method related observed patient survival to that expected from the matched general population. We modelled RS using a flexible parametric approach that modelled the log cumulative hazard using restricted cubic splines. RS of the TAVI cohort was 95.4%, 90.2%, and 83.8% at 30 days, 1 year, and 3 years, respectively. By 1‐year follow‐up, mortality hazards in the >85 years age group were not significantly different from those of the matched general population; by 3 years, survival rates were comparable. The flexible parametric RS model indicated that increasing age was associated with significantly lower excess hazards after the procedure; for example, by 2 years, a 5‐year increase in age was associated with 20% lower excess mortality over the general population. Conclusions RS after TAVI was high, and survival rates in those aged >85 years approximated those of a matched general population within 3 years. High rates of RS indicate that patients selected for TAVI tolerate the risks of the procedure well.
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Affiliation(s)
- Glen P Martin
- Farr Institute, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Matthew Sperrin
- Farr Institute, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - William Hulme
- Farr Institute, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | | | | | - William D Toff
- Department of Cardiovascular Sciences, Clinical Sciences Wing, Glenfield General Hospital, University of Leicester, United Kingdom.,National Institute for Health Research (NIHR) Leicester Cardiovascular Biomedical Research Unit, Leicester, United Kingdom
| | - Oras Alabas
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Neil E Moat
- Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Sagar N Doshi
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Iain Buchan
- Farr Institute, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - John E Deanfield
- National Institute for Cardiovascular Outcomes Research, University College London, London, United Kingdom
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Mamas A Mamas
- Farr Institute, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, United Kingdom .,Keele Cardiovascular Research Group, Institute of Applied Clinical Science and Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
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Ferro CJ, Law JP, Doshi SN, de Belder M, Moat N, Mamas M, Hildick-Smith D, Ludman P, Townend JN. Dialysis Following Transcatheter Aortic Valve Replacement: Risk Factors and Outcomes. JACC Cardiovasc Interv 2017; 10:2040-2047. [DOI: 10.1016/j.jcin.2017.05.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/02/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
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Kotronias RA, Kwok CS, George S, Capodanno D, Ludman PF, Townend JN, Doshi SN, Khogali SS, Généreux P, Herrmann HC, Mamas MA, Bagur R. Transcatheter Aortic Valve Implantation With or Without Percutaneous Coronary Artery Revascularization Strategy: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2017; 6:JAHA.117.005960. [PMID: 28655733 PMCID: PMC5669191 DOI: 10.1161/jaha.117.005960] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Recent recommendations suggest that in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation and coexistent significant coronary artery disease, the latter should be treated before the index procedure; however, the evidence basis for such an approach remains limited. We performed a systematic review and meta‐analysis to study the clinical outcomes of patients with coronary artery disease who did or did not undergo revascularization prior to transcatheter aortic valve implantation. Methods and Results We conducted a search of Medline and Embase to identify studies evaluating patients who underwent transcatheter aortic valve implantation with or without percutaneous coronary intervention. Random‐effects meta‐analyses with the inverse variance method were used to estimate the rate and risk of adverse outcomes. Nine studies involving 3858 participants were included in the meta‐analysis. Patients who underwent revascularization with percutaneous coronary intervention had a higher rate of major vascular complications (odd ratio [OR]: 1.86; 95% confidence interval [CI], 1.33–2.60; P=0.0003) and higher 30‐day mortality (OR: 1.42; 95% CI, 1.08–1.87; P=0.01). There were no differences in effect estimates for 30‐day cardiovascular mortality (OR: 1.03; 95% CI, 0.35–2.99), myocardial infarction (OR: 0.86; 95% CI, 0.14–5.28), acute kidney injury (OR: 0.89; 95% CI, 0.42–1.88), stroke (OR: 1.07; 95% CI, 0.38–2.97), or 1‐year mortality (OR: 1.05; 95% CI, 0.71–1.56). The timing of percutaneous coronary intervention (same setting versus a priori) did not negatively influence outcomes. Conclusions Our analysis suggests that revascularization before transcatheter aortic valve implantation confers no clinical advantage with respect to several patient‐important clinical outcomes and may be associated with an increased risk of major vascular complications and 30‐day mortality. In the absence of definitive evidence, careful evaluation of patients on an individual basis is of paramount importance to identify patients who might benefit from elective revascularization.
