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1. Midterm Durability and Structural Valve Degeneration of Transcatheter Aortic Valve Replacement in a Federal Facility

Author

Yang, Rachel, Grober, Aaron F, Riojas, Ramon, Ponna, Vimala, Shunk, Kendrick A, Zimmet, Jeffrey M, Gustafson, Joshua, Ge, Liang, and Tseng, Elaine E

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Cardiovascular, Bioengineering, Transplantation, Good Health and Well Being, Humans, Aged, Transcatheter Aortic Valve Replacement, Aortic Valve Stenosis, Heart Valve Prosthesis, Retrospective Studies, Treatment Outcome, Risk Factors, Aortic Valve, Heart Valve Prosthesis Implantation, midterm durability, structural valve degeneration, transcatheter aortic valve replacement, Respiratory System
Abstract

ObjectiveTranscatheter aortic valve replacement (TAVR), previously reserved for patients of intermediate to prohibitive surgical risk, has now been expanded to patients of any surgical risk with severe aortic stenosis. Bioprostheses are prone to structural valve degeneration (SVD), a progressive and multifactorial process that limits valve durability. As the population undergoing TAVR shifts toward a lower-risk and younger profile, long-term durability is a crucial determinant for patient outcomes. Our objective was to determine the incidence and risk factors of SVD at midterm follow-up in a veteran TAVR population.MethodsPatients undergoing TAVR at our federal facility were retrospectively evaluated for SVD and other endpoints with standardized consensus criteria. Multivariable Cox proportional hazards analysis was performed to evaluate risk factors for mortality and SVD.ResultsFrom 2013 to 2020, 344 patients (median age, 78 years) underwent TAVR. Survival from all-cause mortality was 91.3% at 1 year, 75.1% at 3 years, and 61.7% at 5 years. Cumulative freedom from SVD was 98.2% at 1 year, 96.5% at 3 years, and 93.7% at 5 years. All 13 patients with SVD met hemodynamic criteria, and 1 required intervention. Median time to hemodynamic SVD was 1.04 years. Independent risk factors for SVD included age (hazard ratio [HR] = 0.92, 95% confidence interval [CI]: 0.86 to 0.99) and valve size (HR = 0.19, 95% CI: 0.04 to 0.89).ConclusionsSVD was evident at a low but detectable rate at 5-year follow-up. Further understanding of TAVR biomechanics as well as continued longer-term follow-up will be essential for informing patient-specific risk of SVD.

Published
2022

4. Symptom Profiles of a Convenience Sample of Patients with COVID-19 — United States, January–April 2020

Author

Burke, Rachel M., Killerby, Marie E., Newton, Suzanne, Ashworth, Candace E., Berns, Abby L., Brennan, Skyler, Bressler, Jonathan M., Bye, Erica, Crawford, Richard, Harduar Morano, Laurel, Lewis, Nathaniel M., Markus, Tiffanie M., Read, Jennifer S., Rissman, Tamara, Taylor, Joanne, Tate, Jacqueline E., Midgley, Claire M., Balachandran, Neha, Dahl, Rebecca M., Dott, Mary, Gilani, Zunera, Grober, Aaron, Leung, Jessica, O’Hegarty, Michelle, Person, John, Ricaldi, Jessica N., Roth, Nicole M., Sejvar, James J., Shimabukuro, Tom, Tran, Cuc H., Watson, John T., Whitham, Hilary, Chiou, Howard, Clogher, Paula, Duca, Lindsey M., Dratch, Alissa, Feldpausch, Amanda, Fill, Mary-Margaret, Ghinai, Isaac, Holshue, Michelle, Scott, Sarah, and Westergaard, Ryan

