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Brener MI, Hamandi M, Hong E, Pizano A, Harloff MT, Garner EF, El Sabbagh A, Kaple RK, Geirsson A, Deaton DW, Islam AM, Veeregandham R, Bapat V, Khalique OK, Ning Y, Kurlansky PA, Grayburn PA, Nazif TM, Kodali SK, Leon MB, Borger MA, Lee R, Kohli K, Yoganathan AP, Colli A, Guerrero ME, Davies JE, Eudailey KW, Kaneko T, Nguyen TC, Russell H, Smith RL, George I. Early outcomes following transatrial transcatheter mitral valve replacement in patients with severe mitral annular calcification. J Thorac Cardiovasc Surg 2024; 167:1263-1275.e3. [PMID: 36153166 DOI: 10.1016/j.jtcvs.2022.07.038] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/29/2022] [Accepted: 07/22/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Implantation of a transcatheter valve-in-mitral annular calcification (ViMAC) has emerged as an alternative to traditional surgical mitral valve (MV) replacement. Previous studies evaluating ViMAC aggregated transseptal, transapical, and transatrial forms of the procedure, leaving uncertainty about each technique's advantages and disadvantages. Thus, we sought to evaluate clinical outcomes specifically for transatrial ViMAC from the largest multicenter registry to-date. METHODS Patients with symptomatic MV dysfunction and severe MAC who underwent ViMAC were enrolled from 12 centers across the United States and Europe. Clinical characteristics, procedural details, and clinical outcomes were abstracted from the electronic record. The primary end point was all-cause mortality. RESULTS We analyzed 126 patients who underwent ViMAC (median age 76 years [interquartile range {IQR}, 70-82 years], 28.6% female, median Society of Thoracic Surgeons score 6.8% [IQR, 4.0-11.4], and median follow-up 89 days [IQR, 16-383.5]). Sixty-one (48.4%) had isolated mitral stenosis, 25 (19.8%) had isolated mitral regurgitation (MR), and 40 (31.7%) had mixed MV disease. Technical success was achieved in 119 (94.4%) patients. Thirty (23.8%) patients underwent concurrent septal myectomy, and 8 (6.3%) patients experienced left ventricular outflow tract obstruction (7/8 did not undergo myectomy). Five (4.2%) patients of 118 with postprocedure echocardiograms had greater than mild paravalvular leak. Thirty-day and 1-year all-cause mortality occurred in 16 and 33 patients, respectively. In multivariable models, moderate or greater MR at baseline was associated with increased risk of 1-year mortality (hazard ratio, 2.31; 95% confidence interval, 1.07-4.99, P = .03). CONCLUSIONS Transatrial ViMAC is safe and feasible in this selected, male-predominant cohort. Patients with significant MR may derive less benefit from ViMAC than patients with mitral stenosis only.
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Affiliation(s)
- Michael I Brener
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Mohanad Hamandi
- Division of Cardiothoracic Surgery, Baylor Scott and White Health, Plano, Tex
| | - Estee Hong
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY
| | - Alejandro Pizano
- Division of Cardiothoracic Surgery, University of Texas Health Science Center, Houston, Tex
| | - Morgan T Harloff
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Evan F Garner
- Division of Cardiothoracic Surgery, University of Alabama-Birmingham, Birmingham, Ala
| | | | - Ryan K Kaple
- Division of Cardiology, Yale University School of Medicine, New Haven, Conn
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Conn
| | - David W Deaton
- Baystate Heart and Vascular Program, Baystate Medical Center, Springfield, Mass
| | - Ashequl M Islam
- Baystate Heart and Vascular Program, Baystate Medical Center, Springfield, Mass
| | | | - Vinayak Bapat
- Division of Cardiothoracic Surgery, Minneapolis Heart Institute Foundation, Minneapolis, Minn
| | - Omar K Khalique
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Yuming Ning
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY
| | - Paul A Kurlansky
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY
| | - Paul A Grayburn
- Division of Cardiology, Baylor Scott and White Health, Plano, Tex
| | - Tamim M Nazif
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Susheel K Kodali
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Martin B Leon
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Michael A Borger
- Division of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Raymond Lee
- Division of Cardiothoracic Surgery, Keck University of Southern California, Los Angeles, Calif
| | - Keshav Kohli
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga
| | - Ajit P Yoganathan
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga
| | - Andrea Colli
- Department of Cardio-Thoracic-Vascular Surgery, University of Pisa, Pisa, Italy
| | - Mayra E Guerrero
- Division of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minn
| | - James E Davies
- Division of Cardiothoracic Surgery, University of Alabama-Birmingham, Birmingham, Ala
| | - Kyle W Eudailey
- Division of Cardiothoracic Surgery, University of Alabama-Birmingham, Birmingham, Ala
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Tom C Nguyen
- Division of Cardiothoracic Surgery, University of California-San Francisco, San Francisco, Calif
| | - Hyde Russell
- Division of Cardiothoracic Surgery, Northshore University HealthSystem, Evanston, Ill
| | - Robert L Smith
- Division of Cardiothoracic Surgery, Baylor Scott and White Health, Plano, Tex
| | - Isaac George
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY.
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2
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Bapat V, Weiss E, Bajwa T, Thourani VH, Yadav P, Thaden JJ, Lim DS, Reardon M, Pinney S, Adams DH, Yakubov SJ, Modine T, Redwood SR, Walton A, Spargias K, Zhang A, Mack M, Leon MB. 2-Year Clinical and Echocardiography Follow-Up of Transcatheter Mitral Valve Replacement With the Transapical Intrepid System. JACC Cardiovasc Interv 2024:S1936-8798(24)00527-2. [PMID: 38639690 DOI: 10.1016/j.jcin.2024.02.033] [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: 10/30/2023] [Revised: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Thirty-day outcomes with the investigational Intrepid transapical (TA) transcatheter mitral valve replacement (TMVR) system have previously demonstrated good technical success, but longer-term outcomes in larger cohorts need to be evaluated. OBJECTIVES The authors sought to evaluate the 2-year safety and performance of the Intrepid TA-TMVR system in patients with symptomatic, ≥moderate-severe mitral regurgitation (MR) and high surgical risk. METHODS Patient eligibility was determined by local heart teams and approved by a central screening committee. Clinical events were adjudicated by an independent clinical events committee. Echocardiography was evaluated by an independent core laboratory. RESULTS The cohort included 252 patients that were enrolled at 58 international sites before February 2021 as part of the global Pilot Study (n = 95) or APOLLO trial (primary cohort noneligible + TA roll-ins, n = 157). Mean age was 74.2 years, mean STS-PROM was 6.3%, 60.3% were male, and 80.6% were in NYHA functional class III/IV. Most presented with secondary MR (70.1%), and nearly all had ≥moderate-severe MR (98.4%). All-cause mortality was 13.1% (30-day), 27.3% (1-year), and 36.2% (2-year). The 30-day ≥major bleeding event rate was 22.3%. Heart failure rehospitalization was 9.6% (30-day) and 36.2% (2-year). At 2 years, >50% of patients were alive with improvement in NYHA functional class (82.1%, class I/II), and all patients with available echocardiograms had ≤mild MR. CONCLUSIONS This analysis represents the largest reported TA-TMVR experience with the longest follow-up in high-risk ≥moderate-severe MR patients. Early mortality and heart failure rehospitalizations were significant, exacerbated by early TA-related bleeding events; however, meaningful improvements in clinical outcomes and marked reductions in MR severity were observed through 2 years.
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Affiliation(s)
- Vinayak Bapat
- St. Thomas' Hospital, London, United Kingdom; New York Presbyterian/Columbia University Medical Center, New York, New York, USA.
| | - Eric Weiss
- Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA
| | - Tanvir Bajwa
- Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA
| | | | | | | | - D Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | - Michael Reardon
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sean Pinney
- Mount Sinai Medical Center, New York, New York, USA
| | | | | | - Thomas Modine
- Department of Heart Valve Therapy, CHU Bordeaux, Bordeaux, France
| | | | - Antony Walton
- Cardiology Department, The Alfred, Melbourne, Australia
| | | | | | - Michael Mack
- Baylor Scott and White Heart Hospital, Plano, Texas, USA
| | - Martin B Leon
- New York Presbyterian/Columbia University Medical Center, New York, New York, USA
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3
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Thourani VH, Abbas AE, Ternacle J, Hahn RT, Makkar R, Kodali SK, George I, Kapadia S, Svensson LG, Szeto WY, Herrmann HC, Ailawadi G, Leipsic J, Blanke P, Webb J, Jaber WA, Russo M, Malaisrie SC, Yadav P, Clavel MA, Khalique OK, Weissman NJ, Douglas P, Bax J, Dahou A, Xu K, Bapat V, Alu MC, Leon MB, Mack MJ, Pibarot P. Patient-Prosthesis Mismatch After Surgical Aortic Valve Replacement: Analysis of the PARTNER Trials. Ann Thorac Surg 2024:S0003-4975(24)00079-1. [PMID: 38316377 DOI: 10.1016/j.athoracsur.2024.01.023] [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] [Received: 02/10/2022] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Our objective was to compare the impact of patient-prosthesis mismatch (PPM) for 2 years after surgical aortic valve replacement within the prospective, randomized Placement of Aortic Transcatheter Valves (PARTNER) trials. METHODS Surgical aortic valve replacement patients from the PARTNER 1, 2, and 3 trials were included. PPM was classified as moderate (indexed effective orifice area ≤0.85 cm2/m2) or severe (indexed effective orifice area ≤0.65 cm2/m2). The primary endpoint was the composite of all-cause death and heart failure rehospitalization at 2 years. RESULTS By the predicted PPM method (PPMP), 59.1% had no PPM, 38.8% moderate PPM, and 2.1% severe PPM; whereas by the measured PPM method (PPMM), 42.4% had no PPM, 36.0% moderate, and 21.6% severe. Patients with no PPMP (23.6%) had a lower rate of the primary endpoint compared with patients with moderate (28.2%, P = .03) or severe PPMP (38.8%, P = .02). Using the PPMM method, there was no difference between the no (17.7%) and moderate PPMM groups (21.1%) in the primary outcome (P = .16). However, those with no PPMM or moderate PPMM were improved compared with severe PPMM (27.4%, P < .001 and P = .02, respectively). CONCLUSIONS Severe PPM analyzed by PPMP was only 2.1% for surgical aortic valve replacement patients. The PPMM method overestimated the incidence of severe PPM relative to PPMP, but was also associated with worse outcome. There was higher all-cause mortality in patients with severe PPM, thus surgical techniques to minimize PPM remain critical.
