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Yoon SH, Amoah JK, Galo J, Dallan LAP, Arruda M, Rashid I, Rajagopalan S, Filby SJ. Incidence, progression, and predictors of left atrial appendage sealing after Watchman FLX device implantation with computed tomographic assessment. Catheter Cardiovasc Interv 2024. [PMID: 38662126 DOI: 10.1002/ccd.31044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/13/2024] [Accepted: 03/31/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Limited data exists regarding incidence, progression, and predictors of left atrial appendage (LAA) sealing after transcatheter LAA closure. We aimed to evaluate the incidence, progression, and predictive factors associated with LAA sealing after LAA closure. METHODS This study includes patients who underwent successful LAA closure with Watchman FLX device and had both pre- and postprocedural computed tomography (CT). Postprocedural CT was performed 45 days after LAA closure and used to evaluate residual LAA patency. Patient who had residual LAA patency at 45 days underwent 1-year follow-up CT. RESULTS A total of 105 patients (mean age: 75.2 ± 9.6 years; 53.3% female) who underwent successful LAA closure with Watchman FLX device and had pre- and postprocedural CT at 45 days were included. Residual patency was observed in 35 (33.3%) patients: 21 (20.0%) patients showed complete contrast opacification in LAA (complete LAA patency) while 14 (13.3%) patients showed contrast opacification only in the distal LAA (distal LAA patency). Among patients with residual LAA patency at 45 days, the rate of LAA sealing at 1 year was significantly higher in the distal LAA patency group than in the complete LAA patency group (75.0% vs. 16.7%; p = 0.019). Increased depth oversizing was associated with both distal LAA patency and complete LAA patency. CONCLUSION Postprocedural CT at 45 days detected patent LAA in one-third of patients after LAA closure. LAA sealing was more frequently observed at 1 year among the distal LAA patency group than the complete LAA patency group.
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Affiliation(s)
- Sung-Han Yoon
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Medicine, Division of Structural Heart Disease, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Joseph Kofi Amoah
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jason Galo
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Luis Augusto Palma Dallan
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Mauricio Arruda
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Imran Rashid
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sanjay Rajagopalan
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Steven J Filby
- Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Milioglou I, Gillombardo CB, Li J, Filby SJ, Deo S, Al-Kindi S. Percutaneous vs surgical revascularization in left main coronary artery disease: A restricted mean survival time analysis of randomized trials. Cardiovasc Revasc Med 2024; 61:93-94. [PMID: 38065714 DOI: 10.1016/j.carrev.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 04/02/2024]
Affiliation(s)
- Ioannis Milioglou
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, United States of America
| | - Carl B Gillombardo
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, United States of America
| | - Jun Li
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, United States of America
| | - Steven J Filby
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, United States of America
| | - Salil Deo
- Surgical Services, Louis Stokes VA Hospital, Cleveland, OH, United States of America; School of Medicine, Case Western Reserve University, Cleveland, OH, United States of America.
| | - Sadeer Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, United States of America; School of Medicine, Case Western Reserve University, Cleveland, OH, United States of America.
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Feroze R, Ullah W, Kang P, Lobo T, Alhabdan N, Alghammass M, Yoon SH, Dallan LAP, Filby SJ. Percutaneous left atrial appendage occlusion in mitral valve disease: A nationwide readmission database analysis. Cardiovasc Revasc Med 2024:S1553-8389(24)00008-3. [PMID: 38267285 DOI: 10.1016/j.carrev.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Percutaneous left atrial appendage occlusion (LAAO) has emerged as a non-pharmacologic alternative to oral anticoagulation in reducing stroke risk in AF patients. However, patients with mitral valve disease (MVD), who are expected to have a significantly greater risk of left atrium (LA) thrombus formation and embolic stroke were excluded from randomized trials examining percutaneous LAAO. To address this gap, we present a national registry analysis of the use of LAAO among patients with MVD. METHODS Using the National Readmissions Database, we performed a retrospective review of all hospitalizations for LAAO identified between September 2015 and November 2019. Of these, patients with ICD-10 codes for MVD were identified. Propensity matched (PSM) analysis was used to compare patients with MVD with a matched sample of patients undergoing LAAO with non-valvular AF. Outcomes examined included all-cause mortality, stroke, major bleeding, pericardial effusion (PE), and tamponade. RESULTS 51,540 patients who underwent LAAO without a history of MVD and 3777 with a history of MVD were identified. Crude analysis demonstrated the odds of mortality, PE, and cardiac tamponade during index hospitalization to be higher in the MVD group. The length of stay and cost of index hospitalization were also slightly greater for the MVD group. A sample of 7649 patients (MVD: 3777 MVD and no MVD: 3872) were selected for PSM analysis with similar comorbidities across the two groups. In the PSM comparison, MVD was associated with higher risk of PE. The MVD group had a slightly higher rate of readmissions the association with PE remained at 30-day readmission (OR: 2.099 [1.360-3.238], p-value: <0.001). CONCLUSION To our knowledge, this is the first study examining the use of LAAO among MVD patients. Our findings suggest that patients with MVD who underwent LAAO had a higher risk of post-procedural PE without an increase in mortality, stroke, or major bleeding. These results provide a rationale for considering LAAO as part of the stroke prevention strategy among patients with valvular AF.
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Affiliation(s)
- Rafey Feroze
- Division of Cardiology, University Hospitals, Cleveland, OH, United States of America
| | - Waqas Ullah
- Department of Cardiology, Thomas Jefferson Hospitals, Philadelphia, PA, United States of America
| | - Puneet Kang
- Division of Internal Medicine, University Hospitals, Cleveland, OH, United States of America
| | - Tabitha Lobo
- Division of Internal Medicine, University Hospitals, Cleveland, OH, United States of America
| | - Nawaf Alhabdan
- Division of Internal Medicine, University Hospitals, Cleveland, OH, United States of America
| | - Mohammed Alghammass
- Division of Cardiology, University Hospitals, Cleveland, OH, United States of America
| | - Sung-Han Yoon
- Division of Cardiology, University Hospitals, Cleveland, OH, United States of America; Structural and Congenital Heart Center, Hackensack Meridian School of Medicine, Hackensack University Medical Center, Hackensack, NJ, United States of America
| | | | - Steven J Filby
- Division of Cardiology, University Hospitals, Cleveland, OH, United States of America.
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Yoon SH, Elgendy AY, Dallan LAP, Filby SJ. Amulet device implantation following incomplete left atrial appendage closure with Watchman legacy device. Catheter Cardiovasc Interv 2024; 103:226-229. [PMID: 37870093 DOI: 10.1002/ccd.30864] [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: 03/26/2023] [Revised: 08/17/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
Peri-device leak after left atrial appendage closure (LAAC) is often treated with endovascular coils, plugs, or second occluders. This is the first study reporting the Amulet device used for peri-device leak. An 80-year-old male with paroxysmal atrial fibrillation and recurrent falls with head trauma who underwent LAAC with a 24 mm Watchman 2.5 device 3 years ago at another institution was referred to our clinic for management of the peri-device leak. Transesophageal echocardiogram showed persistent residual peri-device leak with 5 mm width along the Coumadin ridge aspect of the device. Computed tomography (CT) also showed the peri-device leak with width of 6 mm and complete opacification of left atrial appendage (LAA). Importantly, CT demonstrated that the Watchman 2.5 device was deployed at distal LAA, leaving the proximal part of LAA with length of 10 mm from ostium. Under general anesthesia, a 22 mm Amulet device was deployed successfully with complete sealing of LAA. Procedure planning is the key to minimize the risk of peri-device leak or device-related thrombosis. Careful assessment of LAA anatomy using multimodality images for peri-device leak after LAAC helped optimal treatment strategy including second LAAC with different type of devices.
