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  • 1
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    Online Resource
    Safety of same‐day discharge after uncomplicated, minimalist transcatheter aortic valve replacement in the COVID‐19 era
    Wiley ; 2021
    In:  Catheterization and Cardiovascular Interventions Vol. 97, No. 5 ( 2021-04), p. 940-947
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    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 97, No. 5 ( 2021-04), p. 940-947
    Abstract: We sought to evaluate the safety, efficacy and feasibility of same‐day discharge after uncomplicated, minimalist TAVR. Background At the start of the COVID‐19 pandemic, we created a same‐day discharge (SDD) pathway after conscious sedation, transfemoral (minimalist) TAVR to help minimize risk of viral transmission and conserve hospital resources. Studies support that next‐day discharge (NDD) for carefully selected patients following minimalist TAVR is safe and feasible. There is a paucity of data regarding the safety of SDD after TAVR. Methods In‐hospital and 30 day outcomes of consecutive patients meeting pre‐specified criteria for SDD after minimalist TAVR at our institution between March and July of 2020 were reviewed. Outcomes were compared to a NDD cohort from July 2018 through July 2020 that would have met SDD criteria. Primary endpoints were mortality, delayed pacemaker placement, stroke and cardiovascular readmission at 30 days. Results Twenty nine patients were discharged via the SDD pathway after TAVR. 128 prior NDD patients were identified who met all criteria for SDD. The STS scores were similar between the two groups (SDD 2.6% ±1.5 vs. NDD 2.3% ± 1.2). There were no deaths at 30 days in either group. There was no significant difference in delayed pacemaker placement (SDD 0% vs. NDD 0.8%, p   〉  .99) or cardiovascular readmission (SDD 0% vs. NDD 5.5%, p = .35) at 30 days. Conclusions Same day discharge following uncomplicated, minimalist TAVR in selected patients appears to be safe, achieving similar 30 day outcomes as a cohort of next day discharge patients.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v97.5
    DOI: 10.1002/ccd.29453
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 2
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    Real‐world experience with concomitant or staged transcatheter aortic and mitral valve replacements using balloon‐expandable valves
    Wiley ; 2022
    In:  Catheterization and Cardiovascular Interventions Vol. 100, No. 5 ( 2022-11), p. 890-900
    Details
    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 100, No. 5 ( 2022-11), p. 890-900
    Abstract: To describe outcomes of patients who underwent transcatheter aortic valve replacement (TAVR) in a native valve or failed bioprosthetic valve or transcatheter heart valve (THV) and a transcatheter mitral valve replacement procedure (TMVR; valve‐in‐valve [mViV], valve‐in‐ring [mViR] , and valve in mitral annulus calcification [ViMAC]) either concomitantly (same procedure) or staged (different procedures). Background Patient characteristics, procedural details, and outcomes of concomitant or staged TAVR and TMVR procedures are largely unknown. Methods Data were extracted from the STS/ACC TVT Registry™ for patients undergoing concomitant or staged TAVR and TMVR with SAPIEN XT, SAPIEN 3, or SAPIEN 3 Ultra (Edwards Lifesciences) THVs. Descriptive results were reported for procedural, index hospitalization, 30‐day, and 1‐year outcomes. Results A total of 257 patients underwent TAVR and TMVR in concomitant ( n  = 135) or staged ( n  = 122) procedures. Device success was 82.9% and 83.9% for concomitant TAVR and TMVR procedures and 83.8% and 82.5% for staged TAVR and TMVR procedures. Significant improvements in aortic and mitral valve function remained stable through 1 year. All‐cause mortality for concomitant and staged groups was 14.7% and 10.5% at 30 days, and 32.8% and 24.6% at 1 year, respectively. Stroke rate for concomitant and staged groups was 0.8% and 3.6% at 30 days and 3.9% and 5.6% at 1 year, respectively. Improvements from baseline to 1 year in NYHA class and KCCQ overall summary scores were observed for all patients. Conclusions Concomitant or staged transcatheter treatment of patients with aortic and mitral valve disease can be performed in select high‐risk patients in experienced centers.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v100.5
