252 results on '"Mathew R. Williams"'
Search Results
152. Acquired thrombocytopenia after transcatheter aortic valve replacement: clinical correlates and association with outcomes
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Lakshmana Pendyala, Mathew R. Williams, Israel M. Barbash, Lowell F. Satler, Petros Okubagzi, Philippe Généreux, Rebecca Torguson, Martin B. Leon, Joshua P. Loh, Jessica N. Fields, Salem Badr, Rebecca T. Hahn, Itsik Ben-Dor, Sa'ar Minha, Ron Waksman, Ajay J. Kirtane, Ke Xu, Susheel Kodali, Fang Chen, Craig R. Smith, Danny Dvir, and Augusto D. Pichard
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Male ,medicine.medical_specialty ,Transcatheter aortic ,medicine.medical_treatment ,Logistic regression ,Gastroenterology ,Transcatheter Aortic Valve Replacement ,Valve replacement ,Internal medicine ,medicine ,Humans ,Platelet ,Aged, 80 and over ,business.industry ,Platelet Count ,Incidence (epidemiology) ,Mortality rate ,Hazard ratio ,Aortic Valve Stenosis ,Length of Stay ,Thrombocytopenia ,Surgery ,Treatment Outcome ,Population study ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims This study aimed to evaluate incidence and correlates for low platelet count after transcatheter aortic valve replacement (TAVR) and to determine a possible association between acquired thrombocytopenia and clinical outcomes. Methods and results Patients undergoing TAVR from two medical centres were included in the study. They were stratified according to nadir platelet count post procedure: no/mild thrombocytopenia, ≥100 × 109/L; moderate, 50–99 × 109/L; and severe
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- 2014
153. Improving the accuracy of effective orifice area assessment after transcatheter aortic valve replacement: validation of left ventricular outflow tract diameter and pulsed-wave Doppler location and impact of three-dimensional measurements
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Torsten Vahl, Rebecca T. Hahn, Martin B. Leon, Jean-Michel Paradis, Leo Marcoff, Tamim Nazif, Mathew R. Williams, Nadira Hamid, Omar K. Khalique, Susheel Kodali, and Isaac George
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Heart Ventricles ,Echocardiography, Three-Dimensional ,Sensitivity and Specificity ,Transcatheter Aortic Valve Replacement ,symbols.namesake ,Valve replacement ,Aortic valve replacement ,Internal medicine ,Image Interpretation, Computer-Assisted ,medicine ,Ventricular outflow tract ,Humans ,Radiology, Nuclear Medicine and imaging ,Heart valve ,Aged ,Echocardiography, Doppler, Pulsed ,business.industry ,Stent ,Reproducibility of Results ,Stroke volume ,Aortic Valve Stenosis ,medicine.disease ,Image Enhancement ,medicine.anatomical_structure ,Treatment Outcome ,Aortic valve stenosis ,symbols ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Doppler effect - Abstract
Background Echocardiographic calculation of effective orifice area (EOA) after transcatheter aortic valve replacement is integral to the assessment of transcatheter heart valve (THV) function. The aim of this study was to determine the most accurate method for calculating the EOA of the Edwards SAPIEN and SAPIEN XT THVs. Methods One hundred intraprocedural transesophageal echocardiograms were analyzed. To calculate the post–transcatheter aortic valve replacement left ventricular outflow tract (LVOT) stroke volume (SV), four diameters were measured using two-dimensional echocardiography: (1) baseline LVOT diameter (LVOTd_PRE), (2) postimplantation LVOT diameter, (3) native aortic annular diameter, and (4) THV in-stent diameter. Four corresponding areas were planimetered by three-dimensional echocardiography. Two LVOT velocity-time integrals (VTI) were measured with the pulsed-wave Doppler sample volume at (1) the proximal (apical) edge of the valve stent or (2) within the valve stent at the level of the THV cusps. LVOT velocity-time integral with the sample volume at the proximal edge of the valve stent was used with the LVOT and aortic annular measurements above, whereas in-stent VTI was paired with the in-stent THV diameter to yield eight different SVs. Right ventricular outflow tract (RVOT) SV was calculated using RVOT diameter and RVOT VTI and was used as the primary comparator. Transaortic VTI was obtained by continuous-wave Doppler, and EOA calculations using each SV measurement were compared with (1) EOA calculated using RVOTSV and (2) planimetered aortic valve area using three-dimensional echocardiography (AVAplanimetry3D). Results Post–transcatheter aortic valve replacement EOA calculated using LVOTd_PRE was not significantly different from EOA calculated using RVOTSV (1.88 ± 0.33 vs 1.86 ± 0.39 cm 2 , P = .36) or from AVAplanimetry3D (1.85 ± 0.28, P = .38, n = 34). All other two-dimensional EOA calculations were statistically larger than EOA calculated using RVOTSV. All three-dimensional echocardiography–based EOA calculations were statistically different from AVAplanimetry3D. Conclusions The most accurate EOA after implantation of a balloon-expandable THV is calculated using preimplantation LVOT diameter and VTI.
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- 2013
154. Contemporary real-world outcomes of surgical aortic valve replacement in 141,905 low-risk, intermediate-risk, and high-risk patients
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Rebecca L. Gunter, Robert A. Guyton, Rakesh M. Suri, Vinay Badhwar, Joseph E. Bavaria, Lars G. Svensson, Michael J. Mack, James S. Gammie, Sean M. O'Brien, Gorav Ailawadi, Todd M. Dewey, Vasilis Babaliaros, Vinod H. Thourani, Mathew R. Williams, Wilson Y. Szeto, and Shubin Sheng
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Aortic Valve Insufficiency ,Prom ,Risk Assessment ,Aortic valve replacement ,Valve replacement ,Risk Factors ,Risk of mortality ,Medicine ,Humans ,Aged ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,business.industry ,Retrospective cohort study ,Aortic Valve Stenosis ,medicine.disease ,Surgery ,Treatment Outcome ,Aortic valve stenosis ,Population study ,Female ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment - Abstract
The introduction of transcatheter aortic valve replacement mandates attention to outcomes after surgical aortic valve replacement (SAVR) in low-risk, intermediate-risk, and very high-risk patients.The study population included 141,905 patients who underwent isolated primary SAVR from 2002 to 2010. Patients were risk-stratified by Society of Thoracic Surgeons (STS) predicted risk of mortality (PROM)4% (group 1, n = 113,377), 4% to 8% (group 2, n = 19,769), and8% (group 3, n = 8,759). The majority of patients were considered at low risk (80%), and only 6.2% were categorized as being at high risk. Outcomes were analyzed based on two time periods: 2002 to 2006 (n = 63,754) and 2007 to 2010 (n = 78,151).The mean age was 65 years in group 1, 77 in group 2, and 77 in group 3 (p0.0001). The median STS PROM for the entire population was 1.84: 1.46% in group 1, 5.24% in group 2, and 11.2% in group 3 (p0.0001). Compared with PROM, in-hospital mean mortality was lower than expected in all patients (2.5% vs 2.95%) and when analyzed within risk groups was as follows: group 1 (1.4% vs 1.7%), group 2 (5.1% vs 5.5%), and group 3 (11.8% vs 13.7%) (p0.0001). In the most recent surgical era, operative mortality was significantly reduced in group 2 (5.4% vs 6.4%, p = 0.002) and group 3 (11.9% vs 14.4%, p = 0.0004) but not in group 1.Nearly 80% of patients undergoing SAVR have outcomes that are superior to those by the predicted risk models. In the most recent era, early results have further improved in medium-risk and high-risk patients. This large real-world assessment serves as a benchmark for patients with aortic valve stenosis as therapeutic options are further evaluated.
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- 2013
155. A randomized trial of antithrombin concentrate for treatment of heparin resistance
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David L.S. Morales, Alyssa B D’Ambra, Talia B. Spanier, James Beck, Mathew R. Williams, Mehmet C. Oz, and David N Helman
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Drug Resistance ,Activated clotting time ,Antithrombins ,law.invention ,Randomized controlled trial ,law ,medicine ,Cardiopulmonary bypass ,Humans ,Chemotherapy ,Cardiopulmonary Bypass ,medicine.diagnostic_test ,Heparin ,business.industry ,Anticoagulant ,Antithrombin ,Thrombin ,Middle Aged ,Surgery ,Anesthesia ,Female ,Blood Coagulation Tests ,Fresh frozen plasma ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Background . Heparin resistance is an important clinical problem traditionally treated with additional heparin or fresh frozen plasma. We undertook a randomized clinical trial to determine if treatment with antithrombin (AT) concentrate is effective for treating this condition. Methods . Patients requiring cardiopulmonary bypass who were considered to be heparin resistant (activated clotting time 450 IU/kg heparin) were randomized to receive either 1000 U AT or additional heparin. Results . AT concentrate was effective in 42 of 44 patients (96%) for immediately obtaining a therapeutic activated clotting time. This compared favorably to 28 of 41 patients (68%) treated with additional heparin ( p = 0.001). All patients who failed heparin therapy were successfully treated with AT. The patients receiving AT required less time to obtain an adequate ACT but there was no difference in clinical outcomes among the groups. Study patients had deficient AT activity at baseline (56% ± 25%), which improved in those given AT concentrate (75% ± 31% versus 50% ± 23%, p Conclusions . Heparin resistance is frequently associated with AT deficiency. Treating this deficiency with AT concentrate is more effective and faster for obtaining adequate anticoagulation than using additional heparin.
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- 2000
156. Expression of VEGFR-2 and AC133 by circulating human CD34+ cells identifies a population of functional endothelial precursors
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Shahin Rafii, Mathew R. Williams, William J. Lane, Mario Peichev, Malcolm A.S. Moore, Larry Witte, Daniel S. Pereira, Afzal J. Naiyer, Zhenping Zhu, Daniel J. Hicklin, and Mehmet C. Oz
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Pathology ,medicine.medical_specialty ,Plating efficiency ,Endothelium ,Angiogenesis ,Immunology ,CD34 ,Hematopoietic stem cell ,Cell Biology ,Hematology ,Biology ,Biochemistry ,Molecular biology ,Endothelial progenitor cell ,Endothelial stem cell ,Vascular endothelial growth factor A ,medicine.anatomical_structure ,medicine - Abstract
Emerging data suggest that a subset of circulating human CD34+ cells have phenotypic features of endothelial cells. Whether these cells are sloughed mature endothelial cells or functional circulating endothelial precursors (CEPs) is not known. Using monoclonal antibodies (MoAbs) to the extracellular domain of the human vascular endothelial receptor-2 (VEGFR-2), we have shown that 1.2 ± 0.3% of CD34+ cells isolated from fetal liver (FL), 2 ± 0.5% from mobilized peripheral blood, and 1.4 ± 0.5% from cord blood were VEGFR-2+. In addition, most CD34+VEGFR-2+ cells express hematopoietic stem cell marker AC133. Because mature endothelial cells do not express AC133, coexpression of VEGFR-2 and AC133 on CD34+ cells phenotypically identifies a unique population of CEPs. CD34+VEGFR-2+ cells express endothelial-specific markers, including VE-cadherin and E-selectin. Also, virtually all CD34+VEGFR-2+ cells express the chemokine receptor CXCR4 and migrate in response to stromal-derived factor (SDF)-1 or VEGF. To quantitate the plating efficiency of CD34+ cells that give rise to endothelial colonies, CD34+ cells derived from FL were incubated with VEGF and fibroblast growth factor (FGF)-2. Subsequent isolation and plating of nonadherent FL-derived VEGFR-2+ cells with VEGF and FGF-2 resulted in differentiation of AC133+VEGFR-2+ cells into adherent AC133−VEGFR-2+Ac-LDL+(acetylated low-density lipoprotein) colonies (plating efficiency of 3%). In an in vivo human model, we have found that the neo-intima formed on the surface of left ventricular assist devices is colonized with AC133+VEGFR-2+ cells. These data suggest that circulating CD34+ cells expressing VEGFR-2 and AC133 constitute a phenotypically and functionally distinct population of circulating endothelial cells that may play a role in neo-angiogenesis.
