227 results on '"Tanvir Bajwa"'
Search Results
52. DRUG-COATED BALLOON VS DRUG-ELUDING STENT: A LONG-TERM COMPARISON
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Suhail Allaqaband, Ana Cristina Perez Moreno, Louie Kostopoulos, Nathan Marzlin, M. Fuad Jan, and Tanvir Bajwa
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medicine.medical_specialty ,Drug coated balloon ,Drug-eluting vascular stent ,business.industry ,medicine ,Cardiology and Cardiovascular Medicine ,business ,Surgery - Published
- 2021
53. TYPE 2 MYOCARDIAL INFARCTION IN PATIENTS SELECTED FOR CORONARY ANGIOGRAPHY: ETIOLOGIES AND SURVIVAL
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Tanvir Bajwa, Mohamed Hommeida, Suhail Allaqaband, Ana Cristina Perez Moreno, Katherine Busniewski, M. Fuad Jan, Mahalakshmi Angisetty, Viviana Zlochiver, Jeff Hall, A. Jamil Tajik, and Hlu Vang
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Coronary angiography ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Etiology ,Cardiology ,In patient ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease - Published
- 2021
54. CONTEMPORARY UTILIZATION OF A CHEST PAIN UNIT IN A LARGE TERTIARY CARE REFERRAL CENTER COMPARED TO STANDARD CARE APPROACH: LESSONS LEARNED FROM A REAL WORLD COMMUNITY PRACTICE
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Tanvir Bajwa, Ana Cristina Perez Moreno, Blair Tilkens, M. Fuad Jan, Joell Salfer, Suhail Allaqaband, Nicholas Sommers, Babak Haddadian, Adil S Wani, Stevie Steiro, Rafath Ullah, and Nataly Stenzel
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business.industry ,media_common.quotation_subject ,medicine.disease ,Chest pain ,Tertiary care ,World community ,Unit (housing) ,Standard care ,Referral center ,Medicine ,Medical emergency ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,media_common - Published
- 2021
55. TREND OF ENDOVASCULAR TREATMENT OF CRITICAL FEMORAL-POPLITEAL ARTERIAL DISEASE
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Louie Kostopoulos, Ana Cristina Perez Moreno, Tanvir Bajwa, Nathan Marzlin, Suhail Allaqaband, and M. Fuad Jan
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medicine.medical_specialty ,business.industry ,Arterial disease ,medicine ,Endovascular treatment ,Cardiology and Cardiovascular Medicine ,business ,Surgery - Published
- 2021
56. OUTCOMES OF COVID-19 IN PATIENTS WITH CARDIOVASCULAR DISEASE
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Chau N. Vu, A. Jamil Tajik, Tanvir Bajwa, Viviana Zlochiver, Ana Cristina Perez Moreno, Bijoy K. Khandheria, Suhail Allaqaband, and M. Fuad Jan
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medicine.medical_specialty ,Spotlight on Special Topics ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Internal medicine ,Medicine ,In patient ,Disease ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
57. SARS-COV-2 AND STROKE IN A LARGE HEALTHCARE SYSTEM
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Bijoy K. Khandheria, Viviana Zlochiver, Tanvir Bajwa, Ilana Ruff, Ana Cristina Perez Moreno, Michael Peterson, Suhail Allaqaband, M. Fuad Jan, A. Jamil Tajik, and Aashish Katapadi
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Spotlight on Special Topics ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,medicine ,Medical emergency ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Stroke ,Healthcare system - Published
- 2021
58. 1-Year Results in Patients Undergoing Transcatheter Aortic Valve Replacement With Failed Surgical Bioprostheses
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George Petrossian, Steven J. Yakubov, Daniel O'Hair, Stanley Katz, Jeffrey J. Popma, David H. Adams, Joseph D. Schmoker, Kamal R. Khabbaz, G. Michael Deeb, Daniel R. Watson, Harold L. Dauerman, P. Michael Grossman, Newell Robinson, Tanvir Bajwa, Michael J. Reardon, Neal S. Kleiman, John K. Forrest, Jae K. Oh, Shuzhen Li, Theodore Schreiber, Alan R. Hartman, Himanshu J. Patel, and Stanley Chetcuti
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Male ,Reoperation ,Aortic valve ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Aortic Valve Insufficiency ,Kaplan-Meier Estimate ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Recurrence ,Risk Factors ,Internal medicine ,medicine ,Risk of mortality ,Humans ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Aged ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,business.industry ,Mortality rate ,Hemodynamics ,Aortic Valve Stenosis ,Recovery of Function ,Middle Aged ,medicine.disease ,Prosthesis Failure ,Surgery ,Stenosis ,Treatment Outcome ,medicine.anatomical_structure ,Echocardiography ,Aortic Valve ,Heart Valve Prosthesis ,Aortic valve stenosis ,Quality of Life ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives This study evaluated the safety and effectiveness of self-expanding transcatheter aortic valve replacement (TAVR) in patients with surgical valve failure (SVF). Background Self-expanding TAVR is superior to medical therapy for patients with severe native aortic valve stenosis at increased surgical risk. Methods The CoreValve U.S. Expanded Use Study was a prospective, nonrandomized study that enrolled 233 patients with symptomatic SVF who were deemed unsuitable for reoperation. Patients were treated with self-expanding TAVR and evaluated for 30-day and 1-year outcomes after the procedure. An independent core laboratory was used to evaluate serial echocardiograms for valve hemodynamics and aortic regurgitation. Results SVF occurred through stenosis (56.4%), regurgitation (22.0%), or a combination (21.6%). A total of 227 patients underwent attempted TAVR and successful TAVR was achieved in 225 (99.1%) patients. Patients were elderly (76.7 ± 10.8 years), had a Society of Thoracic Surgeons Predicted Risk of Mortality score of 9.0 ± 6.7%, and were severely symptomatic (86.8% New York Heart Association functional class III or IV). The all-cause mortality rate was 2.2% at 30 days and 14.6% at 1 year; major stroke rate was 0.4% at 30 days and 1.8% at 1 year. Moderate aortic regurgitation occurred in 3.5% of patients at 30 days and 7.4% of patients at 1 year, with no severe aortic regurgitation. The rate of new permanent pacemaker implantation was 8.1% at 30 days and 11.0% at 1 year. The mean valve gradient was 17.0 ± 8.8 mm Hg at 30 days and 16.6 ± 8.9 mm Hg at 1 year. Factors significantly associated with higher discharge mean aortic gradients were surgical valve size, stenosis as modality of SVF, and presence of surgical valve prosthesis patient mismatch (all p Conclusions Self-expanding TAVR in patients with SVF at increased risk for surgery was associated with a low 1-year mortality and major stroke rate, significantly improved aortic valve hemodynamics, and low rates of moderate and no severe residual aortic regurgitation, with improved quality of life.
- Published
- 2017
59. One-Year Outcomes of Transcatheter Aortic Valve Replacement in Patients With End-Stage Renal Disease
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Michael J. Reardon, Tanvir Bajwa, David H. Adams, Stanley Chetcuti, Brijeshwar Maini, Daniel O'Hair, Daniel R. Watson, Robert C. Stoler, Robert F. Hebeler, George Petrossian, Steven J. Yakubov, G. Michael Deeb, Shuzhen Li, Mubashir Mumtaz, Jeffrey J. Popma, and Neal S. Kleiman
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Comorbidity ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,End stage renal disease ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Valve replacement ,Risk Factors ,Cause of Death ,Internal medicine ,medicine ,Risk of mortality ,Humans ,Prospective Studies ,030212 general & internal medicine ,Renal replacement therapy ,Survival rate ,Stroke ,Aged ,Aged, 80 and over ,business.industry ,Mortality rate ,Aortic Valve Stenosis ,medicine.disease ,Surgery ,Renal Replacement Therapy ,Survival Rate ,Echocardiography ,Aortic valve stenosis ,Cardiology ,Kidney Failure, Chronic ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background End-stage renal disease (ESRD) poses unique challenges in the treatment of patients with severe aortic stenosis. Although surgical valve replacement in ESRD patients has been associated with increased mortality, the outcomes from transcatheter aortic valve replacement (TAVR) are not clearly defined. Methods The CoreValve US Expanded Use Study is a prospective, nonrandomized study of TAVR in extreme-risk patients with comorbidities excluding them from the Pivotal Trial. We report on patients with ESRD. The primary endpoint was a composite of all-cause mortality or major stroke at 1 year. Results Ninety-six patients with ESRD underwent TAVR with the CoreValve (Medtronic, Minneapolis, MN) and have reached 1-year follow-up. Mean Society of Thoracic Surgeons Predicted Risk of Mortality score was 16.2% ± 8.4%. The rate of all-cause mortality or major stroke at 1 year was 30.3%. The all-cause mortality rate was 5.3% at 30 days and 30.3% at 1 year. The rate at 1 year of any stroke or transient ischemic attack was 2.1%; major vascular injury was 5.2%; and new permanent pacemaker was 26.8%. Valve performance improved postprocedure and remained improved at 1 year (effective orifice area 1.71 cm 2 , mean gradient 9.33 mm Hg) Conclusions Early mortality in patients with ESRD is comparable to previously published data on extreme-risk patients without ESRD, but our data suggest a higher mortality rate at 1 year for ESRD patients, likely due to comorbid conditions. Stroke and major vascular injury are infrequent, and improved valve hemodynamics are maintained at 1 year.
