12 results on '"Bruce, Christopher"'
Search Results
2. Transcatheter Electrosurgery: A Narrative Review.
- Author
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Bruce CG, Khan JM, Rogers T, Yildirim DK, Babaliaros VC, Greenbaum AB, and Lederman RJ
- Subjects
- Humans, Electrosurgery adverse effects, Electrosurgery methods, Treatment Outcome, Catheterization, Vascular Diseases, Transcatheter Aortic Valve Replacement, Heart Valve Prosthesis
- Abstract
Transcatheter electrosurgery describes the ability to cut and traverse tissue, at a distance, without an open surgical field and is possible using either purpose-built or off-the-shelf devices. Tissue traversal requires focused delivery of radiofrequency energy to a guidewire tip. Initially employed to cross atretic pulmonary valves, tissue traversal has enabled transcaval aortic access, recanalization of arterial and venous occlusions, transseptal access, and many other techniques. To cut tissue, the selectively denuded inner curvature of a kinked guidewire (the Flying-V) or a single-loop snare is energized during traction. Adjunctive techniques may complement or enable contemporary transcatheter procedures, whereas myocardial slicing or excision of ectopic masses may offer definitive therapy. In this contemporary review we discuss the principles of transcatheter electrosurgery, and through exemplary clinical applications highlight the range of therapeutic options offered by this versatile family of procedures.
- Published
- 2023
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3. Toward Transcatheter Leaflet Removal With the CATHEDRAL Procedure: CATHeter Electrosurgical Debulking and RemovAL.
- Author
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Babaliaros VC, Gleason PT, Xie JX, Khan JM, Bruce CG, Byku I, Grubb K, Paone G, Rogers T, Lederman RJ, and Greenbaum AB
- Subjects
- Aortic Valve surgery, Catheters, Cytoreduction Surgical Procedures, Electrosurgery, Humans, Prosthesis Design, Treatment Outcome, Aortic Valve Stenosis surgery, Bioprosthesis, Heart Valve Prosthesis, Transcatheter Aortic Valve Replacement
- Abstract
Competing Interests: Funding Support and Author Disclosures Supported by Emory Structural Heart and Valve program intramural funds and by National Institutes of Health (NIH) grant Z01-HL006040. Dr Babaliaros has institutional research contracts for clinical investigation of transcatheter aortic, mitral, and tricuspid devices from Edwards Lifesciences, Abbott Vascular, Medtronic, and Boston Scientific; is a consultant for Edwards Lifesciences and Abbott Vascular; and has equity interest in Transmural Systems. Drs Gleason, Xie, and Byku have institutional research contracts for clinical investigation of transcatheter aortic, mitral, and tricuspid devices from Edwards Lifesciences, Abbott Vascular, Medtronic, and Boston Scientific. Dr Khan is a proctor for Edwards Lifesciences and Medtronic; and is a coinventor on patents, assigned to the NIH, on devices for electrosurgical tissue laceration. Dr Bruce is a coinventor on patents, assigned to the NIH, on devices for electrosurgical tissue laceration. Dr Grubb is a consultant for Edwards Lifesciences and Medtronic; and has institutional research contracts for clinical investigation of transcatheter aortic, mitral, and tricuspid devices from Edwards Lifesciences, Abbott Vascular, Medtronic, and Boston Scientific. Dr Paone has institutional research contracts for clinical investigation of transcatheter aortic, mitral, and tricuspid devices from Edwards Lifesciences, Abbott Vascular, Medtronic, and Boston Scientific; and is a proctor for Edwards Lifesciences. Dr Lederman is a coinventor on patents, assigned to the NIH, on devices for electrosurgical tissue laceration. Dr Greenbaum has institutional research contracts for clinical investigation of transcatheter aortic, mitral, and tricuspid devices from Edwards Lifesciences, Abbott Vascular, Medtronic, and Boston Scientific; is a proctor for Edwards Lifesciences and Medtronic; and has equity interest in Transmural Systems. Dr Rogers has reported that he has no relationships relevant to the contents of this paper to disclose.