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Affiliation(s)
- Sung-Han Yoon
- University Hospitals Cleveland Medical Center, Harrington Heart and Vascular Institute, Cleveland, Ohio, USA
| | - Akram Y Elgendy
- University Hospitals Cleveland Medical Center, Harrington Heart and Vascular Institute, Cleveland, Ohio, USA
| | - Luis Augusto Palma Dallan
- University Hospitals Cleveland Medical Center, Harrington Heart and Vascular Institute, Cleveland, Ohio, USA
| | - Steven J Filby
- University Hospitals Cleveland Medical Center, Harrington Heart and Vascular Institute, Cleveland, Ohio, USA
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Rana MA, Yoon S, Dallan LAP, Tashtish N, Attizzani GF, Rashid I, Rajagopalan S, Arruda M, Filby SJ. Midterm follow-up after computed tomography angiography planned left atrial appendage closure. Catheter Cardiovasc Interv 2024; 103:129-136. [PMID: 37786977 DOI: 10.1002/ccd.30843] [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: 02/27/2023] [Revised: 07/25/2023] [Accepted: 08/31/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND While studies have shown the advantages of computed tomography angiography (CTA) over transesophageal echocardiography (TEE) in left atrial appendage closure (LAAC) preprocedural planning for WATCHMAN™ legacy and FLX devices, there has been no reported long-term data for this approach. OBJECTIVES We sought to evaluate long-term outcomes using CTA-based preprocedural planning for LAAC using the WATCHMAN™ device. METHODS A prospective analysis of 231 consecutive patients who underwent LAAC in a single, large academic hospital in the United States was conducted over a 5-year period. CTA-guided preprocedural planning was performed in all. Procedural success, adverse events, length of procedure, number of devices used, and length of stay were evaluated. Rates of death, cerebral embolism, systemic embolism, and major and minor bleeding were recorded. Adjusted predicted stroke and major bleeding rates were derived from CHA2DS2-Vasc and HAS-BLED scores, respectively. RESULTS From January 26, 2017, to November 23, 2021, 231 patients underwent LAAC with CTA preprocedural planning by two operating physicians. The mean age of patients was 76.5 ± 8.4. 59.7% of patients were male. Mean CHA2DS2VASc and HAS-BLED scores were 4.5 ± 1.4 and 3.9 ± 0.9, respectively. All procedures were performed with intracardiac echo (100%). The procedural success rate was 99.1%. The CTA sizing strategy accurately predicted the implant size in 93.5% of patients. Mean number of devices used was 1.10 ± 0.3. Peri-procedural complication rate was 2.2%. 6 patients were lost to follow-up. Mean follow-up was 608.94 days with a total of 377.04 patient years. Median follow-up period of 368 days (interquartile range: 209-1067 days). There were 51 deaths from all causes (13.52 per 100 patient-years), 10 cases of cerebral embolism (2.65 per 100 patient-years), 2 cases of systemic embolism (0.53 per 100 patient-years), 17 cases of major bleeding (4.50 per 100 patient-years), and 31 cases of minor bleeding (8.2 per 100 patient-years). All-cause mortality at 1, 2, and 3 years was 12.7%, 20.9%, and 29.2%, respectively. CV event rates at 1, 2, and 3 years were 2.1%, 6.6%, and 10.5%, respectively. CONCLUSIONS CTA-based preprocedural planning is accurate in predicting device size for LAAC and associated with excellent clinical outcomes at 5 years.
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Affiliation(s)
- Mohammad Atif Rana
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sunghan Yoon
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Luis Augusto Palma Dallan
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Nour Tashtish
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Guilherme F Attizzani
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Imran Rashid
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sanjay Rajagopalan
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Mauricio Arruda
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Steven J Filby
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Arafah A, Pham R, Filby SJ. Left Main Coronary Artery and Bilateral Mammary Artery Aneurysms in a Patient With Extensive Aortopathy. Tex Heart Inst J 2023; 50:e238248. [PMID: 38054351 PMCID: PMC10751475 DOI: 10.14503/thij-23-8248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Affiliation(s)
- Ala’ Arafah
- Division of Internal Medicine, Case Western Reserve University, and University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Richard Pham
- Division of Cardiovascular Medicine, University Hospitals Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Steven J. Filby
- Division of Cardiovascular Medicine, University Hospitals Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Ullah W, Sarvepalli D, Kumar A, Zahid S, Saleem S, Muhammadzai HZU, Khattak F, Block PC, Jaber WA, Shishehbor MH, Filby SJ, Devireddy C. Trends and outcomes of combined percutaneous (TAVI+PCI) and surgical approach (SAVR+CABG) for patients with aortic valve and coronary artery disease: A National Readmission Database (NRD) analysis. Catheter Cardiovasc Interv 2023; 102:946-957. [PMID: 37698396 DOI: 10.1002/ccd.30832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND In patients with severe aortic stenosis (AS) and concomitant severe coronary artery disease (CAD), the relative merits of a combined percutaneous (transcatheter aortic valve implantation [TAVI] and percutaneous coronary intervention [PCI]] versus surgical approach (surgical aortic valve replacement [SAVR] and coronary artery bypass graft [CABG]) remain unknown. AIMS To determine the utility of combined percutaneous versus surgical approaches in patients with severe AS and CAD. METHODS The National Readmission Database (NRD) (2015-2019) was queried to identify all cases of TAVI+PCI and SAVR+CABG. The adjusted odds ratios (aOR) of mortality, stroke, and its composite (major adverse cardiovascular events [MACE]) were calculated using a propensity-score matched (PSM) analysis. RESULTS A total of 89,314 (5358 TAVI+PCI, 83,956 SAVR+CABG) patients were included in the crude analysis. There was a gradual increase in the utilization of TAVI+PCI from 2016 to 2019 by 2%-4% per year. Using PSM, a subset of 11,361 (5358 TAVI+PCI, 6003 SAVR+CABG) patients with a balanced set of demographics and baseline comorbidities was selected. During index hospitalization, the adjusted odds of MACE (aOR 0.72, 95% confidence interval [CI] 0.62-0.83), and all-cause mortality (aOR 0.68, 95% CI 0.57-0.81) were significantly lower in patients undergoing TAVI+PCI compared with SAVR+CABG. However, patients undergoing TAVI+PCI had a higher incidence of MACE (aOR 1.40, 95% CI 1.05-1.87), and mortality (aOR 1.75, 95% CI 1.22-2.50) at 30-days. The risk of index-admission (aOR 0.82, 95% CI 0.62-1.09) and 30-day (aOR 0.88, 95% CI 0.51-1.51) stroke was similar between the two groups. CONCLUSION In selected patients with severe AS and concomitant CAD, a combined percutaneous approach (TAVR+PCI) compared with SAVR+CABG may confer a lower risk of MACE and mortality during index admission but a higher incidence of 30-day complications.
