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1. Outcomes Following Percutaneous Coronary Intervention in Patients With Multivessel Disease Who Were Recommended for But Declined Coronary Artery Bypass Graft Surgery

Author

Anoop N. Koshy, Gregg W. Stone, Samantha Sartori, Vishal Dhulipala, Gennaro Giustino, Alessandro Spirito, Serdar Farhan, Kenneth F. Smith, Yihan Feng, Manish Vinayak, Negar Salehi, Richard Tanner, Amit Hooda, Parasuram Krishnamoorthy, Joseph M. Sweeny, Sahil Khera, George Dangas, Farzan Filsoufi, Roxana Mehran, Annapoorna S. Kini, Valentin Fuster, and Samin K. Sharma

Subjects
coronary artery disease, coronary revascularization, multivessel coronary disease, patient preferences, shared decision‐making, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background Patients may prefer percutaneous coronary intervention (PCI) over coronary artery bypass graft (CABG) surgery, despite heart team recommendations. The outcomes in such patients have not been examined. We sought to examine the results of PCI in patients who were recommended for but declined CABG. Methods and Results Consecutive patients with stable ischemic heart disease and unprotected left main or 3‐vessel disease or Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery score >22 who underwent PCI after heart team review between 2013 and 2020 were included. Patients were categorized into 3 groups according to heart team recommendations on the basis of appropriate use criteria: (1) PCI‐recommended; (2) CABG‐eligible but refused CABG (CABG‐refusal); and (3) CABG‐ineligible. The primary end point was the composite of death, myocardial infarction, or stroke at 1 year. The study included 3687 patients undergoing PCI (PCI‐recommended, n=1718 [46.6%]), CABG‐refusal (n=1595 [43.3%]), and CABG‐ineligible (n=374 [10.1%]). Clinical and procedural risk increased across the 3 groups, with the highest comorbidity burden in CABG‐ineligible patients. Composite events within 1 year after PCI occurred in 55 (4.1%), 91 (7.0%), and 41 (14.8%) of patients in the PCI‐recommended, CABG‐refusal, and CABG‐ineligible groups, respectively. After multivariable adjustment, the risk of the primary composite outcome was significantly higher in the CABG‐refusal (hazard ratio [HR], 1.67 [95% CI, 1.08–3.56]; P=0.02) and CABG‐ineligible patients (HR, 3.26 [95% CI, 1.28–3.65]; P=0.004) groups compared with the reference PCI‐recommended group, driven by increased death and stroke. Conclusions Cardiovascular event rates after PCI were significantly higher in patients with multivessel disease who declined or were ineligible for CABG. Our findings provide real‐world data to inform shared decision‐making discussions.

Published
2024
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2. Prevention and Management of Stroke After Transcatheter Aortic Valve Replacement: The Mount Sinai Stroke Initiative

Author

Sahil Khera, Anoop N. Koshy, Gilbert H. L. Tang, Pedro Moreno, Roxana Mehran, George D. Dangas, David Bronster, Annapoorna S. Kini, Michael Fara, and Samin K. Sharma

Subjects
aortic valve stenosis, cerebrovascular disorders, clinical protocols, ischemic attack, transient, stroke, Diseases of the circulatory (Cardiovascular) system, RC666-701
Published
2023
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3. Balloon Dilatation of Expandable Sheath to Facilitate Transfemoral SAPIEN 3 Transcatheter Aortic Valve Replacement in Severely Calcified Vasculature

Author

Maheedhar Gedela, MD, Sahil Khera, MD, MPH, Rami O. Tadros, MD, Parasuram Krishnamoorthy, MD, Amit Hooda, MD, Pedro Moreno, MD, PhD, George D. Dangas, MD, PhD, Samin K. Sharma, MD, Annapoorna S. Kini, MD, and Gilbert H.L. Tang, MD, MSc, MBA

Subjects
Peripheral artery disease, Transcatheter aortic valve replacement, Calcium, Diseases of the circulatory (Cardiovascular) system, RC666-701
Published
2022
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8. Optical coherence tomography in coronary atherosclerosis assessment and intervention

