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6. Transcatheter Mitral Cerclage Ventriculoplasty From Bench to Bedside

Author

Rogers, Toby, Greenbaum, Adam B, Babaliaros, Vasilis C, Foerst, Jason R, Khan, Jaffar M, Bruce, Christopher G, Stine, Annette M, Satler, Lowell F, Perdoncin, Emily, Gleason, Patrick T, Lisko, John C, Tian, Xin, Miao, Rui, Sachdev, Vandana, Chen, Marcus Y, and Lederman, Robert J

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Heart Disease, Clinical Research, Cardiovascular, Biomedical Imaging, Heart Disease - Coronary Heart Disease, Cardiac Catheterization, Heart Failure, Heart Valve Prosthesis Implantation, Humans, Mitral Valve, Mitral Valve Insufficiency, Prospective Studies, Treatment Outcome, Ventricular Dysfunction, Left, cardiomyopathy, heart failure, secondary mitral regurgitation, transcatheter annuloplasty, transcatheter ventriculoplasty, ventricular repair, Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology, Cardiovascular medicine and haematology
Abstract

BackgroundTranscatheter mitral valve repair is beneficial in patients with mitral regurgitation (MR), left ventricular dysfunction, and persistent symptoms despite maximally tolerated medical therapy.ObjectivesThe aim of this study was to evaluate the safety and feasibility of transcatheter mitral cerclage ventriculoplasty in patients with MR and either heart failure with reduced ejection fraction or preserved ejection fraction and in subjects with prior edge-to-edge repair but persistent or recurrent symptomatic MR.MethodsThe National Heart, Lung, and Blood Institute Division of Intramural Research Transcatheter Mitral Cerclage Ventriculoplasty Early Feasibility Study (NCT03929913) was an investigator-initiated prospective multicenter study. The primary endpoint was technical success measured at exit from the catheterization laboratory. Follow-up included heart failure quality-of-life assessments and serial imaging with echocardiography and cardiac computed tomography.ResultsNineteen subjects consented and underwent cerclage, 63% with heart failure with reduced ejection fraction and 37% with heart failure with preserved ejection fraction, with ischemic cardiomyopathy in 26% and nonischemic cardiomyopathy in 74%. There were no procedural deaths, strokes, or transient ischemic attacks or other major cardiovascular adverse events. The primary endpoint was met in 17 subjects. Cerclage induced sustained reductions in mitral regurgitant volume (-41%) and effective orifice area (-33%) after a median of 337 days. Cerclage resulted in improvements in 6-minute walking distance (+78 m) and Kansas City Cardiomyopathy Questionnaire Overall Summary Score (+22 points) at 30 days that were maintained after a median of 265 days. New complete heart block developed in 6 of 17 subjects. Three deaths occurred on postprocedural days 79, 159, and 756, unrelated to cerclage.ConclusionsTranscatheter mitral cerclage ventriculoplasty resulted in significant and sustained improvements in mitral regurgitation and in heart failure quality-of-life assessments.

Published
2022

11. Transcatheter Myotomy to Reduce Left Ventricular Outflow Obstruction

Author

Greenbaum, Adam B., Ueyama, Hiroki A., Gleason, Patrick T., Khan, Jaffar M., Bruce, Christopher G., Halaby, Rim N., Rogers, Toby, Hanzel, George S., Xie, Joe X., Byku, Isida, Guyton, Robert A., Grubb, Kendra J., Lisko, John C., Shekiladze, Nikoloz, Inci, Errol K., Grier, Elizabeth A., Paone, Gaetano, McCabe, James M., Lederman, Robert J., and Babaliaros, Vasilis C.

Published
2024
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13. Contemporary Neuroscience Core Curriculum for Medical Schools

Author

Gelb, Douglas J, Kraakevik, Jeff, Safdieh, Joseph E, Agarwal, Sachin, Odia, Yazmin, Govindarajan, Raghav, Quick, Adam, Soni, Madhu, Bickel, Jennifer, Gamaldo, Charlene, Hannon, Peter, Hatch, Hayden AM, Hernandez, Christian, Merlin, Lisa R, Noble, James M, Reyes-Iglesias, Yolanda, Marie E Salas, Rachel, Sandness, David James, Treat, Lauren, Benameur, Karima, Brown, Robert D, DeLuca, Gabriele C, Garg, Neeta, Goldstein, Larry B, Gutmann, Laurie, Henchcliffe, Claire, Hessler, Amy, Jordan, Justin T, Kilgore, Shannon M, Khan, Jaffar, Levin, Kerry H, Mohile, Nimish A, Nevel, Kathryn S, Roberts, Kirk, Said, Rana R, Simpson, Ericka P, Sirven, Joseph I, Smith, A Gordon, Southerland, Andrew Mebane, and Wilson, Rujuta Bhatt

Subjects
Neurosciences, Quality Education, AAN Undergraduate Education Subcommittee, AAN Education Committee, Clinical Sciences, Cognitive Sciences, Neurology & Neurosurgery
Abstract

