219 results on '"Vinayak, Bapat"'
Search Results
2. Management of Patients With Severe Mitral Annular Calcification
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Omar Chehab, Ross Roberts-Thomson, Antonio Bivona, Harminder Gill, Tiffany Patterson, Amit Pursnani, Karine Grigoryan, Bernardo Vargas, Ujala Bokhary, Christopher Blauth, Gianluca Lucchese, Vinayak Bapat, Mayra Guerrero, Simon Redwood, Bernard Prendergast, and Ronak Rajani
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Cardiology and Cardiovascular Medicine - Published
- 2022
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3. Transcatheter Tricuspid Valve Replacement With the EVOQUE System
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John G. Webb, Anthony (Ming-yu) Chuang, David Meier, Ralph Stephan von Bardeleben, Susheel K. Kodali, Robert L. Smith, Jörg Hausleiter, Geraldine Ong, Robert Boone, Tobias Ruf, Isaac George, Molly Szerlip, Michael Näbauer, Faeez M. Ali, Robert Moss, Felix Kreidel, Vinayak Bapat, Katharina Schnitzler, Jian Ye, Mirjam Wild, Mariama Akodad, Djeven P. Deva, Andrew G. Chatfield, Michael J. Mack, Paul A. Grayburn, Mark D. Peterson, Raj Makkar, Martin B. Leon, Rebecca T. Hahn, and Neil P. Fam
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Cardiology and Cardiovascular Medicine - Published
- 2022
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4. Right ventricular dysfunction by computed tomography associates with outcomes in severe aortic stenosis patients undergoing transcatheter aortic valve replacement
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Paul Sorajja, J. Cavalcante, Vinayak Bapat, Larissa I. Stanberry, Santiago Garcia, Bernardo B.C. Lopes, John R. Lesser, Miho Fukui, Victor Cheng, Mario Gössl, Maurice Enriquez-Sarano, and Go Hashimoto
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Male ,medicine.medical_specialty ,Transcatheter aortic ,Computed Tomography Angiography ,Ventricular Dysfunction, Right ,medicine.medical_treatment ,Computed tomography ,Severity of Illness Index ,Right ventricular ejection fraction ,Transcatheter Aortic Valve Replacement ,Valve replacement ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Retrospective Studies ,Aged, 80 and over ,Univariate analysis ,medicine.diagnostic_test ,business.industry ,Stroke Volume ,Aortic Valve Stenosis ,medicine.disease ,Right ventricular dysfunction ,Stenosis ,Treatment Outcome ,Aortic Valve ,Ventricular Function, Right ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Although cardiac computed tomography angiography (CCTA) assessment of right ventricular dysfunction (RVD) is feasible, the incremental prognostic value remains uncertain in patients undergoing transcatheter aortic valve replacement (TAVR) evaluation. This study sought to determine the incremental clinical utility of RVD identification by CCTA while accounting for clinical and echocardiographic parameters.Patients who underwent multiphasic ECG-gated functional CCTA using dual-source system for routine TAVR planning were evaluated. Biphasic contrast protocol injection allowed for biventricular contrast enhancement. CCTA-based RVD was defined as right ventricular ejection fraction (RVEF) 50%. The association of CCTA-RVD with all-cause mortality and the composite outcome of death or heart failure hospitalization after TAVR was evaluated and examined for its incremental utility beyond clinical risk assessment and echocardiographic parameters.A total of 502 patients were included (median [IQR] age, 82 [77 to 87] years; 56% men) with a median follow-up of 22 [16 to 32] months. Importantly, 126 (25%) patients were identified as having RVD by CCTA that was not identified by echocardiography. CCTA-defined RVD predicted death and the composite outcome in both univariate analyses (HR for mortality, 2.15; 95% CI, 1.44-3.22; p 0.001; HR for composite outcome, 2.11; 95% CI, 1.48-3.01; p 0.001) and in multivariate models that included clinical risk factors and echocardiographic findings (HR for mortality, 1.74; 95% CI, 1.11-2.74; p = 0.02; HR for composite outcome, 1.63; 95% CI, 1.09-2.44; p = 0.02).Functional CCTA assessment pre-TAVR correctly identified 25% of patients with RVD that was not evident on 2D echocardiography. The presence of RVD on CCTA independently associates with clinical outcomes post-TAVR.
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- 2022
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5. Cardiac Computed Tomography and Magnetic Resonance Imaging of the Tricuspid Valve: Preprocedural Planning and Postprocedural Follow-up
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Vinayak Bapat, Go Hashimoto, Markus D. Scherer, Paul Sorajja, Bernardo B.C. Lopes, and João L. Cavalcante
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Cardiac Catheterization ,medicine.medical_specialty ,Cardiac computed tomography ,Less invasive ,Computed tomography ,Humans ,Medicine ,High surgical risk ,cardiovascular diseases ,Tomography ,Heart Valve Prosthesis Implantation ,Tricuspid valve ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Magnetic Resonance Imaging ,Tricuspid Valve Insufficiency ,medicine.anatomical_structure ,cardiovascular system ,Patient evaluation ,Tricuspid Valve ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Cardiac magnetic resonance ,Follow-Up Studies - Abstract
Transcatheter tricuspid valve interventions (TTVIs) are rapidly growing as a less invasive treatment of high surgical risk patients with advanced TR. A comprehensive anatomic and functional assessment of the tricuspid valve and right-sided chambers is essential for candidate selection and procedural planning. Advanced imaging with cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) can provide accurate anatomic and functional assessment of the tricuspid valve, its apparatus, and the right-sided chambers. In this review, we provide an updated overview of the emerging role of CCT and CMR for TR patient evaluation, TTVI planning, and follow-up.
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- 2022
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6. Re-dosing of del Nido cardioplegia in adult cardiac surgery requiring prolonged aortic cross-clamp
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James Beck, Alex M. D'Angelo, Alexander P. Kossar, Koji Takeda, Michael Argenziano, Isaac George, Paul Kurlansky, Vinayak Bapat, Yoshifumi Naka, Craig R. Smith, Jessica Spellman, Hiroo Takayama, Samantha Nemeth, and Catherine Wang
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Male ,Pulmonary and Respiratory Medicine ,Cardiac function curve ,medicine.medical_specialty ,medicine.medical_treatment ,Pilot Projects ,Ventricular Function, Left ,Interquartile range ,medicine ,Clinical endpoint ,Humans ,Cardiac Surgical Procedures ,Cardioplegic Solutions ,Stroke ,Dialysis ,Aged ,Retrospective Studies ,business.industry ,Stroke Volume ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Cardiac surgery ,Aortic cross-clamp ,Anesthesia ,Heart Arrest, Induced ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVES Few data exist on the use of del Nido cardioplegia in adults, specifically during operations requiring prolonged aortic cross-clamp. In this pilot study, we evaluate outcomes of patients undergoing surgery with cross-clamp time >3 h based on re-dosing strategy, using either full dose (FD; 1:4 blood to crystalloid ratio) or dilute (4:1 blood to crystalloid ratio) solution. METHODS Consecutive adult patients (>18 years) undergoing cardiac surgery from 2012 to 2018 with cross-clamp time >3 h were reviewed. Patients were excluded if del Nido cardioplegia was not used. Patients were categorized into FD or dilute groups based on re-dosing solution. Propensity score matching was used to control for baseline differences between groups. The primary endpoint was in-hospital mortality. Other outcomes examined included: postoperative mechanical support, arrhythmia, stroke, dialysis and cardiac function. RESULTS Included for analysis were 173 patients (115 male) with median age of 63.8 (interquartile range 53.9–73.1). Major comorbidities included diabetes (45), cerebrovascular disease (34), hypertension (131), atrial fibrillation (52) and previous cardiac surgery (83). There were 108 patients (62%) who received FD re-dosing, while 65 (38%) received dilute. A greater proportion of patients in the dilute group received retrograde delivery, for both induction (32/108 vs 39/65, P CONCLUSIONS Del Nido cardioplegia has been used in complex cardiac surgery requiring prolonged cross-clamp. Re-dosing can be performed with either FD or dilute del Nido solution with no statistical difference in outcomes.
