432 results on '"Dhoble, Abhijeet"'
Search Results
152. Transient left ventricular apical ballooning and exercise induced hypertension during treadmill exercise testing: is there a common hypersympathetic mechanism?
- Author
-
Dhoble, Abhijeet, primary, Abdelmoneim, Sahar S, additional, Bernier, Mathieu, additional, Oh, Jae K, additional, and Mulvagh, Sharon L, additional
- Published
- 2008
- Full Text
- View/download PDF
153. Right Ventricular Asynergy as a Prognosticator
- Author
-
Punnam, Sujeeth R., primary and Dhoble, Abhijeet, additional
- Published
- 2008
- Full Text
- View/download PDF
154. Dermatomyositis and supraventricular tachycardia
- Author
-
Dhoble, Abhijeet, primary, Puttarajappa, Chethan, additional, and Neiberg, Alan, additional
- Published
- 2008
- Full Text
- View/download PDF
155. Transcatheter patent foramen ovale closure versus medical therapy for cryptogenic stroke: a metaanalysis of randomized clinical trials.
- Author
-
Riaz, Irbaz Bin, Dhoble, Abhijeet, Mizyed, Ahmad, Hsu, Paul, Husnain, Muhammad, Lee, Justin Z., Lotun, Kapildeo, and Lee, Kwan S.
- Subjects
STROKE treatment ,CLINICAL trials ,CORONARY disease ,SUBGROUP analysis (Experimental design) ,ANEURYSMS ,MEDICAL equipment - Abstract
Background There is an association between cryptogenic stroke and patent foramen ovale (PFO). The optimal treatment strategy for secondary prevention remains unclear. The purpose of this study was to analyze aggregate data examining the safety and efficacy of transcatheter device closure versus standard medical therapy in patients with PFO and cryptogenic stroke. Methods A search of published data identified 3 randomized clinical trials for inclusion. The primary outcome was a composite end-point of death, stroke and transient-ischemic attack (TIA). Predefined subgroup analysis was performed with respect to baseline characteristics including age, sex, atrial septal aneurysm and shunt size. Data was synthesized using a random effects model and results presented as hazard ratios (HRs) with 95% confidence intervals (CIs). Results A cohort of 2,303 patients with a history of cryptogenic stroke and PFO were randomized to device closure (n = 1150) and medical therapy (n = 1153). Mean follow-up was 2.5 years. Transcatheter closure was not superior to medical therapy in the secondary prevention of stroke or TIA in intention-to-treat analysis (HR: 0.66, 95% CI: 0.43 to 1.01; p = 0.056). However, the results were statistically significant using per-protocol analysis (HR: 0.64, 95% CI: 0.41 to 0.98; p = 0.043). Males had significant benefit with device closure (HR: 0.48, 95% CI: 0.24 to 0.96; p = 0.038). Conclusions In this meta-analysis, using intention-to-treat analysis, transcatheter device closure of PFO was not superior to standard medical therapy in the secondary prevention of cryptogenic stroke. Transcatheter closure was superior using per-protocol analysis. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
156. Predictors and Prognostic Impact of In-hospital Bleeding after Transcatheter Aortic Valve Replacement According to BARC and VARC-2 Definitions.
- Author
-
daSilva-deAbreu, Adrian, Yelin Zhao, Serauto-Canache, Astrid, Alhafez, Bader, Aribindi, Katyayini, Balan, Prakash, Loyalka, Pranav, Kar, Biswajit, Smalling, Richard, Anderson, H. Vernon, Dhoble, Abhijeet, Siepmann, Timo, and Arain, Salman A.
- Subjects
HEMORRHAGE ,HEART valve prosthesis implantation ,AORTIC valve transplantation - Abstract
The article offers information on relationship between severity of bleeding and postprocedural outcomes according to both Valve Academic Research Consortium 2 (VARC-2) and Bleeding Academic Research Consortium (BARC) bleeding. Topics include use of transcatheter aortic valve replacement (TAVR) database of the Memorial Hermann-Texas Medical Center; clinical characteristics predictive of in-hospital bleeding (IHB); and information about post-TAVR bleeding. events during index hospitalization.
- Published
- 2019
- Full Text
- View/download PDF
157. Abstract 14107: Racial and Income Inequities in Cardiovascular Disease in Cancer versus Non-Cancer Patients: Propensity Score and Machine Learning Augmented Nationally Representative Case-Control Study of Mortality and Cost Among 30 Million Hospitalizations
- Author
-
Monlezun, Dominique, Agrawal, Nikhil, Palaskas, Nicolas L, Cilingiroglu, Mehmet, Marmagkiolis, Konstantinos, Dhoble, Abhijeet, Arain, Salman A, and Iliescu, Cezar
- Abstract
Introduction:We conducted the first known nationally representative propensity score analysis of racial and income inequities in cardiovascular disease (CVD) for patients with and without active cancer.Methods:Propensity score adjusted and backward propagation neural network machine learning augmented multivariable regression was performed by race and income (and their interaction) for the above outcomes in this case-control study of the United States’ largest and first ICD10-coded all-payer hospitalized dataset, the 2016 National Inpatient Sample (NIS). Models were stratified by active cancer and CVD (defined by the 2021 WHO).Results:Of the 30,195,722 adult hospitalized patients, 25.64% had CVD, and 7.11% had active cancer. In fully adjusted regression among patients without cancer, Hispanic (OR 1.34, 95%CI 1.03-1.25; p=0.012) and Asian (OR 1.22; 95%CI 1.11-1.34; p<0.001) had significantly increased mortality compared to Caucasian patients as did the lowest (OR 1.11; 95%CI 1.07-1.15; p<0.001) and second lowest (OR 1.05; 95%CI 1.01-1.08; p=0.006) income quartiles compared to the highest. Among patients with cancer, similar significant racial inequities were noted but without income disparities. Mortality was not significantly increased by the interaction in either strata. Among patients without cancer, Hispanics ($14,196.68; 95%CI 12,887.86-15,505.51; p<0.001) and Asians ($19,377.06; 95%CI 17,939.38-20,814.74; p<0.001) had significantly increased costs compared to Caucasians; African American, Hispanic, and Asian patients in the lowest and second lowest income quartiles had significantly increased costs compared to Caucasians in the highest quartile. Patients with cancer had comparable cost inequities by race but not by income or the interaction.Conclusions:This nationally representative study suggests that significant income and racial inequities exist in inpatient mortality and cost among patients with CVD, though these disparities are less pronounced among cancer versus non-cancer patients.
- Published
- 2021
- Full Text
- View/download PDF
158. Abstract 10501: Clinical Outcomes After Transcatheter Edge-to-Edge Repair of the Mitral Valve with the MitraclipTMSystem in Cancer Survivors
- Author
-
Agrawal, Nikhil, Lin, Kevin, Battel, Lucas, Garcia-Sayan, Enrique, Lopez-Mattei, Juan, Arain, Salman A, Charitakis, Konstantinos, Iliescu, Cezar, Smalling, Richard W, and Dhoble, Abhijeet
- Abstract
Introduction:Valvular diseases, especially Mitral regurgitation (MR) confer a high cardiovascular burden in cancer survivors. Transcatheter Edge-to-Edge Repair (TEER) with the MitraClipTMsystem has shown promising results in the management of severe MR regardless of etiology. However, little is known about the impact of cancer history on patient outcomes.Methods:We studied 456 consecutive patients (cancer: 86; non-cancer: 370) with severe mitral regurgitation who underwent mitral valve TEER at our institution from 2005 to 2020. In addition to pre-and post-procedural characteristics, we examined imaging parameters and outcome data including all-cause mortality. We used Cox regression analysis to identify factors associated with mortality.Results:Patients were followed for a mean of 9.2 months (SD 19). Table 1 shows the baseline and follow-up characteristics for both groups. At 1-year follow-up, only 4 (5%) cancer survivors and 23 (6%) non-cancer patients had died. In a Cox regression analysis, short-term (<90 days) and long-term (1 year) mortality were similar in both cohorts (HR 0.8 and 1.2, respectively; p>0.05). Age and sex were also not significantly associated with mortality (p>0.05). In subgroup analyses, at 1-year follow-up, cancer survivors who had received prior radiation therapy were more likely to have died (11% vs 0; X2=5.07, p=0.024) and cancer survivors with solid tumors were more likely to have an NYHA functional class III-IV at 1-year follow-up than those with hematologic malignancies (X2=4.75, p=0.029).Conclusions:In this large retrospective study, short- and long-term all-cause mortality after mitral valve TEER were similar in both cancer survivors and non-cancer patients. Prior radiation therapy and history of solid tumors may be poor prognostic markers.
- Published
- 2021
- Full Text
- View/download PDF
159. Safety of Contrast Agent Use During Stress Echocardiography A 4-Year Experience From a Single-Center Cohort Study of 26,774 Patients
- Author
-
Abdelmoneim, Sahar S., Bernier, Mathieu, Scott, Christopher G., Dhoble, Abhijeet, Ness, Sue Ann C., Hagen, Mary E., Moir, Stuart, McCully, Robert B., Pellikka, Patricia A., and Mulvagh, Sharon L.
- Subjects
echocardiography ,ultrasonography ,contrast agent safety - Abstract
ObjectivesWe evaluated the short- and long-term safety of contrast agents during stress echocardiography (SE).BackgroundConcerns about contrast agent safety led to revised recommendations for product use in the U.S.MethodsWe studied 26,774 patients who underwent SE between November 1, 2003, and December 31, 2007. The 10,792 patients who comprised the contrast cohort received second-generation perfluorocarbon-based agents for left ventricular opacification during SE. The noncontrast cohort comprised 15,982 patients who had their first SE in the same period but without contrast agents. Short-term (≤72 h and ≤30 days) and long-term (up to 4.5 years) end points were death and myocardial infarction (MI). Cox regression models were used. Immediate contrast agent-related adverse effects were also reported.ResultsThe contrast cohort had older patients (mean [SD] age, 65.8 [12.1] years vs. 62.6 [14.1] years; p < 0.001), a higher percentage of males (57.4% vs. 52.8%, p < 0.001), and higher-risk patients compared with the noncontrast cohort. In addition, dobutamine SE patients had greater cardiac risk than exercise SE patients. Abnormal SE findings in patients who received contrast agents were more frequent (32.4% vs. 27.9%, p < 0.001). The 2 cohorts had no statistical difference in the incidence of short-term events (death and MI). Within 72 h, 1 patient in the contrast cohort and 2 patients in the noncontrast cohort died (p = 0.54); 3 in the contrast cohort and 7 in the noncontrast cohort had MI (p = 0.92). Within 30 days, 37 patients (0.34%) in the contrast cohort and 57 patients (0.36%) in the noncontrast cohort died (p = 0.85); 17 patients (0.16%) in the contrast cohort and 16 patients (0.10%) in the noncontrast cohort had MI (p = 0.19). Adjusted hazard ratios were not different between cohorts for death (0.99; 95% confidence interval: 0.88 to 1.11) or MI (0.99; 95% confidence interval: 0.80 to 1.22).ConclusionsThe use of contrast agents during SE was not associated with an increased short-term or long-term risk of death or MI.
- Full Text
- View/download PDF
160. Takotsubo Cardiomyopathy.
- Author
-
Maiti, Abhishek and Dhoble, Abhijeet
- Subjects
- *
CHEST pain , *HYPOKINESIA - Abstract
The article presents a case study of a takotsubo cardiomyopathy in a 61-year-old woman with hypertension and hypothyroidism presented with acute onset of severe chest pain, whose examinations revealed ST-segment elevation in the anterolateral leads and severe hypokinesis in the apical segments.
- Published
- 2017
- Full Text
- View/download PDF
161. The median doses of beta‐blockers among older adults with heart failure with reduced ejection fraction.
- Author
-
Kwak, Min Ji, Schaefer, Caroline, Krause, Trudy Millard, Goyal, Parag, Kim, Dae Hyun, Dhoble, Abhijeet, Johnson, Michael, Aparasu, Rajender, and Holmes, Holly M.
- Subjects
- *
VENTRICULAR ejection fraction , *AGE distribution , *METOPROLOL , *RETROSPECTIVE studies , *ACQUISITION of data , *ADRENERGIC beta blockers , *MEDICAL protocols , *CARVEDILOL , *MEDICAL records , *DESCRIPTIVE statistics , *BISOPROLOL , *HEART failure , *OLD age - Abstract
In the article, the authors present their study on the trend of beta-blocker doses in various age groups among older people with heart failure with reduced ejection fraction (HFrEF). Also cited are the use of the Medicare Fee-for-Service (FFS0 claims data in the study, and the recommended target doses from the 2013 American College of Foundation/American Heart Association for HF management.