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Affiliation(s)
- Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia.
| | - Amr E Abbas
- Department of Cardiology, Beaumont Hospital, Detroit, Michigan
| | - Julien Ternacle
- Department of Cardiology, Haut-Leveque Cardiology Hospital, Bordeaux University, Pessac, France; Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec, Canada
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Raj Makkar
- Department of Cardiology, Cedars Sinai Medical Center, Los Angeles, California
| | - Susheel K Kodali
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Isaac George
- Division of Cardiac Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Samir Kapadia
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Cardiac Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Wilson Y Szeto
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Howard C Herrmann
- Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Jonathon Leipsic
- Department of Cardiology, University of British Columbia, Vancouver, Canada
| | - Philipp Blanke
- Department of Cardiology, University of British Columbia, Vancouver, Canada
| | - John Webb
- Department of Cardiology, University of British Columbia, Vancouver, Canada
| | - Wael A Jaber
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Mark Russo
- Division of Cardiac Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Northwestern University, Chicago, Illinois
| | - Pradeep Yadav
- Department of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Marie-Annick Clavel
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec, Canada
| | - Omar K Khalique
- Cardiovascular Research Foundation, New York, New York; Department of Cardiology, St. Francis Hospital, Roslyn, New York
| | | | - Pamela Douglas
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Ke Xu
- Edwards Lifesciences, Irvine, California
| | - Vinayak Bapat
- Department of Cardiac Surgery, Minneapolis Heart Institute, Minneapolis, Minnesota
| | - Maria C Alu
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Michael J Mack
- Department of Cardiac Surgery, Baylor Scott and White Health, Dallas, Texas
| | - Philippe Pibarot
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec, Canada
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4
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Zahr F, Song HK, Chadderdon S, Gada H, Mumtaz M, Byrne T, Kirshner M, Sharma S, Kodali S, George I, Merhi W, Yarboro L, Sorajja P, Bapat V, Bajwa T, Weiss E, Thaden JJ, Gearhart E, Lim S, Reardon M, Adams D, Mack M, Leon MB. 1-Year Outcomes Following Transfemoral Transseptal Transcatheter Mitral Valve Replacement: Intrepid TMVR Early Feasibility Study Results. JACC Cardiovasc Interv 2023; 16:2868-2879. [PMID: 37902145 DOI: 10.1016/j.jcin.2023.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND High surgical risk may preclude mitral valve replacement in many patients. Transcatheter mitral valve replacement (TMVR) using transfemoral transseptal access is a novel technology for the treatment of mitral regurgitation (MR) in high-risk surgical patients. OBJECTIVES This analysis evaluates 30-day and 1-year outcomes of the Intrepid TMVR Early Feasibility Study in patients with ≥moderate-severe MR. METHODS The Intrepid TMVR Early Feasibility Study is a multicenter, prospective, single-arm study. Clinical events were adjudicated by a clinical events committee; endpoints were defined according to Mitral Valve Academic Research Consortium criteria. RESULTS A total of 33 patients, enrolled at 9 U.S. sites between February 2020 and August 2022, were included. The median age was 80 years, 63.6% of patients were men, and mean Society of Thoracic Surgeons Predicted Risk of Mortality for mitral valve replacement was 5.3%. Thirty-one (93.9%) patients were successfully implanted. Median postprocedural hospitalization length of stay was 5 days, and 87.9% of patients were discharged to home. At 30 days, there were no deaths or strokes, 8 (24.2%) patients had major vascular complications and none required surgical intervention, there were 4 cases of venous thromboembolism all successfully treated without sequelae, and 1 patient had mitral valve reintervention for severe left ventricular outflow tract obstruction. At 1 year, the Kaplan-Meier all-cause mortality rate was 6.7%, echocardiography showed ≤mild valvular MR, there was no/trace paravalvular leak in all patients, median mitral valve mean gradient was 4.6 mm Hg (Q1-Q3: 3.9-5.3 mm Hg), and 91.7% of survivors were in NYHA functional class I/II with a median 11.4-point improvement in Kansas City Cardiomyopathy Questionnaire overall summary scores. CONCLUSIONS The early benefits of the Intrepid transfemoral transseptal TMVR system were maintained up to 1 year with low mortality, low reintervention, and near complete elimination of MR, demonstrating a favorable safety profile and durable valve function.
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Affiliation(s)
- Firas Zahr
- Oregon Health and Science University, Portland, Oregon, USA.
| | - Howard K Song
- Oregon Health and Science University, Portland, Oregon, USA
| | | | - Hemal Gada
- UPMC Pinnacle Harrisburg Campus, Harrisburg, Pennsylvania, USA
| | - Mubashir Mumtaz
- UPMC Pinnacle Harrisburg Campus, Harrisburg, Pennsylvania, USA
| | - Timothy Byrne
- Abrazo Arizona Heart Hospital, Phoenix, Arizona, USA
| | | | - Samin Sharma
- Mount Sinai Medical Center, New York, New York, USA
| | - Susheel Kodali
- New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA
| | - Isaac George
- New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA
| | - William Merhi
- Spectrum Health Hospitals, Grand Rapids, Michigan, USA
| | - Leora Yarboro
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | - Paul Sorajja
- Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Vinayak Bapat
- Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Tanvir Bajwa
- Aurora Saint Luke's Medical Center, Milwaukee, Wisconsin, USA
| | - Eric Weiss
- Aurora Saint Luke's Medical Center, Milwaukee, Wisconsin, USA
| | | | | | - Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | - Michael Reardon
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - David Adams
- Mount Sinai Medical Center, New York, New York, USA
| | - Michael Mack
- Baylor Scott and White Heart Hospital, Plano, Texas, USA
| | - Martin B Leon
- New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA
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5
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Guerrero ME, Grayburn P, Smith RL, Sorajja P, Wang DD, Ahmad Y, Blusztein D, Cavalcante J, Tang GHL, Ailawadi G, Lim DS, Blanke P, Eleid MF, Kaneko T, Thourani VH, Bapat V, Mack MJ, Leon MB, George I. Diagnosis, Classification, and Management Strategies for Mitral Annular Calcification: A Heart Valve Collaboratory Position Statement. JACC Cardiovasc Interv 2023; 16:2195-2210. [PMID: 37758378 DOI: 10.1016/j.jcin.2023.06.044] [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: 01/27/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 10/02/2023]
Abstract
Mitral annular calcium (MAC) with severe mitral valvular dysfunction presents a complex problem, as valve replacement, either surgical or transcatheter, is challenging because of anatomy, technical considerations, concomitant comorbidities, and advanced age. The authors review the clinical and anatomical features of MAC that are favorable (green light), challenging (yellow light), or prohibitive (red light) for surgical or transcatheter mitral valve interventions. Under the auspices of the Heart Valve Collaboratory, an expert working group of cardiac surgeons, interventional cardiologists, and interventional imaging cardiologists was formed to develop recommendations regarding treatment options for patients with MAC as well as a proposed grading and staging system using both anatomical and clinical features.
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Affiliation(s)
| | | | | | - Paul Sorajja
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | - Yousif Ahmad
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - David Blusztein
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - João Cavalcante
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | | | - D Scott Lim
- University of Virginia, Charlottesville, Virginia, USA
| | - Philipp Blanke
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Tsuyoshi Kaneko
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Vinayak Bapat
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | - Martin B Leon
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Isaac George
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
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6
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Sorajja P, Sato H, Abdelhadi R, Zakaib J, Enriquez-Sarano M, Bapat V, Cavalcante JL, Bae R, Sengupta J, Gornick C, Hamid N. The Impact and Outcomes of Right Ventricular Lead Extraction in CIED-Related Tricuspid Regurgitation. JACC Cardiovasc Interv 2023; 16:2058-2060. [PMID: 37409995 DOI: 10.1016/j.jcin.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 07/07/2023]
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7
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Kossar AP, Nemeth S, Kosuri YD, Kazzi BE, Honzel E, D'Angelo A, Spellman J, Takeda K, Takayama H, Bapat V, Argenziano M, Beck J, Smith CR, Kurlansky P, George I. Re-Dosing del Nido cardioplegia in adult cardiac surgery: Perfusion characteristics and outcomes--Is there an optimal redosing strategy? Perfusion 2023:2676591231197524. [PMID: 37608700 DOI: 10.1177/02676591231197524] [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] [Indexed: 08/24/2023]
Abstract
OBJECTIVES del Nido cardioplegia is utilized for myocardial protection in adult patients undergoing cardiac surgery; however, no standardized re-dosing protocol exists. We describe perfusion characteristics and clinical outcomes in adult cardiac surgery patients who were re-dosed with del Nido cardioplegia. METHODS Chart review was performed for adult patients undergoing cardiac surgery (specific inclusion/exclusion criteria below) who received exactly two doses of del Nido cardioplegia from 2012 to 2019; n = 542 patients. The main outcome was a composite endpoint comprised of operative mortality, myocardial infarction, post-operative cardiac support device (CSD), and postoperative decrease in ejection fraction (EF), which was analyzed via multivariable logistic regression (MVLR). A secondary analysis evaluated postoperative vasoactive-inotropic scores (VIS) via gamma log link regression (GLLR) as a more physiologic indication of myocardial recovery. RESULTS MVLR demonstrated that increased total cardiopulmonary bypass (CPB) time was associated with a positive composite outcome (p < .001), whereas time between doses (p = .237) and the volume of each dose was not (p = .626). GLLR also demonstrated that prolonged CBP, decreased EF, congestive heart failure at time of surgery, and low hematocrit at the start of the surgery were all associated with higher VIS. CONCLUSIONS In this retrospective study, variations in re-dosing strategy for del Nido cardioplegia do not affect postoperative outcomes and increased CPB time is associated with increased operative mortality, myocardial infarction, need for post-operative CSDs, and reduced postoperative EF, and increased VIS, irrespective of the re-dosing strategy. Further studies are warranted to to identify additional patient and operative characteristics that predispose to complications.
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Affiliation(s)
- Alexander P Kossar
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Samantha Nemeth
- Columbia HeartSource, Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York, NY, USA
| | - Yaagnik D Kosuri
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Brigitte E Kazzi
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Emily Honzel
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Alex D'Angelo
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Jessica Spellman
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Koji Takeda
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Vinayak Bapat
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Michael Argenziano
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - James Beck
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Craig R Smith
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Paul Kurlansky
- Columbia HeartSource, Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York, NY, USA
| | - Isaac George
- Division of Cardiothoracic Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
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8
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Chhatriwalla AK, Allen KB, Depta JP, Rodriguez E, Thourani VH, Whisenant BK, Zahr F, Bapat V, Garcia S. Outcomes of Bioprosthetic Valve Fracture in Patients Undergoing Valve-in-Valve TAVR. JACC Cardiovasc Interv 2023; 16:530-539. [PMID: 36922038 DOI: 10.1016/j.jcin.2022.12.019] [Citation(s) in RCA: 4] [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: 09/02/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 03/18/2023]
Abstract
BACKGROUND Valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) is increasingly used to treat degenerated surgical bioprostheses. Bioprosthetic valve fracture (BVF) has been shown to improve hemodynamic status in VIV TAVR in case series. However, the safety and efficacy of BVF are unknown. OBJECTIVES The primary objective of this study was to assess the safety and efficacy of VIV TAVR using SAPIEN 3 and SAPIEN 3 Ultra valves with or without BVF using data from the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry. METHODS The primary outcome was in-hospital mortality. Secondary outcomes included echocardiography-derived valve gradient and aortic valve area. Inverse probability of treatment weighting was used to adjust for baseline characteristics. RESULTS A total of 2,975 patients underwent VIV TAVR from December 15, 2020, to March 31, 2022. BVF was attempted in 619 patients (21%). In adjusted analyses, attempted BVF was associated with higher in-hospital mortality (OR: 2.51; 95% CI: 1.30-4.84) and life-threatening bleeding (OR: 2.55; 95% CI: 1.44-4.50). At discharge, VIV TAVR with attempted BVF was associated with larger aortic valve area (1.6 cm2 vs 1.4 cm2; P < 0.01) and lower mean gradient (16.3 mm Hg vs 19.2 mm Hg; P < 0.01). When BVF was compared with no BVF according to timing (before vs after transcatheter heart valve implantation), BVF after transcatheter heart valve implantation was associated with improved hemodynamic status and similar mortality. CONCLUSIONS BVF as an adjunct to VIV TAVR with the SAPIEN 3 and SAPIEN 3 Ultra valves is associated with a higher risk for in-hospital mortality and significant bleeding and modest improvements in echocardiography-derived hemodynamic status. The timing of BVF is an important determinant of safety and efficacy.