Author

Makoto Araki, Seung-Jung Park, Harold L. Dauerman, Shiro Uemura, Jung-Sun Kim, Carlo Di Mario, Thomas W. Johnson, Giulio Guagliumi, Adnan Kastrati, Michael Joner, Niels Ramsing Holm, Fernando Alfonso, William Wijns, Tom Adriaenssens, Holger Nef, Gilles Rioufol, Nicolas Amabile, Geraud Souteyrand, Nicolas Meneveau, Edouard Gerbaud, Maksymilian P. Opolski, Nieves Gonzalo, Guillermo J. Tearney, Brett Bouma, Aaron D. Aguirre, Gary S. Mintz, Gregg W. Stone, Christos V. Bourantas, Lorenz Räber, Sebastiano Gili, Kyoichi Mizuno, Shigeki Kimura, Toshiro Shinke, Myeong-Ki Hong, Yangsoo Jang, Jin Man Cho, Bryan P. Yan, Italo Porto, Giampaolo Niccoli, Rocco A. Montone, Vikas Thondapu, Michail I. Papafaklis, Lampros K. Michalis, Harmony Reynolds, Jacqueline Saw, Peter Libby, Giora Weisz, Mario Iannaccone, Tommaso Gori, Konstantinos Toutouzas, Taishi Yonetsu, Yoshiyasu Minami, Masamichi Takano, O. Christopher Raffel, Osamu Kurihara, Tsunenari Soeda, Tomoyo Sugiyama, Hyung Oh Kim, Tetsumin Lee, Takumi Higuma, Akihiro Nakajima, Erika Yamamoto, Krzysztof L. Bryniarski, Luca Di Vito, Rocco Vergallo, Francesco Fracassi, Michele Russo, Lena M. Seegers, Iris McNulty, Sangjoon Park, Marc Feldman, Javier Escaned, Francesco Prati, Eloisa Arbustini, Fausto J. Pinto, Ron Waksman, Hector M. Garcia-Garcia, Akiko Maehara, Ziad Ali, Aloke V. Finn, Renu Virmani, Annapoorna S. Kini, Joost Daemen, Teruyoshi Kume, Kiyoshi Hibi, Atsushi Tanaka, Takashi Akasaka, Takashi Kubo, Satoshi Yasuda, Kevin Croce, Juan F. Granada, Amir Lerman, Abhiram Prasad, Evelyn Regar, Yoshihiko Saito, Mullasari Ajit Sankardas, Vijayakumar Subban, Neil J. Weissman, Yundai Chen, Bo Yu, Stephen J. Nicholls, Peter Barlis, Nick E. J. West, Armin Arbab-Zadeh, Jong Chul Ye, Jouke Dijkstra, Hang Lee, Jagat Narula, Filippo Crea, Sunao Nakamura, Tsunekazu Kakuta, James Fujimoto, Valentin Fuster, Ik-Kyung Jang, CarMeN, laboratoire, Massachusetts General Hospital [Boston, MA, USA], Harvard Medical School [Boston] (HMS), Asan Medical Center [Seoul, South Korea] (AMC), University of Vermont [Burlington], Kawasaki Medical School [Okayama, Japan] (KMS), Yonsei University College of Medicine [Seoul, South Korea] (YUCM), Azienda Ospedaliero-Universitaria Careggi [Firenze] (AOUC), University Hospitals Bristol, Azienda Ospedaliera Ospedale Papa Giovanni XXIII [Bergamo, Italy], Technische Universität München = Technical University of Munich (TUM), Munich Heart Alliance [Munich, Allemagne] (MHA), German Heart Center = Deutsches Herzzentrum München [Munich, Germany] (GHC), Aarhus University Hospital [Skejby, Denmark] (AUH), Hospital Universitario de La Princesa, National University of Ireland [Galway] (NUI Galway), University Hospitals Leuven [Leuven], Technische Hochschule Mittelhessen - University of Applied Sciences [Giessen] (THM), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hospices Civils de Lyon (HCL), Université de Lyon, Institut Mutualiste de Montsouris (IMM), CHU Clermont-Ferrand, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux] (CRCTB), Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), National Institute of Cardiology [Warsaw, Poland] (NIC), Instituto de Investigación Sanitaria del Hospital Clínico San Carlos [Madrid, Spain] (IdISSC), Massachusetts General Hospital [Boston], Cardiovascular Research Foundation [New York, NY, USA] (CRF), Icahn School of Medicine at Mount Sinai [New York] (MSSM), Barts Health NHS Trust [London, UK], Queen Mary University of London (QMUL), Bern University Hospital [Berne] (Inselspital), Centro Cardiologico Monzino [Milan, Italy] (2CM), Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Mitsukoshi Health and Welfare Foundation [Tokyo, Japan] (MHWF), Yokohama Minami Kyosai Hospital [Kanagawa, Japan] (YMKH), Showa University Hospital [Tokyo, Japan] (SUH), Kyung Hee University [Seoul, South Korea] (KHU), The Chinese University of Hong Kong [Hong Kong], Università degli studi di Genova = University of Genoa (UniGe), Università degli studi di Parma = University of Parma (UNIPR), Catholic University of the Sacred Heart [Rome, Italy] (CUSH), University Hospital [Ioannina, Greece] (UH), New York University School of Medicine (NYU Grossman School of Medicine), Vancouver General Hospital [Vancouver, British Columbia, Canada] (VGH), University of British Columbia (UBC), Brigham and Women’s Hospital [Boston, MA], New York Presbyterian Hospital, Columbia University Medical Center (CUMC), Columbia University [New York], Ospedale San Giovanni Bosco [Turin, Italy] (OSGB), Johannes Gutenberg - Universität Mainz = Johannes Gutenberg University (JGU), National and Kapodistrian University of Athens (NKUA), Tokyo Medical and Dental University [Japan] (TMDU), Kitasato University, Nippon Medical School Chiba Hokusoh Hospital [Chiba, Japan] (NMSC2H), The Prince Charles Hospital, Nara Medical University [Nara, Japan] (NMU), Tsuchiura Kyodo General Hospital [Ibaraki, Japan] (TKGH), Japanese Red Cross Musashino Hospital [Tokyo], St. Marianna University School of Medicine [Kanagawa, Japan], Kyoto University Graduate School of Medicine [Kyoto, Japan] (KUGSM), Jagiellonian University - Medical College (JUMC), Uniwersytet Jagielloński w Krakowie = Jagiellonian University (UJ), Mazzoni Hospital [Ascoli Piceno, Italy] (MH), Korea Advanced Institute of Science and Technology (KAIST), University of Texas Health Science Center, The University of Texas Health Science Center at Houston (UTHealth), Saint Camillus International University of Health Sciences [Rome, Italy] (SCIUHS), Fondazione IRCCS Policlinico San Matteo [Pavia], Università degli Studi di Pavia = University of Pavia (UNIPV), Universidade de Lisboa = University of Lisbon (ULISBOA), MedStar Washington Hospital Center [Washington, DC, USA] (MedStar WHC), CV Path Institute [Gaithersburg, MD, USA] (CV-PI), Erasmus University Medical Center [Rotterdam] (Erasmus MC), Yokohama City University (YCU), Wakayama University, Tohoku University [Sendai], Mayo Clinic [Rochester, MN, USA], Mayo Clinic [Rochester], University hospital of Zurich [Zurich], Gifu University Graduate School of Medicine, Madras Medical Mission [Chennai, India] (3M), MedStar Health Research Institute [Washington, DC, USA] (MedStar-HRI), Chinese People's Liberation Army General Hospital [Beijing, China] (CPLAGH), Harbin Medical University [China] (HMU), Monash university, University of Melbourne, Royal Papworth Hospital [Cambridge, UK] (RPH), Johns Hopkins University (JHU), Leiden University Medical Center (LUMC), The Open University of Japan [Chiba] (OUJ), and Massachusetts Institute of Technology (MIT)