- Published
- 2023
- Full Text
- View/download PDF
162. 167 - Predictors of Tracheostomy in Acute Heart Failure Exacerbation.
- Author
-
Kwak, Min Ji, Bhise, Viraj, and Dhoble, Abhijeet
- Published
- 2017
- Full Text
- View/download PDF
163. Transcatheter Edge-to-Edge Repair in Patients With Anatomically Complex Degenerative Mitral Regurgitation.
- Author
-
Hausleiter, Jörg, Lim, D. Scott, Gillam, Linda D., Zahr, Firas, Chadderdon, Scott, Rassi, Andrew N., Makkar, Raj, Goldman, Scott, Rudolph, Volker, Hermiller, James, Kipperman, Robert M., Dhoble, Abhijeet, Smalling, Richard, Latib, Azeem, Kodali, Susheel K., Lazkani, Mohamad, Choo, Joseph, Lurz, Philipp, O'Neill, William W., and Laham, Roger
- Subjects
- *
MITRAL valve insufficiency , *MITRAL valve , *HEART failure , *MEDICAL screening , *ECHOCARDIOGRAPHY , *PERCUTANEOUS balloon valvuloplasty - Abstract
Mitral valve transcatheter edge-to-edge repair is safe and effective in treating degenerative mitral regurgitation (DMR) patients at prohibitive surgical risk, but outcomes in complex mitral valve anatomy patients vary. The PASCAL IID registry assessed safety, echocardiographic, and clinical outcomes with the PASCAL system in prohibitive risk patients with significant symptomatic DMR and complex mitral valve anatomy. Patients in the prospective, multicenter, single-arm registry had 3+ or 4+ DMR, were at prohibitive surgical risk, presented with complex anatomic features based on the MitraClip instructions for use, and were deemed suitable for the PASCAL system by a central screening committee. Enrolled patients were treated with the PASCAL system. Safety, effectiveness, and functional and quality-of-life outcomes were assessed. Study oversight also included an echocardiographic core laboratory and clinical events committee. The study enrolled 98 patients (37.2% ≥2 independent significant jets, 15.0% severe bileaflet/multi scallop prolapse, 13.3% mitral valve orifice area <4.0 cm2, and 10.6% large flail gap and/or large flail width). The implant success rate was 92.9%. The 30-day composite major adverse event rate was 11.2%. At 6 months, 92.4% patients achieved MR ≤2+ and 56.1% achieved MR ≤1+ (P < 0.001 vs baseline). The Kaplan-Meier estimates for survival, freedom from major adverse events, and heart failure hospitalization at 6 months were 93.7%, 85.6%, and 92.6%, respectively. Patients experienced significant symptomatic improvement compared with baseline (P < 0.001). The outcomes of the PASCAL IID registry establish the PASCAL system as a useful therapy for prohibitive surgical risk DMR patients with complex mitral valve anatomy. (PASCAL IID Registry within the Edwards PASCAL TrAnScatheter Valve RePair System Pivotal Clinical Trial [CLASP IID] NCT03706833) [Display omitted] [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
164. Medication Complexity Among Older Adults with HF: How Can We Assess Better?
- Author
-
Kwak, Min Ji, Cheng, Monica, Goyal, Parag, Kim, Dae Hyun, Hummel, Scott L., Dhoble, Abhijeet, Deshmukh, Ashish, Aparasu, Rajender, and Holmes, Holly M.
- Subjects
- *
PATIENT readmissions , *MEDICAL care costs , *TREATMENT effectiveness , *MEDICAL care use , *DRUGS , *QUALITY of life , *PATIENT compliance , *HEART failure , *COMORBIDITY , *OLD age - Abstract
Medical management of heart failure (HF) has evolved and has achieved significant survival benefits, resulting in highly complex medication regimens. Complex medication regimens create challenges for older adults, including nonadherence and increased adverse drug events, especially associated with cognitive impairment, physical limitations, or lack of social support. However, the association between medication complexity and patients' health outcomes among older adults with HF is unclear. The purpose of this review is to address how the complexity of HF medications has been assessed in the literature and what clinical outcomes are associated with medication regimen complexity in HF. Further, we aimed to explore how older adults were represented in those studies. The Medication Regimen Complexity Index was the most commonly used tool for assessment of medication regimen complexity. Rehospitalization was most frequently assessed as the clinical outcome, and other studies used medication adherence, quality of life, healthcare utilization, healthcare cost, or side effect. However, the studies showed inconsistent results in the association between the medication regimen complexity and clinical outcomes. We also identified an extremely small number of studies that focused on older adults. Notably, current medication regimen complexity tools did not consider a complicated clinical condition of an older adult with multimorbidity, therapeutic competition, drug interactions, or altered tolerance to the usual dose strength of the medications. Furthermore, the outcomes that studies assessed were rarely comprehensive or patient centered. More studies are required to fill the knowledge gap identifying more comprehensive and accurate medication regimen complexity tools and more patient-centered outcome assessment. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
165. Abstract P278
- Author
-
Dhoble, Abhijeet, Kopecky, Stephen L, Thomas, Randal J, Squires, Ray W, Gau, Gerald T, Sarano, Maurice E, and Allison, Thomas G
- Published
- 2011
166. Abstract P278
- Author
-
Dhoble, Abhijeet, Kopecky, Stephen L, Thomas, Randal J, Squires, Ray W, Gau, Gerald T, Sarano, Maurice E, and Allison, Thomas G
- Abstract
Background:We conducted this study to assess the safety of symptom-limited cardiopulmonary exercise testing (CPX) in patients with varying severity of aortic stenosis (AS). We hypothesized that exercise testing would be safe, as defined by a rates for all-cause death of <0.01 and rate of nonfatal major cardiovascular (CV) events <0.1 within 24 hours of CPX. Secondary purpose of this study was to determine the frequency of complications during CPX.
- Published
- 2010
167. RARE CASE OF AMIODARONE INDUCED CUTANEOUS SMALL VESSEL VASCULITIS AND THROMBOCYTOPENIA.
- Author
-
Goenka, Karan V., Kandula, Vijay Aaroha, Miller, Chase, McNavish, Daniel, and Dhoble, Abhijeet
- Subjects
- *
THROMBOCYTOPENIA , *AMIODARONE , *VASCULITIS , *LEUKOCYTOCLASTIC vasculitis - Published
- 2024
- Full Text
- View/download PDF
168. Outcomes of Acute Myocardial Infarction in Patients with Influenza and Other Viral Respiratory Infections.
- Author
-
Vejpongsa, Pimprapa, Kitkungvan, Danai, Madjid, Mohammad, Charitakis, Konstantinos, Anderson, H. Vernon, Arain, Salman, Balan, Prakash, Smalling, Richard W., and Dhoble, Abhijeet
- Subjects
- *
RESPIRATORY infections , *VIRUS diseases , *MYOCARDIAL infarction , *INFLUENZA , *ADULT respiratory distress syndrome , *CORONARY angiography - Abstract
Background: Acute influenza infection can trigger acute myocardial infarction, however, outcome of patients with acute myocardial infarction during influenza infection is largely unknown.Methods: Patients ≥18 years old with ST-elevation and non-ST-elevation myocardial infarction during January 2013-December 2014 were identified using the National Inpatient Sample. The clinical outcomes were compared among patients who had no respiratory infection to the ones with influenza and other viral respiratory infections using propensity score-matched analysis.Results: Of 1,884,985 admissions for acute myocardial infarction, acute influenza and other viral infections were diagnosed in 9,885 and 11,485 patients, respectively, accounting for 1.1% of patients. Acute myocardial infarction patients with concomitant influenza infection had a worse outcome than those with acute myocardial infarction alone, in terms of in-hospital case fatality rate, development of shock, acute respiratory failure, acute kidney injury, and higher rate of blood transfusion after propensity scores. The length of stay is also significantly longer in influenza patients with acute myocardial infarction, compared with patients with acute myocardial infarction alone. However, patients who developed acute myocardial infarction during other viral respiratory infection have a higher rate of acute respiratory failure but overall lower mortality rate, and are less likely to develop shock or require blood transfusion after propensity match. Despite presenting with acute myocardial infarction, less than one-fourth of patients with concomitant influenza infection underwent coronary angiography, but more than half (51.4%) required revascularization.Conclusion: Influenza infection is associated with worse outcomes in acute myocardial infarction patients, and patients were less likely to receive further evaluation with invasive coronary angiography. [ABSTRACT FROM AUTHOR]- Published
- 2019
- Full Text
- View/download PDF
169. Hyperkalemia masked by pseudo-stemi infarct pattern and cardiac arrest.
- Author
-
Peerbhai, Shareez, Masha, Luke, DaSilva-DeAbreu, Adrian, and Dhoble, Abhijeet
- Subjects
- *
ACUTE kidney failure , *CARDIAC arrest , *DIFFERENTIAL diagnosis , *ELECTROCARDIOGRAPHY , *MYOCARDIAL infarction , *CORONARY angiography , *HYPERKALEMIA , *DISEASE complications , *DIAGNOSIS - Abstract
Background: Hyperkalemia is a common electrolyte abnormality and has well-recognized early electrocardiographic manifestations including PR prolongation and symmetric T wave peaking. With severe increase in serum potassium, dysrhythmias and atrioventricular and bundle branch blocks can be seen on electrocardiogram. Although cardiac arrest is a worrisome consequence of untreated hyperkalemia, rarely does hyperkalemia electrocardiographically manifest as acute ischemia. Case presentation: We present a case of acute renal failure complicated by malignant hyperkalemia and eventual ventricular fibrillation cardiac arrest. Recognition of this disorder was delayed secondary to an initial ECG pattern suggesting an acute ST segment elevation myocardial infarction (STEMI). Emergent coronary angiography performed showed no evidence of coronary artery disease. Conclusions: Pseudo-STEMI patterns are rarely seen in association with acute hyperkalemia and are most commonly described with patient without acute cardiac symptomatology. This is the first such case presenting concurrently with cardiac arrest. A brief review of this rare pseudo-infarct pattern is also given. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
170. E. COLI BACTERIAL PERICARDITIS ASSOCIATED WITH SPONTANEOUS BACTERIAL PERITONITIS.
- Author
-
Amatullah, Atia, Irizarry-Caro, Jorge A., Hoang, Kenneth, Ma, Jennifer, Yarrabothula, Akshitha R., Haque, Kazi, Salman, Justin, Goenka, Karan V., Lobo, Nikita, Dhoble, Abhijeet, Charitakis, Konstantinos, and Owen, Brittany
- Subjects
- *
PERITONITIS , *PERICARDITIS - Published
- 2023
- Full Text
- View/download PDF
171. CANCER, INSURANCE, AND INCOME DISPARITIES IN TRANSCATHETER MITRAL VALVE REPLACEMENT AND REPAIR: MACHINE LEARNING AND PROPENSITY SCORE ANALYSIS OF 4,827 PROCEDURES.
- Author
-
Park, Jong Kun, Monlezun, Dominique, Ali, Abdelrahman, Honan, Kevin, Kim, Jin wan, Patel, Rishi, Javaid, Awad, Karla, Aamuktha, Palaskas, Nicolas L., Cilingiroglu, Mehmet, Dhoble, Abhijeet, Marmagkiolis, Konstantinos, and Iliescu, Cezar
- Subjects
- *
MITRAL valve , *INCOME inequality , *MACHINE learning , *INSURANCE - Published
- 2023
- Full Text
- View/download PDF
172. THE IMPORTANCE OF EARLY RECOGNITION OF DELIRIUM IN PATIENTS UNDERGOING TRANSCATHETER AORTIC AND MITRAL VALVE REPLACEMENT.
- Author
-
Desai, Shyam, Moreno, Miguel Bonilla, Kwak, Min Ji, Dhoble, Abhijeet, and Arain, Salman Atiq
- Subjects
- *
DELIRIUM - Published
- 2023
- Full Text
- View/download PDF
173. Effect of Hospital Volume on Outcomes of Transcatheter Aortic Valve Implantation.
- Author
-
Badheka, Apurva O., Patel, Nileshkumar J., Panaich, Sidakpal S., Patel, Samir V., Jhamnani, Sunny, Singh, Vikas, Pant, Sadip, Patel, Nish, Patel, Nilay, Arora, Shilpkumar, Thakkar, Badal, Manvar, Sohilkumar, Dhoble, Abhijeet, Patel, Achint, Savani, Chirag, Patel, Jay, Chothani, Ankit, Savani, Ghanshyambhai T., Deshmukh, Abhishek, and Grines, Cindy L.