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Affiliation(s)
- Adnan K Chhatriwalla
- St. Luke's Mid America Heart Institute and the University of Missouri, Kansas City, Missouri, USA.
| | - Keith B Allen
- St. Luke's Mid America Heart Institute and the University of Missouri, Kansas City, Missouri, USA
| | - Jeremiah P Depta
- Sands-Constellation Heart Institute/Rochester General Hospital, Rochester, New York, USA
| | | | | | | | - Firas Zahr
- Oregon Health and Science University, Portland, Oregon, USA
| | - Vinayak Bapat
- Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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9
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Vohra HA, Salmasi MY, Mohamed F, Shehata M, Bahrami B, Caputo M, Deshpande R, Bapat V, Bahrami T, Birdi I, Zacharias J. Consensus statement on aortic valve replacement via an anterior right minithoracotomy in the UK healthcare setting. Open Heart 2023; 10:e002194. [PMID: 37001910 PMCID: PMC10069572 DOI: 10.1136/openhrt-2022-002194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/27/2023] [Indexed: 04/04/2023] Open
Abstract
The wide uptake of anterior right thoracotomy (ART) as an approach for aortic valve replacement (AVR) has been limited despite initial reports of its use in 1993. Compared with median sternotomy, and even ministernotomy, ART is considered to be less traumatic to the chest wall and to help facilitate quicker patient recovery. In this statement, a consensus agreement is outlined that describes the potential benefits of the ART AVR. The technical considerations that require specific attention are described and the initiation of an ART programme at a UK centre is recommended through simulation and/or use of specialist instruments in conventional cases. The use of soft tissue retractors, peripheral cannulation, modified aortic clamping and the use of intraoperative adjuncts, such as sutureless valves and/or automated knot fasteners, are important to consider in order to circumvent the challenges of minimal the altered exposure via an ART.A coordinated team-based approach that encourages ownership of the programme by team members is critical. A designated proctor/mentor is also recommended. The organisation of structured training and simulation, as well as planning the initial cases are important steps to consider.
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Affiliation(s)
| | | | | | | | | | | | | | - Vinayak Bapat
- Cardiovascular Directorate, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
| | | | - Inderpaul Birdi
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, UK
| | - Joseph Zacharias
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
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10
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Medranda GA, Rogers T, Modine T, Latib A, Jorde U, Bapat V, Sorajja P, Rowland M, Sutton JA, Baig S, Asch FM, Garcia-Garcia HM, Ben-Dor I, Satler LF, Waksman R. The Clinical Profile and Natural History of Patients Who Fail Screening for Transcatheter Mitral Valve Replacement: Rationale and Design of the Prospective Multicenter Mitral Valve Screening Survey (MVSS). Cardiovasc Revasc Med 2023; 47:72-75. [PMID: 36266153 DOI: 10.1016/j.carrev.2022.09.003] [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: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 01/25/2023]
Abstract
Mitral valve disease is insidious and associated with a decreased quality of life and survival over time. Despite surgery being the standard of care, many patients are at prohibitive surgical risk. Furthermore, a substantial proportion of patients with symptomatic mitral valve disease fail stringent screening criteria for transcatheter mitral valve replacement (TMVR). The natural history of patients who fail screening is not well-characterized, and data are limited on the reasons for screen failure in this population. The Mitral Valve Screening Survey (MVSS) seeks to detail the clinical profile and natural history of patients who fail screening for TMVR. The MVSS is a prospective, multicenter registry enrolling up to 1000 consecutive subjects who, after screening for TMVR, are deemed not to be candidates. Subjects will be followed for 30 days after failing screening for TMVR and annually for up to 5 years with clinical evaluations. The primary study endpoint of the MVSS registry is all-cause mortality at 1 year. Additional secondary endpoints include all-cause mortality, hospitalizations, subsequent mitral valve intervention (transcatheter or surgical), reason for screen failure, and quality-of-life assessments at 30 days and annually up to 5 years of follow-up. The MVSS registry is the first prospective multicenter study to characterize the clinical and anatomical profile of patients who fail screening for TMVR while providing longitudinal clarification on the natural history and outcomes of these patients. CLINICAL TRIAL REGISTRATION: Mitral Valve Screening Survey (MVSS), https://clinicaltrials.gov/ct2/show/NCT04736667, NCT04736667.
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Affiliation(s)
- Giorgio A Medranda
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Thomas Modine
- Interventional Cardiology and Cardiovascular Surgery, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Azeem Latib
- Department of Cardiology, Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | - Ulrich Jorde
- Department of Cardiology, Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | - Vinayak Bapat
- Department of Cardiothoracic Surgery, Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Paul Sorajja
- Department of Cardiology, Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Megan Rowland
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Joseph A Sutton
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Salman Baig
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Federico M Asch
- MedStar Health Research Institute at MedStar Washington Hospital Center, Washington, DC, USA
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
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11
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Velders BJ, Vriesendorp MD, Sabik JF, Dagenais F, Labrousse L, Bapat V, Aldea GS, Anyanwu AC, Cai Y, Klautz RJ. Pledgeted versus nonpledgeted sutures in aortic valve replacement: Insights from a prospective multicenter trial. JTCVS Tech 2022; 17:23-46. [PMID: 36820352 PMCID: PMC9938379 DOI: 10.1016/j.xjtc.2022.10.016] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
Objective The objective of this study was to compare short- and midterm clinical and echocardiographic outcomes according to the use of pledgeted sutures during aortic valve replacement. Methods Patients with aortic stenosis or regurgitation requiring aortic valve replacement were enrolled in a prospective cohort study to evaluate the safety of a new stented bioprosthesis. Outcomes were analyzed according to the use of pledgets (pledgeted group) or no pledgets (nonpledgeted group). The primary outcome was a composite of thromboembolism, endocarditis, and major paravalvular leak at 5 years of follow-up. Secondary outcomes included multiple clinical endpoints and hemodynamic outcomes. Propensity score matching was performed to adjust for prognostic factors, and subanalyses with small valve sizes (<23 mm) and suturing techniques were performed. Results The pledgeted group comprised 640 patients (59%), and the nonpledgeted group 442 (41%), with baseline discrepancies in demographic characteristics, comorbidities, and stenosis severity. There were no differences between groups in any outcome. After propensity score matching, the primary outcome occurred in 41 (11.7%) patients in the pledgeted and 36 (9.8%) in the nonpledgeted group (P = .51). The effective orifice area was smaller in the pledgeted group (P = .045), whereas no difference was observed for the mean or peak pressure gradient. Separate subanalyses with small valve sizes and suturing techniques did not show relevant differences. Conclusions In this large propensity score-matched cohort, comprehensive clinical outcomes were comparable between patients who underwent aortic valve replacement with pledgeted and nonpledgeted sutures up to 5 years of follow-up, but pledgets might lead to a slightly smaller effective orifice area in the long run.
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Key Words
- AVR, aortic valve replacement
- BMI, body mass index
- BSA, body surface area
- EOA, effective orifice area
- EOAi, effective orifice area indexed
- LVOT, left ventricular outflow tract
- PERIGON, PERIcardial SurGical AOrtic Valve ReplacemeNt
- PPM, prosthesis–patient mismatch
- PVL, paravalvular leak
- STS, Society of Thoracic Surgeons
- endocarditis
- paravalvular leak
- pledgets
- surgical aortic valve replacement
- suturing technique
- thromboembolism
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Affiliation(s)
- Bart J.J. Velders
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, the Netherlands,Address for reprints: Bart J. J. Velders, MD, Department of Cardiothoracic Surgery, Leiden University Medical Centre, Albinusdreef 2, Leiden, Zuid-Holland 2333 ZA, The Netherlands.
| | - Michiel D. Vriesendorp
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Joseph F. Sabik
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Francois Dagenais
- Division of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, Quebec, Canada
| | - Louis Labrousse
- Medico-Surgical Department of Valvulopathies, Bordeaux Heart University Hospital, Bourdeaux-Pessac, France
| | - Vinayak Bapat
- Department of Cardiothoracic Surgery, NHS Foundation Trust–St Thomas' Hospital, London, United Kingdom
| | - Gabriel S. Aldea
- Department of Cardiothoracic Surgery, University of Washington School of Medicine, Seattle, Wash
| | - Anelechi C. Anyanwu
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yaping Cai
- Core Clinical Solutions, Medtronic, Mounds View, Minn
| | - Robert J.M. Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, the Netherlands
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12
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Meduri C, Bapat V, Kodali S, Sorajja P, Hamid N, Poon K, Feldt K, Settergren M, Rück A. TCT-471 First-in-Human Study Results With the Novel Anteris DurAVRTM Three-Dimensional Single-Piece TAVR Device. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.556] [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: 11/16/2022]
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13
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Fukui M, Sorajja P, Bapat V, Walser-Kuntz E, Stanberry L, Enriquez-Sarano M, Cavalcante J. TCT-526 Impact of Left Ventricular Scar and Chamber Size on Reverse Remodeling After Transcatheter Mitral Valve Replacement With Tendyne Device. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.619] [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: 11/26/2022]
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14
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Sato H, Bapat V, Cavalcante J, Bae R, Fukui M, Enriquez-Sarano M, Sorajja P. TCT-415 Contemporary Anatomic Criteria and Clinical Outcomes With Transcatheter Mitral Repair. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.489] [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: 10/14/2022]
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15
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Fukui M, Sorajja P, Enriquez-Sarano M, Sato H, Lesser JL, Cavalcante J, Bapat V. TCT-520 Deformation of Transcatheter Heart Valve Following Valve-in-Valve Transcatheter Aortic Valve Replacement: Implications for Hemodynamics. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.613] [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: 11/28/2022]
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16
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Chehab O, Roberts-Thomson R, Bivona A, Gill H, Patterson T, Pursnani A, Grigoryan K, Vargas B, Bokhary U, Blauth C, Lucchese G, Bapat V, Guerrero M, Redwood S, Prendergast B, Rajani R. Management of Patients With Severe Mitral Annular Calcification: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:722-738. [PMID: 35953138 DOI: 10.1016/j.jacc.2022.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/28/2022]
Abstract
Mitral annular calcification (MAC) is a common and challenging pathologic condition, especially in the context of an aging society. Surgical mitral valve intervention in patients with MAC is difficult, with varying approaches to the calcified annular anatomy, and the advent of transcatheter valve interventions has provided additional treatment options. Advanced imaging provides the foundation for heart team discussions and management decisions concerning individual patients. This review focuses on the prognosis of, preoperative planning for, and management strategies for patients with MAC.