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Affiliation(s)
- Waqas Ullah
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | - Arnav Kumar
- Brigham and Women's Hospital Heart & Vascular Center, Boston, Massachusetts, USA
| | - Salman Zahid
- Rochester General Hospital, Rochester, New York, USA
| | - Sameer Saleem
- University of Kentucky, Bowling Green, Kentucky, USA
| | | | - Furqan Khattak
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Peter C Block
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Wissam A Jaber
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mehdi H Shishehbor
- University Hospitals Harrington Heart and Vascular Institute, Cleveland, Ohio, USA
| | - Steven J Filby
- University Hospitals Harrington Heart and Vascular Institute, Cleveland, Ohio, USA
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Carneiro HA, Dallan LAP, Yoon SH, Arora S, Knezevich J, Wass S, Lobo T, Arruda M, Rashid I, Filby SJ. Efficacy of 3D-multidetector computed tomography and fluoroscopy fusion for percutaneous left atrial appendage occlusion procedures. J Cardiovasc Electrophysiol 2023; 34:2076-2083. [PMID: 37592406 DOI: 10.1111/jce.16035] [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: 05/15/2023] [Revised: 07/07/2023] [Accepted: 08/01/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION We studied the impact of the use of three-dimensional multidetector computed tomography (3D-MDCT) and fluoroscopy fusion on percutaneous left atrial appendage occlusion (LAAO) procedures in relation to procedure time, contrast volume, fluoroscopy time, and total radiation. METHODS This was a single-center, prospective, single-blinded, randomized control trial. Patients meeting criteria for LAAO were randomized to undergo LAAO with the WATCHMAN FLXTM device with and without 3D-MDCT-fluoroscopy fusion guidance using a prespecified protocol using computed tomography angiography for WATCHMAN FLXTM sizing, moderate sedation, and intracardiac echocardiography for procedural guidance. RESULTS Overall, 59 participants were randomly assigned to the fusion (n = 33) or no fusion (n = 26) groups. The median (interquartile range) age was 79 (75-83) years, 24 (41%) were female, and 55 (93%) were Caucasian. The median CHA2 DS2 VASc and HASBLED scores were 5 (4-6) and 3 (3-4), respectively. At the time of the study, 51 (53%) patients were on a direct acting oral anticoagulant. There were no significant differences between the fusion and no fusion groups in procedure time (52.4 ± 15.4 vs. 56.8 ± 19.5 min, p = .36), mean contrast volume used (33.8 ± 12.0 vs. 29.6 ± 11.5 mls, p = .19), mean fluoroscopy time (31.3 ± 9.9 vs. 28.9 ± 8.7 min, p = .32), mean radiation dose (1177 ± 969 vs. 1091 ± 692 mGy, p = .70), and radiation dose product curve (23.9 ± 20.5 vs. 35.0 ± 49.1 Gy cm2 , p = .29). There was no periprosthetic leak in the two groups in the immediate 1-month postprocedure follow-up periods. CONCLUSIONS There was no significant difference with and without 3D-MDCT-fluoroscopy fusion in procedure time, contrast volume use, radiation dose, and radiation dose product.
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Affiliation(s)
- Herman A Carneiro
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Luis A P Dallan
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sung-Han Yoon
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Shilpkumar Arora
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Juliana Knezevich
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sojin Wass
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Tabitha Lobo
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Mauricio Arruda
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Imran Rashid
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Steven J Filby
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Kumar S, Yoon S, Milioglou I, Tashtish N, Farmakis I, Dallan LAP, Mogalapalli A, Arruda M, Filby SJ. Left Atrial Appendage Closure Outcomes in Patients With Cancer at a Single Tertiary Center. Am J Cardiol 2023; 202:176-181. [PMID: 37441832 DOI: 10.1016/j.amjcard.2023.06.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/08/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023]
Abstract
Atrial fibrillation is the most common arrhythmia in patients with underlying malignancy. Patients with cancer have a higher risk of bleeding, and at the same time, carry an elevated risk of thromboembolism related to the hypercoagulable state, type of cancer, and anticancer treatment, rendering safe anticoagulation challenging in this population. Left atrial appendage closure is an alternative treatment option in patients with atrial fibrillation and high bleeding risk; however, the data on patients with cancer are limited. Our study aimed to compare the long-term outcomes in patients with cancer receiving left atrial appendage closure using the WATCHMAN device. This is a prospective, single-center study comparing outcomes in 389 patients who underwent percutaneous left atrial appendage closure using the WATCHMAN device over 5 years in a single, large academic hospital in the United States. The postprocedural outcomes of mortality, stroke, and major bleeding were evaluated in patients with and without cancer. Our study included 57 patients with cancer and 332 without cancer. The baseline characteristics were similar between the 2 groups. Metastatic disease was present in 16.4% of patients, and 25% were receiving active treatment at the time of the procedure. The median follow-up time was 354 (interquartile range 85 to 790) days. There was no difference in mortality (hazard ratio [HR] 1.3, 95% confidence interval [CI] 0.72 to 2.35, p = 0.38), major bleeding episodes (HR 1.2, 95% CI 0.45 to 3.33, p = 0.68), and stroke (HR 0.64, 95% CI 0.19 to 2.21, p = 0.49) at 3 years after the procedure in patients with and without cancer. There was no difference in the composite outcome (postprocedural mortality, stroke, and major bleeding) between the 2 groups (HR 1.25, CI 0.75 to 2.07, p = 0.38). Percutaneous left atrial appendage closure in patients with cancer appears to be safe and has a similar long-term risk compared with patients without cancer.
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Affiliation(s)
- Sundeep Kumar
- Division of Cardiology, Harrington Heart & Vascular Institute
| | - SungHan Yoon
- Division of Cardiology, Harrington Heart & Vascular Institute
| | - Ioannis Milioglou
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Nour Tashtish
- Division of Cardiology, Harrington Heart & Vascular Institute
| | - Ioannis Farmakis
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | | | - Akhil Mogalapalli
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Mauricio Arruda
- Division of Cardiology, Harrington Heart & Vascular Institute
| | - Steven J Filby
- Division of Cardiology, Harrington Heart & Vascular Institute.
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Khawaja T, Majmundar M, Zuzek Z, Arora S, Attizzani GF, Filby SJ, Abu-Omar Y, Shishehbor MH, Mackall JA, Ukaigwe A. Surgical and transcatheter left atrial appendage closure in patients with atrial fibrillation and hypertrophic cardiomyopathy. Europace 2023:7152739. [PMID: 37143414 DOI: 10.1093/europace/euad101] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/26/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF) are at increased stroke risk in comparison to those with non-valvular AF not affected by HCM. OBJECTIVES To investigate the role of left atrial appendage closure (LAAC) in patients with HCM and AF. METHODS AND RESULTS We identified patients with HCM and AF using the National Readmission Dataset. Patients were stratified based on LAAC status. The primary efficacy outcome was a composite of ischaemic and haemorrhagic stroke, TIA, and all-cause mortality. The primary safety outcome was a composite of major bleeding and pericardial complications. Patients were matched using inverse probability of treatment weighting. Cox-proportional hazard regression was applied to calculate the hazard ratio (HR) with a 95% confidence interval (CI) on matched cohorts. We identified 71 980 patients with HCM and AF. 1351 (1.9%) patients underwent LAAC. Two hundred and eighty-seven (21.2%) underwent transcatheter LAAC. LAAC was associated with a lower risk of the primary efficacy outcome (2.5% vs. 5.4%, HR: 0.38; 95% CI: 0.17-0.88; P = 0.024), the primary safety outcome (2.9% vs. 6.8%, HR: 0.39; 95% CI: 0.23-0.66, P = 0.001), and reduced major bleeding. The LAAC group trended towards a lower risk of ischaemic stroke and all-cause mortality. CONCLUSION Surgical and transcatheter LAAC was associated with a lower risk of haemorrhagic stroke and major bleeding.