- Subjects
- *
AORTIC valve transplantation , *CATHETERIZATION , *CROSS-sectional method , *MEDICAL care costs , *HEALTH outcome assessment - Abstract
Transcatheter aortic valve implantation (TAVI) is associated with a significant learning curve. There is paucity of data regarding the effect of hospital volume on outcomes after TAVI. This is a cross-sectional study based on Healthcare Cost and Utilization Project's Nationwide Inpatient Sample database of 2012. Subjects were identified by International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes, 35.05 (Trans-femoral/Trans-aortic Replacement of Aortic Valve) and 35.06 (Trans-apical Replacement of Aortic Valve). Annual hospital TAVI volumes were calculated using unique identification numbers and then divided into quartiles. Multivariate logistic regression models were created. The primary outcome was inhospital mortality; secondary outcome was a composite of inhospital mortality and periprocedural complications. Length of stay (LOS) and cost of hospitalization were assessed. The study included 1,481 TAVIs (weighted n = 7,405). Overall inhospital mortality rate was 5.1%, postprocedural complication rate was 43.4%, median LOS was 6 days, and median cost of hospitalization was $51,975. Inhospital mortality rates decreased with increasing hospital TAVI volume with a rate of 6.4% for lowest volume hospitals (first quartile), 5.9% (second quartile), 5.2% (third quartile), and 2.8% for the highest volume TAVI hospitals (fourth quartile). Complication rates were significantly higher in hospitals with the lowest volume quartile (48.5%) compared to hospitals in the second (44.2%), third (39.7%), and fourth (41.5%) quartiles (p <0.001). Increasing hospital volume was independently predictive of shorter LOS and lower hospitalization costs. In conclusion, higher annual hospital volumes are significantly predictive of reduced postprocedural mortality, complications, shorter LOS, and lower hospitalization costs after TAVI. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
174. Resting qualitative and quantitative myocardial contrast echocardiography to predict cardiac events in patients with acute myocardial infarction and percutaneous revascularization.
- Author
-
Abdelmoneim, Sahar, Martinez, Matthew, Mankad, Sunil, Bernier, Mathieu, Dhoble, Abhijeet, Pellikka, Patricia, Chandrasekaran, Krishnaswamy, Oh, Jae, and Mulvagh, Sharon
- Subjects
- *
MYOCARDIAL infarction , *CARDIOVASCULAR diseases risk factors , *MYOCARDIAL revascularization , *CONTRAST echocardiography , *CONTRAST media , *REPERFUSION , *PROGNOSIS ,MYOCARDIAL infarction diagnosis - Abstract
Successful restoration of patency of the infarct-related artery is important in management of acute ST-segment elevation myocardial infarction (STEMI); however, it does not necessarily translate into the restoration of perfusion at the tissue level. In this study, we evaluate the prognostic role of qualitative and quantitative myocardial contrast echocardiography (MCE) in predicting cardiac events (after adjustment for cardiovascular risk factors) in STEMI patients undergoing reperfusion. Bedside resting real-time MCE using continuous infusion of diluted contrast agent (Definity) was performed within a median of 21.4 h from revascularization in STEMI. Myocardial perfusion on qualitative MCE was graded 1 = homogenous; 2 = partial/patchy; and 3 = absent. Perfusion score index (PSI) was calculated by adding the perfusion score in all segments divided by the total number of evaluable segments. Quantitative perfusion parameters [ A, dB; β, sec; and Aβ] were analyzed using a 17-segment model. Patients were followed for cardiac events including death; nonfatal myocardial infarction (MI); hospitalization for cardiac symptoms; coronary revascularization; or heart failure. Thirty-seven reperfused STEMI patients with a mean age of 64 years (range, 40-86 years) were enrolled and followed for a median of 1.4 years. Cardiac events occurred in 22 patients. Patients with cardiac events had a higher perfusion score index (PSI), and lower A, β and Aβ parameters compared to patients without events [1.84 ± 0.36 vs 1.39 ± 0.17 for PSI, P < 0.001; 0.57 ± 0.24 vs 0.85 ± 0.30 for A, P = 0.03; 0.34 ± 0.15 vs. 0.53 ± 0.17 for β, P = 0.002; and 0.21 ± 0.12 vs. 0.49 ± 0.32, for Aβ, P = 0.003; respectively]. A PSI value of 1.58 provided an area under the curve (AUC) of 0.873, while β of 0.423 and Aβ of 0.323 provided an AUC of 0.858 and 0.842, respectively. PSI and Aβ were independent predictors of cardiac events with an adjusted hazard ratio of 3.41 (1.19-12.27); and 4.19 (1.3-19.09), respectively. No contrast-related side effects were reported. Evaluation of perfusion in reperfused STEMI patients by qualitative and quantitative MCE (myocardial blood flow, Aβ) provides independent prediction of cardiac events. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
175. TRANSCATHETER MITRAL VALVE INTERVENTION IN PATIENTS WITH CANCER.
- Author
-
Javaid, Awad, Monlezun, Dominique, Kaur, Banveet, Dhoble, Abhijeet, and Iliescu, Cezar
- Subjects
- *
MITRAL valve , *CANCER patients - Published
- 2022
- Full Text
- View/download PDF
176. Transcatheter Mitral Valve Replacement for Degenerated Bioprosthetic Valves and Failed Annuloplasty Rings
- Author
-
Marco Ancona, Masahiko Asami, Tarun Chakravarty, Victoria Delgado, Joachim Schofer, Stephan Ensminger, James E. Davies, Michael J. Reardon, Antonio Colombo, Rajiv Rampat, Thomas Pilgrim, Florian Deuschl, Jeroen J. Bax, Daniel J. Blackman, Lena Eschenbach, Harindra C. Wijeysundera, Saibal Kar, Niklas Schofer, Ermela Yzeiraj, Buntaro Fujita, Luis Nombela-Franco, Abhijeet Dhoble, Raj Makkar, Francesco Maisano, Horst Sievert, Stefano Cannata, Brian Whisenant, Sabine Bleiziffer, Anthony C. Chyou, Azeem Latib, Antonio H. Frangieh, Sung Han Yoon, Jean Bernard Masson, David Hildick-Smith, Christian Hengstenberg, Enrique Gutiérrez-Ibañes, Stephan Windecker, Tsuyoshi Kaneko, Lenard Conradi, Guiherme F. Attizzani, S. Chiu Wong, Ulrich Schaefer, Maurizio Taramasso, Colin MacLeod Barker, Tomaz Podlesnikar, Albert M. Kasel, Bernard Prendergast, Simon Redwood, Fabian Nietlispach, Rahul Sharma, Yoon, Sung-han, Whisenant, Brian K., Bleiziffer, Sabine, Delgado, Victoria, Schofer, Nikla, Eschenbach, Lena, Fujita, Buntaro, Sharma, Rahul, Ancona, Marco, Yzeiraj, Ermela, Cannata, Stefano, Barker, Colin, Davies, James E., Frangieh, Antonio H., Deuschl, Florian, Podlesnikar, Tomaz, Asami, Masahiko, Dhoble, Abhijeet, Chyou, Anthony, Masson, Jean-bernard, Wijeysundera, Harindra C., Blackman, Daniel J., Rampat, Rajiv, Taramasso, Maurizio, Gutierrez-ibanes, Enrique, Chakravarty, Tarun, Attizzani, Guiherme F., Kaneko, Tsuyoshi, Wong, S. Chiu, Sievert, Horst, Nietlispach, Fabian, Hildick-smith, David, Nombela-franco, Lui, Conradi, Lenard, Hengstenberg, Christian, Reardon, Michael J., Kasel, Albert Marku, Redwood, Simon, Colombo, Antonio, Kar, Saibal, Maisano, Francesco, Windecker, Stephan, Pilgrim, Thoma, Ensminger, Stephan M., Prendergast, Bernard D., Schofer, Joachim, Schaefer, Ulrich, Bax, Jeroen J., Latib, Azeem, and Makkar, Raj R
- Subjects
Male ,Reoperation ,mitral valve ,medicine.medical_specialty ,Cardiac Catheterization ,Mitral Valve Annuloplasty ,medicine.medical_treatment ,Heart Valve Diseases ,Annuloplasty rings ,030204 cardiovascular system & hematology ,Valve in ring ,Prosthesis Design ,degenerated bioprosthese ,03 medical and health sciences ,0302 clinical medicine ,Retrospective Studie ,transcatheter valve implantation ,Mitral valve ,Internal medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,610 Medicine & health ,Bioprosthesi ,Retrospective Studies ,Aged ,Bioprosthesis ,Heart Valve Prosthesis Implantation ,Ejection fraction ,business.industry ,Mitral valve replacement ,annuloplasty ring ,Prosthesis Failure ,Europe ,Survival Rate ,Heart Valve Disease ,medicine.anatomical_structure ,Treatment Outcome ,degenerated bioprostheses ,North America ,Cardiology ,Female ,business ,Cardiology and Cardiovascular Medicine ,Human - Abstract
Background Limited data exist regarding transcatheter mitral valve replacement (TMVR) for patients with failed mitral valve replacement and repair. Objectives This study sought to evaluate the outcomes of TMVR in patients with failed mitral bioprosthetic valves (valve-in-valve [ViV]) and annuloplasty rings (valve-in-ring [ViR]). Methods From the TMVR multicenter registry, procedural and clinical outcomes of mitral ViV and ViR were compared according to Mitral Valve Academic Research Consortium criteria. Results A total of 248 patients with mean Society of Thoracic Surgeons score of 8.9 ± 6.8% underwent TMVR. Transseptal access and the balloon-expandable valve were used in 33.1% and 89.9%, respectively. Compared with 176 patients undergoing ViV, 72 patients undergoing ViR had lower left ventricular ejection fraction (45.6 ± 17.4% vs. 55.3 ± 11.1%; p < 0.001). Overall technical and device success rates were acceptable, at 92.3% and 85.5%, respectively. However, compared with the ViV group, the ViR group had lower technical success (83.3% vs. 96.0%; p = 0.001) due to more frequent second valve implantation (11.1% vs. 2.8%; p = 0.008), and lower device success (76.4% vs. 89.2%; p = 0.009) due to more frequent reintervention (16.7% vs. 7.4%; p = 0.03). Mean mitral valve gradients were similar between groups (6.4 ± 2.3 mm Hg vs. 5.8 ± 2.7 mm Hg; p = 0.17), whereas the ViR group had more frequent post-procedural mitral regurgitation moderate or higher (19.4% vs. 6.8%; p = 0.003). Furthermore, the ViR group had more frequent life-threatening bleeding (8.3% vs. 2.3%; p = 0.03), acute kidney injury (11.1% vs. 4.0%; p = 0.03), and subsequent lower procedural success (58.3% vs. 79.5%; p = 0.001). The 1-year all-cause mortality rate was significantly higher in the ViR group compared with the ViV group (28.7% vs. 12.6%; log-rank test, p = 0.01). On multivariable analysis, failed annuloplasty ring was independently associated with all-cause mortality (hazard ratio: 2.70; 95% confidence interval: 1.34 to 5.43; p = 0.005). Conclusions The TMVR procedure provided acceptable outcomes in high-risk patients with degenerated bioprostheses or failed annuloplasty rings, but mitral ViR was associated with higher rates of procedural complications and mid-term mortality compared with mitral ViV.
- Published
- 2017
177. Contemporary Outcomes and Trends for the Transseptal Mitral Valve-in-Valve Procedure Using Balloon Expandable Transcatheter Valves in the United States.