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Affiliation(s)
- Omar Chehab
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Ross Roberts-Thomson
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Antonio Bivona
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Harminder Gill
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Tiffany Patterson
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom; School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Amit Pursnani
- Division of Cardiology, Evanston Hospital, Northshore University Health System, Evanston, Illinois, USA
| | - Karine Grigoryan
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Bernardo Vargas
- Division of Cardiology, Evanston Hospital, Northshore University Health System, Evanston, Illinois, USA
| | - Ujala Bokhary
- Division of Cardiology, Evanston Hospital, Northshore University Health System, Evanston, Illinois, USA
| | - Christopher Blauth
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Gianluca Lucchese
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Vinayak Bapat
- Center for Valve and Structural Heart Disease, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Mayra Guerrero
- Department of Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Simon Redwood
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom; School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Bernard Prendergast
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom.
| | - Ronak Rajani
- Departments of Cardiology and Cardiac Surgery, St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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17
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Fukui M, Enriquez-Sarano M, Koike H, Aluru J, Lesser A, Bapat V, Lesser J, Sorajja P, Cavalcante J. 441 Volumetric Right Ventricle Assessment Post Transcatheter Aortic Valve Replacement:findings In Routine Clinical Practice And Implications For Outcome. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.046] [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: 10/17/2022]
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18
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Hashimoto G, Koike H, Sato H, Fukui M, Garcia S, Goessl M, Sorajja P, Bapat V, Lesser J, Sarano ME, Cavalcante J. Right Ventricular Dysfunction in Functional Mitral Regurgitation Assessed by CT. Cardiovascular Revascularization Medicine 2022. [DOI: 10.1016/j.carrev.2022.06.152] [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: 11/03/2022]
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19
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Hammadah M, Karam J, Han BK, Bapat V, Cavalcante JL, Lesser J, Garcia S. Pulmonary Artery Pseudoaneurysm After Transcatheter Pulmonary Valve Replacement, a Novel Approach for Complication Management. Struct Heart 2022; 6:100015. [PMID: 37273746 PMCID: PMC10236866 DOI: 10.1016/j.shj.2022.100015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/03/2021] [Accepted: 02/02/2022] [Indexed: 06/06/2023]
Affiliation(s)
- Muhammad Hammadah
- Cardiology Department, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Joseph Karam
- Vascular Surgery Department, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - B. Kelly Han
- Cardiology Department, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Vinayak Bapat
- Cardiothoracic Surgery Department, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Joao L. Cavalcante
- Cardiology Department, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - John Lesser
- Cardiology Department, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Santiago Garcia
- Cardiology Department, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
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20
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Sorajja P, Cavalcante J, Bapat V. Setting expectations for transcatheter mitral valve replacement in the real world. Eur J Heart Fail 2022; 24:908-909. [PMID: 35434899 DOI: 10.1002/ejhf.2506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/06/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.,Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - João Cavalcante
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.,Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Vinayak Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.,Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
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21
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Webb JG, Chuang AMY, Meier D, von Bardeleben RS, Kodali SK, Smith RL, Hausleiter J, Ong G, Boone R, Ruf T, George I, Szerlip M, Näbauer M, Ali FM, Moss R, Kreidel F, Bapat V, Schnitzler K, Ye J, Wild M, Akodad M, Deva DP, Chatfield AG, Mack MJ, Grayburn PA, Peterson MD, Makkar R, Leon MB, Hahn RT, Fam NP. Transcatheter Tricuspid Valve Replacement With the EVOQUE System: 1-Year Outcomes of a Multicenter, First-in-Human Experience. JACC Cardiovasc Interv 2022; 15:481-491. [PMID: 35272772 DOI: 10.1016/j.jcin.2022.01.280] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 12/03/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The aim of this study was to report the midterm outcomes at 1 year in the expanded first-in-human experience with the transfemoral EVOQUE system (Edwards Lifesciences) for tricuspid regurgitation (TR). BACKGROUND Untreated TR is associated with excess mortality and morbidity. The first-in-human experience with the EVOQUE tricuspid valve replacement system reported favorable 30-day outcomes with no mortality in a compassionate use population. METHODS Twenty-seven patients with severe TR were treated with the EVOQUE system in a compassionate use experience at 7 centers between May 2019 and July 2020. All patients had clinical right-sided heart failure (HF) and were deemed inoperable and unsuitable for transcatheter edge-to-edge repair by the institutional heart teams. The clinical outcomes collected included all-cause mortality, symptom status, TR severity, HF hospitalization, and major adverse cardiovascular events. RESULTS At baseline, all patients (age: 77 ± 8 years, 89% female) were at high surgical risk (mean Society of Thoracic Surgeons score: 8.6% ± 5.5%), with 89% New York Heart Association functional class III/IV. TR was predominantly functional in etiology (19/27, 70%). At 1 year, mortality was 7% (2/27), 70% of patients were New York Heart Association functional class I/II, and 96% and 87% of patients had a TR grade ≤2+ and ≤1+, respectively. Between 30 days and 1 year, 2 patients experienced HF hospitalizations, and 1 patient required a new pacemaker implantation. CONCLUSIONS In this early, compassionate use experience, the transfemoral transcatheter EVOQUE tricuspid valve replacement system demonstrated durable efficacy, persistent improvement in symptom status, and low rates of mortality and HF hospitalizations at a 1-year follow-up. Further studies are underway to validate its efficacy.
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Affiliation(s)
| | | | | | | | - Susheel K Kodali
- Structural Heart & Vascular Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Robert L Smith
- Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas, USA
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Geraldine Ong
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Tobias Ruf
- Zentrum für Kardiologie, Universitätsmedizin Mainz, Johannes Gutenberg Universität Mainz, Germany
| | - Isaac George
- Structural Heart & Vascular Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Molly Szerlip
- Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas, USA
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Faeez M Ali
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Felix Kreidel
- Zentrum für Kardiologie, Universitätsmedizin Mainz, Johannes Gutenberg Universität Mainz, Germany
| | - Vinayak Bapat
- Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas, USA
| | - Katharina Schnitzler
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jian Ye
- St. Paul's Hospital, Vancouver, Canada
| | - Mirjam Wild
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Djeven P Deva
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Michael J Mack
- Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas, USA
| | - Paul A Grayburn
- Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas, USA
| | - Mark D Peterson
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Martin B Leon
- Structural Heart & Vascular Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Rebecca T Hahn
- Structural Heart & Vascular Center, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Neil P Fam
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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22
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Bhadra OD, Vitanova K, Saha S, Holzhey DM, Noack T, Kempfert J, Unbehaun A, Reichenspurner H, Bapat V, Tang GH, Conradi L. Outcome after Surgical TAVR Explantation: Insights from the International Multicenter EXPLANT-TAVR Registry. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- O. D. Bhadra
- University Heart and Vascular Center Hamburg, Hamburg, Deutschland
| | - K. Vitanova
- German Heart Center Munich, München, Deutschland
| | - S. Saha
- Klinikum Großhadern, München, Deutschland
| | | | - T. Noack
- Leipzig Heart Center, Leipzig, Deutschland
| | - J. Kempfert
- German Heart Center Berlin, Berlin, Deutschland
| | - A. Unbehaun
- German Heart Center Berlin, Berlin, Deutschland
| | | | - V. Bapat
- Columbia University, New York, United States
| | - G. H.L. Tang
- Mount Sinai Health System, New York, United States
| | - L. Conradi
- University Heart and Vascular Center Hamburg, Hamburg, Deutschland
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Bapat V. DurAVR™ Transcatheter Heart Valve: Designed for Lifetime Patient Management. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.579] [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: 11/30/2022]
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D'Angelo AM, Nemeth S, Wang C, Kossar AP, Takeda K, Takayama H, Bapat V, Naka Y, Argenziano M, Smith CR, Beck J, Spellman J, Kurlansky P, George I. Re-dosing of del Nido cardioplegia in adult cardiac surgery requiring prolonged aortic cross-clamp. Interact Cardiovasc Thorac Surg 2021; 34:556-563. [PMID: 34788429 PMCID: PMC8972223 DOI: 10.1093/icvts/ivab310] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/24/2021] [Accepted: 09/20/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Alex M D'Angelo
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Samantha Nemeth
- Center for Innovation and Outcomes Research, Columbia University, New York, NY, USA
| | - Catherine Wang
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Alexander P Kossar
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Koji Takeda
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Hiroo Takayama
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Vinayak Bapat
- Department of Cardiothoracic Surgery, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Yoshifumi Naka
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Michael Argenziano
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Craig R Smith
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - James Beck
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Jessica Spellman
- Department of Anesthesiology, Columbia University Medical Center, New York, NY, USA
| | - Paul Kurlansky
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Isaac George
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
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Zaid S, Modine T, Denti P, Bapat V, Kaneko T, Tang G. TCT-459 Impact of Type of Mitral Regurgitation on Outcomes of Mitral Valve Surgery After Edge-to-Edge Transcatheter Mitral Repair: Results From the CUTTING-EDGE Registry. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1312] [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: 11/16/2022]
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Fukui M, Cavalcante J, Bae R, Bapat V, Goessl M, Garcia S, Enriquez-Sarano M, Sorajja P. TCT-475 Natural History of Mitral Disease Associated With Mitral Annular Calcification. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1328] [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: 11/24/2022]
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Brener M, Hamandi M, Hong E, Pizano A, Harloff M, Garner E, El Sabbagh A, Kaple R, Deaton D, Islam A, Veeragandham R, Bapat V, Khalique O, Ning Y, Kurlansky P, Nazif T, Kodali S, Leon M, Borger M, Lee R, Kohli K, Yoganathan A, Guerrero M, Davies J, Eudailey K, Kaneko T, Nguyen T, Russell H, Smith R, George I. TCT-104 One-Year Clinical Outcomes Following Open Transatrial Transcatheter Mitral Valve Replacement in Patients With Severe Mitral Annular Calcification. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.954] [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: 11/29/2022]
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28
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Hashimoto G, Sarano M, Sato H, Lopes B, Fukui M, Stanberry L, Cheng V, Garcia S, Goessl M, Sorajja P, Bapat V, Lesser J, Cavalcante J. The left ventricular remodeling assessment by cardiac magnetic resonance in chronic aortic regurgitation; implications for outcome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0231] [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: 11/14/2022] Open
Abstract
Abstract
Background
Chronic aortic regurgitation (AR) causes left ventricular (LV) volume overload resulting in progressive LV remodeling, which negatively affect clinical outcome. Clinical Guidelines recommend assessment of LV remodeling by echocardiography, but little is known about comparative remodeling quantification by cardiac magnetic resonance (CMR) and association with outcomes.