    DOI: 10.1002/ccd.30331
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 3
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    Transcatheter aortic valve deployment influences neo‐sinus thrombosis risk: An in vitro flow study
    Wiley ; 2020
    In:  Catheterization and Cardiovascular Interventions Vol. 95, No. 5 ( 2020-04), p. 1009-1016
    Details
    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 95, No. 5 ( 2020-04), p. 1009-1016
    Abstract: We investigated the impact of (transcatheter heart valve) THV expansion at the level of the native annulus and implant depth on valve performance and neo‐sinus flow stasis. Background Flow stasis in the neo‐sinus is one of the identified risk factors of THV thrombosis. Methods A 29 mm CoreValve and 26 mm SAPIEN 3 were deployed under different expansions (CoreValve, SAPIEN 3) and implant depths (CoreValve) within a patient‐derived aortic root in a pulse duplicator. Fluorescent dye was injected during diastole into the neo‐sinus and imaged over 20 cardiac cycles. Washout times were computed as a measure of flow stasis for each deployment. Results The 10% CoreValve under‐expansion improved neo‐sinus washout over full expansion by 8% ( p 〈  .001), and higher CoreValve implant depth improved neo‐sinus washout ( p 〈  .001). The 10% SAPIEN 3 under‐expansion improved neo‐sinus washout by 23% ( p 〈  .001). Under‐expansion of both valve types caused higher pressure gradients and smaller effective orifice areas than full expansion. Conclusions Neo‐sinus flow stasis is influenced by THV expansion and implant depth (CoreValve). The 10% valve under‐deployment (oversizing) may facilitate reduced flow stasis in the neo‐sinus with minimal increase in pressure gradients. This strategy may be helpful for patient anatomies, which are in‐between transcatheter valve sizes.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v95.5
    DOI: 10.1002/ccd.28388
    Language: English
    Publisher: Wiley
    Publication Date: 2020
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  • 4
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    First‐in‐human transcatheter pledget‐assisted suture tricuspid annuloplasty for severe tricuspid insufficiency
    Wiley ; 2021
    In:  Catheterization and Cardiovascular Interventions Vol. 97, No. 1 ( 2021-01)
    Details
    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 97, No. 1 ( 2021-01)
    Abstract: We report the first pledget‐assisted suture tricuspid annuloplasty (PASTA) in a patient with torrential tricuspid regurgitation (TR). Background Tricuspid valve regurgitation is a common malignant disease with no commercially available transcatheter therapy. PASTA is a “percutaneous surgical” procedure using pledgeted sutures to create a double‐orifice tricuspid valve. Methods An 83‐year‐old man had end‐stage TR caused by a defibrillator lead. He consented to undergo PASTA on a compassionate basis. A double‐orifice valve was created with pledgeted sutures from percutaneous right ventricular apical access. Results TR was reduced from torrential to trace. The vena contracta reduced to from 23 to 1 mm and annular area reduced from 1817 to 782 mm 2 . However, the annulus dehisced and required closure with a percutaneous nitinol plug. The patient was discharged home and was alive 6 months later but with persistent symptoms. Conclusions The anatomy of a double‐orifice valve can eliminate TR but a better solution is required to avoid excessive suture tension on annular tissue.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v97.1
    DOI: 10.1002/ccd.28955