- Author
-
Goel K, Makkar R, Krishnaswamy A, Kapadia S, Kodali S, Shah A, Barker C, Xu K, Dhoble A, Yadav P, Rihal CS, Abbas AE, Guerrero M, and Whisenant B
- Abstract
Background: Previous transcatheter valve therapy registry analyses of transcatheter mitral valve in valve (MViV) replacement of degenerated bioprosthesis reported early experience in the United States. Given recent increases in transseptal MViV volumes and introduction of the SAPIEN 3 Ultra valve, it is important to determine contemporary outcomes for patients undergoing transseptal SAPIEN 3/SAPIEN 3 Ultra MViV replacement., Methods: The Society of Thoracic Surgeons (STS)/American College of Cardiology Transcatheter Valve Therapy Registry was used to extract data for all patients undergoing transseptal SAPIEN 3/SAPIEN 3 Ultra MViV from 2015 to September 2022. Primary efficacy outcome was 1-year all-cause mortality. Secondary end points included 30-day mortality, functional class, quality of life, and mitral valve performance. Primary safety outcomes were device success and in-hospital complications., Results: A total of 4243 patients with a mean STS score of 9.2±7.7 underwent transseptal MViV at 455 sites. The rate of Mitral Valve Academic Research Consortium technical (96.6%) success was high, and procedural complications were low. All-cause in-hospital, 30-day, and 1-year mortality rates were 3.2%, 4.3%, and 13.4%, respectively. Significant improvements in New York Heart Association class (New York Heart Association I/II, 18% to 87%) and quality of life (Kansas City Cardiomyopathy Questionnaire score, 38 to 78) were noted at 1 year ( P <0.0001 for both) after MViV. Upon stratifying by STS scores, it was observed that the low-risk group (STS<4) had a significantly lower in-hospital mortality rate of 0.4%, whereas the intermediate-risk group (STS, 4-8) had an in-hospital mortality rate of 1.9%. From 2015 to 2022, the number of transseptal MViV cases/year increased significantly, whereas procedure times, length of stay, and intensive care unit hours shortened significantly. At the same time, there was a significant trend toward reduced in-hospital ( P =0.0005), 30-day ( P =0.004), and 1-year mortality rates ( P =0.01)., Conclusions: This multicenter, prospective study reports excellent procedural outcomes, 1-year mortality rates, and a significant improvement in quality of life for patients undergoing transseptal MViV in the contemporary era. Patients in the low-risk and intermediate-risk STS score categories had significantly better outcomes compared with those in the high-risk category. MViV is a reasonable therapy for the majority of patients with degenerated bioprosthetic mitral valves, who are anatomical candidates.
- Published
- 2024
- Full Text
- View/download PDF
178. Real-World Outcomes for the Fifth-Generation Balloon Expandable Transcatheter Heart Valve in the United States.
- Author
-
Stinis CT, Abbas AE, Teirstein P, Makkar RR, Chung CJ, Iyer V, Généreux P, Kipperman RM, Harrison JK, Hughes GC, Lyons JM, Rahman A, Kakouros N, Walker J, Roberts DK, Huang PH, Kar B, Dhoble A, Logsdon DP, Khanna PK, Aragon J, and McCabe JM
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Male, Hemodynamics, Postoperative Complications etiology, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, United States, Aortic Valve surgery, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Aortic Valve Stenosis physiopathology, Balloon Valvuloplasty adverse effects, Heart Valve Prosthesis, Prosthesis Design, Recovery of Function, Registries, Transcatheter Aortic Valve Replacement instrumentation, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement mortality
- Abstract
Background: The fifth-generation SAPIEN 3 Ultra Resilia valve (S3UR) incorporates several design changes as compared with its predecessors, the SAPIEN 3 (S3) and SAPIEN 3 Ultra (S3U) valves, including bovine leaflets treated with a novel process intended to reduce structural valve deterioration via calcification, as well as a taller external skirt on the 29-mm valve size to reduce paravalvular leak (PVL). The clinical performance of S3UR compared with S3 and S3U in a large patient population has not been previously reported., Objectives: The aim of this study was to compare S3UR to S3/S3U for procedural, in-hospital, and 30-day clinical and echocardiographic outcomes after transcatheter aortic valve replacement (TAVR)., Methods: Patients enrolled in the STS/ACC TVT (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy) Registry between January 1, 2021, and June 30, 2023, who underwent TAVR with S3UR or S3U/S3 valve platforms were propensity-matched and evaluated for procedural, in-hospital, and 30-day clinical and echocardiographic outcomes., Results: 10,314 S3UR patients were propensity matched with 10,314 patients among 150,539 S3U/S3 patients. At 30 days, there were no statistically significant differences in death, stroke, or bleeding, but a numerically higher hospital readmission rate in the S3UR cohort (8.5% vs 7.7%; P = 0.04). At discharge, S3UR patients exhibited significantly lower mean gradients (9.2 ± 4.6 mm Hg vs 12.0 ± 5.7 mm Hg; P < 0.0001) and larger aortic valve area (2.1 ± 0.7 cm
2 vs 1.9 ± 0.6 cm2 ; P < 0.0001) than patients treated with S3/S3U. The 29-mm valve size exhibited significant reduction in mild PVL (5.3% vs 9.4%; P < 0.0001)., Conclusions: S3UR TAVR is associated with lower mean gradients and lower rates of PVL than earlier generations of balloon expandable transcatheter heart valve platforms., Competing Interests: Funding Support and Author Disclosures Dr Stinis has received consulting fees from Edwards Lifesciences, Medtronic, Boston Scientific, and Shockwave Medical; and serves on an advisory board for Boston Scientific. Dr Abbas has received research grants and consulting fees from Edwards Lifesciences. Dr Teirstein has received research grant and honoraria from Abbott, Boston Scientific, Cordis, and Medtronic; and serves on advisory boards for Boston Scientific and Medtronic. Dr Makkar has received grant support/research contracts from Edwards Lifesciences and St. Jude Medical; and has received consultant fees/honoraria and served on the Speakers Bureaus of Abbott Vascular, Cordis Corporation, and Medtronic. Dr Généreux has been a consultant for Abbott Vascular, Abiomed, BioTrace Medical, Boston Scientific, CARANX, Cardiovascular Systems Inc (for the PI Eclipse Trial), Edwards Lifesciences, GE Healthcare, iRhythm Technologies, Medtronic, Opsens, Pi-Cardia, Puzzle Medical, Saranas, Shockwave, Siemens, Soundbite Medical Inc, Teleflex, and 4C Medical (for the PI Feasibility study). Dr Huang has received speaker honoraria from Abbott Vascular; and has received consulting fees from Edwards Lifesciences. Dr Aragon received has consultant fees from Edwards Lifesciences. Dr McCabe has received fees from Edwards Lifesciences, Boston Scientific, and Teleflex outside the submitted work. Statistical analyses were performed by Edwards Lifesciences. The views or opinions presented here do not represent those of the American College of Cardiology (ACC), Society of Thoracic Surgeons (STS), or the STS/ACC TVT Registry. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)- Published
- 2024
- Full Text
- View/download PDF
179. Dynamic Prognosis Prediction for Patients on DAPT After Drug-Eluting Stent Implantation: Model Development and Validation.
- Author
-
Li F, Rasmy L, Xiang Y, Feng J, Abdelhameed A, Hu X, Sun Z, Aguilar D, Dhoble A, Du J, Wang Q, Niu S, Dang Y, Zhang X, Xie Z, Nian Y, He J, Zhou Y, Li J, Prosperi M, Bian J, Zhi D, and Tao C
- Subjects
- Humans, Platelet Aggregation Inhibitors adverse effects, Artificial Intelligence, Retrospective Studies, Treatment Outcome, Risk Factors, Drug Therapy, Combination, Hemorrhage chemically induced, Prognosis, Myocardial Infarction etiology, Coronary Artery Disease diagnosis, Coronary Artery Disease surgery, Drug-Eluting Stents adverse effects, Percutaneous Coronary Intervention adverse effects
- Abstract
Background: The rapid evolution of artificial intelligence (AI) in conjunction with recent updates in dual antiplatelet therapy (DAPT) management guidelines emphasizes the necessity for innovative models to predict ischemic or bleeding events after drug-eluting stent implantation. Leveraging AI for dynamic prediction has the potential to revolutionize risk stratification and provide personalized decision support for DAPT management., Methods and Results: We developed and validated a new AI-based pipeline using retrospective data of drug-eluting stent-treated patients, sourced from the Cerner Health Facts data set (n=98 236) and Optum's de-identified Clinformatics Data Mart Database (n=9978). The 36 months following drug-eluting stent implantation were designated as our primary forecasting interval, further segmented into 6 sequential prediction windows. We evaluated 5 distinct AI algorithms for their precision in predicting ischemic and bleeding risks. Model discriminative accuracy was assessed using the area under the receiver operating characteristic curve, among other metrics. The weighted light gradient boosting machine stood out as the preeminent model, thus earning its place as our AI-DAPT model. The AI-DAPT demonstrated peak accuracy in the 30 to 36 months window, charting an area under the receiver operating characteristic curve of 90% [95% CI, 88%-92%] for ischemia and 84% [95% CI, 82%-87%] for bleeding predictions., Conclusions: Our AI-DAPT excels in formulating iterative, refined dynamic predictions by assimilating ongoing updates from patients' clinical profiles, holding value as a novel smart clinical tool to facilitate optimal DAPT duration management with high accuracy and adaptability.
- Published
- 2024
- Full Text
- View/download PDF
180. Coronary flow capacity and survival prediction after revascularization: physiological basis and clinical implications.
- Author
-
Gould KL, Johnson NP, Roby AE, Bui L, Kitkungvan D, Patel MB, Nguyen T, Kirkeeide R, Haynie M, Arain SA, Charitakis K, Dhoble A, Smalling R, Nascimbene A, Jumean M, Kumar S, Kar B, Sdringola S, Estrera A, Gregoric I, Lai D, Li R, McPherson D, and Narula J
- Subjects
- Humans, Rubidium Radioisotopes, Prospective Studies, Positron-Emission Tomography methods, Coronary Angiography methods, Coronary Artery Disease
- Abstract
Background and Aims: Coronary flow capacity (CFC) is associated with an observed 10-year survival probability for individual patients before and after actual revascularization for comparison to virtual hypothetical ideal complete revascularization., Methods: Stress myocardial perfusion (mL/min/g) and coronary flow reserve (CFR) per pixel were quantified in 6979 coronary artery disease (CAD) subjects using Rb-82 positron emission tomography (PET) for CFC maps of artery-specific size-severity abnormalities expressed as percent left ventricle with prospective follow-up to define survival probability per-decade as fraction of 1.0., Results: Severely reduced CFC in 6979 subjects predicted low survival probability that improved by 42% after revascularization compared with no revascularization for comparable severity (P = .0015). For 283 pre-and-post-procedure PET pairs, severely reduced regional CFC-associated survival probability improved heterogeneously after revascularization (P < .001), more so after bypass surgery than percutaneous coronary interventions (P < .001) but normalized in only 5.7%; non-severe baseline CFC or survival probability did not improve compared with severe CFC (P = .00001). Observed CFC-associated survival probability after actual revascularization was lower than virtual ideal hypothetical complete post-revascularization survival probability due to residual CAD or failed revascularization (P < .001) unrelated to gender or microvascular dysfunction. Severely reduced CFC in 2552 post-revascularization subjects associated with low survival probability also improved after repeat revascularization compared with no repeat procedures (P = .025)., Conclusions: Severely reduced CFC and associated observed survival probability improved after first and repeat revascularization compared with no revascularization for comparable CFC severity. Non-severe CFC showed no benefit. Discordance between observed actual and virtual hypothetical post-revascularization survival probability revealed residual CAD or failed revascularization., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
- Published
- 2024
- Full Text
- View/download PDF
181. 1-Year Outcomes of Transcatheter Edge-to-Edge Repair in Anatomically Complex Degenerative Mitral Regurgitation Patients.