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Affiliation(s)
- Rafail A Kotronias
- Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom.,Oxford University Clinical Academic Graduate School, Oxford University, Oxford, United Kingdom
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom.,The Heart Centre, Royal Stoke Hospital, University Hospital of North Midlands Trust, Stoke-on-Trent, United Kingdom
| | - Sudhakar George
- Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom.,The Heart Centre, Royal Stoke Hospital, University Hospital of North Midlands Trust, Stoke-on-Trent, United Kingdom
| | - Davide Capodanno
- Cardio-Thoracic-Vascular Department, Ferrarotto Hospital University of Catania, Italy
| | - Peter F Ludman
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Jonathan N Townend
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Sagar N Doshi
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Saib S Khogali
- The Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | - Philippe Généreux
- Cardiovascular Research Foundation, New York, NY.,Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY.,Morristown Medical Center, Morristown, NJ
| | - Howard C Herrmann
- Cardiology Division, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom.,The Heart Centre, Royal Stoke Hospital, University Hospital of North Midlands Trust, Stoke-on-Trent, United Kingdom
| | - Rodrigo Bagur
- Keele Cardiovascular Research Group, Institute for Applied Clinical Science and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom .,Division of Cardiology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Affiliation(s)
| | - Peter F Ludman
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham B15 2TH, UK
| | - Sagar N Doshi
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham B15 2TH, UK
| | - Hamid Khan
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham B15 2TH, UK
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Fryearson J, Edwards NC, Doshi SN, Steeds RP. The role of TTE in assessment of the patient before and following TAVI for AS. Echo Res Pract 2016; 3:R19-34. [PMID: 27249549 PMCID: PMC4989100 DOI: 10.1530/erp-16-0004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 04/06/2016] [Accepted: 04/13/2016] [Indexed: 12/12/2022] Open
Abstract
Transcatheter aortic valve implantation is now accepted as a standard mode of treatment for an increasingly large population of patients with severe aortic stenosis. With the availability of this technique, echocardiographers need to be familiar with the imaging characteristics that can help to identify which patients are best suited to conventional surgery or transcatheter aortic valve implantation, and what parameters need to be measured. This review highlights the major features that should be assessed during transthoracic echocardiography before presentation of the patient to the 'Heart Team'. In addition, this review summarises the aspects to be considered on echocardiography during follow-up assessment after successful implantation of a transcatheter aortic valve.
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Affiliation(s)
- John Fryearson
- University Hospital Birmingham NHS Foundation Trust & Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham
| | - Nicola C Edwards
- University Hospital Birmingham NHS Foundation Trust & Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham
| | - Sagar N Doshi
- University Hospital Birmingham NHS Foundation Trust & Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham
| | - Richard P Steeds
- University Hospital Birmingham NHS Foundation Trust & Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham
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Moody WE, Hübscher SG, Rooney SJ, Doshi SN. Intracardiac ectopic liver mimicking atrial myxoma--An unusual cause for a right atrial mass. Int J Cardiol 2016; 209:210-2. [PMID: 26896625 DOI: 10.1016/j.ijcard.2016.02.055] [Citation(s) in RCA: 6] [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: 01/20/2016] [Accepted: 02/02/2016] [Indexed: 01/31/2023]
Affiliation(s)
- William E Moody
- Department of Cardiology, Nuffield House, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK.