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- 2000
157. Arginine vasopressin in the treatment of 50 patients with postcardiotomy vasodilatory shock
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Mehmet C. Oz, David N Helman, Yoshifumi Naka, Donald W. Landry, David L.S. Morales, David Gregg, and Mathew R. Williams
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Male ,Pulmonary and Respiratory Medicine ,Mean arterial pressure ,Vasopressin ,medicine.medical_treatment ,Population ,Shock, Cardiogenic ,Hemodynamics ,Blood Pressure ,Risk Assessment ,law.invention ,Norepinephrine ,law ,medicine ,Humans ,Vasoconstrictor Agents ,Cardiac Output ,education ,Retrospective Studies ,education.field_of_study ,business.industry ,Incidence ,Middle Aged ,equipment and supplies ,Intensive care unit ,Arginine Vasopressin ,Vasodilation ,Vasomotor System ,Blood pressure ,Shock (circulatory) ,Ventricular assist device ,Anesthesia ,Female ,Vascular Resistance ,Surgery ,Heart-Assist Devices ,Hypotension ,Safety ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,hormones, hormone substitutes, and hormone antagonists ,Follow-Up Studies - Abstract
The barroreflex-mediated secretion of arginine vasopressin has been found to be defective in a variety of vasodilatory shock states, such as postcardiotomy shock, and administration of the hormone markedly improves vasomotor tone and blood pressure. The high incidence of vasodilatory shock in patients undergoing left ventricular assist device (LVAD) implantation makes this population an ideal model in which to assess the risks and benefits of vasopressin.The medical records of the 102 patients receiving LVADs at Columbia-Presbyterian Medical Center from January 1995 to August 1998 were reviewed. Fifty patients were eligible for study based on a history of arginine vasopressin administration in the operating room or intensive care unit within 24 hours of implantation.Despite LVAD implantation and the administration of vasopressors, patients were hypotensive with a mean arterial pressure less than 60 mm Hg. The administration of vasopressin (0.09+/-0.05 U/min) increased mean arterial pressure (58+/-13 to 75+/-14 mm Hg; p0.001) while reducing norepinephrine administration (11.7+/-13 to 7.9+/-6.0 mcg/min; p = 0.023). There was no significant change in LVAD flow. The incidence of compromised regional perfusion was not different between LVAD patients who received vasopressin as compared to hemodynamically stable LVAD patients who did not receive vasopressin.We have demonstrated vasopressin at low doses to be a safe and an effective vasopressor in 50 patients with postcardiotomy vasodilatory shock.
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- 2000
158. TCT-57 Impact Of Coronary Artery Calcification On Clinical Events In Patients Undergoing Coronary Artery Bypass Grafting: Analysis From The ACUITY (Acute Catheterization And Urgent Intervention Triage Strategy) Trial
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Sorin J. Brener, Roxana Mehran, Philippe Généreux, Gregg W. Stone, Gary S. Mintz, Martin Fahy, Konstanze Ertelt, Mahesh V. Madhavan, George R. Reiss, Mathew R. Williams, and Ajay J. Kirtane
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medicine.medical_specialty ,Bypass grafting ,Clinical events ,business.industry ,Triage ,Surgery ,medicine.anatomical_structure ,Coronary artery calcification ,Intervention (counseling) ,Internal medicine ,medicine ,Cardiology ,In patient ,business ,Cardiology and Cardiovascular Medicine ,Artery - Published
- 2013
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159. TCT-92 Transcatheter Mitral Valve-in-Valve / Valve-in-Ring Implantations for Degenerative Post Surgical Valves: Results from the Global Valve-in-Valve Registry
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Webb John, Danny Dvir, Dominique Himbert, M. Wilbring, Enrico Ferrari, Ulrich Schaefer, Claudia Fiorina, Anson Cheung, Sabine Bleiziffer, Francesco Maisano, Hendrik Treede, Didier Tchetche, Anna Sonia Petronio, Ran Kornowski, and Mathew R. Williams
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medicine.medical_specialty ,Mitral regurgitation ,Post surgical ,Ejection fraction ,business.industry ,MitraClip ,Cardiac index ,Hemodynamics ,Valve in ring ,medicine.anatomical_structure ,Internal medicine ,Mitral valve ,medicine ,Cardiology ,business ,Cardiology and Cardiovascular Medicine - Abstract
Clara, CA) procedure have been shown for mitral regurgitation (MR) from mixed etiology, but have not been elucidated in functional MR alone. Also, there is a misconception that reducing functional MR may lead to a detrimental change in acute hemodynamics. Methods: A retrospective review was performed on 85 consecutive patients with functional MR (mean age 76 11 years, 30 (35%) females) who had full set of hemodynamics prior to and after the MitraClip procedure. 57 (67%) patients were included in the high-risk registry (mean STS score 14.9 7.4%) with 78 (92%) in NYHA functional class III or IV and 77 (91%) with MR grade 4 . There were 34 (40%) patients with left ventricular ejection fraction (LVEF) 35% (mean 26 6%); overall mean left ventricular end systolic diameter of 40 10mm. Results: There were significant improvements in the cardiac index (CI; mean pre CI of 1.92 0.47 L/min/m2 vs. post CI 2.43 0.61 L/min/m2, p 0.001) and mean left atrial pressures (MLAP; mean pre MLAP of 20.7 6.7 mmHg vs. post MLAP 17.2 5.7 mmHg, p 0.001). Improvements in CI and MLAP was observed in 75/85 (88%) and 50/74 (68%) patients respectively. At a mean follow-up of 13 9months, 76/85 (89%) was in NYHA functional class I or II (from 78/85 (92%) in NYHA class III or IV at baseline, p 0.001) and 71/85 (84%) had MR grade 2 (from 85/85 (100%) in MR grade 3 or 4 at baseline, p 0.001). Conclusions: In patients with functional MR, the MitraClip procedure resulted in a significant change in CI and MLAP.
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- 2013
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160. TCT-785 The 'Eyeball Test' in Aortic Stenosis: Characterizing Subjective Frailty with Objective Measures
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Christopher W. Hawk, Philip Green, Kishore J. Harjai, Jean-Michel Paradis, Mathew R. Williams, Tiffany Wong, Tamim Nazif, Martin B. Leon, Isaac George, Rosa M. Lazarte, Ajay J. Kirtane, and Susheel Kodali
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Stenosis ,medicine.medical_specialty ,business.industry ,medicine ,Physical therapy ,medicine.disease ,Risk assessment ,business ,Cardiology and Cardiovascular Medicine ,Surgery ,Frailty assessment ,Test (assessment) - Abstract
Assessment of frailty complements traditional risk assessment in high-risk older adults with aortic stenosis (AS). Subjective frailty assessment is widely used, but its associations with objective markers of frailty are poorly characterized. Frailty was subjectively assessed by an interventional
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- 2013
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161. Age alone should not preclude surgery: contemporary outcomes after aortic valve replacement in nonagenarians
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Mathew R. Williams, Halit Yerebakan, Bindu Kalesan, Tamim Nazif, Isaac George, Susheel Kodali, and Craig R. Smith
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Aortic valve replacement ,Risk Factors ,Internal medicine ,medicine ,Humans ,Myocardial infarction ,Hospital Mortality ,Contraindication ,Retrospective Studies ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,Ejection fraction ,Cardiopulmonary Bypass ,business.industry ,Hazard ratio ,Age Factors ,Atrial fibrillation ,Aortic Valve Stenosis ,medicine.disease ,Sternotomy ,Confidence interval ,Surgery ,Stenosis ,Treatment Outcome ,Aortic Valve ,Heart Valve Prosthesis ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives Advanced age plays a major role in surgical risk algorithms; however, the outcomes data for the very elderly are lacking. We, therefore, evaluated the outcomes after surgical aortic valve replacement (SAVR) in nonagenarians (age, >90 years) at our institution during an 11-year period. Methods The demographics, procedural details, and in-hospital outcomes were retrospectively analyzed for 119 nonagenarians with symptomatic, severe aortic stenosis who had undergone SAVR or SAVR plus concomitant surgery from 2001 to 2012. The mean follow-up period was 915 ± 832 days. Results The average age was 91.7 ± 1.9 years (range, 90-98), and the mean Society of Thoracic Surgeons score was 8.9 ± 5.7. The mean aortic valve gradient was 45 ± 16 mm Hg, mean aortic valve area was 0.66 ± 0.2 cm 2 , and mean ejection fraction was 49.8% ± 11.8%; 47% underwent isolated SAVR. The average length of stay was longer than expected; however, the rates of prolonged ventilation (16.8%), new atrial fibrillation (43.7%), stroke (0.8%), and renal failure (5.9%) were acceptable. Three patients (2.5%) required reoperation for bleeding. Overall, the 30-day and 1-year mortality was 7.6% and 21.0%, respectively. The multivariate predictors of mortality at 1 year included previous myocardial infarction (hazard ratio, 2.79; 95% confidence interval, 1.21-6.45; P = .016), obstructive lung disease (hazard ratio, 3.90; 95% confidence interval, 1.66-9.15; P = .025), and diabetes (hazard ratio, 2.77; 95% confidence interval, 1.08-7.07; P = .033). The observed in-hospital mortality was lower than expected (observed/expected, 0.85). Conclusions Excellent procedural and long-term outcomes can be achieved in nonagenarians, and age alone should not be a contraindication to SAVR in selected populations. Our sample cohort has validated the feasibility of a primary operative strategy in elderly patients with aortic stenosis and acceptable risk profiles.
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- 2013
162. Transcatheter valve-in-valve implantation for early prosthetic valve degeneration in aortic and mitral positions
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Kentaro Yamane, Martin B. Leon, Mathew R. Williams, Tamim Nazif, Isaac George, Rebecca T. Hahn, Omar K. Khalique, and Susheel Kodali
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Pulmonary and Respiratory Medicine ,Adult ,Male ,Reoperation ,medicine.medical_specialty ,Cardiac Catheterization ,Time Factors ,Degeneration (medical) ,Prosthesis Design ,Renal Dialysis ,Medicine ,Humans ,Chronic hemodialysis ,Prosthetic valve ,Bioprosthesis ,Heart Valve Prosthesis Implantation ,business.industry ,Aortic Valve Stenosis ,Valve in valve ,Surgery ,Prosthesis Failure ,Aortic Valve ,cardiovascular system ,Kidney Failure, Chronic ,Mitral Valve ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Abstract
Recently, transcatheter valve-in-valve implantation has emerged as a new alternative to surgical reoperation for degenerated bioprosthetic valves, either in the aortic or mitral position. The early experience and outcome of this strategy appears promising in highly selected patient groups. Here we report a case of early structural valve degeneration in the aortic and mitral position in a patient with chronic hemodialysis successfully treated with transthoracic transcatheter valve-in-valve implantation.