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- 2017
60. C-PO01-01 to C-PO01-120
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Rafath Ullah, Tadele W. Mengesha, Khawaja Afzal Ammar, Imran Niazi, Tehsin Majeed, Suhail Allaqaband, A. Jamil Tajik, Tanvir Bajwa, Sulaiman Sultan, M. Fuad Jan, Arshad Jahangir, and Indrajit Choudhuri
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medicine.medical_specialty ,business.industry ,030204 cardiovascular system & hematology ,medicine.disease ,Ventricular tachycardia ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,medicine ,Cardiology ,In patient ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
61. Elevated Diaphragm Causing Marked Kinking of the Inferior Vena Cava
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Tanvir Bajwa, Asad Ghafoor, DO Akshar Jaglan, A. Jamil Tajik, and DO Andy Kieu
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medicine.medical_specialty ,Deep vein ,Inferior vena cava ,Tortuosity ,Elevated diaphragm ,angiogram ,Clinical Vignette ,IVC, inferior vena cava ,Diseases of the circulatory (Cardiovascular) system ,magnetic resonance imaging ,Medicine ,medicine.diagnostic_test ,business.industry ,Imaging Vignette ,Magnetic resonance imaging ,medicine.disease ,echocardiogram ,Thrombosis ,medicine.anatomical_structure ,medicine.vein ,RC666-701 ,Angiography ,cardiovascular system ,Radiology ,inferior vena cava ,Cardiology and Cardiovascular Medicine ,business ,Cardiac magnetic resonance - Abstract
Inferior vena cava (IVC) syndrome is commonly caused by deep vein thrombosis or a mass effect. We present an unusual case of IVC kinking and obstruction detected by echocardiography and confirmed by cardiac magnetic resonance and angiography. Management of marked tortuosity of the IVC secondary to a paralyzed hemidiaphragm is discussed. (Level of Difficulty: Beginner.), Graphical abstract, Inferior vena cava (IVC) syndrome is commonly caused by deep vein thrombosis or a mass effect. We present an unusual case of IVC kinking and…
- Published
- 2020
62. Durability and Clinical Outcomes of Transcatheter Aortic Valve Replacement for Failed Surgical Bioprostheses
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Shuzhen Li, Eduardo de Marchena, Daniel O'Hair, Tanvir Bajwa, G. Michael Deeb, James B. Hermiller, Steven J. Yakubov, Stanley Chetcuti, Ron Waksman, Harold L. Dauerman, Kamal R. Khabbaz, Tomas A. Salerno, Jeffrey J. Popma, Jessica L. Dries-Devlin, Michael J. Reardon, and Neal S. Kleiman
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Aortic valve ,Male ,medicine.medical_specialty ,Time Factors ,Transcatheter aortic ,medicine.medical_treatment ,Prosthesis Design ,Transcatheter Aortic Valve Replacement ,Valve replacement ,Risk Factors ,Medicine ,Humans ,Prospective Studies ,Aged ,Aged, 80 and over ,Bioprosthesis ,Heart Valve Prosthesis Implantation ,business.industry ,Hemodynamics ,Aortic Valve Stenosis ,Recovery of Function ,Middle Aged ,medicine.disease ,Surgery ,Prosthesis Failure ,medicine.anatomical_structure ,Treatment Outcome ,Aortic valve stenosis ,Aortic Valve ,Heart Valve Prosthesis ,Quality of Life ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Valve-in-valve transcatheter aortic valve replacement (TAVR) is an option when a surgical valve demonstrates deterioration and dysfunction. This study reports 3-year results following valve-in-valve with self-expanding TAVR. Methods: The CoreValve US Expanded Use Study is a prospective, nonrandomized, single-arm study that evaluates safety and effectiveness of TAVR in extreme risk patients with symptomatic failed surgical biologic aortic valves. Study end points include all-cause mortality, need for valve reintervention, hemodynamic changes over time, and quality of life through 3 years. Patients were stratified by presence of preexisting surgical valve prosthesis-patient mismatch. Results: From March 2013 to May 2015, 226 patients deemed extreme risk (STS-PROM [Society of Thoracic Surgeons Predicted Risk of Mortality] 9.0±7%) had attempted valve-in-valve TAVR. Preexisting surgical valve prosthesis-patient mismatch was present in 47.2% of the cohort. At 3 years, all-cause mortality or major stroke was 28.6%, and 93% of patients were in New York Heart Association I or II heart failure. Valve performance was maintained over 3 years with low valve reintervention rates (4.4%), an improvement in effective orifice area over time and a 2.7% rate of severe structural valve deterioration. Preexisting severe prosthesis-patient mismatch was not associated with 3-year mortality but was associated with significantly less improvement in quality of life at 3-year follow-up ( P =0.01). Conclusions: Self-expanding TAVR in patients with failed surgical bioprostheses at extreme risk for surgery was associated with durable hemodynamics and excellent clinical outcomes. Preexisting surgical valve prosthesis-patient mismatch was not associated with mortality but did limit patient improvement in quality of life over 3-year follow-up. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01675440.
- Published
- 2019
63. P1854Clinical implications of physical function and resilience in patients undergoing transcatheter aortic valve implantation
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D G Rizik, Axel Linke, Dean J. Kereiakes, Michael J. Reardon, Ron Waksman, Kashish Goel, Neal S. Kleiman, Brian R. Lindman, Colin MacLeod Barker, Jared O'Leary, R Makkar, Tanvir Bajwa, Dominic J. Allocco, and Vivek Rajagopal
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medicine.medical_specialty ,Transcatheter aortic ,business.industry ,medicine ,In patient ,Physical function ,Cardiology and Cardiovascular Medicine ,Resilience (network) ,Intensive care medicine ,business - Abstract
Background Gait speed, as a measure of physical function and marker of frailty, is now routinely screened when evaluating patients with aortic stenosis (AS) for transcatheter aortic valve implantation (TAVI). Assessment of physical function is important to identify patients for whom TAVI may be futile and to assign patients to a procedural risk category. After TAVI, patients may exhibit physical resilience (improvement in physical function) or vulnerability (worsening). Characterizing the trajectory and clinical consequences of physical function after TAVI represent knowledge gaps in the field. Purpose Evaluate associations between physical resilience (improved gait speed) vs vulnerability (decline) after TAVI and subsequent death/hospitalization. Methods The REPRISE III trial compared a mechanically-expanded vs a self-expanding valve in 912 high/extreme risk patients with symptomatic AS. Patients (n=587) who underwent valve implantation and who had a gait speed recorded both pre- and 1-year post-TAVI were analyzed. Gait speed is based on the 5m walk test (slow: 5m in >6s, Results A clinically-meaningful improvement (≥0.1m/s), no change (±0.1m/s), or decline (≥0.1/ms) in gait speed 1 year after TAVI was observed in 39%, 36%, and 26% of patients, respectively. Among the 4 groups defined by pre- and 1-year post-TAVI gait speeds, 1 to 2 year mortality or hospitalization rates were: 6.6% (normal/normal), 20.9% (normal/slow), 8.0% (slow/normal), and 21.5% (slow/slow). Adjusted hazard ratios of the 2 models are shown (Table). Table. Outcome by Change in Gait Speed Death/Hospitalization P-value Death P-value Hospitalization P-value Adjusted HR [95% CI] Adjusted HR [95% CI] Adjusted HR [95% CI] Model 1: Baseline/1 year Gait Speed (Normal/Normal (n=150) [referent]) Normal/Slow (n=59) 3.82 [1.61, 9.08] Conclusion These data reveal there is marked heterogeneity in the trajectory of physical function after TAVI and that this trajectory–more so than baseline physical function–is clinically consequential. Identifying and optimizing factors associated with physical resilience after TAVI may improve outcomes. Acknowledgement/Funding Boston Scientific
- Published
- 2019
64. Early clinical and procedural outcomes in large series of 34-mm self-expanding transcatheter aortic valve replacement
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Khawaja Afzal Ammar, Payal Sharma, Daniel P. O'Hair, Ahmed Dalmar, Zuber Sherefa Ali, Suhail Allaqaband, Tadele W. Mengesha, Bijoy K. Khandheria, Renuka Jain, and Tanvir Bajwa
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Aortic valve ,Male ,medicine.medical_specialty ,Time Factors ,Transcatheter aortic ,Sedation ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Prosthesis Design ,Prosthesis ,Severity of Illness Index ,Perimeter ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Valve replacement ,Risk Factors ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Hospital Mortality ,Aged ,Retrospective Studies ,Aged, 80 and over ,Framingham Risk Score ,business.industry ,General Medicine ,Aortic Valve Stenosis ,Recovery of Function ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Cardiothoracic surgery ,Aortic Valve ,Heart Valve Prosthesis ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives We aimed to evaluate early clinical and procedural outcomes with the 34-mm Evolut R transcatheter aortic valve replacement (TAVR) prosthesis. Background The 34-mm Evolut R (Medtronic, Minneapolis, MN) self-expanding TAVR prosthesis was designed to treat patients with larger annuli. Methods Clinical, demographic, procedural, and echocardiographic data on consecutive patients who underwent TAVR with a 34-mm Evolut R prosthesis at our institution were collected and analyzed. Results One hundred ninety-six patients underwent TAVR with this prosthesis from November 2016 to July 2018, a majority (n = 188, 96%) through transfemoral access and with conscious sedation (n = 182, 93%). Mean age, Society of Thoracic Surgery risk score, and follow-up were 82 ± 8 years, 5.4 ± 5%, and 8.2 ± 5.3 months, respectively. Mean aortic valve (AV) peak velocity was 4.0 ± 0.6 m/s, mean AV gradient was 38 ± 13 mmHg, AV area was 0.79 ± 0.23 cm2 ; calcium score was 3,503 ± 1,970 Agatston units, and perimeter was 85 ± 4.3 mm. Device implantation was successful in all but one patient. Postprocedure mean AV peak velocity, AV mean gradient, and AV area were 1.9 ± 0.4 m/s, 7 ± 3 mmHg, and 2.6 ± 0.7 cm2 , respectively. New pacemaker requirement rate was 16%, and moderate paravalvular leak was present in six patients (3%), which improved to mild in three patients at 6-month follow-up. In-hospital, 30-day, 6-month, and 12-month survival rates were 98%, 96% (hospital discharge), 96% (30-day), 89% (6-month), and 83% (12-month). Conclusion These data demonstrate high success and good procedural, echocardiographic, and clinical outcomes of 34-mm Evolut R in patients with large annuli.