| | - Stefan G Hübscher
- Institute of Immunology & Immunotherapy, University of Birmingham, Department of Cellular Pathology, Queen Elizabeth Hospital, Birmingham B15 2WB, UK
| | - Stephen J Rooney
- Department of Cardiology, Nuffield House, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK
| | - Sagar N Doshi
- Department of Cardiology, Nuffield House, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK
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Mechery A, Jordan PJ, Doshi SN, Khan SQ. Retrieval of a stuck Rotablator burr ("Kokeshi phenomenon") and successful percutaneous coronary intervention. J Cardiol Cases 2015; 13:90-92. [PMID: 30546615 DOI: 10.1016/j.jccase.2015.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/06/2015] [Accepted: 10/28/2015] [Indexed: 11/25/2022] Open
Abstract
We report the case of a 74-year-old man having angioplasty following admission with a troponin positive acute coronary syndrome. Due to heavy coronary artery calcification, rotablation was used. The procedure was complicated by a stuck burr ("Kokeshi phenomenon"). We employed a novel method to safely remove the burr and complete the procedure. <Learning objective: Various methods have been described for the retrieval of an entrapped Rotablator burr; we show in this case that deep engagement of guiding catheter and manual traction is a safe and effective method for retrieval.>.
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Affiliation(s)
- Anthony Mechery
- Department of Interventional Cardiology, University Hospitals Birmingham, Birmingham, UK
| | - Paul J Jordan
- Department of Interventional Cardiology, University Hospitals Birmingham, Birmingham, UK
| | - Sagar N Doshi
- Department of Interventional Cardiology, University Hospitals Birmingham, Birmingham, UK
| | - Sohail Q Khan
- Department of Interventional Cardiology, University Hospitals Birmingham, Birmingham, UK
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40
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Burzotta F, Trani C, Doshi SN, Townend J, van Geuns RJ, Hunziker P, Schieffer B, Karatolios K, Møller JE, Ribichini FL, Schäfer A, Henriques JP. Impella ventricular support in clinical practice: Collaborative viewpoint from a European expert user group. Int J Cardiol 2015; 201:684-91. [DOI: 10.1016/j.ijcard.2015.07.065] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/25/2015] [Indexed: 02/03/2023]
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Khan JN, Doshi SN, Rooney SJ, Bhabra MS, Steeds RP. Transcatheter pulmonary and tricuspid valve-in-valve replacement for bioprosthesis degeneration in carcinoid heart disease. Eur Heart J Cardiovasc Imaging 2015; 17:114. [PMID: 26497736 DOI: 10.1093/ehjci/jev279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jamal N Khan
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Medical Centre, Edgbaston, Birmingham B15 2TH, UK
| | - Sagar N Doshi
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Medical Centre, Edgbaston, Birmingham B15 2TH, UK
| | - Stephen J Rooney
- Department of Cardiac Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Medical Centre, Birmingham B15 2TH, UK
| | - Moninder S Bhabra
- Department of Cardiac Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Medical Centre, Birmingham B15 2TH, UK
| | - Richard P Steeds
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Medical Centre, Edgbaston, Birmingham B15 2TH, UK
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Abstract
In an effort to improve outcomes in percutaneous coronary intervention (PCI), percutaneous ventricular assist devices (PVADs) have been investigated in (1) high-risk PCI, (2) acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) and (3) in AMI without CS. PCI has become an increasing complex due to an ageing population with complex disease and the frequent presence of impaired LV function. Patients undergoing high-risk PCI in these circumstances are prone to acute cardiovascular collapse. Additionally, mortality in AMI complicated by CS remains high. Lastly, LV support during AMI may reduce infarct size and therefore preserve LV function. At present, four commercially available devices exist: intra-aortic balloon pump counterpulsation (IABP), Impella, TandemHeart and extracorporeal membrane oxygenation (ECMO). These devices are employed in an effort to increase cardiac output, mean arterial pressure (MAP) and coronary perfusion and to reduce pulmonary capillary wedge pressure (PCWP). The mechanism of action differs with each device, and there are advantages and disadvantages. In this update, we discuss recent data describing the use of PVADs to support patients with AMI with or without cardiogenic shock and during high-risk PCI. We focus on the unique features of each device, highlighting strengths, weaknesses and frequently encountered complications, which may be important when tailoring the most appropriate PVAD therapy to an individual patient's need.