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 5
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    A single healthcare experience with Impella RP
    Wiley ; 2021
    In:  Catheterization and Cardiovascular Interventions Vol. 97, No. 1 ( 2021-01)
    Details
    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 97, No. 1 ( 2021-01)
    Abstract: To understand the predictors of survival and indications for Impella RP in a single healthcare experience. Background The Impella RP can be used to temporarily support patients with right ventricular (RV) dysfunction after left ventricular assist device (LVAD) placement or myocardial infarction (MI). However, recent postmarket approval data have raised concerns of higher than expected mortality with this device. Methods A retrospective chart review and analysis of all patients that underwent Impella RP placement in the Emory Healthcare system between January 2016 and December 2018 were performed. Patients were classified according to the indication. Results A total of 39 patients underwent Impella RP placement. Six patients were post‐LVAD, 9 were implanted for massive pulmonary embolism with persistent shock, 8 for postcardiac surgery RV failure (non‐LVAD), 11 for RV failure post‐MI, and 5 for new or worsening nonischemic cardiomyopathy. The worst survival was noted in MI‐related cardiogenic shock group and in patients who presented with cardiac arrest (3/12). All observed deaths were due to persistent refractory shock. There was no device related death. Survival improved during the last year of experience compared to the first 2 years. Conclusion This study supports the selective use of the Impella RP, with a higher than national reported survival rate (49% vs. 28.6%). Indication appears to be an important factor determining survival.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v97.1
    DOI: 10.1002/ccd.28986
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 6
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    Prospective validation of a risk score to predict pacemaker implantation after transcatheter aortic valve replacement
    Wiley ; 2023
    In:  Journal of Cardiovascular Electrophysiology
    Details
    In: Journal of Cardiovascular Electrophysiology, Wiley
    Abstract: The need for pacemaker is a common complication after transcatheter aortic valve replacement (TAVR). We previously described the Emory Risk Score (ERS) to predict the need for new pacemaker implant (PPM) after TAVR. Metrics included in the score are a history of syncope, pre‐existing RBBB, QRS duration ≥140 ms, and prosthesis oversizing ≥16%. To prospectively validate the previously described risk score. Methods We prospectively evaluated all patients without pre‐existing pacemakers, ICD, or pre‐existing indications for pacing undergoing TAVR with the Edwards SAPIEN 3 prosthesis at our institution from March 2019 to December 2020 ( n  = 661). Patients were scored prospectively; however, results were blinded from clinical decision‐making. The primary endpoint was PPM at 30 days after TAVR. Performance of the ERS was evaluated using logistic regression, a calibration curve to prior performance, and receiver operating characteristic (ROC) analysis. Results A total of 48 patients (7.3%) had PPM after TAVR. A higher ERS predicted an increased likelihood of PPM (OR 2.61, 95% CI: 2.05–3.25 per point, p   〈  0.001). There was good correlation between observed and expected values on the calibration curve (slope = 1.04, calibration at large = 0.001). The area under the ROC curve was 0.81 (95% CI [0.74–0.88], p   〈  0.001). Conclusions The ERS prospectively predicted the need for PPM in a serial, real‐world cohort of patients undergoing TAVR with a balloon‐expandable prosthesis, confirming findings previously described in retrospective cohorts. Notably, the prospective performance of the score was comparable with that of the initial cohorts. The risk score could serve as a framework for preprocedural risk stratification for PPM after TAVR.