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Affiliation(s)
- Tasveer Khawaja
- Department of Internal Medicine, Case Western Reserve University, University Hospitals, Cleveland, OH, USA
| | - Monil Majmundar
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Zachary Zuzek
- Division of Cardiovascular Health and Disease, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Shilpkumar Arora
- Department of Cardiology, Case Western Reserve University, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 5038, Cleveland, OH 44106, USA
| | - Guilherme F Attizzani
- Department of Cardiology, Case Western Reserve University, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 5038, Cleveland, OH 44106, USA
| | - Steven J Filby
- Department of Cardiology, Case Western Reserve University, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 5038, Cleveland, OH 44106, USA
| | - Yasir Abu-Omar
- Department of Cardiothoracic Surgery, Case Western Reserve University, University Hospitals, Cleveland, OH, USA
| | - Mehdi H Shishehbor
- Department of Cardiology, Case Western Reserve University, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 5038, Cleveland, OH 44106, USA
| | - Judith A Mackall
- Department of Cardiology, Case Western Reserve University, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 5038, Cleveland, OH 44106, USA
| | - Anene Ukaigwe
- Department of Cardiology, Case Western Reserve University, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 5038, Cleveland, OH 44106, USA
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Hibino M, Yoon SH, Dallan LAP, Pelletier MP, Rushing GD, Filby SJ, Elgudin Y, Ukaigwe AC, Baeza CR, Attizzani GF. Feasibility and Safety of Exclusive Noncontrast Computed Tomography for Planning of Transcatheter Aortic Valve Implantation With Self-Expandable Valves. Am J Cardiol 2023; 190:122-124. [PMID: 36623398 DOI: 10.1016/j.amjcard.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/08/2022] [Accepted: 12/18/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Makoto Hibino
- Divisions of Cardiac Surgery, Department of Surgery, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sung-Han Yoon
- Divisions of Cardiology, Department of Medicine, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Luis Augusto Palma Dallan
- Divisions of Cardiology, Department of Medicine, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Marc P Pelletier
- Divisions of Cardiac Surgery, Department of Surgery, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Gregory D Rushing
- Divisions of Cardiac Surgery, Department of Surgery, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Steven J Filby
- Divisions of Cardiology, Department of Medicine, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Yakov Elgudin
- Divisions of Cardiac Surgery, Department of Surgery, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Anene C Ukaigwe
- Divisions of Cardiology, Department of Medicine, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Cristian R Baeza
- Divisions of Cardiac Surgery, Department of Surgery, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Guilherme F Attizzani
- Divisions of Cardiology, Department of Medicine, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio.
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Palma Dallan LA, Yoon SH, Gabasha S, Rana MA, Galo J, Feroze R, Reed J, Rajagopalan S, Rashid I, Al-Kindi S, Filby SJ. CRT-700.42 Pivotal Protocol for Same-Day Discharge Using Cardiac Magnetic Resonance Pre-Procedural Planning for Left Atrial Appendage Closure. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.320] [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: 02/22/2023]
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13
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Mogalapalli A, Kumar S, Lobo T, Reed J, Dallan LAP, Yoon SH, Filby SJ. Delayed Pericardial Effusion Following Left Atrial Appendage Closure: A 5-Year Single-Center Experience. J Invasive Cardiol 2023; 35:E1-E6. [PMID: 36446576] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Though uncommon, pericardial effusion and cardiac tamponade are serious complications of left atrial appendage closure (LAAC). There are few data related to delayed pericardial effusions from this procedure. METHODS This is a single-center prospective analysis of 369 patients who underwent LAAC from December 2016 to March 2022 at a large teaching hospital. We compared patients who developed effusion (n = 5) to patients who did not (n = 364) to determine if there were any factors that predispose patients to developing acute (AEs) or delayed pericardial effusions (DEs). We compared patient characteristics, procedural data, and complications. Unadjusted, stepwise multivariate logistic regression was performed. RESULTS A total of 369 patients underwent LAAC. Of these, 5 patients (1.4%) developed pericardial effusion. Patients in both groups (pericardial effusion vs non-effusion) had similar patient and procedural characteristics. Patients in both groups were older (mean age, 78.4 ± 7.8 years in the effusion group vs 76.3 ± 8.5 years in the non-effusion group; P=.50) and white (60% in the effusion group vs 90.1% in the non-effusion group). CHA2DS2-VASc (4.2 ± 1.1 vs 4.5 ± 1.4; P=.67) and HAS-BLED (3.4 ± 0.5 vs 3.7 ± 0.9; P=.53) scores were similar in the effusion group vs the non-effusion group, respectively. Gastrointestinal bleeding was the most common procedural indication in both groups (80% in the effusion group vs 53.6% in the non-effusion group; P=.23). The majority of the patients in both groups had successful implantation in the first attempt, with the 27-mm device the most commonly used size. There was no significant difference in procedural duration (67 minutes in the effusion group vs 75 minutes in the non-effusion group; P=.16). Among patients who received the Watchman Legacy device, 2 patients developed AEs and no patients had DEs. Of those receiving the Watchman FLX device, 1 patient developed AE and 2 patients developed DEs. All of the patients with effusions had successful recovery. CONCLUSION In this 5-year, single-center experience, DEs were uncommon and potentially related to LAA device anchor microperforation. No statistically significant risk factors predisposing patients to pericardial effusions were identified in our analysis.
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Affiliation(s)
| | | | | | | | | | | | - Steven J Filby
- University Hospitals, Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 3rd floor, Cleveland, OH 44106 USA.
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Dallan LAP, Reed J, Yoon SH, Janus S, Rajagopalan S, Rashid I, Al-Kindi S, Filby SJ. Novel cardiac magnetic resonance imaging-based sizing for left atrial appendage closure. J Cardiovasc Electrophysiol 2022; 33:2649-2650. [PMID: 36300704 DOI: 10.1111/jce.15720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/10/2022] [Accepted: 10/06/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Luis Augusto Palma Dallan
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Joseph Reed
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sung-Han Yoon
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Scott Janus
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sanjay Rajagopalan
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Imran Rashid
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sadeer Al-Kindi
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Steven J Filby
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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15
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Wass SY, Galo J, Yoon SH, Dallan LAP, Mogalapalli A, Ukaigwe A, Attizani GF, Simon DI, Arruda M, Filby SJ. Predictors of successful same-day discharge and 1-year outcomes after left atrial appendage closure. Catheter Cardiovasc Interv 2022; 100:1307-1313. [PMID: 36316818 DOI: 10.1002/ccd.30464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/06/2022] [Accepted: 10/09/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Same-day discharge (SDD) following left atrial appendage closure (LAAC) is increasingly common but predictors of successful SDD and 1-year clinical outcomes have not been described. OBJECTIVE The purpose of this study was to explore predictors of successful SDD and report 1-year outcomes in patients undergoing LAAC with SDD. METHODS A prospective analysis was performed over a 20-month period of 225 consecutive patients that underwent LAAC in a large, academic hospital. All patients included in the study underwent a SDD protocol. Baseline characteristics and 1-year outcomes of patients discharged same day of the procedure versus those that required at least one overnight stay were compared. Adverse events, procedural success, and procedure times were evaluated. RESULTS One hundred and sixty-one patients (72%) of patients were discharged the same day and 64 patients (28%) required at least an overnight stay (non-SDD: NSDD). NSDD patients were older and more often female. Procedure time was also longer in the NSDD group than in the SDD (63.4 vs. 55.1 min; p = 0.01). While overall procedural success rates were similar between the SDD and NSDD groups (99.4% vs. 98.4%; p = 0.39), NSDD patients had more complications (9.4% vs. 0%; p = 0.01) and higher number of devices per procedure (1.2 vs. 1.0; p = 0.01) as compared to SDD. At 1 year, there were no significant difference between the SDD and NSDD groups in stroke (1.1% vs. 0%; log-rank p = 0.44) and all-cause mortality (3.9% vs. 4.7%; log-rank p = 0.70). CONCLUSION In this single-center LAAC experience, female sex, older age, and longer procedure duration were associated with higher likelihood for need of overnight stay. At 1-year follow-up, there were no significant differences in stroke events and death rates between SDD and NSDD groups.