- Published
- 2022
- Full Text
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4. Lessons From TAVR in the Gulf.
- Author
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Khan JM and Bruce CG
- Subjects
- Aortic Valve diagnostic imaging, Aortic Valve surgery, Humans, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Transcatheter Aortic Valve Replacement adverse effects
- Published
- 2022
- Full Text
- View/download PDF
5. Transcaval Versus Transaxillary TAVR in Contemporary Practice: A Propensity-Weighted Analysis.
- Author
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Lederman RJ, Babaliaros VC, Lisko JC, Rogers T, Mahoney P, Foerst JR, Depta JP, Muhammad KI, McCabe JM, Pop A, Khan JM, Bruce CG, Medranda GA, Wei JW, Binongo JN, and Greenbaum AB
- Subjects
- Aortic Valve diagnostic imaging, Aortic Valve surgery, Humans, Registries, Risk Factors, Treatment Outcome, United States, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Ischemic Attack, Transient, Stroke, Transcatheter Aortic Valve Replacement
- Abstract
Objectives: The aim of this study was to compare transcaval and transaxillary artery access for transcatheter aortic valve replacement (TAVR) at experienced medical centers in contemporary practice., Background: There are no systematic comparisons of transcaval and transaxillary TAVR access routes., Methods: Eight experienced centers contributed local data collected for the STS/ACC TVT Registry (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry) between 2017 and 2020. Outcomes after transcaval and axillary/subclavian (transaxillary) access were adjusted for baseline imbalances using doubly robust (inverse propensity weighting plus regression) estimation and compared., Results: Transcaval access was used in 238 procedures and transaxillary access in 106; for comparison, transfemoral access was used in 7,132 procedures. Risk profiles were higher among patients selected for nonfemoral access but similar among patients requiring transcaval and transaxillary access. Stroke and transient ischemic attack were 5-fold less common after transcaval than transaxillary access (2.5% vs 13.2%; OR: 0.20; 95% CI: 0.06-0.72; P = 0.014) compared with transfemoral access (1.7%). Major and life-threatening bleeding (Valve Academic Research Consortium 3 ≥ type 2) were comparable (10.0% vs 13.2%; OR: 0.66; 95% CI: 0.26-1.66; P = 0.38) compared with transfemoral access (3.5%), as was blood transfusion (19.3% vs 21.7%; OR: 1.07; 95% CI: 0.49-2.33; P = 0.87) compared with transfemoral access (7.1%). Vascular complications, intensive care unit and hospital length of stay, and survival were similar between transcaval and transaxillary access. More patients were discharged directly home and without stroke or transient ischemic attack after transcaval than transaxillary access (87.8% vs 62.3%; OR: 5.19; 95% CI: 2.45-11.0; P < 0.001) compared with transfemoral access (90.3%)., Conclusions: Patients undergoing transcaval TAVR had lower rates of stroke and similar bleeding compared with transaxillary access in a contemporary experience from 8 US centers. Both approaches had more complications than transfemoral access. Transcaval TAVR access may offer an attractive option., Competing Interests: Funding Support and Author Disclosures This work was supported by the Emory Structural Heart and Valve program intramural funds, and by National Institutes of Health Z01-HL006040. Drs Babaliaros and Greenbaum have served as consultants for Edwards Lifesciences and Abbott Vascular; have an employer with research contracts for clinical investigation of transcatheter aortic, mitral, and tricuspid devices from Edwards Lifesciences, Abbott Vascular, Medtronic, and Boston Scientific; and own equity interest in Transmural Systems. Drs Lederman and Rogers are coinventors on device patents, assigned to the National Institutes of Health, for closure of transcaval access ports. Dr Rogers has served as consultant and physician proctor for Edwards Lifesciences and Medtronic; has been on the advisory board for Medtronic; and has equity interest in Transmural Systems. Dr Mahoney has served as a proctor and consultant and has received institutional research support from Edwards Lifesciences, Medtronic, and Abbott. Dr Foerst has served as a proctor for Edwards Lifesciences and Medtronic. Dr Depta has served as a consultant or advisory board member for Edwards Lifesciences, Boston Scientific, Abbott, V-Wave-Ltd, and WL Gore & Associates. Dr Muhammad has served as a proctor and consultant for Edwards Lifesciences and Medtronic. Dr McCabe has served as a consultant and has received honoraria from Boston Scientific, Cardiovascular Systems Inc, Edwards Lifesciences, and Medtronic. Dr Pop is a consultant for Edwards Lifesciences and Shockwave Medical. Dr Khan has served as a proctor for Edwards Lifesciences and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Published by Elsevier Inc.)