Purpose
To assess LV remodeling in AR by CMR, compared with echocardiographic measures and determine its impact on clinical outcome.
Methods
Patients with native, ≥moderate, chronic AR by echocardiography who underwent CMR exam within 90 days of diagnosis from January 2012 to February 2020 were enrolled. The endpoint was a composite of death, heart failure hospitalization, and heart failure symptom exacerbation during follow-up.
Results
The 178 patients included had median age (IQR) of 58 years (44–69), and most (88%, n=158) presented with no or minimal symptoms (NYHA class I/II). At diagnosis symptomatic vs. no/minimal symptoms patients presented with much more advanced LV remodeling by CMR (EDVI 133 [83–151] vs. 96 [80–123] p=0.024, ESVI 66 [46–85] vs. 42 [30–58], P=0.001) while echocardiography showed limited differences (EDVI 76 [57–93] vs. 65 [54–87] p=0.507, ESVI 38 [30–58] vs. 27 [20–42], p=0.072). During follow-up (3.3 years [1.6–5.8]), aortic valve replacement (AVR) was performed in 49 patients. In patients with no/minimal symptoms, the composite endpoint occurred in 54 (34%) patients including eight deaths and 30 heart failure hospitalizations. Patients with LV end-systolic volume index (LVESVi) >45 ml/m2 by CMR had higher likelihood for composite endpoint (Panel A) confirmed in multivariate models, adjusting for age, sex, AVR (time-dependent), EuroSCORE2, and LV End-systolic-dimension-index (LVESDi) >25 mm/2, with adjusted hazard ratio 1.84 [1.02–3.33], p<0.044 (Panel B). LVESVi by CMR was at least as powerful in determining clinical outcomes as guideline-recommended Doppler-Echocardiographic variables.
Conclusion
Assessment of LV remodeling by CMR in patients with clinically significant AR is feasible in routine clinical practice, detects with high sensitivity LV remodeling associated with development of HF symptoms and is independently predictive of clinical outcome. Hence, CMR provides a powerful tool for evaluation and risk stratification of patients with AR.
Funding Acknowledgement
Type of funding sources: None. Panel APanel B
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Affiliation(s)
- G Hashimoto
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - M Sarano
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - H Sato
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - B Lopes
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - M Fukui
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - L Stanberry
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - V Cheng
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - S Garcia
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - M Goessl
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - P Sorajja
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - V Bapat
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - J Lesser
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - J Cavalcante
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
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Brener MI, Olds A, Nemeth S, Kurlansky P, Nazif TM, Vahl TP, Khalique OK, Hamid NB, Patel A, Ng VG, Chen S, Cahill TJ, Rahim HM, Hahn RT, Bapat V, Sarraf M, Ahmed MI, Leon MB, Kodali S, Eudailey KW, George I. Suprasternal Versus Transfemoral Access for Transcatheter Aortic Valve Replacement: Insights From a Propensity Score Matched Analysis. J Am Heart Assoc 2021; 10:e020491. [PMID: 34376060 PMCID: PMC8475036 DOI: 10.1161/jaha.120.020491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Suprasternal access is an alternative access strategy for transcatheter aortic valve replacement (TAVR) where the innominate artery is cannulated from an incision above the sternal notch. To date, suprasternal access has never been compared with transfemoral TAVR. Thus, we sought to assess safety, feasibility, and early clinical outcomes between suprasternal and transfemoral access for patients undergoing TAVR. Methods and Results We evaluated patients from 2 institutional prospective, observational registries containing 1348 patients. Patients were selected in a 2:1 ratio (transfemoral:suprasternal) on the basis of propensity score matching. The primary outcome was in-hospital mortality, and secondary outcomes included the incidence of ischemic stroke, major bleeding, vascular injury, left bundle-branch block, and permanent pacemaker implantation at 30-day follow-up. Propensity score matching identified 89 patients undergoing suprasternal TAVR and 159 patients undergoing transfemoral TAVR suitable for analysis. There was no significant difference between suprasternal TAVR and transfemoral TAVR with respect to in-hospital mortality (1.1% versus 0.6%; odds ratio [OR], 1.80; 95% CI, 0.11-29.06; P=0.680). No patients in either cohort suffered an ischemic stroke. The incidence of major bleeding (2.2% versus 2.5%; OR, 0.89; 95% CI, 0.16-4.96; P=0.895) and vascular injury (1.1% versus 1.9%; OR, 0.59; 95% CI, 0.06-5.77; P=0.651) did not differ significantly. The frequency of left bundle-branch block (9.4% versus 15.8%; OR, 0.56; 95% CI, 0.24-1.30; P=0.177) and permanent pacemaker implantation (11.2% versus 5.9%; OR, 2.01; 95% CI, 0.75-5.45; P=0.169) were not statistically significantly different. Conclusions Suprasternal TAVR was safe and achieved promising short-term clinical outcomes when compared with transfemoral TAVR. Future studies seeking to identify the optimal alternative access site should evaluate suprasternal TAVR access alongside other substitutes for transfemoral TAVR.
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Affiliation(s)
- Michael I Brener
- Division of Cardiology Department of Medicine College of Physicians and Surgeons of Columbia University New York Presbyterian Hospital New York NY
| | - Anna Olds
- Department of Surgery University of Southern California Los Angeles CA
| | - Samantha Nemeth
- Division of Cardiothoracic Surgery Department of Surgery College of Physicians and Surgeons of Columbia University New York Presbyterian Hospital New York NY
| | - Paul Kurlansky
- Division of Cardiothoracic Surgery Department of Surgery College of Physicians and Surgeons of Columbia University New York Presbyterian Hospital New York NY
| | - Tamim M Nazif
- Division of Cardiology Department of Medicine College of Physicians and Surgeons of Columbia University New York Presbyterian Hospital New York NY
| | - Torsten P Vahl
- Division of Cardiology Department of Medicine College of Physicians and Surgeons of Columbia University New York Presbyterian Hospital New York NY
| | - Omar K Khalique
- Division of Cardiology Department of Medicine College of Physicians and Surgeons of Columbia University New York Presbyterian Hospital New York NY
| | - Nadira B Hamid
- Division of Cardiology Department of Medicine College of Physicians and Surgeons of Columbia University New York Presbyterian Hospital New York NY
| | - Amisha Patel
- Division of Cardiology Department of Medicine College of Physicians and Surgeons of Columbia University New York Presbyterian Hospital New York NY
| | - Vivian G Ng
- Division of Cardiology Department of Medicine College of Physicians and Surgeons of Columbia University New York Presbyterian Hospital New York NY
| | - Shmuel Chen
- Division of Cardiology Department of Medicine College of Physicians and Surgeons of Columbia University New York Presbyterian Hospital New York NY
| | - Thomas J Cahill
- Division of Cardiology Department of Medicine College of Physicians and Surgeons of Columbia University New York Presbyterian Hospital New York NY
| | - Hussein M Rahim
- Division of Cardiology Department of Medicine College of Physicians and Surgeons of Columbia University New York Presbyterian Hospital New York NY
| | - Rebecca T Hahn
- Division of Cardiology Department of Medicine College of Physicians and Surgeons of Columbia University New York Presbyterian Hospital New York NY
| | - Vinayak Bapat
- Division of Cardiothoracic Surgery Department of Surgery Minneapolis Heart Institute Minneapolis MN
| | - Mohammad Sarraf
- Princeton Heart and Thoracic Brookwood Baptist Health Birmingham AL
| | - Mustafa I Ahmed
- Division of Cardiothoracic Surgery Department of Surgery University of Alabama-Birmingham AL
| | - Martin B Leon
- Division of Cardiology Department of Medicine College of Physicians and Surgeons of Columbia University New York Presbyterian Hospital New York NY
| | - Susheel Kodali
- Division of Cardiology Department of Medicine College of Physicians and Surgeons of Columbia University New York Presbyterian Hospital New York NY
| | - Kyle W Eudailey
- Division of Cardiothoracic Surgery Department of Surgery University of Alabama-Birmingham AL
| | - Isaac George
- Division of Cardiothoracic Surgery Department of Surgery College of Physicians and Surgeons of Columbia University New York Presbyterian Hospital New York NY
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Hahn RT, Kodali S, Fam N, Bapat V, Bartus K, Rodés-Cabau J, Dagenais F, Estevez-Loureiro R, Forteza A, Kapadia S, Latib A, Maisano F, McCarthy P, Navia J, Ong G, Peterson M, Petrossian G, Pozzoli A, Reinartz M, Ricciardi MJ, Robinson N, Sievert H, Taramasso M, Agarwal V, Bédard E, Tarantini G, Colli A. Early Multinational Experience of Transcatheter Tricuspid Valve Replacement for Treating Severe Tricuspid Regurgitation. JACC Cardiovasc Interv 2021; 13:2482-2493. [PMID: 33153565 DOI: 10.1016/j.jcin.2020.07.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 07/01/2020] [Accepted: 07/07/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this registry was to evaluate the feasibility and safety of transcatheter tricuspid valve implantation (TTVI) in patients with extreme surgical risk. BACKGROUND Isolated tricuspid regurgitation (TR) surgery is associated with high in-hospital mortality. METHODS Thirty consecutive patients (mean age 75 ± 10 years; 56% women) from 10 institutions, with symptomatic functional TR, had institutional and notified body approval for compassionate use of the GATE TTVI system. Baseline, discharge, and 30-day follow-up echocardiographic data and procedural, in-hospital, and follow-up clinical outcomes were collected. RESULTS At baseline, all patients had multiple comorbidities, severe or greater TR, and reduced baseline right ventricular function. Technical success was achieved in 26 of 30 patients (87%). Device malpositioning occurred in 4 patients, with conversion to open heart surgery in 2 (5%). Of those who received the device, 100% had reductions in TR of ≥1, and 75% experienced reductions of ≥2 grades, resulting in 18 of 24 of patients (76%) with mild or less TR at discharge. All patients had mild or less central TR. There was continued improvement in TR grade between discharge and 30 days in 15 of 19 patients (79%). In-hospital mortality was 10%. At mean follow-up of 127 ± 82 days, 4 patients (13%) had died. Of patients alive at follow-up, 62% were in New York Heart Association functional class I or II, with no late device-related adverse events. CONCLUSIONS Compassionate treatment of severe, symptomatic functional TR using a first-generation TTVI device is associated with significant reduction in TR and improvement in functional status with acceptable in-hospital mortality. Further studies are needed to determine the appropriate patient population and long-term outcomes with TTVI therapy.