- Published
- 2019
65. Cardiac Amyloidosis Presenting as Severe Mitral Regurgitation
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Tanvir Bajwa, Khawaja Afzal Ammar, Suhail Allaqaband, Bijoy K. Khandheria, Steven C. Port, Renuka Jain, Gary Neitzel, and A. Jamil Tajik
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Technetium Tc 99m Sestamibi ,0301 basic medicine ,medicine.medical_specialty ,Biopsy ,medicine.medical_treatment ,Echocardiography, Three-Dimensional ,macromolecular substances ,030204 cardiovascular system & hematology ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Severity of illness ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Heart transplantation ,Mitral regurgitation ,medicine.diagnostic_test ,business.industry ,Amyloidosis ,Mitral Valve Insufficiency ,medicine.disease ,Echocardiography, Doppler, Color ,030104 developmental biology ,Cardiac amyloidosis ,cardiovascular system ,Cardiology ,Heart Transplantation ,Radiopharmaceuticals ,Cardiomyopathies ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Abstract
Although mild to moderate mitral regurgitation is common in cardiac amyloidosis (CA), severe mitral regurgitation as the primary presenting finding is rare [(1)][1]. We present 3 such cases of patients with severe mitral regurgitation who on further workup were discovered to have CA [(2)][2] ([
- Published
- 2016
66. Development and Validation of a Preprocedural Risk Score to Predict Access Site Complications After Peripheral Vascular Interventions Based on the Vascular Quality Initiative Database
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Tanvir Bajwa, Anjan Gupta, Suhail Allaqaband, Maharaj Singh, Mark W. Mewissen, Arshad Jahangir, and Daniel Ortiz
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medicine.medical_specialty ,media_common.quotation_subject ,Psychological intervention ,lcsh:Medicine ,030204 cardiovascular system & hematology ,risk score ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Quality (business) ,030212 general & internal medicine ,media_common ,Framingham Risk Score ,business.industry ,peripheral vascular intervention ,lcsh:R ,hematoma ,pseudoaneurysm ,General Medicine ,PERIPHERAL VASCULAR INTERVENTION ,medicine.disease ,Peripheral ,Emergency medicine ,Access site ,Medical emergency ,business - Abstract
Purpose: Access site complications following peripheral vascular intervention (PVI) are associated with prolonged hospitalization and increased mortality. Prediction of access site complication risk may optimize PVI care; however, there is no tool designed for this. We aimed to create a clinical scoring tool to stratify patients according to their risk of developing access site complications after PVI. Methods: The Society for Vascular Surgery’s Vascular Quality Initiative database yielded 27,997 patients who had undergone PVI at 131 North American centers. Clinically and statistically significant preprocedural risk factors associated with in-hospital, post-PVI access site complications were included in a multivariate logistic regression model, with access site complications as the outcome variable. A predictive model was developed with a random sample of 19,683 (70%) PVI procedures and validated in 8,314 (30%). Results: Access site complications occurred in 939 (3.4%) patients. The risk tool predictors are female gender, age > 70 years, white race, bedridden ambulatory status, insulin-treated diabetes mellitus, prior minor amputation, procedural indication of claudication, and nonfemoral arterial access site (model c-statistic = 0.638). Of these predictors, insulin-treated diabetes mellitus and prior minor amputation were protective of access site complications. The discriminatory power of the risk model was confirmed by the validation dataset (c-statistic = 0.6139). Higher risk scores correlated with increased frequency of access site complications: 1.9% for low risk, 3.4% for moderate risk and 5.1% for high risk. Conclusions: The proposed clinical risk score based on eight preprocedural characteristics is a tool to stratify patients at risk for post-PVI access site complications. The risk score may assist physicians in identifying patients at risk for access site complications and selection of patients who may benefit from bleeding avoidance strategies.
- Published
- 2016
67. TCT CONNECT-81 Late Outcomes After Transcatheter Aortic Valve Replacement With a Mechanically Expanded Versus Self-Expandable Valve: 4-Year Results From the REPRISE III Randomized Trial
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David Rizik, Christopher Meduri, Raj Makkar, Tanvir Bajwa, Mauricio Cohen, Louis Cannon, Nicolas Van Mieghem, Robert Jobe, Howard Herrmann, Barry Cohen, Trip Zorn, John Lasala, Todd Dewey, Paul Underwood, Dominic Allocco, and Michael Reardon
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Cardiology and Cardiovascular Medicine - Published
- 2020
68. IMPACT OF PATIENT PROSTHESIS MISMATCH IN THE REPRISE III RANDOMIZED CONTROLLED TRIAL
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Neil J. Weissman, Leo Ihlberg, David Gerard Rizik, Robert Stoler, Tanvir Bajwa, Federico M. Asch, Dean Kereiakes, and Dominic Allocco
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,medicine.disease ,Prosthesis ,law.invention ,Surgery ,Reprise ,Aortic valve replacement ,Randomized controlled trial ,law ,medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Patient-prosthesis mismatch (PPM) is common after aortic valve replacement but its significance is controversial. Though PPM has been linked to worse outcomes post SAVR, its impact after TAVR is still unclear. We present 3-year outcomes in REPRISE III by degree of PPM. In REPRISE III, 912 patients
- Published
- 2020
69. THE HOLY GRAIL OF IDENTIFYING PATIENTS NEEDING PERMANENT PACEMAKER IMPLANTATION AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION WITH 100% ACCURACY
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Tonga Nfor, Muhammad Fuad Jan, Tanvir Bajwa, Khawaja Afzal Ammar, Jayant Khitha, A. Jamil Tajik, Steven C Port, Jessica Roback, Daniel O'Hair, and Suhail Allaqaband
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medicine.medical_specialty ,Transcatheter aortic ,business.industry ,medicine ,Permanent pacemaker ,Cardiology and Cardiovascular Medicine ,business ,Surgery ,Holy Grail - Published
- 2020
70. PREDICTORS OF CONDUCTION RECOVERY IN PATIENTS WITH HIGH-DEGREE ATRIOVENTRICULAR BLOCK AFTER SELF-EXPANDABLE TRANSCATHETER AORTIC VALVE REPLACEMENT
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Arshad Jahangir, Tanvir Bajwa, Khawaja Afzal Ammar, Ana Cristina Perez Moreno, Abdur Rahman Ahmad, and Jodi Zilinski
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medicine.medical_specialty ,Transcatheter aortic ,business.industry ,Self expandable ,medicine.medical_treatment ,Cardiomyopathy ,medicine.disease ,Valve replacement ,Internal medicine ,cardiovascular system ,Cardiology ,Medicine ,In patient ,Permanent pacemaker ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Atrioventricular block - Abstract
High-degree atrioventricular (HD-AVB) block is frequently seen post transcatheter aortic valve replacement (TAVR) with right ventricular pacing induced cardiomyopathy being a potential long-term complication. A retrospective review of 59 patients (32 women, 27 men) who underwent permanent pacemaker
- Published
- 2020
71. 14-YEAR EXPERIENCE IN DOOR-TO-BALLOON TIMES WITH A 24/7 STEMI PROGRAM: SIXTY IS THE NEW NINETY
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Khawaja Afzal Ammar, Tanvir Bajwa, M. Fuad Jan, Suhail Allaqaband, Xiaoxiao Qian, and Babak Haddadian
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine.medical_treatment ,medicine ,Door-to-balloon ,Cardiology ,Percutaneous coronary intervention ,cardiovascular diseases ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business - Abstract
Current evidence shows that patients with acute ST-segment elevation myocardial infarction (STEMI) experience delay in primary percutaneous coronary intervention (PPCI) when they present to the hospital during off-hours (weekends and/or nights) compared with regular hours. We studied the impact of a
- Published
- 2020
72. THE ABANDONED INFERIOR VENA CAVA FILTER: IS IT A BIG DEAL? IVC FILTER RETRIEVAL RATES AND CLINICAL OUTCOMES OF NON-RETRIEVAL
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Tonga Nfor, Muhammad Fuad Jan, Tanvir Bajwa, Ufaira Shaik, Jason Rauba, and Suhail Allaqaband
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medicine.medical_specialty ,Vena cava ,Clinical events ,business.industry ,Ivc filter ,Inferior vena cava filter ,Retrospective cohort study ,Inferior vena cava ,humanities ,medicine.vein ,cardiovascular system ,medicine ,In patient ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Many patients with inferior vena cava filters (IVCF) never have them retrieved and there are no well validated studies examining IVCF retrieval rates and clinical events in patients with abandoned IVCF. In this retrospective cohort study, we evaluate differences in the rates of venous
- Published
- 2020
73. VERY LATE PRESENTATION OF FULMINANT MYOCARDIAL IMMUNE-RELATED TOXICITY IN A PATIENT ON PEMBROLIZUMAB
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Kevin Bodker, Tanvir Bajwa, Daniel Johnsrud, Tarek Ajam, Zeinab A. Saleh, Marc Atzenhoefer, Adil S Wani, Patrycja Galazka, Mahmoud Ali, and M. Fuad Jan
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Oncology ,medicine.medical_specialty ,business.industry ,Fulminant ,Pembrolizumab ,medicine.disease ,Immune system ,Internal medicine ,Toxicity ,Carcinoma ,medicine ,Medical history ,Exertion ,Cardiology and Cardiovascular Medicine ,Adverse effect ,business - Abstract
Immune checkpoint inhibitors (ICI) can manifest as toxicity in the form of autoimmune, breakthrough or immune-related adverse events. A 59-year-old woman presented with worsening dyspnea on exertion for 1 week. Her medical history was significant for non-small cell lung carcinoma treated with
- Published
- 2020
74. Understanding the Musical Dance of the Engaged Coronary Catheter: Insights From Advanced Myocardial Mechanics
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Khawaja Afzal, Ammar, Tanvir, Bajwa, Suhail Q, Allaqaband, and Anthony, DeFranco
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Reference Values ,Humans ,Reproducibility of Results ,Female ,Middle Aged ,Coronary Vessels ,Myocardial Contraction ,Cardiac Catheters ,Echocardiography, Doppler - Abstract
A case of a 56-year-old woman with normal coronaries displays the side-to-side motion of the unengaged catheter followed by the rhythmic up-and-down, piston-like movements of the catheter tip after engagement.