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- 2013
163. Transthoracic access for transcatheter aortic valve replacement: technique using the Edwards Sapien Retroflex delivery system
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Jacob Kriegel, Isaac George, Bindu Kalesan, Omar K. Khalique, Jean-Michel Paradis, Tamim Nazif, Martin B. Leon, Mathew R. Williams, Susheel Kodali, and Rebecca T. Hahn
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Cardiac Catheterization ,Transcatheter aortic ,medicine.medical_treatment ,Prosthesis Design ,Valve replacement ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Heart Valve Prosthesis Implantation ,business.industry ,Aortic Valve Stenosis ,Equipment Design ,Sternotomy ,Surgery ,Catheter ,Treatment Outcome ,Aortic Valve ,Cardiology ,Delivery system ,Cardiology and Cardiovascular Medicine ,business ,Edwards sapien ,Follow-Up Studies - Abstract
We describe our experience using the Edwards Sapien transfemoral Retroflex 3 catheter delivery system for transcatheter aortic valve replacement through the transapical and transaortic approaches. Transthoracic transcatheter valve replacement by the transapical and transaortic approaches can be safely and effectively performed with the Retroflex 3 delivery catheter, which affords several advantages over other available delivery devices.
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- 2013
164. Relation Between Six-Minute Walk Test Performance and Outcomes After Transcatheter Aortic Valve Implantation (from the PARTNER Trial)
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Ajay J. Kirtane, Maria Alu, Martin B. Leon, Mathew R. Williams, Michael J. Mack, Thomas McAndrew, Mathew S. Maurer, Philip Green, Danny Dvir, Philippe Généreux, Suzanne V. Arnold, Samir R. Kapadia, Susheel Kodali, Nirat Beohar, Charanjit S. Rihal, and David J. Cohen
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Aortic valve ,Male ,SIX MINUTE WALK ,medicine.medical_specialty ,Cardiac Catheterization ,Transcatheter aortic ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Walking ,Article ,law.invention ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,Longitudinal Studies ,Cardiac catheterization ,Aged ,Proportional Hazards Models ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,Proportional hazards model ,business.industry ,Aortic Valve Stenosis ,medicine.disease ,medicine.anatomical_structure ,Treatment Outcome ,Aortic valve stenosis ,Aortic Valve ,Cardiology ,Exercise Test ,Test performance ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Functional capacity as assessed by 6-minute walk test distance (6MWTD) has been shown to predict outcomes in selected cohorts with cardiovascular disease. To evaluate the association between 6MWTD and outcomes after transcatheter aortic valve implantation (TAVI) among participants in the Placement of AoRTic TraNscathetER valve (PARTNER) trial, TAVI recipients (n = 484) were stratified into 3 groups according to baseline 6MWTD: unable to walk (n = 218), slow walkers (n = 133), in whom 6MWTD was below the median (128.5 meters), and fast walkers (n = 133) with 6MWTD >128.5 meters. After TAVI, among fast walkers, follow-up 6MWTD decreased by 44 ± 148 meters at 12 months (p
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- 2013
165. CLINICAL IMPLICATIONS OF NEW LEFT BUNDLE BRANCH BLOCK: SUB–ANALYSIS FROM THE PARTNER TRIAL
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Ke Xu, Susheel Kodali, Tamim Nazif, Raj Makkar, Martin B. Leon, Craig R. Smith, Samir R. Kapadia, Todd M. Dewey, William F. Fearon, Jose Dizon, Rebecca T. Hahn, Vasilis Babaliaros, Hasan Jilaihawi, Danny Dvir, Mathew R. Williams, and Wilson Y. Szeto
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medicine.medical_specialty ,Cardiac conduction disturbances ,Transcatheter aortic ,Bundle branch block ,business.industry ,Clinical events ,Left bundle branch block ,medicine.medical_treatment ,medicine.disease ,Valve replacement ,Internal medicine ,PARTNER trial ,medicine ,Cardiology ,business ,Cardiology and Cardiovascular Medicine - Abstract
Cardiac conduction disturbances, including new–onset left bundle branch block (LBBB), occur frequently following transcatheter aortic valve replacement (TAVR). Recent studies have demonstrated a possible association between new LBBB and adverse clinical events, including death and permanent
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- 2013
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166. Aortic valve and ascending aorta guidelines for management and quality measures: executive summary
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Eric E. Roselli, Michael J. Mack, David M. Shahian, Richard S. D’Agostino, Hartzell V. Schaff, Bruce W. Lytle, Thomas G. Gleason, Joseph Bavaria, Craig R. Smith, Martin B. Leon, E. Murat Tuzcu, Cary W. Akins, Lars G. Svensson, Samir R. Kapadia, Mathew R. Williams, T. Brett Reece, Nicholas T. Kouchoukos, David H. Adams, Tirone E. David, John Webb, Katherine B. Harrington, Eugene H. Blackstone, Robert O. Bonow, Nimesh D. Desai, D. Craig Miller, Patrick T. O'Gara, Todd M. Dewey, Brian Lima, Vinod H. Thourani, Susheel Kodali, and George R. Reiss
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Pulmonary and Respiratory Medicine ,Aortic valve ,medicine.medical_specialty ,Quality Assurance, Health Care ,media_common.quotation_subject ,MEDLINE ,Aorta, Thoracic ,Aortic valve replacement ,Health care ,medicine ,Humans ,Quality (business) ,Societies, Medical ,media_common ,Executive summary ,Notice ,business.industry ,Thoracic Surgery ,Thoracic Surgical Procedures ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Aortic Valve ,Practice Guidelines as Topic ,Medical emergency ,Cardiology and Cardiovascular Medicine ,business ,Quality assurance - Abstract
The Society of Thoracic Surgeons Clinical Practice Guidelines are intended to assist physicians and other health care providers in clinical decision making by describing a range of generally acceptable approaches for the diagnosis, management, or prevention of specific diseases or conditions. These guidelines should not be considered inclusive of all proper methods of care or exclusive of other methods of care reasonably directed at obtaining the same results. Moreover, these guidelines are subject to change over time, without notice. The ultimate judgment regarding the care of a particular patient must be made by the physician in light of the individual circumstances presented by the patient.
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- 2012
167. Stent exteriorization facilitates surgical repair for large-bore sheath complications
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Isaac, George, Gautam, Shrikhande, and Mathew R, Williams
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Heart Valve Prosthesis Implantation ,Aortic Aneurysm, Thoracic ,Endovascular Procedures ,Vascular System Injuries ,Prosthesis Design ,Aortography ,Iliac Artery ,Blood Vessel Prosthesis ,Aortic Dissection ,Blood Vessel Prosthesis Implantation ,Treatment Outcome ,Aortic Valve ,Humans ,Female ,Stents ,Tomography, X-Ray Computed ,Ultrasonography, Interventional ,Aged - Abstract
Endovascular therapy for peripheral vascular and valvular disease has rapidly expanded and yet also produced new challenges for vascular access and closure. Current generation thoracic endograft (TEVAR) outer diameter sheath sizes range from 18 to 25 French, and the options for vascular access closure include off-label use of a closure device versus surgical cutdown. We describe a patient with a complex, post-dissection, descending aortic aneurysm who required TEVAR and had a vascular access complication repaired with stent exteriorization with open repair.
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- 2012
168. Patient radiation exposure during transcatheter aortic valve replacement procedures
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Stephen Balter, Benoit Daneault, Jean-Michel Paradis, Martin B. Leon, George R. Reiss, Philip Green, Philippe Généreux, Mathew R. Williams, Jeffrey W. Moses, Craig P. Smith, Susheel Kodali, and Ajay J. Kirtane
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Male ,medicine.medical_specialty ,Cardiac Catheterization ,Time Factors ,Transcatheter aortic ,medicine.medical_treatment ,Body weight ,Radiation Dosage ,Radiography, Interventional ,Article ,Body Mass Index ,Valve replacement ,Radiation Monitoring ,medicine ,Fluoroscopy ,Humans ,Prospective Studies ,Prospective cohort study ,Aged ,Retrospective Studies ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,medicine.diagnostic_test ,business.industry ,Body Weight ,Retrospective cohort study ,Aortic Valve Stenosis ,Surgery ,Radiation exposure ,Aortic Valve ,cardiovascular system ,Female ,Radiology ,Clinical Competence ,Clinical competence ,Cardiology and Cardiovascular Medicine ,business - Abstract
To describe patient radiation utilisation during transcatheter aortic valve replacement (TAVR) on a series of consecutive patients.Data on radiation exposure were prospectively collected for consecutive patients undergoing TAVR and percutaneous coronary interventions at our centre. Radiation dose during the procedure was recorded using the US Food and Drug Administration (FDA) reference point (Ka,r) and the dose area product (PKA). In addition to quantifying overall radiation doses during TAVR, radiation exposure during transfemoral (TF) (n=79) and transapical (TA) (n=26) cases was compared. The median radiation dose during TAVR was 1,639 mGy (983-2,420), or 188 (106-321) Gy*cm2. Radiation dose was significantly lower among TA patients using either the reference point (TA: 946 [777-1,261] vs. TF: 1,932 [1,383-2,614] mGy; p0.001) or the dose area product (TA: 89 [60-115] vs. TF: 236 [164-338] Gy*cm2; p0.001). Fluoroscopy time was lower for TA patients (TA: 10 [8-11] vs. TF: 30 [24-34] minutes; p0.001). Operators experience did not affect radiation exposure for TF cases.Radiation exposure during TAVR appears similar to other percutaneous coronary interventions of moderate complexity. Radiation doses were significantly lower for TA procedures. A higher dose of radiation in TF patients may be related to additional imaging requirements to optimise percutaneous vascular access and closure.
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- 2012
169. Transcatheter aortic valve implantation: 10-year anniversary part II: clinical implications
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Jean Michel Paradis, Marco Spaziano, Susheel Kodali, Martin B. Leon, A. Pieter Kappetein, Mathew R. Williams, Philippe Généreux, Stuart J. Head, John G. Webb, David A. Wood, Alain Cribier, and Cardiothoracic Surgery
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medicine.medical_specialty ,Cardiac Catheterization ,Transcatheter aortic ,Stroke etiology ,Aortic Valve Insufficiency ,Hemorrhage ,Aortic valve replacement ,medicine ,Humans ,Vascular Diseases ,Randomized Controlled Trials as Topic ,Heart Valve Prosthesis Implantation ,business.industry ,Valve prosthesis ,Structural integrity ,Arrhythmias, Cardiac ,Aortic Valve Stenosis ,Surgical procedures ,Acute Kidney Injury ,medicine.disease ,Surgery ,Stroke ,Stenosis ,Coronary Occlusion ,Heart Injuries ,Curative treatment ,Heart Valve Prosthesis ,Cardiology and Cardiovascular Medicine ,business - Abstract
Transcatheter aortic valve implantation (TAVI) has been increasingly recognized as a curative treatment for severe aortic stenosis (AS). Despite important improvements in current device technology and implantation techniques, specific complications still remain and warrant consideration. Vascular complications and peri-procedural neurological events were the first concerns to emerge with this new technology. Recently, significant post procedural para-valvular leak has been shown to be more frequent after TAVI than after surgical aortic valve replacement (SAVR), and its potential association with worse long-term prognostic has raised concerns. In moving toward treatment of lower risk populations, structural integrity and long-term durability of heat valve prosthesis are becoming of central importance. Emerging technologies and newer generations of devices seem promising in dealing with these matters.