- Author
-
Smith RL, Lim DS, Gillam LD, Zahr F, Chadderdon S, Rassi AN, Makkar R, Goldman S, Rudolph V, Hermiller J, Kipperman RM, Dhoble A, Smalling R, Latib A, Kodali SK, Lazkani M, Choo J, Lurz P, O'Neill WW, Laham R, Rodés-Cabau J, Kar S, Schofer N, Whisenant B, Inglessis-Azuaje I, Baldus S, Kapadia S, Szerlip M, Kliger C, Boone R, Webb JG, Williams MR, von Bardeleben RS, Ruf TF, Guerrero M, Eleid M, McCabe JM, Davidson C, Hiesinger W, Kaneko T, Shah PB, Yadav P, Koulogiannis K, Marcoff L, and Hausleiter J
- Subjects
- Humans, Echocardiography, Mitral Valve diagnostic imaging, Mitral Valve surgery, Treatment Outcome, Clinical Trials as Topic, Cardiac Catheterization adverse effects, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency surgery
- Abstract
Background: Favorable 6-month outcomes from the CLASP IID Registry (Edwards PASCAL transcatheter valve repair system pivotal clinical trial) demonstrated that mitral valve transcatheter edge-to-edge repair with the PASCAL transcatheter valve repair system is safe and beneficial for treating prohibitive surgical risk degenerative mitral regurgitation (DMR) patients with complex mitral valve anatomy., Objectives: The authors sought to assess 1-year safety, echocardiographic and clinical outcomes from the CLASP IID Registry., Methods: Patients with 3+ or 4+ DMR who were at prohibitive surgical risk, had complex mitral valve anatomy based on the MitraClip Instructions for Use, and deemed suitable for treatment with the PASCAL system were enrolled prospectively. Safety, clinical, echocardiographic, functional, and quality-of-life outcomes were assessed at 1 year. Study oversight included a central screening committee, echocardiographic core laboratory, and clinical events committee., Results: Ninety-eight patients were enrolled. One-year Kaplan-Meier (KM) estimates of freedom from composite major adverse events, all-cause mortality, and heart failure hospitalization were 83.5%, 89.3%, and 91.5%, respectively. Significant mitral regurgitation (MR) reduction was achieved at 1 year (P < 0.001 vs baseline) including 93.2% at MR ≤2+ and 57.6% at MR ≤1+ with improvements in related echocardiographic measures. NYHA functional class and Kansas City Cardiomyopathy Questionnaire score also improved significantly (P < 0.001 vs baseline)., Conclusions: At 1 year, treatment with the PASCAL system demonstrated safety and significant MR reduction, with continued improvement in clinical, echocardiographic, functional, and quality-of-life outcomes, illustrating the value of the PASCAL system in the treatment of prohibitive surgical risk patients with 3+ or 4+ DMR and complex mitral valve anatomy., Competing Interests: Funding Support and Author Disclosures Dr Smith is on the CLASP IID Trial leadership team and has received institutional grant and travel support for device evaluation from Edwards Lifesciences; has received institutional grants from Artivion; and honoraria for speaking from Artivion and Medtronic. Dr Lim is a consultant for Opus, Nyra, Philips, Venus, and Valgen; and has received research grants from Abbott, Boston Scientific, Corvia, Edwards Lifesciences, Medtronic, V Wave, and WL Gore. Dr Gillam is a consultant for Philips, Bracco, and Edwards Lifesciences; and directs an echocardiography core laboratory for Abbott, Edwards Lifesciences, and Medtronic for which she receives no direct compensation. Dr Zahr is a consultant and has received research grants from Edwards Lifesciences. Dr Chadderdon is an educational consultant for Edwards Lifesciences and Medtronic. Dr Makkar is a consultant and has received research grants from Edwards Lifesciences, Abbott, Medtronic, and Boston Scientific. Dr Goldman consults in minimally invasive mitral valve observation for Edwards Lifesciences. Dr Rudolph has received research grants from Edwards Lifesciences, Abbott, and Boston Scientific. Dr Hermiller is a consultant and proctor for Edwards Lifesciences. Dr Dhoble is a consultant and proctor for Edwards Lifesciences and Abbott. Dr Smalling has received clinical trial grant support from Edwards Lifesciences, Medtronic, and Abbott; and serves as a consultant for Abbott. Dr Latib is a consultant and serves on the advisory board for Boston Scientific, Edwards Lifesciences, Medtronic, Abbott, and Philips. Dr Kodali is a consultant for Admedus, Dura Biotech, TriCares, Phillips, and TriFlo; has received institutional research funding from Edwards Lifesciences, Medtronic, Abbott, Boston Scientific, and JenaValve; and serves on a scientific advisory board and has received equity from Dura Biotech, MicroInterventional Devices, Thubrikar Aortic Valve Inc, Supira, Admedus, TriFlo, Adona, Tioga, and X-Dot. Dr Lurz has received institutional grants from Edwards Lifesciences, Abbott, and ReCor. Dr O’Neill is a consultant for Abiomed, BSCI, and Abbott; and was previously a consultant for Edwards Lifesciences. Dr Laham is a speaker for Abbott, Edwards Lifesciences, and Medtronic. Dr Kar is a consultant for Abbott, Medtronic, Boston Scientific, WL Gore, Laminar, Intershunt, and V wave; has received institutional research grants from Abbott, Medtronic, Boston Scientific, Edwards Lifesciences, and Highlife; is the co-national principal investigator for the REPAIR MR Trial and EXPAND registry and co-national principal investigator for the PINNACLE FLX Trial and CHAMPION Trial; serves on the steering committee for the Triluminate Trial; and is an executive committee member for the RELIEVE HF Trial. Dr Schofer has received travel support from Edwards Lifesciences and Abbott/St. Jude Medical; has received speaker honoraria from Edwards Lifesciences and Boston Scientific; and is a consultant for Edwards Lifesciences and Abbott. Dr Inglessis-Azuaje is a proctor for Edwards Lifesciences and Medtronic; and serves as a lecturer for Edwards Lifesciences and Boston Scientific. Dr Baldus has received research funding from Abbott; and has received lecturing fees from Edwards Lifesciences, Abbott, and Medtronic. Dr Szerlip is a proctor for Edwards Lifesciences and Abbott; is a speaker for Edwards Lifesciences and Boston Scientific; serves as a national principal investigator for an early feasibility study for Edwards Lifesciences; serves on the advisory board for Abbott; and is part of a steering committee for Medtronic. Dr Kliger is a consultant for and has received speaker honoraria from Edwards Lifesciences, Medtronic, and Siemens. Dr Webb is a consultant and national principal investigator for Edwards Lifesciences–sponsored clinical studies; and has received speaking honoraria, travel support, or grant support from Edwards Lifesciences. Dr von Bardeleben is a principal investigator for Phase 3, post-market clinical trials and investigator-initiated trials (Reshape II HF, TENDER, EuroSMR and other registries) for Abbott, Daiichi Sankyo, Edwards Lifesciences, Medtronic, Neochord, Philips and Siemens. Dr Ruf has received speaker, consulting, and proctoring fees from Abbott Laboratories and Edwards Lifesciences. Dr Guerrero has received grant support, and consulting and proctoring fees from Edwards Lifesciences. Dr McCabe is a consultant and has received honoraria from Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott; and holds equity in Excision Medical. Dr Davidson is a consultant and has received research grant support from Edwards Lifesciences. Dr Shah has received grant support, consulting, and proctoring fees from Edwards Lifesciences. Dr Yadav is a consultant and speaker for Edwards Lifesciences, Abbott, Dasi Simulations, and Shockwave Medical. Dr Koulogiannis is a consultant and advisory board member for Edwards Lifesciences; and is a speaker for Abbott. Dr Marcoff serves as a member of the echocardiography core laboratory for Edwards Lifesciences and Abbott for which he receives no direct compensation. Dr Hausleiter is a consultant, and receives speaker honoraria and institutional research support from Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023. Published by Elsevier Inc.)
- Published
- 2023
- Full Text
- View/download PDF
182. Heart Brain Clinic: An Integrated Approach to Stroke Care.
- Author
-
Tariq MB, Qadri SKS, Sharrief A, Tulod K, Dhoble A, Gurung S, Jamilla Lacap M, Okpala M, Manwani B, Smalling RW, and Gonzales N
- Abstract
Background and Objectives: Multidisciplinary clinics have been shown to improve care. Patients with patent foramen ovale (PFO)-associated stroke need evaluation by cardiology and neurology specialists. We report our experience creating a multidisciplinary Structural Heart Brain Clinic (HBC) with a focus on patients with PFO-associated stroke., Methods: Demographic and clinical data were retrospectively collected for patients with PFO-associated ischemic stroke. Patients with PFO-associated stroke were divided into a standard care group and Heart Brain Clinic group for analysis. Outcome measures included time from stroke to PFO closure and number of clinic visits before decision regarding closure. Nonparametric analysis evaluated differences in median time to visit and clinical decision, while the chi square analysis compared differences in categorical variables between groups., Results: From February 2017 to December 2021, 120 patients were evaluated for PFO-associated stroke. The Structural HBC began in 12/2018 with coordination between Departments of Neurology and Cardiology. For this analysis, 41 patients were considered in the standard care group and 79 patients in the HBC group. During data analysis, 107 patients had received recommendations about PFO closure. HBC patients required fewer clinic visits ( p = 0.001) before decision about closure; however, among patients who underwent PFO closure, there was no significant difference in weeks from stroke to PFO closure. Clinicians were more likely to recommend against PFO closure among patients seen in HBC compared with those seen in standard care ( p = 0.021)., Discussion: Our data demonstrate that a multidisciplinary, patient-centered approach to management of patients with PFO-associated ischemic stroke is feasible and may improve the quality of care in this younger patient population. The difference in recommendation to not pursue PFO closure between groups may reflect selection and referral bias. Additional work is needed to determine whether this approach improves other aspects of care and outcomes., (© 2023 American Academy of Neurology.)
- Published
- 2023
- Full Text
- View/download PDF
183. Outcomes of transcatheter aortic valve replacement in patients with cardiogenic shock.
- Author
-
Goel K, Shah P, Jones BM, Korngold E, Bhardwaj A, Kar B, Barker C, Szerlip M, Smalling R, and Dhoble A
- Subjects
- Humans, United States, Shock, Cardiogenic, Quality of Life, Treatment Outcome, Aortic Valve surgery, Registries, Risk Factors, Transcatheter Aortic Valve Replacement methods, Aortic Valve Stenosis complications, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnosis
- Abstract
Aims: The safety and efficacy of transcatheter aortic valve replacement (TAVR) with contemporary balloon expandable transcatheter valves in patients with cardiogenic shock (CS) remain largely unknown. In this study, the TAVRs performed for CS between June 2015 and September 2022 using SAPIEN 3 and SAPIEN 3 Ultra bioprosthesis from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry were analysed., Methods and Results: CS was defined as: (i) coding of CS within 24 h on Transcatheter Valve Therapy Registry form; and/or (ii) pre-procedural use of inotropes or mechanical circulatory support devices and/or (iii) cardiac arrest within 24 h prior to TAVR. The control group was comprised of all the other patients undergoing TAVR. Baseline characteristics, all-cause mortality, and major complications at 30-day and 1-year outcomes were reported. Landmark analysis was performed at 30 days post-TAVR. Cox-proportional multivariable analysis was performed to determine the predictors of all-cause mortality at 1 year. A total of 309 505 patients underwent TAVR with balloon-expandable valves during the study period. Of these, 5006 patients presented with CS prior to TAVR (1.6%). The mean Society of Thoracic Surgeons score was 10.76 ± 10.4. The valve was successfully implanted in 97.9% of patients. Technical success according to Valve Academic Research Consortium-3 criteria was 94.5%. In a propensity-matched analysis, CS was associated with higher in-hospital (9.9% vs. 2.7%), 30-day (12.9% vs. 4.9%), and 1-year (29.7% vs. 22.6%) mortality compared to the patients undergoing TAVR without CS. In the landmark analysis after 30 days, the risk of 1-year mortality was similar between the two groups [hazard ratio (HR) 1.07, 95% confidence interval (CI) 0.95-1.21]. Patients who were alive at 1 year noted significant improvements in functional class (Class I/II 89%) and quality of life (ΔKCCQ score +50). In the multivariable analysis, older age (HR 1.02, 95% CI 1.02-1.03), peripheral artery disease (HR 1.25, 95% CI 1.06-1.47), prior implantation of an implantable cardioverter-defibrillator (HR 1.37, 95% CI 1.07-1.77), patients on dialysis (HR 2.07, 95% CI 1.69-2.53), immunocompromised status (HR 1.33, 95% CI 1.05-1.69), New York Heart Association class III/IV symptoms (HR 1.50, 95% CI 1.06-2.12), lower aortic valve mean gradient, lower albumin levels, lower haemoglobin levels, and lower Kansas City Cardiomyopathy Questionnaire scores were independently associated with 1-year mortality., Conclusion: This large observational real-world study demonstrates that the TAVR is a safe and effective treatment for aortic stenosis patients presenting with CS. Patients who survived the first 30 days after TAVR had similar mortality rates to those who were not in CS., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
- Published
- 2023
- Full Text
- View/download PDF
184. Geriatric Condition Burden in Cardiovascular Clinics.
- Author
-
Kwak MJ, Goyal P, Krishnaswami A, Rich MW, Lee M, Dhoble A, Kim DH, Aparasu RR, and Holmes HM
- Published
- 2023
- Full Text
- View/download PDF
185. Total Transfemoral Percutaneous Endovascular Aortic Arch Repair Using 3-Vessel Inner Branch Stent-Graft.
- Author
-
Tenorio ER, Macedo TA, Ocasio L, Neto MD, Barbosa Lima GB, Baghbani-Oskouei A, Estrera AL, Dhoble A, Zhou SF, and Oderich GS
- Abstract
Endovascular repair has been introduced to decrease the morbidity and mortality associated with open surgical repair of aortic arch pathology. We illustrate total percutaneous transfemoral approach with a 3-vessel inner branch stent-graft to treat aortic arch aneurysm. ( Level of Difficulty: Advanced. )., Competing Interests: Dr Oderich has received consulting fees and grants from Cook Medical, W.L. Gore, Centerline Biomedical, and GE Healthcare (all paid to Mayo Clinic and the University of Texas Health Science at Houston with no personal income). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2022 The Authors.)