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Affiliation(s)
- Sojin Youn Wass
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jason Galo
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sung-Han Yoon
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Luis A P Dallan
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Akhil Mogalapalli
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Anene Ukaigwe
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Guilherme F Attizani
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Daniel I Simon
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Mauricio Arruda
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Steven J Filby
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Dallan LAP, Rana MA, Arruda M, Yoon S, Filby SJ. Reply to: “Seize the day, …s(e)ize the device: The emerging imaging modality to improve left atrial appendage device sizing”. J Cardiovasc Electrophysiol 2022; 33:2419. [DOI: 10.1111/jce.15693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/23/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Luis Augusto Palma Dallan
- Division of Cardiology, Harrington Heart & Vascular InstituteUniversity Hospitals Cleveland Medical CenterClevelandOH44106United States
| | - Mohammad Atif Rana
- Division of Cardiology, Harrington Heart & Vascular InstituteUniversity Hospitals Cleveland Medical CenterClevelandOH44106United States
| | - Mauricio Arruda
- Division of Cardiology, Harrington Heart & Vascular InstituteUniversity Hospitals Cleveland Medical CenterClevelandOH44106United States
| | - Sung‐Han Yoon
- Division of Cardiology, Harrington Heart & Vascular InstituteUniversity Hospitals Cleveland Medical CenterClevelandOH44106United States
| | - Steven J. Filby
- Division of Cardiology, Harrington Heart & Vascular InstituteUniversity Hospitals Cleveland Medical CenterClevelandOH44106United States
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Khawaja T, Jaswaney R, Arora S, Jain A, Arora N, Augusto Palma Dallan L, Yoon S, Najeeb Osman M, Filby SJ, Attizzani GF. Transcatheter aortic valve replacement in patients with aortic stenosis and cardiac amyloidosis. IJC Heart & Vasculature 2022; 40:101008. [PMID: 35330979 PMCID: PMC8938882 DOI: 10.1016/j.ijcha.2022.101008] [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: 02/09/2022] [Revised: 03/09/2022] [Accepted: 03/15/2022] [Indexed: 11/21/2022]
Abstract
Background Though the co-prevalence of aortic stenosis (AS) and cardiac amyloidosis (CA) is increasingly recognized, the role of transcatheter aortic valve replacement (TAVR) in patients with CA remains unclear. Methods The National Readmission Dataset (2016–18) and ICD-10 codes were used to identify those with CA and AS, in conjunction with TAVR status. The primary outcome was a composite of heart failure (HF) readmissions and all-cause mortality. All outcomes were followed up to 1-year with a median follow up time 172-days. Kaplan-Meier curves and multivariate cox-proportional hazard regression were used for time-to-event analysis. Results Of 1,127 CA patients, 92 (8.2%) had undergone TAVR. Patients with CA who received TAVR were younger and more commonly had coronary artery disease (67.3% vs 44.2%). Teaching (93.6% vs 81.1%) and large hospitals (77.7% vs 59.3%) performed more TAVRs. In multivariate analysis, TAVR was associated with an improved primary outcome (8.9% vs 24.4%, HR:0.32; 95% CI 0.14–0.71, p = 0.007) and with reduced HF readmissions (3.8% vs 19.4%, HR:0.22; 95% CI 0.07–0.68, p = 0.008). All-cause mortality was numerically lower in TAVR patients with CA but did not reach statistical significance. Conclusions CA patients who receive TAVR are younger, and the procedure is more commonly performed at large, teaching hospitals. TAVR was associated with a lower primary composite outcome of HF readmissions and all-cause mortality.
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Palma Dallan LA, Yoon SH, Filby SJ. Dual Wire Technique for Transseptal Passage of Intracardiac Echocardiogram Probe During Left Atrium Appendage Closure. Struct Heart 2022; 6:100020. [PMID: 37273743 PMCID: PMC10236780 DOI: 10.1016/j.shj.2022.100020] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/02/2021] [Accepted: 12/13/2021] [Indexed: 06/06/2023]
Affiliation(s)
| | | | - Steven J. Filby
- Address correspondence to: Steven J. Filby, MD, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 3rd Floor, Cleveland, OH 44106
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Dallan LAP, Arruda M, Yoon SH, Rana MA, Mogalapalli A, Carneiro HA, Reed J, Rashid I, Rajagopalan S, Filby SJ. Novel Computed Tomography Angiography-Based Sizing Methodology for WATCHMAN FLX Device in Left Atrial Appendage Closure. J Cardiovasc Electrophysiol 2022; 33:1781-1787. [PMID: 35586899 DOI: 10.1111/jce.15548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/14/2022] [Accepted: 03/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND While there is recent data suggesting an advantage of Computed Tomography Angiography (CTA) over transesophageal echocardiography (TEE) for pre-procedural left atrial appendage closure (LAAC) planning, there is limited published experience for sizing strategies. Device sizing for LAAC may be challenging and non-invasive algorithms that improve this selection process are warranted. OBJECTIVES We sought to evaluate the safety and the feasibility for the implementation of a novel CTA-based sizing methodology for WATCHMAN™ FLX device in a series of patients undergoing LAAC using the TruPlan™ software package. METHODS A prospective analysis of 136 consecutive patients who underwent LAAC over a 12-month period in a single, large academic hospital in the United States was conducted. CTA-guided pre-procedural planning and intracardiac echocardiography (ICE) was performed in all. Procedural success, adverse events, length of procedure, number of devices used, and length of stay were evaluated. RESULTS A total of 136 patients who underwent LAAC procedure with WATCHMAN™ FLX platform between October 1, 2020 until September 30, 2021 were included. The pre-specified protocol using CTA and ICE was implemented in all patients (100%). Mean CHA2 DS2 VASc score was 4.4 ± 1.3 and the mean HAS-BLED score was 3.9 ± 0.8. ICE-guided 100% transseptal puncture success rate was 100% with 98.5% of overall procedural success rate. Pre-procedural CTA sizing strategy accurately predicted the implanted size in 91.1% of patients. Ten patients (7.4%) required another sized device and 2 cases were aborted. At 45-day follow-up, only 1 patient (0.7%) had significant peri-device leak (≥ 5mm) on TEE. CONCLUSIONS CTA-based pre-procedural sizing methodology for WATCHMAN™ FLX in LAAC was safe, feasible and associated with excellent procedural outcomes. Further studies are warranted to confirm if the features specific to TruPlan™ may reduce the number of deployment attempts, the number of devices utilized in the procedure, and the risk of complications. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Luis Augusto Palma Dallan
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106
| | - Mauricio Arruda
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106
| | - Sung-Han Yoon
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106
| | - Mohammad Atif Rana
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106
| | - Akhil Mogalapalli
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, 44106
| | - Herman A Carneiro
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106
| | - Joseph Reed
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, 44106
| | - Imran Rashid
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106
| | - Sanjay Rajagopalan
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106
| | - Steven J Filby
- Division of Cardiology, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106
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Milioglou I, Janko MR, Hassan HU, ElHaq M, Filby SJ, Pelletier MP. Idiopathic posterior papillary muscle rupture; a case report. BMC Cardiovasc Disord 2022; 22:151. [PMID: 35387586 PMCID: PMC8988393 DOI: 10.1186/s12872-022-02570-4] [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: 08/15/2021] [Accepted: 03/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Papillary muscle rupture is a rare condition. Its clinical presentation, diagnosis and management can be very challenging for the clinician. CASE PRESENTATION A 73-year-old woman with hypertension presented with chest pain, ST-segment changes, and elevated serum troponin levels. Coronary angiography was normal. Echocardiography revealed normal ventricular function, flail posterior mitral leaflet, and severe mitral regurgitation. She underwent emergent mitral valve replacement. CONCLUSION The diagnostic and management strategies of this uncommon presentation are discussed.