Subjects
[SDV] Life Sciences [q-bio], [SDV]Life Sciences [q-bio], Cardiology and Cardiovascular Medicine
Abstract

Optical coherence tomography (OCT) has been widely adopted in research on coronary atherosclerosis and adopted clinically to optimize percutaneous coronary intervention. In this Review, Jang and colleagues summarize this rapidly progressing field, with the aim of standardizing the use of OCT in coronary atherosclerosis.Since optical coherence tomography (OCT) was first performed in humans two decades ago, this imaging modality has been widely adopted in research on coronary atherosclerosis and adopted clinically for the optimization of percutaneous coronary intervention. In the past 10 years, substantial advances have been made in the understanding of in vivo vascular biology using OCT. Identification by OCT of culprit plaque pathology could potentially lead to a major shift in the management of patients with acute coronary syndromes. Detection by OCT of healed coronary plaque has been important in our understanding of the mechanisms involved in plaque destabilization and healing with the rapid progression of atherosclerosis. Accurate detection by OCT of sequelae from percutaneous coronary interventions that might be missed by angiography could improve clinical outcomes. In addition, OCT has become an essential diagnostic modality for myocardial infarction with non-obstructive coronary arteries. Insight into neoatherosclerosis from OCT could improve our understanding of the mechanisms of very late stent thrombosis. The appropriate use of OCT depends on accurate interpretation and understanding of the clinical significance of OCT findings. In this Review, we summarize the state of the art in cardiac OCT and facilitate the uniform use of this modality in coronary atherosclerosis. Contributions have been made by clinicians and investigators worldwide with extensive experience in OCT, with the aim that this document will serve as a standard reference for future research and clinical application.