- Published
- 2022
- Full Text
- View/download PDF
186. Gender Differences in the Outcomes of Cardiogenic Shock Requiring Percutaneous Mechanical Circulatory Support.
- Author
-
Bravo-Jaimes K, Mejia MO, Abelhad NI, Zhou Y, Jumean MF, Nathan S, and Dhoble A
- Subjects
- Aged, Female, Hospital Mortality, Humans, Intra-Aortic Balloon Pumping, Male, Medicare, Sex Factors, Shock, Cardiogenic epidemiology, Shock, Cardiogenic etiology, Shock, Cardiogenic therapy, Treatment Outcome, United States epidemiology, Heart Failure complications, Heart Failure epidemiology, Heart Failure therapy, Heart-Assist Devices adverse effects, Myocardial Infarction, Respiratory Insufficiency
- Abstract
There is evidence for the lower use of percutaneous mechanical circulatory support (pMCS) in women. We aimed to determine (1) whether gender differences exist regarding in-hospital mortality, hospital course, and procedures; (2) whether socio-demographic and treatment-related factors were associated with these differences. Using the National Inpatient Sample, we collected the International Classification of Diseases, Ninth Revision, Clinical Modification codes for cardiogenic shock (CS) because of acute myocardial infarction AMI or acutely decompensated advanced heart failure and included intra-aortic balloon pump, Impella or Tandem Heart percutaneous ventricular assist devices (pVADs), extracorporeal membrane oxygenation. Demographics, co-morbidities, in-hospital course and procedures were recorded, and the Charlson Co-morbidity Index was calculated. Multivariable hierarchical logistic regression analysis and additional sensitivity analyses were performed. We identified 376,116 cases of CS because of acute myocardial infarction or acutely decompensated advanced heart failure, of which 113,305 required pMCS. Women were more likely to be older, non-White, insured by Medicare, and have a higher burden of co-morbidities and higher Charlson Co-morbidity Index. pMCS devices were inserted in 35,516 women (24.9%) and 77,789 men (33.3%). Women were less likely to receive pVAD or pulmonary artery (PA) catheters. Blood transfusions and acute respiratory failure were more common in women than men. Women had 15% higher in-hospital mortality and in a multivariate analysis, women, older age, having no insurance, diabetes mellitus, chronic kidney disease, cerebrovascular disease, peripheral arterial disease, longer time to pMCS insertion, receiving PA catheter, pVAD or extracorporeal membrane oxygenation and having cardiac arrest were associated with higher in-hospital mortality. In conclusion, women requiring pMCS support had a higher co-morbidity load, in-hospital mortality, acute respiratory failure, blood transfusions, and lower PA catheter use. Studies addressing early gender-specific interventions in CS are needed to reduce these differences., (Copyright © 2022 Elsevier Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
187. Safety, Feasibility, and Outcomes of Cerebral Protection Using SENTINEL Device in Bovine Arches.
- Author
-
Honan KA, Ahmed T, Desai S, Cerra Z, Smalling RW, and Dhoble A
- Abstract
Competing Interests: Dr Abhijeet Dhoble and Dr Richard Smalling are consultants for Abbott Vascular and Edwards Lifesciences. The other authors reported no financial disclosures.
- Published
- 2022
- Full Text
- View/download PDF
188. Catastrophic Cardiac Events During Transcatheter Aortic Valve Replacement.
- Author
-
Liang Y, Dhoble A, Pakanati A, Zhao Y, Kork F, Ruan W, Markham T, Smalling R, Balan P, Estrera A, Nguyen TC, Gregoric I, Kar B, and Eltzschig H
- Subjects
- Aged, Female, Follow-Up Studies, Heart Failure epidemiology, Hospital Mortality trends, Humans, Incidence, Male, Postoperative Complications epidemiology, Retrospective Studies, Risk Factors, Survival Rate trends, Texas epidemiology, Aortic Valve surgery, Aortic Valve Stenosis surgery, Heart Failure etiology, Postoperative Complications etiology, Risk Assessment methods, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Background: Perioperative complications of transcatheter aortic valve replacement (TAVR) are decreasing but can be catastrophic when they occur. Systematic reports of the nature of these events are lacking in the contemporary era. Our study aimed to report the incidence, outcomes, and perioperative management of catastrophic cardiac events in patients undergoing TAVR and to propose a working strategy to address these complications., Methods: This is a retrospective cohort study of patients who developed catastrophic cardiac events during or immediately after TAVR between 2015 and 2019 at a single academic centre., Results: Of 2102 patients who underwent TAVR, 51 (2.5%) developed catastrophic cardiac events. The causes included cardiac perforation and tamponade (n = 19, 37.3%), acute left- ventricular failure (n = 10, 19.6%), coronary artery obstruction (n = 10, 19.6%), aortic-root disruption (n = 7, 13.7%), and device embolization (n = 5, 9.8%). Twenty-four patients (47.0%) with catastrophic cardiac events required stabilization by either intra-aortic balloon counter-pulsation or extracorporeal membrane oxygenation. The in-hospital mortality rate increased by 11.7-fold for patients with catastrophic cardiac events compared with those without (25.5% vs 2.0%, P < 0.001). Patients who developed aortic root disruption had the highest mortality rate (42.8%) compared with the others. The incidence of catastrophic cardiac events remained stable over a 5-year period, but the associated mortality decreased from 38.5% in 2015 to 9.1% in 2019., Conclusions: Catastrophic cardiac events during TAVR are rare, but they account for a dramatic increase in perioperative mortality. Early recognition and development of a standardized perioperative team approach can help manage patients experiencing these complications., (Copyright © 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
189. Delirium Among Hospitalized Older Adults With Acute Heart Failure Exacerbation.
- Author
-
Kwak MJ, Avritscher E, Holmes HM, Jantea R, Flores R, Rianon N, Chung TH, Balan P, and Dhoble A
- Subjects
- Aged, Hospital Mortality, Hospitalization, Humans, Length of Stay, Retrospective Studies, Delirium diagnosis, Delirium epidemiology, Heart Failure diagnosis, Heart Failure epidemiology
- Abstract
Background: Delirium among older adults hospitalized with acute heart failure is associated with increased mortality. However, studies concomitantly assessing the association of delirium with both clinical and economic outcomes in this population, such as mortality, hospital cost, or length of stay, are lacking., Methods and Results: We conducted a retrospective observational study using National Inpatient Sample data from 2011 to 2014. Using multivariable logistic regression, we assessed the association of delirium with in-hospital mortality, then estimated the incremental hospital cost and excessive length of stay adjusting for demographic and clinical factors using multivariable generalized linear regression. The association of other medical complications on clinical and economic outcomes was also assessed. A total of 568,565 (weighted N = 2,826,131) hospitalizations of patients 65 years or older with acute heart failure from 2011 to 2014 were included in the final analysis. The reported prevalence of delirium was 4.53%. After multivariable adjustment, delirium was associated with a 2.35-fold increase in the odds of in-hospital mortality (95% confidence interval [CI] 2.23-2.47), which was lower than the odds ratio for sepsis/septicemia (5.36; 95% CI, 5.02-5.72) or respiratory failure (4.53; 95% CI, 4.38-4.69), but similar to that for acute kidney injury (2.39; 95% CI, 2.31-2.48) and higher than for non-ST elevation myocardial infarct (1.57; 95% CI, 1.46-1.68). Delirium increased the total hospital cost by $4,262 (95% CI, $4,002-4,521) and the length of stay by 1.73 days (95% CI, 1.68-1.78), which was slightly lower than, but similar to, acute kidney injury ($4,771; 95% CI, $4,644-4,897) and 1.82 days (95% CI, 1.79-1.84), and higher than non-ST elevation myocardial infarct ($1,907; 95% CI, $1,629-2,185) and 0.31 days (95% CI, 0.25-0.37)., Conclusions: Delirium was associated with increased in-hospital mortality, total hospital cost, and length of stay, and the magnitude of the effect was similar to that for acute kidney injury. Enhanced efforts to prevent delirium are needed to decrease its adverse impact on clinical and economic outcomes for hospitalized older adults with acute heart failure., Competing Interests: Declaration of Competing Interest Dr Holmes reports grants from Healthcare Services Corporation, a foundation of Blue Cross/Blue Shield, grants from Cancer Prevention and Research Institute of Texas, grants from National Center to Advance Translational Sciences, outside the submitted work. Dr Balan is a consultant for Osprey Medical and served as a speaker for Abiomed and Chiesi, outside the submitted work. The other authors do not report any conflict of interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
190. Randomized Evaluation of TriGuard 3 Cerebral Embolic Protection After Transcatheter Aortic Valve Replacement: REFLECT II.
- Author
-
Nazif TM, Moses J, Sharma R, Dhoble A, Rovin J, Brown D, Horwitz P, Makkar R, Stoler R, Forrest J, Messé S, Dickerman S, Brennan J, Zivadinov R, Dwyer MG, and Lansky AJ
- Subjects
- Aortic Valve diagnostic imaging, Aortic Valve surgery, Humans, Prospective Studies, Risk Factors, Single-Blind Method, Time Factors, Treatment Outcome, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Embolic Protection Devices, Stroke etiology, Stroke prevention & control, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Objectives: The REFLECT II (Randomized Evaluation of TriGuard 3 Cerebral Embolic Protection After Transcatheter Aortic Valve Implantation) trial was designed to investigate the safety and efficacy of the TriGUARD 3 (TG3) cerebral embolic protection in patients undergoing transcatheter aortic valve replacement., Background: Cerebral embolization occurs frequently following transcatheter aortic valve replacement and procedure-related ischemic stroke occurs in 2% to 6% of patients at 30 days. Whether cerebral protection with TriGuard 3 is safe and effective in reducing procedure-related cerebral injury is not known., Methods: This prospective, multicenter, single-blind, 2:1 randomized (TG3 vs. no TG3) study was designed to enroll up to 345 patients. The primary 30-day safety endpoint (Valve Academic Research Consortium-2 defined) was compared with a performance goal (PG). The primary hierarchical composite efficacy endpoint (including death or stroke at 30 days, National Institutes of Health Stroke Scale score worsening in hospital, and cerebral ischemic lesions on diffusion-weighted magnetic resonance imaging at 2 to 5 days) was compared using the Finkelstein-Schoenfeld method., Results: REFLECT II enrolled 220 of the planned 345 patients (63.8%), including 41 roll-in and 179 randomized patients (121 TG3 and 58 control subjects) at 18 US sites. The sponsor closed the study early after the U.S. Food and Drug Administration recommended enrollment suspension for unblinded safety data review. The trial met its primary safety endpoint compared with the PG (15.9% vs. 34.4% (p < 0.0001). The primary hierarchal efficacy endpoint at 30 days was not met (mean scores [higher is better]: -8.58 TG3 vs. 8.08 control; p = 0.857). A post hoc diffusion-weighted magnetic resonance imaging analysis of per-patient total lesion volume above incremental thresholds showed numeric reductions in total lesion volume >500 mm
3 (-9.7%) and >1,000 mm3 (-44.5%) in the TG3 group, which were more pronounced among patients with full TG3 coverage: -51.1% (>500 mm3 ) and -82.9% (>1,000 mm3 )., Conclusions: The REFLECT II trial demonstrated that the TG3 was safe compared with a historical PG but did not meet its pre-specified primary superiority efficacy endpoint., Competing Interests: FUNDING SUPPORT AND Author Disclosures This work was supported by an unrestricted research grant from Keystone Heart. Dr. Nazif has equity in Venus Medtech; and has received consulting fees or honoraria from Keystone Heart, Edwards Lifesciences, Medtronic, and Boston Scientific. Dr. Dhoble has received honoraria from Edwards Lifesciences, Abbott Vascular, and Keystone Heart. Dr. Forrest has received consulting fees from Edwards Lifesciences and Medtronic. Dr. Zivadinov has received personal compensation from Bristol Myers Squibb, EMD Serono, Sanofi, Keystone Heart, Protembis, and Novartis for speaker and consulting fees; and has received financial support for research activities from Sanofi, Novartis, Bristol Myers Squibb, Mapi Pharma, Keystone Heart, Protembis, Boston Scientific, and V-WAVE Medical. Dr. Dwyer has received personal compensation from Novartis, EMD Serono, and Keystone Heart; and has received financial support for research activities from Bristol Myers Squibb, Novartis, Mapi Pharma, Keystone Heart, Protembis, and V-WAVE Medical. Dr. Lansky has equity in Venus Medtech; and has received consulting fees from Keystone Heart, Medtronic, Boston Scientific, and AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)- Published
- 2021
- Full Text
- View/download PDF
191. Trends and Impact of the Use of Mechanical Circulatory Support for Cardiogenic Shock Secondary to Takotsubo Cardiomyopathy.