Subjects
myalgia, Male, Pediatrics, Health (social science), Epidemiology, Health, Toxicology and Mutagenesis, 01 natural sciences, Severity of Illness Index, 0302 clinical medicine, Health Information Management, Pandemic, 030212 general & internal medicine, Full Report, Young adult, Child, Aged, 80 and over, General Medicine, Middle Aged, Hospitalization, Child, Preschool, Chills, Female, medicine.symptom, Symptom Assessment, Coronavirus Infections, Adult, medicine.medical_specialty, Adolescent, Fever, Pneumonia, Viral, MEDLINE, 03 medical and health sciences, Betacoronavirus, Young Adult, Severity of illness, medicine, Humans, 0101 mathematics, Pandemics, Aged, business.industry, SARS-CoV-2, Public health, 010102 general mathematics, COVID-19, Infant, medicine.disease, United States, Pneumonia, Dyspnea, Cough, business
Abstract

Coronavirus disease 2019 (COVID-19) was first detected in the United States in January 2020 (1), and by mid-July, approximately 3.4 million cases had been reported in the United States (2). Information about symptoms among U.S. COVID-19 patients is limited, especially among nonhospitalized patients. To better understand symptom profiles of patients with laboratory-confirmed COVID-19 in the United States, CDC used an optional questionnaire to collect detailed information on a convenience sample of COVID-19 patients from participating states. Symptom data were analyzed by age group, sex, hospitalization status, and symptom onset date relative to expansion of testing guidelines on March 8, 2020 (3). Among 164 symptomatic patients with known onset during January 14-April 4, 2020, a total of 158 (96%) reported fever, cough, or shortness of breath. Among 57 hospitalized adult patients (aged ≥18 years), 39 (68%) reported all three of these symptoms, compared with 25 (31%) of the 81 nonhospitalized adult patients. Gastrointestinal (GI) symptoms and other symptoms, such as chills, myalgia, headache, and fatigue, also were commonly reported, especially after expansion of testing guidelines. To aid prompt recognition of COVID-19, clinicians and public health professionals should be aware that COVID-19 can cause a wide variety of symptoms.

Published
2020

5. Visual abstract – Supplemental material for Midterm Durability and Structural Valve Degeneration of Transcatheter Aortic Valve Replacement in a Federal Facility

Author

Yang, Rachel, Grober, Aaron F., Riojas, Ramon, Ponna, Vimala, Shunk, Kendrick A., Zimmet, Jeffrey M., Gustafson, Joshua, Ge, Liang, and Tseng, Elaine E.

Subjects
FOS: Clinical medicine, 110323 Surgery
Abstract

Supplemental material, sj-pptx-1-inv-10.1177_15569845221123259 for Midterm Durability and Structural Valve Degeneration of Transcatheter Aortic Valve Replacement in a Federal Facility by Rachel Yang, Aaron F. Grober, Ramon Riojas, Vimala Ponna, Kendrick A. Shunk, Jeffrey M. Zimmet, Joshua Gustafson, Liang Ge and Elaine E. Tseng in Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery

Published
2022
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6. Assessment of Child Lead Exposure in a Philadelphia Community, 2014

Author

Dignam, Timothy, primary, Pomales, Ana, additional, Werner, Lora, additional, Newbern, E. Claire, additional, Hodge, James, additional, Nielsen, Jay, additional, Grober, Aaron, additional, Scruton, Karen, additional, Young, Rand, additional, Kelly, Jack, additional, and Brown, Mary Jean, additional

Published
2019
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11. Challenges of service coordination for evacuees of Hurricane Maria through the National Disaster Medical System.

Author

Vora, Neil M., Grober, Aaron, Goodwin, Bradley P., Davis, Michelle S., McGee, Chris, Luckhaupt, Sara E., Cockrill, Jennifer A., Ready, Selena, Bluemle, Laura Nichole, Brewer, Lauren, Brown, Angela, Brown, Cassidy, Clement, Julie, Downie, Diane L., Garner, Michael R., Lerner, Ruby, Mahool, Margaret, Mojica, Shirley A., Nolen, Leisha D., and Pedersen, Melanie R.