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Affiliation(s)
- Ioannis Milioglou
- Departments of Cardiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
| | - Matthew R Janko
- Departments of Cardiac Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Hafeez Ul Hassan
- Departments of Cardiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Mohammed ElHaq
- Departments of Pathology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Steven J Filby
- Departments of Cardiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Marc P Pelletier
- Departments of Cardiac Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
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21
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Palma Dallan LA, Rana MA, Yoon SH, Mogalapalli A, Carneiro H, Reed J, Rashid I, Rajagopalan S, Arruda M, Filby SJ. CRT-700.47 Novel Computed Tomography Angiography-Based Sizing Methodology for Watchman FLX Device in Left Atrial Appendage Closure. JACC Cardiovasc Interv 2022. [DOI: 10.1016/j.jcin.2022.01.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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22
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Dallan LAP, Bezerra HG, Cochet A, Kobayashi A, Attizzani GF, Rashid I, Rajagopalan S, Simon DI, Shishehbor MH, Arruda M, Filby SJ. Safety, Efficacy, and Cost-Effectiveness of Same-Day Discharge for Left Atrial Appendage Occlusion. J Invasive Cardiol 2022; 34:E124-E131. [PMID: 35100555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Percutaneous left atrial appendage occlusion (LAAO) with the Watchman device is FDA approved for stroke prevention in patients with nonvalvular atrial fibrillation who have an appropriate indication. During the COVID-19 pandemic, a same-day discharge protocol (SDDP) was employed to improve resource utilization, relieve hospital occupation, and reduce the possible risk of in-hospital virus transmission. OBJECTIVES We sought to analyze the safety, feasibility, and cost effectiveness for SDDP in patients receiving LAAO. METHODS A prospective analysis of 142 consecutive patients, 119 treated prior to SDDP and 23 who underwent SDDP following LAAO with cardiac computed tomography angiography (CTA)-guided pre-procedural planning and intracardiac echocardiogram (ICE). Procedures were performed in a single, large academic hospital in the United States. In-hospital and 45-day procedural success, adverse events, length of procedure, and length-of-stay were evaluated. RESULTS Baseline patient characteristics including mean CHA2DS2VASc scores and mean HAS-BLED scores were similar in both groups. All procedures were successful. There was no significant difference in rates of procedural complications or in-hospital adverse events. The mean procedure time in the SDDP group was 11 minutes longer than in the conventional group (62.1 ± 5.9 vs 51.1 ± 21; P=.01). Outcomes at 45-day follow-up were similar. SDDP was associated with a reduced length of stay compared with conventional strategy and a 15% reduction in total costs. CONCLUSIONS Same-day discharge strategy for LAAO appears safe, feasible and could become the new standard approach for LAAO. A protocol including CTA pre-procedural planning, ICE-guided deployment and conscious sedation reduces hospital occupation and lowers costs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Steven J Filby
- University Hospitals, Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 3rd floor, Cleveland, OH, 44106 USA.
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Filby SJ, Dallan LAP, Cochet A, Kobayashi A, Attizzani GF, Rashid I, Rajagopalan S, Arruda M, Shishehbor MH, Bezerra HG. Left Atrial Appendage Occlusion Using Cardiac CT Angiography and Intracardiac Echocardiography: A Prospective, Single-Center Study. J Invasive Cardiol 2021; 33:E851-E856. [PMID: 34619655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES We reviewed the periprocedural events, accuracy of device selection, and outcomes of a series of patients receiving percutaneous left atrial appendage occlusion (LAAO) with cardiac computed tomography angiography (CTA)-guided preprocedural planning and intracardiac echocardiography (ICE)-guided device deployment. BACKGROUND Percutaneous LAAO with the Watchman device (Boston Scientific) is approved by the United States Food and Drug Administration for stroke prevention in patients with non-valvular atrial fibrillation with a demonstrated contraindication to oral anticoagulation. Cardiac CTA preprocedural planning with utilization of an ICE-guided deployment may be associated with favorable outcomes. METHODS A prospective analysis of 71 non-consecutive patients who underwent LAAO over an 18-month period with cardiac CTA-guided preprocedural planning and ICE was conducted. Procedures were performed in a single large, academic hospital in the United States. Procedural success, correlation of CTA preprocedural device sizing with final device size utilization, adverse events, length of procedure, and length of stay were evaluated. RESULTS Preprocedural cardiac CTA-guided device sizing was consistent with the final deployed device in 69 patients (97.2%) evaluated in this case series. Procedure success rate was 100%. All implants were performed using Watchman devices, 45 (63.4%) with the original 2.5 platform and 26 (36.6%) with the Watchman FLX platform. All patients were treated with conscious sedation and the mean length of stay was 1.45 ± 0.72 days. Only 2 adverse events occurred and both resolved. CONCLUSIONS Cardiac CTA-guided preprocedural planning resulted in accurate device sizing in this patient sample and may be used in conjunction with ICE and conscious sedation for a same-day discharge strategy in select patients.
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Affiliation(s)
- Steven J Filby
- University Hospitals, Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 3rd floor, Cleveland, OH 44106 USA.
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Mously H, Shah N, Zuzek Z, Alshaghdali I, Karim A, Jaswaney R, Filby SJ, Simon DI, Shishehbor MH, Forouzandeh F. Door-to-balloon Time for ST-elevation MI in the Coronavirus Disease 2019 Era. US Cardiology Review 2021. [DOI: 10.15420/usc.2021.05] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In patients presenting with ST-elevation MI, prompt primary coronary intervention is the preferred treatment modality. Several studies have described improved outcomes in patients with door-to-balloon (D2B) and symptom onset-to-balloon (OTB) times of less than 2 hours, but the specific implications of the coronavirus disease 2019 (COVID-19) pandemic on D2B and OTB times are not well-known. This review aims to evaluate the impact of COVID-19 on D2B time and elucidate both the factors that delay D2B time and strategies to improve D2B time in the contemporary era. The search was directed to identify articles discussing the significance of D2B times before and during COVID-19, from the initialization of the database to December 1, 2020. The majority of studies found that onset-of-symptom to hospital arrival time increased in the COVID-19 era, whereas D2B time and mortality were unchanged in some studies and increased in others.