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- 2012
170. Concomitant transcatheter aortic and mitral valve-in-valve replacements using transfemoral devices via the transapical approach: first case in United States
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Jean-Michel, Paradis, Susheel K, Kodali, Rebecca T, Hahn, Isaac, George, Benoit, Daneault, Elana, Koss, Tamim M, Nazif, Martin B, Leon, and Mathew R, Williams
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Aged, 80 and over ,Bioprosthesis ,Heart Valve Prosthesis Implantation ,Male ,Cardiac Catheterization ,Aortic Valve Insufficiency ,Mitral Valve Insufficiency ,Prosthesis Design ,United States ,Echocardiography, Doppler, Color ,Prosthesis Failure ,Treatment Outcome ,Heart Valve Prosthesis ,Humans ,Echocardiography, Transesophageal - Published
- 2012
171. Paravalvular leak after transcatheter aortic valve replacement: the new Achilles' heel? A comprehensive review of the literature
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Philippe, Généreux, Stuart J, Head, Rebecca, Hahn, Benoit, Daneault, Susheel, Kodali, Mathew R, Williams, Nicolas M, van Mieghem, Maria C, Alu, Patrick W, Serruys, A Pieter, Kappetein, and Martin B, Leon
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Heart Valve Prosthesis Implantation ,Cardiac Catheterization ,Postoperative Complications ,Aortic Valve ,Heart Valve Prosthesis ,Humans ,Prosthesis Design - Abstract
Paravalvular leak (PVL) is a frequent complication of transcatheter aortic valve replacement (TAVR) and is seen at a much higher rate after TAVR than after conventional surgical aortic valve replacement. Recent reports indicating that PVL may be correlated with increased late mortality have raised concerns. However, the heterogeneity of methods for assessing and quantifying PVL, and lack of consistency in the timing of such assessments, is a hindrance to understanding its true prevalence, severity, and effect. This literature review is an effort to consolidate current knowledge in this area to better understand the prevalence, progression, and impact of post-TAVR PVL and to help direct future efforts regarding the assessment, prevention, and treatment of this troublesome complication.
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- 2012
172. Transcatheter tricuspid valve-in-valve replacement resulting in 4 different prosthetic heart valves in a single patient
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Martin B. Leon, Mathew R. Williams, Susheel Kodali, Jean-Michel Paradis, and Benoit Daneault
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Heart Failure ,Heart Valve Prosthesis Implantation ,Male ,medicine.medical_specialty ,Cardiac Catheterization ,Tricuspid valve ,business.industry ,medicine.medical_treatment ,Surgery ,Single patient ,medicine.anatomical_structure ,Valve replacement ,Right Internal Jugular ,Heart Valve Prosthesis ,Medicine ,Humans ,Tricuspid Valve ,Rheumatic Fever ,Cardiology and Cardiovascular Medicine ,business ,Tricuspid Valve Stenosis ,Right anterior ,Prosthetic heart ,Edwards sapien ,Aged - Abstract
[Figure][1] ![Figure][1] [Video 1][2] Right Anterior Oblique View Showing the 2 Mechanical Valves and the Bioprosthesis. ![Figure][1] [Video 2][3] Deployment of the Edwards Sapien Valve Into the Bioprosthesis in the Tricuspid Position From the Right Internal Jugular ![
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- 2012
173. Vascular complications after transcatheter aortic valve replacement: insights from the PARTNER (Placement of AoRTic TraNscathetER Valve) trial
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Philippe, Généreux, John G, Webb, Lars G, Svensson, Susheel K, Kodali, Lowell F, Satler, William F, Fearon, Charles J, Davidson, Andrew C, Eisenhauer, Raj R, Makkar, Geoffrey W, Bergman, Vasilis, Babaliaros, Joseph E, Bavaria, Omaida C, Velazquez, Mathew R, Williams, Irene, Hueter, Ke, Xu, and Martin B, Leon
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Aged, 80 and over ,Heart Defects, Congenital ,Heart Valve Prosthesis Implantation ,Male ,Cardiac Catheterization ,Heart Valve Diseases ,Cohort Studies ,Femoral Artery ,Postoperative Complications ,Bicuspid Aortic Valve Disease ,Predictive Value of Tests ,Aortic Valve ,Heart Valve Prosthesis ,Humans ,Vascular Diseases ,Aged - Abstract
This study sought to identify incidence, predictors, and impact of vascular complications (VC) after transfemoral (TF) transcatheter aortic valve replacement (TAVR).VC after TF-TAVR are frequent and may be associated with unfavorable prognosis.From the randomized controlled PARTNER (Placement of AoRTic TraNscathetER Valve) trial, a total of 419 patients (177 from cohort B [inoperable] and 242 from cohort A [operable high-risk]) were randomly assigned to TF-TAVR and actually received the designated treatment. First-generation Edwards-Sapien valves and delivery systems were used, via a 22- or 24-F sheath. The 30-day rates of major and minor VC (modified Valve Academic Research Consortium definitions), predictors, and effect on 1-year mortality were assessed.Sixty-four patients (15.3%) had major VC and 50 patients (11.9%) had minor VC within 30 days of the procedure. Among patients with major VC, vascular dissection (62.8%), perforation (31.3%), and access-site hematoma (22.9%) were the most frequent modes of presentation. Major VC, but not minor VC, were associated with significantly higher 30-day rates of major bleeding, transfusions, and renal failure requiring dialysis, and with a significantly higher rate of 30-day and 1-year mortality. The only identifiable independent predictor of major VC was female gender (hazard ratio [HR]: 2.31 [95% confidence interval (CI): 1.08 to 4.98], p = 0.03). Major VC (HR: 2.31 [95% CI: 1.20 to 4.43], p = 0.012), and renal disease at baseline (HR: 2.26 [95% CI: 1.34 to 3.81], p = 0.002) were identified as independent predictors of 1-year mortality.Major VC were frequent after TF-TAVR in the PARTNER trial using first-generation devices and were associated with high mortality. However, the incidence and impact of major VC on 1-year mortality decreased with lower-risk populations.
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- 2012
174. Two-year outcomes after transcatheter or surgical aortic-valve replacement
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Martin B. Leon, Todd M. Dewey, Susheel Kodali, Kevin L. Greason, Michael P. Fischbein, Paul S. Teirstein, Scott Lim, Duolao Wang, Jodi J. Akin, Pamela S. Douglas, Rebecca T. Hahn, Gregory P. Fontana, Trial Investigators, Wilson Y. Szeto, William N. Anderson, Raj Makkar, Vinod H. Thourani, S. Chris Malaisrie, Alan Zajarias, Augusto D. Pichard, Brian Whisenant, Craig R. Smith, Mathew R. Williams, John G. Webb, and Lars G. Svensson
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Male ,Cardiac Catheterization ,medicine.medical_specialty ,Aortic Valve Insufficiency ,Hemodynamics ,Hemorrhage ,Kaplan-Meier Estimate ,Regurgitation (circulation) ,law.invention ,Postoperative Complications ,Randomized controlled trial ,Aortic valve replacement ,law ,Humans ,Medicine ,Survival rate ,Ultrasonography ,Heart Valve Prosthesis Implantation ,Heparin ,business.industry ,Hazard ratio ,Anticoagulants ,Aortic Valve Stenosis ,General Medicine ,medicine.disease ,Confidence interval ,Prosthesis Failure ,Surgery ,Stroke ,Survival Rate ,Treatment Outcome ,Aortic Valve ,Heart Valve Prosthesis ,PARTNER trial ,Female ,business ,Platelet Aggregation Inhibitors ,Follow-Up Studies - Abstract
BACKGROUND: The Placement of Aortic Transcatheter Valves (PARTNER) trial showed that among high-risk patients with aortic stenosis, the 1-year survival rates are similar with transcatheter aortic-valve replacement (TAVR) and surgical replacement. However, longer-term follow-up is necessary to determine whether TAVR has prolonged benefits. METHODS: At 25 centers, we randomly assigned 699 high-risk patients with severe aortic stenosis to undergo either surgical aortic-valve replacement or TAVR. All patients were followed for at least 2 years, with assessment of clinical outcomes and echocardiographic evaluation. RESULTS: The rates of death from any cause were similar in the TAVR and surgery groups (hazard ratio with TAVR, 0.90; 95% confidence interval [CI], 0.71 to 1.15; P=0.41) and at 2 years (Kaplan-Meier analysis) were 33.9% in the TAVR group and 35.0% in the surgery group (P=0.78). The frequency of all strokes during follow-up did not differ significantly between the two groups (hazard ratio, 1.22; 95% CI, 0.67 to 2.23; P=0.52). At 30 days, strokes were more frequent with TAVR than with surgical replacement (4.6% vs. 2.4%, P=0.12); subsequently, there were 8 additional strokes in the TAVR group and 12 in the surgery group. Improvement in valve areas was similar with TAVR and surgical replacement and was maintained for 2 years. Paravalvular regurgitation was more frequent after TAVR (P
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- 2012
175. INCIDENCE, PREDICTORS AND IMPACT OF BLEEDING EVENTS AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) COMPARED TO SURGICAL AORTIC VALVE REPLACEMENT (SAVR): INSIGHTS FROM THE PARTNER TRIAL
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E. Murat Tuzcu, Jeffrey W. Moses, Martin B. Leon, John G. Webb, Lars Svensson, Philippe Généreux, Mathew R. Williams, D. Craig Miller, Michael J. Mack, Craig R. Smith, and Susheel Kodali
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medicine.medical_specialty ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,Incidence (epidemiology) ,medicine.disease ,Valve replacement ,Aortic valve replacement ,Internal medicine ,Cohort ,PARTNER trial ,medicine ,Cardiology ,business ,Cardiology and Cardiovascular Medicine - Abstract
Bleeding events after SAVR are frequent and are associated with an unfavorable prognosis. However, there are no data from randomized studies concerning the incidence, predictors and impact of bleeding events on long-term prognosis after TAVR compared with SAVR. From cohort B in the PARTNER Trial
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- 2012
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176. THE IMPORTANCE OF VASCULAR COMPLICATIONS AFTER TRANS-FEMORAL TRANS-CATHETER AORTIC VALVE REPLACEMENT (TAVR): INSIGHTS FROM THE PARTNER TRIAL
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E. Murat Tuzcu, John G. Webb, Mathew R. Williams, Lars Svensson, D. Craig Miller, Philippe Généreux, Jeffrey W. Moses, Martin B. Leon, Susheel Kodali, Craig R. Smith, and Michael J. Mack
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medicine.medical_specialty ,Catheter ,Aortic valve replacement ,business.industry ,Internal medicine ,PARTNER trial ,Cardiology ,medicine ,business ,medicine.disease ,Cardiology and Cardiovascular Medicine - Published
- 2012
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177. ACCELEROMETER-MEASURED PHYSICAL ACTIVITY RECOVERY IN THE FIRST MONTH AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT
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Susheel Kodali, Martin B. Leon, Philip Green, Craig R. Smith, Ajay J. Kirtane, Mathew S. Maurer, Abigail E. Woglom, Susan Schnell, Philippe Généreux, Mathew R. Williams, Jeffrey W. Moses, and Marian Hawkey
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medicine.medical_specialty ,Transcatheter aortic ,Valve replacement ,business.industry ,Internal medicine ,medicine.medical_treatment ,Physical activity ,Cardiology ,Medicine ,business ,Accelerometer ,Cardiology and Cardiovascular Medicine - Published
- 2012
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178. Transcatheter aortic valve implantation 10-year anniversary: review of current evidence and clinical implications
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Susheel Kodali, Stuart J. Head, Jean Michel Paradis, Marco Spaziano, Mathew R. Williams, John G. Webb, Philippe Généreux, David A. Wood, A. Pieter Kappetein, Martin B. Leon, Alain Cribier, and Cardiothoracic Surgery
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medicine.medical_specialty ,Cardiac Catheterization ,Standard of care ,Transcatheter aortic ,Cost-Benefit Analysis ,Treatment outcome ,MEDLINE ,Prosthesis Design ,law.invention ,Aortic valve replacement ,Randomized controlled trial ,law ,medicine ,Prosthesis design ,Humans ,Registries ,Symptomatic aortic stenosis ,Randomized Controlled Trials as Topic ,Heart Valve Prosthesis Implantation ,business.industry ,Patient Selection ,Hemodynamics ,Aortic Valve Stenosis ,medicine.disease ,Surgery ,Prosthesis Failure ,Treatment Outcome ,Heart Valve Prosthesis ,Feasibility Studies ,Cardiology and Cardiovascular Medicine ,business - Abstract
Surgical aortic valve replacement (SAVR) is currently the standard of care to treat patients with severe symptomatic aortic stenosis (AS) and is generally accepted to alleviate symptoms and prolong survival. Based on the results of randomized trials, transcatheter aortic valve implantation (TAVI) is the new standard of care for patients with symptomatic AS who are deemed 'inoperable'. Debatably, TAVI is also an alternative to SAVR in selected patients who are at high risk but operable. As we approach 10 years of clinical experience with TAVI, with over 50 000 implantations in 40 countries, a review of the current literature and clinical outcomes with this rapidly evolving technology is appropriate.