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Affiliation(s)
- Jon Spiro
- Department of Cardiology, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
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Spiro J, Venugopal V, Raja Y, Ludman PF, Townend JN, Doshi SN. Feasibility and efficacy of the 2.5 L and 3.8 L impella percutaneous left ventricular support device during high-risk, percutaneous coronary intervention in patients with severe aortic stenosis. Catheter Cardiovasc Interv 2014; 85:981-9. [DOI: 10.1002/ccd.25355] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 08/26/2013] [Revised: 12/20/2013] [Accepted: 01/03/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Jon Spiro
- Interventional Cardiology Department; Queen Elizabeth Hospital Birmingham; Edgbaston Birmingham United Kingdom B15 2WB
| | - Vinod Venugopal
- Interventional Cardiology Department; Queen Elizabeth Hospital Birmingham; Edgbaston Birmingham United Kingdom B15 2WB
| | - Yogesh Raja
- Interventional Cardiology Department; Queen Elizabeth Hospital Birmingham; Edgbaston Birmingham United Kingdom B15 2WB
| | - Peter F. Ludman
- Interventional Cardiology Department; Queen Elizabeth Hospital Birmingham; Edgbaston Birmingham United Kingdom B15 2WB
| | - Jonathan N. Townend
- Interventional Cardiology Department; Queen Elizabeth Hospital Birmingham; Edgbaston Birmingham United Kingdom B15 2WB
| | - Sagar N. Doshi
- Interventional Cardiology Department; Queen Elizabeth Hospital Birmingham; Edgbaston Birmingham United Kingdom B15 2WB
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Moody WE, Chue CD, Ludman PF, Chan YKC, Narayan G, Millington JM, Townend JN, Doshi SN. Bleeding outcomes after routine transradial primary angioplasty for acute myocardial infarction using eptifibatide and unfractionated heparin: A single-center experience following the HORIZONS-AMI trial. Catheter Cardiovasc Interv 2013; 82:E138-47. [DOI: 10.1002/ccd.24703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 09/11/2012] [Accepted: 10/07/2012] [Indexed: 11/07/2022]
Affiliation(s)
- William E. Moody
- Department of Cardiovascular Medicine; Nuffield House; Queen Elizabeth Hospital Birmingham; Edgbaston; Birmingham, B15 2TH; United Kingdom
| | - Colin D. Chue
- Department of Cardiovascular Medicine; Nuffield House; Queen Elizabeth Hospital Birmingham; Edgbaston; Birmingham, B15 2TH; United Kingdom
| | - Peter F. Ludman
- Department of Cardiovascular Medicine; Nuffield House; Queen Elizabeth Hospital Birmingham; Edgbaston; Birmingham, B15 2TH; United Kingdom
| | - Yik-ki C. Chan
- Department of Cardiovascular Medicine; Nuffield House; Queen Elizabeth Hospital Birmingham; Edgbaston; Birmingham, B15 2TH; United Kingdom
| | - Gautam Narayan
- Department of Cardiovascular Medicine; Nuffield House; Queen Elizabeth Hospital Birmingham; Edgbaston; Birmingham, B15 2TH; United Kingdom
| | - Jenna M. Millington
- Department of Cardiovascular Medicine; Nuffield House; Queen Elizabeth Hospital Birmingham; Edgbaston; Birmingham, B15 2TH; United Kingdom
| | - Jonathan N. Townend
- Department of Cardiovascular Medicine; Nuffield House; Queen Elizabeth Hospital Birmingham; Edgbaston; Birmingham, B15 2TH; United Kingdom
| | - Sagar N. Doshi
- Department of Cardiovascular Medicine; Nuffield House; Queen Elizabeth Hospital Birmingham; Edgbaston; Birmingham, B15 2TH; United Kingdom
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Roos JB, Doshi SN, Konorza T, Palacios I, Schreiber T, Borisenko OV, Henriques JPS. The cost-effectiveness of a new percutaneous ventricular assist device for high-risk PCI patients: mid-stage evaluation from the European perspective. J Med Econ 2013; 16:381-90. [PMID: 23301850 DOI: 10.3111/13696998.2012.762004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE A new and smaller percutaneous ventricular assist device (pVAD, Impella, Abiomed, Danvers, MA) has been developed to provide circulatory support in hemodynamically unstable patients and to prevent hemodynamic collapse during high-risk percutaneous coronary interventions (PCI). The objective of the study was to assess the cost-effectiveness of this specific device compared to the intra-aortic balloon pump (IABP) from the European perspective. Additional analysis on extracorporeal membrane oxygenation was conducted for observational purposes only, given its use in some European countries. METHODS A combination of a decision tree and Markov model was developed to assess the cost-effectiveness