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3 results on '"Bruce Haik"'

1. Left Ventricular Function Recovery After Transapical TAVR in Patients With Previous Coronary Artery Bypass Graft Surgery

Author

Nathan Kang, Bruce Haik, Marc Cohen, Chunguang Chen, Alexis K. Okoh, Christoph Sossou, Mark J. Russo, Devangi Dave, and Jonathan Decker

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Transcatheter aortic, medicine.medical_treatment, Coronary Disease, Kaplan-Meier Estimate, Ventricular Function, Left, Transcatheter Aortic Valve Replacement, Valve replacement, medicine, Humans, In patient, cardiovascular diseases, Coronary Artery Bypass, Retrospective Studies, Aged, 80 and over, Ejection fraction, Ventricular function, business.industry, Aortic Valve Stenosis, General Medicine, medicine.disease, Surgery, Treatment Outcome, medicine.anatomical_structure, Aortic valve stenosis, Female, Cardiology and Cardiovascular Medicine, business, Artery
Abstract

Objective The transapical (TA) approach is an alternative access technique for transcatheter aortic valve replacement (TAVR) in patients with symptomatic aortic valve stenosis. The impact of prior coronary artery bypass graft (CABG) surgery and how it affects left ventricular function recovery is not well defined. Methods Patients who had TAVR at a single center between June 2012 and December 2016 were reviewed. High-risk patients who underwent the procedure via a TA approach were divided into 2 groups based on their history of CABG surgery. Postoperative outcomes were compared between groups. CABG/TA-TAVR patients were subdivided into 2 per baseline left ventricular ejection fraction (LVEF) Results Of 923 cases in total, 183 (19.8%) were performed via a TA approach. The mean ± SD Society of Thoracic Surgeons risk score of TA patients was 10.2 ± 4.6. Forty-nine (27%) had a surgical history of CABG. Overall all-cause mortality rates at 30 days, 1 year, and 2 years were similar for both groups ( P = 0.59, P = 0.64, P = 0.78). Subgrouping of CABG-TAVR patients ( n = 49) identified 24 patients (49%) with LVEF ≥50% vs. 25 (51%) with LVEF 2, P < 0.001; mean gradient: ∆: −38 mmHg, P < 0.001); LVEF 2, P < 0.001; MG: ∆: −31 mmHg, P < 0.001). Conclusions TA-TAVR can be safely performed with acceptable postoperative outcomes in patients with a history of CABG surgery. In those with reduced EF, significant improvements in LV and valve functions are seen at 1-year follow-up.

Published
2019
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3. Clinical and Functional Outcomes Associated with Age after Transapical Transcatheter Aortic Valve Replacement.

Author

Okoh AK, Kang N, Haik N, Fugar S, Chunguang C, Bruce H, Cohen M, and Russo MJ

Subjects
Aged, Aged, 80 and over, Aortic Valve diagnostic imaging, Aortic Valve pathology, Echocardiography, Female, Femoral Artery surgery, Heart Septum surgery, Humans, Incidence, Male, Middle Aged, Perioperative Period mortality, Postoperative Period, Subclavian Artery surgery, Survival Analysis, Survival Rate, Transcatheter Aortic Valve Replacement methods, Transcatheter Aortic Valve Replacement mortality, Treatment Outcome, Acute Kidney Injury etiology, Aortic Valve surgery, Aortic Valve Stenosis surgery, Transcatheter Aortic Valve Replacement adverse effects
Abstract

Objective: Transcatheter aortic valve replacement (TAVR) via a transapical (TA) approach has been associated with high morbidity. The aim of this study is to investigate the association of age and clinical and functional outcomes after TA-TAVR., Methods: Patients who had TA-TAVR at a single center were divided into 3 age groups: <75 years (Group I), 75 to 85 years (Group II), and >85 years (Group III). Pre- and postoperative clinical, functional status, and procedure-related outcomes were compared among patient groups. A multivariable Cox proportional hazards model was used to assess the impact of age on overall all-cause mortality., Results: Out of 183 TA-TAVR cases performed, 117 met the study criteria. These included 15 aged <75 years, 60 aged 75 to 85 years, and 42 aged >85 years. Short-term (30-day) clinical and functional status improved significantly for all age groups. The incidence of acute kidney injury, access site complications, and requirement for permanent pacemaker were similar for all age groups at 30 days. After a median follow-up of 26 months, overall all-cause survival rates were 86% for Group I, 88% for Group II, and 83% for Group III at 1 year. Cox proportional hazards model showed frailty status (HR: 1.84; 95% CI, 1.23 to 2.69; P = 0.003) but not age as an independent predictor of overall all-cause mortality., Conclusions: Findings from this study suggest that both older and younger patients benefit from TA-TAVR with comparable operative outcomes. Age should not be an exclusion criterion for TA-TAVR.

Published
2019
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