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- 2012
179. Intraoperative radiofrequency linear catheter ablation of accessory pathways in children with Ebstein’s anomaly undergoing tricuspid annuloplasty
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Robert H. Pass, Allan J. Hordof, Jan M. Quaegebeur, Leonardo Liberman, and Mathew R. Williams
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Catheter ablation ,Sudden death ,Internal medicine ,Ebstein's anomaly ,Humans ,Medicine ,cardiovascular diseases ,education ,education.field_of_study ,Intraoperative Care ,Tricuspid valve ,business.industry ,Infant ,Cryoablation ,medicine.disease ,Ablation ,Tricuspid Valve Insufficiency ,Surgery ,Ebstein Anomaly ,medicine.anatomical_structure ,Child, Preschool ,Catheter Ablation ,cardiovascular system ,Cardiology ,Supraventricular tachycardia ,Cardiology and Cardiovascular Medicine ,business - Abstract
Ebstein’s anomaly is an uncommon congenital lesion affecting approximately 1% of patients with congenital heart disease. It is characterized by downward displacement of the tricuspid valve with the septal and posterior leaflets of the tricuspid valve adherent to the right ventricular septal wall. Ebstein’s anomaly is often associated with supraventricular tachycardia, with estimates of the arrhythmia incidence in this population as high as 42%. 1–5 Wolff-Parkinson-White syndrome has been estimated to affect 5% to 10% of this patient group, and sudden death occurred in 20% of older patients and adults. 3,6 Accessory pathways are usually located along the annulus of the tricuspid valve. There are 2 standard techniques for the definitive treatment of supraventricular tachycardia in this population (radiofrequency catheter ablation [RFCA] in the catheterization laboratory and either intraoperative cryoablation or direct surgical division of accessory pathways). Results for RFCA in children are, in general, good with an acute RFCA success rate of 81% for all ablation targets, though with a 1-year success rate of 57%. 7 Thus, despite encouraging acute results in this group, RFCA was ultimately successful in only slightly more than half of those in whom RFCA was attempted. Cryoablation and surgical division with intraoperative mapping have been used with excellent results, although both approaches are time consuming when on cardiopulmonary bypass. 8,9 In this report, we present the results of 2 patients with Ebstein’s anomaly and severe tricuspid regurgitation requiring annuloplasty who underwent intraoperative RFCA without intraoperative mapping, using a new, commercially available linear ablation catheter. Two patients underwent intraoperative RFCA. RFCA was performed before tricuspid annuloplasty, after cannulation and institution of cardiopulmonary bypass. The ablation procedure was performed after the anterior part of the anterior leaflets of the tricuspid valve was detached to the anteroseptal commisure. Both patients underwent ablation using a Food and Drug Administration-approved surgical probe (Cobra, Boston Scientific-EP Tech
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- 2002
180. Thyroidectomy Using Local Anesthesia in Critically Ill Patients with Amiodarone-Induced Thyrotoxicosis: A Review and Description of the Technique
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Paul Lo Gerfo and Mathew R. Williams
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Adult ,medicine.medical_specialty ,endocrine system diseases ,Side effect ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Amiodarone ,Disease ,Amiodarone-induced thyrotoxicosis ,Endocrinology ,Risk Factors ,medicine ,Humans ,Local anesthesia ,Intensive care medicine ,Aged ,Critically ill ,business.industry ,Thyroidectomy ,Middle Aged ,Thyrotoxicosis ,Treatment Outcome ,Anesthesia ,business ,Anti-Arrhythmia Agents ,Anesthesia, Local ,medicine.drug - Abstract
Hyperthyroidism caused by amiodarone is a well-known and accepted side effect of therapy. This problem can frequently be treated by medical means if patients are stable. In some patients, particularly those who are critically ill with cardiac disease the addition of hyperthyroidism can be particularly detrimental. These patients present with an interesting paradox because they are frequently on amiodarone because of life-threatening arrhythmias not responsive to other regimens, yet the amiodarone can precipitate hyperthyroidism that can acutely worsen the progression of their disease and prevalence of arrhythmias. In these patients, prompt treatment of their hyperthyroidism by total thyroidectomy may be the best option. Unfortunately, this also raises another treatment paradox in that these patients are at particularly high risk for complications from general anesthesia. In this subset of patients, total thyroidectomy under local anesthesia may be the best treatment option. Herein, we present a review of amiodarone-induced hyperthyroidism and our technique and review of our experience in its management with total thyroidectomy performed under local anesthesia.
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- 2002
181. A novel approach to percutaneous right-ventricular mechanical support
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Yoshifumi Naka, Hiroo Takayama, Susheel Kodali, Ulrich P. Jorde, Julie A. Vincent, Mathew R. Williams, and Linda J. Addonizio
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Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,Percutaneous ,Adolescent ,medicine.medical_treatment ,Femoral vein ,Femoral artery ,Prosthesis Implantation ,Internal medicine ,medicine.artery ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,cardiovascular diseases ,Child ,Aged ,Retrospective Studies ,Heart transplantation ,Heart Failure ,business.industry ,Central venous pressure ,Hemodynamics ,General Medicine ,Middle Aged ,Cannula ,Surgery ,Ventricular assist device ,Pulmonary artery ,Acute Disease ,Cardiology ,Feasibility Studies ,Heart Transplantation ,Female ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective: We report our initial experience with our newly developed percutaneous right-ventricular assist device (VAD) with CentriMag (perc CM-RVAD). Methods: A flexible outflow cannula placed from the right internal jugular vein to the pulmonary artery and an inflow cannula placed from the femoral vein to the right atrium constituted the perc CM-RVAD. When needed, biventricular support was provided with left VAD (LVAD), either with a percutaneous LVAD placed through axillary or femoral artery access or with a fully implantable LVAD. Results: Between January 2009 and June 2010, all of the attempted patients successfully received perc CM-RVAD (n = 8). Mean blood pressure, heart rate, and central venous pressure showed a trend toward improvement after the perc CM-RVAD, with less inotrope/vasopressor requirement. Mixed venous oxygen saturation (SvO2) increased significantly from 64 20 Torr to 78 6 Torr (P < 0.01). The percutaneous VADs were explanted after myocardial recovery in seven patients; however, in three of these, perc CM-RVAD was used as a temporary bridge to other devices. One patient was bridged to a surgical biventricular assist device (BiVAD) and transferred back to the referring hospital on support. One death occurred due to multiple-organ failure 8 days after explantation of the RVAD with recovery. Conclusions: Perc CM-RVAD was feasible and provided hemodynamic improvement. # 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
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- 2011
182. A decade of pediatric mechanical circulatory support before and after cardiac transplantation
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Kevin Charette, Hiroo Takayama, Linda J. Addonizio, Alejandro Garcia, Marc E. Richmond, Mathew R. Williams, Lisa Gilmore, and Jonathan M. Chen
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Pulmonary and Respiratory Medicine ,Graft Rejection ,medicine.medical_specialty ,Percutaneous ,Time Factors ,Adolescent ,Waiting Lists ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Risk Assessment ,Young Adult ,Extracorporeal Membrane Oxygenation ,Risk Factors ,Preoperative Care ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Child ,Postoperative Care ,Salvage Therapy ,medicine.diagnostic_test ,business.industry ,Patient Selection ,Panel reactive antibody ,Anticoagulants ,Infant ,Surgery ,Transplantation ,Survival Rate ,surgical procedures, operative ,Treatment Outcome ,Ventricular assist device ,Child, Preschool ,Circulatory system ,Cohort ,Heart Transplantation ,New York City ,Heart-Assist Devices ,business ,Cardiology and Cardiovascular Medicine ,Partial thromboplastin time - Abstract
Objectives We reviewed the use of pediatric mechanical circulatory support before and after transplantation to examinine current results and future strategies. Methods All patients listed for transplantation from January 2000 to December 2010 who required either extracorporeal membrane oxygenation (ECMO) or ventricular assist device (VAD) support before ("intention to transplant") or after transplantation were included. Indications for mechanical assistance, age, weight, duration of support, complications while on support, causes of death, and overall actuarial survival were recorded. Results Thirty-seven patients were received VADs; 32 (86.5%) survived to transplantation. Postoperative hemorrhagic or thrombotic complications affected all of those under 15 kg. One patient in the survivor cohort demonstrated focal neurologic findings. Three (8.1%) had panel reactive antibody levels of 10% or more while on device support; all received transplants. ECMO as an intention to bridge to transplantation was used in 28 patients; 7 died, 7 were weaned, and 14 were bridged to transplantation. Nineteen patients required ECMO after transplantation; 3 additional patients had percutaneous VAD support for late rejection. There was a significant ( P = .02) difference in survival after listing for transplantation among those supported with ECMO, with VAD, and those not supported with a device. No difference in posttransplant survival was demonstrated between those patients supported with either ECMO or VAD before transplant compared with all others not bridged to transplantation. Conclusions Both VAD and ECMO support are highly effective means of bridging patients to transplantation and supporting patients after transplanatation. Ideally, the availability of smaller devices for children will have a favorable impact on the morbidity related to anticoagulation in the smallest patients.
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- 2011
183. Stroke associated with surgical and transcatheter treatment of aortic stenosis: a comprehensive review
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Benoit, Daneault, Ajay J, Kirtane, Susheel K, Kodali, Mathew R, Williams, Philippe, Genereux, George R, Reiss, Craig R, Smith, Jeffrey W, Moses, and Martin B, Leon
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Heart Valve Prosthesis Implantation ,Stroke ,Cardiac Catheterization ,Risk Factors ,Incidence ,Humans ,Aortic Valve Stenosis ,United States ,Follow-Up Studies - Abstract
Stroke is a potential complication of treating patients with aortic stenosis via surgical aortic valve replacement (AVR), transcatheter aortic valve replacement (TAVR), and balloon aortic valvuloplasty. Because there are limited and heterogeneous data on the incidence, risk factors, and outcomes of stroke among patients being treated for aortic stenosis, we performed a comprehensive review of the literature. The risk of stroke after AVR in the general population is approximately 1.5%, and the risk is increased (to approximately 2% to 4%) in older and higher-risk patients. Strokes were reported in 1.5% to 6% of patients treated with TAVR, and in the only randomized trial of AVR versus TAVR, there was an increased risk of 30-day strokes (minor and major strokes and transient ischemic attacks) with TAVR (5.5% vs. 2.4%, p = 0.04).