Medical students need to understand core neuroscience principles as a foundation for their required clinical experiences in neurology. In fact, they need a solid neuroscience foundation for their clinical experiences in all other medical disciplines also, because the nervous system plays such a critical role in the function of every organ system. Due to the rapid pace of neuroscience discoveries, it is unrealistic to expect students to master the entire field. It is also unnecessary, as students can expect to have ready access to electronic reference sources no matter where they practice. In the pre-clerkship phase of medical school, the focus should be on providing students with the foundational knowledge to use those resources effectively and interpret them correctly. This article describes an organizational framework for teaching the essential neuroscience background needed by all physicians. This is particularly germane at a time when many medical schools are re-assessing traditional practices and instituting curricular changes such as competency-based approaches, earlier clinical immersion, and increased emphasis on active learning. This article reviews factors that should be considered when developing the pre-clerkship neuroscience curriculum, including goals and objectives for the curriculum, the general topics to include, teaching and assessment methodology, who should direct the course, and the areas of expertise of faculty who might be enlisted as teachers or content experts. These guidelines were developed by a work group of experienced educators appointed by the Undergraduate Education Subcommittee (UES) of the American Academy of Neurology (AAN). They were then successively reviewed, edited, and approved by the entire UES, the AAN Education Committee, and the AAN Board of Directors.

Published
2021

15. Novel transcatheter electrosurgical laceration of heart valve leaflets to prevent blood flow obstruction from transcatheter heart valve implantation

Author

Khan, Jaffar and Redwood, Simon Robert

Subjects
617.4
Abstract

Transcatheter intervention for cardiac valve disease is an attractive alternative to open heart surgery, avoiding a thoracotomy and cardiopulmonary bypass, and associated morbidity. A limitation of transcatheter intervention is the inability to cut tissue – the hallmark of surgery, and what makes it so versatile. During transcatheter valve implantation, native diseased valve tissue is displaced rather than resected. However, this displacement can occasionally cause fatal complications. In transcatheter mitral valve implantation, septal displacement of the anterior mitral valve leaflet can obstruct the left ventricular outflow tract. In transcatheter aortic valve implantation, displacement of the left or right coronary cusps may obstruct the flow to the coronary arteries. This thesis explores the use of radiofrequency energy delivered through guidewires directed by catheters to enable closed-chest beating-heart valve leaflet laceration using marketed devices. We call this technique transcatheter electrosurgery. Two entirely novel procedures are developed that use transcatheter electrosurgery techniques to cut valve tissue prior to transcatheter valve implantation: LAMPOON (Laceration of the Anterior Mitral leaflet to Prevent left ventricular Outflow ObstructioN); and BASILICA (Bioprosthetic and native Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction). Benchtop experiments, pre-clinical procedure development in swine, first-in-human “compassionate use” experience, and early feasibility clinical trials are described for each procedure.

Published
2020

17. Coronary Obstruction From TAVR in Native Aortic Stenosis: Development and Validation of Multivariate Prediction Model

Author

Khan, Jaffar M., Kamioka, Norihiko, Lisko, John C., Perdoncin, Emily, Zhang, Cheng, Maini, Aneel, Chen, Mao, Li, Yijian, Ludwig, Sebastian, Westermann, Dirk, Amat Santos, Ignacio J., Kalińczuk, Łukasz, Sinning, Jan-Malte, Kawaguchi, Tomohiro, Fuku, Yasushi, Cheema, Asim N., Félix-Oliveira, Afonso, Yamamoto, Masanori, Kagase, Ai, Codner, Pablo, Valle, Raquel del, Iyer, Vijay S., Kim, Hyo-Soo, Lin, Mao-Shin, Maini, Brijeshwar, Rodriguez, Roberto, Montorfano, Matteo, Ancona, Marco B., Tada, Norio, Miyasaka, Masaki, Ahmad, Hasan, Ruggiero, Nicholas J., Torguson, Rebecca, Ben-Dor, Itsik, Shults, Christian C., Weissman, Gaby, Lederman, Robert J., Greenbaum, Adam B., Babaliaros, Vasilis C., Waksman, Ron, and Rogers, Toby

Published
2023
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19. Reshaping the Ventricle From Within: MIRTH (Myocardial Intramural Remodeling by Transvenous Tether) Ventriculoplasty in Swine

Author

Bruce, Christopher G., Khan, Jaffar M., Rogers, Toby, Yildirim, D. Korel, Jaimes, Andrea E., Seemann, Felicia, Chen, Marcus Y., O’Brien, Kendall, Herzka, Daniel A., Schenke, William H., Eckhaus, Michael A., Potersnak, Amanda G., Campbell-Washburn, Adrienne, Babaliaros, Vasilis C., Greenbaum, Adam B., and Lederman, Robert J.