Published
2022
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9. Perioperative management of P2Y12 inhibitors in patients undergoing cardiac surgery within 1 year of PCI

Author

Davide Cao, Julie A Swain, Samantha Sartori, Matteo Nardin, Zhongjie Zhang, Anastasios Roumeliotis, Johny Nicolas, Mauro Chiarito, Rishi Chandiramani, Carlo A Pivato, Alessandro Spirito, Gennaro Giustino, Giulio G Stefanini, George D Dangas, Usman Baber, Deepak L Bhatt, David H Adams, Samin K Sharma, Annapoorna S Kini, and Roxana Mehran

Subjects
Ticagrelor, Percutaneous Coronary Intervention, Purinergic P2Y Receptor Antagonists, Myocardial Infarction, Humans, Hemorrhage, Pharmacology (medical), Cardiac Surgical Procedures, Cardiology and Cardiovascular Medicine
Abstract

Aims To evaluate the impact of perioperative P2Y12 receptor inhibitor therapy among patients undergoing cardiac surgery within 1 year of percutaneous coronary intervention (PCI). Methods and results Patients undergoing cardiac surgery in the year post-PCI at three tertiary care centres between 2011 and 2018 were stratified into those who had received at least one dose of P2Y12 inhibitor prior to surgery (within 5 days for clopidogrel or prasugrel, or within 3 days for ticagrelor) and those who had not. The outcomes of interest were major adverse cardiac and cerebrovascular events (MACCEs) and bleeding. Among 20 279 PCI patients, 359 (1.8%) underwent cardiac surgery in the ensuing year, 76.3% of whom received coronary artery bypass grafts. Overall, 33 (9.2%) MACCEs and 85 (23.7%) bleeding events occurred within 30 days post-cardiac surgery. Perioperative P2Y12 inhibition (N = 133, 37%) was not associated with the risk of MACCEs or bleeding, despite numerically lower rates of myocardial infarction or stent thrombosis (0.0% vs. 2.6%; P = 0.089). Patients who continued the P2Y12 inhibitor until the day of surgery (N = 60, 17%) had significantly higher bleeding risk [adjusted odds ratio 2.93, 95% confidence interval 1.53–5.59)]. Predictors of MACCEs included a time interval from PCI to cardiac surgery of ≤30 days and reduced ejection fraction, whereas urgent/emergent surgery predicted bleeding. Chronic kidney disease and myocardial infarction as indication for PCI predicted both MACCEs and bleeding. Conclusion Among patients undergoing cardiac surgery in the year after PCI, the perioperative risk of ischaemic and bleeding events might be influenced by P2Y12 inhibitor therapy in addition to other risk parameters, including the timing and urgency of the procedure.

Published
2022
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10. Coronary plaque vulnerability in statin-treated patients with elevated LDL-C and hs-CRP: optical coherence tomography study

Author

Surbhi Chamaria, Hiroki Ueyama, Keisuke Yasumura, Kipp W. Johnson, Yuliya Vengrenyuk, Naotaka Okamoto, Nitin Barman, Samit Bhatheja, Vishal Kapur, Choudhury Hasan, Joseph Sweeney, Usman Baber, Samin K. Sharma, Jagat Narula, and Annapoorna S. Kini

Subjects
Radiology, Nuclear Medicine and imaging, Cardiology and Cardiovascular Medicine
Published
2022
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11. Outcomes and feasibility of redo‐TAVR after Sapien 3 Ultra TAVR in extremely‐undersized versus nominally‐sized annuli

Author

Gilbert H. L. Tang, Amit Hooda, Syed Zaid, Ming‐Yu Chuang, Sahil Khera, Parasuram Krishnamoorthy, Stamatios Lerakis, Malcolm Anastasius, Hasan A. Ahmad, Joshua B. Goldberg, Mariama Akodad, David A. Wood, Jonathon A. Leipsic, Philipp Blanke, George D. Dangas, Samin K. Sharma, Annapoorna S. Kini, John G. Webb, and Janarthanan Sathananthan