    Type of Medium: Online Resource
    ISSN: 1045-3873 , 1540-8167
    URL: Article
    DOI: 10.1111/jce.16061
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2037519-0
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  • 7
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    Adverse clinical outcomes in patients undergoing both PCI and TAVR : Analysis from a pooled multi‐center registry
    Wiley ; 2021
    In:  Catheterization and Cardiovascular Interventions Vol. 97, No. 3 ( 2021-02-15), p. 529-539
    Details
    In: Catheterization and Cardiovascular Interventions, Wiley, Vol. 97, No. 3 ( 2021-02-15), p. 529-539
    Abstract: There is a paucity of data regarding the optimum timing of PCI in relation to TAVR. Objective We compared the major adverse cardiovascular and cerebrovascular events (MACCE) rates among patients who underwent percutaneous coronary intervention (PCI) before transcatheter aortic valve replacement (TAVR) with those who received PCI with/after TAVR. Methods In this multicenter study, we pooled all consecutive patients who underwent TAVR at three high volume centers. Results Among 3,982 patients who underwent TAVR, 327 (8%) patients underwent PCI within 1 year before TAVR, 38 (1%) had PCI the same day as TAVR and 15 (0.5%) had PCI within 2 months after TAVR. Overall, among patients who received both PCI and TAVR ( n = 380), history of previous CABG (HR:0.501; p = .001), higher BMI at TAVR (HR:0.970; p = .038), and statin therapy after TAVR (HR:0.660, p = .037) were independently associated with lower MACCE while warfarin therapy after TAVR was associated with a higher risk of MACCE (HR:1.779, p = .017). Patients who received PCI within 1 year before TAVR had similar baseline demographics, STS scores, clinical risk factors when compared to patients receiving PCI with/after TAVR. Both groups were similar in PCI (Syntax Score, ACC/AHA lesion class) and TAVR (valve types, access) related variables. There were no significant differences in terms of MACCE (log rank p = .550), all‐cause mortality (log rank p = .433), strokes (log rank p = .153), and repeat PCI (log rank p = .054) in patients who underwent PCI with/after TAVR when compared to patients who received PCI before TAVR. Conclusion Among patients who underwent both PCI and TAVR, history of CABG, higher BMI, and statin therapy had lower, while those discharged on warfarin, had higher adverse event rates. Adverse events rates were similar regardless of timing of PCI.
    Type of Medium: Online Resource
    ISSN: 1522-1946 , 1522-726X
    URL: Issue
    URL: Article
    DOI: 10.1002/ccd.v97.3
    DOI: 10.1002/ccd.29233
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 8
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    Outflow graft obstruction after left ventricular assist device implantation: a retrospective, single‐centre case series
    Wiley ; 2021
    In:  ESC Heart Failure Vol. 8, No. 3 ( 2021-06), p. 2349-2353
    Details
    In: ESC Heart Failure, Wiley, Vol. 8, No. 3 ( 2021-06), p. 2349-2353
    Abstract: Outflow graft obstruction is a poorly described complication following left ventricular assist device (LVAD) surgery. We sought to define the incidence of LVAD outflow graft obstruction and assess clinical outcomes with a percutaneous treatment strategy. Methods and results From January 2012 to October 2020, 322 patients with LVAD were managed at our institution. Patients with LVAD outflow graft obstruction were identified by cardiac computed tomography with angiography and invasive haemodynamic assessment and were subsequently treated with percutaneous intervention. Poisson regression was used to analyse time‐dependent differences in the incidence of LVAD outflow graft obstruction. Kaplan–Meier analysis was used to estimate survival. Twenty patients (6.2%) developed haemodynamically significant LVAD outflow graft obstruction at a rate of 0.03 events per patient‐year. Outflow graft obstruction presented a median of 33 (26–49) months after surgery. Patients presented with low estimated LVAD pump flow (95%), heart failure (90%), or both (85%), and 59% developed cardiogenic shock prior to intervention. The most common aetiology identified by cardiac computed tomography with angiography was external compression of the outflow graft (78%). On presentation, the median peak gradient in the outflow graft was 78 (64–100) mmHg. Outflow graft stenting was 100% successful with no in‐hospital mortality, and it reduced the peak outflow graft gradient to 10 (2–17) mmHg ( P   〈  0.001). Outflow graft stenting was durable with two patients (10%) requiring a repeat procedure over a median follow‐up of 13 (7–20) months and did not impact survival. Conclusions Left ventricular assist device outflow graft obstruction is a relatively common and underappreciated cause of recurrent heart failure and LVAD dysfunction. Outflow graft stenting can be achieved with low morbidity and provides a long‐term solution to this complication.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v8.3
    DOI: 10.1002/ehf2.13333
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2814355-3
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