- Published
- 2022
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6. Troubleshooting transcaval access: Honoring our commitments.
- Author
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Bruce CG and Lederman RJ
- Subjects
- Aortic Valve surgery, Humans, Treatment Outcome, Aortic Valve Stenosis surgery, Heart Valve Prosthesis, Transcatheter Aortic Valve Replacement
- Published
- 2022
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7. Balloon-Augmented Leaflet Modification With Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction and Laceration of the Anterior Mitral Leaflet to Prevent Outflow Obstruction: Benchtop Validation and First In-Man Experience.
- Author
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Perdoncin E, Bruce CG, Babaliaros VC, Yildirim DK, Depta JP, McCabe JM, Gleason PT, Xie J, Grubb KJ, Paone G, Kohli K, Kamioka N, Khan JM, Rogers T, Lederman RJ, and Greenbaum AB
- Subjects
- Animals, Coronary Vessels diagnostic imaging, Coronary Vessels surgery, Humans, Iatrogenic Disease prevention & control, Mitral Valve diagnostic imaging, Mitral Valve surgery, Treatment Outcome, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation adverse effects, Lacerations etiology, Lacerations prevention & control, Pectinidae, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Background: Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) and laceration of the anterior mitral leaflet to prevent outflow obstruction (LAMPOON) reduce the risk of coronary and left ventricular outflow obstruction obstruction during transcatheter aortic valve replacement and transcatheter mitral valve replacement. Despite successful laceration, BASILICA or LAMPOON may fail to prevent obstruction caused by inadequate leaflet splay in patients having challenging anatomy such as very small valve-to-coronary distance, diffusely calcified, rigid leaflets, or undergoing transcatheter aortic valve replacement inside existing transcatheter aortic valve replacement. We describe a novel technique of balloon-augmented (BA) leaflet laceration to enhance leaflet splay., Methods: We measured the incremental leaflet splay from BA-BASILICA in vitro. From November 2019 to March 2021, 16 patients underwent BA-BASILICA and 4 BA-LAMPOON at 3 centers., Results: BA-BASILICA increased benchtop leaflet tip splay 17%, maximum splay angle 30%, and splay area 23%, resulting in a more rounded apex and larger effective area. Sixteen patients at risk for inadequate BASILICA leaflet splay, including 4 transcatheter aortic valve replacement inside existing transcatheter aortic valve replacement, underwent BA-BASILICA. All had successful leaflet laceration. One had coronary obstruction requiring immediate orthotopic stenting. Two underwent elective orthotopic coronary stenting through the transcatheter valve cells for leaflet prolapse without coronary ischemia. There were no deaths during the procedure or at 30 days. Four patients at risk for inadequate anterior mitral leaflet splay underwent BA-LAMPOON. All had successful target leaflet laceration without left ventricular outflow obstruction obstruction or procedural death. One died within 30 days., Conclusions: BA leaflet laceration enhances leaflet splay in vitro and may allow transcatheter aortic valve replacement and transcatheter mitral valve replacement in patients otherwise ineligible for traditional BASILICA or LAMPOON due to challenging anatomy. Graphic Abstract: A graphic abstract is available for this article.