Subjects
Transcatheter Aortic Valve Replacement, Treatment Outcome, Risk Factors, Aortic Valve, Heart Valve Prosthesis, Feasibility Studies, Humans, Radiology, Nuclear Medicine and imaging, Aortic Valve Stenosis, General Medicine, Prosthesis Design, Cardiology and Cardiovascular Medicine
Abstract

To compare outcomes in Sapien 3 Ultra (S3U) transcatheter aortic valve replacement (TAVR) with extreme annular undersizing (EAU) versus nominal annular sizing (NAS).The Edwards S3U valve has reduced paravalvular leak (PVL) in TAVR but outcomes remain unknown in extremely undersized anatomy. Implanting a smaller S3U valve may facilitate future redo-TAVR but risk compromising hemodynamics.From December 2019 to July 2021, 366 patients with native aortic stenosis underwent S3U TAVR. Patients with EAU (annular areas430 mmThere were 79 (21.6%) EAU patients, with more bicuspid (p = 0.0014) and ≥moderate annular/left ventricular outflow tract calcification (p 0.001). The EAU group had less annular oversizing than NAS group (23 mm: -8.2 ± 2.6% vs. 4.0 ± 7.0%, p 0.001; 26 mm: -8.9 ± 2.2% vs. 6.7 ± 6.9%, p 0.001), more balloon overfilling (71.3% vs. 11.6%, p 0.001), and postdilatation (15.0% vs. 5.8%, p = 0.016). No differences were found in in-hospital or 30-day mortality and stroke (p 0.05). Mild PVL (13.4% EAU vs. 11.5% NAS, p = 0.56) and mean gradients (23 mm: 13.0 ± 4.5 vs. 14.1 ± 5.4 mmHg, p = 0.40; 26 mm: 11.4 ± 4.1 vs. 11.5 ± 3.9 mmHg, p = 1.0) were similar at 30 days. Had the EAU group undergone NAS with the larger Sapien 3/S3U, by computed tomography analysis simulating 80:20 or 90:10 target implant depth, 33.3%-60.9% (vs. 4.3%-23.2%) would not be feasible for redo-TAVR due to high risk of coronary obstruction.In this first report of EAU with S3U TAVR, similar excellent short-term outcomes can be achieved compared to NAS, and may preserve future redo-TAVR option.

Published
2022
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12. Outcomes of SAPIEN 3 Ultra TAVR in Extremely Undersized Versus Equivalent Nominally Sized Anatomies

Author

Gilbert H L, Tang, Amit, Hooda, Ming-Yu Anthony, Chuang, Syed, Zaid, Hasan A, Ahmad, Joshua B, Goldberg, Samin K, Sharma, Annapoorna S, Kini, John G, Webb, and Janarthanan, Sathananthan

Subjects
Transcatheter Aortic Valve Replacement, Treatment Outcome, Risk Factors, Aortic Valve, Heart Valve Prosthesis, Humans, Aortic Valve Stenosis, Prosthesis Design, Cardiology and Cardiovascular Medicine
Published
2022
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13. Efficacy and Safety of an Upfront RotaTripsy Strategy in the Treatment of De Novo and In-Stent Restenosis Cases

Author

Prashant, Dwivedi, Vishal, Dhulipala, Kartik R, Kumar, Anoop N, Koshy, Keisuke, Yasumura, Amit, Hooda, Raman, Sharma, George, Dangas, Annapoorna S, Kini, and Samin K, Sharma

Abstract

Use of both rotational atherectomy (RA) and intravascular lithotripsy (IVL)-the "RotaTripsy" technique-offers a potentially synergistic calcium-modification strategy that can treat both luminal and abluminal calcification. An upfront RotaTripsy strategy using an undersized burr in large-caliber coronaries also offers the advantage of facilitating IVL catheter passage while being able to undertake the procedure with a 6-Fr system.Consecutive patients with heavily calcified lesions on angiographic or intravascular imaging and large target-vessel caliber (≥3 mm) who underwent an upfront RA followed by IVL between July 2021 and January 2022 were included in this study. Study aims were to evaluate periprocedural efficacy and safety.Of the 21 patients included, RotaTripsy was used for treatment of de novo lesions in 12 patients (57%) and for in-stent-restenosis in 9 patients (43%). Seven cases of in-stent restenosis (ISR) involved 2 layers of stents. Mean reference vessel diameter was 3.67 ± 0.46 mm and baseline diameter stenosis was 77.4 ± 11.3%. Average RA burr-to-artery ratio was 0.43 ± 0.05 and IVL balloon-to-artery ratio was 0.93 ± 0.06, with IVL balloon crossing the lesion in all cases following RA. Procedural success was attained in 20 of 21 cases; 1 periprocedural complication (a death related to coronary perforation following stent postdilation) was recorded.An upfront RotaTripsy strategy is associated with a high degree of procedural success in de novo lesions and ISR cases by facilitating the use of a smaller burr-to-artery ratio and smaller-bore vascular access. Larger studies are required to further evaluate the potential benefits of an upfront RotaTripsy strategy from a safety and cost-benefit perspective.