of the small, pVAD. The short-term (30-day) effectiveness and safety (early survival, risk of bleeding, and stroke) were modeled, as well as long-term risk of major adverse cardiovascular events (recurrent myocardial infarction, stroke, and heart failure). The short-term effectiveness and safety data for the device were obtained from two registries (the Europella and USpella), both of which are large multi-center studies in high-risk patient groups. Probabilities of long-term major adverse cardiovascular events were obtained from various published clinical studies. The economic analysis was conducted from a German statutory health insurance perspective and only direct medical costs were included. Cost-effectiveness was estimated over a 10-year time horizon. RESULTS Compared with IABP, the pVAD generated an incremental quality-adjusted life-year (QALY) of 0.22 (with Euro-registry data) and 0.27 (with US-registry data). The incremental cost-effectiveness ratio (ICER) of the device varied between €38,069 (with Euro-registry data) and €31,727 (with US-registry data) per QALY compared with IABP. KEY LIMITATIONS Unadjusted, indirect comparisons of short-term effectiveness and safety between the interventions were used in the model. Cost and utility data were retrieved from various sources. Therefore, differences in patient populations may bias the estimated cost-effectiveness. CONCLUSIONS Compared with IABP, the pVAD is a cost-effective intervention for high-risk PCI patients, with ICERs well-below the conventional cost-effectiveness threshold.
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Raja Y, Trevelyan J, Doshi SN. Intramural hemotoma presenting as acute coronary syndrome: The importance of intravascular ultrasound. Cardiol J 2012; 19:323-5. [DOI: 10.5603/cj.2012.0058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Spiro J, Nadeem A, Doshi SN. Delayed left main stem obstruction following successful TAVI with an Edwards SAPIEN XT valve: successful resuscitation and percutaneous coronary intervention using a non-invasive automated chest compression device (AutoPulse). J Invasive Cardiol 2012; 24:224-228. [PMID: 22562917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Acute coronary artery obstruction at the time of device implantation is a recognized, albeit rare, complication of TAVI and is most frequently managed by emergency percutaneous intervention. This complication usually manifests with circulatory collapse due to compromising left ventricular ischemia and is most often observed immediately following valve deployment in the catheter laboratory or in theater. Immediate circulatory support is often necessary. We describe the first report of delayed left main stem obstruction 3.5 hours after successful deployment of a 26 mm Edwards SAPIEN XT valve via transfemoral implantation, with sudden development of circulatory collapse on the ward. Circulatory support was rapidly and effectively instituted with an automated non-invasive cardiac massage device, AutoPulse, that delivers continuous chest compressions. Successful emergency percutaneous intervention was then undertaken to the left main stem to displace a calcified nodule during automated external cardiac massage with the AutoPulse.
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Affiliation(s)
- Jon Spiro
- Department of Interventional Cardiology, Queen Elizabeth University Hospital, Birmingham, United Kingdom
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Raja Y, Doshi SN, Townend JN. Kissing drug eluting balloons for in-stent restenosis complicating bifurcations treated with drug-eluting stents. Catheter Cardiovasc Interv 2012; 79:392-6. [DOI: 10.1002/ccd.23256] [Citation(s) in RCA: 2] [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: 01/17/2011] [Accepted: 05/26/2011] [Indexed: 11/11/2022]
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Raja Y, Mascaro J, Doshi SN. Successful implantation of the edwards sapien THV via direct aortic access in a patient with previous pneumonectomy and no other access. Catheter Cardiovasc Interv 2011; 78:1008-12. [DOI: 10.1002/ccd.23115] [Citation(s) in RCA: 6] [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: 12/30/2010] [Accepted: 03/07/2011] [Indexed: 11/10/2022]
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Affiliation(s)
- Yogesh Raja
- Department of Interventional Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
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