- Published
- 2021
- Full Text
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8. BASILICA Trial: One-Year Outcomes of Transcatheter Electrosurgical Leaflet Laceration to Prevent TAVR Coronary Obstruction.
- Author
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Khan JM, Greenbaum AB, Babaliaros VC, Dvir D, Reisman M, McCabe JM, Satler L, Waksman R, Eng MH, Paone G, Chen MY, Bruce CG, Stine AM, Tian X, Rogers T, and Lederman RJ
- Subjects
- Aortic Valve diagnostic imaging, Aortic Valve surgery, Electrosurgery, Humans, Prospective Studies, Prosthesis Design, Treatment Outcome, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Bioprosthesis, Heart Valve Prosthesis, Lacerations, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Background: Coronary artery obstruction is a rare, devastating complication of transcatheter aortic valve replacement. Transcatheter electrosurgical aortic leaflet laceration (Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction [BASILICA]) is a novel technique to prevent coronary artery obstruction. We report the 1-year outcomes of the BASILICA trial. Primary end points of 30-day success and safety have been reported previously., Methods: The BASILICA trial was a prospective, multicenter, single-arm safety and feasibility study. Subjects with severe native or bioprosthetic aortic valve disease at high or extreme risk for surgery, and high risk of coronary artery obstruction, were included. End points at 1 year included death, stroke, and myocardial infarction. Source data was independently verified and end points independently adjudicated., Results: Thirty subjects were enrolled between February 2018 and July 2018. At 30 days, BASILICA was successful in 28 subjects (93.3%), there were 3 strokes (10%), including 1 disabling stroke (3.3%), 1 death (3.3%), and 1 periprocedural myocardial infarction (3.3%). Between 30 days and 1 year, there were no additional strokes, no myocardial infarction, and 2 deaths (10% 1-year mortality). No subject needed repeat intervention for aortic valve or coronary disease. Two subjects had infective endocarditis (6.7%), but neither was isolated to the aortic valve. There were no hospital admissions for heart failure. Fourteen (46.7%) subjects required repeat hospital admission for other causes. Aortic valve gradients on echocardiography, New York Heart Association functional class, and Kansas City Cardiomyopathy Questionnaire scores improved from baseline to 30 days and were maintained at 1 year., Conclusions: In these subjects with multiple comorbidities and restrictive anatomy that underwent transcatheter aortic valve replacement, there was no late stroke, myocardial infarction, or death related to BASILICA. Mitigation of coronary obstruction remained intact at 1 year and was not related to recurrent readmission. These results are reassuring for patients and physicians who wish to avoid the long-term complications related to snorkel stenting., Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03381989.
- Published
- 2021
- Full Text
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9. Balloon-Assisted BASILICA to Facilitate Redo TAVR.
- Author
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Greenbaum AB, Kamioka N, Vavalle JP, Lisko JC, Gleason PT, Paone G, Grubb KJ, Bruce CG, Lederman RJ, and Babaliaros VC
- Subjects
- Aortic Valve diagnostic imaging, Aortic Valve surgery, Humans, Prosthesis Design, Treatment Outcome, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Heart Valve Prosthesis, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Competing Interests: Funding Support and Author Disclosures This research was supported by Emory Structural Heart and Valve program intramural funds and by National Institutes of Health grant Z01-HL006040. Dr. Greenbaum is a proctor for Edwards Lifesciences and Medtronic; and is a consultant with equity in Transmural Systems. Dr. Greenbaum’s employer has research contracts for investigation of transcatheter aortic and mitral devices from Edwards Lifesciences, Abbott Vascular, Medtronic, and Boston Scientific. Dr. Vavalle is a consultant for Edwards Lifesciences. Dr. Paone is a consultant and proctor for Edwards Lifesciences. Dr. Grubb is a speaker, a proctor, and an investigator for Edwards Lifesciences; is a speaker, a proctor, and an advisory board member for Boston Scientific; and is a speaker, a proctor, an investigator, and an advisory board member for Medtronic. Dr. Lederman is principal investigator in a cooperative research and development agreement between Edwards Lifesciences and the National Institutes of Health on transcatheter modification of the mitral valve. Dr. Babaliaros is a consultant for Edwards Lifesciences; and is a consultant with equity in Transmural Systems. Dr. Babaliaros’s employer has research contracts for investigation of transcatheter aortic and mitral devices from Edwards Lifesciences, Abbott Vascular, Medtronic, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Published
- 2021
- Full Text
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10. Transcatheter Electrosurgery: JACC State-of-the-Art Review.