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Affiliation(s)
- Rebecca T Hahn
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York.
| | - Susheel Kodali
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Neil Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vinayak Bapat
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Krzysztof Bartus
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada
| | - Francois Dagenais
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada
| | | | | | | | | | | | - Patrick McCarthy
- Northwestern University Feinberg School of Medicine, Northwestern Medicine, Chicago, Illinois
| | - Jose Navia
- Cleveland Clinic Foundation, Cleveland, Ohio
| | - Geraldine Ong
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mark Peterson
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - George Petrossian
- NorthShore Cardiovascular Institute, NorthShore University Health System, Evanston, Illinois
| | | | - Markus Reinartz
- St. Francis Hospital, The Heart Center, Catholic Health Services, Roslyn, New York
| | - Mark J Ricciardi
- NorthShore Cardiovascular Institute, NorthShore University Health System, Evanston, Illinois
| | - Newell Robinson
- St. Francis Hospital, The Heart Center, Catholic Health Services, Roslyn, New York
| | | | | | | | - Elisabeth Bédard
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada
| | - Giuseppe Tarantini
- Department of Cardiology, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy
| | - Andrea Colli
- Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
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Percy ED, Harloff MT, Hirji S, McGurk S, Yazdchi F, Newell P, Malarczyk A, Sabe A, Landes U, Webb J, Reardon MJ, Thourani VH, Tang GHL, Bapat V, Bhatt D, O'Gara P, Gleason T, Shah P, Kaneko T. Nationally Representative Repeat Transcatheter Aortic Valve Replacement Outcomes: Report From the Centers for Medicare and Medicaid Services. JACC Cardiovasc Interv 2021; 14:1717-1726. [PMID: 34353602 DOI: 10.1016/j.jcin.2021.06.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/01/2021] [Accepted: 06/15/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The aim of this study was to examine real-world experience with repeat transcatheter aortic valve replacement (TAVR) in a population-based national database. BACKGROUND Repeat TAVR is a growing option in patients requiring reintervention for TAVR. However, large-scale studies with longitudinal follow-up are limited. METHODS All Medicare beneficiaries who underwent TAVR from 2012 to 2017 were included. Outcomes included 30-day and longitudinal mortality and major adverse cardiovascular events, defined as death, stroke, pacemaker insertion, major bleeding, acute kidney injury, or cardiac arrest. Outcomes of repeat TAVR were compared with surgical explantation after TAVR (TAVR explantation) in a matched analysis. RESULTS Of 133,250 patients who underwent TAVR, 617 (0.46%) underwent subsequent repeat TAVR at a median interval of 154 days (interquartile range: 58-537 days). Mortality at 30 days and 1 year was 6.0% and 22.0%, respectively. Rates of 30-day stroke and pacemaker insertion were 1.8% and 4.2%. Mortality at 30 days was lower in those who underwent their first TAVR during the later era (2015-2017) compared with earlier years (2012-2014) (4.6% vs 8.7%; P = 0.049). Repeat TAVR was associated with lower 30-day mortality compared with a matched group undergoing TAVR explantation (6.2% vs 12.3%; P = 0.05), although 1-year mortality was similar (21.0% vs 20.8%; P = 1.000). The incidence of 30-day major adverse cardiovascular events was higher with TAVR explantation compared with repeat TAVR (risk ratio: 2.92; 95% CI: 1.88-4.99; P ≤ 0.001). CONCLUSIONS Repeat TAVR was performed with acceptable 30-day mortality in this high-risk population. Short-term outcomes were superior to surgical explantation, but 1-year outcomes were similar. Repeat TAVR will likely be an important option for aortic valve reintervention after TAVR.
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Affiliation(s)
- Edward D Percy
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Morgan T Harloff
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sameer Hirji
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Siobhan McGurk
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Farhang Yazdchi
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paige Newell
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra Malarczyk
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ashraf Sabe
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Uri Landes
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Webb
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael J Reardon
- Houston Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, Texas, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vinayak Bapat
- Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Deepak Bhatt
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Patrick O'Gara
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas Gleason
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pinak Shah
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Hamid N, Ranard L, Khalique O, Hahn R, Nazif T, George I, Ng V, Patel A, Cahill T, Chen S, Rahim H, Sharma A, Nemshah Y, Bapat V, Leon M, Kodali S, Vahl T. COMMISSURAL ALIGNMENT AFTER TRANSFEMORAL DELIVERY OF THE JENAVALVE TRANSCATHETER AORTIC VALVE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02336-6] [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: 11/29/2022]
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Hashimoto G, Cavalcante J, Fukui M, Lopes BB, Sato H, Schmidt C, Burns M, Gossl M, Sorajja P, Sarano ME, Lesser J, Bapat V, Garcia S. ASSESSMENT OF BIOPROSTHETIC VALVE REMODELING WITH FRACTURE PROCEDURE IN VALVE-IN-VALVE TAVR BY COMPUTED TOMOGRAPHY ANGIOGRAPHY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02672-3] [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: 10/21/2022]
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34
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Lopes BBC, Kwon DH, Shah DJ, Lesser JR, Bapat V, Enriquez-Sarano M, Sorajja P, Cavalcante JL. Importance of Myocardial Fibrosis in Functional Mitral Regurgitation: From Outcomes to Decision-Making. JACC Cardiovasc Imaging 2021; 14:867-878. [PMID: 33582069 DOI: 10.1016/j.jcmg.2020.10.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/19/2020] [Accepted: 10/08/2020] [Indexed: 12/27/2022]
Abstract
Functional mitral regurgitation (FMR) is a common and complex valve disease, in which severity and risk stratification is still a conundrum. Although risk increases with FMR severity, it is modulated by subjacent left ventricular (LV) disease. The extent of LV remodeling and dysfunction is traditionally evaluated by echocardiography, but a growing body of evidence shows that myocardial fibrosis (MF) assessment by cardiac magnetic resonance (CMR) may complement risk stratification and inform treatment decisions. This review summarizes the current knowledge on the comprehensive evaluation that CMR can provide for patients with FMR, in particular for the assessment of MF and its potential impact in clinical decision-making.
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Affiliation(s)
- Bernardo B C Lopes
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Deborah H Kwon
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Dipan J Shah
- Houston Methodist Debakey Heart & Vascular Center, Houston, Texas, USA
| | - John R Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Vinayak Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
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Fukui M, Hashimoto G, Lopes B, Du Y, Stanberry L, Garcia S, Goessl M, Enriquez-Sarano M, Bapat V, Sorajja P, Lesser J, Cavalcante J. Computed tomography derived left ventricular global longitudinal strain associate with clinical outcomes in patients undergoing transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.226] [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: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Computed tomography angiography (CTA) is key imaging modality for procedure planning for transcatheter aortic valve replacement (TAVR). Functional assessment by CTA with LV global longitudinal strain (LVGLS) has recently shown to be feasible. However, there is limited data on its prognostic value in patients with severe aortic stenosis (AS) who treated with TAVR.
Purpose
To evaluate the association of baseline CTA-LVGLS with post-TAVR outcome.
Methods
Patients who underwent contrast multiphasic gated CTA for TAVR planning were studied. LVGLS was measured using dedicated feature-tracking software (Medis®). Cox regression analysis evaluated the association of baseline LVGLS with a composite outcome of all-cause death and heart failure hospitalization after TAVR.
Results
A total of 431 patients were included (median [IQR] age, 83 [77,87]years; 44% female); the society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) score, 3.3 [2.3,5.1]%; CTA-LVGLS, -18.0 [-21.6,-14.2]%; LV ejection fraction was preserved at 60 [55,65]%. After a median follow-up of 19 [13,27] months, 99 composite outcomes occurred after TAVR. On multivariable Cox regression analysis, LVGLS was associated with the risk of composite outcome even after adjustment for baseline characteristics (Figure A). Patients with reduced LVGLS (above the median >-18.0%) had higher risk of the composite outcome than those with preserved GLS (p = 0.003; Figure B).
Conclusion
Baseline CTA-LVGLS was associated with the risk of death or heart failure hospitalization over the clinical and echocardiographic characteristics in severe AS patients undergoing TAVR.
Abstract Figure.
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Affiliation(s)
- M Fukui
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - G Hashimoto
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - B Lopes
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - Y Du
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - L Stanberry
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - S Garcia
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - M Goessl
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - M Enriquez-Sarano
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - V Bapat
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - P Sorajja
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - J Lesser
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - J Cavalcante
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
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Abstract
Transcatheter aortic valve implantation is now a mainstay of treatment in patients with aortic stenosis who are considered intermediate, high and prohibitive risk for surgery. Extended use of this innovative platform in treating other conditions has led to its approval in treating degenerated aortic bioprosthesis. Similarly, use of transcatheter devices in treating degenerated mitral bioprosthesis and failed mitral valve repairs with annuloplasty rings has opened a potential alternative to surgery in these patients. Experience in mitral valve-in-valve (MVIV) and valve-in-ring (VIR), while still limited, is on the rise. Although similar in many ways to the aortic VIV, it is different with respect to patient selection, planning and procedural steps. Familiarity with the bioprosthetic properties and dimensions can help an operator choose an appropriate transcatheter device and deploy it in an ideal position. Due to greater variability in construction and properties, mitral rings have led to poorer results compared to mitral valve-in-valve. Understanding the properties of mitral rings is critical and has been simplified by us in a stepwise manner. We also describe steps in patient preparation and procedure, which should help operators in performing this procedure. Certain unique complications, such as left ventricular outflow tract obstruction and risk of embolization, are discussed with tips to address these issues. Once these steps are followed, the procedure can be performed with minimal risk and good outcome.