Published
2023

17. Deploying a novel custom mobile application for STEMI activation and transfer in a large healthcare system to improve cross-team workflow. STEMIcathAID implementation project

Author

Haydee Garcia, Bernadette Springer, Andriy Vengrenyuk, Parasuram Krishnamoorthy, Derek Pineda, Brian Wasielewski, Wilfred AS Tan, Ashley D'Amiento, Julianna Bastone, Nitin Barman, Jeffrey Bander, Joseph Sweeny, George Dangas, Umesh Gidwani, Yuliya Vengrenyuk, Ugo Ezenkwele, Abraham Warshaw, Atul Kukar, Kevin Chason, Michael Redlener, Matthew Bai, Jennifer Siller, and Annapoorna S. Kini

Subjects
Myocardial Infarction, Humans, ST Elevation Myocardial Infarction, Pilot Projects, Cardiology and Cardiovascular Medicine, Delivery of Health Care, Mobile Applications, Workflow
Abstract

ST-segment elevation myocardial infarction (STEMI) is a high-risk patient medical emergency. We developed a secure mobile application, STEMIcathAID, to optimize care for STEMI patients by providing a digital platform for communication between the STEMI care team members, EKG transmission, cardiac catherization laboratory (cath lab) activation and ambulance tracking. The aim of this report is to describe the implementation of the app into the current STEMI workflow in preparation for a pilot project employing the app for inter-hospital STEMI transfer.App deployment involved key leadership stakeholders from all multidisciplinary teams taking care of STEMI patients. The team developed a transition plan addressing all aspects of the health system improvement process including the workflow analysis and redesign, app installation, personnel training including user account access to the app, and development of a quality assurance program for progress evaluation. The pilot will go live in the Emergency Department (ED) of one of the hospitals within the Mount Sinai Hospital System (MSHS) during the daytime weekday hours at the beginning and extending to 24/7 schedule over 4-6 weeks. For the duration of the pilot, ED personnel will combine the STEMIcathAID app activation with previous established STEMI activation processes through the MSHS Clinical Command Center (CCC) to ensure efficient and reliable response to a STEMI alert. More than 250 people were provisioned app accounts including ED Physicians and frontline nurses, and trained on their user-specific roles and responsibilities and scheduled in the app. The team will be provided with a feedback form that is discipline specific to complete after every STEMI case in order to collect information on user experience with the STEMIcathAID app functionality. The form will also provide quantitative metrics for the key time sensitive steps in STEMI care.We developed a uniform approach for deployment of a mobile application for STEMI activation and transfer in a large urban healthcare system to optimize the clinical workflow in STEMI care. The results of the pilot will demonstrate whether the app has a significant impact on the quality of care for transfer of STEMI patients.