- Author
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Khan JM, Rogers T, Greenbaum AB, Babaliaros VC, Yildirim DK, Bruce CG, Herzka DA, Schenke WH, Ratnayaka K, and Lederman RJ
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- Cardiology methods, Cardiology trends, Electrosurgery trends, Heart Valve Diseases diagnostic imaging, Heart Valve Diseases surgery, Heart Valve Prosthesis Implantation trends, Humans, Prosthesis Design trends, Review Literature as Topic, Transcatheter Aortic Valve Replacement trends, Electrosurgery methods, Heart Valve Prosthesis Implantation methods, Prosthesis Design methods, Transcatheter Aortic Valve Replacement methods
- Abstract
Transcatheter electrosurgery refers to a family of procedures using radiofrequency energy to vaporize and traverse or lacerate tissue despite flowing blood. The authors review theory, simulations, and benchtop demonstrations of how guidewires, insulation, adjunctive catheters, and dielectric medium interact. For tissue traversal, all but the tip of traversing guidewires is insulated to concentrate current. For leaflet laceration, the "Flying V" configuration concentrates current at the inner lacerating surface of a kinked guidewire. Flooding the field with non-ionic dextrose eliminates alternative current paths. Clinical applications include traversing occlusions (pulmonary atresia, arterial and venous occlusion, and iatrogenic graft occlusion), traversing tissue planes (atrial and ventricular septal puncture, radiofrequency valve repair, transcaval access, Potts and Glenn shunts), and leaflet laceration (BASILICA, LAMPOON, ELASTA-Clip, and others). Tips are provided for optimizing these techniques. Transcatheter electrosurgery already enables a range of novel therapeutic procedures for structural heart disease, and represents a promising advance toward transcatheter surgery., (Published by Elsevier Inc.)
- Published
- 2020
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11. TAVR Roulette: Caution Regarding BASILICA Laceration for TAVR-in-TAVR.
- Author
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Khan JM, Bruce CG, Babaliaros VC, Greenbaum AB, Rogers T, and Lederman RJ
- Subjects
- Aortic Valve diagnostic imaging, Coronary Stenosis diagnostic imaging, Coronary Stenosis etiology, Equipment Failure Analysis, Materials Testing, Prosthesis Design, Reoperation, Risk Factors, Transcatheter Aortic Valve Replacement adverse effects, Aortic Valve surgery, Bioprosthesis, Coronary Stenosis prevention & control, Heart Valve Prosthesis, Prosthesis Failure, Transcatheter Aortic Valve Replacement instrumentation
- Published
- 2020
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12. Toward Transcatheter Leaflet Removal With the CATHEDRAL Procedure: CATHeter Electrosurgical Debulking and RemovAL
- Author
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Babaliaros, Vasilis C., Gleason, Patrick T., Xie, Joe X., Khan, Jaffar M., Bruce, Christopher G., Byku, Isida, Grubb, Kendra, Paone, Gaetano, Rogers, Toby, Lederman, Robert J., and Greenbaum, Adam B.
- Subjects
Bioprosthesis ,Transcatheter Aortic Valve Replacement ,Catheters ,Treatment Outcome ,Aortic Valve ,Heart Valve Prosthesis ,Electrosurgery ,Humans ,Aortic Valve Stenosis ,Cytoreduction Surgical Procedures ,Prosthesis Design ,Article - Published
- 2022
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