Published
2023
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23. CMR fluoroscopy right heart catheterization for cardiac output and pulmonary vascular resistance: results in 102 patients

Author

Rogers, Toby, Ratnayaka, Kanishka, Khan, Jaffar M, Stine, Annette, Schenke, William H, Grant, Laurie P, Mazal, Jonathan R, Grant, Elena K, Campbell-Washburn, Adrienne, Hansen, Michael S, Ramasawmy, Rajiv, Herzka, Daniel A, Xue, Hui, Kellman, Peter, Faranesh, Anthony Z, and Lederman, Robert J

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Lung, Cardiovascular, Clinical Trials and Supportive Activities, Bioengineering, Heart Disease, Biomedical Imaging, Clinical Research, Administration, Inhalation, Adult, Aged, Cardiac Catheterization, Cardiac Output, Case-Control Studies, Female, Fluoroscopy, Humans, Hypertension, Pulmonary, Magnetic Resonance Imaging, Interventional, Male, Middle Aged, Models, Cardiovascular, Nitric Oxide, Oxygen, Predictive Value of Tests, Prospective Studies, Pulmonary Artery, Time Factors, Vascular Resistance, Interventional MRI catheterization, Right heart catheterization, Invasive hemodynamics, Phase contrast MRI flow, Real-time MRI, CMR, Cardiac MRI, Cardiorespiratory Medicine and Haematology, Nuclear Medicine & Medical Imaging, Cardiovascular medicine and haematology
Abstract

BackgroundQuantification of cardiac output and pulmonary vascular resistance (PVR) are critical components of invasive hemodynamic assessment, and can be measured concurrently with pressures using phase contrast CMR flow during real-time CMR guided cardiac catheterization.MethodsOne hundred two consecutive patients underwent CMR fluoroscopy guided right heart catheterization (RHC) with simultaneous measurement of pressure, cardiac output and pulmonary vascular resistance using CMR flow and the Fick principle for comparison. Procedural success, catheterization time and adverse events were prospectively collected.ResultsRHC was successfully completed in 97/102 (95.1%) patients without complication. Catheterization time was 20 ± 11 min. In patients with and without pulmonary hypertension, baseline mean pulmonary artery pressure was 39 ± 12 mmHg vs. 18 ± 4 mmHg (p

Published
2017

27. One-Year Outcomes After Treatment of Ostial In-Stent Restenosis in Left Circumflex Versus Left Anterior Descending or Right Coronary Artery

Author

Chezar-Azerrad, Chava, Musallam, Anees, Shea, Corey, Zhang, Cheng, Torguson, Rebecca, Yerasi, Charan, Case, Brian C., Forrestal, Brian J., Khalid, Nauman, Khan, Jaffar M., Shlofmitz, Evan, Chen, Yuefeng, Satler, Lowell F., Bernardo, Nelson L., Ben-Dor, Itsik, Rogers, Toby, Hashim, Hayder, Mintz, Gary S., and Waksman, Ron

Published
2021
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30. Preventing Coronary Obstruction During Transcatheter Aortic Valve Replacement: Results From the Multicenter International BASILICA Registry

Author

Khan, Jaffar M., Babaliaros, Vasilis C., Greenbaum, Adam B., Spies, Christian, Daniels, David, Depta, Jeremiah P., Oldemeyer, J. Bradley, Whisenant, Brian, McCabe, James M., Muhammad, Kamran I., George, Isaac, Mahoney, Paul, Lanz, Jonas, Laham, Roger J., Shah, Pinak B., Chhatriwalla, Adnan, Yazdani, Shahram, Hanzel, George, Pershad, Ashish, Leonardi, Robert A., Khalil, Ramzi, Tang, Gilbert H.L., Herrmann, Howard C., Agarwal, Shikhar, Fail, Peter S., Zhang, Ming, Pop, Andrei, Lisko, John, Perdoncin, Emily, Koch, Rachel L., Ben-Dor, Itsik, Satler, Lowell F., Zhang, Cheng, Cohen, Jeffrey E., Lederman, Robert J., Waksman, Ron, and Rogers, Toby

Published
2021
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31. Tip-to-Base LAMPOON for Transcatheter Mitral Valve Replacement With a Protected Mitral Annulus

Author

Lisko, John C., Babaliaros, Vasilis C., Khan, Jaffar M., Kamioka, Norihiko, Gleason, Patrick T., Paone, Gaetano, Byku, Isida, Tiwana, Jasleen, McCabe, James M., Cherukuri, Krishna, Khalil, Ramzi, Lasorda, David, Goel, Sachin S., Kleiman, Neal S., Reardon, Michael J., Daniels, David V., Spies, Christian, Mahoney, Paul, Case, Brian C., Whisenant, Brian K., Yadav, Pradeep K., Condado, Jose F., Koch, Rachel, Grubb, Kendra J., Bruce, Christopher G., Rogers, Toby, Lederman, Robert J., and Greenbaum, Adam B.

Published
2021
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32. Procedural Outcomes of Patients Undergoing Percutaneous Coronary Intervention for De Novo Lesions in the Ostial and Proximal Left Circumflex Coronary Artery

Author

Musallam, Anees, Chezar-Azerrad, Chava, Torguson, Rebecca, Case, Brian C., Yerasi, Charan, Forrestal, Brian J., Zhang, Cheng, Khalid, Nauman, Shlofmitz, Evan, Chen, Yuefeng, Khan, Jaffar M., Satler, Lowell F., Bernardo, Nelson, Ben-Dor, Itsik, Rogers, Toby, Hashim, Hayder, Mintz, Gary S., and Waksman, Ron

Published
2020
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