Published
2018
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12. Abstract 12069: JT Interval Prolongation and Risk of Cardiovascular Mortality

Author

Mohebi, Reza, Grober, Aaron, Jehan, Ayesha, and Froelicher, Victor

Abstract

Objective:Since QRS duration and QT interval have been demonstrated to have independent prognostic value, we hypothesized that seperating depolarization (QRS duration) and repolarization (JT interval) into individual components would enhance the prognostic power of these ECG measurements.Methods:Participants include 19,695 veterans who had an initial ECG at the Palo Alto Veterans Affairs (VA) Health Care System between March 31, 1987, and December 20, 1999, and were followed for cardiovascular (CV) death. Linear regression analysis was used to evaluate how QT correction formulas were correlated with its components (QRS and JT interval) and heart rate. Cox proportional hazard regression analysis was performed to estimate the hazard ratio of the corrected QT interval, corrected JT interval and the QRS interval for risk prediction of cardiovascular death.Results:During median of 17.5 years of follow-up, 739 cardiovascular deaths occurred. Comparison of mean JT intervals among those with normal and abnormal ventricular rhythms showed that the latter group had significantly lower JTc intervals (312 msec vs 298 msec). JTc interval was inversely correlated with QRS interval. The QTc interval was mostly dependent on the JTc interval rather than the QRS segment. However, prolongation of both the JTc and QRS increase the risk of QTc prolongation with similar odds ratios. Among those with normal ventricular conduction rhythms, prolongation of the JTc (HR; 1.12(1.10-1.15)), QRS(HR;1.29(1.22-1.37)) and QTc(HR; 1.15(1.13-1.17)) increased the risk of CVD. Among those with ventricular conduction abnormalities, increases in JTc interval did not increase the risk of CVD (HR; 1.04(0.96-1.12)), however, increase in QRS and QT was associated with increased risk of CVDConclusion:Individuals with ventricular conduction abnormalities had significantly shorter JTc intervals compared with the general population. In that cohort, increases in JTc did not increase the risk of CVD, however, prolongation of QRS and QTc was associated with increased risk of CVD. Among individuals with normal ventricular rhythms, prolongation of all three intervals, the JTc, QRS and QTc, increase the risk of CVD.

Published
2019
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13. Midterm Durability and Structural Valve Degeneration of Transcatheter Aortic Valve Replacement in a Federal Facility.

Author

Yang R, Grober AF, Riojas R, Ponna V, Shunk KA, Zimmet JM, Gustafson J, Ge L, and Tseng EE

Subjects
Humans, Aged, Retrospective Studies, Treatment Outcome, Risk Factors, Aortic Valve surgery, Transcatheter Aortic Valve Replacement adverse effects, Aortic Valve Stenosis, Heart Valve Prosthesis adverse effects, Heart Valve Prosthesis Implantation adverse effects
Abstract

Objective: Transcatheter aortic valve replacement (TAVR), previously reserved for patients of intermediate to prohibitive surgical risk, has now been expanded to patients of any surgical risk with severe aortic stenosis. Bioprostheses are prone to structural valve degeneration (SVD), a progressive and multifactorial process that limits valve durability. As the population undergoing TAVR shifts toward a lower-risk and younger profile, long-term durability is a crucial determinant for patient outcomes. Our objective was to determine the incidence and risk factors of SVD at midterm follow-up in a veteran TAVR population., Methods: Patients undergoing TAVR at our federal facility were retrospectively evaluated for SVD and other endpoints with standardized consensus criteria. Multivariable Cox proportional hazards analysis was performed to evaluate risk factors for mortality and SVD., Results: From 2013 to 2020, 344 patients (median age, 78 years) underwent TAVR. Survival from all-cause mortality was 91.3% at 1 year, 75.1% at 3 years, and 61.7% at 5 years. Cumulative freedom from SVD was 98.2% at 1 year, 96.5% at 3 years, and 93.7% at 5 years. All 13 patients with SVD met hemodynamic criteria, and 1 required intervention. Median time to hemodynamic SVD was 1.04 years. Independent risk factors for SVD included age (hazard ratio [HR] = 0.92, 95% confidence interval [CI]: 0.86 to 0.99) and valve size (HR = 0.19, 95% CI: 0.04 to 0.89)., Conclusions: SVD was evident at a low but detectable rate at 5-year follow-up. Further understanding of TAVR biomechanics as well as continued longer-term follow-up will be essential for informing patient-specific risk of SVD.

Published
2022
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