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- 2021
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7. Mitral Valve Surgery After Transcatheter Edge-to-Edge Repair
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Alejandro Pizano, Serdar Akansel, Augusto D'Onofrio, Miguel A. Pinon, Marco Di Eusanio, George Petrossian, Nicholas Dumonteil, Chawannuch Ruaengsri, Guido Ascione, Francesco Massi, Moritz C. Wyler von Ballmoos, Flavien Vincent, Anita W. Asgar, Ana Paula Tagliari, Filippo Capestro, Philippe Demers, Pinak B. Shah, Kendra J. Grubb, Basel Ramlawi, John J. Squiers, Jean-François Obadia, Lionel Leroux, Rebecca T. Hahn, Michele Flagiello, Ryan Kaple, Vinayak Bapat, Guillaume Leurent, Michael W.A. Chu, Tamim Nazif, Michele Triggiani, Matthew A. Romano, Michael A. Borger, Arnar Geirsson, Ashish S. Shah, Gorav Ailawadi, Kashish Goel, Marco Gennari, Gilbert H.L. Tang, Amedeo Anselmi, Paul Werner, Tsuyoshi Kaneko, Keti Vitanova, Shahar Lavi, Markus Krane, Luigi Pirelli, Rüdiger Lange, Martin Andreas, Michael J. Reardon, Christian Hagl, Shekhar Saha, Eric Van Belle, J. Michael DiMaio, Andrea Garatti, Sameer A. Hirji, D. Scott Lim, Maurizio Taramasso, Tom C. Nguyen, Neal S. Kleiman, Erik Bagaev, Tom Denimal, Herve Corbineau, Michael J. Mack, Molly I. Szerlip, Michel Pellerin, Isaac George, Didier Tchetche, Robert L. Smith, Francesco Maisano, Chiara Tessari, Antonio L. Bartorelli, Volkmar Falk, Chad Kliger, Rodrigo Estévez-Loureiro, Marissa Donatelle, Lin Wang, Marvin D. Atkins, Jörg Kempfert, Thomas Modine, Newell Robinson, Joachim Schofer, Oliver D. Bhadra, Paolo Denti, Syed Zaid, Denis Bouchard, Walid Ben Ali, Angie Ghattas, Christina Brinkmann, Muhanad Algadheeb, Thilo Noack, Lenard Conradi, and Florian Fahr
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Mitral regurgitation ,medicine.medical_specialty ,Longitudinal data ,business.industry ,medicine.medical_treatment ,Mortality rate ,Mitral valve replacement ,030204 cardiovascular system & hematology ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Interquartile range ,Mitral valve ,Concomitant ,medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Mitral valve surgery - Abstract
Objectives The aim of this study was to determine clinical and echocardiographic characteristics, mechanisms of failure, and outcomes of mitral valve (MV) surgery after transcatheter edge-to-edge repair (TEER). Background Although >100,000 mitral TEER procedures have been performed worldwide, longitudinal data on MV surgery after TEER are lacking. Methods Data from the multicenter, international CUTTING-EDGE registry were retrospectively analyzed. Clinical and echocardiographic outcomes were evaluated. Median follow-up duration was 9.0 months (interquartile range [IQR]: 1.2-25.7 months) after MV surgery, and follow-up was 96.1% complete at 30 days and 81.1% complete at 1 year. Results From July 2009 to July 2020, 332 patients across 34 centers underwent MV surgery after TEER. The mean age was 73.8 ± 10.1 years, median Society of Thoracic Surgeons risk for MV repair at initial TEER was 4.0 (IQR: 2.3-7.3), and primary/mixed and secondary mitral regurgitation were present in 59.0% and 38.5%, respectively. The median interval from TEER to surgery was 3.5 months (IQR: 0.5-11.9 months), with overall median Society of Thoracic Surgeons risk of 4.8% for MV replacement (IQR: 2.8%-8.4%). The primary indication for surgery was recurrent mitral regurgitation (33.5%), and MV replacement and concomitant tricuspid surgery were performed in 92.5% and 42.2% of patients, respectively. The 30-day and 1-year mortality rates were 16.6% and 31.3%, respectively. On Kaplan-Meier analysis, the actuarial estimates of mortality were 24.1% at 1 year and 31.7% at 3 years after MV surgery. Conclusions In this first report of the CUTTING-EDGE registry, the mortality and morbidity risks of MV surgery after TEER were not negligible, and only
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- 2021
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8. Nationally Representative Repeat Transcatheter Aortic Valve Replacement Outcomes
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Deepak L. Bhatt, Michael J. Reardon, Morgan Harloff, Farhang Yazdchi, Vinayak Bapat, Gilbert H.L. Tang, Uri Landes, Pinak B. Shah, Ashraf A. Sabe, Sameer A. Hirji, John G. Webb, Patrick T. O'Gara, Siobhan McGurk, Paige Newell, Edward Percy, Alexandra Malarczyk, Tsuyoshi Kaneko, Thomas G. Gleason, and Vinod H. Thourani
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Aortic valve ,medicine.medical_specialty ,education.field_of_study ,business.industry ,medicine.medical_treatment ,Incidence (epidemiology) ,Population ,Acute kidney injury ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Valve replacement ,Interquartile range ,Relative risk ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,education ,Stroke - Abstract
Objectives The aim of this study was to examine real-world experience with repeat transcatheter aortic valve replacement (TAVR) in a population-based national database. Background Repeat TAVR is a growing option in patients requiring reintervention for TAVR. However, large-scale studies with longitudinal follow-up are limited. Methods All Medicare beneficiaries who underwent TAVR from 2012 to 2017 were included. Outcomes included 30-day and longitudinal mortality and major adverse cardiovascular events, defined as death, stroke, pacemaker insertion, major bleeding, acute kidney injury, or cardiac arrest. Outcomes of repeat TAVR were compared with surgical explantation after TAVR (TAVR explantation) in a matched analysis. Results Of 133,250 patients who underwent TAVR, 617 (0.46%) underwent subsequent repeat TAVR at a median interval of 154 days (interquartile range: 58-537 days). Mortality at 30 days and 1 year was 6.0% and 22.0%, respectively. Rates of 30-day stroke and pacemaker insertion were 1.8% and 4.2%. Mortality at 30 days was lower in those who underwent their first TAVR during the later era (2015-2017) compared with earlier years (2012-2014) (4.6% vs 8.7%; P = 0.049). Repeat TAVR was associated with lower 30-day mortality compared with a matched group undergoing TAVR explantation (6.2% vs 12.3%; P = 0.05), although 1-year mortality was similar (21.0% vs 20.8%; P = 1.000). The incidence of 30-day major adverse cardiovascular events was higher with TAVR explantation compared with repeat TAVR (risk ratio: 2.92; 95% CI: 1.88-4.99; P ≤ 0.001). Conclusions Repeat TAVR was performed with acceptable 30-day mortality in this high-risk population. Short-term outcomes were superior to surgical explantation, but 1-year outcomes were similar. Repeat TAVR will likely be an important option for aortic valve reintervention after TAVR.
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- 2021
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9. Tricuspid Anatomic Regurgitant Orifice Area by Functional DSCT
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Robert S. Schwartz, Vinayak Bapat, João L. Cavalcante, Maurice Enriquez-Sarano, Paul Sorajja, John R. Lesser, Richard Bae, Santiago Garcia, Go Hashimoto, Larissa Stanberry, Miho Fukui, Yu Du, and Bernardo B.C. Lopes
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medicine.medical_specialty ,Text mining ,business.industry ,Orifice area ,Internal medicine ,Cardiology ,medicine ,Radiology, Nuclear Medicine and imaging ,Regurgitation (circulation) ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
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10. The clinical profile and natural history of patients who fail screening for transcatheter mitral valve replacement: Rationale and design of the prospective multicenter Mitral Valve Screening Survey (MVSS)
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Giorgio A. Medranda, Toby Rogers, Thomas Modine, Azeem Latib, Ulrich Jorde, Vinayak Bapat, Paul Sorajja, Megan Rowland, Joseph A. Sutton, Salman Baig, Federico M. Asch, Hector M. Garcia-Garcia, Itsik Ben-Dor, Lowell F. Satler, and Ron Waksman
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General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Mitral valve disease is insidious and associated with a decreased quality of life and survival over time. Despite surgery being the standard of care, many patients are at prohibitive surgical risk. Furthermore, a substantial proportion of patients with symptomatic mitral valve disease fail stringent screening criteria for transcatheter mitral valve replacement (TMVR). The natural history of patients who fail screening is not well-characterized, and data are limited on the reasons for screen failure in this population. The Mitral Valve Screening Survey (MVSS) seeks to detail the clinical profile and natural history of patients who fail screening for TMVR. The MVSS is a prospective, multicenter registry enrolling up to 1000 consecutive subjects who, after screening for TMVR, are deemed not to be candidates. Subjects will be followed for 30 days after failing screening for TMVR and annually for up to 5 years with clinical evaluations. The primary study endpoint of the MVSS registry is all-cause mortality at 1 year. Additional secondary endpoints include all-cause mortality, hospitalizations, subsequent mitral valve intervention (transcatheter or surgical), reason for screen failure, and quality-of-life assessments at 30 days and annually up to 5 years of follow-up. The MVSS registry is the first prospective multicenter study to characterize the clinical and anatomical profile of patients who fail screening for TMVR while providing longitudinal clarification on the natural history and outcomes of these patients. CLINICAL TRIAL REGISTRATION: Mitral Valve Screening Survey (MVSS), https://clinicaltrials.gov/ct2/show/NCT04736667, NCT04736667.
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- 2022
11. Outcomes of Prosthesis-Patient Mismatch Following Supra-Annular Transcatheter Aortic Valve Replacement
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John K. Forrest, Fang Liu, Annapoorna Kini, Vinayak Bapat, Samin K. Sharma, Basel Ramlawi, Michael J. Reardon, Amit N. Vora, Ryan Kaple, Sophia L. Alexis, Gilbert H.L. Tang, Aditya Sengupta, Susheel Kodali, Hemal Gada, and David H. Adams
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Aortic valve ,medicine.medical_specialty ,Transcatheter aortic ,business.industry ,Adverse outcomes ,medicine.medical_treatment ,macromolecular substances ,030204 cardiovascular system & hematology ,medicine.disease ,Prosthesis ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Valve replacement ,Aortic valve stenosis ,medicine ,In patient ,030212 general & internal medicine ,De novo stenosis ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives The aim of this study was to assess the outcomes of severe prosthesis-patient mismatch (PPM) in the TVT (Transcatheter Valve Therapy) Registry in patients undergoing supra-annular transcatheter aortic valve replacement (TAVR) for de novo stenosis or failed surgical bioprostheses (transcatheter aortic valve [TAV]–in–surgical aortic valve [SAV]). Background Severe PPM has been associated with adverse outcomes following TAVR, yet the clinical outcome of severe PPM after supra-annular TAVR is largely unknown. Methods Supra-annular TAVR was performed in patients enrolled in the TVT Registry with de novo stenosis (n = 42,174) or TAV-in-SAV (n = 5,446). Valve Academic Research Consortium-3 criteria were used to define severe PPM. The clinical impact of severe PPM on 1-year mortality and valve-related readmission was assessed using multivariate regression. A generalized linear mixed model was used to evaluate predictors of severe PPM. Results Severe PPM was found in 5.3% of patients undergoing de novo TAVR and 27.0% of patients undergoing TAV-in-SAV. The presence of severe PPM was not significantly associated with 1-year mortality or valve-related readmissions in both groups. Mean aortic gradients were higher in patients with severe PPM than in those without severe PPM at 1 month (9.7 ± 5.7 mm Hg vs. 7.3 ± 4.0 mm Hg; p Conclusions Severe PPM after supra-annular TAVR was not associated with increased 1-year mortality or valve-related readmissions. Longer-term follow-up is needed to determine if higher residual gradients in patients with severe PPM predict long-term outcomes. (STS/ACC Transcatheter Valve Therapy Registry [TVT Registry]; NCT01737528 )
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- 2021
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12. Anatomic classification of mitral annular calcification for surgical and transcatheter mitral valve replacement
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Isaac George, Gilbert H.L. Tang, Martin B. Leon, Michael Salna, Annapoorna Kini, Stamatios Lerakis, George Dangas, Deniz Akkoc, Samin K. Sharma, Rebecca T. Hahn, Ahmed El-Eshmawi, Susheel Kodali, Talal Alzahrani, David H. Adams, Aditya Sengupta, Sophia L. Alexis, Omar K. Khalique, and Vinayak Bapat