- Published
- 2018
75. Impact of annular and supra-annular CoreValve deployment locations on aortic and coronary artery hemodynamics
- Author
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Arshad Jahangir, Armaan Shaikh, Setu D. Trivedi, Harkamaljot S. Kandail, Tanvir Bajwa, John F. LaDisa, and Daniel O'Hair
- Subjects
Patient-Specific Modeling ,medicine.medical_specialty ,medicine.medical_treatment ,0206 medical engineering ,Finite Element Analysis ,Biomedical Engineering ,Hemodynamics ,02 engineering and technology ,030204 cardiovascular system & hematology ,Biomaterials ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,Valve replacement ,Internal medicine ,medicine.artery ,Ascending aorta ,medicine ,Humans ,Aorta ,Aortic hemodynamics ,medicine.disease ,020601 biomedical engineering ,Coronary Vessels ,Coronary arteries ,medicine.anatomical_structure ,Mechanics of Materials ,Heart Valve Prosthesis ,cardiovascular system ,Cardiology ,Geology ,Artery - Abstract
CoreValve is widely used in transcatheter aortic valve replacement, but the impact of its deployment location on hemodynamics is unexplored despite a potential role in subsequent aortic and coronary artery pathologies. The objectives of this investigation were to perform fluid-structure interaction (FSI) simulations for a 29 mm CoreValve deployed in annular vs supra-annular locations, and characterize resulting hemodynamics including velocity and wall shear stress (WSS). Patient-specific geometry was reconstructed from computed tomography scans and CoreValve was deployed using a finite element approach. FSI simulations were then performed using a boundary conforming method and realistic boundary conditions. Results showed that CoreValve deployment location impacts hemodynamics in the ascending aorta and flow patterns in the coronary arteries. During peak-systole, annularly deployed CoreValve produced a jet-like flow structure impinging on the outer-curvature of the ascending aorta. Supra-annularly deployed CoreValve having a lateral tilt of 10° led to a more centered jet impinging further downstream. At mid-systole, valve leaflets of the annularly deployed CoreValve closed asymmetrically leading to disorganized flow patterns in the ascending aorta vs those from the supra-annular position. Supra-annularly deployed CoreValve also led to high-velocity para-valvular flow supplying the coronary arteries. CoreValve in the supra-annular position significantly (P
- Published
- 2018
76. Clinical Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Surgery in High Surgical Risk Patients With Left Main or Three-Vessel Coronary Artery Disease
- Author
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Quinta Nfor, Kambiz Shetabi, Jayant Khitha, Wael Hassan, Anjan Gupta, Tonga Nfor, Suhail Allaqaband, and Tanvir Bajwa
- Subjects
Drug ,medicine.medical_specialty ,left main ,media_common.quotation_subject ,coronary artery bypass grafting ,stenting ,lcsh:Medicine ,high risk ,Coronary artery disease ,Coronary artery bypass surgery ,Internal medicine ,Heart team ,THREE VESSEL DISEASE ,Heart Team ,Medicine ,High surgical risk ,cardiovascular diseases ,Myocardial infarction ,media_common ,business.industry ,lcsh:R ,General Medicine ,medicine.disease ,surgical procedures, operative ,Cardiology ,three-vessel disease ,business - Abstract
Purpose: Previous studies comparing percutaneous coronary intervention (PCI) with coronary artery bypass graft surgery (CABG) in patients with unprotected left main or three-vessel coronary artery disease (LM-3VD) have excluded patients at high surgical risk. We compared clinical outcomes after PCI with drug-eluting stents to CABG in high surgical risk patients with LM-3VD. Methods: Patients with symptomatic LM-3VD who had Society of Thoracic Surgeons (STS)-predicted operative mortality > 5% and were undergoing either PCI with drug-eluting stents or CABG at a tertiary care center from January 2009 to December 2010 were enrolled in this nonrandomized prospective study. Results: Mean STS score was 14.5 ± 5.8% for PCI (n=83) vs. 13.6 ± 7.1% for CABG (n=187) (P=0.31). After mean follow-up of 37 months, incidence of the composite primary endpoint (death, myocardial infarction or stroke) was 42.2% for PCI and 39.6% for CABG (P=0.69, hazard ratio 1.3, 95% confidence interval 0.5-2.8). There were no differences in the individual components of the primary endpoint between PCI and CABG. Repeat revascularization was 30.1% for PCI vs. 9.6% for CABG (P=0.001). Major adverse cardiac and cerebrovascular event rates were similar between PCI and CABG, 50.6% vs. 42.2%, respectively (P=0.23). Patients in the PCI group were less likely than those in the CABG group to be discharged to a nursing home (12.1% vs. 47.1%, P 5%.
- Published
- 2015
77. Beneficial Effects of a Point-of-Care Bleeding Risk Calculator on Anticoagulant Selection in the Coronary Catheterization Laboratory
- Author
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Anjan Gupta, Suhail Allaqaband, James L. Schulgit, Frank C. Spexarth, Mia Stone, Rachel Pedersen, Tanvir Bajwa, Anthony C. DeFranco, and Jocelyn J. Kerl
- Subjects
Male ,medicine.medical_specialty ,medicine.drug_class ,Point-of-Care Systems ,medicine.medical_treatment ,Hemorrhage ,Pilot Projects ,Risk Assessment ,Percutaneous Coronary Intervention ,Humans ,Medicine ,Bivalirudin ,Pharmacology (medical) ,Prospective Studies ,Aged ,Point of care ,Aged, 80 and over ,business.industry ,Incidence (epidemiology) ,Anticoagulant ,Anticoagulants ,Percutaneous coronary intervention ,Health Care Costs ,Hirudins ,Peptide Fragments ,Recombinant Proteins ,Surgery ,Cohort ,Conventional PCI ,Emergency medicine ,Female ,Observational study ,business ,Glomerular Filtration Rate ,medicine.drug - Abstract
Study Objectives To estimate periprocedural bleeding risk before elective percutaneous coronary intervention (PCI) by using a point-of-care bleeding risk calculator and to document changes in anticoagulant use and bleeding complications after implementation of use of this calculator. Design Prospective observational pilot study with a historical control cohort. Setting Tertiary care medical center. Patients The pilot cohort consisted of 100 patients undergoing ad hoc PCI during elective cardiac catheterization procedures between January and May 2013, whose bleeding risk and accompanying PCI anticoagulant recommendations were determined by the use of a pre-PCI point-of-care bleeding risk calculator. The historical control cohort consisted of all patients who underwent elective PCI at the same facility between April 1, 2011, and March 31, 2012, before implementation of use of the bleeding risk calculator. Measurements and Main Results The pre-PCI bleeding risk calculator distinguished patients in the pilot cohort as high risk (score 12 or higher) or low risk (lower than 12) for bleeding after a PCI procedure. The primary outcome was bivalirudin use in the pilot cohort compared with its use in the historical control cohort. Implementation of the bleeding risk calculator significantly decreased bivalirudin use compared with bivalirudin use in the historical control cohort (87% in the control cohort vs 60% in the pilot cohort, p
- Published
- 2015
78. Five-year outcomes of transcatheter reduction of significant mitral regurgitation in high-surgical-risk patients
- Author
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D. Scott Lim, John M. Lasala, Ted Feldman, Richard W. Smalling, Howard C Hermann, James B. Hermiller, Saibal Kar, Patrick L. Whitlow, Atif Qasim, Samir R. Kapadia, Donald D. Glower, Mark Reisman, Alfredo Trento, Robert Kipperman, Laura Mauri, Wesley R. Pedersen, and Tanvir Bajwa
- Subjects
Male ,medicine.medical_specialty ,Cardiac Catheterization ,Time Factors ,Heart Ventricles ,030204 cardiovascular system & hematology ,Risk Assessment ,Severity of Illness Index ,Nyha class ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Risk Factors ,Mitral valve ,Medicine ,Humans ,High surgical risk ,030212 general & internal medicine ,Prospective Studies ,Adverse effect ,Aged ,Heart Valve Prosthesis Implantation ,Mitral regurgitation ,business.industry ,MitraClip ,Incidence ,Mitral Valve Insufficiency ,medicine.disease ,Comorbidity ,United States ,Surgery ,Survival Rate ,Stenosis ,medicine.anatomical_structure ,Echocardiography ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
ObjectivesThis study evaluates the 5-year clinical outcomes of transcatheter mitral valve (MV) repair with the MitraClip device in patients at high risk for MV surgery treated in the Endovascular Valve Edge-to-Edge Repair (EVEREST) II High Risk Study (HRS).MethodsPatients with mitral regurgitation (MR) 3+ or 4+ and predicted surgical mortality risk ≥12% or surgeon assessment based on prespecified high-risk factors were enrolled. Patients prospectively consented to 5 years of follow-up.ResultsAt 5 years, clinical follow-up was achieved in 90% of 78 enrolled patients. The rate of postprocedural adverse events declined from 30 days to 1 year follow-up and was stable thereafter through 5 years. Two patients (2.6%) developed mitral stenosis (MS). Two patients underwent MV surgery, including one due to MS. A total of 42 deaths were reported through 5 years. Effectiveness measures at 5 years showed reductions in MR severity to ≤2+ in 75% of patients (p=0.0107), left ventricular (LV) end-diastolic volume (−38.2 mL; 95% CI −55.0 to –21.4; pConclusionsThe EVEREST II HRS demonstrated long-term safety and efficacy of MitraClip in high-surgical-risk patients through 5 years. The observed mortality was most likely a consequence of the advanced age and comorbidity profile of the enrolled patients, while improvements in NYHA class in surviving patients were durable through long-term follow-up.Trial registration numberNCT01940120.