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- 2011
184. Clinical outcomes using a new crossover balloon occlusion technique for percutaneous closure after transfemoral aortic valve implantation
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Ajay J. Kirtane, Martin B. Leon, Yanai Ben-Gal, Mathew R. Williams, George R. Reiss, Philippe Généreux, Susheel Kodali, Craig R. Smith, Benoit Daneault, and Jeffrey W. Moses
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Aortic valve ,Male ,medicine.medical_specialty ,Cardiac Catheterization ,Percutaneous ,Blood transfusion ,Catheters ,Time Factors ,medicine.medical_treatment ,Hemorrhage ,Femoral artery ,Punctures ,Radiography, Interventional ,closure device ,TAVI ,medicine.artery ,medicine ,Humans ,Blood Transfusion ,Prospective Studies ,Prospective cohort study ,Aged ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,business.industry ,aortic stenosis ,Aortic Valve Stenosis ,Balloon Occlusion ,Length of Stay ,medicine.disease ,Surgery ,Femoral Artery ,Stenosis ,medicine.anatomical_structure ,Treatment Outcome ,Balloon occlusion ,Heart Valve Prosthesis ,Female ,New York City ,Index hospitalization ,business ,Cardiology and Cardiovascular Medicine - Abstract
Objectives This study sought to evaluate the technical success and clinical outcomes of an adjunctive crossover balloon occlusion technique (CBOT) combined with the 10-F Prostar percutaneous closure device (PCD) on the incidence of vascular and bleeding complications in patients after transfemoral transcatheter aortic valve implantation (TAVI). Background Vascular closure following large-vessel access has most commonly been performed using a surgical cut-down and repair procedure. Methods Between November 2008 and September 2010, 58 consecutive patients with severe aortic stenosis underwent TAVI via a retrograde femoral artery approach using the Edwards-SAPIEN transcatheter valve. Among these patients, 56 were treated with a CBOT using the “pre-close” technique and the 10-F Prostar system. The technical success of this new CBOT and the 30-day frequency of clinical events, including all-cause mortality, major vascular complications, and major bleeding (defined according to a modified version of the Valve Academic Research Consortium criteria), were assessed. Results Successful closure was obtained in all but 3 patients (94.6%). The 30-day frequencies of mortality, major vascular complications, and major bleeding were 7.1%, 14.3%, and 5.4% respectively. No deaths were directly related to access site complications. Fourteen patients (25%) received at least 1 transfusion during the index hospitalization, of which 8 (57.1%) were not related to vascular complications. The mean and median hospital lengths of stay were 7.8 and 6.0 days. Conclusions This new percutaneous adjunctive CBOT combined with the Prostar PCD resulted in controlled, safe, and successful percutaneous closure in most patients after TAVI.
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- 2011
185. 1992 Scientific Session of the Society of American Gastrointestinal Surgeons (SAGES) Washington, D.C., USA, April 11–12, 1992
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Luigi Masoni, G. R. Orangio, B. Detroz, G. Meiser, Ingram, M. T. Nelson, Phillip Donahue, D. Johnson, Hideki Abe, L. E. Smith, J. Dubuc, R. H. Furman, Kenneth Adashek, Charles Aprahamian, J. Mamazza, Bruce M. Wolfe, R. Welling, Takashi Kusaka, F. Lehofer, S. M. Krishnan, R. Doerr, J. L. Flowers, R. C. W. Bell, Bruce D. Schirmer, J. L. Meakins, Donald L. Kaminski, Mary E. Front, Nicholas P. W. Coe, P. Honore, Christopher J. Saunders, R. Berguer, Harold Unger, C. F. Frey, M. A. Mansour, Timothy J. Pritchard, Kajiwara Shuji, E. J. Hinchey, Z. Szabo, John M. Cosgrove, I. Simon, Harrison Mr, Richard A. Kozarek, James M. Becker, Joseph J. Pietrafitta, Deanna L. Dunnegan, B. Murphy, B. J. Carroll, R. de la Torre, Ken-ichiro Hayashi, Streck, Kouji Miura, James W. Fleshman, W. L. Ambroze, Angel Escudero-Fabre, Newman, M. Kulaylat, M. S. Lucia, Mark D. Williams, Edward J. Quebbeman, N. Jacquet, L. Nathanson, M. Aguilar, Edward M. Phillips, Paul P. Priebe, G. W. Lucas, Yoichi Ishizaki, David M. Kam, L. C. Rusin, Jeffrey H. Peters, R. Satava, Edward S. Kondi, V. J. Lobbato, Mark A. Davanzo, J. Canady, T. R. Scott, Kimberly Ann Hobday, Bowman, J. Hill, George Berci, E. Nicolo, W. Cheadle, David S. Edleman, Charles E. Lucas, Samuel K. Snyder, J. G. Hunter, Dennis L. Fowler, P. Schlesinger, J. Brandabur, W. A. Scovill, Y. Fujiyama, Peter C. Murr, Jonathan M. Sackier, Zoltan Szabo, David L. Carr-Locke, Edgar D. Staren, Hiroyuki Kimata, Gerald M. Larson, Matt B. Martin, R. C. Thirlby, Y. Oba, D. H. Wittmann, D. J. Patterson, D. Baird, M. J. Fallas, David C. Brooks, Irving B. Margolis, D. P. Fletcher, Donald W. Weaver, Michael F. McGrath, R. Ghobrial, F. Nezhat, Richard C. Frazee, Farley, Robert G. Molnar, Davis, Toshihiko Yasuda, K. A. Zucker, Dido Franceschi, John N. Graber, James M. Church, J. Dix, M. Lavelle-Jones, J. Kim, Shinichi Hashimoto, P. C. Jolly, D. S. Edelman, Lee L. Swanstrom, John D. Corbitt, N. Keiter, Young, Albert Wetter, C. Gallagher, Hashimoto Daijo, Steven G. Economou, P. F. Leahy, Keith W. Millikan, J. Downey, M. Yamamoto, Frank B. Miller, M. Moriyama, Harvey H. Sigman, H. Leigh, Lloyd M. Nyhus, L. Daykhovsky, Debra L. Sudan, Fred A. Luchette, H. S. Himal, J. A. Hunter, J. McQueen, Charles H. Andrus, Norman B. Halpern, J. P. Andrus, Ballen, Mark Catalano, Michael A. Polacek, Keith N. Apelgren, O. Boeckl, K. Grannan, Barry Salky, Route G. Miscusi, Leonard S. Schultz, Hoshino Takanobu, Abrams, David Ollila, Gary C. Vitale, Yasuhiro Munakata, M. L. Eckhauser, Mark R. Borowicz, Stephen J. Shapiro, Masatoshi Makuuchi, Nichols, Robert J. Brodish, Blievernicht, S. W. Unger, D E Scheeres, James G. Tyburski, John G. Hunter, M. Castellano, Yasutsugu Bandai, R. Dewitty, Hideo Nagai, Christopher P. Brandt, Jonathan Sack, Marc L. Eckhauser, Sean J. Mulvihill, David B. Adams, Mathew R. Williams, J. A. Ryan, T. J. Ball, David R. Fletcher, Jack M. Bergstein, Shin-ei Kudo, M. Herndon, Choichi Sugawa, Gerald M. Fried, William Sangster, G. V. Stiegmann, Lindsey, Marcello Gasparrini, E. Christopher Ellison, John D. Mellinger, Leone, Jeffrey S. Bender, E. M. Elmann, Michael R. Treat, Michel Gagner, David F. Hickok, G. Orangio, Kouji Nakajima, Sidney F. Miller, Gregory V. Stiegmann, Seiji Kawasaki, Lawrence W. Way, Steven K. Libutti, Brock M. Bordelon, David Bouwman, Seigo Kitano, Joel J. Bauer, Leon Daykhovsky, K. Kelly, Bruce A. Orkin, C. Jagdeo, Kogoro Kasahara, K. Anan, R. M. Stephan, Hoxworth, O. Miho, J. Garzon, Horace F. Henriques, L. W. Traverso, J. Sun, John M. Kisala, K. Hashiba, W. C. Cirocco, Yukio Takano, Kazuyuki Shimomura, G. Berci, T. A. Meininger, T. A. Wierson, R. E. Schmieg, W. Voight, Weatherly, P. Green, Randall W. Smith, K. Sugimachi, Leo A. Gordon, Gregory E. Gibbons, A. Montori, D. G. Wechter, L. Michael Brunt, J. Osachoff, William O. Richards, M. Numata, R. P. Pennino, Isaac Raijman, G. W. Lexer, John T. Cunningham, Alfred Cuschieri, B. F. Leary, Unger Sw, G. Ch. Lexer, Daniel J. Deziel, E. Kieth, Jeffrey Barkun, B. Gardiner, P. M. Y. Goh, F. Fontana, H. Zinnecker, K. Sluss, Mark A. Talamini, D. Church, Barry N. Haicken, D. Congreve, Price, John C. Hendricks, M. Nakashima, Yasuo Kondo, Arkin, C. Nezhat, Stephen A. Shoop, Jonathan B. Lamphier, J. G. Tucker, S. Miller, Margaret Paz-Partlow, Sharon A. White, Marc Bessler, Catherine M. Wittgen, Tamaki Noie, Tsuneo Fukuyo, M. Legrand, Mark E. Stoker, Kyotaro Kanazawa, Nathaniel J. Soper, Yasuo Idezuki, Bruce V. MacFadyen, M. J. Wexler, R. Pons, Jeffrey T. Innes, David W. Easter, S. A. Nayeem, J. M. Sackier, Douglas O. Olsen, James M. Estes, Diflo T, Howard Franklin, William P. Reed, Richard Symmonds, John W. Roberts, H. M. Unger, Nadler, D. Seone, F. T. Wootton, B. Attar, I. A. Mustafa, M. Rheault, G. Rosenbaum, R. W. Bailey, A. L. De Paula, John Miller, J. Durham, Pamela J. Connors, Yumiko Ohtomo, Yasuhiko Hashikura, J. L. Meakin, J. Lohmuller, S. M. Graham, D. Litwin, and A. L. Imbembo
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Gerontology ,medicine.medical_specialty ,business.industry ,General surgery ,Internal medicine ,medicine ,Surgery ,Session (computer science) ,Hepatology ,business ,Abdominal surgery - Published
- 1992
186. Alternative Energy Sources for the Surgical Treatment of Atrial Fibrillation
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Mathew R. Williams and Mark J. Russo
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medicine.medical_specialty ,business.industry ,Internal medicine ,Cardiology ,Alternative energy ,Medicine ,Atrial fibrillation ,business ,medicine.disease ,Surgical treatment - Published
- 2008
187. Matching high-risk recipients with marginal donor hearts is a clinically effective strategy
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Annetine C. Gelijns, Michael Argenziano, Alan J. Moskowitz, Jonathan M. Chen, Allan S. Stewart, Deborah D. Ascheim, Isaac George, Mathew R. Williams, Mark J. Russo, Yoshifumi Naka, Ryan R. Davies, and Kimberly N. Hong
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Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,Tissue and Organ Procurement ,medicine.medical_treatment ,Renal function ,Transplants ,Article ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,Survival analysis ,Dialysis ,Aged ,Hepatitis ,Heart transplantation ,business.industry ,Incidence (epidemiology) ,Patient Selection ,Middle Aged ,medicine.disease ,Survival Analysis ,Tissue Donors ,Surgery ,Transplantation ,Heart Transplantation ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background The purpose of this study is to determine the clinical outcomes associated with alternate listing transplantation, which utilizes "marginal" donor organs by transplanting them into high-risk recipients who fail to meet the standard criteria for transplantation. Methods The United Network for Organ Sharing provided de-identified patient-level data. Analysis focused on patients undergoing heart transplantation between January 1, 1999, and December 31, 2005 (n = 13,024). High-risk criteria included age more than 65 years old, retransplantation, hepatitis C-positive, human immunodeficiency virus-positive, creatinine clearance less than 30 mL/min, diabetes mellitus with peripheral vascular disease, and diabetes with creatinine clearance less than 40 mL/min. Marginal donor criteria included age more than 55 years, diabetes mellitus, hepatitis C-positive, human immunodeficiency virus-positive, ejection fraction less than 45%, and donor:recipient weight less than 0.7. Results Survival in the standard transplant group, defined as non–high-risk patients who received nonmarginal organs, was better than in all other groups ( p ω 0.001). Alternate listing transplantation patients had the worst survival ( p ω 0.001). The 5-year survival for the alternate listing transplantation group was 51.4%, compared with 75.1% in the standard transplant group; the standard transplant patients, with the lowest incidence of in-hospital infection (21.1%) and dialysis (7.1%), also had the best transplant hospitalization outcomes ( p ω 0.001). In contrast, alternate listing transplantation patients had the highest incidence of in-hospital infection (35.4%; p ω 0.001). Length of stay during transplant hospitalization was also shortest in the standard transplant group (18.8 days; p ω 0.001). Conclusions Alternate listing transplantation is associated with greater morbidity and resource utilization compared with standard transplantation. However, this strategy offers a median survival of 5.2 years to patients who would otherwise be expected to live 1 year, and therefore, may be reasonably applied to expand the benefits of transplantation. Further studies examining the costs and quality of life related to this approach are needed.