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Affiliation(s)
- Luigi Pirelli
- Department of Cardiothoracic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - Estee Hong
- Department of Cardiothoracic Surgery, Columbia University Irvine Medical Center, New York, NY, USA
| | - Robert Steffen
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, USA
| | - Torsten P Vahl
- Department of Cardiothoracic Surgery, Columbia University Irvine Medical Center, New York, NY, USA
| | - Susheel K Kodali
- Department of Cardiothoracic Surgery, Columbia University Irvine Medical Center, New York, NY, USA
| | - Vinayak Bapat
- Department of Cardiothoracic Surgery, Columbia University Irvine Medical Center, New York, NY, USA
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Dowling C, Gooley R, McCormick L, Brecker S, Firoozi S, Bapat V, Kodali S, Khalique O, Brouwer J, Swaans M. Patient-Specific Computer Simulation to Optimise Transcatheter Heart Valve Sizing and Positioning in Bicuspid Aortic Valve. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.496] [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: 10/20/2022]
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Bhadra OD, Vitanova K, Krane M, Tang G, Denti P, Zaid S, Modine T, Kaneko T, Bapat V, Reichenspurner H, Lange R, Conradi L. Outcomes of Mitral Valve Surgery after Edge-to-Edge Transcatheter Mitral Valve Repair: The Cutting-Edge Registry. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Vriesendorp MD, Deeb GM, Reardon MJ, Kiaii B, Bapat V, Labrousse L, Rao V, Sabik JF, Gearhart E, Klautz RJM. Why the categorization of indexed effective orifice area is not justified for the classification of prosthesis-patient mismatch. J Thorac Cardiovasc Surg 2020; 164:822-829.e6. [PMID: 33339597 DOI: 10.1016/j.jtcvs.2020.10.123] [Citation(s) in RCA: 10] [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: 06/07/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Although the impact of prosthesis-patient mismatch (PPM) on survival has been widely studied, there has been little debate about whether the current definition of PPM truly reflects hemodynamic obstruction. This study aimed to validate the categorization of indexed effective orifice area (EOAi) for the classification of PPM. METHODS In total, 2171 patients who underwent aortic valve replacement with a surgical stented bioprosthesis in 5 trials (CoreValve US High-Risk, SURTAVI [Surgical Replacement and Transcatheter Aortic Valve Implantation Trial], Evolut Low Risk, PERIGON [PERIcardial SurGical AOrtic Valve ReplacemeNt] Pivotal Trial for the Avalus valve, and PERIGON Japan) were used for this analysis. The echocardiographic images at the 1-year follow-up visit were evaluated to explore the association between EOAi and mean aortic gradient and its interaction with other patient characteristics, including obesity. In addition, different criteria of PPM were compared with reflect elevated mean aortic gradients (≥20 mm Hg). RESULTS A relatively smaller exponential decay in mean aortic gradient was found for increasing EOAi, as the slope on the log scale was -0.83 versus -2.5 in the publication from which the current cut-offs for PPM originate. The accuracy of the American Society of Echocardiography, Valve Academic Research Consortium-2, and European Association of Cardiovascular Imaging definitions of PPM to reflect elevated mean aortic gradients was 49%, 57%, and 57%, respectively. The relation between EOAi and mean aortic gradient was not significantly different between obese and non-obese patients (P = .20). CONCLUSIONS The use of EOAi thresholds to classify patients with PPM is undermined by a less-pronounced exponential relationship between EOAi and mean aortic gradient than previously demonstrated. Moreover, recent adjustment for obesity in the definition of PPM is not supported by these data.
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Affiliation(s)
- Michiel D Vriesendorp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan Health System-University Hospital, Ann Arbor, Mich
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex
| | - Bob Kiaii
- Department of Cardiovascular and Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Vinayak Bapat
- Department of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Louis Labrousse
- Medico-Surgical Department of Valvulopathies, CHU Hospital of Bordeaux, Bordeaux, France
| | - Vivek Rao
- Department of Cardiovascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Joseph F Sabik
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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Gatzoflias S, Beier MA, Ning Y, Kossar A, Gailes M, Guaman K, Segall M, Vasireddi A, Wang C, Takeda K, Takayama H, Bapat V, Naka Y, Argenziano M, Smith CR, Gordon R, Gutierrez J, Kurlansky P, George I. Efficacy of Primary Surgical Versus Medical Intervention for Treatment of Left-Sided Infective Endocarditis. Ann Thorac Surg 2020; 110:1615-1621. [DOI: 10.1016/j.athoracsur.2020.03.047] [Citation(s) in RCA: 2] [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: 11/13/2019] [Revised: 03/06/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
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Durko AP, Pibarot P, Atluri P, Bapat V, Cameron DE, Casselman FPA, Chen EP, Dahle G, Elefteriades JA, Lancellotti P, Prager RL, Rosenhek R, Speir A, Stijnen M, Tasca G, Yoganathan A, Walther T, De Paulis R. Essential Information on Surgical Heart Valve Characteristics for Optimal Valve Prosthesis Selection: Expert Consensus Document From the European Association for Cardio-Thoracic Surgery (EACTS)-The Society of Thoracic Surgeons (STS)-American Association for Thoracic Surgery (AATS) Valve Labelling Task Force. Ann Thorac Surg 2020; 111:314-326. [PMID: 33036738 DOI: 10.1016/j.athoracsur.2020.05.060] [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] [Received: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 10/23/2022]
Abstract
Comprehensive information on the characteristics of surgical heart valves (SHVs) is essential for optimal valve selection. Such information is also important in assessing SHV function after valve replacement. Despite the existing regulatory framework for SHV sizing and labelling, this information is challenging to obtain in a uniform manner for various SHVs. To ensure that clinicians are adequately informed, the European Association for Cardio-Thoracic Surgery (EACTS), The Society of Thoracic Surgeons (STS) and American Association for Thoracic Surgery (AATS) set up a Task Force comprised of cardiac surgeons, cardiologists, engineers, regulatory bodies, representatives of the International Organization for Standardization and major valve manufacturers. Previously, the EACTS-STS-AATS Valve Labelling Task Force identified the most important problems around SHV sizing and labelling. This Expert Consensus Document formulates recommendations for providing SHV physical dimensions, intended implant position and hemodynamic performance in a transparent, uniform manner. Furthermore, the Task Force advocates for the introduction and use of a standardized chart to assess the probability of prosthesis-patient mismatch and calls valve manufacturers to provide essential information required for SHV choice on standardized Valve Charts, uniformly for all SHV models.
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Affiliation(s)
- Andras P Durko
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Philippe Pibarot
- Québec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vinayak Bapat
- Department of Cardiovascular Surgery, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Duke E Cameron
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Filip P A Casselman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Edward P Chen
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Gry Dahle
- Department of Cardiothoracic and Thoracic Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - John A Elefteriades
- Department of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences, Department of Cardiology, University of Liège Hospital, Liège, Belgium
| | - Richard L Prager
- Department of Cardiac Surgery, University of Michigan Hospital, Ann Arbor, Michigan
| | - Raphael Rosenhek
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Alan Speir
- Department of Cardiac Surgery, Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | - Giordano Tasca
- Cardiac Surgery Unit, Heart Health Center, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ajit Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory School of Medicine, Atlanta, Georgia
| | - Thomas Walther
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University, Frankfurt, Germany
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Durko AP, Pibarot P, Atluri P, Bapat V, Cameron DE, Casselman FP, Chen EP, Dahle G, Elefteriades JA, Lancellotti P, Prager RL, Rosenhek R, Speir A, Stijnen M, Tasca G, Yoganathan A, Walther T, De Paulis R. Essential information on surgical heart valve characteristics for optimal valve prosthesis selection: expert consensus document from the European Association for Cardio-Thoracic Surgery (EACTS)–The Society of Thoracic Surgeons (STS)–American Association for Thoracic Surgery (AATS) Valve Labelling Task Force. Eur J Cardiothorac Surg 2020; 59:54-64. [DOI: 10.1093/ejcts/ezaa263] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/26/2020] [Accepted: 04/08/2020] [Indexed: 01/17/2023] Open
Abstract
Abstract
Comprehensive information on the characteristics of surgical heart valves (SHVs) is essential for optimal valve selection. Such information is also important in assessing SHV function after valve replacement. Despite the existing regulatory framework for SHV sizing and labelling, this information is challenging to obtain in a uniform manner for various SHVs. To ensure that clinicians are adequately informed, the European Association for Cardio-Thoracic Surgery (EACTS), The Society of Thoracic Surgeons (STS) and American Association for Thoracic Surgery (AATS) set up a Task Force comprised of cardiac surgeons, cardiologists, engineers, regulatory bodies, representatives of the International Organization for Standardization and major valve manufacturers. Previously, the EACTS–STS–AATS Valve Labelling Task Force identified the most important problems around SHV sizing and labelling. This Expert Consensus Document formulates recommendations for providing SHV physical dimensions, intended implant position and haemodynamic performance in a transparent, uniform manner. Furthermore, the Task Force advocates for the introduction and use of a standardized chart to assess the probability of prosthesis–patient mismatch and calls valve manufacturers to provide essential information required for SHV choice on standardized Valve Charts, uniformly for all SHV models.
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Affiliation(s)
- Andras P Durko
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Philippe Pibarot
- Québec Heart and Lung Institute, Laval University, Quebec, QC, Canada
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Vinayak Bapat
- Department of Cardiovascular Surgery, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Duke E Cameron
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Filip P.A Casselman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Edward P Chen
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Gry Dahle
- Department of Cardiothoracic and Thoracic surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - John A Elefteriades
- Department of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences, Department of Cardiology, University of Liège Hospital, Liège, Belgium
| | - Richard L Prager
- Department of Cardiac Surgery, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Raphael Rosenhek
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Alan Speir
- Department of Cardiac Surgery, Inova Heart and Vascular Institute, Falls Church, VA, USA
| | | | - Giordano Tasca
- Cardiac Surgery Unit, Heart Health Center, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ajit Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory School of Medicine, Atlanta, GA, USA
| | - Thomas Walther
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University, Frankfurt, Germany
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Tang G, Sengupta A, Zaid S, Vitanova K, Lange R, Munsterer A, Simon S, Fukuhara S, Deeb G, Oakley J, Voisine P, Mohammadi S, Kalavrouziotis D, Doyle D, Rodés-Cabau J, Dumont E, Alperi A, von Ballmoos M, Reardon M, Atkins M, Kleiman N, Chu M, Bagur R, Algadheeb M, Desai N, Bavaria J, Walsh E, Conradi L, Bhadra O, Schults C, Satler L, Waksman R, Ramlawi B, Andreas M, Werner P, Modine T, Leroux L, Whisenant B, Doty J, Robinson N, Wang L, Petrossian G, Goldberg J, Spielvogel D, Ahmad H, Bruschi G, Goel K, Shah AS, Geirsson A, Forrest J, Grubb K, Hirji S, Shah P, Gelpi G, Ouzounian M, Ruel M, Al-Atassi T, Kempfert J, Unbehaun A, Sonnabend S, Ben Ali W, Demers P, Ibrahim R, Garatti A, Nguyen T, Pizano A, Di Eusanio M, Capestro F, Estevez-Loureiro R, Salinger M, Rovin J, Fisher S, D'Onofrio A, Divirgilio A, Maisano F, Taramasso M, Gennari M, Colli A, Denti P, Kaneko T, Bapat V. TCT CONNECT-4 Surgical EXPLANTation After Transcatheter Aortic Valve Replacement Failure: Midterm Outcomes From the EXPLANT-TAVR International Registry. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.019] [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: 10/23/2022]
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George I, Salna M, Kobsa S, Deroo S, Kriegel J, Blitzer D, Shea NJ, D’Angelo A, Raza T, Kurlansky P, Takeda K, Takayama H, Bapat V, Naka Y, Smith CR, Bacha E, Argenziano M. The rapid transformation of cardiac surgery practice in the coronavirus disease 2019 (COVID-19) pandemic: insights and clinical strategies from a centre at the epicentre. Eur J Cardiothorac Surg 2020; 58:667-675. [PMID: 32573737 PMCID: PMC7337744 DOI: 10.1093/ejcts/ezaa228] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The onset of the coronavirus disease 2019 (COVID-19) pandemic has forced our cardiac surgery programme and hospital to enact drastic measures that has forced us to change how we care for cardiac surgery patients, assist with COVID-19 care and enable support for the hospital in terms of physical resources, providers and resident training. METHODS In this review, we review the cardiovascular manifestations of COVID-19 and describe our system-wide adaptations to the pandemic, including the use of telemedicine, how a severe reduction in operative volume affected our programme, the process of redeployment of staff, repurposing of residents into specific task teams, the creation of operation room intensive care units, and the challenges that we faced in this process. RESULTS We offer a revised set of definitions of surgical priority during this pandemic and how this was applied to our system, followed by specific considerations in coronary/valve, aortic, heart failure and transplant surgery. Finally, we outline a path forward for cardiac surgery for the near future. CONCLUSIONS We recognize that individual programmes around the world will eventually face COVID-19 with varying levels of infection burden and different resources, and we hope this document can assist programmes to plan for the future.