- Published
- 2017
79. The role of the interventionalist in peripheral vascular interventions
- Author
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Jayant Khitha, Alfred Hurley, and Tanvir Bajwa
- Subjects
medicine.medical_specialty ,business.industry ,Psychological intervention ,medicine ,Intensive care medicine ,business ,Peripheral - Published
- 2017
80. P6444Patients with aneurysmal coronary artery disease are at greater risk of aortic dissection than non-aneurysmal coronary artery disease
- Author
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A. Jamil Tajik, Arshad Jahangir, Sulaiman Sultan, Rafath Ullah, M. Fuad Jan, Tanvir Bajwa, Tadele W. Mengesha, Tehsin Majeed, Khawaja Afzal Ammar, and Suhail Allaqaband
- Subjects
Coronary artery disease ,Aortic dissection ,medicine.medical_specialty ,Non aneurysmal ,Framingham Risk Score ,business.industry ,Internal medicine ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease - Published
- 2017
81. Direct Aortic Access for Transcatheter Aortic Valve Replacement Using a Self-Expanding Device
- Author
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Steven J. Yakubov, Jeffrey J. Popma, Daniel R. Watson, Newell Robinson, Neal S. Kleiman, Michael J. Reardon, David H. Adams, Samin Sharma, Daniel O'Hair, Angie Zhang, Michael Caskey, Timothy Byrne, George Petrossian, and Tanvir Bajwa
- Subjects
Pulmonary and Respiratory Medicine ,Aortic valve ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Prosthesis Design ,Prosthesis ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Propensity Score ,Stroke ,Aged, 80 and over ,Vascular disease ,business.industry ,Mortality rate ,Aortic Valve Stenosis ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Echocardiography ,Aortic valve stenosis ,Aortic Valve ,Heart Valve Prosthesis ,Propensity score matching ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Transcatheter aortic valve replacement (TAVR) using a self-expanding valve has been shown to be superior to an open operation in high-risk patients. Extensive iliofemoral peripheral vascular disease can prohibit femoral access. In these cases, direct aortic (DA) implantation may be a suitable option.The current analysis compared outcomes in patients undergoing TAVR with the self-expanding CoreValve prosthesis (Medtronic, Minneapolis, MN) by direct aortic (DA) access vs iliofemoral (IF) access. Patients treated in the CoreValve US High Risk and Extreme Risk Pivotal Trials and Continued Access Study were included. Propensity score matching was used to account for differences in baseline characteristics between groups. Clinical outcomes were compared at 30 days and 1 year.We identified 394 matched pairs of IF and DA patients. The all-cause mortality rate was significantly higher in the DA group than in the IF group at 30 days (10.9% vs 4.1%, p0.001), but this difference was reduced at 1 year (28.1% vs 23.2%, p = 0.063). All-cause mortality or major stroke was significantly higher for DA vs IF access at 30 days (13.5% vs 5.3%, p0.001) and at 1 year (30.4% vs 24.2%, p = 0.025). Major/life-threatening bleeding and acute kidney injury were significantly greater in the DA group at 30 days (66.7% vs 35.4% and 19.7% vs 10.0%, respectively, both p0.001).When femoral access is not feasible, DA access allows effective delivery of the valve but incurs an increased risk of death and adverse events, potentially the result of procedural differences.
- Published
- 2017
82. Enhanced store-operated Ca2+ influx and ORAI1 expression in ventricular fibroblasts from human failing heart
- Author
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Farhan Rizvi, Francis X Downey, Ekhson Holmuhamedov, Larisa Emelyanova, Gracious R Ross, Arshad Jahangir, Paul H Werner, A. Jamil Tajik, Tanvir Bajwa, and Stacie Edwards
- Subjects
0301 basic medicine ,medicine.medical_specialty ,QH301-705.5 ,Cardiac fibrosis ,Science ,chemistry.chemical_element ,Heart failure ,030204 cardiovascular system & hematology ,Calcium ,Biology ,General Biochemistry, Genetics and Molecular Biology ,Extracellular matrix ,03 medical and health sciences ,0302 clinical medicine ,Fibrosis ,Internal medicine ,medicine ,Biology (General) ,Fibroblast ,ORAI1 ,medicine.disease ,030104 developmental biology ,Endocrinology ,medicine.anatomical_structure ,chemistry ,Store-operated Ca2+ entry ,General Agricultural and Biological Sciences ,Intracellular - Abstract
Excessive cardiac fibrosis, characterized by increased collagen-rich extracellular matrix (ECM) deposition, is a major predisposing factor for mechanical and electrical dysfunction in heart failure (HF). The human ventricular fibroblast (hVF) remodeling mechanisms that cause excessive collagen deposition in HF are unclear, although reports suggest a role for [Ca2+]i in fibrosis. Therefore, we determined the association of differences in cellular Ca2+ dynamics and collagen secretion/deposition between hVFs from failing and normal (control) hearts. Histology of left ventricle sections (Masson trichrome) confirmed excessive fibrosis in HF vs normal. In vitro, hVFs from HF showed increased secretion/deposition of soluble collagen in 48 hours of culture compared with control [85.9±7.4 μg/106 vs 58.5±8.8 μg/106 cells, P
- Published
- 2017
83. Clinical Outcomes of Unprotected Left Main Coronary Artery Stenting in Nonsurgical Patients: A Single-Center Experience
- Author
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Suhail Allaqaband, Mohamed Djelmami-Hani, Naoyo Mori, John-Paul Pham, Anjan Gupta, Abdelazim Hashim, Mohamed Taha, Joaquin Solis, and Tanvir Bajwa
- Subjects
left main coronary artery ,medicine.medical_specialty ,medicine.medical_treatment ,stenting ,lcsh:Medicine ,percutaneous revascularization ,Single Center ,Coronary artery disease ,Interquartile range ,Internal medicine ,medicine ,Myocardial infarction ,Ejection fraction ,business.industry ,Standard treatment ,percutaneous coronary intervention ,lcsh:R ,Percutaneous coronary intervention ,General Medicine ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Cardiology ,business ,coronary artery disease ,Artery - Abstract
Purpose: Coronary artery bypass graft is the standard treatment for unprotected left main disease; however, some patients are poor surgical candidates due to comorbidities. We assessed the safety and clinical outcome of elective, unprotected left main coronary artery stenting in nonsurgical patients. Methods: Between October 2004 and June 2006, 50 consecutive patients underwent elective, unprotected left main coronary artery stenting at our institution. Patients were followed for a median of 16 and 96 months and clinical outcomes monitored. Results: Median logistic euroSCORE was 28.6 (interquartile range: 14.6-43.4). Median baseline left ventricular ejection fraction (LVEF) was 50%. Procedural success rate was 100%. The rates of cerebrovascular accident, myocardial infarction, target vessel revascularization and cardiovascular death were 2%, 4%, 4% and 2%, respectively, at 30 days, 2%, 6%, 6% and 2% at 16 months, and 2%, 6%, 12% and 4% at 96 months. Major adverse cardiac and cerebrovascular event rate was 12% at 30 days, 16% at 16 months and 24% at 96 months. Median LVEF at 16 months was 55%, significantly improved from baseline (P
- Published
- 2014
84. Percutaneous Mitral Valve Repair for Mitral Regurgitation in High-Risk Patients
- Author
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Ramon Quesada, Patrick M. McCarthy, Tanvir Bajwa, Michael J. Mack, Laura Mauri, Saibal Kar, Ted Feldman, Donald D. Glower, Patrick L. Whitlow, Alfredo Trento, Michael Rinaldi, D. Scott Lim, and Paul A. Grayburn
- Subjects
medicine.medical_specialty ,Mitral regurgitation ,High risk patients ,Percutaneous ,business.industry ,MitraClip ,Surgery ,Cardiac surgery ,medicine.anatomical_structure ,Internal medicine ,Mitral valve ,Cohort ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Percutaneous Mitral Valve Repair - Abstract
Background The EVEREST II (Endovascular Valve Edge-to-Edge REpair STudy) High-Risk registry and REALISM Continued Access Study High-Risk Arm are prospective registries of patients who received the MitraClip device (Abbott Vascular, Santa Clara, California) for mitral regurgitation (MR) in the United States. Objectives The purpose of this study was to report 12-month outcomes in high-risk patients treated with the percutaneous mitral valve edge-to-edge repair. Methods Patients with grades 3 to 4+ MR and a surgical mortality risk of ≥12%, based on the Society of Thoracic Surgeons risk calculator or the estimate of a surgeon coinvestigator following pre-specified protocol criteria, were enrolled. Results In the studies, 327 of 351 patients completed 12 months of follow-up. Patients were elderly (76 ± 11 years of age), with 70% having functional MR and 60% having prior cardiac surgery. The mitral valve device reduced MR to ≤2+ in 86% of patients at discharge (n = 325; p Conclusions The percutaneous mitral valve device significantly reduced MR, improved clinical symptoms, and decreased LV dimensions at 12 months in this high-surgical-risk cohort. (Endovascular Valve Edge-to-Edge REpair STudy [EVERESTIIRCT]; NCT00209274)
- Published
- 2014
85. Recurrent Acute Myocardial Infarction in Patients with Immune Thrombocytopenic Purpura
- Author
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Tanvir Bajwa, Fengyi Shen, and Tonga Nfor
- Subjects
medicine.medical_specialty ,Pediatrics ,medicine.medical_treatment ,lcsh:Medicine ,thrombocytopenia ,Disease ,immune system diseases ,hemic and lymphatic diseases ,Internal medicine ,medicine ,Platelet ,Myocardial infarction ,anticoagulation ,business.industry ,percutaneous coronary intervention ,lcsh:R ,Percutaneous coronary intervention ,General Medicine ,medicine.disease ,Thrombosis ,Thrombocytopenic purpura ,Pathophysiology ,Purpura ,myocardial infarction ,purpura ,Cardiology ,medicine.symptom ,business - Abstract
Immune thrombocytopenic purpura (ITP), also known as idiopathic thrombocytopenic purpura, is an acquired immune-mediated disease of adults and children characterized by a transient or persistent decrease of platelets and, depending upon the degree of thrombocytopenia, an increased risk of bleeding. The use of standard treatments for acute myocardial infarction (AMI), such as antiplatelet agents and anticoagulants, pose serious problems in patients with ITP due to the potential higher risk of bleeding complications. There are no current guidelines available for management of ITP patients with AMI. In this brief review of the limited available literature, we discuss the proposed pathophysiological link between ITP and arterial thrombosis and the challenging medical and interventional treatment of these patients. (J Patient-Centered Res Rev.