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Pulmonary and Respiratory Medicine ,Cardiac Catheterization ,medicine.medical_specialty ,Mitral annular calcification ,Percutaneous ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Ventricular Outflow Obstruction ,03 medical and health sciences ,0302 clinical medicine ,Suture (anatomy) ,Multidetector computed tomography ,medicine ,Humans ,Ventricular outflow tract ,Heart Valve Prosthesis Implantation ,business.industry ,Operative mortality ,Mitral valve replacement ,Mitral Valve Insufficiency ,Surgical risk ,Surgery ,Treatment Outcome ,030228 respiratory system ,Heart Valve Prosthesis ,Mitral Valve ,Cardiology and Cardiovascular Medicine ,business - Abstract
BACKGROUND AND AIM OF THE STUDY: A systematic approach to quantify mitral annular calcification (MAC) in all-comers by multidetector computed tomography (MDCT) is essential to guide treatment, but lacking. METHODS From September 2015 to July 2019, 82 patients with MAC underwent MDCT at two institutions to evaluate for surgical mitral valve replacement (SMVR), transcatheter mitral valve replacement (TMVR), or medical management. Type 1 MAC was defined as
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- 2021
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13. Treatment of Acute Aortic Insufficiency With a Dedicated Device
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Torsten Vahl, Tamim Nazif, Vivian Ng, Vinayak Bapat, Rebecca T. Hahn, Omar K. Khalique, Amisha Patel, Susheel Kodali, Nadira Hamid, and Isaac George
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0301 basic medicine ,Aortic valve ,medicine.medical_specialty ,Transcatheter aortic ,AS, aortic stenosis ,medicine.medical_treatment ,030105 genetics & heredity ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Internal medicine ,Heart team ,Diseases of the circulatory (Cardiovascular) system ,Medicine ,Endocarditis ,Mini-Focus Issue: Valvular Heart Disease ,TAVR, transcatheter aortic valve replacement ,business.industry ,Cardiogenic shock ,TEE, transesophageal echocardiography ,Refractory Multiple Myeloma ,medicine.disease ,aortic valve ,Multiorgan failure ,medicine.anatomical_structure ,TTE, transthoracic echocardiography ,AI, aortic insufficiency ,RC666-701 ,endocarditis ,cardiovascular system ,Cardiology ,Case Report: Clinical Case ,valve replacement ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
A 66-year-old man with refractory multiple myeloma presented with acute severe aortic insufficiency leading to cardiogenic shock and multiorgan failure. After comprehensive heart team evaluation, he underwent successful JenaValve transcatheter aortic valve (JenaValve Technology, Inc., Irvine, California) implantation resulting in resolution of his aortic insufficiency and improvement in his clinical status. (Level of Difficulty: Advanced.), Central Illustration
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- 2021
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14. Importance of Myocardial Fibrosis in Functional Mitral Regurgitation
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Vinayak Bapat, Deborah H Kwon, Paul Sorajja, John R. Lesser, Bernardo B.C. Lopes, Maurice Enriquez-Sarano, João L. Cavalcante, and Dipan J. Shah
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medicine.medical_specialty ,Potential impact ,business.industry ,Disease ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Risk stratification ,cardiovascular system ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Myocardial fibrosis ,Treatment decision making ,Cardiology and Cardiovascular Medicine ,business ,Cardiac magnetic resonance ,Functional mitral regurgitation ,Valve disease - Abstract
Functional mitral regurgitation (FMR) is a common and complex valve disease, in which severity and risk stratification is still a conundrum. Although risk increases with FMR severity, it is modulated by subjacent left ventricular (LV) disease. The extent of LV remodeling and dysfunction is traditionally evaluated by echocardiography, but a growing body of evidence shows that myocardial fibrosis (MF) assessment by cardiac magnetic resonance (CMR) may complement risk stratification and inform treatment decisions. This review summarizes the current knowledge on the comprehensive evaluation that CMR can provide for patients with FMR, in particular for the assessment of MF and its potential impact in clinical decision-making.
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- 2021
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15. Prospective Study of TMVR Using Balloon-Expandable Aortic Transcatheter Valves in MAC
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Anastasia Jermihov, Hyde M. Russell, Tatiana Kaptzan, Gilbert H.L. Tang, Dee Dee Wang, William W. O'Neill, Igor F. Palacios, Michael H. Salinger, Jeremy J. Thaden, Amit Pursnani, Carl L. Tommaso, Ignacio Inglesis, Christopher Meduri, Vinayak Bapat, Charanjit S. Rihal, Mayra Guerrero, Ted Feldman, Brian Whisenant, Rebecca T. Hahn, Jae K. Oh, Mackram F. Eleid, Bradley R. Lewis, Pamela S. Douglas, G. Dangas, Susheel Kodali, Mark Reisman, Martin B. Leon, Philip Krause, and Isaac George
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Mitral regurgitation ,Alcohol septal ablation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Mitral valve replacement ,Ventricular outflow tract obstruction ,030204 cardiovascular system & hematology ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Interquartile range ,Mitral valve ,medicine ,030212 general & internal medicine ,Heart valve ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Prospective cohort study ,business - Abstract
Objectives The aim of this study was to evaluate 1-year outcomes of valve–in–mitral annular calcification (ViMAC) in the MITRAL (Mitral Implantation of Transcatheter Valves) trial. Background The MITRAL trial is the first prospective study evaluating the feasibility of ViMAC using balloon-expandable aortic transcatheter heart valves. Methods A multicenter prospective study was conducted, enrolling high-risk surgical patients with severe mitral annular calcification and symptomatic severe mitral valve dysfunction at 13 U.S. sites. Results Between February 2015 and December 2017, 31 patients were enrolled (median age 74.5 years [interquartile range (IQR): 71.3 to 81.0 years], 71% women, median Society of Thoracic Surgeons score 6.3% [IQR: 5.0% to 8.8%], 87.1% in New York Heart Association functional class III or IV). Access was transatrial (48.4%), transseptal (48.4%), or transapical (3.2%). Technical success was 74.2%. Left ventricular outflow tract obstruction (LVOTO) with hemodynamic compromise occurred in 3 patients (transatrial, n = 1; transseptal, n = 1; transapical, n = 1). After LVOTO occurred in the first 2 patients, pre-emptive alcohol septal ablation was implemented to decrease risk in high-risk patients. No intraprocedural deaths or conversions to open heart surgery occurred during the index procedures. All-cause mortality at 30 days was 16.7% (transatrial, 21.4%; transseptal, 6.7%; transapical, 100% [n = 1]; p = 0.33) and at 1 year was 34.5% (transatrial, 38.5%; transseptal, 26.7%; p = 0.69). At 1-year follow-up, 83.3% of patients were in New York Heart Association functional class I or II, the median mean mitral valve gradient was 6.1 mm Hg (IQR: 5.6 to 7.1 mm Hg), and all patients had ≤1+ mitral regurgitation. Conclusions At 1 year, ViMAC was associated with symptom improvement and stable transcatheter heart valve performance. Pre-emptive alcohol septal ablation may prevent transcatheter mitral valve replacement–induced LVOTO in patients at risk. Thirty-day mortality of patients treated via transseptal access was lower than predicted by the Society of Thoracic Surgeons score. Further studies are needed to evaluate safety and efficacy of ViMAC.
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- 2021
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16. Neo-LVOT and Transcatheter Mitral Valve Replacement
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Vinayak Bapat, João L. Cavalcante, Jonathon Leipsic, Sagit Ben Zekry, Jeroen J. Bax, Dee Dee Wang, Stephanie C. Tarazi, Abdul Rahman Ihdayhid, Philipp Blanke, Mansi Turaga, Nicolo Piazza, and Anna B. Reid
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Mitral valve replacement ,Computed tomography ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Cardiology ,Ventricular outflow tract ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business - Abstract
With the advent of transcatheter mitral valve replacement (TMVR), the concept of the neo-left ventricular outflow tract (LVOT) was introduced and remains an essential component of treatment planning. This paper describes the LVOT anatomy and provides a step-by-step computed tomography methodology to segment and measure the neo-LVOT while discussing the current evidence and outstanding challenges. It also discusses the technical and hemodynamic factors that play a major role in assessing the neo-LVOT. A summary of expert-based recommendations about the overall risk of LVOT obstruction in different scenarios is presented along with the currently available methods to reduce the risk of LVOT obstruction and other post-procedural complications.
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- 2021
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17. B-21 | Coronary Angiography Within 30 days from Coronary Artery Bypass Graft Surgery: Indications, Findings and Outcomes
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Beatrice D. Rynders, Bahadir Simsek, Brynn Okeson, Bavana V. Rangan, Athanasios Rempakos, Spyridon Kostantinis, Judit Karacsonyi, Elizabeth Page, Melina Cahnbley, Larissa Stanberry, Olga C. Mastrodemos, Salman S. Allana, Sarah Palmer, Robert Steffen, Carly Lodewyks, Erik Beckmann, Benjamin Sun, Vinayak Bapat, Yader B. Sandoval, M. Nicholas Burke, and Emmanouil S. Brilakis
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- 2023
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18. Transfemoral Transcatheter Tricuspid Valve Replacement With the EVOQUE System
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Faeez M. Ali, John G. Webb, Mark Hensey, Djeven P. Deva, Tobias Ruf, Vinayak Bapat, Paul A. Grayburn, Neil Fam, Martin B. Leon, Ralph Stephan von Bardeleben, Robert H. Boone, Mark D. Peterson, Rebecca T. Hahn, Susheel Kodali, Robert Moss, Michael Nabauer, Jörg Hausleiter, Jian Ye, Molly Szerlip, Katharina Schnitzler, Michael J. Mack, Felix Kreidel, Geraldine Ong, Isaac George, and Robert L. Smith
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medicine.medical_specialty ,education.field_of_study ,Framingham Risk Score ,business.industry ,medicine.medical_treatment ,Population ,Tricuspid valve replacement ,030204 cardiovascular system & hematology ,System a ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,cardiovascular system ,Etiology ,Medicine ,Observational study ,cardiovascular diseases ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Prospective cohort study ,education ,Dialysis - Abstract
Objectives The purpose of this observational first-in-human experience was to investigate the feasibility and safety of the EVOQUE tricuspid valve replacement system and its impact on short-term clinical outcomes. Background Transcatheter tricuspid intervention is a promising option for selected patients with severe tricuspid regurgitation (TR). Although transcatheter leaflet repair is an option for some, transcatheter tricuspid valve replacement (TTVR) may be applicable to a broader population. Methods Twenty-five patients with severe TR underwent EVOQUE TTVR in a compassionate-use experience. The primary outcome was technical success, with NYHA (NYHA) functional class, TR grade, and major adverse cardiac and cerebrovascular events assessed at 30-day follow-up. Results All patients (mean age 76 ± 3 years, 88% women) were at high surgical risk (mean Society of Thoracic Surgeons risk score 9.1 ± 2.3%), with 96% in NYHA functional class III or IV. TR etiology was predominantly functional, with mean tricuspid annular diameter of 44.8 ± 7.8 mm and mean tricuspid annular plane systolic excursion of 16 ± 2 mm. Technical success was 92%, with no intraprocedural mortality or conversion to surgery. At 30-day follow-up, mortality was 0%, 76% of patients were in NYHA functional class I or II, and TR grade was ≤2+ in 96%. Major bleeding occurred in 3 patients (12%), 2 patients (8%) required pacemaker implantation, and 1 patient (4%) required dialysis. Conclusions This first-in-human experience evaluating EVOQUE TTVR demonstrated high technical success, acceptable safety, and significant clinical improvement. Larger prospective studies are needed to confirm durability and safety and the impact on long-term clinical outcomes.