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Affiliation(s)
- Haytham Mously
- Harrington Heart and Vascular Institute and Case Western Reserve University, Cleveland, OH
| | - Nischay Shah
- Harrington Heart and Vascular Institute and Case Western Reserve University, Cleveland, OH
| | - Zachary Zuzek
- Harrington Heart and Vascular Institute and Case Western Reserve University, Cleveland, OH
| | - Ibrahim Alshaghdali
- Harrington Heart and Vascular Institute and Case Western Reserve University, Cleveland, OH
| | - Adham Karim
- Harrington Heart and Vascular Institute and Case Western Reserve University, Cleveland, OH
| | - Rahul Jaswaney
- Harrington Heart and Vascular Institute and Case Western Reserve University, Cleveland, OH
| | - Steven J Filby
- Harrington Heart and Vascular Institute and Case Western Reserve University, Cleveland, OH
| | - Daniel I Simon
- Harrington Heart and Vascular Institute and Case Western Reserve University, Cleveland, OH
| | - Mehdi H Shishehbor
- Harrington Heart and Vascular Institute and Case Western Reserve University, Cleveland, OH
| | - Farshad Forouzandeh
- Harrington Heart and Vascular Institute and Case Western Reserve University, Cleveland, OH
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Filby SJ, Dallan LAP, Cochet A, Kobayashi A, Attizzani GF, Rashid I, Rajagopalan S, Arruda M, Shishehbor M, Bezerra HG. Left Atrial Appendage Occlusion Using Cardiac Computed Tomography Angiography and Intracardiac Echocardiography: A Prospective, Single-Center Study. Cardiovascular Revascularization Medicine 2021. [DOI: 10.1016/j.carrev.2021.06.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Filby SJ, Dallan LAP, Cochet A, Kobayashi A, Arruda M. Novel Technique for Transseptal Passage of Intracardiac Echocardiogram Probe During Left Atrial Appendage Closure. Cardiovasc Revasc Med 2021; 28S:150-152. [PMID: 33935001 DOI: 10.1016/j.carrev.2021.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/08/2021] [Accepted: 04/21/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Steven J Filby
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
| | - Luis Augusto Palma Dallan
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Anthony Cochet
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Akihiro Kobayashi
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Mauricio Arruda
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
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Goraya MHN, Kalsoom S, Almas T, Amin MK, Hussain N, Awan JR, Ehtesham M, Niaz MA, Virk HUH, Filby SJ. Simultaneous Left Ventricular Aneurysm and Ventricular Septal Rupture Complicating Delayed STEMI Presentation: A Case-Based Review of Post-MI Mechanical Complications Amid the COVID-19 Pandemic. J Investig Med High Impact Case Rep 2021; 9:23247096211031135. [PMID: 34259086 PMCID: PMC8283223 DOI: 10.1177/23247096211031135] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 11/23/2022] Open
Abstract
Amid the coronavirus disease 2019 (COVID-19) pandemic, there is an unprecedented increase in public avoidance of hospitals predominantly driven by fear of contracting the virus. Recent publications highlight a re-emergence of rare post-myocardial infarction complications. While mechanical complications are infrequent in the era of primary percutaneous coronary intervention, they are associated with high mortality rates. The concurrent occurrence of mechanical complications such as left ventricular aneurysm and ventricular septal rupture is an extremely rare entity. We hereby delineate a unique case of a 53-year-old Caucasian male who underwent successful concomitant closure of a ventricular septal rupture, left ventricular aneurysmectomy, and 3-vessel coronary artery bypass grafting. Due to a delayed initial presentation owing to the patient's fear of contracting COVID-19, the surgery was carried out 3 months after the myocardial infarction. His postoperative evaluation confirmed normal contractility of the left ventricle and complete closure of the ventricular septal rupture. Six months postoperatively, the patient continues to do well. We also present a literature review of the mechanical complications following delayed presentation of myocardial infarction amid the COVID-19 pandemic. This article illustrates that clinicians should remain cognizant of these extremely rare but potentially lethal collateral effects during the ongoing global public-health challenge. Furthermore, it highlights a significant concern regarding the delay in first medical contact due to the reluctance of patients to visit the hospital during the COVID-19 pandemic.
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Affiliation(s)
| | - Sidra Kalsoom
- Conemaugh Memorial Medical Center, Johnstown, PA, USA
| | - Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | | | | | | | - Steven J. Filby
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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28
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Hammad TA, Parikh M, Tashtish N, Lowry CM, Gorbey D, Forouzandeh F, Filby SJ, Wolf WM, Costa MA, Simon DI, Shishehbor MH. Impact of COVID-19 pandemic on ST-elevation myocardial infarction in a non-COVID-19 epicenter. Catheter Cardiovasc Interv 2020; 97:208-214. [PMID: 32478961 PMCID: PMC7300525 DOI: 10.1002/ccd.28997] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [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: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 01/20/2023]
Abstract
Objectives We sought to study the impact of COVID‐19 pandemic on the presentation delay, severity, patterns of care, and reasons for delay among patients with ST‐elevation myocardial infarction (STEMI) in a non‐hot‐spot region. Background COVID‐19 pandemic has significantly reduced the activations for STEMI in epicenters like Spain. Methods From January 1, 2020, to April 15, 2020, 143 STEMIs were identified across our integrated 18‐hospital system. Pre‐ and post‐COVID‐19 cohorts were based on March 23rd, 2020, whenstay‐at‐home orders were initiated in Ohio. We used presenting heart rate, blood pressure, troponin, new Q‐wave, and left ventricle ejection fraction (LVEF) to assess severity. Duration of intensive care unit stay, total length of stay, door‐to‐balloon (D2B) time, and radial versus femoral access were used to assess patterns of care. Results Post‐COVID‐19 presentation was associated with a lower admission LVEF (45 vs. 50%, p = .015), new Q‐wave, and higher initial troponin; however, these did not reach statistical significance. Among post‐COVID‐19 patients, those with >12‐hr delay in presentation 31(%) had a longer average D2B time (88 vs. 53 min, p = .033) and higher peak troponin (58 vs. 8.5 ng/ml, p = .03). Of these, 27% avoided the hospital due to fear of COVID‐19, 18% believed symptoms were COVID‐19 related, and 9% did not want to burden the hospital during the pandemic. Conclusions COVID‐19 has remarkably affected STEMI presentation and care. Patients' fear and confusion about symptoms are integral parts of this emerging public health crisis.
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Affiliation(s)
- Tarek A Hammad
- Cardiovascular Interventional Center, Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Melanie Parikh
- Cardiovascular Interventional Center, Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Nour Tashtish
- Cardiovascular Interventional Center, Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Cynthia M Lowry
- Cardiovascular Interventional Center, Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Diane Gorbey
- Cardiovascular Interventional Center, Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Farshad Forouzandeh
- Cardiovascular Interventional Center, Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Steven J Filby
- Cardiovascular Interventional Center, Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - William M Wolf
- Cardiovascular Interventional Center, Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Marco A Costa
- Cardiovascular Interventional Center, Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Daniel I Simon
- Cardiovascular Interventional Center, Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Mehdi H Shishehbor
- Cardiovascular Interventional Center, Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Singh IM, Filby SJ, El Sakr F, Gorodeski EZ, Lincoff AM, Ellis SG, Shishehbor MH. Drug-eluting stents versus bare-metal stents for treatment of bare-metal in-stent restenosis. Catheter Cardiovasc Interv 2010; 76:257-62. [PMID: 20665874 DOI: 10.1002/ccd.22509] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [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: 11/11/2022]
Abstract
OBJECTIVES We compared the long-term outcomes of drug-eluting stents (DES) versus bare-metal stents (BMS) for treatment of bare-metal in-stent restenosis (ISR). BACKGROUND There are no randomized trials or observational studies directly comparing the safety and efficacy of DES versus BMS for treatment of bare-metal ISR. METHODS We examined data on all patients who underwent percutaneous coronary intervention (PCI) for ISR at Cleveland Clinic between 05/1999 and 06/2007. We compared the efficacy and safety of DES to BMS for treating bare-metal ISR. The primary end point was a composite of death, myocardial infarction (MI), or target lesion revascularization (TLR). The secondary endpoints were individual components of the primary endpoint. RESULTS Of the 931 patients identified over 8 years, 706 had bare-metal ISR and met our study criteria. Of the 706 patients with bare-metal ISR, 362 were treated with DES and 344 with BMS. There were 230 cumulative events for a median follow-up of 3.2 years. After adjusting for 27 variables, DES were associated with lower primary endpoint compared to BMS for treatment of bare-metal ISR (21% vs. 45%, adjusted hazard ratio [HR] 0.63; 95% confidence interval [CI], 0.42-0.95; P = 0.03). The individual secondary endpoint of death (8% vs. 24%, P = 0.005) favored DES, but MI (3% vs. 8%, P = 0.31), and TLR (13% vs. 20%, P = 0.23) failed to reach statistical significance. CONCLUSIONS In our multivariate analysis of patients with bare-metal ISR, DES use was associated with significantly lower death, MI, or TLR when compared to BMS.