- Published
- 2014
86. Left Atrial Laceration With Epicardial Ligation Device
- Author
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Vincent P. Keating, Jasbir Sra, Bijoy K. Khandheria, Christopher Kolibash, David C. Kress, and Tanvir Bajwa
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Percutaneous ,Atrial Appendage ,Coronary Angiography ,Lacerations ,law.invention ,law ,Cardiac tamponade ,Atrial Fibrillation ,Cardiopulmonary bypass ,Humans ,Medicine ,Heart Atria ,Cardiac Surgical Procedures ,Ligation ,Aged ,Aged, 80 and over ,Suture ligation ,medicine.diagnostic_test ,business.industry ,Suture Techniques ,Gastroenterology ,Atrial fibrillation ,Equipment Design ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Heart Injuries ,Angiography ,Female ,Tamponade ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Abstract
Many new devices and techniques are being developed to attempt a reduction in embolic stroke risk for patients with atrial fibrillation who are either unable or unwilling to maintain long-term anticoagulation. One of these new devices (LARIAT®, SentreHEART Inc., Redwood City, California, USA) employs delivery of an epicardial suture to ligate the left atrial appendage after percutaneous pericardial and transseptal access. This series presents three clinical cases that demonstrate a serious and recurrent complication of left atrial laceration and cardiac tamponade shortly following delivery of an epicardial suture ligation to the left atrial appendage. Three clinical cases are described in detail with pre- and postprocedure angiography and echocardiography as well as illustrations reflecting the surgeon's findings on direct visualization of the left atrial lacerations postligation. Potential hypotheses of each injury are examined in light of the case timelines and findings at sternotomy. There was no suggestion that tamponade was related to pericardial or transseptal access, but rather a complication with device delivery. These three patients quickly progressed to clinical cardiac tamponade despite attempted drainage, stressing the importance of cardiovascular surgery backup, including a cardiopulmonary bypass pump, when delivering novel, percutaneous ligation devices for the left atrial appendage.
- Published
- 2014
87. Prophylactic use of thoracic endovascular aortic repair in a young patient with impending aortic rupture
- Author
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Joseph R. Whitnah, Tanvir Bajwa, Rafath Ullah, M. Fuad Jan, John Crouch, and Puneet Menaria
- Subjects
Adult ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Aortic Rupture ,Endovascular Procedures ,Aorta, Thoracic ,Interventional radiology ,Computed tomography ,General Medicine ,Aortic repair ,Blood Vessel Prosthesis Implantation ,Treatment Outcome ,Pedicle Screws ,medicine ,Humans ,Female ,Stents ,Radiology, Nuclear Medicine and imaging ,Radiology ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Aortic rupture - Published
- 2018
88. TCT-76 Mid-Term Outcomes after Transcatheter Aortic Valve Replacement With a Mechanically-Expanded Versus Self-Expandable Valve: 3-Year Results From the REPRISE III Randomized Trial
- Author
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David G. Rizik, Jeffrey Southard, Steven J. Yakubov, Michael J. Reardon, Tanvir Bajwa, Paul S. Teirstein, Leo Ihlberg, Donald E. Cutlip, Vivek Rajagopal, and Dominic Allocco
- Subjects
medicine.medical_specialty ,Transcatheter aortic ,business.industry ,Self expandable ,medicine.medical_treatment ,fungi ,food and beverages ,medicine.disease ,Surgical risk ,Surgery ,law.invention ,Stenosis ,Reprise ,Valve replacement ,Randomized controlled trial ,law ,Medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
REPRISE III is the first large randomized comparison of 2 TAVR platforms: the mechanically-expanded Lotus valve (Boston Scientific, Marlborough, Massachusetts) and self-expanding CoreValve (CV) (Medtronic, Dublin, Ireland). In aortic stenosis patients with high/extreme surgical risk, Lotus was
- Published
- 2019
89. TCT-684 Treatment Strategies in Patients With Stable Obstructive Coronary Artery Disease and Severe Aortic Valve Stenosis Who Underwent TAVR
- Author
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Tanvir Bajwa, Louie Kostopoulos, Khalil Odeh, Marc Atzenhoefer, Renuka Jain, Suhail Allaqaband, Mahmoud Ali, Ana Cristina Perez Moreno, Payal Sharma, and Khawaja Afzal Ammar
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,medicine.disease ,Coronary artery disease ,Clinical equipoise ,Stenosis ,Valve replacement ,Aortic valve replacement ,Internal medicine ,Aortic valve stenosis ,cardiovascular system ,medicine ,Cardiology ,Treatment strategy ,In patient ,Cardiology and Cardiovascular Medicine ,business - Abstract
Obstructive coronary artery disease (OCAD) is frequently found in the workup of severe aortic valve stenosis (AS), and bypass is routinely performed during surgical aortic valve replacement. Clinical equipoise remains for OCAD management prior to transcatheter aortic valve replacement (TAVR). A
- Published
- 2019
90. TCT-252 Pericardial Tamponade Secondary to Complications of Interventional and Endovascular Procedures
- Author
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Daniel Johnsrud, Suhail Allaqaband, Jasbir Sra, M. Fuad Jan, and Tanvir Bajwa
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Tamponade ,Cardiology and Cardiovascular Medicine ,business ,Surgery - Published
- 2019
91. OPTIMAL OVERSIZING IN TRANSCATHETER AORTIC VALVE REPLACEMENT: IS BIGGER BETTER? INSIGHTS FROM A LARGE SELF-EXPANDING VALVE CASE SERIES
- Author
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Daniel O'Hair, Khawaja Afzal Ammar, Tanvir Bajwa, David Houff, and Suhail Allaqaband
- Subjects
Aortic valve ,medicine.medical_specialty ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Valve replacement ,Internal medicine ,medicine ,Cardiology ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
The current guideline for optimal sizing in self-expanding (Medtronic Core, Evolut R and Pro) transcatheter aortic valve replacement (TAVR) is between 10-20% oversizing, measured by aortic valve perimetry equation applied to CT data. This recommendation is based on limited data to achieve the lowest
- Published
- 2019
92. EARLY CLINICAL AND PROCEDURAL OUTCOMES IN A LARGE SERIES OF 34 MM SELF-EXPANDING TRANSCATHETER AORTIC VALVE REPLACEMENT
- Author
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Khawaja Afzal Ammar, Tadele W. Mengesha, Bijoy K. Khandheria, Zuber Sherefa Ali, Tanvir Bajwa, Payal Sharma, Suhail Allaqaband, Daniel O'Hair, Ahmed Dalmar, and Renuka Jain
- Subjects
medicine.medical_specialty ,Valve replacement ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,medicine ,Large series ,Cardiology and Cardiovascular Medicine ,business ,Prosthesis ,Surgery - Abstract
The 34 mm EVOLUT R (Medtronic, Minneapolis, MN) self-expanding transcatheter aortic valve replacement (TAVR) was designed to treat patients with larger annuli. We describe clinical and procedural outcomes with this prosthesis in the largest single-center experience to date. Clinical, demographic
- Published
- 2019
93. AN UNEXPECTED AND RARE FINDING ON CORONARY ANGIOGRAM: MULTIVESSEL CORONARY ARTERY ECTASIA IN A YOUNG WOMAN WITH CHEST PAIN
- Author
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John Crouch, Mohsin Khan, Akshar Jaglan, A. Jamil Tajik, Port Steven, Tarek Ajam, C. Tanvir Bajwa, and Ramagopal Tumuluri
- Subjects
education.field_of_study ,medicine.medical_specialty ,business.industry ,Population ,Coronary artery ectasia ,Coronary angiogram ,medicine.disease ,Chest pain ,Internal medicine ,Cardiology ,Medicine ,Kawasaki disease ,cardiovascular diseases ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,education - Abstract
Coronary artery ectasia (CAE) is a rare anomaly that can present at any age. Predisposing risk factors include Kawasaki disease in a younger population and atherosclerosis in an older generation. We present a unique case of a young woman diagnosed with multivessel CAE in the setting of acute