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- 2021
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19. Reintervention with Transcatheter and Surgical Aortic Valves: A Systematic Review and Meta-Analysis
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Kevin Buda, Michael Megaly, Robert Steffen, Santiago Garcia, Vinayak Bapat, and João L. Cavalcante
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Aortic valve ,medicine.medical_specialty ,business.industry ,Odds ratio ,medicine.disease ,Thrombosis ,medicine.anatomical_structure ,Aortic valve replacement ,Internal medicine ,medicine ,Clinical endpoint ,Cardiology ,Endocarditis ,Myocardial infarction ,business ,Stroke - Abstract
Background: Despite expanding indications, data regarding the long-term durability of transcatheter heart valves (THV) are limited. Methods: We performed a systematic review and meta-analysis of all published studies with ≥5years of follow-up reporting aortic valve reintervention rates of transcatheter (TAVR) and surgical aortic valve replacement (SAVR). Randomized controlled trials (n = 4) and propensity-matched observational studies (n = 1) involving all surgical risk categories were included. The primary endpoint was the composite of aortic valve reintervention and death. Results: The meta- analysis included 4145 patients: 2101 underwent TAVR (mean age 81.7 ± 6.7 years, 54% male) and 2044 SAVR (mean age 81.8 ± 6.6 years, 54% male). All TAVR procedures were performed with early generations of THV. At a median follow-up of 5 years (range 5 - 6 years), TAVR had higher reintervention rates (odds ratio (OR) 3.33; 95% CI: [1.78, 6.24], p 2 = 0%), all-cause mortality (OR 1.45; 95% CI: [1.22, 1.75], p 2 = 44%) and the composite of reintervention and death (OR 1.47; 95% CI: [1.14, 1.91], p 2 = 64%). Rates of myocardial infarction, transient ischemic attack, stroke, endocarditis, and the composite of endocarditis and thrombosis were similar between the groups. Conclusion: Despite comparable short and medium-term results, TAVR with early-generation THV has higher rates of reintervention and the composite of reintervention and death. Further studies employing newer definitions of structural valve deterioration and bioprosthetic valve failure are needed to assess whether technological enhancements in THV technology will improve long-term outcomes.
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- 2021
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20. When Excluded From Randomized Clinical Trials
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Susheel Kodali, Vinayak Bapat, and Poonam Velagapudi
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medicine.medical_specialty ,Randomized controlled trial ,law ,business.industry ,Internal medicine ,medicine ,MEDLINE ,Cardiology and Cardiovascular Medicine ,business ,law.invention - Published
- 2021
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21. Perspective Chapter: Valve-in-Valve Transcatheter Aortic Valve Replacement (ViV) for Failed Bioprosthetic Valves
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Aravdeep Jhand, Vinayak Bapat, Thomas Porter, and Poonam Velagapudi
- Abstract
Aortic valve disease remains the second most common valvular heart disease worldwide. Surgical aortic valve replacement (SAVR) with mechanical or bioprosthetic valves and transcatheter aortic valve replacement (TAVR) with bioprosthetic valves are both approved therapies for patients with severe aortic stenosis (AS) across all surgical risk categories. On the other hand, SAVR remains the mainstay of treatment for severe aortic regurgitation (AR) with TAVR reserved for selected patients at prohibitive surgical risk. Both surgical and transcatheter bioprosthetic valves are prone to bioprosthetic valve failure (BVF) due to various etiologies, and can lead to restenosis, regurgitation, or a combination of both. BVF can now be addressed by repeat valve replacement whether surgical or valve-in-valve TAVR (ViV). ViV is a desirable option for elderly patients at high surgical risk and requires meticulous planning with pre-operative CT imaging to optimize outcomes and minimize complications.
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- 2022
22. Early Multinational Experience of Transcatheter Tricuspid Valve Replacement for Treating Severe Tricuspid Regurgitation
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Geraldine Ong, Susheel Kodali, Andrea Colli, Krzysztof Bartus, Francesco Maisano, Patrick M. McCarthy, Josep Rodés-Cabau, Newell Robinson, Maurizio Taramasso, Alberto Forteza, George A. Petrossian, Neil Fam, Alberto Pozzoli, Markus Reinartz, Rodrigo Estévez-Loureiro, Mark J. Ricciardi, Samir R. Kapadia, Vinayak Bapat, Mark D. Peterson, Azeem Latib, François Dagenais, Vratika Agarwal, Jose L. Navia, Giuseppe Tarantini, Rebecca T. Hahn, Elisabeth Bédard, and Horst Sievert
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Male ,Cardiac Catheterization ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Tricuspid valve replacement ,Regurgitation (circulation) ,tricuspid valve ,Severity of Illness Index ,Valve replacement ,medicine ,Humans ,In patient ,tricuspid regurgitation ,valve replacement ,Aged ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,Tricuspid valve ,business.industry ,Recovery of Function ,Tricuspid Valve Insufficiency ,Surgical risk ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
The aim of this registry was to evaluate the feasibility and safety of transcatheter tricuspid valve implantation (TTVI) in patients with extreme surgical risk.Isolated tricuspid regurgitation (TR) surgery is associated with high in-hospital mortality.Thirty consecutive patients (mean age 75 ± 10 years; 56% women) from 10 institutions, with symptomatic functional TR, had institutional and notified body approval for compassionate use of the GATE TTVI system. Baseline, discharge, and 30-day follow-up echocardiographic data and procedural, in-hospital, and follow-up clinical outcomes were collected.At baseline, all patients had multiple comorbidities, severe or greater TR, and reduced baseline right ventricular function. Technical success was achieved in 26 of 30 patients (87%). Device malpositioning occurred in 4 patients, with conversion to open heart surgery in 2 (5%). Of those who received the device, 100% had reductions in TR of ≥1, and 75% experienced reductions of ≥2 grades, resulting in 18 of 24 of patients (76%) with mild or less TR at discharge. All patients had mild or less central TR. There was continued improvement in TR grade between discharge and 30 days in 15 of 19 patients (79%). In-hospital mortality was 10%. At mean follow-up of 127 ± 82 days, 4 patients (13%) had died. Of patients alive at follow-up, 62% were in New York Heart Association functional class I or II, with no late device-related adverse events.Compassionate treatment of severe, symptomatic functional TR using a first-generation TTVI device is associated with significant reduction in TR and improvement in functional status with acceptable in-hospital mortality. Further studies are needed to determine the appropriate patient population and long-term outcomes with TTVI therapy.
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- 2020
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23. Efficacy of Primary Surgical Versus Medical Intervention for Treatment of Left-Sided Infective Endocarditis
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Yoshifumi Naka, Jose Gutierrez, Stergios Gatzoflias, Catherine Wang, Vinayak Bapat, Michael Argenziano, Paul Kurlansky, Marcia Gailes, Hiroo Takayama, Yuming Ning, Rachel J. Gordon, Koji Takeda, Michal Segall, Alex Kossar, Anisha Vasireddi, Karina Guaman, Matthew A. Beier, Isaac George, and Craig R. Smith
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,End stage renal disease ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Internal medicine ,medicine ,Humans ,Stroke ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,Septic shock ,business.industry ,Hazard ratio ,Endocarditis, Bacterial ,Middle Aged ,medicine.disease ,030228 respiratory system ,Infective endocarditis ,Propensity score matching ,Cohort ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Left-sided staphylococcal, streptococcal, and enterococcal infective endocarditis (IE) is associated with poor clinical outcomes. Our primary aim is to compare clinical outcomes of staphylococcal, streptococcal, and enterococcal IE patients who undergo valve replacement surgery and outcomes of patients who are treated solely with antibiotics.All patients were treated medically or surgically for left-sided staphylococcal, streptococcal, or enterococcal IE at our institution from 1998 to 2014 and were retrospectively studied. The primary outcome of interest was 30-day and 1-year mortality, and secondary outcomes included posttreatment septic shock, embolic events, stroke, and end-stage renal disease at 30 days. Inverse probability treatment weights, derived from propensity scores, were used to balance the medical and surgical cohorts across clinical risk factors, The Society of Thoracic Surgeon scores, and pathogens. Outcomes were compared comprehensively and in a staphylococcal-only subanalysis.Study population consisted of 245 surgical patients and 164 medical patients. Mortality at 30 days was higher in the medical cohort, both in aggregate and for staphylococcal only (all, 7% vs 16%, P.001; staphylococcal only, 7% vs 22%, P.001). Surgical patients had a higher incidence of septic shock and renal dysfunction; however, stroke and embolic events at 30 days were not different between cohorts. Cox survival analysis demonstrated that surgical treatment provided a 1-year survival benefit, with a hazard ratio of 0.48 (95% confidence interval, 0.36 to 0.64) that was robust regardless of pathogen.Compared with medical management, valve replacement surgery in patients with left-sided staphylococcal, streptococcal, or enterococcal IE appears to confer a survival advantage at 30 days and 1 year.