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Affiliation(s)
- Isaac George
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Michael Salna
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Serge Kobsa
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Scott Deroo
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Jacob Kriegel
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - David Blitzer
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Nicholas J Shea
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Alex D’Angelo
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Tasnim Raza
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Paul Kurlansky
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Koji Takeda
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Hiroo Takayama
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Vinayak Bapat
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Yoshifumi Naka
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Craig R Smith
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Emile Bacha
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Michael Argenziano
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
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Guerrero M, Wang DD, Pursnani A, Eleid M, Khalique O, Urena M, Salinger M, Kodali S, Kaptzan T, Lewis B, Kato N, Cajigas HM, Wendler O, Holzhey D, Pershad A, Witzke C, Alnasser S, Tang GH, Grubb K, Reisman M, Blanke P, Leipsic J, Williamson E, Pellikka PA, Pislaru S, Crestanello J, Himbert D, Vahanian A, Webb J, Hahn RT, Leon M, George I, Bapat V, O’Neill W, Rihal C. A Cardiac Computed Tomography–Based Score to Categorize Mitral Annular Calcification Severity and Predict Valve Embolization. JACC Cardiovasc Imaging 2020; 13:1945-1957. [DOI: 10.1016/j.jcmg.2020.03.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/02/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
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Anastasius M, Godoy M, Weir-McCall JR, Bapat V, Sathananthan J, Hensey M, Sellers SL, Cheung A, Ye J, Wood DA, Leipsic J, Webb J, Blanke P. Reference dimensions of stented surgical aortic bioprostheses for valve size determination. EUROINTERVENTION 2020; 16:e502-e506. [PMID: 32011284 DOI: 10.4244/eij-d-19-00921] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Malcolm Anastasius
- Center for Heart Valve Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
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Little SH, Bapat V, Blanke P, Guerrero M, Rajagopal V, Siegel R. Imaging Guidance for Transcatheter Mitral Valve Intervention on Prosthetic Valves, Rings, and Annular Calcification. JACC Cardiovasc Imaging 2020; 14:22-40. [PMID: 32771581 DOI: 10.1016/j.jcmg.2019.10.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 04/13/2019] [Revised: 10/09/2019] [Accepted: 10/18/2019] [Indexed: 10/23/2022]
Abstract
Catheter-based interventions to improve mitral valve function are dependent on anatomic and functional information provided by noninvasive imaging to plan, perform, and evaluate each intervention. In this review we highlight the importance of imaging guidance for catheter-based interventions on prosthetic mitral valves, surgical rings, and native valve annular calcification. Both repair and replacement procedures are discussed. We review the general features common to this collection of procedures and discuss specific imaging issues and concerns for each procedure. Figures and intraprocedural videos emphasize central messages using case examples.
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Affiliation(s)
- Stephen H Little
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
| | - Vinayak Bapat
- Columbia University Medical Center, New York, New York, USA
| | - Philipp Blanke
- St. Paul's Hospital, University of Vancouver, Vancouver, British Columbia, Canada
| | | | | | - Robert Siegel
- Cedars-Sinai Medical Center, Los Angeles, California, USA
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48
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George I, Salna M, Kobsa S, Deroo S, Kriegel J, Blitzer D, Shea NJ, D'Angelo A, Raza T, Kurlansky P, Takeda K, Takayama H, Bapat V, Naka Y, Smith CR, Bacha E, Argenziano M. The rapid transformation of cardiac surgery practice in the coronavirus disease 2019 (COVID-19) pandemic: Insights and clinical strategies from a center at the epicenter. J Thorac Cardiovasc Surg 2020; 160:937-947.e2. [PMID: 32624303 PMCID: PMC7331531 DOI: 10.1016/j.jtcvs.2020.04.060] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 04/14/2020] [Revised: 04/14/2020] [Accepted: 04/18/2020] [Indexed: 02/08/2023]
Abstract
Background The onset of the coronavirus disease 2019 (COVID-19) pandemic has forced our cardiac surgery program and hospital to enact drastic measures that has forced us to change how we care for cardiac surgery patients, assist with COVID-19 care, and enable support for the hospital in terms of physical resources, providers, and resident training. Methods In this review, we review the cardiovascular manifestations of COVID-19 and describe our system-wide adaptations to the pandemic, including the use of telemedicine, how a severe reduction in operative volume affected our program, the process of redeployment of staff, repurposing of residents into specific task teams, the creation of operation room intensive care units, and the challenges that we faced in this process. Results We offer a revised set of definitions of surgical priority during this pandemic and how this was applied to our system, followed by specific considerations in coronary/valve, aortic, heart failure and transplant surgery. Finally, we outline a path forward for cardiac surgery for the near future. Conclusions We recognize that individual programs around the world will eventually face COVID-19 with varying levels of infection burden and different resources, and we hope this document can assist programs to plan for the future.
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Affiliation(s)
- Isaac George
- Division of Cardiac, Thoracic and Vascular Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY.
| | - Michael Salna
- Division of Cardiac, Thoracic and Vascular Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
| | - Serge Kobsa
- Division of Cardiac, Thoracic and Vascular Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
| | - Scott Deroo
- Division of Cardiac, Thoracic and Vascular Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
| | - Jacob Kriegel
- Division of Cardiac, Thoracic and Vascular Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
| | - David Blitzer
- Division of Cardiac, Thoracic and Vascular Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
| | - Nicholas J Shea
- Division of Cardiac, Thoracic and Vascular Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
| | - Alex D'Angelo
- Division of Cardiac, Thoracic and Vascular Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
| | - Tasnim Raza
- Division of Cardiac, Thoracic and Vascular Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
| | - Paul Kurlansky
- Division of Cardiac, Thoracic and Vascular Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
| | - Koji Takeda
- Division of Cardiac, Thoracic and Vascular Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
| | - Hiroo Takayama
- Division of Cardiac, Thoracic and Vascular Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
| | - Vinayak Bapat
- Division of Cardiac, Thoracic and Vascular Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
| | - Yoshifumi Naka
- Division of Cardiac, Thoracic and Vascular Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
| | - Craig R Smith
- Division of Cardiac, Thoracic and Vascular Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
| | - Emile Bacha
- Division of Cardiac, Thoracic and Vascular Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
| | - Michael Argenziano
- Division of Cardiac, Thoracic and Vascular Surgery, NewYork Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY
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49
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George I, Salna M, Kobsa S, Deroo S, Kriegel J, Blitzer D, Shea NJ, D'Angelo A, Raza T, Kurlansky P, Takeda K, Takayama H, Bapat V, Naka Y, Smith CR, Bacha E, Argenziano M. The Rapid Transformation of Cardiac Surgery Practice in the Coronavirus Disease 2019 (COVID-19) Pandemic: Insights and Clinical Strategies From a Center at the Epicenter. Ann Thorac Surg 2020; 110:1108-1118. [PMID: 32591132 PMCID: PMC7309733 DOI: 10.1016/j.athoracsur.2020.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 02/08/2023]
Abstract
Background The onset of the coronavirus disease 2019 (COVID-19) pandemic has forced our cardiac surgery program and hospital to enact drastic measures that has forced us to change how we care for cardiac surgery patients, assist with COVID-19 care, and enable support for the hospital in terms of physical resources, providers, and resident training. Methods In this review, we review the cardiovascular manifestations of COVID-19 and describe our system-wide adaptations to the pandemic, including the use of telemedicine, how a severe reduction in operative volume affected our program, the process of redeployment of staff, repurposing of residents into specific task teams, the creation of operation room intensive care units, and the challenges that we faced in this process. Results We offer a revised set of definitions of surgical priority during this pandemic and how this was applied to our system, followed by specific considerations in coronary/valve, aortic, heart failure and transplant surgery. Finally, we outline a path forward for cardiac surgery for the near future. Conclusions We recognize that individual programs around the world will eventually face COVID-19 with varying levels of infection burden and different resources, and we hope this document can assist programs to plan for the future.
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Affiliation(s)
- Isaac George
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York.
| | - Michael Salna
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Serge Kobsa
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Scott Deroo
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Jacob Kriegel
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - David Blitzer
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Nicholas J Shea
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Alex D'Angelo
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Tasnim Raza
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Paul Kurlansky
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Koji Takeda
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Hiroo Takayama
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Vinayak Bapat
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Yoshifumi Naka
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Craig R Smith
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Emile Bacha
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Michael Argenziano
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
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50
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Chung CJ, Nazif TM, Wolbinski M, Hakemi E, Lebehn M, Brandwein R, Rezende CP, Doolittle J, Rabbani L, Uriel N, Schwartz A, Biviano A, Wan E, Hathaway L, Hahn R, Khalique O, Hamid N, Ng V, Patel A, Vahl T, Kirtane A, Bapat V, George I, Leon MB, Kodali SK. Restructuring Structural Heart Disease Practice During the COVID-19 Pandemic: JACC Review Topic of the Week. J Am Coll Cardiol 2020; 75:2974-2983. [PMID: 32278716 PMCID: PMC7146690 DOI: 10.1016/j.jacc.2020.04.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 01/08/2023]
Abstract
Patients with structural heart disease are at increased risk of adverse outcomes from the coronavirus disease-2019 (COVID-19) due to advanced age and comorbidity. In the midst of a global pandemic of a novel infectious disease, reality-based considerations comprise an important starting point for formulating clinical management pathways. The aims of these "crisis-driven" recommendations are: 1) to ensure appropriate and timely treatment of structural heart disease patients; 2) to minimize the risk of COVID-19 exposure to patients and health care workers; and 3) to limit resource utilization under conditions of constraint. Although the degree of disruption to usual practice will vary across the United States and elsewhere, we hope that early experiences from a heart team operating in the current global epicenter of COVID-19 may prove useful for others adapting their practice in advance of local surges of COVID-19.
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Affiliation(s)
- Christine J Chung
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Tamim M Nazif
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Mariusz Wolbinski
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Emad Hakemi
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Mark Lebehn
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Russell Brandwein
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Carolina Pinheiro Rezende
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - James Doolittle
- Division of Adult Cardiac Surgery, Department of Surgery, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Leroy Rabbani
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Allan Schwartz
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Elaine Wan
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Lisa Hathaway
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Rebecca Hahn
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Omar Khalique
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Nadira Hamid
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Vivian Ng
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Amisha Patel
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Torsten Vahl
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Ajay Kirtane
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Vinayak Bapat
- Division of Adult Cardiac Surgery, Department of Surgery, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Isaac George
- Division of Adult Cardiac Surgery, Department of Surgery, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Martin B Leon
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Susheel K Kodali
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York.
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