- Published
- 2019
94. 4-Year Results of a Randomized Controlled Trial of Percutaneous Repair Versus Surgery for Mitral Regurgitation
- Author
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Tanvir Bajwa, Andrew Wang, Wesley R. Pedersen, Joseph M. Massaro, William A. Gray, John M. Lasala, Howard C. Herrmann, Laura Mauri, James B. Hermiller, Patricia Apruzzese, Ted Feldman, Donald D. Glower, Reginald I. Low, Paul A. Grayburn, Elyse Foster, and Everest Investigators
- Subjects
medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Percutaneous Coronary Intervention ,Mitral valve ,medicine ,Humans ,percutaneous valve therapy ,Prospective Studies ,Mitral regurgitation ,mitral repair ,business.industry ,MitraClip ,valvular heart disease ,Mitral Valve Insufficiency ,Percutaneous coronary intervention ,medicine.disease ,Surgery ,Survival Rate ,Treatment Outcome ,medicine.anatomical_structure ,mitral regurgitation ,Cardiology and Cardiovascular Medicine ,business ,Mitral valve regurgitation ,Percutaneous Mitral Valve Repair ,Follow-Up Studies - Abstract
ObjectivesThis study sought to evaluate 4-year outcomes of percutaneous repair versus surgery for mitral regurgitation.BackgroundTranscatheter therapies are being developed to treat valvular heart disease. In the EVEREST (Endovascular Valve Edge-to-Edge Repair Study) II trial, treatment of mitral valve regurgitation (MR) with a novel percutaneous device was compared with surgery and showed superior safety, but less reduction in MR at 1 year overall. We report the 4-year outcomes from the EVEREST II trial.MethodsPatients with grade 3+ or 4+ MR were randomly assigned to percutaneous repair with the MitraClip (Abbott, Menlo Park, California) device or conventional mitral valve surgery in a 2:1 ratio (184:95). Patients prospectively consented to 5 years of follow-up.ResultsAt 4 years, the rate of the composite endpoint of freedom from death, surgery, or 3+ or 4+ MR in the intention-to-treat population was 39.8% versus 53.4% in the percutaneous repair group and surgical groups, respectively (p = 0.070). Rates of death were 17.4% versus 17.8% (p = 0.914), and 3+ or 4+ MR was present in 21.7% versus 24.7% (p = 0.745) at 4 years of follow-up, respectively. Surgery for mitral valve dysfunction, however, occurred in 20.4% versus 2.2% (p < 0.001) at 1 year and 24.8% versus 5.5% (p < 0.001) at 4 years.ConclusionsPatients treated with percutaneous repair of the mitral valve more commonly required surgery to treat residual MR; however, after the first year of follow-up, there were few surgeries required after either percutaneous or surgical treatment and no difference in the prevalence of moderate-severe and severe MR or mortality at 4 years. (Endovascular Valve Edge-to-Edge Repair Study [EVEREST II]; NCT00209274)
- Published
- 2013
95. Subintimal angioplasty with a true reentry device for treatment of chronic total occlusion of the arteries of the lower extremity
- Author
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Tanvir Bajwa, Naoyo Mori, Babak Haddadian, Mark W. Mewissen, Mohammad Shakil Aslam, and Suhail Allaqaband
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,General Medicine ,Femoral artery ,Intermittent claudication ,Popliteal artery ,Surgery ,Catheter ,Angioplasty ,medicine.artery ,Occlusion ,medicine ,Radiology, Nuclear Medicine and imaging ,Artery occlusion ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Percutaneous intentional extraluminal revascularization - Abstract
Objective To report the efficacy and safety of the Outback® LTD® Re-Entry Catheter in reentering the distal true lumen during percutaneous intentional extraluminal revascularization (PIER). Background Reentry catheters are used to treat chronic, total arterial occlusions of the lower extremities when standard methods of recanalization have failed. Success and complication rates of these catheters in the real world are uncertain and variable. Methods A retrospective review of our peripheral catheterization database from January 2004 to September 2009 was undertaken to identify consecutive cases of peripheral chronic total occlusions (CTOs) requiring the use of the Outback reentry catheter. Patient demographics, indication for the procedure, location and extent of occlusion, procedural success, and complications were studied. Results A total of 51 patients were identified. Of the 51, 28 (54.9%) patients presented with nonhealing ulcer and 22 (43.1%) had lifestyle-limiting claudication. One patient presented with acute limb ischemia. There were 6 (11.8%) patients with common iliac artery occlusion, 2 (3.9%) with external iliac artery occlusion, 1 (1.9%) with common femoral artery occlusion, 35 (68.6%) with superficial femoral artery occlusion, 6 (11.8%) with popliteal artery occlusion, and 1 (1.9%) with tibioperoneal artery occlusion. Median lesion length was 230 mm. Procedural success was achieved in 49 patients (96.1%). There was 1 (1.9%) periprocedural complication. Conclusion Use of Outback® LTD® Re-Entry Catheter is a safe and valuable option for PIER/subintimal angioplasty and recanalization in patients with symptomatic lower-extremity CTOs. However, long-term patency remains unknown. © 2012 Wiley Periodicals, Inc.
- Published
- 2013
96. Heparin-bonded, Expanded Polytetrafluoroethylene-lined Stent Graft in the Treatment of Femoropopliteal Artery Disease: 1-Year Results of the VIPER (Viabahn Endoprosthesis with Heparin Bioactive Surface in the Treatment of Superficial Femoral Artery Obstructive Disease) Trial
- Author
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Tanvir Bajwa, Darren B. Schneider, Paul A. Jones, Richard R. Saxon, Richard J. Begg, Arun Chervu, John G. Adams, Charles M. Eichler, Gary M. Ansel, Peter A. Soukas, Dennis Gable, and Michael Rush
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Femoral artery ,Lesion ,Peripheral Arterial Disease ,chemistry.chemical_compound ,Coated Materials, Biocompatible ,medicine.artery ,medicine ,Humans ,Popliteal Artery ,Radiology, Nuclear Medicine and imaging ,Polytetrafluoroethylene ,Aged ,Heparin ,business.industry ,Anticoagulants ,Stent ,Drug-Eluting Stents ,Equipment Design ,United States ,Popliteal artery ,Surgery ,Equipment Failure Analysis ,Femoral Artery ,Clinical trial ,Treatment Outcome ,medicine.anatomical_structure ,chemistry ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,Artery - Abstract
To evaluate the performance of a heparin-bonded, expanded polytetrafluoroethylene (ePTFE)-lined nitinol endoprosthesis in the treatment of long-segment occlusive disease of the femoropopliteal artery (FPA) and to identify factors associated with loss of patency.In a single-arm, prospective, 11-center study (VIPER [Gore Viabahn Endoprosthesis with Heparin Bioactive Surface in the Treatment of Superficial Femoral Artery Obstructive Disease] trial), 119 limbs (113 patients; 69 men; mean age, 67 y), including 88 with Rutherford category 3-5 disease and 72 with Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) C or D lesions of the FPA, underwent stent graft implantation. The mean lesion length was 19 cm; 56% of lesions were occlusions. Follow-up evaluations included color duplex ultrasonography in all patients, with patency defined as a peak systolic velocity ratio2.5.At 12 months, Rutherford category and ankle-brachial index (ABI) were significantly improved (mean category improvement, 2.4; ABI increased from 0.6±0.2 to 0.9±0.19; P.0001). Primary and secondary patency rates were 73% and 92%. The primary patency for devices oversized20% at the proximal landing zone was 88%, whereas the primary patency for devices oversized by20% was 70% (P = .047). Primary patency was not significantly affected by device diameter (5 vs 6 vs 7 mm) or lesion length (≤20 cm vs20 cm). The 30-day major adverse event rate was 0.8%.The heparin-bonded, ePTFE/nitinol stent graft provided clinical improvement and a primary patency rate of 73% at 1 year in the treatment of long-segment FPA disease. Careful sizing of the device relative to vessel landing zones is essential for achieving optimal outcomes.