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- 2020
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24. Incidence, Characteristics, Predictors, and Outcomes of Surgical Explantation After Transcatheter Aortic Valve Replacement
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Vinod H. Thourani, Martin B. Leon, Siobhan McGurk, Morgan Harloff, Patrick T. O'Gara, Gilbert H.L. Tang, Ashraf A. Sabe, Pinak B. Shah, Edward Percy, Vinayak Bapat, Farhang Yazdchi, Deepak L. Bhatt, Alexandra Malarczyk, Tsuyoshi Kaneko, and Sameer A. Hirji
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medicine.medical_specialty ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,Incidence (epidemiology) ,030204 cardiovascular system & hematology ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Currently, there is a paucity of information on surgical explantation after transcatheter aortic valve replacement (TAVR). Objectives The purpose of this study was to examine th...
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- 2020
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25. Left ventricular injury: Beware the wire
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Susheel Kodali, Lyle Dershowitz, Mariusz Wolbinski, Isaac George, and Vinayak Bapat
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Pulmonary and Respiratory Medicine ,business.industry ,Medicine ,Surgery ,Adult: Mitral Valve: Case Reports ,business - Published
- 2020
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26. The rapid transformation of cardiac surgery practice in the coronavirus disease 2019 (COVID-19) pandemic: insights and clinical strategies from a centre at the epicentre
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Isaac George, Michael Salna, Serge Kobsa, Scott Deroo, Jacob Kriegel, David Blitzer, Nicholas J Shea, null Shea, Alex D’Angelo, Tasnim Raza, Paul Kurlansky, Koji Takeda, Hiroo Takayama, Vinayak Bapat, Yoshifumi Naka, Craig R Smith, Emile Bacha, Michael Argenziano, and null Argenziano
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Pulmonary and Respiratory Medicine ,Telemedicine ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,New York ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Report ,Intensive care ,Pandemic ,Medicine ,030212 general & internal medicine ,Reorganization ,Repurposing ,Coronavirus disease 2019 ,business.industry ,General Medicine ,Cardiac surgery ,medicine.disease ,Intensive care unit ,Heart failure ,Surgery ,Medical emergency ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVES The onset of the coronavirus disease 2019 (COVID-19) pandemic has forced our cardiac surgery programme and hospital to enact drastic measures that has forced us to change how we care for cardiac surgery patients, assist with COVID-19 care and enable support for the hospital in terms of physical resources, providers and resident training. METHODS In this review, we review the cardiovascular manifestations of COVID-19 and describe our system-wide adaptations to the pandemic, including the use of telemedicine, how a severe reduction in operative volume affected our programme, the process of redeployment of staff, repurposing of residents into specific task teams, the creation of operation room intensive care units, and the challenges that we faced in this process. RESULTS We offer a revised set of definitions of surgical priority during this pandemic and how this was applied to our system, followed by specific considerations in coronary/valve, aortic, heart failure and transplant surgery. Finally, we outline a path forward for cardiac surgery for the near future. CONCLUSIONS We recognize that individual programmes around the world will eventually face COVID-19 with varying levels of infection burden and different resources, and we hope this document can assist programmes to plan for the future.
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- 2020
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27. Restructuring Structural Heart Disease Practice During the COVID-19 Pandemic
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Allan Schwartz, Isaac George, Angelo B. Biviano, Torsten Vahl, Susheel Kodali, Martin B. Leon, Christine J. Chung, Lisa Hathaway, Rebecca T. Hahn, Elaine Wan, Omar K. Khalique, LeRoy E. Rabbani, Amisha Patel, Ajay J. Kirtane, Nadira Hamid, Mariusz Wolbinski, Carolina Pinheiro Rezende, Nir Uriel, Emad Hakemi, Tamim Nazif, James Doolittle, Vivian Ng, Russell Brandwein, Mark Lebehn, and Vinayak Bapat
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medicine.medical_specialty ,Heart disease ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Restructuring ,MEDLINE ,030204 cardiovascular system & hematology ,medicine.disease ,Comorbidity ,03 medical and health sciences ,0302 clinical medicine ,Infectious disease (medical specialty) ,Health care ,Pandemic ,medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine - Abstract
Patients with structural heart disease are at increased risk of adverse outcomes from the coronavirus disease-2019 (COVID-19) due to advanced age and comorbidity. In the midst of a global pandemic of a novel infectious disease, reality-based considerations comprise an important starting point for formulating clinical management pathways. The aims of these "crisis-driven" recommendations are: 1) to ensure appropriate and timely treatment of structural heart disease patients; 2) to minimize the risk of COVID-19 exposure to patients and health care workers; and 3) to limit resource utilization under conditions of constraint. Although the degree of disruption to usual practice will vary across the United States and elsewhere, we hope that early experiences from a heart team operating in the current global epicenter of COVID-19 may prove useful for others adapting their practice in advance of local surges of COVID-19.
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- 2020
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28. Transapical implantation of the Intrepid device: Case planning and operative technique
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Estee Hong and Vinayak Bapat
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Pulmonary and Respiratory Medicine ,business.industry ,Adult: Aortic Valve: Surgical Technique ,Medicine ,Surgery ,business - Published
- 2020
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29. Setting expectations for transcatheter mitral valve replacement in the real world
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Paul Sorajja, João Cavalcante, and Vinayak Bapat
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Heart Failure ,Heart Valve Prosthesis Implantation ,Cardiac Catheterization ,Motivation ,Mitral Valve Annuloplasty ,Treatment Outcome ,Heart Valve Prosthesis ,Humans ,Mitral Valve ,Mitral Valve Insufficiency ,Cardiology and Cardiovascular Medicine - Published
- 2022
30. Management of Patients With Severe Mitral Annular Calcification: JACC State-of-the-Art Review
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Omar, Chehab, Ross, Roberts-Thomson, Antonio, Bivona, Harminder, Gill, Tiffany, Patterson, Amit, Pursnani, Karine, Grigoryan, Bernardo, Vargas, Ujala, Bokhary, Christopher, Blauth, Gianluca, Lucchese, Vinayak, Bapat, Mayra, Guerrero, Simon, Redwood, Bernard, Prendergast, and Ronak, Rajani
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Heart Valve Prosthesis Implantation ,Treatment Outcome ,Heart Valve Diseases ,Calcinosis ,Humans ,Mitral Valve ,Mitral Valve Insufficiency - Abstract
Mitral annular calcification (MAC) is a common and challenging pathologic condition, especially in the context of an aging society. Surgical mitral valve intervention in patients with MAC is difficult, with varying approaches to the calcified annular anatomy, and the advent of transcatheter valve interventions has provided additional treatment options. Advanced imaging provides the foundation for heart team discussions and management decisions concerning individual patients. This review focuses on the prognosis of, preoperative planning for, and management strategies for patients with MAC.
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- 2022
31. Early outcomes following transatrial transcatheter mitral valve replacement in patients with severe mitral annular calcification
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Michael I. Brener, Mohanad Hamandi, Estee Hong, Alejandro Pizano, Morgan T. Harloff, Evan F. Garner, Abdallah El Sabbagh, Ryan K. Kaple, Arnar Geirsson, David W. Deaton, Ashequl M. Islam, Ramesh Veeregandham, Vinayak Bapat, Omar K. Khalique, Yuming Ning, Paul A. Kurlansky, Paul A. Grayburn, Tamim M. Nazif, Susheel K. Kodali, Martin B. Leon, Michael A. Borger, Raymond Lee, Keshav Kohli, Ajit P. Yoganathan, Andrea Colli, Mayra E. Guerrero, James E. Davies, Kyle W. Eudailey, Tsuyoshi Kaneko, Tom C. Nguyen, Hyde Russell, Robert L. Smith, and Isaac George
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
Implantation of a transcatheter valve-in-mitral annular calcification (ViMAC) has emerged as an alternative to traditional surgical mitral valve (MV) replacement. Previous studies evaluating ViMAC aggregated transseptal, transapical, and transatrial forms of the procedure, leaving uncertainty about each technique's advantages and disadvantages. Thus, we sought to evaluate clinical outcomes specifically for transatrial ViMAC from the largest multicenter registry to-date.Patients with symptomatic MV dysfunction and severe MAC who underwent ViMAC were enrolled from 12 centers across the United States and Europe. Clinical characteristics, procedural details, and clinical outcomes were abstracted from the electronic record. The primary end point was all-cause mortality.We analyzed 126 patients who underwent ViMAC (median age 76 years [interquartile range {IQR}, 70-82 years], 28.6% female, median Society of Thoracic Surgeons score 6.8% [IQR, 4.0-11.4], and median follow-up 89 days [IQR, 16-383.5]). Sixty-one (48.4%) had isolated mitral stenosis, 25 (19.8%) had isolated mitral regurgitation (MR), and 40 (31.7%) had mixed MV disease. Technical success was achieved in 119 (94.4%) patients. Thirty (23.8%) patients underwent concurrent septal myectomy, and 8 (6.3%) patients experienced left ventricular outflow tract obstruction (7/8 did not undergo myectomy). Five (4.2%) patients of 118 with postprocedure echocardiograms had greater than mild paravalvular leak. Thirty-day and 1-year all-cause mortality occurred in 16 and 33 patients, respectively. In multivariable models, moderate or greater MR at baseline was associated with increased risk of 1-year mortality (hazard ratio, 2.31; 95% confidence interval, 1.07-4.99, P = .03).Transatrial ViMAC is safe and feasible in this selected, male-predominant cohort. Patients with significant MR may derive less benefit from ViMAC than patients with mitral stenosis only.
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- 2022
32. Consensus statement on aortic valve replacement via an anterior right minithoracotomy in the UK healthcare setting
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Hunaid A Vohra, M Yousuf Salmasi, Fatemazahra Mohamed, Monica Shehata, Bardia Bahrami, Massimo Caputo, Ranjit Deshpande, Vinayak Bapat, Toufan Bahrami, Inderpaul Birdi, and Joseph Zacharias
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Cardiology and Cardiovascular Medicine - Abstract
The wide uptake of anterior right thoracotomy (ART) as an approach for aortic valve replacement (AVR) has been limited despite initial reports of its use in 1993. Compared with median sternotomy, and even ministernotomy, ART is considered to be less traumatic to the chest wall and to help facilitate quicker patient recovery. In this statement, a consensus agreement is outlined that describes the potential benefits of the ART AVR. The technical considerations that require specific attention are described and the initiation of an ART programme at a UK centre is recommended through simulation and/or use of specialist instruments in conventional cases. The use of soft tissue retractors, peripheral cannulation, modified aortic clamping and the use of intraoperative adjuncts, such as sutureless valves and/or automated knot fasteners, are important to consider in order to circumvent the challenges of minimal the altered exposure via an ART.A coordinated team-based approach that encourages ownership of the programme by team members is critical. A designated proctor/mentor is also recommended. The organisation of structured training and simulation, as well as planning the initial cases are important steps to consider.