- Author
-
Napierkowski S, Banerjee U, Anderson HV, Charitakis K, Madjid M, Smalling RW, and Dhoble A
- Subjects
- Aged, Female, Follow-Up Studies, Hospital Mortality trends, Humans, Incidence, Male, Retrospective Studies, Shock, Cardiogenic epidemiology, Shock, Cardiogenic etiology, Survival Rate trends, Texas epidemiology, Extracorporeal Membrane Oxygenation methods, Heart-Assist Devices, Intra-Aortic Balloon Pumping methods, Shock, Cardiogenic therapy, Takotsubo Cardiomyopathy complications
- Abstract
Data on the trend and impact of mechanical circulatory support (MCS) in patients with Takotsubo cardiomyopathy (TC) are scarce. We evaluated the incidence and outcomes of cardiogenic shock (CS) in TC patients and the trend in use of MCS over time. The National Inpatient Sample from 2005 to 2014 was used to identify patients admitted with TC and those receiving MCS. Multivariate logistic regression was performed to identify predictors of mortality. The Cochran-Armitage test was used for the trend analysis across the years. Admissions for TC showed a linear increase for the study period. From 2005 to 2014 the proportion of TC managed with MCS remained stable, with some yearly fluctuations. Crude in-hospital mortality rate was 2.5% in the patients admitted with TC but was significantly higher in those with CS (15.81% vs 1.68%, p < 0.001). There was no difference in mortality in TC patients with CS, both with and without the use of MCS. However, patients managed with MCS were more likely to be discharged to a skilled nursing facility (31% vs 25.55, p = 0.015) compared with TC patients with CS who were medically managed. The cost of care for patients with TC and CS, managed with MCS was significantly higher than those managed medically ($171K vs $128K, p <0.001). In patients managed with MCS, only sepsis was associated with a higher likelihood of death using multivariate analysis (Odds Ratio 2.538, Confidence Interval 1.245 to 5.172; p = 0.011). In conclusion, the incidence of TC has increased over the years, but the proportion of patients requiring MCS has declined. Crude mortality rate for TC was 2.5%, but was 15.8% in the TC patients with CS. The use of MCS did not lead to improved mortality but was associated with higher cost and increased likelihood of skilled nursing facility discharge., Competing Interests: Declaration of interests The authors declare that they have no known competing financial interests or personal relations that could have appeared to influence the work reported in this report., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
192. Outcomes of Patients Undergoing Transcatheter Aortic Valve Implantation With Incidentally Discovered Masses on Computed Tomography.
- Author
-
Ghotra AS, Monlezun DJ, Boone D, Jacob R, Poosti K, Loghin C, Garcia-Sayan E, Johnson S, Zhao Y, Balan P, Nguyen TC, Estrera A, Gregoric ID, Loyalka P, Kar B, Smalling RW, and Dhoble A
- Subjects
- Aged, Aged, 80 and over, Aortic Valve surgery, Female, Follow-Up Studies, Humans, Incidence, Male, Neoplasms epidemiology, Retrospective Studies, Risk Factors, United States epidemiology, Aortic Valve Stenosis surgery, Incidental Findings, Neoplasms diagnosis, Tomography, X-Ray Computed methods, Transcatheter Aortic Valve Replacement methods
- Abstract
Routine preprocedural chest and abdomen computed tomography is done prior to transcatheter aortic valve implantation (TAVI), which, in turn, have led to the discovery of radiographic potentially malignant incidental masses (pMIM). It is largely unknown whether pMIM impact the outcomes of patients undergoing TAVI. In this retrospective cohort study from a single center, 1,081 patients underwent TAVI from 2012 to 2016, who had available computed tomographies, survived the index hospitalization, and also had 1 year follow-up data for review. Machine learning (backward propagation neural network)-augmented multivariable regression for mortality by pMIM was conducted. In this cohort of 1,081 patients, the mean age was 79.1 (± 9.0), 48.8% were females, 16.8% had a history of prior malignancy, and 21.1% had pMIM. One-year mortality for the entire cohort was 12.6%. The most common prior malignancies were prostate, breast, and lymphoma and the most common pMIM were present in the lung, kidneys, and thyroid. In a fully adjusted regression analysis, neither prior malignancy nor pMIM increased mortality odds. However, having both was associated with a higher 1-year mortality (odds ratio 4.02, 95% confidence interval 1.50 to 10.73, p = 0.006). In conclusion, presence of pMIM alone was not associated with an increased 1-year mortality among patients undergoing TAVI. However, the presence of pMIM and a history of prior malignancy was associated with a significant increase in 1-year mortality., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
193. Early tracheostomy in acute heart failure exacerbation.
- Author
-
Kwak MJ, Lal LS, Swint JM, Du XL, Chan W, Akkanti B, and Dhoble A
- Subjects
- Hospital Mortality, Humans, Length of Stay, Respiration, Artificial, Retrospective Studies, United States epidemiology, Heart Failure, Tracheostomy
- Abstract
Background: The optimal timing for tracheostomy among patients with acute heart failure (AHF) exacerbation has been controversial, despite multiple studies assessing the utility of early tracheostomy. Our objective was to assess the trend of utilization and outcomes of early tracheostomy among patients with AHF exacerbation in the United States., Methods and Results: A retrospective cohort study using the National Inpatient Sample from 2005 to 2014 was conducted. Among those who were admitted with AHF exacerbation (n = 1,390,356), 0.26% of patients underwent tracheostomy (n = 2,571), and among them, 19.4% received early tracheostomy (n = 496). There was no significant shift in the percentage of early tracheostomy from 2008 to 2014. We used propensity score matching to compare the clinical and economic outcomes between the early tracheostomy group and late tracheostomy group. In-hospital mortality did not show any difference between the two groups (13.97% in early group vs. 18.04% in late group; p =0.163). The median total hospital cost ($53,466), total hospital length of stay (19 days), and length of stay after intubation (16 days) in the early tracheostomy group were significantly lower than in the late tracheostomy group ($73,680; 26 days; 23 days, respectively)., Conclusion: Early tracheostomy showed economic benefit with lower hospital costs and shorter length of stay, without a difference in in-hospital mortality compared to late tracheostomy., Competing Interests: Declaration of Competing Interest Dr. Lal reports employment at Optum, outside the submitted work. Other authors do not have conflict of interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
194. National trend of utilization, clinical and economic outcomes of transcatheter aortic valve replacement among patients with chronic obstructive pulmonary disease.
- Author
-
Kwak MJ, Bhise V, Warner MT, Balan P, Nguyen TC, Estrera AL, Smalling RW, and Dhoble A
- Subjects
- Female, Humans, Male, Patient Discharge, Retrospective Studies, Treatment Outcome, Pulmonary Disease, Chronic Obstructive epidemiology, Pulmonary Disease, Chronic Obstructive mortality, Pulmonary Disease, Chronic Obstructive surgery, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement economics, Transcatheter Aortic Valve Replacement mortality, Transcatheter Aortic Valve Replacement statistics & numerical data
- Abstract
Objectives: We aimed to trend the utilization of transcatheter aortic valve replacement (TAVR) among COPD patients, compare its outcomes to surgical aortic valve replacement (SAVR) and assess any social disparities in its outcomes. Background: Patients with chronic obstructive pulmonary disease (COPD) have been increasingly undergoing TAVR, but studies to evaluate the national trend of TAVR utilization and outcomes are still lacking. Methods: We conducted a retrospective observational study using a nationally representative database, the National Inpatient Sample (NIS). Results: From 2010 to 2014, the proportion of TAVR among COPD patients has increased from <1% to >50%. Patients who underwent TAVR were older, more likely to be women or white, carried more public insurance and had more comorbidities. There was no overall difference in mortality between TAVR and SAVR (2.74% vs. 2.59%, p = .860), and it has been consistently similar over time. However, patients with TAVR had shorter length of stay in the hospital after the procedure and were more likely to be discharged home than the SAVR group. Among the TAVR group, there were no gender, race or insurance disparities for in-hospital mortality, but female gender was related to lower discharge home rate, higher cost and longer stay in hospital. Conclusions: The rate of TAVR among COPD patients has been increasing nationally since 2011. In spite of higher comorbidities, TAVR did not show a difference in hospital mortality compared to SAVR but demonstrated shorter length of stay and more home discharges. This suggests that TAVR is a viable and potentially better option for patients with COPD.
- Published
- 2019
- Full Text
- View/download PDF
195. Predictors of Left Ventricular Outflow Tract Obstruction After Transcatheter Mitral Valve Replacement.
- Author
-
Yoon SH, Bleiziffer S, Latib A, Eschenbach L, Ancona M, Vincent F, Kim WK, Unbehaum A, Asami M, Dhoble A, Silaschi M, Frangieh AH, Veulemans V, Tang GHL, Kuwata S, Rampat R, Schmidt T, Patel AJ, Nicz PFG, Nombela-Franco L, Kini A, Kitamura M, Sharma R, Chakravarty T, Hildick-Smith D, Arnold M, de Brito FS Jr, Jensen C, Jung C, Jilaihawi H, Smalling RW, Maisano F, Kasel AM, Treede H, Kempfert J, Pilgrim T, Kar S, Bapat V, Whisenant BK, Van Belle E, Delgado V, Modine T, Bax JJ, and Makkar RR
- Subjects
- Aged, Aged, 80 and over, Calcinosis diagnostic imaging, Calcinosis mortality, Calcinosis physiopathology, Cardiac Catheterization instrumentation, Cardiac Catheterization mortality, Echocardiography, Female, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation, Heart Valve Prosthesis Implantation mortality, Humans, Male, Mitral Valve diagnostic imaging, Mitral Valve physiopathology, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency mortality, Mitral Valve Insufficiency physiopathology, Mitral Valve Stenosis diagnostic imaging, Mitral Valve Stenosis mortality, Mitral Valve Stenosis physiopathology, Multidetector Computed Tomography, Prosthesis Design, Prosthesis Failure, Registries, Risk Assessment, Risk Factors, Treatment Outcome, Ventricular Outflow Obstruction diagnostic imaging, Ventricular Outflow Obstruction mortality, Ventricular Outflow Obstruction physiopathology, Calcinosis surgery, Cardiac Catheterization adverse effects, Heart Valve Prosthesis Implantation adverse effects, Mitral Valve surgery, Mitral Valve Insufficiency surgery, Mitral Valve Stenosis surgery, Ventricular Outflow Obstruction etiology
- Abstract
Objectives: The aim of this study was to evaluate the predictors of left ventricular outflow tract (LVOT) obstruction after transcatheter mitral valve replacement (TMVR)., Background: LVOT obstruction is a major concern with TMVR, but limited data exist regarding its predictors and impact on outcomes., Methods: Patients with pre-procedural multidetector row computed tomography (MDCT) undergoing TMVR for failed mitral bioprosthetic valves (valve-in-valve), annuloplasty rings (valve-in-ring), and mitral annular calcification (valve-in-MAC) were included in this study. Echocardiographic and procedural characteristics were recorded, and comprehensive assessment with MDCT was performed to identify the predictors of LVOT obstruction (defined as an increment of mean LVOT gradient ≥10 mm Hg from baseline). The new LVOT (neo-LVOT) area left after TMVR was estimated by embedding a virtual valve into the mitral annulus on MDCT, simulating the procedure., Results: Among 194 patients with pre-procedural MDCT undergoing TMVR (valve-in-valve, 107 patients; valve-in-ring, 50 patients; valve-in-MAC, 37 patients), LVOT obstruction was observed in 26 patients (13.4%), with a higher rate after valve-in-MAC than valve-in-ring and valve-in-valve (54.1% vs. 8.0% vs. 1.9%; p < 0.001). Patients with LVOT obstruction had significantly higher procedural mortality compared with those without LVOT obstruction (34.6% vs. 2.4%; p < 0.001). Receiver-operating characteristic curve analysis showed that an estimated neo-LVOT area ≤1.7 cm
2 predicted LVOT obstruction with sensitivity of 96.2% and specificity of 92.3%., Conclusions: LVOT obstruction after TMVR was associated with higher procedural mortality. A small estimated neo-LVOT area was significantly associated with LVOT obstruction after TMVR and may help identify patients at high risk for LVOT obstruction., (Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)- Published
- 2019
- Full Text
- View/download PDF
196. Outcomes and readmissions after transcatheter and surgical aortic valve replacement in patients with cirrhosis: A propensity matched analysis.