Published
2022

18. Mitral Valve Infective Endocarditis after Trans-Catheter Aortic Valve Implantation

Author

Vassili Panagides, David del Val, Mohamed Abdel-Wahab, Norman Mangner, Eric Durand, Nikolaj Ihlemann, Marina Urena, Costanza Pellegrini, Francesco Giannini, Piotr Scislo, Zenon Huczek, Martin Landt, Vincent Auffret, Jan Malte Sinning, Asim N. Cheema, Luis Nombela-Franco, Chekrallah Chamandi, Francisco Campelo-Parada, Erika Munoz-Garcia, Howard C Herrmann, Luca Testa, Won-Keun Kim, Juan Carlos Castillo, Alberto Alperi, Didier Tchetche, Antonio L. Bartorelli, Samir Kapadia, Stefan Stortecky, Ignacio Amat-Santos, Harindra C. Wijeysundera, John Lisko, Enrique Gutiérrez-Ibanes, Vicenç Serra, Luisa Salido, Abdullah Alkhodair, Ugolino Livi, Tarun Chakravarty, Stamatios Lerakis, Victoria Vilalta, Ander Regueiro, Rafael Romaguera, Utz Kappert, Marco Barbanti, Jean-Bernard Masson, Frédéric Maes, Claudia Fiorina, Antonio Miceli, Susheel Kodali, Henrique B. Ribeiro, Jose Armando Mangione, Fabio Sandoli de Brito, Guglielmo Mario Actis Dato, Francesco Rosato, Maria-Cristina Ferreira, Valter Correia de Lima, Alexandre Siciliano Colafranceschi, Alexandre Abizaid, Marcos Antonio Marino, Vinicius Esteves, Julio Andrea, Roger R. Godinho, Fernando Alfonso, Helene Eltchaninoff, Lars Søndergaard, Dominique Himbert, Oliver Husser, Azeem Latib, Hervé Le Breton, Clement Servoz, Isaac Pascual, Saif Siddiqui, Paolo Olivares, Rosana Hernandez-Antolin, John G. Webb, Sandro Sponga, Raj Makkar, Annapoorna S. Kini, Marouane Boukhris, Philippe Gervais, Axel Linke, Lisa Crusius, David Holzhey, Josep Rodés-Cabau, Université Laval [Québec] (ULaval), Universität Leipzig [Leipzig], Technische Universität Dresden = Dresden University of Technology (TU Dresden), Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Rigshospitalet [Copenhagen], Copenhagen University Hospital, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Deutsches Herzzentrum München (DHM), Ospedale San Raffaele, Medical University of Warsaw - Poland, Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Hôpital Rangueil, CHU Toulouse [Toulouse], UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Département cardiovasculaire, Universität Leipzig, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)

Subjects
MESH: Endocarditis, Catheters, MESH: Humans, Endocarditis, MESH: Heart Valve Prosthesis, Aortic Valve Insufficiency, Aortic Valve Stenosis, MESH: Aortic Valve Insufficiency, MESH: Mitral Valve, Transcatheter Aortic Valve Replacement, Treatment Outcome, Risk Factors, MESH: Risk Factors, Aortic Valve, Heart Valve Prosthesis, Humans, Mitral Valve, [SDV.IB]Life Sciences [q-bio]/Bioengineering, MESH: Transcatheter Aortic Valve Replacement, MESH: Catheters, Cardiology and Cardiovascular Medicine, 610 Medicine & health, MESH: Aortic Valve, MESH: Aortic Valve Stenosis, MESH: Treatment Outcome
Abstract

Scarce data exist on mitral valve (MV) infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI). This multicenter study included a total of 579 patients with a diagnosis of definite IE after TAVI from the IE after TAVI International Registry and aimed to evaluate the incidence, characteristics, management, and outcomes of MV-IE after TAVI. A total of 86 patients (14.9%) had MV-IE. These patients were compared with 284 patients (49.1%) with involvement of the transcatheter heart valve (THV) only. Two factors were found to be associated with MV-IE: the use of self-expanding valves (adjusted odds ratio 2.49, 95% confidence interval [CI] 1.23 to 5.07, p = 0.012), and the presence of an aortic regurgitation >= 2 at discharge (adjusted odds ratio 3.33; 95% CI 1.43 to 7.73, p < 0.01). There were no differences in IE timing and causative microorganisms between groups, but surgical management was significantly lower in patients with MV-IE (6.0%, vs 21.6% in patients with THV-IE, p = 0.001). All-cause mortality rates at 2-year follow-up were high and similar between patients with MV-IE (51.4%, 95% CI 39.8 to 64.1) and patients with THV-IE (51.5%, 95% CI 45.4 to 58.0) (log-rank p = 0.295). The factors independently associated with increased mortality risk in patients with MV-IE were the occurrence of heart failure (adjusted p < 0.001) and septic shock (adjusted p < 0.01) during the index hospitalization. One of 6 IE episodes after TAVI is localized on the MV. The implantation of a self-expanding THV and the presence of an aortic regurgitation >= 2 at discharge were associated with MV-IE. Patients with MV-IE were rarely operated on and had a poor prognosis at 2-year follow-up. (C) 2022 Elsevier Inc. All rights reserved.