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- 2008
188. Restoring sinus rhythm in patients with previous pacemaker implantation submitted to cardiac surgery and concomitant surgical ablation of atrial fibrillation
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Marta P. Marques, João Queiroz e Melo, Mathew R. Williams, Michel Knaut, Stefano Benussi, Ottavio Alfieri, Fernando Hornero, Marques, Mp, Melo, Jq, Knaut, M, Alfieri, Ottavio, Benussi, S, Williams, Mr, and Hornero, F.
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Ablation of atrial fibrillation ,Heart Rate ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Arrhythmia, Sinus ,Sinus rhythm ,Heart Atria ,Sinus (anatomy) ,Aged ,business.industry ,Cardiac Pacing, Artificial ,Atrial fibrillation ,General Medicine ,medicine.disease ,Ablation ,Surgery ,Cardiac surgery ,Treatment Outcome ,medicine.anatomical_structure ,Concomitant ,Catheter Ablation ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Surgical ablation - Abstract
Objective: Some patients submitted to cardiac surgery have concomitant atrialfibrillationand a previously implanted pacemaker. Because it is unknown if there is any potential for these patients to reassume a regular rate sinus rhythm after ablation of atrial fibrillation, we reviewed the results of all patients with pacemaker enrolled in the Registry of Atrial Fibrillation. Materials: Thirty-six patients were included in this study. Twenty-six had valve disease,seven had coronarydiseaseand three had congenital heart disease.They were submitted concomitantly to ablation of atrialfibrillation using biatrialapproaches (seven patients),left sided (27), or right sided(three patients).Thirty-threehospital survivors had a mean follow-up of 18 months, and a maximum of 25 months. Results: At 1 year (n = 21), patients’ rhythm was sinus non-pacing dependent (52%), sinus pacing-dependent (14%), and atrial fibrillation (14%). At 2 years (n = 14), patients’ rhythm was sinus non-pacing dependent (57%) and atrial fibrillation (43%). The only factor that may have had impact on the recovery of sinus rhythm at 1 year was the small size of the left atrium (p = 0.05). Conclusions: We conclude that in a significant number of patients, having a pacemaker before surgery does not preclude sinus rhythm recovery after a cardiac operation and ablation for concomitant atrial fibrillation. # 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
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- 2008
189. Effect of epicardial fat on ablation performance: a three-energy source comparison
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Alex Trzebucki, Mathew R. Williams, Michael Argenziano, Mark J. Russo, Mehmet C. Oz, Elyse A. Liberman, and Kimberly N. Hong
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Pulmonary and Respiratory Medicine ,Study groups ,Time Factors ,Swine ,medicine.medical_treatment ,Pilot Projects ,In Vitro Techniques ,In vitro model ,Atrial Fibrillation ,Medicine ,Animals ,Bipolar radiofrequency ,Microwaves ,Adiposity ,business.industry ,Myocardium ,Penetration (firestop) ,Anatomy ,Ablation ,Lesion depth ,Epicardial fat ,Catheter Ablation ,Surgery ,Laser Therapy ,Cardiology and Cardiovascular Medicine ,business ,Energy source ,Pericardium ,Biomedical engineering - Abstract
Objectives: To investigate the effect of epicardial fat on surgical atrial fibrillation ablation performance using an in vitro model. Two tissue models were employed to investigate standard penetration and maximal lesion depth performance of bipolar radiofrequency (RF), microwave, and laser energy sources. Methods: Ventricular veal tissue was utilized in various thicknesses (3 mm, 5 mm, 7 mm, 15 mm). Epicardial fat was modeled by layering porcine fat (1 mm, 2 mm and 4 mm) on moistened tissue. In each group, 8 to 10 lesions were created. Post ablation, tissue samples were sectioned and ablation depth of each myocardial section measured using 1% tetrazolium tetrachloride dye solution. Results: The laser energy source produced nearly 100% transmural lesions in almost all study groups irrespective of myocardium thickness and fat thickness. The microwave device maintained transmurality in all 3-mm and most 5-mm myocardium trials but fell to near zero with all 7-mm myocardium trials. The bipolar RF maintained transmurality only when no fat was applied. In the maximal lesion depth models, the laser was capable of producing lesions >8 mm with no fat and >6 mm with either 2 mm or 4 mm of fat present. The microwave produced lesions in the no fat (>6 mm) and 2-mm (>4 mm) fat group. The bipolar RF produced 83% transmurality with no fat and zero percent transmurality with 2 mm of fat present. Conclusions: Epicardial fat can severely limit transmurality in energy sources that utilize conductive heating. Laser energy was uniformly superior at producing both transmural and deep lesions irrespective of the presence of fat.
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- 2007
190. Appropriate patient selection or health care rationing? Lessons from surgical aortic valve replacement in the Placement of Aortic Transcatheter Valves I trial
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Jeevanantham Rajeswaran, Rakesh M. Suri, Martin B. Leon, Hartzell V. Schaff, Craig R. Smith, Samir R. Kapadia, D. Craig Miller, Mathew R. Williams, Eugene H. Blackstone, Lars G. Svensson, Robert A. Guyton, John Ehrlinger, David Cohen, Patrick M. McCarthy, Wilson Y. Szeto, Bruce W. Lytle, E. Murat Tuzcu, John G. Webb, Joseph E. Bavaria, Paul J. Corso, Lawrence H. Cohn, Michael J. Mack, and Vinod H. Thourani
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Male ,Pulmonary and Respiratory Medicine ,Aortic valve ,medicine.medical_specialty ,Time Factors ,Population ,Kaplan-Meier Estimate ,Risk Assessment ,Postoperative Complications ,Aortic valve replacement ,Risk Factors ,Internal medicine ,medicine ,Humans ,Hospital Mortality ,education ,Stroke ,Aged ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,education.field_of_study ,Health Care Rationing ,business.industry ,Patient Selection ,Process Assessment, Health Care ,Aortic Valve Stenosis ,medicine.disease ,United States ,Surgery ,Benchmarking ,Stenosis ,Treatment Outcome ,medicine.anatomical_structure ,Aortic Valve ,Aortic valve stenosis ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Risk assessment ,business ,Medical Futility ,Body mass index - Abstract
Objectives The study objectives were to (1) compare the safety of high-risk surgical aortic valve replacement in the Placement of Aortic Transcatheter Valves (PARTNER) I trial with Society of Thoracic Surgeons national benchmarks; (2) reference intermediate-term survival to that of the US population; and (3) identify subsets of patients for whom aortic valve replacement may be futile, with no survival benefit compared with therapy without aortic valve replacement. Methods From May 2007 to October 2009, 699 patients with high surgical risk, aged 84 ± 6.3 years, were randomized in PARTNER-IA; 313 patients underwent surgical aortic valve replacement. Median follow-up was 2.8 years. Survival for therapy without aortic valve replacement used 181 PARTNER-IB patients. Results Operative mortality was 10.5% (expected 9.3%), stroke 2.6% (expected 3.5%), renal failure 5.8% (expected 12%), sternal wound infection 0.64% (expected 0.33%), and prolonged length of stay 26% (expected 18%). However, calibration of observed events in this relatively small sample was poor. Survival at 1, 2, 3, and 4 years was 75%, 68%, 57%, and 44%, respectively, lower than 90%, 81%, 73%, and 65%, respectively, in the US population, but higher than 53%, 32%, 21%, and 14%, respectively, in patients without aortic valve replacement. Risk factors for death included smaller body mass index, lower albumin, history of cancer, and prosthesis–patient mismatch. Within this high-risk aortic valve replacement group, only the 8% of patients with the poorest risk profiles had estimated 1-year survival less than that of similar patients treated without aortic valve replacement. Conclusions PARTNER selection criteria for surgical aortic valve replacement, with a few caveats, may be more appropriate, realistic indications for surgery than those of the past, reflecting contemporary surgical management of severe aortic stenosis in high-risk patients at experienced sites.