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Affiliation(s)
- Inder M Singh
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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30
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Singh IM, Filby SJ, Sakr FE, Gorodeski EZ, Lincoff AM, Ellis SG, Shishehbor MH. Clinical outcomes of drug-eluting versus bare-metal in-stent restenosis. Catheter Cardiovasc Interv 2010; 75:338-42. [PMID: 19937786 DOI: 10.1002/ccd.22278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/11/2022]
Abstract
In-stent restenosis (ISR) is a challenging syndrome that affects drug-eluting stents and bare-metal stents. However, data comparing the outcomes of drug-eluting versus bare-metal ISR are limited. Our objective was to evaluate the long-term clinical outcomes of drug-eluting versus bare-metal ISR. Patients who underwent percutaneous coronary intervention at Cleveland Clinic for ISR from 05/1999 to 06/2007 were included. Unadjusted outcomes were tested using Kaplan-Meier curves followed by multivariable adjusted Cox proportional hazards analyses. Twenty seven variables, including type of stent used to treat ISR and procedural date, were included. The primary end point was a composite of death, myocardial infarction (MI), or target lesion revascularization (TLR). The secondary endpoints were components of the primary endpoint. Of 931 patients identified, 225 had drug-eluting ISR and 706 had bare-metal ISR. There were 279 cumulative events for a median follow-up of 3.2 years. The primary endpoint was not different between drug eluting and bare-metal ISR (22% versus 33%, adjusted hazard ratio [HR] 1.14; 95% confidence interval [CI], 0.79-1.66; P = 0.49). The secondary endpoints of death (8% versus 16%, adjusted HR 1.05; 95% CI, 0.56-1.98; P = 0.88), MI (4% versus 5%, adjusted HR 1.48; 95% CI, 0.54-4.04; P = 0.45), and TLR (15% versus 16%, adjusted HR 1.30; 95% CI, 0.81-2.11; P = 0.28) were also not different. This study represents the largest analysis comparing drug-eluting to bare-metal ISR. On multivariable Cox proportional hazard analyses, drug-eluting and bare-metal ISR have similar long term outcomes.
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Affiliation(s)
- Inder M Singh
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Cohen MG, Filby SJ, Roe MT, Chen AY, Menon V, Stouffer GA, Gibler WB, Smith SC, Pollack CV, Peterson ED, Ohman EM. The paradoxical use of cardiac catheterization in patients with non-ST-elevation acute coronary syndromes: lessons from the Can Rapid Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC /AHA Guidelines (CRUSADE) Quality Improvement Initiative. Am Heart J 2009; 158:263-70. [PMID: 19619704 DOI: 10.1016/j.ahj.2009.05.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 05/08/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The long-term benefits of coronary revascularization are proportional to the severity of underlying coronary artery disease (CAD). We sought to identify patients with a greater probability of severe CAD to target those who could receive the greatest benefit from revascularization. METHODS We used multivariable logistic generalized estimating equations modeling to identify clinical factors associated with severe CAD in 83,490 patients, without prior bypass surgery, who underwent coronary angiography after presenting with non-ST-segment elevation acute coronary syndromes enrolled in CRUSADE. We then compared actual patterns of cardiac catheterization use relative to patients' probability of severe CAD in those who underwent catheterization and those who did not. RESULTS Independent factors associated with severe CAD included older age, male sex, diabetes, no prior percutaneous coronary intervention, signs or history of heart failure, prior myocardial infarction, ST-segment depression, and family history of CAD. Cardiac catheterization rates were inversely related to the probability of severe CAD as estimated by the model. CONCLUSIONS There is a misalignment in the use of cardiac catheterization in patients with non-ST-segment elevation acute coronary syndromes relative to their predicted probability of severe CAD. The use of catheterization appears to target patients who would derive less benefit from revascularization. Further quality improvement efforts should promote appropriate use of cardiac catheterization procedures among patients with the greatest potential benefit.
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Weisz G, Filby SJ, Cohen MG, Allie DE, Weinstock BS, Kyriazis D, Walker CM, Moses JW, Danna P, Fearon WF, Sachdev N, Wiechmann BN, Vora K, Findeiss L, Price MJ, Mehran R, Leon MB, Teirstein PS. Safety and performance of targeted renal therapy: the Be-RITe! Registry. J Endovasc Ther 2009; 16:1-12. [PMID: 19281283 DOI: 10.1583/08-2515.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the safety and patterns of use of targeted renal therapy (TRT) with the Benephit system. TRT, the delivery of therapeutic agents directly to the kidneys by renal arterial infusion, has the advantage of providing a higher local effective dose with potentially greater renal effects, while limiting systemic adverse effects due to renal first-pass elimination. METHODS The Benephit System Renal Infusion Therapy (Be-RITe!) Multicenter Registry was a post-market registry following patients treated using the Benephit systems for TRT. The registry enrolled 501 patients (332 men; mean age 72.2+/-9.5 years) at high risk for contrast-induced nephropathy (CIN) during coronary or peripheral angiography/intervention or cardiovascular surgery. The Mehran score was used to compare the actual to predicted incidence of CIN within 48 hours post procedure. RESULTS Bilateral renal artery cannulation was successful in 94.2%, with a mean cannulation time of 2.0 minutes. Either fenoldopam mesylate, sodium bicarbonate, alprostadil, or B-type natriuretic peptide (BNP) was infused for 184+/-212 minutes. Mean creatinine levels did not change significantly (baseline, 24, and 48 hours post procedure: 1.95, 1.99, and 1.98 mg/dL, respectively; p = NS). In 285 patients who received TRT with fenoldopam and were followed for at least 48 hours, the incidence of CIN was 71% lower than predicted (8.1% actual CIN versus 28.0% predicted; p<0.0001). Only 4 (1.4%) patients required dialysis (versus the 2.6% predicted rate, p = NS). CONCLUSION The Benephit system and TRT during coronary and endovascular procedures in patients at high risk for renal failure is simple to use and safe. With the infusion of intrarenal fenoldopam, the incidence of CIN was significantly lower than predicted by risk score calculations.
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Affiliation(s)
- Giora Weisz
- Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, NY 10032, USA.
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Shishehbor MH, Filby SJ, Chhatriwalla AK, Christofferson RD, Jain A, Kapadia SR, Lincoff AM, Bhatt DL, Ellis SG. Impact of drug-eluting versus bare-metal stents on mortality in patients with anemia. JACC Cardiovasc Interv 2009; 2:329-36. [PMID: 19463445 DOI: 10.1016/j.jcin.2008.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 11/18/2008] [Accepted: 11/23/2008] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Our aim was to assess the incidence of all-cause mortality in patients with anemia undergoing percutaneous coronary intervention (PCI) receiving drug-eluting stents (DES) or bare-metal stents (BMS). BACKGROUND Anemia has been associated with poor clinical outcomes in patients undergoing PCI. However, it is unknown whether stent selection (DES or BMS) has a differential outcome in this high-risk group. METHODS Anemia was defined as a hematocrit below 36% for female subjects and below 40% for male subjects as defined by the World Health Organization. All patients undergoing PCI with DES or BMS alone from March 2003 to June 2007 were included. The primary end point was all-cause mortality. Anemia was further characterized using mean corpuscular volume as microcytic, normocytic, or macrocytic. RESULTS A total 11,181 patients underwent PCI over a 4.5-year interval; of these, 2,172 met our inclusion criteria. There were a total of 429 deaths. The majority of patients had normocytic anemia (n = 1,931). Of the 3 anemia subtypes, macrocytic anemia (DES 26%, BMS 44%) had the highest mortality followed by normocytic (DES 17%, BMS 25%) and microcytic (DES 13%, BMS 18%) anemia, respectively. All-cause mortality was significantly lower with DES in unadjusted and multivariable adjusted Cox proportional models (adjusted hazard ratio: 0.66, 95% confidence interval: 0.54 to 0.82; p < 0.001). CONCLUSIONS In an adjusted analysis, the use of DES as compared with the use of BMS was associated with decreased mortality in patients with anemia. Additionally, among anemia subtypes, macrocytic anemia had the highest mortality.
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Affiliation(s)
- Mehdi H Shishehbor
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195-0002, USA.
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