Published
2022
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19. Sex Differences Among Patients Receiving Edoxaban vs Vitamin K Antagonist for Atrial Fibrillation After TAVR

Author

Roxana Mehran, Alessandro Spirito, James Jin, Cathy Chen, Julia Seeger, Julia Mascherbauer, Pascal Vranckx, Raul Moreno, Irene M. Lang, Anil Duggal, Yusuke Watanabe, Piera Capranzano, Annapoorna S. Kini, Verena Veulemans, Elena Tessitore, Kentaro Hayashida, Martin Unverdorben, Nicolas M. Van Mieghem, Christian Hengstenberg, and George D. Dangas

Published
2023
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20. Perivalvular Extension of Infective Endocarditis after Transcatheter Aortic Valve Replacement

Author

Vassili Panagides, David del Val, Mohamed Abdel-Wahab, Norman Mangner, Eric Durand, Nikolaj Ihlemann, Marina Urena, Costanza Pellegrini, Francesco Giannini, Tomasz Gasior, Wojtek Wojakowski, Martin Landt, Vincent Auffret, Jan Malte Sinning, Asim N Cheema, Luis Nombela-Franco, Chekrallah Chamandi, Francisco Campelo-Parada, Erika Munoz-Garcia, Howard C Herrmann, Luca Testa, Won Keun Kim, Juan Carlos Castillo, Alberto Alperi, Didier Tchetche, Antonio L Bartorelli, Samir Kapadia, Stefan Stortecky, Ignacio Amat-Santos, Harindra C Wijeysundera, John Lisko, Enrique Gutiérrez-Ibanes, Vicenç Serra, Luisa Salido, Abdullah Alkhodair, Ugolino Livi, Tarun Chakravarty, Stamatios Lerakis, Victoria Vilalta, Ander Regueiro, Rafael Romaguera, Utz Kappert, Marco Barbanti, Jean Bernard Masson, Frédéric Maes, Claudia Fiorina, Antonio Miceli, Susheel Kodali, Henrique B Ribeiro, Jose Armando Mangione, Fabio Sandoli de Brito, Guglielmo Mario Actis Dato, Francesco Rosato, Maria Cristina Ferreira, Valter Correia de Lima, Alexandre Siciliano Colafranceschi, Alexandre Abizaid, Marcos Antonio Marino, Vinicius Esteves, Julio Andrea, Roger R Godinho, Fernando Alfonso, Helene Eltchaninoff, Lars Søndergaard, Dominique Himbert, Oliver Husser, Azeem Latib, Hervé Le Breton, Clement Servoz, Isaac Pascual, Saif Siddiqui, Paolo Olivares, Rosana Hernandez-Antolin, John G Webb, Sandro Sponga, Raj Makkar, Annapoorna S Kini, Marouane Boukhris, Philippe Gervais, Axel Linke, Lisa Crusius, David Holzhey, Josep Rodés-Cabau, Université Laval [Québec] (ULaval), Universität Leipzig, Endothélium, valvulopathies et insuffisance cardiaque (EnVI), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Clinique Pasteur [Toulouse], Technische Universität Dresden = Dresden University of Technology (TU Dresden), Leipzig University, Universität Leipzig [Leipzig], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Hôpital de Rangueil, CHU Toulouse [Toulouse], Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Microbiology (medical), Coagulase, Infective endocarditis, TAVI, TAVR, heart surgery, Endocarditis, infective endocarditis, 610 Medicine & health, Endocarditis, Bacterial, 030204 cardiovascular system & hematology, Abscess, 3. Good health, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, 0302 clinical medicine, Infectious Diseases, Risk Factors, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Humans, 030212 general & internal medicine, Renal Insufficiency, Chronic, Aneurysm, False
Abstract

Background Infective endocarditis (IE) following transcatheter aortic valve replacement (TAVR) has been associated with a dismal prognosis. However, scarce data exist on IE perivalvular extension (PEE) in such patients. Methods This multicenter study included 579 patients who had the diagnosis of definite IE at a median of 171 (53–421) days following TAVR. PEE was defined as the presence of an intracardiac abscess, pseudoaneurysm, or fistula. Results A total of 105 patients (18.1%) were diagnosed with PEE (perivalvular abscess, pseudoaneurysm, fistula, or a combination in 87, 7, 7, and 4 patients, respectively). A history of chronic kidney disease (adjusted odds ratio [ORadj], 2.08; 95% confidence interval [CI]: 1.27–3.41; P = .003) and IE secondary to coagulase-negative staphylococci (ORadj, 2.71; 95% CI: 1.57–4.69; P Conclusions PEE occurred in about one-fifth of IE post-TAVR patients, with the presence of coagulase-negative staphylococci and chronic kidney disease determining an increased risk. Patients with PEE-IE exhibited high early and late mortality rates, and surgery during IE hospitalization seemed to be associated with better outcomes.

Published
2021
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