- Author
-
Dhoble A, Bhise V, Nevah MI, Balan P, Nguyen TC, Estrera AL, and Smalling RW
- Subjects
- Aged, Aortic Valve physiopathology, Aortic Valve Stenosis economics, Aortic Valve Stenosis mortality, Aortic Valve Stenosis physiopathology, Blood Transfusion, Databases, Factual, Female, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation economics, Heart Valve Prosthesis Implantation mortality, Hospital Costs, Hospital Mortality, Humans, Length of Stay, Liver Cirrhosis economics, Liver Cirrhosis mortality, Male, Propensity Score, Risk Factors, Time Factors, Treatment Outcome, United States epidemiology, Aortic Valve surgery, Aortic Valve Stenosis surgery, Heart Valve Prosthesis Implantation methods, Liver Cirrhosis epidemiology, Patient Readmission economics, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement economics, Transcatheter Aortic Valve Replacement mortality
- Abstract
Background: The data on the comparative outcomes and readmissions after transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with cirrhosis are limited. We compared mortality, complications, discharge disposition, 30-day readmission rates, length of stay, and cost of hospitalization in cirrhotic patients undergoing TAVR and SAVR., Methods: The National Inpatient Sample (NIS) and the National Readmission Database (NRD) were used for the study. The International Classification of Diseases-9th version was used to define cohorts of patients undergoing TAVR and SAVR. Patients undergoing concomitant other valve or coronary bypass surgery were excluded. Propensity-score matching was used to compare the outcomes between the groups., Results: From 2012 to 2014, a total of 126 and 157 patients with cirrhosis underwent TAVR and SAVR, respectively. Of the 283 patients, 16 (5.7%) died during the same hospitalization. We found 345 patients with cirrhosis who had undergone an aortic valve replacement (156 with TAVR, and 189 with SAVR) in the 2013 and 2014 NRD. On propensity matching, there were no significant differences between the in-hospital mortality, readmissions, hospitalization costs, and discharges to home within the TAVR and SAVR groups. However, post-procedure length of stay (6.3 vs. 10.2 days; P < 0.001) and blood transfusion rates (22% vs. 58%; P < 0.001) were significantly lower in TAVR patients., Conclusions: Cirrhotic patients undergoing TAVR has high, but similar mortality and 30-day readmission rates when compared to SAVR; however, has shorter length of stay and lower blood transfusion rates., (© 2017 Wiley Periodicals, Inc.)
- Published
- 2018
- Full Text
- View/download PDF
197. Early readmissions after transcatheter and surgical aortic valve replacement.
- Author
-
Vejpongsa P, Bhise V, Charitakis K, Vernon Anderson H, Balan P, Nguyen TC, Estrera AL, Smalling RW, and Dhoble A
- Subjects
- Aged, Aged, 80 and over, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis mortality, Aortic Valve Stenosis physiopathology, Chi-Square Distribution, Databases, Factual, Female, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation mortality, Humans, Kaplan-Meier Estimate, Length of Stay, Logistic Models, Male, Multivariate Analysis, Odds Ratio, Propensity Score, Risk Factors, Time Factors, Treatment Outcome, United States, Aortic Valve surgery, Aortic Valve Stenosis surgery, Heart Valve Prosthesis Implantation methods, Patient Readmission, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement mortality
- Abstract
Objectives: We aimed to determine and compare the prevalence, and predictors of readmissions after the transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR)., Background: There are limited data on the readmission rates after TAVR in comparison with SAVR., Methods: We analyzed the data from 2013 National Readmission Database. Propensity-matched pairs were used to analyze differences in readmission rates between TAVR and SAVR for patients aged ≥65., Results: A total of 24,020 (TAVR-transfemoral 3,469, TAVR-transapical 1,433, SAVR 19,118) patients were included. The readmission rates were not statistically different for all propensity-matched TAVR and SAVR patients (17.2% vs. 20.6%, P = 0.28). However, in subgroup analysis, transapical TAVR had the highest readmission rate (22.8% vs. 16.5% vs. 16.0%, P < 0.001, respectively) and readmission leading to death (7.1% vs. 5.3% vs. 3.9%, P = 0.022, respectively) when compared with transfemoral TAVR and SAVR. In all the groups, two-thirds of readmissions were due to noncardiac causes. Congestive heart failure (CHF) and arrhythmia were the most frequent cardiac etiologies. The independent predictors of readmission were female sex, CHF, and chronic obstructive pulmonary disease. Patients who received care in teaching hospitals had lower probability of readmission., Conclusions: One of six patients were readmitted within 30 days after the aortic valve replacement. On propensity score analysis, there were no significant differences between the early readmission rates between TAVR and SAVR groups. However, the patients undergoing transapical TAVR were at higher risk for readmission, and subsequent deaths when compared with transfemoral TAVR and SAVR. © 2017 Wiley Periodicals, Inc., (© 2017 Wiley Periodicals, Inc.)
- Published
- 2017
- Full Text
- View/download PDF
198. The Society of Thoracic Surgery Risk Score as a Predictor of 30-Day Mortality in Transcatheter vs Surgical Aortic Valve Replacement: A Single-Center Experience and its Implications for the Development of a TAVR Risk-Prediction Model.
- Author
-
Balan P, Zhao Y, Johnson S, Arain S, Dhoble A, Estrera A, Smalling R, and Nguyen TC
- Subjects
- Aged, Aged, 80 and over, Aortic Valve Stenosis diagnosis, Female, Humans, Male, Mortality, Position-Specific Scoring Matrices, Predictive Value of Tests, Prognosis, ROC Curve, Research Design, Retrospective Studies, Risk Factors, Severity of Illness Index, United States, Aortic Valve Stenosis surgery, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation methods, Heart Valve Prosthesis Implantation mortality, Risk Assessment methods, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement methods, Transcatheter Aortic Valve Replacement mortality
- Abstract
Background: The Society of Thoracic Surgery (STS) risk score serves as an important determinant of eligibility for transcatheter aortic valve replacement (TAVR). The STS score's validity for predicting TAVR mortality, however, is incompletely understood. This study compares the STS score's discriminatory power for TAVR mortality as compared with surgical aortic valve replacement (SAVR) mortality., Methods: A retrospective analysis of STS score and 30-day mortality for TAVR patients (n = 426) and SAVR patients (n = 297) at a single institution was performed. The performance of the STS score was evaluated from the standpoint of discriminatory power. The predictive ability of STS for 30-day mortality was detected by generation of receiver operator characteristic (ROC) curves., Results: The STS score possesses predictive ability for 30-day SAVR mortality with an area under the ROC curve of 0.791 (95% confidence interval [CI], 0.690-0.893). The STS score also possesses predictive ability for 30-day TAVR mortality with an area under the ROC curve of 0.674 (95% CI, 0.541-0.807). When stratifying TAVR by access route, the STS score for transfemoral TAVR provides an area under the ROC curve of 0.789 (95% CI, 0.569-1.000). There is not a statistically significant difference in predictive ability between SAVR and TAVR., Conclusion: The STS score possesses predictive value for 30-day mortality in both SAVR and TAVR. Although not designed for TAVR, the STS score may provide some insight into TAVR mortality, and therefore serves as an appropriate model for efforts to develop a TAVR-specific risk prediction instrument.
- Published
- 2017
199. Outcome of paravalvular leak repair after transcatheter aortic valve replacement with a balloon-expandable prosthesis.
- Author
-
Dhoble A, Chakravarty T, Nakamura M, Abramowitz Y, Tank R, Mihara H, Mangat G, Jilaihawi H, Shiota T, and Makkar R
- Subjects
- Aged, Aged, 80 and over, Aortic Valve Insufficiency etiology, Aortic Valve Insufficiency mortality, Aortic Valve Insufficiency physiopathology, Cardiac Catheterization adverse effects, Cardiac Catheterization methods, Cardiac Catheterization mortality, Disease-Free Survival, Echocardiography, Transesophageal, Feasibility Studies, Female, Heart Failure etiology, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation methods, Heart Valve Prosthesis Implantation mortality, Humans, Kaplan-Meier Estimate, Los Angeles, Male, Patient Readmission, Patient Selection, Prosthesis Design, Retreatment, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve Insufficiency therapy, Balloon Valvuloplasty, Cardiac Catheterization instrumentation, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation
- Abstract
Background: Significant paravalvular leak (PVL) occurs in up to 13% of patients after transcatheter aortic valve replacement (TAVR) with a balloon-expandable bioprosthesis. Transcatheter PVL repair has emerged as a less invasive alternative for this problem., Objectives: The aim of this study was to evaluate the safety, feasibility, and clinical outcomes of transcatheter PVL repair after TAVR with balloon-expandable valve., Methods: We retrospectively identified 15 patients who underwent 16 PVL repair procedures after the TAVR at our center. Procedural characteristics, results, and clinical outcomes were analyzed. The association of PVL repairs with subsequent hospitalizations and mortality was assessed and compared to 57 patients who did not undergo repair for at least moderate PVL after TAVR., Results: The PVL repair was successful in 13 (87%) patients, without significant procedure or device related complications. In patients with successful PVL repair, there was an improvement in symptom status, subsequent hospitalizations, and B-type natriuretic peptide levels. There was 1 (out of 13, 8%) death in the group of patients who successfully underwent PVL repair whereas 24 (out of 57, 42%) patients died during follow up in the group that did not undergo repair of their PVL. Similarly, there was significant reduction in the subsequent heart failure related hospitalization after the PVL repair, compared with the patients who did not undergo PVL repair (P = 0.03)., Conclusion: Transcatheter repair of PVL after TAVR can be safely and effectively accomplished in carefully selected patients, and may lead to reduction in hospitalizations, improvement in symptoms, and long-term survival. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)
- Published
- 2017
- Full Text
- View/download PDF
200. Predicting long-term cardiovascular risk using the mayo clinic cardiovascular risk score in a referral population.
- Author
-
Dhoble A, Lahr BD, Allison TG, Bailey KR, Thomas RJ, Lopez-Jimenez F, Kullo IJ, Gupta B, and Kopecky SL
- Subjects
- Adult, Aged, Aged, 80 and over, Cardiovascular Diseases diagnosis, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Minnesota epidemiology, Predictive Value of Tests, Prognosis, Risk Factors, Severity of Illness Index, Time Factors, Cardiovascular Diseases epidemiology, Exercise Test methods, Referral and Consultation, Risk Assessment methods
- Abstract
Exercise testing provides valuable information but is rarely integrated to derive a risk prediction model in a referral population. In this study, we assessed the predictive value of conventional cardiovascular risk factors and exercise test parameters in 6,546 consecutive adults referred for exercise testing, who were followed for a period of 8.1 ± 3.7 years for incident myocardial infarction, coronary revascularization, and cardiovascular death. A risk prediction model was developed, and cross-validation of model was performed by splitting the data set into 10 equal random subsets, with model fitting based on 9 of the 10 subsets and testing in of the remaining subset, repeated in all 10 possible ways. The best performing model was chosen based on measurements of model discrimination and stability. A risk score was constructed from the final model, with points assigned for the presence of each predictor based on the regression coefficients. Using both conventional risk factors and exercise test parameters, a total of 9 variables were identified as independent and robust predictors and were included in a risk score. The prognostic ability of this model was compared with that of the Adult Treatment Panel III model using the net reclassification and integrated discrimination index. From the cross-validation results, the c statistic of 0.77 for the final model indicated strong predictive power. In conclusion, we developed, tested, and internally validated a novel risk prediction model using exercise treadmill testing parameters., (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Published
- 2014
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.