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- 2013
97. Neurological Events Following Transcatheter Aortic Valve Replacement and Their Predictors
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Neal S. Kleiman, Brijeshwar J. Maini, Michael J. Reardon, John Conte, Stanley Katz, Vivek Rajagopal, James Kauten, Alan Hartman, Raymond McKay, Robert Hagberg, Jian Huang, Jeffrey Popma, David Adams, Niv Ad, Vicken Aharonian, William D. Anderson, Robert Applegate, Amar Bafi, Tanvir Bajwa, Mamdouh Bakhos, Stephen Ball, Sanjay Batra, Nirat Beohar, William Brachinsky, Derek Brinster, John Brown, John Byrne, Timothy Byrne, Alfred Casale, Michael Caskey, Atul Chawla, Howard Cohen, Joseph Coselli, Marco Costa, John Cheatham, Stanley J. Chetcuti, Juan Crestanello, Thomas Davis, G. Michael Deeb, Jose Diez, Harold Dauerman, John Elefteriades, Peter Fail, Edgar Feinberg, Gregory Fontana, John L. Forrest, Aubrey Galloway, John Giacomini, Thomas G. Gleason, Vincent Guadiani, J. Kevin Harrison, Robert Hebeler, David Heimansohn, John Heiser, Louis Heller, Scott Henry, James Hermiller, David Hockmuth, G. Chad Hughes, James Joye, Ali Kafi, Biswajit Kar, Kamal Khabbaz, Robert Kipperman, Chad Kliger, Neal Kon, Joseph Lamelas, Joon Sup Lee, Ferdinand Leya, Juan Carlos Londono, Steven Macheers, Abeel Mangi, Eduardo de Marchena, Alan Markowitz, Ray Matthews, William Merhi, Mubashir Mumtaz, Daniel O’Hair, George Petrossian, Thomas Pfeffer, Bryan Raybuck, Jon Resar, Mark Robbins, Robert Robbins, Newell Robinson, Michael Ring, Tomas Salerno, Theodore Schreiber, Joseph Schmoker, Samin Sharma, Lee Siwek, Kimberly Skelding, James Slater, Vaughn Starnes, Robert Stoler, Valavanur Subramanian, Peter Tadros, Craig Thompson, Ron Waksman, Daniel Watson, Steven Yakubov, David Zhao, and George L. Zorn
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Balloon Valvuloplasty ,Male ,Aortic valve ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Risk Assessment ,Severity of Illness Index ,Transcatheter Aortic Valve Replacement ,Angina ,03 medical and health sciences ,Coronary artery bypass surgery ,0302 clinical medicine ,Valve replacement ,Risk Factors ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Stroke ,Aged ,Proportional Hazards Models ,Aged, 80 and over ,Bioprosthesis ,Body surface area ,Clinical Trials as Topic ,business.industry ,Incidence ,Hazard ratio ,Cardiac Pacing, Artificial ,Calcinosis ,Aortic Valve Stenosis ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Intracranial Embolism ,Aortic Valve ,Heart Valve Prosthesis ,Aortic valve stenosis ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background— The risk for stroke after transcatheter aortic valve replacement (TAVR) is an important concern. Identification of predictors for stroke is likely to be a critical factor aiding patient selection and management as TAVR use becomes widespread. Methods and Results— Patients enrolled in the CoreValve US Extreme Risk and High Risk Pivotal Trials or Continued Access Study treated with the self-expanding CoreValve bioprosthesis were included in this analysis. The 1-year stroke rate after TAVR was 8.4%. Analysis of the stroke hazard rate identified an early phase (0–10 days; 4.1% of strokes) and a late phase (11–365 days; 4.3% of strokes). Baseline predictors of early stroke included National Institutes of Health stroke scale score >0, prior stroke, prior transient ischemic attack, peripheral vascular disease, absence of prior coronary artery bypass surgery, angina, low body mass index (2 ), and falls within the past 6 months. Significant procedural predictors were total time in the catheterization laboratory or operating room, delivery catheter in the body time, rapid pacing used during valvuloplasty, and repositioning of the prosthesis. Predictors of stroke between 11 and 365 days were small body surface area, severe aortic calcification, and falls within the past 6 months. There were no significant imaging predictors of early or late stroke. Conclusions— Predictors of early stroke after TAVR included clinical and procedural factors; predictors of later stroke were limited to patient but not anatomic characteristics. These findings indicate that further refinement of imaging to identify anatomic factors predisposing to embolization may help improve stroke prediction in patients undergoing TAVR. Clinical Trial Registrations— URL: http://www.clinicaltrials.gov . Unique identifiers: NCT01240902, NCT01531374.
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- 2016
98. Use of Resting Non-hyperemic Indices for Avoidance of Fractional Flow Reserve Measurement: The Goal of 100% Accuracy
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Khawaja Afzal, Ammar, Syed Shahab, Kazmi, Mirza Nubair, Ahmad, Mirza Mujadil, Ahmad, Arsalan, Riaz, Imran, Husain, Fatima, Husain, Suhail, Allaqaband, Tanvir, Bajwa, and Anjan, Gupta
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Male ,Cardiac Catheterization ,Adenosine ,Vasodilator Agents ,Coronary Stenosis ,Hemodynamics ,Hyperemia ,Middle Aged ,Coronary Vessels ,Severity of Illness Index ,Fractional Flow Reserve, Myocardial ,Predictive Value of Tests ,Humans ,Arterial Pressure ,Female ,Diagnostic Errors ,Aged ,Retrospective Studies - Abstract
Recent studies have suggested that fractional flow reserve (FFR) measurement can be avoided by using similar ranges of baseline mean coronary pressure (Pd) to mean aortic pressure (Pa) ratio (0.88-0.95). Further studies have suggested that too many significant coronary stenoses are misclassified based on these ranges. We hypothesized that with a certain range of baseline Pd/Pa, 100% positive predictive value (PPV) and negative predictive value (NPV) can be achieved to avoid misclassification.We retrospectively evaluated the pressure tracings of 555 consecutive intermediate coronary stenotic lesions that had undergone FFR measurement in the cardiac catheterization laboratory of a tertiary-care center. The baseline Pd/Pa was manually measured and correlated with final FFR. The operating test characteristics were calculated using an abnormal FFR of ≤0.80 as the criterion standard for the presence of hemodynamic, significant coronary stenosis.The area under the receiver-operating characteristics curve of baseline Pd/Pa for predicting FFR was 0.89, very similar to published results for instantaneous wave-free ratio and Pd/Pa. However, a significant number of lesions were mischaracterized (ie, using a baseline Pd/Pa of ≤0.88 to0.95, there were 22 misclassifications, with 6 false-positive and 16 false-negative results). At a Pd/Pa of ≤0.86, 100% PPV was achieved, and 100% NPV was achieved at1.00.A baseline Pd/Pa of ≤0.86 is associated with a PPV of 100%, which can avoid the misclassification errors seen in prior studies. This provides a more clinically useful application of baseline Pd/Pa.
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- 2016
99. ePhenotyping for Abdominal Aortic Aneurysm in the Electronic Medical Records and Genomics (eMERGE) Network: Algorithm Development and Konstanz Information Miner Workflow
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Peggy L. Peissig, Eric B. Larson, Catherine A. McCarty, Tanvir Bajwa, Michael Michalkiewicz, James R. Elmore, Jonathan A. Bock, David J. Carey, Gail P. Jarvik, David P. Franklin, Jennifer A. Pacheco, John B. Harley, David Carrell, James G. Linneman, Abel N. Kho, Kenneth M. Borthwick, Joshua C. Denny, William K. Thompson, Gerard Tromp, Harpreet Parmar, Omri Gottesman, Helena Kuivaniemi, Jyotishman Pathak, Suzette J. Bielinski, Iftikhar J. Kullo, Erwin P. Bottinger, Diane T. Smelser, Zi Ye, and Evan J. Ryer
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SQL ,Computer science ,Electronic medical record ,KNIME ,computer.software_genre ,Article ,Computing methodologies ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Electronic health records ,030212 general & internal medicine ,030304 developmental biology ,computer.programming_language ,0303 health sciences ,Aortic aneurysm ,Node (networking) ,Medical record ,Case-Control study ,computer.file_format ,medicine.disease ,Abdominal aortic aneurysm ,Data access ,Workflow ,Current Procedural Terminology ,Data mining ,Executable ,computer ,ICD-9 - Abstract
Background and objective: We designed an algorithm to identify abdominal aortic aneurysm cases and controls from electronic health records to be shared and executed within the “electronic Medical Records and Genomics” (eMERGE) Network. Materials and methods: Structured Query Language, was used to script the algorithm utilizing “Current Procedural Terminology” and “International Classification of Diseases” codes, with demographic and encounter data to classify individuals as case, control, or excluded. The algorithm was validated using blinded manual chart review at three eMERGE Network sites and one non-eMERGE Network site. Validation comprised evaluation of an equal number of predicted cases and controls selected at random from the algorithm predictions. After validation at the three eMERGE Network sites, the remaining eMERGE Network sites performed verification only. Finally, the algorithm was implemented as a workflow in the Konstanz Information Miner, which represented the logic graphically while retaining intermediate data for inspection at each node. The algorithm was configured to be independent of specific access to data and was exportable (without data) to other sites. Results: The algorithm demonstrated positive predictive values (PPV) of 92.8% (CI: 86.8-96.7) and 100% (CI: 97.0-100) for cases and controls, respectively. It performed well also outside the eMERGE Network. Implementation of the transportable executable algorithm as a Konstanz Information Miner workflow required much less effort than implementation from pseudo code, and ensured that the logic was as intended. Discussion and conclusion: This ePhenotyping algorithm identifies abdominal aortic aneurysm cases and controls from the electronic health record with high case and control PPV necessary for research purposes, can be disseminated easily, and applied to high-throughput genetic and other studies.
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- 2016
100. Bivalirudin versus unfractionated heparin during peripheral vascular interventions: A Propensity-matched Study
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Tanvir Bajwa, Jayant Khitha, Suhail Allaqaband, Mark W. Mewissen, Maharaj Singh, Arshad Jahangir, and Daniel Ortiz
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Male ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,0302 clinical medicine ,Risk Factors ,Odds Ratio ,Bivalirudin ,030212 general & internal medicine ,Registries ,Hematoma ,General Medicine ,Heparin ,Hirudins ,Patient Discharge ,Recombinant Proteins ,Treatment Outcome ,Cohort ,Female ,Cardiology and Cardiovascular Medicine ,medicine.drug ,medicine.medical_specialty ,Canada ,Hemorrhage ,Punctures ,Antithrombins ,03 medical and health sciences ,Internal medicine ,Catheterization, Peripheral ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Propensity Score ,Aged ,Retrospective Studies ,Chi-Square Distribution ,business.industry ,Percutaneous coronary intervention ,Anticoagulants ,Retrospective cohort study ,Length of Stay ,medicine.disease ,Peptide Fragments ,United States ,Surgery ,Logistic Models ,Propensity score matching ,business ,Discovery and development of direct thrombin inhibitors - Abstract
Objectives This study aimed to compare the association of access site complications and the use of unfractionated heparin versus bivalirudin during subinguinal peripheral vascular intervention. Background Compared to unfractionated heparin, bivalirudin has been associated with fewer bleeding complications in patients undergoing percutaneous coronary intervention but more ischemic events. The safety and efficacy of direct thrombin inhibitors in peripheral vascular interventions is not well defined. Methods We compared the incidence of in-hospital access site complications and discharge status among patients in the multicenter, prospective Vascular Quality Initiative registry who underwent peripheral vascular intervention between August 2007 and January 2014 using bivalirudin or unfractionated heparin. Propensity score matching was used to obtain a balanced cohort of 1,524 patients in each treatment group. Results Patients treated with bivalirudin had a significantly lower incidence of access site hematomas (2.4% vs. 3.9%, P = 0.018), shorter post-procedural hospitalization (1.0 vs. 1.2 days, P
- Published
- 2016
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