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- 2023
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33. The Impact of Spontaneous Echocardiographic Contrast Occurring After Clip Deployment in Transcatheter Edge-to-Edge Repair for Mitral Regurgitation
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Hirotomo Sato, João Cavalcante, Richard Bae, Maurice Enriquez-Sarano, Vinayak Bapat, Santiago Garcia, Go Hashimoto, Miho Fukui, and Paul Sorajja
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General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2022
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34. Right Ventricular Dysfunction in Functional Mitral Regurgitation Assessed by CT
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Go Hashimoto, Hideki Koike, Hirotomo Sato, Miho Fukui, Santiago Garcia, Mario Goessl, Paul Sorajja, Vinayak Bapat, John Lesser, Maurice Enriquez Sarano, and Joao Cavalcante
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General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2022
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35. The left ventricular remodeling assessment by cardiac magnetic resonance in chronic aortic regurgitation; implications for outcome
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Victor Y. Cheng, Larissa Stanberry, Miho Fukui, Bernardo Lopes, Maurice E. Sarano, Santiago Garcia, Vinayak Bapat, Paul Sorajja, H Sato, Mario Goessl, João L. Cavalcante, Go Hashimoto, and John R. Lesser
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cardiology ,Regurgitation (circulation) ,Cardiology and Cardiovascular Medicine ,Ventricular remodeling ,medicine.disease ,Cardiac magnetic resonance ,business - Abstract
Background Chronic aortic regurgitation (AR) causes left ventricular (LV) volume overload resulting in progressive LV remodeling, which negatively affect clinical outcome. Clinical Guidelines recommend assessment of LV remodeling by echocardiography, but little is known about comparative remodeling quantification by cardiac magnetic resonance (CMR) and association with outcomes. Purpose To assess LV remodeling in AR by CMR, compared with echocardiographic measures and determine its impact on clinical outcome. Methods Patients with native, ≥moderate, chronic AR by echocardiography who underwent CMR exam within 90 days of diagnosis from January 2012 to February 2020 were enrolled. The endpoint was a composite of death, heart failure hospitalization, and heart failure symptom exacerbation during follow-up. Results The 178 patients included had median age (IQR) of 58 years (44–69), and most (88%, n=158) presented with no or minimal symptoms (NYHA class I/II). At diagnosis symptomatic vs. no/minimal symptoms patients presented with much more advanced LV remodeling by CMR (EDVI 133 [83–151] vs. 96 [80–123] p=0.024, ESVI 66 [46–85] vs. 42 [30–58], P=0.001) while echocardiography showed limited differences (EDVI 76 [57–93] vs. 65 [54–87] p=0.507, ESVI 38 [30–58] vs. 27 [20–42], p=0.072). During follow-up (3.3 years [1.6–5.8]), aortic valve replacement (AVR) was performed in 49 patients. In patients with no/minimal symptoms, the composite endpoint occurred in 54 (34%) patients including eight deaths and 30 heart failure hospitalizations. Patients with LV end-systolic volume index (LVESVi) >45 ml/m2 by CMR had higher likelihood for composite endpoint (Panel A) confirmed in multivariate models, adjusting for age, sex, AVR (time-dependent), EuroSCORE2, and LV End-systolic-dimension-index (LVESDi) >25 mm/2, with adjusted hazard ratio 1.84 [1.02–3.33], p Conclusion Assessment of LV remodeling by CMR in patients with clinically significant AR is feasible in routine clinical practice, detects with high sensitivity LV remodeling associated with development of HF symptoms and is independently predictive of clinical outcome. Hence, CMR provides a powerful tool for evaluation and risk stratification of patients with AR. Funding Acknowledgement Type of funding sources: None. Panel APanel B
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- 2021
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36. Suprasternal Versus Transfemoral Access for Transcatheter Aortic Valve Replacement: Insights From a Propensity Score Matched Analysis
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Samantha Nemeth, Omar K. Khalique, Mohammad Sarraf, Vinayak Bapat, Kyle W. Eudailey, Susheel Kodali, Rebecca T. Hahn, Tamim Nazif, Shmuel Chen, Nadira Hamid, Anna Olds, P. Kurlansky, Vivian Ng, Hussein M. Rahim, Michael I. Brener, Amisha Patel, Isaac George, Thomas J. Cahill, Mustafa I. Ahmed, Torsten Vahl, and Martin B. Leon
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Male ,medicine.medical_specialty ,Time Factors ,suprasternal ,Transcatheter aortic ,medicine.medical_treatment ,Aortic Valve Replacement/Transcather Aortic Valve Implantation ,Punctures ,Risk Assessment ,Transcatheter Aortic Valve Replacement ,Postoperative Complications ,Valve replacement ,Risk Factors ,Catheter-Based Coronary and Valvular Interventions ,Catheterization, Peripheral ,Clinical Studies ,medicine ,Humans ,Hospital Mortality ,Prospective Studies ,Registries ,transfemoral aortic valve implantation ,Propensity Score ,Brachiocephalic Trunk ,transcatheter aortic valve implantation ,Aged ,Original Research ,Aged, 80 and over ,business.industry ,aortic stenosis ,Aortic Valve Stenosis ,Surgery ,access site ,Femoral Artery ,medicine.anatomical_structure ,Treatment Outcome ,Valvular Heart Disease ,Propensity score matching ,Access site ,Alabama ,Feasibility Studies ,Female ,New York City ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Background Suprasternal access is an alternative access strategy for transcatheter aortic valve replacement (TAVR) where the innominate artery is cannulated from an incision above the sternal notch. To date, suprasternal access has never been compared with transfemoral TAVR. Thus, we sought to assess safety, feasibility, and early clinical outcomes between suprasternal and transfemoral access for patients undergoing TAVR. Methods and Results We evaluated patients from 2 institutional prospective, observational registries containing 1348 patients. Patients were selected in a 2:1 ratio (transfemoral:suprasternal) on the basis of propensity score matching. The primary outcome was in‐hospital mortality, and secondary outcomes included the incidence of ischemic stroke, major bleeding, vascular injury, left bundle‐branch block, and permanent pacemaker implantation at 30‐day follow‐up. Propensity score matching identified 89 patients undergoing suprasternal TAVR and 159 patients undergoing transfemoral TAVR suitable for analysis. There was no significant difference between suprasternal TAVR and transfemoral TAVR with respect to in‐hospital mortality (1.1% versus 0.6%; odds ratio [OR], 1.80; 95% CI, 0.11–29.06; P =0.680). No patients in either cohort suffered an ischemic stroke. The incidence of major bleeding (2.2% versus 2.5%; OR, 0.89; 95% CI, 0.16–4.96; P =0.895) and vascular injury (1.1% versus 1.9%; OR, 0.59; 95% CI, 0.06–5.77; P =0.651) did not differ significantly. The frequency of left bundle‐branch block (9.4% versus 15.8%; OR, 0.56; 95% CI, 0.24–1.30; P =0.177) and permanent pacemaker implantation (11.2% versus 5.9%; OR, 2.01; 95% CI, 0.75–5.45; P =0.169) were not statistically significantly different. Conclusions Suprasternal TAVR was safe and achieved promising short‐term clinical outcomes when compared with transfemoral TAVR. Future studies seeking to identify the optimal alternative access site should evaluate suprasternal TAVR access alongside other substitutes for transfemoral TAVR.
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- 2021
37. Fracturing surgical valves to improve hemodynamics in transcatheter aortic valve-in-valve replacement: Insanity or ingenuity?
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Gilbert H.L. Tang and Vinayak Bapat
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Bioprosthesis ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Transcatheter aortic ,business.industry ,media_common.quotation_subject ,Coronary Stenosis ,Hemodynamics ,Prosthesis Design ,Surgical valves ,Valve in valve ,Surgery ,Transcatheter Aortic Valve Replacement ,Ingenuity ,Insanity ,Aortic Valve ,Heart Valve Prosthesis ,Humans ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,media_common - Published
- 2019
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38. Balloon-expandable transcatheter aortic valve implantation with or without pre-dilation – results of a meta-analysis of 3 multicenter registries
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Nikolaos Bonaros, Vinayak Bapat, Gerhard Schymik, Martin Thoenes, Holger Schröfel, Mauro Romano, Jana Kurucova, Justus T. Strauch, Andreas Busjahn, Tanja K. Rudolph, Stephan Baldus, Cornelia Deutsch, Jannik Ole Ashauer, Christian Butter, Markus Kofler, and Peter Bramlage
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Balloon Valvuloplasty ,Male ,medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Time Factors ,medicine.medical_treatment ,Pre-dilation ,030204 cardiovascular system & hematology ,Prosthesis Design ,Balloon ,Risk Assessment ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Humans ,Multicenter Studies as Topic ,Medicine ,Registries ,030212 general & internal medicine ,Adverse effect ,Aged ,Angiology ,Aged, 80 and over ,Transcatheter aortic valve implantation ,business.industry ,Aortic stenosis ,Hemodynamics ,Aortic Valve Stenosis ,Odds ratio ,Confidence interval ,Aortic valvuloplasty ,Cardiac surgery ,Europe ,Observational Studies as Topic ,Treatment Outcome ,lcsh:RC666-701 ,Aortic Valve ,Heart Valve Prosthesis ,Cardiology ,Balloon dilation ,Female ,Cardiology and Cardiovascular Medicine ,business ,Balloon aortic valvuloplasty ,Research Article - Abstract
Background To evaluate the outcomes of transcatheter aortic valve implantation (TAVI) without balloon aortic valvuloplasty (BAV) in a real-world setting through a patient-level meta-analysis. Methods The meta-analysis included patients of three European multicenter, prospective, observational registry studies that compared outcomes after Edwards SAPIEN 3 or XT TAVI with (n = 339) or without (n = 355) BAV. Unadjusted and adjusted pooled odds ratios (with 95% confidence intervals) were calculated for procedural and 30-day outcomes. Results Median procedural time was shorter in the non-BAV group than in the BAV group (73 versus 93 min, p = 0.001), as was median fluoroscopy time (7 versus 11 min, p = 0.001). Post-delivery balloon dilation (15.5% versus 22.4%, p = 0.02) and catecholamine use (9.0% vs. 17.9%; p = 0.016) was required less often in the non-BAV group than in the BAV group with the difference becoming insignificant after multiple adjustment. There was a reduced risk for periprocedural atrioventricular block during the intervention (1.4% versus 4.1%, p = 0.035) which was non-significant after adjustment. The rate of moderate/severe paravalvular regurgitation post-TAVI was 0.6% in the no-BAV group versus 2.7% in the BAV group. There were no between-group differences in the risk of death, stroke or other adverse clinical outcomes at day 30. Conclusions This patient-level meta-analysis of real-world data indicates that TAVI performed without BAV is advantageous as it has an adequate device success rate, reduced procedure time and no adverse effects on short-term clinical outcomes.