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- 2015
191. THE EFFECT OF OVERSIZING ON THE HEMODYNAMIC PERFORMANCE OF THE SAPIEN 3 TRANSCATHETER HEART VALVE
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Brendan Fox, Tamim Nazif, Susheel Kodali, Rebecca T. Hahn, Isaac George, Jonathon White, Mathew R. Williams, Puja Parikh, Omar K. Khalique, Hemal Gada, Nadira Hamid, Torsten Vahl, and Martin B. Leon
- Subjects
medicine.medical_specialty ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,Hemodynamics ,medicine.anatomical_structure ,Valve replacement ,Internal medicine ,medicine ,Cardiology ,High surgical risk ,Heart valve ,Cardiology and Cardiovascular Medicine ,Symptomatic aortic stenosis ,business - Abstract
Sizing algorithms for the SAPIEN 3 recommend less oversizing. Whether oversizing of the valve affects hemodynamics of the transcatheter heart valve (THV) is unknown. 63 high surgical risk patients with severe, symptomatic aortic stenosis had transcatheter aortic valve replacement (TAVR) with the
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- 2015
192. Off-pump epicardial atrial fibrillation surgery utilizing a novel bipolar radiofrequency system
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Deon W Vigilance, Elaine Wan, Jeffrey A. Morgan, Mathew R. Williams, Michael Argenziano, Craig R. Smith, Ann Zeidner, Mauricio Garrido, Aftab R. Kherani, Yoshifumi Naka, Jennifer Casher, and Mehmet C. Oz
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Male ,medicine.medical_specialty ,Atrial Appendage ,Pulmonary vein ,law.invention ,Dogs ,law ,Internal medicine ,Atrial Fibrillation ,medicine ,Cardiopulmonary bypass ,Animals ,Bipolar radiofrequency ,Cardiac Surgical Procedures ,Cardiopulmonary Bypass ,business.industry ,Cardiac arrhythmia ,Atrial fibrillation ,medicine.disease ,Disease Models, Animal ,Clamp ,Cardiology ,Catheter Ablation ,Surgery ,Female ,Cardiology and Cardiovascular Medicine ,business ,Left Pulmonary Vein - Abstract
Background Over the past several years, pulmonary vein isolation for the treatment of atrial fibrillation has gained significant popularity. This study was undertaken to evaluate a novel radiofrequency (RF)-enabled clamp system designed to create transmural lesions epicardially on the beating heart using bipolar RF. Methods A set of differently shaped clamps modified to deliver bipolar RF energy were used to create a series of lesions in a beating heart canine model. The pulmonary veins and atrial appendages of 6 dogs were electrically isolated using bipolar RF energy. The right and left atrial appendages served as controls for the right and left pulmonary veins, respectively. Temperature-controlled RF energy was delivered to maintain a tissue temperature of 80 degrees C for 15 seconds. Electrical isolation was assessed acutely and after 4 weeks by a bipolar pacing protocol. Results A total of 24 circumferential lesions were created. By pacing analysis, 100% (24/24) of these lesions were electrically isolated acutely and 95% (19/20) were still isolated 4 weeks later. At 4 weeks, 92% (22/24) of lesions were transmural by histologic analysis, and 96% (23/24) demonstrated endocardial continuity. One animal experienced a fatal cardiac arrhythmia during initiation of the post-survival procedure, prior to electrophysiologic evaluation, accounting for the reduced number of potential electrically isolated lesions. Conclusion Bipolar RF ablation utilizing a novel bipolar RF clamp device results in electrical isolation and histologic transmurality in an off-pump epicardial model.
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- 2006
193. Radiofrequency and microwave energy sources in surgical ablation of atrial fibrillation: a comparative analysis
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Renata Bastos, Veli K. Topkara, Michael Argenziano, Judy F. Liu, Mark J. Russo, Fabio Barili, Mathew R. Williams, Elyse A. Liberman, and Mehmet C. Oz
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Male ,medicine.medical_specialty ,New York ,Risk Assessment ,Left atrial ,Risk Factors ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Surgical treatment ,Microwaves ,Survival rate ,business.industry ,Incidence ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Prognosis ,Surgery ,Log-rank test ,Survival Rate ,Treatment Outcome ,Baseline characteristics ,Cardiology ,Catheter Ablation ,Female ,Cardiology and Cardiovascular Medicine ,business ,Atrial flutter ,Surgical ablation - Abstract
Background Due to its complexity and risk of bleeding, the Maze III procedure has been largely replaced by surgical ablation for atrial fibrillation (AF) using alternative energy sources. Radiofrequency (RF) and microwave (MW) are the most commonly used energy forms. In this study, we sought to compare these energy modalities in terms of clinical outcomes. Methods Two hundred five patients underwent surgical ablation of AF, from October 1999 to May 2004 at our institution via an endocardial approach. Patients were categorized into 2 groups: RF and MW. Baseline characteristics, operative details, and clinical outcomes were compared between the 2 groups. Rhythm success was defined as freedom from AF and atrial flutter as determined by postoperative electrocardiograms. Results One hundred twenty patients (58.5%) were ablated using RF, whereas 85 (41.5%) were ablated with MW. Most of the patients had persistent AF in both the RF and MW groups (85.7% versus 80.0%, respectively; P = .363). Intraoperative left atrial size was 6.4 +/- 1.7 cm for the RF group and 6.4 +/- 1.7 cm for the MW group (P = .820). Postoperative rhythm success at 6 and 12 months was 72.4% versus 71.4% (P +/- .611) and 75.0% versus 66.7% (P = .909) for the RF and MW groups, respectively. Hospital length of stay was comparable for both groups (15.4 +/- 14.0 versus 13.3 +/- 13.9 days; P = .307). Postoperative survival at 6 months, 1 year, and 3 years was 90.4%, 89.5%, and 86.1% for RF patients compared to 87.9%, 86.5%, and 84.4% for MW patients, respectively (log rank P = .490). Conclusions RF and MW energy forms yield comparable postoperative rhythm success, hospital length of stay, and postoperative survival. Both sources are rapid, safe, and effective alternatives to "cut and sew" techniques for surgical treatment of AF.
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- 2006
194. Mechanisms of atrial tachyarrhythmias following surgical atrial fibrillation ablation
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Deon W Vigilance, Anthony R. Magnano, Mehmet C. Oz, Kevin Rueter, Jose Dizon, Hilary A. Yegen, Michael Argenziano, Hasan Garan, and Mathew R. Williams
- Subjects
Tachycardia ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Catheter ablation ,Diagnosis, Differential ,Electrocardiography ,Heart Conduction System ,Heart Rate ,Physiology (medical) ,Internal medicine ,Heart rate ,Atrial Fibrillation ,medicine ,Humans ,Sinus rhythm ,cardiovascular diseases ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Ablation ,Prognosis ,Atrial Flutter ,cardiovascular system ,Cardiology ,Catheter Ablation ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Atrial flutter ,Follow-Up Studies - Abstract
Atrial Arrhythmias After Surgical AF ablation. Introduction: Typical and atypical atrial flutters (AFLs) and atrial tachycardias (ATs) have been reported in patients with prior surgical atrial fibrillation ablation. The underlying mechanisms for this group of atrial tachyarrhythmias have not been well characterized and the efficacy of catheter ablation in their treatment is unknown. Methods and Results: Twenty patients (6 females) with a surface ECG diagnosis of AFL or AT following surgical atrial fibrillation ablation underwent 26 electrophysiology studies. Patients manifesting sustained, organized, and beat-by-beat reproducible atrial electrical activity underwent complete right and left atrial catheter mapping and catheter ablation. One patient had no inducible tachyarrhythmia, while 5 patients had nonmappable arrhythmias. Nineteen of the 31 potentially mappable atrial tachyarrhythmias were completely characterized in 14 patients. The underlying mechanisms were macro-reentrant left AFL (n = 9), focal left AT (n = 3), typical right AFL (n = 6), and atypical right AFL (n = 1). Of the 19 completely characterized atrial arrhythmias, catheter ablation was performed for 18, and the procedure was successful for 13 of these. After a mean follow-up of 15 ± 10 months, 15 of 20 patients (75%) were in sinus rhythm including 10 of 13 patients (77%) with AT/flutter ablation. Ten patients, including 6 following ablation, were maintaining sinus rhythm without antiarrhythmic medications. Conclusions: Patients with an ECG diagnosis of AFL or AT following surgical atrial fibrillation ablation may have multiple tachycardia mechanisms with the right or left atrium as the site of origin. Many of these rhythms may resolve with further maturation of surgical atrial fibrillation ablation (SAFA) lesions or be treatable with antiarrhythmic medication. However, persistent tachyarrhythmias can often be treated successfully with catheter mapping and ablation.
- Published
- 2006
195. Epicardial cardiac ablation using laser energy
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Mathew R, Williams, Mark J, Russo, Mehmet C, Oz, and Michael, Argenziano
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Equipment Failure Analysis ,Humans ,Equipment Design ,Laser Therapy ,Cardiac Surgical Procedures ,Pericardium - Abstract
We describe epicardial ablation using a new device that utilizes 980 nm wavelength laser energy. The device can be used in both open and minimally invasive approaches and should make ablation therapy safe, effective, and easy to use.
- Published
- 2006
196. TCT-709 Hemodynamic Outcomes of Post-dilatation in Transcatheter Aortic Valve Replacement
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Jean-Michel Paradis, Molly Forster, Kendra J. Grubb, Martin B. Leon, Mathew R. Williams, Rebecca T. Hahn, Susheel Kodali, Omar K. Khalique, Tamim Nazif, and Isaac George
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medicine.medical_specialty ,Valve replacement ,Transcatheter aortic ,business.industry ,Internal medicine ,medicine.medical_treatment ,Cardiology ,cardiovascular system ,Medicine ,Hemodynamics ,Regurgitation (circulation) ,business ,Cardiology and Cardiovascular Medicine - Abstract
Post-dilatation (PD) can treat paravalvular regurgitation (PVR) following transcatheter aortic valve replacement (TAVR). We studied the effect of PD on hemodynamic outcome. Intra-procedural TEE was performed on 276 TAVR pts; 102 pts had PD. Measured parameters included: prosthesis-patient mismatch
- Published
- 2013
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197. Two-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement
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Scott Lim, Jodi J. Akin, Raj Makkar, Michael P. Fischbein, Gregory P. Fontana, Pamela S. Douglas, Duolao Wang, William N. Anderson, Lars G. Svensson, Wilson Y. Szeto, Augusto D. Pichard, Brian Whisenant, Vinod H. Thourani, John G. Webb, Craig R. Smith, Susheel Kodali, Kevin L. Greason, Mathew R. Williams, Rebecca T. Hahn, Paul S. Teirstein, S. Chris Malaisrie, Alan Zajarias, Todd M. Dewey, and Martin B. Leon
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medicine.medical_specialty ,Aortic valve replacement ,business.industry ,medicine ,medicine.disease ,business ,Surgery - Published
- 2013
198. Biventricular assist device as a bridge to transplantation in a pediatric patient
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Daphne T. Hsu, Jan M. Quaegebeur, Mathew R. Williams, Linda J. Addonizio, Maryanne R. Kichuk, and Mehmet C. Oz
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Aorta ,business.industry ,Biventricular assist device ,Hemodynamics ,Anastomosis ,Surgery ,Pediatric patient ,surgical procedures, operative ,medicine.artery ,Pulmonary artery ,cardiovascular system ,medicine ,Bridge to transplantation ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,Idiopathic Cardiomyopathy - Abstract
A 5 1/2-year-old boy with idiopathic cardiomyopathy and rapidly worsening hemodynamic parameters underwent placement of a biventricular assist device as a bridge to transplantation. Direct anastomoses to both the aorta and pulmonary artery with Dacron grafts attached to Carmeda-coated tubing facilitated the support period. Inflow was provided by right atrial appendage and left ventricular apex cannulas. A centrifugal pump provided support for 2 days until a suitable donor was identified. The technique is simple, reproducible, and effective for patients with small body surface areas.
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- 1996
199. Less Invasive Surgical Treatment of Atrial Fibrillation
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Mathew R. Williams and Michael Argenziano
- Published
- 2003
200. Minimally invasive and robotic treatment of atrial fibrillation using microwave energy
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Michael Argenziano, Kimberly Klein, W. Randolph Chitwood, Mauricio Garrido, Deon W. Vigilance, Mehmet C. Oz, Yoshifumi Naka, Jennifer Casher, L. Wiley Nifong, and Mathew R. Williams
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congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,business.industry ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,Atrial fibrillation ,cardiovascular diseases ,medicine.disease ,business ,Cardiology and Cardiovascular Medicine ,Microwave - Published
- 2003
- Full Text
- View/download PDF
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