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- 2019
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39. Imaging in patients with severe mitral annular calcification: insights from a multicentre experience using transatrial balloon-expandable valve replacement
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Kyle W. Eudailey, Catherine Wang, Ashequl Islam, Deniz Akkoc, Torsten Vahl, Martin B. Leon, Omar K. Khalique, Alex Kantor, Joongheum Park, David W. Deaton, Rebecca T. Hahn, Raymond Lee, Tsuyoshi Kaneko, Mayra Guerrero, Ramesh Veeragandham, Michael A. Borger, Hyde M. Russell, Dee Dee Wang, Susheel Kodali, Isaac George, Fabien Praz, Isaac Y. Wu, Vinayak Bapat, Diana Leung, Hiroo Takayama, Tamim Nazif, and Diane C H Tang
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Cardiac Catheterization ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Heart Valve Diseases ,Diastole ,030204 cardiovascular system & hematology ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Aortic valve replacement ,Internal medicine ,medicine ,Humans ,Ventricular outflow tract ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Systole ,education ,Heart Valve Prosthesis Implantation ,education.field_of_study ,Mitral regurgitation ,business.industry ,valvular heart disease ,Aortic Valve Stenosis ,General Medicine ,medicine.disease ,Treatment Outcome ,Aortic Valve ,Heart Valve Prosthesis ,Cardiology ,Mitral Valve ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims To investigate valve sizing and the haemodynamic relevance of the predicted left ventricular outflow tract (LVOT) in patients with mitral annular calcification (MAC) undergoing transatrial transcatheter valve implantation (THV). Methods and results In total, 21 patients undergoing transatrial THV, multiplanar reconstruction (MPR), maximum intensity projection (MIP), and cubic spline interpolation (CSI) were compared for MA sizing during diastole. In addition, predicted neo-LVOT areas were measured in 18 patients and correlated with the post-procedural haemodynamic dimensions. The procedure was successful in all patients (100%). Concomitant aortic valve replacement was performed in eight patients (43%) (AVR group). Sizing using MPR and MIP yielded comparable results in terms of area, perimeter, and diameter, whereas the dimensions obtained with CSI were systematically smaller. The simulated mean systolic neo-LVOT area was 133.4 ± 64.2 mm2 with an anticipated relative LVOT area reduction (neo-LVOT area/LVOT area × 100) of 59.3 ± 14.7%. The systolic relative LVOT area reduction, but not the absolute neo-LVOT area, was found to predict the peak (r = 0.69; P = 0.002) and mean (r = 0.65; P = 0.004) post-operative aortic gradient in the overall population as well as separately in the AVR (peak: r = 0.91; P = 0.002/mean: r = 0.85; P = 0.002) and no-AVR (peak: r = 0.89; P = 0.003/mean: r = 0.72; P = 0.008) groups. Conclusion In patients with severe MAC undergoing transatrial transcatheter valve implantation, MPR, and MIP yielded comparable annular dimensions, while values obtained with CSI tended to be systematically smaller. Mitral annular area and the average annular diameter appear to be reliable parameters for valve selection. Simulated relative LVOT reduction was found to predict the post-procedural aortic gradients.
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- 2019
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40. TCT-520 Deformation of Transcatheter Heart Valve Following Valve-in-Valve Transcatheter Aortic Valve Replacement: Implications for Hemodynamics
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Miho Fukui, Paul Sorajja, Maurice Enriquez-Sarano, Hirotomo Sato, John Lesser Lesser, Joao Cavalcante, and Vinayak Bapat
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Cardiology and Cardiovascular Medicine - Published
- 2022
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41. TCT-415 Contemporary Anatomic Criteria and Clinical Outcomes With Transcatheter Mitral Repair
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Hirotomo Sato, Vinayak Bapat, Joao Cavalcante, Richard Bae, Miho Fukui, Maurice Enriquez-Sarano, and Paul Sorajja
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Cardiology and Cardiovascular Medicine - Published
- 2022
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42. TCT-526 Impact of Left Ventricular Scar and Chamber Size on Reverse Remodeling After Transcatheter Mitral Valve Replacement With Tendyne Device
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Miho Fukui, Paul Sorajja, Vinayak Bapat, Evan Walser-Kuntz, Larissa Stanberry, Maurice Enriquez-Sarano, and Joao Cavalcante
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Cardiology and Cardiovascular Medicine - Published
- 2022
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43. TCT-471 First-in-Human Study Results With the Novel Anteris DurAVRTM Three-Dimensional Single-Piece TAVR Device
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Christopher Meduri, Vinayak Bapat, Susheel Kodali, Paul Sorajja, Nadira Hamid, Karl Poon, Kari Feldt, Magnus Settergren, and Andreas Rück
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Cardiology and Cardiovascular Medicine - Published
- 2022
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44. Current state of transcatheter mitral valve implantation in bioprosthetic mitral valve and in mitral ring as a treatment approach for failed mitral prosthesis
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Prabhjot Singh, Ryan Kaple, Vratika Agarwal, Vinayak Bapat, and Hetal H. Mehta
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medicine.medical_specialty ,education.field_of_study ,Keynote Lecture Series ,business.industry ,medicine.medical_treatment ,Population ,Less invasive ,Mitral ring ,Prosthesis ,Mitral prosthesis ,Surgery ,medicine.anatomical_structure ,Mitral valve ,Materials Chemistry ,cardiovascular system ,Medicine ,Complication rate ,Heart valve ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,education - Abstract
With heightened awareness of mitral valve disease and improvement in surgical techniques, the use of mitral valve bioprostheses has increased. There is a large aging population with prior surgical valvular interventions. Limited durability of the prosthesis due to valvular degeneration over time may necessitate the need for repair or replacement of the prior prosthesis in the future. This usually entails another surgical intervention in this population with elevated risk for a reoperation. There is an ongoing clinical need for newer, less invasive options that are feasible and carry a lower complication rate. The advent of transcatheter heart valve (THV) therapies has opened up a wide range of therapeutic options for treatment of a failed bioprosthesis. Their safety and feasibility are now well established. This article serves as a review of the currently available THVs for implantation in the mitral position, the pre-procedural assessment, the challenges associated with implantation, as well as outcomes associated with a mitral valve-in-valve (VIV) and a mitral valve-in-ring (VIR) procedure.
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- 2021
45. TCT-46 Deformation of Transcatheter Aortic Valve Prostheses: Implications for Hypo-Attenuating Leaflet Thickening
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Maurice Enriquez-Sarano, Paul Sorajja, Miho Fukui, Marshall Dworak, Go Hashimoto, Hirotomo Sato, Santiago Garcia, Vinayak Bapat, João L. Cavalcante, and John Lesser
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medicine.medical_specialty ,Leaflet (botany) ,Transcatheter aortic ,business.industry ,Internal medicine ,medicine ,Cardiology ,Thickening ,Deformation (meteorology) ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
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46. Reoperative Mitral Surgery Versus Transcatheter Mitral Valve Replacement: A Systematic Review
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Gilbert H.L. Tang, Tsuyoshi Kaneko, Vinayak Bapat, Farhang Yazdchi, Deepak L. Bhatt, Sophia L. Alexis, Akash Premkumar, Sameer A. Hirji, Edward Percy, and Aditya Sengupta
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Reoperation ,Cardiac Catheterization ,medicine.medical_specialty ,transcatheter mitral valve replacement ,medicine.medical_treatment ,Heart Valve Diseases ,reoperative mitral valve replacement ,030204 cardiovascular system & hematology ,Valve in ring ,redo mitral valve repair ,03 medical and health sciences ,0302 clinical medicine ,Catheter-Based Coronary and Valvular Interventions ,Contemporary Review ,medicine ,Humans ,030212 general & internal medicine ,Heart Valve Prosthesis Implantation ,Mitral valve repair ,business.industry ,Mitral valve replacement ,valve‐in‐valve ,Valve in valve ,Surgery ,valve‐in‐ring ,Heart Valve Prosthesis ,Valvular Heart Disease ,Mitral Valve ,Cardiology and Cardiovascular Medicine ,business ,Mitral valve surgery - Abstract
Bioprosthetic mitral structural valve degeneration and failed mitral valve repair (MVr) have traditionally been treated with reoperative mitral valve surgery. Transcatheter mitral valve‐in‐valve (MVIV) and valve‐in‐ring (MVIR) replacement are now feasible, but data comparing these approaches are lacking. We sought to compare the outcomes of (1) reoperative mitral valve replacement (redo‐MVR) and MVIV for structural valve degeneration, and (2) reoperative mitral valve repair (redo‐MVr) or MVR and MVIR for failed MVr. A literature search of PubMed, Embase, and the Cochrane Library was conducted up to July 31, 2020. Thirty‐two studies involving 25 832 patients were included. Redo‐MVR was required in ≈35% of patients after index surgery at 10 years, with 5% to 15% 30‐day mortality. MVIV resulted in >95% procedural success with 30‐day and 1‐year mortality of 0% to 8% and 11% to 16%, respectively. Recognized complications included left ventricular outflow tract obstruction (0%–6%), valve migration (0%–9%), and residual regurgitation (0%–6%). Comparisons of redo‐MVR and MVIV showed no statistically significant differences in mortality (11.3% versus 11.9% at 1 year, P =0.92), albeit higher rates of major bleeding and arrhythmias with redo‐MVR. MVIR resulted in 0% to 34% mortality at 1 year, whereas both redo‐MVr and MVR for failed repairs were performed with minimal mortality and durable long‐term results. MVIV is therefore a viable alternative to redo‐MVR for structural valve degeneration, whereas redo‐MVr or redo‐MVR is preferred for failed MVr given the suboptimal results with MVIR. However, not all patients will be candidates for MVIV/MVIR because anatomical restrictions may preclude transcatheter options from adequately addressing the underlying pathology.
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- 2021
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47. Nationally Representative Repeat Transcatheter Aortic Valve Replacement Outcomes: Report From the Centers for Medicare and Medicaid Services
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Edward D, Percy, Morgan T, Harloff, Sameer, Hirji, Siobhan, McGurk, Farhang, Yazdchi, Paige, Newell, Alexandra, Malarczyk, Ashraf, Sabe, Uri, Landes, John, Webb, Michael J, Reardon, Vinod H, Thourani, Gilbert H L, Tang, Vinayak, Bapat, Deepak, Bhatt, Patrick, O'Gara, Thomas, Gleason, Pinak, Shah, and Tsuyoshi, Kaneko
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Heart Valve Prosthesis Implantation ,Transcatheter Aortic Valve Replacement ,Treatment Outcome ,Risk Factors ,Aortic Valve ,Humans ,Aortic Valve Stenosis ,Medicare ,Centers for Medicare and Medicaid Services, U.S ,United States ,Aged - Abstract
The aim of this study was to examine real-world experience with repeat transcatheter aortic valve replacement (TAVR) in a population-based national database.Repeat TAVR is a growing option in patients requiring reintervention for TAVR. However, large-scale studies with longitudinal follow-up are limited.All Medicare beneficiaries who underwent TAVR from 2012 to 2017 were included. Outcomes included 30-day and longitudinal mortality and major adverse cardiovascular events, defined as death, stroke, pacemaker insertion, major bleeding, acute kidney injury, or cardiac arrest. Outcomes of repeat TAVR were compared with surgical explantation after TAVR (TAVR explantation) in a matched analysis.Of 133,250 patients who underwent TAVR, 617 (0.46%) underwent subsequent repeat TAVR at a median interval of 154 days (interquartile range: 58-537 days). Mortality at 30 days and 1 year was 6.0% and 22.0%, respectively. Rates of 30-day stroke and pacemaker insertion were 1.8% and 4.2%. Mortality at 30 days was lower in those who underwent their first TAVR during the later era (2015-2017) compared with earlier years (2012-2014) (4.6% vs 8.7%; P = 0.049). Repeat TAVR was associated with lower 30-day mortality compared with a matched group undergoing TAVR explantation (6.2% vs 12.3%; P = 0.05), although 1-year mortality was similar (21.0% vs 20.8%; P = 1.000). The incidence of 30-day major adverse cardiovascular events was higher with TAVR explantation compared with repeat TAVR (risk ratio: 2.92; 95% CI: 1.88-4.99; P ≤ 0.001).Repeat TAVR was performed with acceptable 30-day mortality in this high-risk population. Short-term outcomes were superior to surgical explantation, but 1-year outcomes were similar. Repeat TAVR will likely be an important option for aortic valve reintervention after TAVR.
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- 2021
48. Surgical and Transcatheter Mitral Valve Replacement in Mitral Annular Calcification: A Systematic Review
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Sophia L. Alexis, Isaac George, Martin B. Leon, Susheel Kodali, Vinayak Bapat, David H. Adams, Syed Zaid, Aaqib H. Malik, Aditya Sengupta, Gilbert H.L. Tang, Rebecca T. Hahn, Ahmed El-Eshmawi, Mayra Guerrero, and Omar K. Khalique
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mitral valve ,medicine.medical_specialty ,Mitral annular calcification ,Cardiac Catheterization ,medicine.medical_treatment ,Heart Valve Diseases ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Catheter-Based Coronary and Valvular Interventions ,Mitral valve ,Internal medicine ,Contemporary Review ,Medicine ,Humans ,030212 general & internal medicine ,Aged ,Heart Valve Prosthesis Implantation ,Cardiovascular Surgery ,business.industry ,Mitral valve replacement ,Calcinosis ,mitral valve replacement ,medicine.anatomical_structure ,Treatment Outcome ,transcatheter ,Cardiology ,mitral annulus calcification ,Cardiology and Cardiovascular Medicine ,business ,Mitral annulus calcification - Abstract
Mitral annular calcification with mitral valve disease is a challenging problem that could necessitate surgical mitral valve replacement (SMVR). Transcatheter mitral valve replacement (TMVR) is emerging as a feasible alternative in high‐risk patients with appropriate anatomy. PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to December 25, 2019 for studies discussing SMVR or TMVR in patients with mitral annular calcification; 27 of 1539 articles were selected for final review. TMVR was used in 15 studies. Relevant data were available on 82 patients who underwent hybrid transatrial TMVR, and 354 patients who underwent transapical or transseptal TMVR. Outcomes on SMVR were generally reported as small case series (447 patients from 11 studies); however, 1 large study recently reported outcomes in 9551 patients. Patients who underwent TMVR had a shorter median follow‐up of 9 to 12 months (range, in‐hospital‒19 months) compared with patients with SMVR (54 months; range, in‐hospital‒120 months). Overall, those undergoing TMVR were older and had higher Society of Thoracic Surgeons risk scores. SMVR showed a wide range of early (0%–27%; median 6.3%) and long‐term mortality (0%–65%; median at 1 year, 15.8%; 5 years, 38.8%, 10 years, 62.4%). The median in‐hospital, 30‐day, and 1‐year mortality rates were 16.7%, 22.7%, and 43%, respectively, for transseptal/transapical TMVR, and 9.5%, 20.0%, and 40%, respectively, for transatrial TMVR. Mitral annular calcification is a complex disease and TMVR, with a versatile option of transatrial approach in patients with challenging anatomy, offers a promising alternative to SMVR in high‐risk patients. However, further studies are needed to improve technology, patient selection, operative expertise, and long‐term outcomes.
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- 2021
49. Mitral valve-in-valve and valve-in-ring: tips, tricks, and outcomes
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Estee Hong, Robert Steffen, Vinayak Bapat, Luigi Pirelli, Susheel K Kodali, and Torsten P Vahl
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medicine.medical_specialty ,Keynote Lecture Series ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,Ventricular outflow tract obstruction ,Annuloplasty rings ,030204 cardiovascular system & hematology ,Valve in ring ,medicine.disease ,Surgery ,03 medical and health sciences ,Stenosis ,0302 clinical medicine ,medicine.anatomical_structure ,Mitral valve ,cardiovascular system ,Medicine ,In patient ,030212 general & internal medicine ,Embolization ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Transcatheter aortic valve implantation is now a mainstay of treatment in patients with aortic stenosis who are considered intermediate, high and prohibitive risk for surgery. Extended use of this innovative platform in treating other conditions has led to its approval in treating degenerated aortic bioprosthesis. Similarly, use of transcatheter devices in treating degenerated mitral bioprosthesis and failed mitral valve repairs with annuloplasty rings has opened a potential alternative to surgery in these patients. Experience in mitral valve-in-valve (MVIV) and valve-in-ring (VIR), while still limited, is on the rise. Although similar in many ways to the aortic VIV, it is different with respect to patient selection, planning and procedural steps. Familiarity with the bioprosthetic properties and dimensions can help an operator choose an appropriate transcatheter device and deploy it in an ideal position. Due to greater variability in construction and properties, mitral rings have led to poorer results compared to mitral valve-in-valve. Understanding the properties of mitral rings is critical and has been simplified by us in a stepwise manner. We also describe steps in patient preparation and procedure, which should help operators in performing this procedure. Certain unique complications, such as left ventricular outflow tract obstruction and risk of embolization, are discussed with tips to address these issues. Once these steps are followed, the procedure can be performed with minimal risk and good outcome.
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- 2021
50. Essential information on surgical heart valve characteristics for optimal valve prosthesis selection: Expert consensus document from the European Association for Cardio-Thoracic Surgery (EACTS)–The Society of Thoracic Surgeons (STS)–American Association for Thoracic Surgery (AATS) Valve Labelling Task Force
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Andras P. Durko, Philippe Pibarot, Pavan Atluri, Vinayak Bapat, Duke E. Cameron, Filip P.A. Casselman, Edward P. Chen, Gry Dahle, John A. Elefteriades, Patrizio Lancellotti, Richard L. Prager, Raphael Rosenhek, Alan Speir, Marco Stijnen, Giordano Tasca, Ajit Yoganathan, Thomas Walther, Ruggero De Paulis, Jurgen de Hart, Nicole Ibrahim, John Laschinger, Changfu Wu, Giovanni Di Rienzo, Alexander McLaren, Hazel Randall, Lisa Becker, Scott Capps, Brian Duncan, Chad Green, John C. Hay, Stuart J. Head, Ornella Ieropoli, Ashwini A. Jacob, A. Pieter Kappetein, Eric Manasse, Salvador Marquez, William F. Northrup, Tim Ryan, Wendel Smith, Cardiothoracic Surgery, and Internal Medicine
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Standardization ,Association (object-oriented programming) ,medicine.medical_treatment ,Heart Valve Diseases ,MEDLINE ,030204 cardiovascular system & hematology ,Prosthesis Design ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,medicine ,Humans ,Medical physics ,Heart valve ,Selection (genetic algorithm) ,Bioprosthesis ,Heart Valve Prosthesis Implantation ,Task force ,business.industry ,General surgery ,Decision Trees ,Hemodynamics ,Valve prosthesis ,Expert consensus ,Heart Valves ,medicine.anatomical_structure ,030228 respiratory system ,Cardiothoracic surgery ,Aortic Valve ,Heart Valve Prosthesis ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Comprehensive information on the characteristics of surgical heart valves (SHVs) is essential for optimal valve selection. Such information is also important in assessing SHV function after valve replacement. Despite the existing regulatory framework for SHV sizing and labelling, this information is challenging to obtain in a uniform manner for various SHVs. To ensure that clinicians are adequately informed, the European Association for Cardio-Thoracic Surgery (EACTS), The Society of Thoracic Surgeons (STS) and American Association for Thoracic Surgery (AATS) set up a Task Force comprised of cardiac surgeons, cardiologists, engineers, regulatory bodies, representatives of the International Organization for Standardization and major valve manufacturers. Previously, the EACTS–STS–AATS Valve Labelling Task Force identified the most important problems around SHV sizing and labelling. This Expert Consensus Document formulates recommendations for providing SHV physical dimensions, intended implant position and hemodynamic performance in a transparent, uniform manner. Furthermore, the Task Force advocates for the introduction and use of a standardized chart to assess the probability of prosthesis–patient mismatch and calls valve manufacturers to provide essential information required for SHV choice on standardized Valve Charts, uniformly for all SHV models.
- Published
- 2021
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